Mandatory Passages and Language for MC+ Managed Care Health Plan Handbook, page 13

Emergency Medical Services

In an emergency, go to the nearest emergency room even if it is not in your health plan's network or call 911. When you go to the emergency room a health care provider will check to see if you need emergency care. You can call the number listed on the back of your MC+ Managed Care health plan card anytime day or night if you have questions about going to the emergency room. Call your PCP after an emergency room visit.

An emergency is when you call 911 or go to the nearest emergency room for things like:

chest pain;
stroke;
difficulty breathing;
bad burns;
deep cuts/heavy bleeding; or
gunshot wound.

If you aren't sure about the medical condition, get help right away or call your PCP's office for advice. Ask for a number you can call when the office is closed. You can also call your health plan's Nurse Advice Helpline.

It's best to call or go to your PCP's office for things that are not emergencies, like:

earaches;
sore throat;
backaches;
small cuts; or
cold/flu.

You should call your PCP to be treated for these things. If you go to the emergency room and it is not an emergency, you may have to pay for the care you get.

Emergency medical services are those health care items and services furnished that are required to evaluate or stabilize a sudden and unforeseen situation or occurrence or a sudden onset of a medical or mental health condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that the failure to provide immediate medical attention could reasonably be expected by a prudent lay person, possessing average knowledge of health and medicine, to result in:

placing the patient's physical or mental health (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; or
serious impairment of bodily functions; or
serious dysfunction of any bodily organ or part; or
serious harm to self or others due to an alcohol or drug abuse emergency; or
injury to self or bodily harm to others; or
with respect to a pregnant woman who is having contractions:
- There is inadequate time to effect a safe transfer to another hospital before delivery; or
- Transfer may pose a threat to the health or safety of the woman or the unborn.

[** Health Plans must provide you locations of where to receive or obtain ER services.]

Emergency Transportation

Call 911 or the closest ambulance.