Common use of If You Have a Medical Emergency Clause in Contracts

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.

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 Emergency Department or 9-1-1 Ambulance Medical Emergency services. Medical Emergencies include, but are not limited to: • Heart attack; • Stroke; • Severe trauma; • Shock; • Loss of consciousness; • Seizures; and • Convulsions. Once you are transferred out of the Emergency Department, Notification and clinical review are required to determine when your emergency medical condition is stabilized. Once your condition is stabilized, Notification and Prior Approval requirements apply. SAMPLE If you are hospitalized, Notification to Health Options via our Member Services toll free number at 1-855-855- 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-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.

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). Refer to Section 2.B for information regarding Hospital admissions. When there is an inadequate network, balance billing does not apply. Refer to Section 2.B for information regarding Hospital admissions.

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 Emergency Department or 9-1-1 Ambulance Medical Emergency services. Medical Emergencies include, but are not limited to: • Heart attack; • Stroke; • Severe trauma; • Shock; • Loss of consciousness; • Seizures; and • Convulsions. Once you are transferred out of the Emergency Department, Notification and clinical review are required to determine when your emergency medical condition is stabilized. Once your condition is stabilized, Notification and Prior Approval requirements apply. SAMPLE If you are hospitalized, Notification to Health Options via our Member Services toll free number at 1-855-855- 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-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). Refer to Section 2.B for information regarding Hospital admissions. When there is an inadequate network, balance billing does not apply. Refer to Section 2.B for information regarding Hospital admissions.

If You Have a Medical Emergency. If you need Medical Emergency services, you should go immediately to the nearest emergency department or call 9-1-9 - 1- 1 or another local emergency number. You do not need a Referral or Prior Approval for Emergency Department or 9 - 1- 1 Ambulance Medical Emergency Emergen cy services. .. Medical Emergencies include, but are not limited to: • Heart attack; • Stroke; • Severe trauma; • Shock; • Loss of consciousness; • Seizures; and • Convulsions. Once you are transferred out of the Emergency Department, Notification and clinical rev iew are required to determine when your emergency medical condition is stabilized. Once your 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 1-855-624-1 - 855 - 624 - 6463 is required r equired 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-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-follow - up care you may need. Your emergency department Out-of-Out - of- Pocket Costs are listed on the Schedule of BenefitsBenefits . If you are admitted to the Hospital from the emergency department, your Out-of-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-Non - Network Provider, your Out-of-Out - of- Pocket Costs for the Maximum Allowable AmountAmount , as determined by Health Options (see section 6 for more info), will be at the Network Provider (or In-In - Network) cost-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.

If You Have a Medical Emergency. SAMPLE 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 Emergency Department or 9-1-1 Ambulance Medical Emergency services. Medical Emergencies include, but are not limited to: • Heart attack; • Stroke; • Severe trauma; • Shock; • Loss of consciousness; • Seizures; and • Convulsions. Once you are transferred out of the Emergency Department, Notification and clinical review are required to determine when your emergency medical condition is stabilized. Once your condition is stabilized, Notification and Prior Approval requirements apply. If you are hospitalized, Notification to Community 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 Community 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 Community 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 Community 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.

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 Emergency Department or 9-1-1 Ambulance Medical Emergency services. Medical Emergencies include, but are not limited to: •  Heart attack; •  Stroke; •  Severe trauma; •  Shock; •  Loss of consciousness; •  Seizures; and •  Convulsions. Once you are transferred out of the Emergency Department, Notification and clinical review are required to determine when your emergency medical condition is stabilized. Once your condition is stabilized, Notification and Prior Approval requirements apply. SAMPLE If you are hospitalized, Notification to Health Options via our Member Services toll free number at 1-855-855- 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-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). Refer to Section 2.B for information regarding Hospital admissions. When there is an inadequate network, balance billing does not apply. Refer to Section 2.B for information regarding Hospital admissions.

