Urgent care and emergency room (ER) services are two different levels of care. The plan follows a prudent layperson standard, meaning an emergency is defined as a condition where a reasonable person would believe their life, health, or ability to function is at serious risk without immediate care.
Urgent care is intended for non-emergency medical issues, while the ER is intended for severe or life-threatening conditions.
Member copays for urgent care are capped at $30, and several options for urgent care with a $0 copay are available within the Health Investment Network.
Emergency rooms cost significantly more, often reaching $1,000 member out-of-pocket for a single visit.
If you're unsure of which type of care is the most appropriate, call the 24/7 free nurse advice line at 866-232-4490.
If you're experiencing a life-threatening condition, call 911 or head to your nearest emergency room. To prevent issues with your claims, emergency rooms must submit a prior authorization for your care within 24 hours, especially if they are not an in-network facility. Failure to obtain authorization may result in reduction or loss of benefits.