Continuity of Care

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In compliance with the Centers for Medicare and & Medicaid Services (CMS) effective January 1, 2024, Banner Medicare Advantage will provide new members up to a 90-day transition period when a member is undergoing an active course of treatment and switches from a previous Medicare Advantage plan or Medicare Fee for Service to a Banner Medicare Advantage plan.

If a member has newly enrolled with Medicare and joins a Banner Medicare Advantage plan, the transition policy will also apply. The option to request extended coverage up to 90 days from their previous benefit, out-of-network health care professional at network rates for a limited time due to a specific medical condition, until the safe transfer to a network health care professional can be arranged.

Examples of medical conditions that may qualify for Continuity of Care includes, but is not limited to: 

  • Newly diagnosed or relapsed cancer and currently receiving chemotherapy, radiation therapy or reconstruction. 
  • Transplant candidates or transplant recipients in need of ongoing care due to complications associated with a transplant. 
  • Recent major surgeries in the acute phase and follow-up period (generally six to eight weeks after surgery). 
  • Serious acute conditions in active treatment such as heart attacks or strokes. 
  • Other serious chronic conditions that require active treatment.

Please complete the New Member Transition of Care Request form below to begin the process. 

Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our Customer Care Center or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.