Health Plan at-a-glance: 
        Hospital benefits
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The Health Plan provides coverage for inpatient services from Network hospitals and Non-Network hospitals, subject to copayment and coinsurance. To maximize your benefits and reduce out-of-pocket costs, choose hospitals and other health care providers within the AFTRA Health Plan’s Preferred Provider Organization (PPO) Networks.

Network Hospital Coverage
  • Copayment
$100 per inpatient admission.
  • Inpatient/outpatient benefit
90% of first $10,000 in covered expenses for pre-certified¹ inpatient admissions and/or outpatient services per year; 100% thereafter. Excludes $100 copayment.
  • Coinsurance
10% of first $10,000 in covered expenses for pre-certified inpatient admissions and/or outpatient services per year.
  • Annual out-of-pocket limit
$1,000 (plus $100 copayment per inpatient admission).
Non-Network Hospital
  • Copayment
$100 per inpatient admission.
  • Inpatient/outpatient benefit
60% of first $7,000 in covered expenses for pre-certified¹ inpatient admissions and/or outpatient services per year; 100% thereafter. Excludes $100 copayment.
  • Coinsurance
40% of first $7,000 in covered expenses for pre-certified inpatient admissions and/or outpatient services per year.
  • Annual out-of-pocket limit
$2,800 (plus a $100 copayment per inpatient admission).
 
 
¹ All inpatient hospital admissions must be pre-certified by CareAllies, except in the case of emergency admissions which must be authorized within 72 hours of the admission.

See pages 32-36 of the 2005 Health Plan Summary Plan Description and relevant Benefits Updates for additional information and details. The information provided above is summarized and is not a complete description of the actual terms and provisions of the Health Plan documents. If any conflict arises between this information and the Plan documents, or if any point is not discussed above or is only partially discussed, the Plan documents will govern in all cases.