Member Resources

What does Transition of Care and Continuity of Care mean?

Transition of Care allows new members and/or members whose plan has experienced a recent provider network change to continue to receive services for specified medical and behavioral conditions, with health care professionals that are not participating in the plan’s designated provider network, until the safe transfer of care to a participating provider and/or facility can be arranged. The provider must agree to accept network rates for the defined period of time. Examples of qualifying medical conditions can be found below. You must apply for Transition of Care no later than 30 days after the date your coverage becomes effective or after the effective date of the network change using the request form below.

Continuity of Care allows members the option to apply to receive services at in-network coverage levels for specified medical and behavioral conditions, from their current health care provider if the provider is or is soon to be out-of-network. This arrangement will be allowed until the safe transfer of care to a participating provider and/or facility can be arranged. The provider must agree to accept network rates for the defined period of time. Examples of covered medical conditions can be found below. You must apply for Continuity of Care within 30 days of your health care provider’s termination date (this is the date your provider is leaving the network) using the request form below.