If you are re-hospitalized within 90 days with the same
           illness, it would be considered a continuation of your
           previous stay.

For a better benefit for

California Residents see Blue Cross, and

Non-California Residents see AHF.

 RETIRED 

without

RETIRED
with
Medicare

Payment is limited to the most common semi-private room rate.  Intensive Care Unit is paid at 2 1/2 times the semi-private room rate.

NOTE:    This benefit does not apply to care for substance abuse. (See Psychiatric/ Substance Abuse Treatment)

If you or your dependent are hospitalized at the time eligibility terminates, the Fund will continue to provide hospital benefits only until you are discharged.  

If you or your eligible dependents are going to be admitted to a hospital for non-emergency care you are encouraged to have as many of the tests required for admission performed on an outpatient basis before your stay begins.  This is called Pre-Admission Testing.  Charges for these tests will be paid at 100% of Usual and Customary with no deductible.  Diagnostic testing is not included in this benefit.

If you do not become a registered bed patient, but incur hospital charges in the Outpatient Department of a hospital for care that normally cannot be performed in a doctor's office or laboratory:

Ambulatory surgery is surgery that is done without staying overnight in the hospital. This surgery is sometimes called "same day surgery" or "outpatient surgery." "Same day surgery" may be done in the outpatient department of a hospital, or in a special clinic known as an "Ambulatory Surgery Center."

When you have surgery done in the Outpatient Department of a hospital or in an Ambulatory Surgery Center, the Fund will pay 90% of the first $1,000 of Usual and Customary charges and 60% of the remaining allowable charges for the hospital or ambulatory surgery center.  

Ask your doctor for an estimate of the facility's charge and consider whether or not it would be less costly for you to be admitted to the hospital overnight for your surgery.  If your surgery is performed while inpatient at an AHF contracting hospital, your maximum out-of-pocket expense would be $500 for Active participants or 10% to $2,000 for Retired participants.  If your surgery is performed while outpatient at an AHF contracting hospital, your maximum out-of-pocket expense would be 10% of the hospital's charge.

When you are hospitalized, we urge you to review the itemized bill provided by the hospital.  If the hospital has charged for something that was not provided, you should bring the matter to the attention of the Fund Office immediately.

If the error is verified by the Fund's hospital auditor, you will receive 50% of the amount saved by the Fund, up to a maximum of $1,000.

If the Fund Office discovers the error first or is contacted first by the hospital, there will be no reimbursement to the participant.

It is not necessary to audit a bill from a hospital under contract with the Fund (AHF). The itemized bill does not show the contract terms between the Fund and the hospital.  The contract terms decide the amount to be paid by the Fund.

In addition to care in an acute general or specialized hospital, benefits will be provided for care in an "Skilled Nursing Facility" (Convalescent Hospital).  Skilled Nursing Facility confinement will be covered for a maximum of 60 days only if the following requirement is met: You must be confined in an acute general hospital for at least 3 consecutive days and then transferred to Skilled Nursing Facility within 30 days.  The Fund will pay 80% of covered charges and the deductible is waived.

This benefit does not apply to custodial care cases where the patient does not require skilled nursing care.

Nursing homes provide long-term nursing care for persons who are unable to care for themselves due to disability, senility, and/or old age.  This is considered to be "custodial" care.

Custodial care or housekeeping care is not a covered expense.  Nursing homes are sometimes referred to as convalescent homes but they are not the same.  If you have questions regarding nursing homes, please get in touch with the Fund Office.

HOSPITAL EXPENSES NOT COVERED BY THIS PLAN  

ZIP CODE LIST

If your home address appears below, there is an AHF-Contracted hospital within approximately 20 miles of your home.