HEALTH AND WELLNESS Urgently Needed Care and Emergency Care Under Both Medical Options Urgently needed care is medical treatment for conditions that require prompt medical attention, but are not life threatening emergencies. Examples include but are not limited to minor sprains, fractures, pain, heat exhaustion, and breathing difficulties. Even if it’s after office hours, always contact your physician to schedule an appointment each time you need to be treated by a medical professional. If your doctor feels you need to be seen immediately, your doctor will refer you to the appropriate medical facility. Make sure you verify network status. See the chart on page 25 for additional information. Emergency care is a covered service due to the sudden and unexpected onset of a condition or injury that you believe endangers your life or could result in serious injury or disability and that requires immediate medical or surgical care. If you believe your condition is an emergency, dial 911 for immediate medical assistance or go to the nearest Emergency Center. After the medical emergency has been resolved, contact your physician for appropriate follow-up. Scripps Medical Plans pay benefits according to how your medical need is classified. Benefits for “emergency care” are different from those provided for “urgently needed care.” 24 Prior Authorization Required for Both Medical Plan Options Both medical plan options have prior authorization requirements for certain services. Prior authorization procedures are managed by your Plan Medical Group for the HMO option and by Personify Health for the EPO option. If you do not receive prior authorization when required, benefits may be denied, reduced, and/or a penalty applied. Please refer to the appropriate plan document online at MyScrippsHealthPlan.com for a detailed explanation of prior authorization and when it is required.
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