Definition of (13); would lead a prudent layperson acting reasonably to believe “Emergency WAC that a health condition exists that requires immediate medical Medical attention, if failure to provide medical attention would result in Condition” serious impairment to bodily functions or serious dysfunction of (Cont’d) a bodily organ or part, or would place the person's health in serious jeopardy”. Required RCW Plan must cover emergency services necessary to screen and Terms of 48.43.093 stabilize a covered person if a prudent layperson acting Emergency (1)(a) reasonably would have believed that an emergency medical Services condition existed. Emergency Coverage 42 U.S.C. The contract must not require prior authorization of Services (EHB) emergency services provided prior to the point of (Cont’d) stabilization if a prudent layperson acting reasonably would have believed that an emergency medical condition existed. RCW The plan must cover out-of-network emergency services 48.43.093 necessary to screen and stabilize a covered person if a prudent (1)(a) layperson would have reasonably believed that use of an 42 U.S.C. emergency department would result in a delay that would worsen the emergency, or if a provision of federal, state, or local law requires the use of a specific provider or facility. (B-C) 45 C.F.R. The issuer must not require prior authorization of emergency 147.138 services provided prior to the point of stabilization if a (b)(2) (ii) prudent layperson acting reasonably would have believed that an emergency medical condition existed and that use of an in-network emergency department would result in a delay that would worsen the emergency.
Emergency Services (EHB) (Cont’d) Definition of “Emergency Medical Condition” (Cont’d) (13); WAC would lead a prudent layperson acting reasonably to believe that a health condition exists that requires immediate medical attention, if failure to provide medical attention would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person's health in serious jeopardy”. Required Terms of Emergency Services Coverage RCW 48.43.093 (1)(a) Plan must cover emergency services necessary to screen and stabilize a covered person if a prudent layperson acting reasonably would have believed that an emergency medical condition existed. 42 U.S.C. The contract must not require prior authorization of emergency services provided prior to the point of stabilization if a prudent layperson acting reasonably would have believed that an emergency medical condition existed. RCW 48.43.093 (1)(a) 42 U.S.C. (B-C) The plan must cover out-of-network emergency services necessary to screen and stabilize a covered person if a prudent layperson would have reasonably believed that use of an emergency department would result in a delay that would worsen the emergency, or if a provision of federal, state, or local law requires the use of a specific provider or facility. 45 C.F.R. 147.138 (b)(2) (ii) The issuer must not require prior authorization of emergency services provided prior to the point of stabilization if a prudent layperson acting reasonably would have believed that an emergency medical condition existed and that use of an in-network emergency department would result in a delay that would worsen the emergency.