Care given for a medical emergency when you believe that your health is in serious danger when every second counts.
The sudden and unexpected onset of symptoms that are severe enough to require immediate hospital-level care, or an accident causing injuries that are severe enough to require immediate hospital-level care. Examples include poisoning, severe bleeding and an inability to breathe.
Care for the sudden or 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: placing the health of an individual or with respect to a pregnant woman, the health of the pregnant woman or her unborn child in serious jeopardy, serious physical impairment to bodily functions, serious dysfunction of any bodily organ or part or death. Heart attacks, strokes, uncontrolled bleeding, poisonings, major burns, prolonged loss of consciousness, spinal injuries, shock, and other severe, acute conditions are examples of emergencies.
Care for a medical or behavioral condition, the onset of which is sudden, that manifests itself by symptoms of sufficient severity, including severe pain, that a prudent layperson, possessing an average knowledge of medicine and health, could reasonably expect the absence of immediate medical attention to result in: (a) placing the health of the person afflicted with such condition in serious jeopardy, or in the case of a behavioral condition placing the health of such person or others in serious jeopardy, (b) serious impairment to such person's bodily functions; (c) serious dysfunction of any bodily organ or part of such person,- or (d) serious disfigurement of such person.
Health services required for medical conditions that if not immediately diagnosed or treated would lead to disability or death.
Emergency care is care received for medical emergencies (e.g., heart attack, stroke, loss of consciousness, broken bones, etc.) Emergency care typically is given in an emergency room and treats the acute condition. Any follow up care needed (including admission to the hospital) is typically not considered emergency care.
Covered services that are 1) furnished by a provider qualified to furnish emergency services; and 2) needed to evaluate or stabilize an emergency medical condition.
A medical emergency includes severe pain, an injury, sudden illness, or suddenly worsening illness that would cause a reasonably prudent layperson to expect that delay in treatment may cause serious danger to the person's health if he/she does not get immediate medical care.
Healthcare services are provided in an emergency facility or setting after the onset of a medical condition that manifests itself by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could be reasonably be expected by the prudent lay person, who possesses an average knowledge of health and medicine, to result in a) serious jeopardy to the mental or physical health of the individual, or b) danger of serious impairment to bodily functions, or c) serious dysfunction of any bodily organ, or d) in the case of a pregnant woman, serious jeopardy to the health of the fetus.
Those health care services that are provided in an emergency facility or setting after the onset of an illness or medical condition that manifests itself by symptoms of sufficient severity that without immediate medical attention could be reasonably expected by the prudent lay person, who possesses an average knowledge of health and medicine, to result in: a) placing the Member's physical and or mental health in serious jeopardy; b) serious impairment to bodily functions; or serious dysfunction of any bodily organ or part.
An injury or sudden, unexpected illness (including severe pain and active labor) of sufficient severity that if the member does not receive immediate treatment, it could present a serious threat to his or her health, could seriously impair physical functions, or could cause a serious dysfunction of any organ or body part if immediate medical treatment is not received.
Care for sudden, life-threatening medical conditions requiring immediate medical care, such as loss of consciousness, chest pain, difficulty breathing, heavy bleeding, a broken bone, poisoning, etc.
Care for patients with severe or life-threatening conditions that require immediate intervention.
Any illness or injury that, without immediate medical attention, could result in loss of life or limb, or cause serious harm to bodily functions (for example, an apparent heart attack, severe bleeding, loss of consciousness, or severe or multiple injuries).
A life threatening medical condition that requires immediate medical attention. It is a sickness or injury of a nature that failure to get immediate medical care could put the person's life in danger or cause serious harm to bodily functions.
care you get when your health problem is life threatening.
Health care services provided in a hospital emergency facility or comparable facility to evaluate and stabilize sudden and severe medical conditions.
A medical condition manifesting itself by acute symptoms of sufficient severity, (including severe pain) such that a prudent layperson, who possesses an average knowledge of medicine and health, could reasonably expect the absence of immediate medical attention to result in 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; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part.
a true emergency situation required immediate medical attention at the nearest facility to prevent death or disability due to a sudden trauma or illness, such as a stroke or broken leg. Emergency care is covered at someone's plan highest level of benefits.
Most plans cover emergency care in a hospital emergency room if it is an extremely urgent medical emergency, even if the hospital you are taken to is not in the plan's network. It is possible, however, that after your condition has been stabilized, you would be transferred to a participating plan hospital.
Care needed immediately to treat a life-threatening or serious injury or illness. Medical emergencies include but are not limited to heart attacks, strokes, poisonings, loss of consciousness, loss of breathing, severe bleeding, and convulsions. Insurers may question your use of the emergency room at a hospital to make sure you actually had a medical emergency. If the insurer decides you did not have a medical emergency, you may be responsible for all or part of the cost of the care you received. Emergency care differs from urgent care.
Every insurer shall provide coverage for emergency services to the extent necessary to screen and stabilize the person covered under the plan and shall not require prior authorization of the services if a prudent layperson acting reasonably would have believed that an emergency medical condition existed. Payment of claims for emergency services shall be based on the retrospective review of the presenting history and symptoms of the covered person.
Care for severe pain, injury, sudden illness, or suddenly worsening illness that you believe can cause serious danger to your health if you do not get immediate medical care.
Services provided after a sudden or unexpected life of limb-threatening condition occurs.
Medical care necessary to treat a sudden illness or injury that is life or limb-threatening.
Care provided to the insured who suffers an accidental injury or the sudden onset of a medical condition with symptoms so severe, including severe pain, that without immediate medical attention the insured could reasonably expect that 1) his or health would be in serious jeopardy; 2) his or her bodily function would be seriously impaired; or 3) a bodily organ or part would be seriously damaged. Note: Benefits for Emergency Care vary by plan. Refer to your Certificate of Insurance for specific plan details.