What You Need to Know About Continuity of Care and How to Apply

What is Continuity of Care?

 

Continuity of Care (CoC) is one way Anthem Blue Cross protects members who are currently receiving care when a doctor, hospital, or other provider leaves our network. In certain situations, eligible members may be able to continue receiving in-network benefits when seeing their current provider for a limited time, even if that provider has left Anthem’s network.

 

This temporary accommodation is meant to help avoid sudden disruptions in care for members who are in the middle of treatment, have a serious or ongoing health condition, are pregnant, or have care already scheduled when a care provider leaves our network. Continuity of Care is not automatic, and extended coverage depends on your health plan type, medical situation, provider participation, and applicable rules. If you think you may qualify after reviewing the information below, plesae contact us to ask about your options.

Let’s Start with Understanding Your Health Plan Type

 

CoC coverage varies by health plan type due to state and federal regulations. See below for health plan categories. It's important to know the type of health plan  you have.

 

Employer Health Plans fall into three categories: self-funded, fully insured, and employer-sponsored Medicare Advatage group retiree plans. Each has different rules and regulations about Continuity of Care. If you’re unsure which plan you have, ask your employer or call our Member Service Center at the number on your ID card.

  • Fully insured health plans are plans for which Anthem pays the member’s healthcare claims and the employer pays Anthem a monthly premium.
  • Self-funded health plans are the most common employer health plan. In these plans, the employer pays the plan members’ healthcare claims. The employer pays Anthem a flat administration fee.
  • Employer-sponsored Medicare Advantage group retiree plans - are Medicare Advantage group retiree plans that are health insurance policies provided by a former employer, union, or government sponsor to retired workers. Managed by private insurance companies, these plans bundle hospital, medical, and often prescription drug coverage into a single package tailored specifically for that group

 Medicare Advantage Health Plans, also called Medicare Part C, are alternatives to Original Medicare offered by Anthem Blue Cross. These plans include the same Part A and Part B benefits as Original Medicare and include additional benefits, such as prescription drug coverage, dental, vision, hearing, or wellness services, depending on the plan.


Medi-Cal Health Plans provide health coverage through California’s Medicaid program for eligible residents. Medi-Cal managed care plans, such as those offered by Anthem Blue Cross, help members access covered services like doctor visits, hospital care, preventive care, prescriptions, behavioral health services, and other benefits. Eligibility and covered services depend on state guidelines and the member’s specific plan.

 

Individual Affordable Care Act (ACA) Health Plans are individual or family health plans that meet federal coverage standards under the Affordable Care Act. In California, these plans are offered through Covered California, the state’s health insurance marketplace, and through health insurance brokers. Plans include essential health benefits, such as doctor visits, preventive care, prescriptions, hospital care, maternity care, and behavioral health services.

CoC Qualifying Health Conditions by Plan Type and How to Apply 

State of California Resources

 

The State of California can be of additional assistance to you to understand CoC and how it may apply to you. To learn which State of California departments regulate your health plan, please consult your plan materials. Depending on your health plan type, this information can be found in your Evidence of Coverage (EOC), Certificate of Coverage, Certificate of Insurance, Benefit Booklet, or Member Handbook.

 

If you have a health plan that is regulated by the Department of Managed Health Care and have more questions, you can also contact the Department of Managed Health Care, which protects consumers. Visit their website at dmhc.ca.gov or call toll-free at 888-HMO-2219 (or TDD 877-688-9891 for people with a hearing or speech impairment).

If you have a health plan that is regulated by the California Department of Insurance and you have more questions, you may contact the California Department of Insurance. Visit their website at insurance.ca.gov or call 800-927-4357 (or TDD 800-482-4833 for people with a hearing or speech impairment.

 

If you have a health plan that is regulated by Department of Health Care Services and have more questions, you may contact the department at dhcs.ca.gov or call 888-452-8609.

 

Frequently Asked Questions