If you are admitted to the hospital, you pay a $250 deductible, and the Fund covers the rest of the costs of your care while you are hospitalized.
Your doctor or the hospital must get (pre-authorization) before you are admitted to the hospital. If you are admitted in an emergency, the hospital must get approval within 24 hours.
The Fund provides benefits for surgery at many outpatient surgery centers, where you do not have to stay overnight.
Hospital Emergency Rooms:
Emergency Room Care Copay:
Emergency
Not an Emergency
$150 per visit
$150 copay
+ 40% of cost coinsurance
($500 limit Fund will pay)
Emergency rooms should only be used for emergencies!
If you visit an emergency room and do not get admitted, you pay the emergency room copayment. If you are admitted to the hospital, you will be responsible for only the hospital deductible, not both.
The chart above explains the costs for using the emergency room. If you visit an emergency room for care that is not an emergency, you will pay much more for your care. Click here for help with what to do when you need care.