Common use of Transition of Care Benefits Clause in Contracts

Transition of Care Benefits. If you are a new HMO enrollee and you are receiving care for a condition that requires an Ongoing Course of Treatment or if you have entered into the second or third trimester of pregnancy, and your Physician does not belong to the Plan's network, but is within the Plan's service area, you may request the option of xxxx­ sition of care benefits. You must submit a written request to the Plan for transition of care benefits within 15 business days of your eligibility effective date. If you are a current HMO enrollee and you are receiving care for a condition that re­ quires an Ongoing Course of Treatment or if you have entered into the second or third trimester of pregnancy and your Primary Care Physician or Woman's Princi­ pal Health Care Provider leaves the Plan's network, you may request the option of transition of care benefits. You must submit a written request to the Plan for xxxx­ sition of care benefits within 30 business days after receiving notification of your Primary Care Physician or Woman's Principal Health Care Provider's termina­ tion. The Plan may authorize transition of care benefits for a period up to 90 days. Au­ thorization of benefits is dependent on the Physician's agreement to contractual requirements and submission of a detailed treatment plan. A written notice of the Plan's determination will be sent to you within 15 business days of receipt of your request. PHYSICIAN BENEFITS This section of your Certificate explains what your benefits are when you receive care from a Physician. Remember, to receive benefits for Covered Services, (except for the treatment of Mental Illness other than Serious Mental Illness), they must be performed by or ordered by your Primary Care Physician or Woman's Principal Health Care Pro­ vider. In addition, only services performed by Physicians are eligible for benefits unless another Provider, for example, a Dentist, is specifically mentioned in the description of the service. Whenever we use “you” or “your” in describing your benefits, we mean all eligi­ ble family members who are covered under Family Coverage. COVERED SERVICES Your coverage includes benefits for the following Covered Services: Surgery — when performed by a Physician, Dentist or Podiatrist or other Pro­ vider acting within the scope of his/her license. However, benefits for oral Surgery are limited to the following services:

Transition of Care Benefits. If you are a new HMO enrollee and you are receiving care for a condition that requires an Ongoing Course of Treatment or if you have entered into the second or third trimester of pregnancy, and your Physician does not belong to the Plan's network, but is within the Plan's service area, you may request the option of xxxx­ sition trans­ ition of care benefits. You must submit a written request to the Plan for transition of care benefits within 15 business days of your eligibility effective date. If you are a current HMO enrollee and you are receiving care for a condition that re­ quires requires an Ongoing Course of Treatment or if you have entered into the second or third trimester of pregnancy and your Primary Care Physician or Woman's Princi­ pal Principal Health Care Provider leaves the Plan's network, you may request the option of transition of care benefits. You must submit a written request to the Plan for xxxx­ sition transition of care benefits within 30 business days after receiving notification of your Primary Care Physician or Woman's Principal Health Care Provider's termina­ tionter­ mination. The Plan may authorize transition of care benefits for a period up to 90 days. Au­ thorization of benefits is dependent on the Physician's agreement to contractual requirements and submission of a detailed treatment plan. A written notice of the Plan's determination will be sent to you within 15 business days of receipt of your request. PHYSICIAN BENEFITS This section of your Certificate explains what your benefits are when you receive care from a Physician. Remember, to receive benefits for Covered Services, (except for the treatment of Mental Illness other than Serious Mental Illness), they must be performed by or ordered by your Primary Care Physician or Woman's Principal Health Care Pro­ vider. In addition, only services performed by Physicians are eligible for benefits unless another Provider, for example, a Dentist, is specifically mentioned in the description of the service. Whenever we use “you” or “your” in describing your benefits, we mean all eligi­ ble xxx­ gible family members who are covered under Family Coverage. COVERED SERVICES Your coverage includes benefits for the following Covered Services: Surgery — when performed by a Physician, Dentist or Podiatrist or other Pro­ vider acting within the scope of his/her license. However, benefits for oral Surgery are limited to the following services:

