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If you are changing medical plans for 2008, there may be some transition of care issues to consider. Many plans offer standard transition of care support provisions to bridge the gap between old and new plans. These provisions are important for members who are currently under care from providers who will no longer be in-network under the member's new plan. This arrangement allows a period of time to facilitate transition to a new plan network provider. Transition of care staff at your new plan will help you identify network providers who can offer you necessary care once the transition period ends.
Examples of the types of conditions that might qualify for transition support include:
- Acute medical condition (heart attack, stroke) or a serious chronic condition (cancer, leukemia) in active treatment
- Terminal illness
- Scheduled for authorized surgery/procedure after January 1, 2008
- Pregnancy (certain trimesters)
- Trauma
- Hospital confinement on December 31, 2007
All decisions on qualification for transition of care benefits, which are intended to allow members to temporarily receive services from non-network providers at in-network rates, require acceptance of contractual and payment terms by the non-contracted provider.
There may be additional special transition benefits for you and covered family members if your UC plan is being discontinued.
- If you are in PacifiCare and transferring to Health Net
- If you are in Health Net or WHA and your behavior health benefits will be transferred to United Behavioral Health (UBH) - Non-Medicare members only
- If you are in Blue Cross PLUS or Definity and your out-of-network behavioral health benefits will be eliminated
- If you are in Definity and transferring to Cigna
- If you are in PacifiCare Nevada or Select EPO and transferring to Blue Cross PPO
- If you are in High Option Non-Medicare and transferring to Blue Cross PPO
