Automobile Emergency Medical Expense


If you have to go to the hospital to receive medical treatment immediately or with 48 hours from being in an automobile accident, this benefit will reimburse up to $5,000 in expenses related to that immediate treatment.

  • Provides protection in the event emergency room treatment is required as a result of an accident that occurs in a vehicle.  Benefit will pay up to $5,000 per occurrence, per year.


Definition:  “You or “Your” means the enrolled Member.  The term “You” or “Your” shall also include each Family Member.  Family Member means the Member’s spouse and all unmarried children under 21 years of age (or less than 23 years of age if a full-time student at an accredited college or university), who have the same principal residence as the Member.

The automobile emergency medical expense reimbursement benefit is payable if the Member requires emergency treatment in an Out-patient Facility as a result of an injury due to an automobile accident. The emergency treatment must be received within (forty-eight) 48 hours of the automobile accident which caused the injury. The benefit will pay up to $5,000 per occurrence, per year, in excess of any other applicable insurance and/or indemnity for which the Member or Member's family is entitled to receive, for the emergency treatment expenses actually incurred by the member during the (forty-eight) 48 hour period immediately following the time emergency treatment was first received and that are not covered by any other insurance available to the Member.

Automobile accident means an accident:

  • which occurs while the Member is operating, riding in, entering or exiting a private passenger automobile; or
  • which involves a private passenger automobile striking the Member while the Member is a pedestrian.

Emergency treatment expenses means outpatient facility charges for:

  • diagnosis, treatment or surgery performed by a physician, surgeon or dentist;
  • laboratory tests and X-ray examinations, if such tests or examinations are made by, or at the request of, the physician, surgeon or dentist;
  • casts, splints and medication, and
  • any other reasonable and necessary emergency services and supplies.

In no event, however, will emergency treatment expenses include any in-patient charges or any out-patient facility charges, which exceed the usual and customary charges for comparable diagnosis, treatment, surgery, tests, examinations, cast, splints, medication, services and supplies. To submit a valid claim, Membership must be in effect when accident occurs.


  1. Suicide or self-destruction, or any attempt thereat, while sane or insane;
  2. Declared or undeclared war, or any act thereof;
  3. Bacterial infection, except pus-forming infections resulting from Injury;
  4. Participating in or attempting to commit a felony;
  5. Illness, disease or allergic reaction;
  6. Ingestion of a poisonous substance (except that accidental ingestion of a poisonous substance which causes Injury is not excluded);
  7. Being under the influence of narcotics, unless taken in accordance with the advice of a physician;
  8. Any in-patient charges;
  9. Any loss caused by or resulting from operating, riding in, entering or exiting any vehicle which is
    1. being tested or time tested, or
    2. participating in races, speed contests or exhibitions of any kind;
  10. Any loss caused by or resulting from being struck as a pedestrian by operating farm equipment or any other vehicle which is not designed or licensed for use on public roads;
  11. Being under the influence of alcohol.
This summary is a brief overview of the program and is not to be considered a full disclosure of policy terms. Please refer to the Terms and Conditions for complete forms, conditions, limitations, definitions, and exclusions.

How To File a Claim

How to file a claim:

In the event an automobile accident occurs and the Member seeks reimbursement for the benefits above, he/she should call 1-800-711-4280 to request a Claim form.

Once the Claim form is received by the Member, it should be completed and mailed back to the address shown at the bottom of the Claim form with the following documentation:

  1. Copy of the police report describing the collision/accident.
  2. Copy of the Member’s primary automobile insurance policy listing the Vehicle involved in the collision/accident.
  3. Copy of in-patient medical bills explaining treatment received.
  4. Any other documentation requested by Claims Administrator.