Don’t worry, you’re covered with Capital Health Plan! Out of network coverage consists of the services Capital Health Plan (CHP) covers when you are outside our service area or network of care for a medical emergency, urgently needed care, renal dialysis, and/or care that we have approved in advance.
A medical emergency is when you, or a prudent layperson with an average knowledge of health and medicine, believe that you have medical symptoms that require immediate medical attention to prevent loss of life, loss of a limb, or loss of function of a limb. The medical symptoms may be an illness, injury, severe pain, or a medical condition that is quickly getting worse. Our members are covered for medical emergencies anywhere in the world.
If you have a medical emergency:
- Get help as quickly as possible. Call 911 for help or go to the nearest emergency room or hospital. Call for an ambulance if you need it. You do not need to get approval or a referral first from your primary care physician.
- As soon as possible, make sure your health plan has been notified about your emergency. Health plans need to follow up on your emergency care. You or someone else should call to tell your health plan about your emergency care, usually within 48 hours. Member Services can assist you if you call the number located on your plan membership card.
Urgently needed care is a non-emergency, unforeseen medical illness, injury, or condition that requires immediate medical care. Urgently needed care may be furnished by in-network providers or by out-of-network providers when network providers are temporarily unavailable or inaccessible. The unforseen condition could, for example, be an unforeseen flare-up of a known condition that you have. Our members are covered for urgently needed care anywhere in the world.