Current through Register Vol. 46, No. 39, September 25, 2024
Basic hospital insurance is an insurance policy which
provides coverage subject to no deductible in excess of $500 for a period of
not less than 60 days for any continuous hospital confinement of each covered
person for services rendered while confined in a hospital (except as to
subdivision [c] of this section) or, in the case of an article 43 corporation,
for services rendered while confined in a member hospital, for necessary
treatment because of sickness or injury for at least:
(a) Daily room and board, consisting of bed
and board, including general nursing care and special diets, in an amount not
less than the lesser of:
(1) 80 percent of
the charges for semiprivate accommodations;
(2) 100 percent of the charges for
semiprivate accommodations for the first 20 days of confinement and at least 50
percent of such charges for the next 40 days; or
(3) $240 per day; except that such $240 may
be reduced to $165 for policies issued for delivery outside the metropolitan
area.
(b) Miscellaneous
hospital services, during each period of continuous hospital confinement as an
inpatient, in an amount not less than 80 percent of the charges incurred, up to
at least $5,000 or 20 times the daily room and board rate if specified in
dollar amounts for at least:
(1) the use of
operating, recovery and cystoscopic rooms and equipment;
(2) the use of intensive care or special care
units and equipment to the extent not otherwise provided in the
policy;
(3) diagnostic and
therapeutic items, such as drugs and medications, sera, biologicals and
vaccines, intravenous preparations and visualizing dyes for care in the
hospital, and administration thereof, but not including those which are not
commercially available for purchase and readily obtainable by the
hospital;
(4) dressings and plaster
casts;
(5) supplies and use of
equipment in connection with oxygen, anesthesia, physiotherapy, chemotherapy,
electrocardiographs, electroencephalographs, X-ray examinations and radiation
therapy, laboratory and pathological examinations, blood products, except when
participation in a volunteer blood replacement program is available to the
insured or covered person;
(6)
radiation therapy and chemotherapy; and
(7) any medical services and supplies which
are customarily provided by hospitals, unless specifically excluded in the
insurance or subscriber contract and the individual certificates issued in
connection with group insurance.
(c) Outpatient services, consisting of:
(1) hospital services on the day surgery is
performed;
(2) hospital services
rendered within 24 hours after accidental injury, in an amount not less than
the lesser of the reasonable charges incurred or the per-day amount provided
for daily room and board if specified in dollar amounts under subdivision (a)
of this section; and
(3) with
respect to individual insurance written by insurers other than article 43
corporations, X-ray and laboratory tests performed in the outpatient department
of a hospital, to the extent that benefits for such services would have been
provided if rendered to an inpatient of the hospital.
