TakeCare Insurance Company, Inc
Urgent Care and Emergency Care Services Urgent Care Urgent Care services are available within the service area through contracted providers. If you are out of the service area, urgent care services must be received in a doctor’s office or an urgent care facility. Please refer to your “schedule of benefits” for specific coverage levels for certain benefits.
Emergency Care Services In an emergency, seek immediate medical attention and make sure you or someone else notifies TakeCare within forty-eight (48) hours or as soon as reasonably possible after initial receipt of services to inform them of the location, duration and nature of the services provided.
Examples of emergencies include heart attack, stroke, poisoning and sudden inability to breathe. The use of the hospital emergency services for conditions that are not defined as an emergency are not covered. Please refer to your “schedule of benefits” for specific coverage levels for certain benefits. Emergency ground ambulance services required for transport to an emergency treatment facility are covered. Air ambulance services are not covered. Ground ambulance services not used for bonafide emergency transport are not covered.
TakeCare covers emergency medical services worldwide. Emergency services are medically necessary medical or hospital services required as the result of a medical condition manifesting itself by the sudden onset of symptoms of sufficient severity, which may include severe pain, such that a reasonable person would expect the absence of immediate medical attention to result in:
placing your health in serious jeopardy,
serious impairment to your bodily functions, or
serious dysfunction of any bodily part.
Member Handbook 012111
8