Continuing or transitioning care

Continuity of care

In the event you must change your current primary care physician, specialty care physician or general hospital provider because that provider leaves the network or because your employer changed health plan offerings, you may have the right to continue receiving services from your current provider for a period of time under state or federal law.

Conditions that qualify for this benefit are:

  • Continuation of treatment for up to 90 days for insureds undergoing active treatment for a chronic or acute medical condition (this includes behavioral health conditions); or
  • A specified course of treatment for a terminal illness or a related condition, for a period of up to 90 days; or
  • Pregnancy within the first trimester, for up to 90 days; or
  • Pregnancy beyond the first trimester, with such care continuing through the postpartum care related to the childbirth and delivery.

You may also request continuity of care benefits for culturally appropriate services or when we do not have a provider who can communicate with you directly or through an interpreter.

Continuity of care benefits will not be available or may be discontinued if the provider is terminated from the network for misconduct.

Call Member Services for further information regarding continuity of care benefits.