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.