2008
Hospital Benefits
Refer
to the 2008 NALC Health Benefit
Plan brochure (RI 71-009) for complete details.
2007
Hospital Benefits at a Glance and Previous brochures are also available.
Precertify Your Admission:
You,
your representative, your physician or your hospital must call us
before you are admitted to the hospital. If you have an emergency
admission, you must precertify within 2 days of the admission. Call
us at 1-877-220-6252, unless the admission is related to
a mental health or substance abuse condition. In that case, call
1-877-468-1016. We will reduce benefits if the hospital stay
is not precertified.
You do not need to precertify
when you are admitted to a hospital outside of the United States
or when another group health insurance, such as Medicare Part A,
is the primary payer for the hospital stay. If you exhaust your
Medicare hospital benefits and do not want to use your Medicare
lifetime reserve days, you need to precertify by calling 1-877-220 -6252.
More information
about the precertification process follows the benefit chart below.
For a complete explanation of Physician Benefits or the precertification
process, please view our official
brochure.
|
Benefit |
You
pay at
PPO Provider |
You
pay at
Non-PPO Provider |
| Inpatient
Hospital Care (precertification
required) |
| Maternity |
Nothing |
30% after $100 per admission copay |
Medical/Surgery
Room and Board
Other Services and Supplies
|
Nothing
10% |
30% after $100 per admission copay
30% after $100 per admission copay |
Mental
Health/Substance Abuse
Room & Board
Other Services and Supplies
|
Nothing
10%
|
50% after
$500 per admission copay; all charges
after 50 days
50% after
$500 per admission copay; all charges
after 50 days
|
| Outpatient
Hospital Care |
| Medical |
15% after $250 deductible |
30% after $300 deductible |
| Emergency (auto accident, acute myocardial infarction & concussion) |
15% after $250 deductible |
15% after $250 deductible |
|
