Outside the Service Area. If you’re traveling outside your service area and you need urgent or emergency care, go to the nearest appropriate health care facility. You are covered for the urgent or emergency care visit and one follow-up visit while outside the service area. Any additional follow-up care must be arranged by your PCP. Please see your subscriber certificate for more information.
Outside the Service Area. This care is covered only during temporary absences from the Service Area in which the receipt of urgently needed services for an unexpected illness or injury cannot safely be delayed until the Member's return to the Service Area. Such care must be rendered by qualified medical personnel.
Outside the Service Area. Outside of the Service Area, Members may receive Emergency Services or Urgent Care Services described in the Member Handbook and Supplemental Benefits brochures, if applicable.
Outside the Service Area. Subject to the foregoing limitations, Health Plan will pay 80% of Applicable Charges for Emergency Services received outside of the Service Area. Services and items received during an Emergency Services visit are included in the Supplemental Charge specified in this section S-1(b), except prescribed imaging services (including interpretation of imaging) and related materials in section D-1(b)(ii) are provided in accord with the Supplemental kpgroup_bensch_16r.doc B-10 rev 07/2015 Charge specified in D-1(b)(ii). The Supplemental Charge specified in this section S-1(b) does not apply if the Member is admitted directly to a hospital as an inpatient immediately following an emergency visit. However, it does apply if the Member is admitted as anything other than hospital inpatient. For example, the Supplemental Charge specified in this section S-1(b) does apply if the Member is admitted for observation following an emergency visit. If, following an emergency visit, the Member is directly admitted to a hospital as an inpatient, then the services and items provided during the emergency visit will be included in the applicable Supplemental Charge for hospital inpatient care.
Outside the Service Area. Subject to the foregoing limitations, Health Plan will pay 80% of Applicable Charges for Urgent Care Services received while the Member is temporarily outside the Service Area from medical practitioners other than Physicians and in facilities other than Health Plan-designated Hospitals.
Outside the Service Area. Subject to the foregoing limitations, Emergency Services received outside the Service Area are provided upon payment of a $75.00 Supplemental Charge per visit. Services and items received during an Emergency Services visit are included in the Supplemental Charge specified in this section S-1(b), except prescribed imaging services (including interpretation of imaging) and related materials in section D-1(b)(ii) are provided in accord with the Supplemental Charge specified in D-1(b)(ii). The Supplemental Charge specified in this section S-1(b) does not apply if the Member is admitted directly to a hospital as an inpatient immediately following an emergency visit. However, it does apply if the Member is admitted as anything other than hospital inpatient. For example, the Supplemental Charge specified in this section S-1(b) does apply if the Member is admitted for observation following an emergency visit. If, following an emergency visit, the Member is directly admitted to a hospital as an inpatient, then the services and items provided during the emergency visit will be included in the applicable Supplemental Charge for hospital inpatient care. kpgroup_emerg_inarea_75d_outarea_75d_16r.doc rev 07/2015 HEARING AID RIDER - 60% Section 6-A(15) of the Group Medical and Hospital Service Agreement is amended to read as follows: Artificial Aids and Corrective Appliances. Artificial aids and corrective appliances, such as external prosthetic devices, braces, orthopedic aids, hearing aids, corrective lenses and eyeglasses are excluded except that:
