If You Have a Medical Emergency Sample Clauses

If You Have a Medical Emergency. If you need Medical Emergency services, you should go immediately to the nearest emergency department or call 9-1-1 or another local emergency number. You do not need a Referral or Prior Approval for Medical Emergency services. Medical Emergencies include, but are not limited to: • Heart attack; • Stroke; • Severe trauma; • Shock; • Loss of consciousness; • Seizures; and • Convulsions. Once your emergency medical condition is stabilized, Notification and Prior Approval requirements apply. If you are hospitalized, Notification to Health Options via our Member Services toll free number at 1-855-624-6463 is required within 48 hours of the admission. When you are admitted to a Network Provider facility, the staff at that facility is required to notify Health Options of your admission. If you are admitted to a Non-Network Provider facility, you or your designee is required to notify your PCP and Health Options within 48 hours of admission. Your PCP will arrange for any follow-up care you may need. Your emergency department Out-of-Pocket Costs are listed on the Schedule of Benefits. If you are admitted to the Hospital from the emergency department, your Out-of-Pocket Costs for the emergency department visit as outlined in the Schedule of Benefits will be waived. Should you seek Medical Emergency services at a Hospital that is a Non-Network Provider, your Out-of-Pocket Costs for the Maximum Allowable Amount, as determined by Health Options (see section 6 for more info), will be at the Network Provider (or In-Network) cost-sharing level. You may be responsible for charges above the Maximum Allowable Amount (also known as balance billing). When there is an inadequate network, balance billing does not apply. Refer to Section 2.B for information regarding Hospital admissions.
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Related to If You Have a Medical Emergency

  • Medical Emergency A medical condition which manifests itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate attention to result in 1) placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; 2) serious impairment to bodily functions; or 3) serious dysfunction of any bodily organ or part. Examples of a medical emergency are severe pain, suspected heart attacks and fractures. Examples of a non- medical emergency are minor cuts and scrapes. Medically Necessary and Medical Necessity Services a physician, exercising prudent clinical judgment, would use with a patient to prevent, evaluate, diagnose or treat an illness or injury or its symptoms. These services must:  Agree with generally accepted standards of medical practice  Be clinically appropriate in type, frequency, extent, site and duration., They must also be considered effective for the patient’s illness, injury or disease  Not be mostly for the convenience of the patient, physician, or other healthcare provider. They do not cost more than another service or series of services that are at least as likely to produce equivalent therapeutic or diagnostic results for the diagnosis or treatment of that patient’s illness, injury or disease. For these purposes, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer reviewed medical literature. This published evidence is recognized by the relevant medical community, physician specialty society recommendations and the views of physicians practicing in relevant clinical areas and any other relevant factors. Member Any person covered under this plan. Mental Condition A condition that is listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). This does not include conditions and treatments for chemical dependency. Mental Health Services Medically necessary outpatient and inpatient services provided to treat mental conditions. State and federal law require that the copays and coinsurance for mental health services will be no more than the copays and coinsurance for medical and surgical services. Prescription drugs for mental conditions are covered under the same terms and conditions as other prescription drugs covered under this plan.

  • Medical Emergencies If you encounter a medical emergency that makes you unable to pay your bill for a period of time, or that requires your account remain active, even if it has already been suspended or disconnected, Viasat may payment or reconnection options available for you. You must contact Viasat immediately upon learning of such emergency to determine what options are available in your situation. If you reside in Maine or Pennsylvania, please contact us regarding the specific procedures to follow for relief.

  • National Emergency In cases of national emergency, the Contractor must maintain and support certain systems/ functions considered mission essential. In this event, the Government may require that certain essential personnel report for duty or, may provide support on an on-call or as-needed basis.

  • Child or Elder Care Emergencies Leave without pay, compensatory time or paid leave may be granted for child or elder care emergencies.

  • De-commissioning due to Emergency 17.6.1 If, in the reasonable opinion of the Concessionaire, there exists an Emergency which warrants de-commissioning and closure of the whole or any part of the Bus Terminal, the Concessionaire shall be entitled to de- commission and close the whole or any part of the Bus Terminal to Users and passengers for so long as such Emergency and the consequences thereof warrant; provided that such de-commissioning and particulars thereof shall be notified by the Concessionaire to the Authority without any delay, and the Concessionaire shall diligently carry out and abide by any reasonable directions that the Authority may give for dealing with such Emergency.

  • Medical Care and Emergency Leave An employee is entitled to a leave of absence without pay because of any of the following:

  • Financial Hardship Must include verification appropriate to the circumstance and must demonstrate a loss of income that has occurred since the cancellation deadline as stated in Section III C. The Licensee must submit a copy of the current academic year financial aid award summary for evaluation. Students must show that they have exhausted all viable options, including taking out student loans before a consideration to cancel is made.

  • Personal Emergency Leave 1. A teacher will be granted up to five (5) days of leave per year to cover situations other than personal illness beyond the control of the teacher which would significantly impair teaching service. Deductions from the gross pay of a teacher for this leave shall be made at the degreed substitute rate of pay for each day taken.

  • Post Retirement Health Care Benefit Employees who separate from State service and who, at the time of separation are insurance eligible and entitled to immediately receive an annuity under a State retirement program, shall be entitled to a contribution of two hundred fifty dollars ($250) to the Minnesota State Retirement System’s (MSRS) Health Care Savings Plan. Employees who have a HCSP waiver on file shall receive a two hundred fifty dollars ($250) cash payment. If the employee separates due to death, the two hundred fifty dollars ($250) is paid in cash, not to the HCSP. An employee who becomes totally and permanently disabled on or after January 1, 2008, who receives a State disability benefit, and is eligible for a deferred annuity under a State retirement program is also eligible for the two hundred fifty dollar ($250) contribution to the MSRS Health Care Savings Plan. Employees are eligible for this benefit only once.

  • Pregnancy Leave Benefits Definitions

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