Definition of Emergency Room:
"Emergency Room" means a trauma center, or special area in a Hospital that is equipped and staffed to give people emergency room treatment on an outpatient basis. An Emergency Room is not a clinic or a Physician's office.
Treatment for Medical Emergency will be paid ONLY for Sickness or Injury which fulfills the definition of Medical Emergency.
Definition of Medical Emergency:
Means a Sickness or Injury for which the Covered Person seeks immediate medical treatment at the nearest available facility. The condition must be one which manifests itself by acute symptoms which are sufficiently sever (including severe pain) that without immediate medical care a prudent lay person possessing an average knowledge of health and medicine would reasonably expect that failure to receive immediate medical attention would cause:
- Covered Person's life or health would be in serious jeopardy, or with respect to a pregnant woman, serious jeopardy to the health of the woman or her unborn Child;
- Serious disfigurement of the Covered Person;
- Covered Person's bodily functions would be seriously impaired; or
- A body organ or part would be seriously damaged.
The Group Hospital Fixed Indemnity Insurance underwritten by United States Fire Insurance Company for the UBA Gap Products that include this benefit are :
Gap ER, Gap AME+ER, Gap Max, Super Gap & Super Gap Plus
Read the Certificate(s) of Insurance carefully for your product. The brochure is a brief description of various group association insurance products and is not an insurance contract, nor part of the Certificate of Insurance and is subject to the terms, conditions, limitations, and exclusions of the Certificate(s) of Insurance and/or Certificate Riders. Coverage may vary or may not be available in all states. You'll find complete coverage details in the Certificate(s) of Insurance and/or Certificate Riders. Group Hospital Fixed Indemnity Insurance is underwritten by United States Fire Insurance Company, Eatontown, NJ. The insurance described in this Help Guide article provides limited benefits. Limited benefit plans are insurance products with reduced benefits intended to help supplement comprehensive health insurance plans. The insurance coverage is not an alternative to comprehensive coverage. It does not provide major medical or comprehensive medical coverage and is not designed to replace major medical insurance. Further, the insurance coverage is not minimum essential benefits as set forth under the Patient Protection and Affordable Care Act.
Important: HealthyAmerica and United Business Association (UBA) are not authorized to pay claims or be involved in the claims decision process. All claim decisions are made by the TPA claims administrator and the insurance carrier.