Pam is an HIC subscriber and is involved in an automobile accident outside of the HIC service area. Which of these statements is true regarding her treatment?

• A. Treatment is covered as an emergency health service
• B. Treatment is not covered
• C. Treatment must be accepted by the HIC before given
• D. Treatment must be given at an approved provider

Answer: (A)

In emergencies, health plans cover the care that’s immediately needed, even if it happens outside the usual service area. Pam’s automobile accident is an urgent situation, so the treatment she receives is covered as an emergency health service by HIC, regardless of location. This means pre-authorization isn’t required to obtain essential care in that moment, and it isn’t limited to only “approved” providers for the initial emergency response. After the emergency is addressed, standard plan rules apply for billing and reimbursement.