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

  • Unforeseeable Emergency In the event of a Participant’s Unforeseeable Emergency, such Participant may request an emergency withdrawal from his or her Account. Any such request shall be subject to the approval of the Administrator, which approval shall not be granted to the extent that such need may be relieved (i) through reimbursement or compensation by insurance or otherwise or (ii) by liquidation of the Participant’s assets (to the extent the liquidation of such assets would not itself cause severe financial hardship). A Participant may withdraw all or a portion of his or her Account due to an Unforeseeable Emergency; provided, however, that the withdrawal shall not exceed the amount reasonably needed to satisfy the need created by the Unforeseeable Emergency.

  • Medical Care and Emergency Leave An employee is entitled to a leave of absence without pay because of any of the following: 1. A personal illness, injury or medical emergency. 2. The death, illness, injury or medical emergency of an individual described in this Article. 3. An urgent matter that concerns an individual described in this Article. For the purposes of this Article, the individuals referred to in this Article are: - the employee’s spouse - a parent, step-parent or xxxxxx parent of the employee or the employee’s spouse - a child, step-child or xxxxxx child of the employee or the employee’s spouse - a grandparent, step-grandparent, grandchild or step-grandchild of the employee or of the employee’s spouse - the spouse of a child of the employee - the employee’s brother or sister - a relative of the employee who is dependent on the employee for care or assistance. An employee who wishes to take leave under this section shall advise his or her Hospital that he or she will be doing so. If the employee must begin the leave before advising the Hospital, the employee shall advise the Hospital of the leave as soon as possible after beginning it. An employee is entitled to take a total of 10 days’ leave under this section each year. If an employee takes any part of a day as leave under this section, the Hospital may deem the employee to have taken one day’s leave on that day for the purposes of this Article. The Hospital may require an employee who takes leave under this section to provide evidence reasonable in the circumstances that the employee is entitled to the leave. Upon the conclusion of an employee’s leave under this Article, the Hospital shall reinstate the employee to the position the employee most recently held with the Hospital, if it still exists, or to a comparable position, if it does not.

  • Financial Hardship (a) A Financial Hardship distribution may only be made on account of an immediate and heavy financial need of the Participant, and where the distribution is necessary to satisfy the immediate and heavy financial need. A Financial Hardship distribution will only be considered as necessary to satisfy an immediate and heavy financial need of the Participant if the distribution is not in excess of the amount of the immediate and heavy financial need (including amounts necessary to pay any federal, state or local income taxes or penalties reasonably anticipated to result from the distribution); (b) Financial Hardship shall be determined in accordance with Code Section 403(b), and the regulations thereunder, and the Employer’s or Custodian’s hardship policy and procedures, if applicable. The following are the only financial needs considered immediate and heavy: (1) expenses incurred (or necessary to obtain) for medical care that would be deductible under Code Section 213(d), determined without regard to the limitations in Code Section 213(a) (relating to the applicable percentage of adjusted gross income and the recipients of the medical care) provided that, if the recipient of the medical care is not listed in Code Section 213(a), the recipient is a primary beneficiary under the Plan (as that term is defined in Treas. Reg. 1 401(k)-1(d)(3)(ii)(C); (2) costs directly related to the purchase (excluding mortgage payments) of a principal residence for the Participant; (3) payment of tuition and related educational fees for the next twelve (12) months of post-secondary education for the Participant, the Participant’s spouse, children or dependents, or the Participant’s primary beneficiary; (4) payment necessary to prevent the eviction of the Participant from, or a foreclosure on the mortgage of, the Participant’s principal residence; (5) payments for funeral or burial expenses for the Participant’s deceased parent, spouse, child or dependent, or the Participant’s primary beneficiary; (6) expenses to repair damage to the Participant’s principal residence that would qualify for a casualty loss deduction under Code Section 165 (determined without regard to whether the loss exceeds ten percent (10%) of adjusted gross income; and (7) expenses and losses, including loss of income, incurred by the Participant on account of a disaster declared by the Federal Emergency Management Agency (FEMA), provided that the Participant’s principal residence or principal place of employment at the time of the disaster was located in an area designated by FEMA for individual assistance with respect to the disaster.

  • Personal Emergency Leave 1. An educator will be granted up to five (5) days of leave per year to cover situations beyond the control of the educator which would significantly impair teaching service. Personal emergency leave may not be used for illness or injury, or illness or injury in the immediate family. Deductions from the gross pay of an educator for this leave shall be made at the degreed substitute rate of pay for each day taken. 2. An educator may be granted up to five (5) days leave without pay for business or personal reasons having unusual circumstances.

