Transition of Care for Cigna Members
We understand that transitioning to a new medical insurance carrier can be challenging, especially if your current treating provider is out-of-network. If you are under treatment for a serious condition, you may be able to receive transition of care and continue to treat with your current provider at the in-network benefit level, for an approved period during the 2024 plan year.
Transition of Care
With Transition of Care, you may be able to continue to receive services for specified medical conditions with health care professionals who are not in the Cigna network at in-network coverage levels. This care is for a defined period of time until the safe transfer of care to an in-network doctor or facility can be arranged.
Medical Conditions that Qualify for Transition of Care
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Pregnancy in the second or third trimester at the time of the plan effective date of coverage
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Pregnancy is considered ‘high risk’ if mother’s age is 35 years or older or has/had the following:
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Early delivery (three weeks) in previous pregnancy.
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Gestational diabetes.
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Pregnancy induced hypertension.
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Multiple inpatient admissions during this pregnancy​
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Newly diagnosed or relapsed cancer in the midst of chemotherapy, radiation therapy or reconstruction.
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Trauma
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Transplant candidates
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Recent major surgeries still in the follow-up period, that is generally six to eight weeks.
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Acute conditions in active treatment such as heart attacks, strokes or unstable chronic conditions.
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Hospital confinement on the plan effective date
Approval Time Frame
If Cigna determines that transitioning to an in-network health care professional is not recommended or safe for the conditions that qualify, services by the approved out-of-network health care professional will be authorized for a specified period of time (usually 90 days). Or, services will be approved until care has been completed or transitioned to an in-network health care professional, whichever comes first.
How to Apply for Transition of Care
Requests must be submitted in writing, using the Transition of Care/Continuity of Care request form. This form must be submitted at the time of enrollment, change in Cigna medical plan. It cannot be submitted more than 30 days after the effective date of your plan. To access the Transition of Care /Continuity of Care request form, click here.
Questions?
For questions prior to enrollment, please contact Cigna One Guide at 888-806-5094. For more information on Transition of Care click here. Once you become a Cigna member, please contact Cigna Member Services at 866-494-2111.