• An accidental injury, life threatening or a sudden, unexpected onset of a condition which reasonably appears to have the potential of causing immediate disability or death, or which requires the immediate alleviation of pain and discomfort. Maxicare shall depend on the concurrence of the attending ER physician to determine whether a case is emergency in nature or not.

Any device, medical treatment, supply or procedure whose safety and efficacy has not been established and proven is considered experimental/investigational (unproven) and is excluded from the coverage.