Health Care
Medical (2009)
Emergency Medical Care
In case of a life-threatening injury or illness, you should seek care from the nearest
emergency room. Approved emergency room services are covered at in-network levels no
matter where you go, provided you notify Member Services, if admitted, within 48 hours.
What’s Covered
A medical emergency is a situation so serious that it demands immediate medical
attention and could put a person’s life in danger or cause serious harm. The plan pays
maximum in-network benefits for emergency room services in the case of approved medical emergencies.
For non-approved use of emergency facilities, benefits are paid at out-of-network levels.
These coverage levels apply whether the hospital is in- or out-of-network.
Examples of medical emergencies include:
Severe chest pain or pressure
Uncontrollable bleeding
Loss of consciousness, or confusion
Difficulty breathing
Severe or multiple injuries, including obvious fractures.
For more information, see Plan Details.
What You Should Do
For a life-threatening emergency, go to the nearest emergency room immediately
or call 911. Emergency rooms are staffed with the medical supplies, equipment
and people necessary to treat life-threatening injuries or illnesses.
If you go to an emergency room and are then admitted to the hospital, you must
notify Member Services within 48 hours. If you do not
notify Member Services, benefits will be paid at out-of-network levels.
For non-emergencies, call Health Dialog — the 24-hour phone line
— at 1-800-369-0142 (TTY: 1-800-369-1284) for assistance. A Health Coach can help
direct you to the appropriate care. You can also go to an urgent care center. Urgent care
centers are for walk-in patients who, for example, are traveling when they need to see a doctor.