Transition of Care for new Enrollees. Contractor will identify new Enrollees who require transition services by using a variety of sources, including:
Transition of Care for new Enrollees. You may request continued care from a provider, including a Hospital, that does not contract with Health Net if, at the time of enrollment with Health Net, you were receiving care from such a provider for any of the following conditions: An Acute Condition; A Serious Chronic Condition not to exceed twelve months from your Effective Date of coverage under this Plan; A pregnancy (including the duration of the pregnancy and immediate postpartum care); A newborn up to 36 months of age not to exceed twelve months from your Effective Date of coverage under this Plan; A Terminal Illness (for the duration of the Terminal Illness); or A surgery or other procedure that has been authorized by your prior health plan as part of a documented course of treatment. For definitions of Acute Condition, Serious Chronic Condition and Terminal Illness see the "Definitions" section. Health Net may provide coverage for completion of services from such a provider, subject to applicable Copayments and any exclusions and limitations of this Plan. You must request the coverage within 60 days of your Group’s effective date unless it is shown that it was not reasonably possible to make the request within 60 days of the Group’s effective date and you make the request as soon as reasonably possible. The non-Participating Provider must be willing to accept the same contract terms applicable to providers currently contracted with Health Net, who are not capitated and who practice in the same or similar geographic region. If the provider does not accept such terms, Health Net is not obligated to provide coverage for that provider. If you would like more information on how to request continued care, or request a copy of our continuity of care policy, please contact the Customer Contact Center at the telephone number on your Health Net ID Card.
Transition of Care for new Enrollees. If you are receiving ongoing care for an acute, serious or chronic mental health condition from a non- Participating Mental Health Professional at the time you enroll with Health Net, we may temporarily cover services from a provider not affiliated with the Behavioral Health Administrator, subject to applicable Copay- ments and any other exclusions and limitations of this SELECT Plan. Your non-Participating Mental Health Professional must be willing to accept the Behavioral Health Adminis- trator’s standard mental health provider contract terms and conditions and be located in the Plan’s service area in order for the services to be covered under the SELECT 1 benefit level. If you would like more information on how to request continued care, or request a copy of our continuity of care policy, please call the Customer Contact Center at the telephone number on your Health Net ID Card.
Transition of Care for new Enrollees. You may request continued care from a provider, including a Hospital, that does not contract with Health Net if, at the time of enrollment with Health Net, you were receiving care from such a provider for any of the following conditions: • An Acute Condition; • A Serious Chronic Condition not to exceed twelve months from the Member’s Effective Date of coverage under this Plan; • A pregnancy (including the duration of the pregnancy and immediate postpartum care); • A newborn up to 36 months of age not to exceed twelve months from your Effective Date of coverage under this Plan; • A Terminal Illness (for the duration of the Terminal Illness); or • A surgery or other procedure that has been authorized by your prior health plan as part of a documented course of treatment. In addition, You may request continued care from a provider, including a Hospital, if you have been enrolled in another Health Net HMO plan that included a larger network than this plan, Health Net will offer the same scope of continuity of care for completion of services, regardless of whether You had the opportunity to retain Your current provider by selecting either:
Transition of Care for new Enrollees. If you are receiving ongoing care for an acute, serious, or chronic mental health condition from a non-Participating Mental Health Professional at the time you enroll with Health Net, we may temporarily cover services from a provider not affiliated with the Behavioral Health Administrator, subject to applicable Copayments and any other exclusions and limitations of this Plan. Your non-Participating Mental Health Professional must be willing to accept the Behavioral Health Administrator’s standard mental health provider contract terms and conditions and be located in the Plan’s service area. If you would like more information on how to request continued care, or request a copy of our continuity of care policy, please call the Customer Contact Center at the telephone number on your Health Net ID Card. The following benefits are provided: Outpatient Services Outpatient services are covered as shown in "Schedule of Benefits and Copayments," Section 200, under "Mental Disorders and Chemical Dependency Benefits." Covered services include: • Outpatient office visits/professional consultation including chemical dependency: Includes outpatient crisis intervention, short-term evaluation and therapy, medication management, drug therapy monitoring, longer- term specialized therapy, and individual and group mental health evaluation and treatment. • Outpatient services other than an office visits/professional consultation including chemical dependency: Includes psychological and neuropsychological testing when necessary to evaluate a Mental Disorder, other outpatient procedures, intensive outpatient care program, day treatment and partial hospitalization program. Intensive outpatient care program is a treatment program that is utilized when a patient’s condition requires structure, monitoring, and medical/psychological intervention at least three (3) hours per day, three (3) times per week. Partial hospitalization/day treatment program is a treatment program that may be free-standing or Hospital-based and provides services at least four (4) hours per day and at least four (4) days per week • Behavioral Health Treatment for Pervasive Developmental Disorder or Autism: Professional services for behavioral health treatment, including applied behavior analysis and evidence-based behavior intervention programs that develop or restore, to the maximum extent practicable, the functioning of a Member diagnosed with the Severe Mental Illnesses of pervasive developmental disorder o...
