To qualify for the Emergency Room Visit Benefit with the Group Hospital Fixed Indemnity Insurance an emergency visit must meet the definition of a medical emergency as defined in the Certificate of Insurance.
Definition of a 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 severe (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.
Treatment for Medical Emergency will be paid only for Sickness or Injury which fulfills the above conditions.
If you have a MINOR sickness and NOT an Emergency (as defined above):
If you have MINOR sickness and ailments, consider using a non-insurance service through MeMD which is a FREE* service to you as part of your paid membership in the United Business Association (UBA) if your optional supplemental UBA Gap product includes Benefit Boost Services for Virtual Urgent Care Visits. The Emergency Room Visit Benefit with Group Hospital Fixed Indemnity Insurance should be used for emergencies and not minor sickness that could be taken care of at a doctor's office or with MeMD.
You can use $0 Cost MeMD Virtual Urgent Care Visits for ALL minor sickness and ailments as well as Virtual Talk Therapy. You don't have to pay ANYTHING* at time of service as it is part of your UBA Gap Product that includes the Benefit Boost Subscription services and you can speak with a medical provider at your convenience without having to leave your home or work. With MeMD you can get a diagnosis and prescription** day or night.
*Visits are paid by HealthyAmerica and not by you.
**When medically necessary, MeMD's providers (except therapists) can submit a prescription electronically for purchase and pick-up at your local participating pharmacy; however, MeMD providers cannot prescribe elective medications, narcotic pain relievers, or controlled substances. MeMD's providers are each licensed by the appropriate licensing board for the state in which they are providing services and all have prescriptive authority for each of the states in which they are licensed.
Note: United States Fire Insurance Company is not affiliated with the additional Non-Insurance services and programs as provided as part of membership in the United Business Association including MeMD.
Read the Certificate(s) of Insurance carefully of your product. This 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.