Page 4

§17-1720-10 §§17-1720-7 to 17-1720-9 (Reserved) . SUBCHAPTER 3 STANDARD BENEFITS PACKAGE §17-1720-10 Standard benefits package. Within a twelve-month benefit period, participating health plans shall provide the following medically necessary services which minimally include, but are not limited to, the following and which may require prior authorization and be subject to limitations as described in chapter 17-1737: 3206 .) (1) Medical inpatient days for medically necessary inpatient hospital care related to medical care, surgery, post-stabilization, acute rehabilitation and behavioral health inpatient days for psychiatric care include, but are not limited to, the following: (A) Semi-private room and board and general nursing care for inpatient stays related to medical care, surgery, and psychiatric care; (B) Intensive care room and board and general nursing care for medical care and surgery; (C) Use of an operating room and related facilities, inpatient anesthesia, radiology, laboratory and other diagnostic services agreed upon by the plan medical director for medical care and surgery; (D) Drugs, dressings, blood derivatives and their administration, general medical supplies, and diagnostic and therapeutic procedures as prescribed by the attending physician; and 1720-4