Medical Emergency Guidelines

How do you know if there’s a “medical emergency condition” and whether benefits will be payable?  Here are the criteria that determines a medical emergency:

·        The condition must be one in which failure to render care and/or treatment could reasonably result in deterioration to the point of placing the patient’s permanent health in jeopardy and/or causing significant impairment to the patient’s bodily functions.

·        Medical emergency coverage is administered on the basis of signs or symptoms shown by the patient as verified by the physician at the time of treatment and not on the basis of final diagnosis.

·        Prompt care must be secured.  A medical emergency will not be considered to exist if medical treatment is not secured within 72 hours after the onset of the condition.

·        Acute symptoms must occur suddenly and unexpectedly.  The symptoms must be sufficiently severe to cause a person to seek medical assistance regardless of the hour of the day or night.

·        A chronic condition in which symptoms have existed over a period of time would not qualify for medical emergency consideration.  However, coverage is available for chronic conditions if symptoms become acute enough to require immediate medical assistance (as determined by the attending physician), consistent with the criteria above.

Emergency First Aid/Accidental Injury

Under the provisions of the Health Care Program, a service will be considered as emergency first aid for an accidental injury if it was performed as a result of a traumatic bodily injury.

In addition to conditions that are obviously a result of traumatic injury, such as abrasions and contusions, emergency first aid benefits for an accidental injury are payable for the following conditions:

·        Sprains

·        Strains

·        Subluxations

·        Ingestion of poisons, overdose of sleeping pills or other medications, regardless of whether accidental or intentional

·        Allergic reactions – if result of trauma, such as bee sting or insect bite

·        Inhalation of smoke, carbon monoxide or fumes

·        Burns, initial treatment

·        Frostbite, sunburn, or sunstroke

·        Attempted suicide

Allergy Shots

The serum mixture is covered.  Allergy testing and the injection procedure will not be covered.  To be reimbursed for the cost of the serum itself, mail the following items to Medco:

1.      A prescription drug reimbursement form.  Forms can be obtained at www.medco.com or be calling Medco 24/7 at 1(800) 464-4679.  (Tip:  Make copies of the completed form so you can reuse it next time.)

2.      An itemized bill from your provider showing date of service, procedure code, diagnosis code, and cost.

3.      A detailed make up of the serum and dosage (ex. 10% grass, 20% dog, 10% ragweed) from the provider.

If you have any questions, please call Medco.

Retiree’s:  Please call the Benefit Office for an appointment.

Active Members:  To meet with your Benefit Rep, please make an appointment.  Sign up sheets will be on the table outside the office.  Or, for urgent matters, please leave a short detailed message at 246-3450.

Your Local 730 Benefit Reps -

Grant Holst, Jolan Jackson, Lauri Veneman

Alternates:  Denise DeBoer and Sylvia Lillard

Benefit Office:  246-3450 or 1(800) 730-8292

BCBS:              1(800) 482-2210

Medco:             1(800) 464-4679