  • When You Have More Than One Plan with BCBSRI If you are covered under more than one plan with us, you are entitled to covered benefits under both plans. If one plan has a benefit that the other(s) does not, you are entitled to coverage under the plan that has the benefit. The total payments you receive will never be more than the total allowable expense for the services you receive.

  • Contact Us If You Have a Question If you have questions about your benefits or anything in this agreement, we are happy to help. Simply call our Customer Service Department or visit one of our Your Blue Store locations. As a BCBSRI member, you may also log in to our secure member website to find out BCBSRI news, get plan information or use many of our self-service options.

  • Family Medical Leave or Critical Illness Leave a) Family Medical Leave or Critical Illness leaves granted to a permanent teacher, long-term occasional teacher or teacher hired into a term position under this Article shall be in accordance with the provisions of the Employment Standards Act, as amended. b) The teacher will provide to the employer such evidence as necessary to prove entitlement under the Employment Standards Act. c) A teacher contemplating taking such leave(s) shall notify the employer of the intended date the leave is to begin and the anticipated date of return to active employment. d) Seniority and experience continue to accrue during such leave(s). e) Where a teacher is on such leave(s), the Employer shall continue to pay its share of the benefit premiums, where applicable. To maintain participation and coverage under the Collective Agreement, the teacher must agree to provide for payment for the teacher’s share of the benefit premiums, where applicable. f) In order to receive pay for such leaves, a teacher must access Employment Insurance and the Supplemental Employment Benefit (SEB) in accordance with g) to j), if allowable by legislation. An employee who is eligible for E.I. is not entitled to benefits under a school board’s sick leave and short term disability plan. g) The Employer shall provide for permanent teachers, long-term occasional teachers and teachers hired into a term position who access such Leaves, a SEB plan to top up their E.I.

  • What Will Happen After We Receive Your Letter When we receive your letter, we must do two things:

  • Catastrophic Leave Program Leave credits, as defined below, may be transferred from one (1) or more employees to another employee, on an hour-for-hour basis, in accordance with departmental policies upon the request of both the receiving employee and the transferring employee and upon approval of the employee's appointing authority, under the following conditions: A. The receiving employee is required to be absent from work due to injury or the prolonged illness of the employee, employee's spouse, registered domestic partner, a domestic partner listed on an “Affidavit for Enrollment of Domestic Partners,” submitted to employee benefits, parent or child, has exhausted all earned leave credits, including but not limited to sick leave, compensatory time, holiday credits and disability leave and is therefore facing financial hardship. B. The transfers must be for a minimum of four (4) hours and in whole hour increments thereafter. C. Transfers shall be allowed to cross-departmental lines in accordance with the policies of the receiving department. D. The total maximum leave credits received by an employee shall normally not exceed five hundred twenty (520) hours; however, if approved by his/her appointing authority, the total leave credits may be up to one thousand forty (1,040) hours. Total leave credits in excess of one thousand forty (1,040) hours will be considered on a case-by-case basis by the appointing authority subject to the approval of the Chief Administrative Officer. E. The transfers are irrevocable, and will be indistinguishable from other leave credits belonging to the receiving employee. Transfers will be subject to all taxes required by law. F. Leave credits that may be transferred under this program are defined as the transferring employee’s vacation credits or up to twenty-four (24) hours of sick leave per fiscal year. G. Transfers shall be administered according to the rules and regulations of the Auditor and Controller, and made on a form prescribed by the Auditor and Controller. Approvals of the receiving and donating employee, the donating employee's appointing authority and the receiving employee's appointing authority (in the case of an interdepartmental transfer) will be provided for on such form. H. This program is not subject to the Grievance Procedure of this Agreement.

  • Limited Liability in Emergency Conditions Except as otherwise provided in the Tariff or the Operating Agreement, no Interconnection Party shall be liable to any other Interconnection Party for any action that it takes in responding to an Emergency Condition, so long as such action is made in good faith, is consistent with Good Utility Practice and is not contrary to the directives of the Transmission Provider or of the Interconnected Transmission Owner with respect to such Emergency Condition. Notwithstanding the above, Interconnection Customer shall be liable in the event that it fails to comply with any instructions of Transmission Provider or the Interconnected Transmission Owner related to an Emergency Condition.

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