Emergency Care Services. Coverage is provided for the treatment of bodily injuries resulting from an accident or the treatment of a medical condition with acute symptoms of sufficient severity or severe pain for which care is sought as soon as possible after the medical condition becomes evident to the member or the member’s parent or guardian and which the absence of immediate medical attention could reasonably result in: a) placing the member’s health in jeopardy, b) causing serious impairment to bodily functions, c) causing serious dysfunction of any bodily organ or part or d) causing other serious medical consequences. Treatment for an occupational injury for which benefits are provided under any Workers’ Compensation Law or any similar Occupational Disease Law is not covered. Transportation and related emergency services provided by an ambulance service shall constitute emergency care if the injury or the condition satisfies the criteria above. In the event that the member requires Emergency Care Services, benefits will be provided at the network services benefit levels. The member will not be responsible for any difference between the Plan payment and the provider’s charge.
Appears in 3 contracts
Sources: Comprehensive Major Medical Preferred Provider High Deductible Subscription Agreement, Comprehensive Major Medical Preferred Provider High Deductible Subscription Agreement, Comprehensive Major Medical Preferred Provider High Deductible Subscription Agreement