Emergency care is covered for medical, maternity, or psychiatric conditions that would lead a prudent layperson (someone with average knowledge of health and medicine) to believe that a serious medical condition existed or that the absence of immediate medical attention would result in a threat to life, limb, or sight; or when the person manifests painful symptoms requiring immediate palliative effort to relieve suffering. This includes situations where a beneficiary arrives at the emergency room with severe pain (except dental pain), or is at immediate risk of serious harm to self or others. In the case of a pregnant woman, the danger to the health of the woman or her unborn child should be considered.

In the event of a life-, limb-, or eyesight-threatening emergency, the beneficiary should go, or be taken, to the nearest appropriate medical facility for care.