How HMOs Work

How It Works

In an Emergency

Emergencies are conditions that require immediate care. Typically, an emergency is considered to be an accidental injury or the sudden or unexpected onset of a severe medical condition such as chest pains, convulsions, loss of consciousness, head injuries, lacerations, or vomiting blood.

You may be liable for the cost of your emergency room visit if you do not receive approval for that visit from your HMO either before you go to the emergency room or within 24 or 48 hours after your visit.

When you follow the proper procedures, emergency care is covered by the HMOs 24 hours a day, 7 days a week, no matter where you are or what is needed.

Review your HMO materials for specific instructions and details about what to do in an emergency before you experience a life-threatening situation. Each HMO requires that you contact them within a specific time period following the emergency. Also, the definition of an emergency may vary, depending on the specific HMO.

While this Summary Plan Description summarizes the major provisions of this plan, it does not provide you with every plan detail. The plan documents, which govern this plan, provide full details. If there are any discrepancies between this Summary Plan Description and the legal plan documents, the legal plan documents control.