Required provision concerning coverage for medically necessary emergency services; prohibitions.
1. Each managed care organization shall provide coverage for medically necessary emergency services provided at any hospital.
2. A managed care organization shall not require prior authorization for medically necessary emergency services.
3. As used in this section, “medically necessary emergency services” means health care services that are provided to an insured by a provider of health care after the sudden onset of a medical condition that manifests itself by symptoms of such sufficient severity that a prudent person would believe that the absence of immediate medical attention could result in:
(a) Serious jeopardy to the health of an insured;
(b) Serious jeopardy to the health of an unborn child;
(c) Serious impairment of a bodily function; or
(d) Serious dysfunction of any bodily organ or part.
4. A health care plan subject to the provisions of this section that is delivered, issued for delivery or renewed on or after October 1, 1999, has the legal effect of including the coverage required by this section, and any provision of the plan or the renewal which is in conflict with this section is void.
Last modified: February 27, 2006