Common use of Emergency or Urgently Needed Services Clause in Contracts

Emergency or Urgently Needed Services. Emergency Services obtained from Non-Plan providers will be payable at the same benefit level as would be applied to care received from Plan Providers. Benefits are limited to Eligible Medical Expenses for Non-Plan Provider Emergency Services as defined under “SHL Reimbursement Schedule”. You are responsible for any Non-Plan Provider Emergency Service charges that exceed payments made by SHL. Benefits for Emergency Services are subject to any limit shown in the Attachment A Benefit Schedule. If Emergency Services are required during an emergency as defined in this AOC, all Covered Services which are Medically Necessary and appropriate will be paid for within the limit, if any, established in the Attachment A Benefit Schedule. IMPORTANT NOTE: If treatment is received by an Insured in a Hospital emergency room or other emergency facility for a condition which is Medically Necessary but which does not require Emergency Services, a reduced benefit will be allowed toward the Covered Services included in such treatment. Examples of conditions which require Medically Necessary treatment, but are not Emergency Services, include:  Sore throats.  Flu or fever.  Earaches.  Sore or stiff muscles.  Sprains, strains or minor cuts.  Suture removal.  Routine dental services.  Medication refills. If the treatment received is not a Covered Service or if treatment is received for a condition which is not Medically Necessary, no benefit is payable.

Emergency or Urgently Needed Services. Emergency Services obtained from Non-Plan providers will be payable at the same benefit level as would be applied to care received from Plan Providers. Benefits are limited to Eligible Medical Expenses Expenses, or the Recognized Amount when applicable, for Non-Plan Provider Emergency Services as defined under “SHL Reimbursement Schedule”. You are responsible for any Non-Plan Provider Emergency Service charges that exceed payments made by SHL. Benefits for Emergency Services are subject to any limit shown in the Attachment A Benefit Schedule. If Emergency Services are required during an emergency as defined in this AOC, all Covered Services which are Medically Necessary and appropriate will be paid for within the limit, if any, established in the Attachment A Benefit Schedule. IMPORTANT NOTE: If treatment is received by an Insured in a Hospital emergency room or other emergency facility for a condition which is Medically Necessary but which does not require Emergency Services, a reduced benefit will be allowed toward the Covered Services included in such treatment. Examples of conditions which require Medically Necessary treatment, but are not Emergency Services, include:  • Sore throats.  • Flu or fever.  • Earaches.  • Sore or stiff muscles.  • Sprains, strains or minor cuts.  • Suture removal.  Agreement of Coverage • Routine dental services.  • Medication refills. If the treatment received is not a Covered Service or if treatment is received for a condition which is not Medically Necessary, no benefit is payable.

Emergency or Urgently Needed Services. Emergency Services obtained from Non-Plan providers will be payable at the same benefit level as would be applied to care received from Plan Providers. Benefits are limited to Eligible Medical Expenses for Non-Plan Provider Emergency Services as defined under “SHL Reimbursement Schedule”. You are responsible for any Non-Plan Provider Emergency Service charges that exceed payments made by SHL. Benefits for Emergency Services are subject to any limit shown in the Attachment A Benefit Schedule. If Emergency Services are required during an emergency as defined in this AOCCertificate, all Covered Services which are Medically Necessary and appropriate will be paid for within the limit, if any, established in the Attachment A Benefit Schedule. IMPORTANT NOTE: If Medically Necessary treatment is received by an Insured in a Hospital emergency room or other emergency facility for a condition which is Medically Necessary but which does not require Emergency Services, a reduced benefit will be allowed payable toward the Covered Services included in such treatment. Examples of conditions which require Medically Necessary treatment, but are not Emergency Services, include:  Sore throats.  Flu or fever.  Earaches.  Sore or stiff muscles.  Sprains, strains or minor cuts.  Suture removal.  Routine dental services.  Medication refills. If the treatment received is not a Covered Service or if treatment is received for a condition which is not Medically Necessary, no benefit is payable.

Emergency or Urgently Needed Services. Emergency Services obtained from Non-Plan providers will be payable at the same benefit level as would be applied to care received from Plan Providers. Benefits are limited to Eligible Medical Expenses for Non-Plan Provider Emergency Services as defined under “SHL Reimbursement Schedule”. You are responsible for any Non-Plan Provider Emergency Service charges that exceed payments made by SHL. Benefits for Emergency Services are subject to any limit shown in the Attachment A Benefit Schedule. If Emergency Services are required during an emergency as defined in this AOC, all Covered Services which are Medically Necessary and appropriate will be paid for within the limit, if any, established in the Attachment A Benefit Schedule. IMPORTANT NOTE: If treatment is received by an Insured in a Hospital emergency room or other emergency facility for a condition which is Medically Necessary but which does not require Emergency Services, a reduced benefit will be allowed toward the Covered Services included in such treatment. Examples of conditions which require Medically Necessary treatment, but are not Emergency Servicesemergency treatment, include:  • Sore throats.  • Flu or fever.  • Earaches.  • Sore or stiff muscles.  • Sprains, strains or minor cuts.  • Suture removal.  • Routine dental services.  • Medication refills. If the treatment received is not a Covered Service or if treatment is received for a condition which is not Medically Necessary, no benefit is payable.

Emergency or Urgently Needed Services. Emergency Services obtained from Non-Plan providers will be payable at the same benefit level as would be applied to care received from Plan Providers. Benefits are limited to Eligible Medical Expenses for Non-Plan Provider Emergency Services as defined under “SHL Reimbursement Schedule”. You are responsible for any Non-Plan Provider Emergency Service charges that exceed payments made by SHL. Benefits for Emergency Services are subject to any limit shown in the Attachment A Benefit Schedule. If Emergency Services are required during an emergency as defined in this AOCCertificate, all Covered Services which are Medically Necessary and appropriate will be paid for within the limit, if any, established in the Attachment A Benefit Schedule. IMPORTANT NOTE: If Medically Necessary treatment is received by an Insured in a Hospital emergency room or other emergency facility for a condition which is Medically Necessary but which does not require Emergency Services, a reduced benefit will be allowed payable toward the Covered Services included in such treatment. Examples of conditions which require Medically Necessary treatment, but are not Emergency Services, include:  Sore throats. Certificate of Coverage  Flu or fever.  Earaches.  Sore or stiff muscles.  Sprains, strains or minor cuts.  Suture removal.  Routine dental services.  Medication refills. If the treatment received is not a Covered Service or if treatment is received for a condition which is not Medically Necessary, no benefit is payable.