Common use of Continuity of Care Clause in Contracts

Continuity of Care. Continuity of care with a Non-Participating Provider may be available if your provider leaves the Blue Shield or MHSA networks, or if you are a newly-covered Member whose previous health plan was withdrawn from the market. You can request to continue treatment with your Non-Participating Provider in the situations described above if you are currently receiving the following care: • Ongoing treatment for an acute or serious chronic condition; • Pregnancy care, including care immediately after giving birth; • Treatment for a maternal mental health condition; • Treatment for a terminal illness; • Other services authorized by a now-terminated provider as part of a documented course of treatment; or • Care for a child up to 36 months old. To request continuity of care, visit xxxxxxxxxxxx.xxx and fill out the Continuity of Care Application. Blue Shield will confirm your eligibility and review your request for Medical Necessity. The Non-Participating Provider must agree to accept Blue Shield’s Allowable Amount as payment in full for your ongoing care. If the provider agrees and your request is authorized, you may continue to see the Non-Participating Provider at the Participating Provider Cost Share for: • Up to 12 months; • For a maternal mental health condition, 12 months after the condition’s diagnosis or 12 months after the end of the pregnancy, whichever is later; or • If you have a terminal illness, for the duration of the terminal illness. See the Your payment information section for more information about the Allowable Amount. You can consult a Participating or Non-Participating Provider for a second medical opinion in situations including but not limited to: • You have questions about the reasonableness or necessity of the treatment plan; • There are different treatment options for your medical condition; • Your diagnosis is unclear; • Your condition has not improved after completing the prescribed course of treatment; • You need additional information before deciding on a treatment plan; or • You have questions about your diagnosis or treatment plan. You do not need prior authorization from Blue Shield or your PCP for a second medical opinion.

Continuity of Care. Continuity of care with a Non-Participating Provider may be available if your provider leaves the Blue Shield or MHSA networks, if you are a newly-covered Member whose coverage choices do not include out-of-network Benefits, or if you are a newly-covered Member whose previous health plan was withdrawn from the market. You can request to continue treatment with your Non-Participating Provider in the situations described above if you are currently receiving the following care: •  Ongoing treatment for an acute or serious chronic condition; •  Pregnancy care, including care immediately after giving birth; •  Treatment for a maternal mental health condition; •  Treatment for a terminal illness; •  Other services authorized by a now-terminated provider as part of a documented course of treatment; or •  Care for a child up to 36 months old. To request continuity of care, visit xxxxxxxxxxxx.xxx and fill out the Continuity of Care Application. Blue Shield will confirm your eligibility and review your request for Medical Necessity. The Non-Participating Provider must agree to accept Blue Shield’s Allowable Amount Allowed Charges as payment in full for your ongoing care. If the provider agrees and your request is authorized, you may continue to see the Non-Participating Provider at the Participating Provider Cost Share for: •  Up to 12 months; •  For a maternal mental health condition, 12 months after the condition’s diagnosis or 12 months after the end of the pregnancy, whichever is later; or •  If you have a terminal illness, for the duration of the terminal illness. See the Your payment information section for more information about the Allowable AmountAllowed Charges. You can consult ask your PCP for a Participating or Non-Participating Provider referral to another provider for a second medical opinion in situations including but not limited to: •  You have questions about the reasonableness or necessity of the treatment plan; •  There are different treatment options for your medical condition; •  Your diagnosis is unclear; •  Your condition has not improved after completing the prescribed course of treatment; •  You need additional information before deciding on a treatment plan; or •  You have questions about your diagnosis or treatment plan. You do not need prior authorization from Blue Shield or your PCP Your Medical Group will work with you to arrange for a second medical opinion. A proposed treatment plan from your PCP Another PCP in your Medical Group A proposed treatment plan from a Specialist A Participating Provider in the same or equivalent specialty If you need urgent or emergency medical care while traveling outside of California, you’re covered. Blue Shield has relationships with health plans in other states, Puerto Rico, and the U.S. Virgin Islands through the BlueCard® Program. The Blue Cross Blue Shield Association can help you access care in those geographic areas. See the Out-of-area services section for more information about receiving care while outside of California. To find participating providers while outside of California, visit xxxx.xxx. You or your Dependent may be able to enroll in Away from Home Care when you are on an extended stay within the service area of another Blue Cross or Blue Shield plan outside of California. Away from Home Care may be available for Dependents who are full-time students, Dependents of Subscribers who are required by court order to provide coverage, and long-term travelers. For more information on the program and which states participate, visit xxxxxxxxxxxx.xxx or call the Blue Shield of California Away from Home Care coordinators at (000) 000-0000.

