Common use of Transition of Care Clause in Contracts

Transition of Care. A transition of care option is available for members using a hos- pital or dialysis facility that loses network sta- tus during the plan year. A subscriber and his/her dependents using a hospital or dialy- sis facility that loses network status during the plan year may apply for a ninety- (90-) day transition of care to continue receiving network benefits with that hospital or dialysis facility. The request for consideration must be submitted to the medical plan within forty-five (45) days of the last day the hospital or dialysis facility was a contracted network provider to be eligible for transition of care benefits. A subscriber and his/her dependents may apply for additional days beyond the ninety- (90-) day transition if care is related to a moderate or high risk pregnancy, if care is during a member’s second or third trimester of preg- xxxxx, or up to eight (8) weeks postpartum. The subscriber and his/her dependents must apply for additional transition of care days prior to the end of the initial ninety- (90-) day transition of care period. Most routine ser- vices, treatment for stable conditions, minor illnesses, and elective surgeries will not be covered by transition of care benefits. The rate of payment during the transitional period shall be the same fee as paid prior to leaving the network. Benefits eligible for transition of care include:

Transition of Care. A transition of care option is available for members using a hos- pital or dialysis facility that loses network sta- tus during the plan year. A subscriber and his/her dependents using a hospital or dialy- sis facility that loses network status during the plan year may apply for a ninety- (90-) day transition of care to continue receiving network benefits with that hospital or dialysis facility. The request for consideration must be submitted to the medical plan within forty-forty- five (45) days of the last day the hospital or dialysis facility was a contracted network provider provider, to be eligible for transition of care benefits. A subscriber and his/her dependents may apply for additional days beyond the ninety- (90-) day transition if care is related to a moderate or high risk pregnancy, if care is during a member’s second or third trimester of preg- xxxxxpregnancy, or up to eight (8) weeks postpartum. The subscriber and his/her dependents must apply for additional transition of care days prior to the end of the initial ninety- (90-) day transition of care period. Most routine ser- vicesservices, treatment for stable conditions, minor illnesses, and elective elec- tive surgeries will not be covered by transition transi- tion of care benefits. The rate of payment during the transitional period shall be the same fee as paid prior to leaving the network. Benefits eligible for transition of care include: