In Case of An Emergency Situation

Note: PacifiCare changed its name to UHC of California and will do business as (dba) UnitedHealthcare of California, effective May 2011. (See the March 25, 2011 announcement.)

What to do when a member requires emergency services is detailed under Using Emergency or Urgently Needed Services in the PacifiCare Member Handbook. Worldwide, wherever you are, PacifiCare provides coverage for emergency medical services. If you believe that you need Emergency Services you should call 911 or go directly to the nearest medical facility for treatment. It is appropriate for you to use the "911" emergency response system or alternative emergency system in your area, for assistance in an emergency situation as described below when ambulance transport services are required and you reasonably believe that your condition is immediate and serious and requires emergency ambulance transport services to transport you to an appropriate facility. You must notify PacifiCare or your Participating Medical Group within 24 hours or as soon as reasonably possible after the initial receipt of Emergency Services to inform them of the location, duration and nature of the services provided.

If you are temporarily outside the Service Area and you believe that you require Urgently Needed Service, you should, if possible, call, or have someone on your behalf call your Primary Care Physician or Participating Medical Group. The telephone numbers for your Primary Care Physician and Participating Medical Group are on the front of your PacifiCare ID card. Assistance is available 24 hours a day, seven days a week. If you are unable to contact your Primary Care Physician or Participating Medical Group, you should seek care for Urgently Needed Services from a licensed medical professional where you are located.

An Emergency Service is a Medically Necessary Medical or Hospital Service 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.