Transition of Care Benefits. If you are a new HMO enrollee Enrollee and you are receiving care for a condition that requires an Ongoing Course ongoing course of Treatment treatment or if you have entered into the second or third trimester of pregnancy, and your Physician does not belong to the Plan's network, but is within the Plan's service area, you may request the option of xxxx­ sition transition of care benefits. You must submit a written request to the Plan for transition of care benefits within 15 business days of your eligibility effective date. If you are a current HMO enrollee and you are receiving care for a condition that re­ quires an Ongoing Course of Treatment or if you have entered into the second or third trimester of pregnancy and your Primary Care Physician or Woman's Princi­ pal Health Care Provider leaves the Plan's network, you may request the option of transition of care benefits. You must submit a written request to the Plan for xxxx­ sition of care benefits within 30 business days after receiving notification of your Primary Care Physician or Woman's Principal Health Care Provider's termina­ tion. The Plan may authorize transition of care benefits for a period up to 90 daysdays from the effective date of enrollment. Au­ thorization Authorization of benefits is dependent on the Physician's agreement to contractual requirements and submission of a detailed treatment plan. A written notice of the Plan's determination will be sent to you within 15 business days of receipt of your request. PHYSICIAN BENEFITS This section If you are a current HMO Enrollee and you are receiving care for a condition that requires an ongoing course of your Certificate explains what your benefits are when treatment or if you receive care from a Physician. Remember, to receive benefits for Covered Services, (except for have entered into the treatment second or third trimester of Mental Illness other than Serious Mental Illness), they must be performed by or ordered by pregnancy and your Primary Care Physician or Woman's Principal Health Care Pro­ viderProvider leaves the Plan's network, you may request the option of Continuity of Care benefits as described in the Continuity of Care provision in the OTHER THINGS YOU SHOULD KNOW section. In addition, only services performed by Physicians You must submit a written request to the Plan for continuity of care benefits within 30 business days after receiving notification of your Primary Care Physician or Woman's Principal Health Care Provider's termination. The Plan may authorize transition of care benefits for a period up to 90 days. Authorization of benefits is dependent on the Physician's agreement to contractual requirements and submission of a detailed treatment plan. A written notice of the Plan's determination will be sent to you within 15 business days of receipt of your request. Note: Providers that contract with other Blue Cross and Blue Shield Plans are eligible for benefits unless another not familiar with the Prior Authorization requirements of BCBSIL. Unless a Provider contracts directly with BCBSIL as a Participating Provider, the Provider is not responsible for examplebeing aware of this Plan’s Prior Authorization requirements, a Dentist, is specifically mentioned except as described in the description of the service. Whenever we use section “you” or “yourThe BlueCard® Program” in describing your benefits, we mean all eligi­ ble family members who are covered under Family Coverage. COVERED SERVICES Your coverage includes benefits for the following Covered Services: Surgery — when performed by a Physician, Dentist or Podiatrist or other Pro­ vider acting within the scope of his/her license. However, benefits for oral Surgery are limited to the following services:OTHER THINGS YOU SHOULD KNOW Section.

Transition of Care Benefits. If you are a new HMO enrollee Enrollee and you are receiving care for a condition that requires an Ongoing Course of Treatment or if you have entered into the second or third trimester of pregnancy, and your Physician does not belong to the Plan's network, but is within the Plan's service area, you may request the option of xxxx­ sition transition of care benefits. You must submit a written request to the Plan for transition of care benefits within 15 business days of your eligibility effective date. The Plan may authorize transition of care benefits for a period up to 90 days from the effective date of enrollment. Authorization of benefits is dependent on the Physician's agreement to contractual requirements and submission of a detailed treatment plan. A written notice of the Plan's determination will be sent to you within 15 business days of receipt of your request. If you are a current HMO enrollee Enrollee and you are receiving care for a condition that re­ quires requires an Ongoing Course of Treatment or if you have entered into the second or third trimester of pregnancy and your Primary Care Physician or Woman's Princi­ pal Principal Health Care Provider leaves the Plan's network, you may request the option of transition Continuity of care benefitsCare benefits as described in the Continuity of Care provision in the Other Things You Should Know section. You must submit a written request to the Plan for xxxx­ sition Continuity of care Care benefits within 30 business days after receiving notification of your Primary Care Physician or Woman's Principal Health Care Provider's termina­ tiontermination. The Plan may authorize transition of care benefits for a period up to 90 days. Au­ thorization Authorization of benefits is dependent on the Physician's agreement to contractual requirements and submission of a detailed treatment plan. A written notice of the Plan's determination will be sent to you within 15 business days of receipt of your request. PHYSICIAN BENEFITS This section of your Certificate explains what your benefits are when you receive care from a Physician. Remember, to receive benefits for Covered Services, (except for the treatment of Mental Illness other than Serious Mental Illness), they must be performed by or ordered by your Primary Care Physician or Woman's Principal Health Care Pro­ viderProvider. In addition, only services performed by Physicians are eligible for benefits unless another Provider, for example, a Dentist, is specifically mentioned in the description of the service. Whenever we use “you” or “your” in describing your benefits, we mean all eligi­ ble eligible family members who are covered under Family Coverage. COVERED SERVICES Your coverage includes benefits for the following Covered Services: Surgery — when performed by a Physician, Dentist or Podiatrist or other Pro­ vider Provider acting within the scope of his/her license. However, benefits for oral Surgery are limited to the following services:

