Charges for emergency room care within 72 hours of an accident
or within 24 hours of the sudden onset of an illness (medical emergency) are subject to a $35 $60 copayment per visit. Effective
January 1, 2005, this Hospital Emergency Room copayment will be $50 for
emergency room services covered by the hospital contract. Effective 2007
$60 $70 for
emergency room services covered by the hospital contract. Charges
for other outpatient services covered by the hospital contract are subject to a $25 $35
copayment per outpatient visit regardless of the number and type of services
rendered in the hospital outpatient setting. Effective January 1, 2005, the copayment for other outpatient services
covered by the hospital contract will be $35. Effective Effective January 1, 2005, services Services provided in a hospital owned or operated
extension clinic will be paid by the hospital carrier, subject to appropriate
copayment. Enrollees have the
right of appeal of copayments not charged in
accordance with this provision. Appeals should be directed to the hospital
carrier or to the Health Benefits Administrator. In addition, there will be
participating provider copayment for covered services for the treatment of
alcohol or substance abuse. The
outpatient and emergency room hospital copayments
will be waived for persons admitted to the hospital as an inpatient directly
from the outpatient setting, for pre-admission testing/pre-surgical testing
prior to an inpatient admission or for the following covered chronic care
outpatient services: chemotherapy, radiation therapy, or hemodialysis