These data reflect the most commonly purchased benefits package for each of the health plans in
the year 2000. Coventry/Principal would not supply updated information.

HMO Ambulance
Aetna US Healthcare Covers: Ambulance service in an emergency or when certified as medically necessary by PCP and approved in advance by Aetna. Also covers transportation from a non-participating provider to a participating provider when medically necessary. Aetna will reimburse member for the reasonable cost.
Blue Cross Blue Shield Covers: Ambulance when medically necessary and when other forms of travelling may not be safe for your condition.

Cost Sharing: Coinsurance applies.

CIGNA / Healthsource Covers: Ambulance in an emergency when medically necessary. Members should dial 911 to access this service. If 911 services are unavailable, members should contact the nearest emergency care facility.
Doctors Health Plan Covers: Ambulance services when medically necessary.
Generations Covers: Ambulance services when medically necessary. Services covered from the site of injury or onset of symptoms to the nearest hospital, in or outside the service area.

Limits: Transport between facilities must have Prior authorization.

Excludes: Transportation by a non-participating provider or for care that is determined not to be a true emergency.

Optimum Choice Covers: Medically necessary ambulance and special transportation services such as helicopter or airplane when medically necessary.
PARTNERS Covers: Ambulance services in an emergency to nearest medical facility.

Limits: Non-emergency, inter-facility ambulance transfers are covered with prior approval by the plan.

Coventry/Principal Health Care of the Carolinas Covers: Ambulance services for medical emergencies only. Benefits for transportation by air ambulance are reimbursed at the cost of ground ambulance transportation.
QualChoice Covers: Medically necessary ambulance services from a licensed carrier.
The Wellness Plan of North Carolina, Inc. Covers: Ambulance in any emergency or when authorized by a TWP-NC physician.
United HealthCare Covers: Emergency ground or air transportation provided by a licensed ambulance service to the nearest participating hospital for treatment of a true medical emergency.

Cost Sharing: Copayment applies.

WellPath Covers: Emergency ambulance service to the nearest medical facility. Also covers non-emergency ambulance transportation when pre-approved by WellPath.

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