Transition & Continuity of Care

What is Transition of Care/Continuity of Care?

This policy applies to all Covered Persons under KPIC’s medical insurance plans such as 3-Tier POS, PPO, and EPO plans. This Policy does not apply to Self-Funded Plans.

Continuity of Care: When a new Covered Person, currently receiving Covered Services from a Non-Participating Provider maintains their care with the Non-Participating Provider and receives benefits under the Group Policy payable at the Non-Participating Provider tier. The new Covered Person must meet certain requirements to qualify for this process.

Transition of Care: The right to uninterrupted health care for a specific medical condition from the first point of contact to the point of resolution or long- term maintenance with the same provider in certain cases even when the provider has terminated their contract.

If meeting the eligibility requirements and criteria provided for under these Policies, KPIC may allow Covered Persons to continue treatment with the following:

• A Terminated Participating Provider, in accordance with the terms of the Applicable Contract at the time of termination, even after the termination of the Provider’s or Rental Network’s contract with KPIC or its Contracted Provider Network.
• A Provider who is not contracted with KPIC or KPIC’s Rental Network while such Covered Person was covered under a Prior Coverage other than KPIC.

Qualify Events:

• Serious Acute Health Condition
• Serious Chronic Condition
• Active Course of Treatment
• Pregnancy
• Maternal Mental Health
• Care for Child under age 3
• Life-threatening health condition
• Terminal Illness
• Inpatient

If you feel you have a member that is interested in or qualifies for this program within 7 days of plan enrollment, please complete the Transition of Care Form -English  | Transition of Care Form - Spanish. You may either fax or email the form to 866-338-0266 or to Permanente-Advantage@kp.org.

** Requests submitted for Transition of Care will only be considered for review 7 days prior to or 30 days after plan enrollment.