44 Benefits are available in a Hospital Emergency Room or freestanding Emergency Facility for services and supplies to treat the onset of symptoms for an Emergency, which is defined below. Services provided for conditions that do not meet the definition of Emergency will not be covered. Emergency (Emergency Medical Condition) “Emergency” or “Emergency Medical Condition” means an accidental traumatic bodily injury or other medical or behavioral health condition that arises suddenly and unexpectedly and manifests itself by acute symptoms of such severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent layperson who possesses an average knowledge of health and medicine to: (a) place an individual's health or the health of another person in serious jeopardy; (b) result in serious impairment to the individual's bodily functions; or (c) result in serious dysfunction of a bodily organ or part of the individual. “Stabilize” means the provision of medical treatment to you in an Emergency as may be necessary to assure, within reasonable medical probability that material deterioration of your condition is not likely to result from or during any of the following: • your discharge from an emergency department or other care setting where Emergency Care is provided to you; or • your transfer from an emergency department or other care setting to another facility; or • your transfer from a Hospital emergency department or other Hospital care setting to the Hospital's Inpatient setting. Emergency Care “Emergency Care” means a medical or behavioral health exam done in the Emergency Department of a Hospital or freestanding Emergency Facility, and includes services routinely available in the Emergency Department to evaluate an Emergency Condition. It includes any further medical or behavioral health exams and treatment required to stabilize the patient. Emergency Care may also include necessary services, including observation services, provided as part of the Emergency visit regardless of the department in which the services are provided. Medically Necessary services will be covered whether you get care from a Participating or Non- Participating Provider. Emergency Care you get from a Non-Participating Provider will be covered as a Participating service and will not require Precertification. For Surprise Billing claims, the Non-Participating Provider can only charge you any applicable Deductible, Coinsurance, and/or Copayment and cannot bill you for the difference between the Maximum Allowed Amount and their billed charges until your condition is stable and the Non-Participating Provider has complied with the notice and consent process as described in the “Consolidated Appropriations Act of 2021 Notice” at the front of this Booklet. Your cost shares will be based on the Recognized Amount and will be applied to your Participating Deductible and Out-of-Pocket Limit. The Maximum Allowed Amount for Emergency Care from a Non-Participating Provider will be determined using the median Plan Participating contract rate we pay Participating Providers for the geographic area where the service is provided for the same or similar services. If you are admitted to the Hospital from the Emergency Room, be sure that you or your Doctor calls the Claims Administrator as soon as you are stabilized. The Claims Administrator will review your care to decide if a Hospital stay is needed an d how many days you should stay. See “Getting Approval for Benefits” for more details.