Transition of Care Benefits. If you are a new HMO enrollee Enrollee and you are receiving care for a condition that requires an Ongoing Course of Treatment or if you have entered into the second or third trimester of pregnancy, and your Physician does not belong to the Plan's network, but is within the Plan's service area, you may request the option of xxxx­ sition transition of care benefits. You must submit a written request to the Plan for transition of care benefits within 15 business days of your eligibility effective date. The Plan may authorize transition of care benefits for a period up to 90 days from the effective date of enrollment. Authorization of benefits is dependent on the Physician's agreement to contractual requirements and submission of a detailed treatment plan. A written notice of the Plan's determination will be sent to you within 15 business days of receipt of your request. If you are a current HMO enrollee Enrollee and you are receiving care for a condition that re­ quires requires an Ongoing Course of Treatment or if you have entered into the second or third trimester of pregnancy and your Primary Care Physician or Woman's Princi­ pal Principal Health Care Provider leaves the Plan's network, you may request the option of transition Continuity of care benefitsCare benefits as described in the Continuity of Care provision in the Other Things You Should Know section. You must submit a written request to the Plan for xxxx­ sition continuity of care benefits within 30 business days after receiving notification of your Primary Care Physician or Woman's Principal Health Care Provider's termina­ tiontermination. The Plan may authorize transition of care benefits for a period up to 90 days. Au­ thorization Authorization of benefits is dependent on the Physician's agreement to contractual requirements and submission of a detailed treatment plan. A written notice of the Plan's determination will be sent to you within 15 business days of receipt of your request. PHYSICIAN BENEFITS This section of your Certificate explains what your benefits are when you receive care from a Physician. Remember, to receive benefits for Covered Services, (except for the treatment of Mental Illness other than Serious Mental Illness), they must be performed by or ordered by your Primary Care Physician or Woman's Principal Health Care Pro­ viderProvider. In addition, only services performed by Physicians are eligible for benefits unless another Provider, for example, a Dentist, is specifically mentioned in the description of the service. Whenever we use “you” or “your” in describing your benefits, we mean all eligi­ ble eligible family members who are covered under Family Coverage. COVERED SERVICES Your coverage includes benefits for the following Covered Services: Surgery — when performed by a Physician, Dentist or Podiatrist or other Pro­ vider Provider acting within the scope of his/her license. However, benefits for oral Surgery are limited to the following services:

Transition of Care Benefits. If you are a new HMO enrollee and you are receiving care for a condition that requires an Ongoing Course of Treatment or if you have entered into the second or third trimester of pregnancy, and your Physician does not belong to the Plan's network, but is within the Plan's service area, you may request the option of xxxx­ sition of care benefits. You must submit a written request to the Plan for transition of care benefits within 15 business days of your eligibility effective date. .If you are a current HMO enrollee and you are receiving care for a condition that re­ quires an Ongoing Course of Treatment or if you have entered into the second or third trimester of pregnancy and your Primary Care Physician or Woman's Princi­ pal Health Care Provider leaves the Plan's network, you may request the option of transition of care benefits. You must submit a written request to the Plan for xxxx­ sition of care benefits within 30 business days after receiving notification of your Primary Care Physician or Woman's Principal Health Care Provider's termina­ tion. The Plan may authorize transition of care benefits for a period up to 90 days. Au­ thorization of benefits is dependent on the Physician's agreement to contractual requirements and submission of a detailed treatment plan. A written notice of the Plan's determination will be sent to you within 15 business days of receipt of your request. PHYSICIAN BENEFITS This section of your Certificate explains what your benefits are when you receive care from a Physician. Remember, to receive benefits for Covered Services, (except for the treatment of Mental Illness other than Serious Mental Illness), they must be performed by or ordered by your Primary Care Physician or Woman's Principal Health Care Pro­ vider. In addition, only services performed by Physicians are eligible for benefits unless another Provider, for example, a Dentist, is specifically mentioned in the description of the service. Whenever we use “you” or “your” in describing your benefits, we mean all eligi­ ble family members who are covered under Family Coverage. COVERED SERVICES Your coverage includes benefits for the following Covered Services: Surgery — when performed by a Physician, Dentist or Podiatrist or other Pro­ vider acting within the scope of his/her license. However, benefits for oral Surgery are limited to the following services: