It is an injury or condition serious enough to prevent you from taking the time to call your PCP before receiving care. If you are a member through Tufts Health Plan's HMO or EPO options, or if you are a POS member and want to receive coverage at the authorized level of benefits, your PCP must arrange any follow-up care. There is a copayment for an emergency room visit. You are covered for urgent and emergency care services that you may receive when traveling.
Emergency care is defined above.
An urgent condition means that care is needed to prevent serious deterioration of health. If you seek urgent or emergency care while traveling, you or someone acting on your behalf should notify your PCP within 48 hours after the onset of the urgent condition. Your PCP will provide or arrange for any routine or follow-up care. Members through the POS option also must choose a PCP to receive coverage at the authorized level of benefits. You may search for a network physician by accessing our provider search function, OR you can call a Tufts Health Plan Customer Relations Coordinator.