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 Emergency Department or 9-1-1 Ambulance Medical Emergency services. Medical Emergencies include, but are not limited to: •  Heart attack; •  Stroke; •  Severe trauma; •  Shock; •  Loss of consciousness; •  Seizures; and •  Convulsions. Once you are transferred out of the Emergency Department, Notification and clinical review are required to determine when your emergency medical condition is stabilized. Once your condition is stabilized, Notification and Prior Approval requirements apply. SAMPLE If you are hospitalized, Notification to Health Options via our Member Services toll free number at 1-855-855- 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-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.

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 Emergency Department or 9-1-1 Ambulance Medical Emergency services. SAMPLE Medical Emergencies include, but are not limited to: • Heart attack; • Stroke; • Severe trauma; • Shock; • Loss of consciousness; • Seizures; and • Convulsions. Once you are transferred out of the Emergency Department, Notification and clinical review are required to determine when your emergency medical condition is stabilized. Once your 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). Refer to Section 2.B for information regarding Hospital admissions. When there is an inadequate network, balance billing does not apply. Refer to Section 2.B for information regarding Hospital admissions.

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 Emergency Department or 9-1-1 Ambulance Medical Emergency services. .. Medical Emergencies include, but are not limited to: • Heart attack; • Stroke; • Severe trauma; • Shock; • Loss of consciousness; • Seizures; and • Convulsions. Once you are transferred out of the Emergency Department, Notification and clinical review are required to determine when your emergency medical condition is stabilized. Once your 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.

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 9‐1‐1 or another local emergency number. You do not need a Referral or Prior Approval for Emergency Department or 9‐1‐1 Ambulance Medical Emergency services. Medical Emergencies include, but are not limited to: • Heart attack; • Stroke; • Severe trauma; • Shock; • Loss of consciousness; • Seizures; and • Convulsions. Once you are transferred out of the Emergency Department, Notification and clinical review are required to determine when your emergency medical condition is stabilized. Once your condition is stabilized, Notification and Prior Approval requirements apply. If you are hospitalized, Notification to Community 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 Community Health Options of your admission. If you are admitted to a Non-Network Non‐Network Provider facility, you or your designee is required to notify your PCP and Community Health Options within 48 hours of admission. Your PCP will arrange for any follow-up follow‐up care you may need. Your emergency department Out-of-Pocket 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 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 Non‐Network Provider, your Out-of-Pocket Out‐of‐Pocket Costs for the Maximum Allowable Amount, as determined by Community Health Options (see section 6 for more info), will be at the Network Provider (or In-NetworkIn‐Network) cost-sharing 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.

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 Emergency Department or 9-1-1 Ambulance Medical Emergency services. Medical Emergencies include, but are not limited to: • Heart attack; • Stroke; • Severe trauma; • Shock; • Loss of consciousness; • Seizures; and • Convulsions. Once you are transferred out of the Emergency Department, Notification and clinical review are required to determine when your emergency medical condition is stabilized. Once your condition is stabilized, Notification and Prior Approval requirements apply. If you are hospitalized, Notification to Community 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 Community 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 Community 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 Community 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.

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 9‐1‐1 or another local emergency number. You do not need a Referral or Prior Approval for Emergency Department or 9‐1‐1 Ambulance Medical Emergency services. .. Medical Emergencies include, but are not limited to: • Heart attack; • Stroke; • Severe trauma; • Shock; • Loss of consciousness; • Seizures; and • Convulsions. Once you are transferred out of the Emergency Department, Notification and clinical review are required to determine when your emergency medical condition is stabilized. Once your condition is stabilized, Notification and Prior Approval requirements apply. If you are hospitalized, Notification to Community 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 Community Health Options of your admission. If you are admitted to a Non-Network Non‐Network Provider facility, you or your designee is required to notify your PCP and Community Health Options within 48 hours of admission. Your PCP will arrange for any follow-up follow‐up care you may need. Your emergency department Out-of-Pocket 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 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 Non‐Network Provider, your Out-of-Pocket Out‐of‐Pocket Costs for the Maximum Allowable Amount, as determined by Community Health Options (see section 6 for more info), will be at the Network Provider (or In-NetworkIn‐Network) cost-sharing 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.

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.