Health care services provided to a member after the sudden onset of a medical condition that manifests itself by acute symptoms of sufficient severity or severe pain. A condition such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:

  • Placing the health of the member or, with respect to a pregnant woman, the health of her unborn child, in serious jeopardy;
  • Serious impairment to bodily functions; or
  • Serious dysfunction of any bodily organ or part.

Emergency transportation and related emergency service provided by a licensed ambulance service shall constitute an emergency service.