Any request with respect to which the application of the time periods for making non-urgent care determinations:

Could seriously jeopardize the life or health of the enrollee or the enrollee’s ability to regain maximum function, based on a subjective standard that focuses on the belief in the existence of an Emergency Medical Condition or Psychiatric Emergency Medical Condition that requires immediate medical and/or psychiatric treatment; or

In the opinion of a practitioner with knowledge of the enrollee’s medical condition, would subject the enrollee to severe pain that cannot be adequately managed without the care or treatment that is the subject of the request.