Medical Event / Incident
A medical incident includes medical treatment or testing that lasts until one of the following events occurs:
A certain medical condition is cured according to official medical records;
Treatment is at a routine maintenance level; or
You experience 90 days without any kind of treatment for that particular condition.
If 90 days pass and you receive no further treatment, any future bills you incur will be considered a separate incident.
Personal responsibility amounts for the Silver and Bronze participation levels are per incident (Gold personal responsibility is per person, per year).
Example: You go to the doctor due to pain in your side. He examines you and gives you some instructions before sending you home. The next week you return because the pain has continued. The doctor orders a blood test and an ultrasound. After reviewing the results, he diagnoses you with appendicitis and sends you to the hospital. He performs an appendectomy.
The hospital releases you with instructions to visit the doctor’s office in one week for follow-up. At that visit the doctor tells you come back again the following week, at which time he pronounces you cured.
All the medical bills you incurred for each of these situations fall under the category of a single incident.
Your total cost will be your personal responsibility
(Gold: $0 Silver $1,000 Bronze $5,000).
If you obtained self-pay discount, it might be deducted from your personal responsibility. So if your total bills added up to be
$8,500 and you obtained a total discount of $4,000 you would get fully reimbursed for the Gold and Silver plan, if you have the Bronze
plan you would still pay $1,000.00.
Please note, for the Gold plan your bills have to be over $500 to be covered. If you bill is over $500 and according to CHM guidelines, then your responsibility will be 0.
The medical bills incurred from the first test to the last treatment before the doctor releases you to a regular, routine maintenance regimen are considered a single incident.