Common use of Continuing Care Clause in Contracts

Continuing Care. Medically Necessary care provided by any Provider other than a Member’s Primary Care Physician will be covered, subject to the Section CS - Description of Covered Services, Section EX - Exclusions, Section SC - Schedule of Cost Sharing sections, and the Medical Care Preauthorization Schedule only until they can, without medically harmful consequences, be transferred to the care of their Primary Care Physician or a Referred Specialist designated by their Primary Care Physician. All continuing care must be provided or Referred by a Member’s Primary Care Physician or coordinated through Keystone’s Customer Service Department. Members who will be out of Keystone’s Approved Service Area for an extended period of time may wish to enroll in Keystone’s Away From Home Care Guest Membership Program. This program gives Members coverage, similar to that provided by Keystone, and the BlueCross and/or BlueShield HMO in that particular geographic area. Members will have a PCP both at the guest HMO and in Keystone’s Limited Network Area. Essentially, the Member is covered under two (2) plans at the same time at no additional cost. Members who take extended business trips (three to six months), students at college, or families living apart may all take advantage of the benefit of a Guest Membership. Not all geographic areas within the United States participate in the Guest Membership Program. Members should contact Keystone’s Customer Service Department by calling the telephone number on their ID card or as outlined in this Agreement to find out if the geographic area where they will be staying participates in the Guest Membership Program and to find out if they are eligible. Subscribers who will be out of Keystone’s Approved Service Area for greater than six (6) months or who change their permanent residence to an address outside of Keystone’s Limited Network Area, are not eligible for the Guest Membership Program.

Continuing Care. Medically Necessary care provided by any Provider other than a Member’s Primary Care Physician will be covered, subject to the Section CS - Description of Covered Services, Section EX - Exclusions, Section SC - Schedule of Cost Sharing sections, and the Medical Care Preauthorization Schedule only until they can, without medically harmful consequences, be transferred to the care of their Primary Care Physician or a Referred Specialist designated by their Primary Care Physician. All continuing care must be provided or Referred by a Member’s Primary Care Physician or coordinated through Keystone’s Customer Service Department. Members who will be out of Keystone’s Approved Service Area for an extended period of time may wish to enroll in Keystone’s Away From Home Care Guest Membership Program. This program gives Members coverage, similar to that provided by Keystone, and the BlueCross and/or BlueShield HMO in that particular geographic area. Members will have a PCP both at the guest HMO and in Keystone’s Limited Network Approved Service Area. Essentially, the Member is covered under two (2) plans at the same time at no additional cost. Members who take extended business trips (three to six months), students at college, or families living apart may all take advantage of the benefit of a Guest Membership. Not all geographic areas within the United States participate in the Guest Membership Program. Members should contact KeystoneXxxxxxxx’s Customer Service Department by calling the telephone number on their ID card or as outlined in this Agreement to find out if the geographic area where they will be staying participates in the Guest Membership Program and to find out if they are eligible. Subscribers who will be out of Keystone’s Approved Service Area for greater than six (6) months or who change their permanent residence to an address outside of Keystone’s Limited Network Approved Service Area, are not eligible for the Guest Membership Program.