Continuity of Care Changes

Nov. 3, 2021

Requirement of the Consolidated Appropriations Act (plan years on or after Jan. 1, 2022)

Most of our group and fully insured plans currently include a period for continuity of care at in-network reimbursement rates when a provider leaves our networks. The new legislation also requires continuity of care for affected members when:

  • A provider’s network status changes
  • A group health plan changes health insurance issuer, resulting in the member no longer having access to a participating provider in our network

What this means for you
If you leave our network, we will notify members and allow them to request continuity of care for the following conditions or care:

  • Treatment of a serious and complex condition
  • Institutional or inpatient care
  • Schedule a nonelective surgery
  • Pregnancy or course of treatment for pregnancy
  • Terminal illness

Members can choose to continue services with the same in-network coverage for either 90 days after the notice or until the date they’re no longer a continuing care patient, whichever is earlier.

State laws, which may require a longer continuity of care period for certain conditions, will continue to apply.

You (or your facility) must accept payment from us plus member cost share as payment in full during the continuity of care period.

More on the CAA and Transparency in Coverage Final Rule.