Minn. R. 2740.9909
Current through Register Vol. 48, No. 51, June 17, 2024
The composite point values for a qualified plan number three for 1984 are as shown herein.
| Composite Point Values for Minnesota Qualified Plan Number 3 | |
| Points | Benefit |
| 363 | Hospital room and board, unlimited days, semiprivate. |
| 480 | Hospital extras (i.e., hospital services, hospital miscellaneous, hospital special services, or ancillary services) including anesthesia. |
| 243 | Surgery, including administration of anesthesia, assistant surgeon and oral surgery but no tooth repair or extractions. |
| 215 | Home and office physician care, unlimited. |
| 51 | Physician care in hospital, unlimited. |
| 63 | Obstetrics, unlimited. |
| 110 | Hospital maternity, unlimited. |
| 105 | X-rays and laboratory tests, outpatient and out of hospital. |
| 100 | Prescription drugs and medicine, outpatient and out of hospital. |
| 15 | Radioactive therapy, outpatient and out of hospital. |
| 16 | Nursing or convalescent facility. |
| 8 | Home health agency care. |
| 10 | Physical therapy. |
| 4 | Oxygen. |
| 5 | Prostheses. |
| 5 | Durable medical equipment rental or purchase. |
| 2 | Second opinion surgery. |
| 2 | Private duty nursing. |
| 3 | Ambulance. |
| -12 | Adjustment for major medical maximum. |
| _____ 1788 | Total reasonable and customary medical services |
| -245 | $150 deductible. |
| -309 | 20 percent coinsurance. |
| _____ 1234 | Total after deductions for deductible and coinsurance |
| -49 | Coordination of benefits. |
| -31 | Nonduplication with no-fault. |
| 30 | 3,000 annual "out-of-pocket" expense limit. |
| 8 | Well baby care. |
| 0 | Emergency accident. |
| 0 | Supplement accident. |
| 0 | Student dependents. |
| _____ 1192 | Grand Total |
Minn. R. 2740.9909
Statutory Authority: MS s 62E.09