In the case of an emergency, the plan provides benefits for emergency services.

An emergency is the sudden and unexpected onset of a condition of such severity that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in any of the following:

Heart attacks, strokes, uncontrolled bleeding, poisonings, major burns, prolonged loss of consciousness, spinal injuries, shock and other severe, acute conditions are examples of emergencies.

In an emergency, you should seek care from an emergency room or other similar facility. If necessary and available, call 911 or use other community emergency resources to obtain assistance in handling life threatening emergencies.

Pre-certification is not required for emergency services. Your visit to the emergency room will be covered if your condition meets the definition of an emergency.

In order to receive in-network benefits for follow-up care related to the emergency (such as office visits or therapy once you left the emergency room or were discharged from the hospital), you must use in-network providers. Follow-up care related to the emergency condition is not considered an emergency and will be treated the same as a normal health care benefit.

The plan also provides benefits for urgent care services. Urgent care includes services provided for a condition that occurs suddenly and unexpectedly and requires prompt diagnosis or treatment such that, in the absence of immediate care, the member could reasonably be expected to suffer chronic illness, prolonged impairment or the need for more serious treatment. Fever over 101 degrees Fahrenheit, ear infection, sprains, some lacerations and dizziness are examples of conditions that would be considered urgent. When you need urgent care, call your physician, a specialist or go to an urgent care provider.

The plan covers services for licensed ambulance services to or from the nearest hospital where the needed medical care and treatment can be provided. Non-emergency ambulance transfers that do not either begin or end at a hospital are not covered.