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- Alaska Statutes.
- Title 21. Insurance
- Chapter 55. State Health Insurance
- Section 110. Minimum Benefits of State Health Insurance Plan.
previous: Section 100
. Types of Insurance Plans.
next: Section 120
. Deductibles and Copayments.
AS 21.55.110. Minimum Benefits of State Health Insurance Plan.
Except as provided in AS 21.55.120
- 21.55.140, the minimum standard benefits of a
health insurance plan offered under AS 21.55.100
(a) shall be benefits with a lifetime maximum of $1,000,000 for each individual for usual, customary, reasonable, or
prevailing charges or, when applicable, the allowance agreed upon between a provider and the plan administrator for
charges. The minimum standard benefits of the plan must cover the following medical services performed for an
individual covered by the plan for the diagnosis or treatment of nonoccupational disease or nonoccupational injury:
- (1) hospital services;
- (2) subject to the limitations of AS 21.36.090
(d), professional services that are rendered by a physician or by a registered nurse at the physician's direction,
other than services for mental or dental conditions;
- (3) the diagnosis or treatment of mental conditions, as defined in regulations of the director, rendered during the year
on other than an inpatient basis, up to a yearly maximum benefit of $4,000;
- (4) legend drugs requiring a physician's prescription;
- (5) services of a skilled nursing facility for not more than 120 days in a policy year;
- (6) home health agency services up to a maximum of 270 visits in a calendar year if the services commence within seven
days following confinement in a hospital or skilled nursing facility of at least three consecutive days for the same
condition, except that in the case of an individual diagnosed by a physician as terminally ill with a prognosis of six
months or less to live, the home health agency services may commence irrespective of whether the covered person was
previously confined or, if the covered person was confined, irrespective of the seven-day period, and the yearly
benefit for medical social services may not exceed $200;
- (7) hospice services for up to six months in a calendar year;
- (8) use of radium or other radioactive materials;
- (9) outpatient chemotherapy;
- (10) oxygen;
- (11) anesthetics;
- (12) nondental prosthesis and maxillo-facial prosthesis used to replace any anatomic structure lost during treatment for
head and neck tumors or additional appliances essential for the support of the prosthesis;
- (13) rental, or purchase if purchase is more cost effective than rental, of durable medical equipment that has no personal
use in the absence of the condition for which it was prescribed;
- (14) diagnostic x-rays and laboratory tests;
- (15) oral surgery for excision of partially or completely unerupted impacted teeth or excision of a tooth root without the
extraction of the entire tooth;
- (16) services of a licensed physical therapist rendered under the direction of a physician;
- (17) transportation by a local ambulance operated by licensed or certified personnel to the nearest health care institution
for treatment of the illness or injury and round trip transportation by air to the nearest health care institution for
treatment of the illness or injury if the treatment is not available locally; if the patient is a child under 12 years
of age, the transportation charges of a parent or legal guardian accompanying the child may be paid if the attending
physician certifies the need for the accompaniment;
- (18) confinement in a licensed or certified facility established primarily for the treatment of alcohol or drug abuse, or
in a part of a hospital used primarily for this treatment, for a period of at least 45 days within any calendar year;
- (19) alternatives to inpatient services as defined by the association in the state plan benefits;
- (20) second surgical opinions;
- (21) other services that are medically necessary in the treatment or diagnosis of an illness or injury as may be designated
or approved by the director.
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