Urgently Needed Care definition

Urgently Needed Care or “urgent care” means those health care services that are necessary to treat a condition or illness of an individual that if not treated within twenty- four (24) hours presents a serious risk of harm.
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Urgently Needed Care means Covered Services provided when a Covered Individual is either: 1.10.1 Temporarily absent from Plan's Medicare Advantage service area and such Covered Services are Medically Necessary and immediately required: (1) as a result of an unforeseen illness, injury, or condition; and (2) it was not reasonable, given the circumstances, to obtain the services through Plan's Medicare Advantage Network; or 1.10.2 Under unusual and extraordinary circumstances, the Covered Individual is in the service area but Plan's provider Network is temporarily unavailable or inaccessible and such Covered Services are Medically Necessary and immediately required: (1) as a result of an unforeseen illness, injury, or condition; and (2) it was not reasonable, given the circumstances, to obtain the services through Plan's Medicare Advantage Network.
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Urgently Needed Care means the care provided to you when you are outside of the LIFE service area and you believe your illness or injury is too severe to postpone treatment until you return to the service area, but your life or function is not in severe jeopardy.
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Examples of Urgently Needed Care in a sentence

  • We will provide benefits for Urgently Needed Care provided by a Participating or a Non-Participating Provider.

  • All covered services and supplies, except for Emergency and Urgently Needed Care, for Subscribers and their eligible Dependents must be performed by Physician Group within the Salud Network, SIMNSA or authorized by them to be performed by other provider.Any covered service or supply may require a Copayment or have a benefit maximum.

  • However, if you need to file a claim (for example, for Emergency or Urgently Needed Care from a non-Health Net provider), you must do so within one year from the date you receive the services or supplies.

  • Your Physician Group performs or authorizes all care, and you will not have to file claims.There is an exception when you receive covered Emergency Care or Urgently Needed Care from a provider who does not have a contract with Health Net.When cash benefits are due, Health Net will reimburse you for the amount you paid for services or supplies, less any applicable Copayment.

  • Emergency, Urgently Needed Care, Renal DialysisEmergency care, urgently needed care, and out-of-service-area renal (kidney) dialysis are required under the Medicare program to be covered at in-network cost sharing levels for both in- network and out-of-network providers.

  • All covered services and supplies, except for Emergency and Urgently Needed Care, for Subscribers and their eligible Dependents must be performed by Physician Group within the Salud Network, SIMNSA or authorized by them to be performed by another provider.Any covered service or supply may require a Copayment or have a benefit maximum.

  • H2986_PD_033 Accepted 2015Instructions for Emergency Care and Urgently Needed Care When Traveling Outside Our Service Area You can always receive emergency care in or out of the University Health Care Advantage service area from the nearest available provider.

  • They may not receive any services in California, except for Emergency or Urgently Needed Care.

  • Coverage is generally not provided to enrollees outside of the Health Net Service Area, except in cases of Emergency or Urgently Needed Care.

  • After your medical problem (including Severe Mental Illness and Serious Emotional Disturbances of a Child) no longer requires Urgently Needed Care or ceases to be an emergency and your condition is stable, any additional care you receive is considered Follow-Up Care.


More Definitions of Urgently Needed Care

Urgently Needed Care means any otherwise Covered Service necessary to prevent seri- ous deterioration of the health of a Member, resulting from an unforeseen illness, injury, or complication of an existing condition, includ- ing pregnancy, for which treatment cannot be delayed until the Member is able to see his
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Urgently Needed Care means any otherwise Covered Service necessary to prevent serious deterioration of the health of a Member, resulting from an unforeseen illness, injury, or complication of an existing condition, including pregnancy, for which treatment cannot be delayed until the Member is able to see his or her PCP. This includes maternity services necessary to prevent serious deterioration of the health of the Member or the Member’s
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Urgently Needed Care means any otherwise Covered Service necessary to prevent seri-
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Urgently Needed Care is when you need medical help for an unforeseen illness, injury, or condition, but your health is not in serious danger and you are generally outside of the service area. How to get urgently needed care If, while temporarily outside the Plan’s service area, you require urgently needed care, then you may get this care from any provider.
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Urgently Needed Care means MA Covered Services provided when a MA Member is either: (1) temporarily absent from Plan's Medicare Advantage service area and such MA Covered Services are Medically Necessary and immediately required: (a) as a result of an unforeseen illness, injury, or condition; and (b) it was not reasonable, given the circumstances, to obtain the services through Plan's Medicare Advantage Network; or
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Urgently Needed Care means MA Covered Services provided when a MA Member is either: (1) temporarily absent from Plan's Medicare Advantage service area and such MA Covered Services are Medically Necessary and immediately required: (a) as a result of an unforeseen illness, injury, or condition; and (b) it was not reasonable, given the circumstances, to obtain the services through Plan's Medicare Advantage Network; or (2) under unusual and extraordinary circumstances, the MA Member is in the service area but Plan's Network is temporarily unavailable or inaccessible and such MA Covered Services are Medically Necessary and immediately required: (a) as a result of an unforeseen illness, injury, or condition; and (b) it was not reasonable, given the circumstances, to obtain the services through Plan's Medicare Advantage Network.
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Related to Urgently Needed Care

