Common use of Emergency Room Benefits Clause in Contracts

Emergency Room Benefits. Benefits are provided for Medically Necessary Services pro- vided in the Emergency Room of a Hospital. For the lowest out-of-pocket expenses covered non-emergency Services or emergency room follow-up Services (e.g., suture removal, wound check, etc.) should be received in a Participating Phy- sician’s office. Emergency Services are Services provided for an unexpected medical condition, including a psychiatric emergency medi- cal condition, manifesting itself by acute symptoms of suffi- cient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in any of the following: (1) placing the Member’s health in serious jeopardy; (2) serious impairment to bodily functions; (3) serious dysfunction of any bodily organ or part. Note: Emergency Room Services resulting in an admission to a Non-Preferred Hospital which the Plan determines are not emergencies will be paid as part of the Inpatient Hospital Services. The Subscriber Copayment for non-emergency Inpatient Hospital Services from a Non-Preferred Hospital is shown in the Summary of Benefits. For Emergency Room Services directly resulting in an ad- mission to a different Hospital, the Subscriber is responsible for the emergency room Subscriber Copayment plus the ap- propriate admitting Hospital Services Subscriber Copayment as shown in the Summary of Benefits.

Emergency Room Benefits. Benefits are provided for Medically Necessary Services pro- vided provided in the Emergency Room of a Hospital. For the lowest out-of-pocket expenses covered non-emergency Services Ser- vices or emergency room follow-up Services (e.g., suture removal, wound check, etc.) should be received in a Participating Phy- sicianPartici- pating Physician’s office. Emergency Services are Services provided for an unexpected unex- pected medical condition, including a psychiatric emergency medi- cal emergen- cy medical condition, manifesting itself by acute symptoms of suffi- cient sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in any of the following: (1) placing the Member’s health in serious jeopardy; (2) serious impairment impair- ment to bodily functions; (3) serious dysfunction of any bodily organ or part. Note: Emergency Room Services resulting in an admission to a Non-Preferred Hospital which the Plan determines are not emergencies will be paid as part of the Inpatient Hospital Hospi- tal Services. The Subscriber Copayment for non-emergency Inpatient Hospital Services from a Non-Preferred Hospital is shown in the Summary of Benefits. For Emergency Room Services directly resulting in an ad- mission to a different Hospital, the Subscriber is responsible for the emergency room Subscriber Copayment plus the ap- propriate admitting Hospital Services Subscriber Copayment Copay- ment as shown in the Summary of Benefits.