Continuity of Care
- Physicians (does not apply to CMC)
- Participating Physician Groups (PPG)
The completion of covered services must be provided by a terminated provider to a member who at the time of the contract termination, was receiving services from that provider for one of the conditions described below.
Additionally, the completion of covered services must be provided by a non-participating provider to a newly covered member who, at the time their coverage became effective, was receiving services from that provider for one of the conditions below.
- A serious chronic condition.
- A pregnancy.
- A terminal illness.
- The care of a newborn child between birth and age 36 months.
- Performance of a surgery or other procedure that is authorized by the plan as part of a documented course of treatment and has been recommended and documented by the provider to occur within 180 days of the contract's termination date or within 180 days of the effective date of coverage for a newly covered enrollee.
For more detailed information refer to California Code, Health and Safety Code - HSC § 1373.96.
Refer to the Health Net Member Services Department for assistance.
Non-DSNP members COC services not covered for Medicare members are:
- Durable medical equipment (DME) providers or other ancillary services, such as transportation or carve-out services.
- Out-of-network providers who do not agree to abide by Health Net's utilization management policies.
For COC requirements for Dual Eligible Special Needs Plan (D-SNP) members, refer to the DHCS DSNP Policy Guide Section V. Medicare Continuity of Care Guidance for All D-SNPs.