Emergency Room Services

The information below applies to the HPH/HMO Commercial Copay Table.

General Provisions Applicable to All Coverage Codes Listed

Benefit coverage includes statewide emergency services at an emergency room for severe medical conditions. HMSA’s payment includes the portion of eligible charge remaining less the member’s copayment. Follow-up treatment performed in the emergency room is not covered unless provided or arranged by the member's Personal Care Physician (PCP).

Footnotes

1. This plan waives the member copayment for emergency room services when the member is admitted to the hospital.
2. The member copayment applies when services are provided by network providers with a referral from the member’s PCP. The member’s copayment is higher when services are provided by non-network providers.
3. This plan has a 12-month waiting period for any pre-existing illness or condition, including conditions resulting from an injury. The waiting period also applies to a complication resulting from a pre-existing illness or condition.
4. This plan has a 12-month waiting period for any pre-existing illness or condition, including conditions resulting from an injury. The waiting period also applies to a complication resulting from a pre-existing illness or condition. This plan has a 12-month waiting period for maternity care, pregnancy, childbirth and related conditions.
5. This plan has a nine-month waiting period for maternity care, pregnancy, childbirth and related conditions.

Revision History