Transition of Care Benefits

Blue Cross and Blue Shield of Illinois (BCBSIL) HMO members have the right to request authorization for transition of care. Transition of care benefits can be requested when a member's doctor leaves the HMO participating network, or when an individual is considering joining HMO Illinois and his or her doctor is not in the network.

• To qualify for transition of care services, a member must currently be undergoing a course of evaluation and/or medical treatment or be in the second or third trimester of pregnancy.
• Transitional care benefits may be authorized for a period of up to 90 days from the doctor's termination date from the network or the member's original effective date (for new members).
• Authorization of benefits depends on the doctor's agreement to comply with contractual requirements and submit a detailed treatment plan, including reimbursement from the HMO at specified rates, adherence to the HMO's quality assurance requirements and the HMO's policies and procedures.
• All care must be transitioned to the member's new HMO primary care physician (PCP) in the Medical Group/Independent Practice Association (MG/IPA) after the transition period has expired. The selected MG/IPA is responsible for the care of a new member as of his or her effective date. Coverage will be provided only for benefits outlined in the member's certificate.
• To be eligible for transition of care benefits, an individual must be a member of a BCBSIL HMO. If you've completed a BCBSIL HMO application, you must submit a copy of the application along with the transition of benefits request.

Note: Ongoing course of evaluation or medical treatment means the treatment of a condition or disease that requires repeated health care services pursuant to a plan of treatment by a doctor because of the potential for changes in a therapeutic regimen.