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Emergency Care

  1. Do you cover emergency care?
  2. What do I do in case of an emergency?

  1. Do you cover emergency care?
    Yes, we cover emergency care. An emergency medical condition is defined for the member as one manifesting itself by acute symptoms of sufficient severity such that a prudent layperson, who possesses average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in serious jeopardy to the person's health, or with respect to a pregnant woman, the health of the woman and her unborn child. This definition may vary based on state regulations.

  2. What do I do in case of an emergency?
    When an emergency strikes, health care coverage should be the least of your worries.

    Emergency care is covered 24 hours a day, 7 days a week, anywhere in the world.

    If the emergency occurs within the Aetna service area:

    • Call the local emergency hotline (ex. 911) or go to the nearest emergency facility. If a delay would not be detrimental to your health, call your primary care provider. Notify your primary care provider as soon as possible after receiving treatment.

    • After assessing and stabilizing the member's condition, the emergency room should try to contact the member's primary care physician. The primary care physician knows the member and his or her medical history and is also responsible for coordinating the member's health care.

    • All follow-up care must be coordinated through the primary care physician.

    If an emergency occurs outside the Aetna service area:

    • Urgently needed care is covered while you are travelling outside of your local Aetna service area.

    • The member should seek immediate treatment for any illness or injury that would be considered an emergency, or for the care of any urgent problem.

    • If the patient is admitted to an inpatient facility, the primary physician and Aetna should be notified immediately.

    • In other cases the primary care physician and Aetna should be contacted within 48 hours of the emergency.

    The member should notify his or her primary care physician as soon as possible after receiving emergency or urgently needed services.

    • Service received must be a covered service under the contract.

    • The member is responsible for the appropriate emergency copayment.

    • The emergency room copayment does not apply if the patient is admitted overnight as a result of the emergency.

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