  • Urgently Needed Services means Covered Services needed to prevent a serious deterioration in a Member’s health. While not as immediate as Emergency Services, these services cannot be delayed until the Member can see a Plan Provider.

  • Urgent Care means treatment for a condition that is not a threat to life or limb but does require prompt medical attention. Also, the severity of an urgent condition does not necessitate a trip to the hospital emergency room. An Urgent Care facility is a freestanding facility that is not a physician’s office and which provides Urgent Care.

  • Medically necessary care means care that is (1) appropriate and consistent with and essential for the prevention, diagnosis, or treatment of a Patient’s condition; (2) the most appropriate supply or level of service for the Patient’s condition that can be provided safely; (3) not provided primarily

  • Emergency medical care means such medical procedures as:

  • Mental health therapist means the same as that term is defined in Section 58-60-102.

  • Adult foster care means room and board, supervision, and special services to an adult who has a

  • Health Care Operations shall have the meaning given to such term under the HIPAA 2 Privacy Rule in 45 CFR § 164.501.

  • Child care means continuous care and supervision of five or more qualifying children that is:

  • Emergency medical services or “EMS” means an integrated medical care delivery system to provide emergency and nonemergency medical care at the scene or during out-of-hospital patient transportation in an ambulance.

  • Mental health services means interventions designed to provide the maximum reduction of mental disability and restoration or maintenance of functioning consistent with the requirements for learning, development and enhanced self-sufficiency. Services shall include: a. Assessment means a service activity, which may include a clinical analysis of the history and current status of a beneficiary’s mental, emotional, or behavioral disorder, relevant cultural issues and history, Diagnosis and the use of testing procedures.

  • Primary care giver" means a person who assumes the principal role of providing care and attention to a child.

  • Primary care physician means a physician qualified to be an attending physician according to ORS 656.005(12)(b)(A) and who is a general practitioner, family practitioner, or internal medicine practitioner.

  • Centers for Medicare and Medicaid Services or “CMS” means the federal office under the Secretary of the United States Department of Health and Human Services, responsible for the Medicare and Medicaid programs.

  • Emergency Care means management for an illness or injury which results in symptoms which occur suddenly and unexpectedly, and requires immediate care by a medical practitioner to prevent death or serious long term impairment of the insured person’s health.

  • URGENT CARE CENTER means a healthcare center either affiliated with a hospital or other institution or independently owned and operated. These centers may also be referred to as walk-in centers.

  • Emergency medical care provider means an individual who has been trained to provide emergency and nonemergency medical care at the first responder, EMT-basic, EMT-intermediate, EMT-paramedic, paramedic specialist or other certification levels recognized by the department before 1984 and who has been issued a certificate by the department.

  • Respiratory care means the practice of the allied health profession responsible for the direct and

  • Primary care-giver means a person who assumes the principal role of providing care and attention to a child.

  • Emergency Medical Technician (EMT means: an individual licensed with cognitive knowledge and a scope of practice that corresponds to that level in the National EMS Education Standards and National EMS Scope of Practice Model.

  • Medically Necessary Services means those covered services that are, under the terms and conditions of the contract, determined through contractor utilization management to be:

  • Skilled Nursing Care means that level of care which:

  • Hospice Care means a coordinated program of active professional

  • Emergency medical technician means a person who is either an EMT-I, EMT-II, or EMT-P (paramedic), and possesses a valid certificate or license in accordance with the standards of Division 2.5 (commencing with Section 1797) of the Health and Safety Code.

  • Mental health facility means a mental health facility as defined by the Inpatient Mental Health Treatment of Children Act;

  • Inpatient care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered event.

  • Emergency Medical Transportation means the transportation, by ambulance, of sick, injured or otherwise incapacitated persons who require emergency medical care.