Common use of Emergency and urgently Clause in Contracts

Emergency and urgently. needed care outside the service area. Professional services of a physician, emergency room treatment, and inpatient hospital services are covered at eighty percent (80%) of the first two thousand dollars ($2,000) of the charges incurred per insurance year, and one hundred percent (100%) thereafter. The maximum eligible out-of-pocket expense per individual per year for this benefit is four hundred dollars ($400). This benefit is not available when the member’s condition permits him/her to receive care within the network of the plan in which the individual is enrolled.