Sec. 5.7. Subject to appeal to the office, an individual may be held responsible under the plan for receiving nonemergency services in an emergency room setting, including prohibiting the individual from using funds in the individual’s health care account to pay for the nonemergency services and paying a copayment for the services of at least eight dollars ($8) for the nonemergency use of a hospital emergency department. However, an individual may not be prohibited from using funds in the individual’s health care account to pay for nonemergency services provided in an emergency room setting for a medical condition that arises suddenly and unexpectedly and manifests itself by acute symptoms of such severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent layperson who possesses an average knowledge of health and medicine to:

(1) place an individual’s health in serious jeopardy;

(2) result in serious impairment to the individual’s bodily functions; or

(3) result in serious dysfunction of a bodily organ or part of the individual.

As added by P.L.30-2016, SEC.34. Amended by P.L.114-2018, SEC.7.