When Coverage Terminates While Member is Hospitalized

Provider Type

  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

If Health Net coverage begins while the member is hospitalized, the prior carrier must continue coverage until one of the following occurs:

  • Health plan benefits are exhausted before the member is discharged.
  • The member is discharged from the hospital. If a member is confined to a hospital and is transferred to another hospital with no more than a 24-hour lapse in care, the confinement is a continuous hospital stay.

The prior carrier is responsible for covering the stay until the member is discharged from the hospital or moved to a non-acute, inpatient hospital level of care (for example, a skilled nursing facility (SNF) within the same hospital).

Health Net and the participating physician group (PPG) are liable after the member is discharged or transferred to a lower level of care.