Continuity of Care. Continuity of care with a Non-Participating Provider may be available if your provider leaves the Blue Shield or MHSA networks, if you are a newly-covered Member whose coverage choices do not include out-of-network Benefits, or if you are a newly-covered Member whose previous health plan was withdrawn from the market. You can request to continue treatment with your Non-Participating Provider in the situations described above if you are currently receiving the following care: • Ongoing treatment for an acute or serious chronic condition; • Pregnancy care, including care immediately after giving birth; • Treatment for a maternal mental health condition; • Treatment for a terminal illness; • Other services authorized by a now-terminated provider as part of a documented course of treatment; or • Care for a child up to 36 months old. To request continuity of care, visit xxxxxxxxxxxx.xxx and fill out the Continuity of Care Application. Blue Shield will confirm your eligibility and review your request for Medical Necessity. The Non-Participating Provider must agree to accept Blue Shield’s Allowable Amount Allowed Charges as payment in full for your ongoing care. If the provider agrees and your request is authorized, you may continue to see the Non-Participating Provider at the Participating Provider Cost Share for: • Up to 12 months; • For a maternal mental health condition, 12 months after the condition’s diagnosis or 12 months after the end of the pregnancy, whichever is later; or • If you have a terminal illness, for the duration of the terminal illness. See the Your payment information section for more information about the Allowable AmountAllowed Charges. You can consult ask your PCP for a Participating or Non-Participating Provider referral to another provider for a second medical opinion in situations including but not limited to: • You have questions about the reasonableness or necessity of the treatment plan; • There are different treatment options for your medical condition; • Your diagnosis is unclear; • Your condition has not improved after completing the prescribed course of treatment; • You need additional information before deciding on a treatment plan; or • You have questions about your diagnosis or treatment plan. You do not need prior authorization from Blue Shield or your PCP Your Medical Group will work with you to arrange for a second medical opinion. A proposed treatment plan from your PCP Another PCP in your Medical Group A proposed treatment plan from a Specialist A Participating Provider in the same or equivalent specialty If you need urgent or emergency medical care while traveling outside of California, you’re covered. Blue Shield has relationships with health plans in other states, Puerto Rico, and the U.S. Virgin Islands through the BlueCard® Program. The Blue Cross Blue Shield Association can help you access care in those geographic areas. See the Out-of-area services section for more information about receiving care while outside of California. To find participating providers while outside of California, visit xxxx.xxx. You or your Dependent may be able to enroll in Away from Home Care when you are on an extended stay within the service area of another Blue Cross or Blue Shield plan outside of California. Away from Home Care may be available for Dependents who are full-time students, Dependents of Subscribers who are required by court order to provide coverage, and long-term travelers. For more information on the program and which states participate, visit xxxxxxxxxxxx.xxx or call the Blue Shield of California Away from Home Care coordinators at (000) 000-0000.

Continuity of Care. Continuity of care with a Non-Participating Provider may be available if your provider leaves the Blue Shield or MHSA networks, or if you are a newly-covered Member whose previous health plan was withdrawn from the market. You can request to continue treatment with your Non-Participating Provider in the situations described above if you are currently receiving the following care: •  Ongoing treatment for an acute or serious chronic condition; •  Pregnancy care, including care immediately after giving birth; •  Treatment for a maternal mental health condition; •  Treatment for a terminal illness; •  Other services authorized by a now-terminated provider as part of a documented course of treatment; or •  Care for a child up to 36 months old. To request continuity of care, visit xxxxxxxxxxxx.xxx and fill out the Continuity of Care Application. Blue Shield will confirm your eligibility and review your request for Medical Necessity. The Non-Participating Provider must agree to accept Blue Shield’s Allowable Amount as payment in full for your ongoing care. If the provider agrees and your request is authorized, you may continue to see the Non-Participating Provider at the Participating Provider Cost Share for: •  Up to 12 months; •  For a maternal mental health condition, 12 months after the condition’s diagnosis or 12 months after the end of the pregnancy, whichever is later; or •  If you have a terminal illness, for the duration of the terminal illness. See the Your payment information section for more information about the Allowable Amount. You can consult a Participating or Non-Participating Provider for a second medical opinion in situations including but not limited to: •  You have questions about the reasonableness or necessity of the treatment plan; •  There are different treatment options for your medical condition; •  Your diagnosis is unclear; •  Your condition has not improved after completing the prescribed course of treatment; •  You need additional information before deciding on a treatment plan; or •  You have questions about your diagnosis or treatment plan. You do not need prior authorization from Blue Shield or your PCP for a second medical opinion.