Transition of Care Benefits. If you are a new HMO enrollee and you are receiving care for a condition that requires an Ongoing Course of Treatment or if you have entered into the second or third trimester of pregnancy, and your Physician does not belong to the Plan's network, but is within the Plan's service area, you may request the option of xxxx sition of care benefits. You must submit a written request to the Plan for transition of care benefits within 15 business days of your eligibility effective date. If you are a current HMO enrollee and you are receiving care for a condition that re quires an Ongoing Course of Treatment or if you have entered into the second or third trimester of pregnancy and your Primary Care Physician or Woman's Princi pal Health Care Provider leaves the Plan's network, you may request the option of transition of care benefits. You must submit a written request to the Plan for xxxx sition of care benefits within 30 business days after receiving notification of your Primary Care Physician or Woman's Principal Health Care Provider's termina tion. The Plan may authorize transition of care benefits for a period up to 90 days. Au thorization of benefits is dependent on the Physician's agreement to contractual requirements and submission of a detailed treatment plan. A written notice of the Plan's determination will be sent to you within 15 business days of receipt of your request. PHYSICIAN BENEFITS This section of your Certificate explains what your benefits are when you receive care from a Physician. Remember, to receive benefits for Covered Services, (except for the treatment of Mental Illness other than Serious Mental Illness), they must be performed by or ordered by your Primary Care Physician or Woman's Principal Health Care Pro vider. In addition, only services performed by Physicians are eligible for benefits unless another Provider, for example, a Dentist, is specifically mentioned in the description of the service. Whenever we use “you” or “your” in describing your benefits, we mean all eligi ble family members who are covered under Family Coverage. COVERED SERVICES Your coverage includes benefits for the following Covered Services: Surgery — when performed by a Physician, Dentist or Podiatrist or other Pro vider acting within the scope of his/her license. However, benefits for oral Surgery are limited to the following services:
Transition of Care Benefits. If you are a new HMO enrollee and you are receiving care for a condition that requires an Ongoing Course of Treatment or if you have entered into the second or third trimester of pregnancy, and your Physician does not belong to the Plan's network, but is within the Plan's service area, you may request the option of xxxx sition of care benefits. You must submit a written request to the Plan for transition of care benefits within 15 business days of your eligibility effective date. If you are a current HMO enrollee and you are receiving care for a condition that requires an Ongoing Course of Treatment or if you have entered into the second or third trimester of pregnancy and your Primary Care Physician or Woman's Principal Health Care Provider leaves the Plan's network, you may request the option of transition of care benefits. You must submit a written request to the Plan for transition of care benefits within 30 business days after receiving notification of your Primary Care Physician or Woman's Principal Health Care Provider's ter mination. The Plan may authorize transition of care benefits for a period up to 90 days. Au thorization of benefits is dependent on the Physician's agreement to contractual requirements and submission of a detailed treatment plan. A written notice of the Plan's determination will be sent to you within 15 business days of receipt of your request. GB‐16 HCSC 28
