• Your Privacy
• Women’s Health and Cancer Rights Act
• The Newborns’ and Mothers’ Health Protection Act
• Mental Health Parity & Addiction Equity Act
• Notice of Extended Coverage to Participants Covered Under a Group Health Plan
• Medicaid and the Children’s Health Insurance Program
• Your Rights and Protections Against Surprise Medical Bills
• Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
  

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.

As of January 1, 2023, the Transparency in Coverage Rule mandates member access to a healthcare price comparison tool.

We have partnered with TALON to bring you access to MyMedicalShopper™; which provides you the ability to shop for healthcare services based on price, quality, and location. Just like we shop for everything else! Use your member subscriber ID to access the pricing tool using the link below.

If you need assistance with the shopping tool or with obtaining pricing please contact our Customer Service Team at 877-585-8480

View the video below for additional information on the MyMedicalShopper pricing tool:

Reference the below Performance Health Open Negotiation Notice for details on the process your provider must follow for disputing the allowable rate used on your claim.

Machine Readable Files

Pricing Information in Compliance with the Transparency in Coverage Rule

As part of the Transparency in Coverage Rule, health insurers and group plans, including self-insured plan sponsors, are required to provide pricing data through machine-readable files (MRFs), effective July 1, 2022. These files will be updated monthly.