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Continuation-of-Care Benefits

If you are receiving covered services (other than obstetrical care, post-operative care, oncological treatment or psychiatric treatment) from a terminated health care professional who was under contract with us at the time your treatment started, you may continue care or services with that health care professional for up to four months, when medically necessary.

If you are receiving obstetrical care, post-operative care, oncological treatment or psychiatric treatment from a terminated health care professional who was under contract with us at the time your treatment started, you may continue to be treated by that health care professional for the duration of the treatment or care as follows:

  • For pregnancy: Coverage of services will continue through the postpartum evaluation, up to six weeks after delivery.
  • For post-operative follow-up care: Coverage of services may continue for up to six months from the date of termination of the doctor or other health care professional.
  • For oncological treatment: Coverage of services may continue for up to one year from the date of termination of the doctor or other health care professional.
  • For psychiatric treatment: Coverage of services may continue for up to one year from the date of termination of the doctor or other health care professional.

These guidelines won’t apply if the health care professional is terminated immediately under any of these circumstances:

  • In the opinion of Horizon BCBSNJ’s medical director, the health care professional is an imminent danger to a patient or the public health, safety and welfare.
  • There has been a determination of fraud or a breach of contract by the health care professional.
  • The health care professional is the subject of disciplinary action by the State Board of Medical Examiners.

Please contact Member Services if you have questions about your continuation-of-care benefits. As always, your benefits are subject to policy limits and normal Horizon BCBSNJ policies and procedures, including prior authorization and utilization management requirements.