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General Coverage Scope of Coverage Level of Coverage Ambulance Services Pre-hospital emergency medical services, including prompt evaluation and treatment of an emergency condition and/or non-airborne transportation to a hospital. Services must be provided by an ambulance service issued a certificate to operate pursuant to Section 3005 of the Public Health Law.

Evaluation and treatment services must be for an emergency condition defined as a medical or behavioral condition, the onset of which is sudden, that manifests itself by symptoms of sufficient severity, including severe pain, that a prudent layperson, possessing an average knowledge of medicine and health, could reasonably expect the absence of immediate medical attention to result in:  Placing the health of the person afflicted with such condition in serious jeopardy, or in the case of a behavioral condition placing the health of such person or others in serious jeopardy;  Serious impairment to such person’s bodily functions;  Serious dysfunction of any bodily organ or part of such person; or  Serious disfigurement of such person.

Coverage for non-airborne emergency transportation is based on whether a prudent layperson, possessing an average knowledge of medicine and health, could reasonable expect the absence of such transportation to result in:  Placing the health of the person afflicted with such condition in serious jeopardy;  Serious impairment to such person’s bodily functions;  Serious dysfunction of any bodily organ or part of such person; or  Serious disfigurement of such person.

Maternity Care Inpatient hospital coverage for at least 48 hours after childbirth for any delivery other than a C-Section and in at least 96 hours following a C-section. Also coverage of parent education, assistance and training in breast and bottle feeding and any necessary maternal and newborn clinical assessments. The mother shall have the option to be discharged earlier than the 48/96 hours, provided that at least one home care visit is covered post-discharge. Prenatal, labor and delivery is covered. No limitations; (however subsidized children requiring maternity care services will be referred to Medicaid).