WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 25 Part 3 Emergency Services You do not need a referral from your health care provider or an approval from Blue Cross Blue Shield HMO Blue before you obtain emergency medical care. As a member of this health plan, you will receive worldwide emergency coverage. These emergency medical services may include inpatient or outpatient services by health care providers who are qualified to furnish emergency medical care. This includes care that is needed to evaluate or stabilize your emergency medical condition. At the onset of an emergency medical condition that in your judgment requires emergency medical care, you should go to the nearest emergency room. If you need help, dial 911. Or, call your local emergency medical service system phone number. You will not be denied coverage for medical and transportation services that you incur as a result of your emergency medical condition. You usually need emergency medical services because of the sudden onset of an emergency medical condition. An “emergency medical condition” is a medical condition, whether physical, behavioral, related to substance use, or mental, manifesting itself by acute symptoms of sufficient severity (including severe pain) that, in the absence of prompt care, could reasonably be expected by a prudent layperson who has an average knowledge of health and medicine to result in: placing your life or health or the health of another (including an unborn child) in serious jeopardy; or serious impairment of bodily functions; or serious dysfunction of any bodily organ or part; or, as determined by a provider with knowledge of your condition, severe pain that cannot be managed without such care. Some examples of conditions that require emergency medical care are: suspected heart attacks; strokes; poisoning; loss of consciousness; convulsions; and suicide attempts. Inpatient Emergency Admissions Your condition may require that you be admitted into a hospital for inpatient emergency medical care. If this happens, you or the admitting facility (or someone on your behalf) must call Blue Cross Blue Shield HMO Blue within 48 hours of your admission. (A health care facility that participates in your health care network should call Blue Cross Blue Shield HMO Blue for you.) This call must include: your name; your ID number; the name of the health care facility; the date of admission; and the condition for which you are receiving treatment. This information is required so that Blue Cross Blue Shield HMO Blue can evaluate and monitor the appropriateness of your inpatient health care services. Outpatient Emergency Services When you have an emergency medical condition, you should receive care at the nearest emergency room. If you receive emergency medical care at an emergency room of a hospital that does not participate in your health care network, your health plan will provide the same coverage that you would otherwise receive if you had gone to a hospital that does participate in your health care network. Post-Stabilization Care After your emergency medical condition has been evaluated and stabilized in the hospital emergency room, you may be ready to go home. Or, you may require further care. Blue Cross Blue Shield HMO Blue will consider post-stabilization covered services to be approved if an approval is not given within 30 minutes of the emergency room provider’s call. If the emergency room provider and your health care provider do not agree as to the right medical treatment for you, your health plan will cover the health care