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Request continuity of care benefits

Keep the health care provider you know and love while you finish treatments, or care for your newborn child.

 

Continuity of care means continued services, under certain conditions, with your current health care provider until your provider completes your care. 

As a newly enrolled  Sharp Health Plan member, you may receive continuity of care services when

  • You are receiving care from a non-Sharp Health Plan provider; or 
  • Your previous coverage terminated due to your health plan either withdrawing from the market in your service area or ceasing to offer the applicable health benefit plan in your service area.

As a current  Sharp Health Plan member, you may also obtain continuity of care benefits when your

  • Sharp Health Plan Network has changed; or 
  • Sharp Health Plan Medical Group, hospital, or health care provider is no longer contracted with Sharp Health Plan.

Eligible treatments

Continuity of care may be provided for the completion of care when you or your family member is in an active course of treatment for these conditions.

 

ConditionLength of time for continuity of care
Acute conditionDuration of acute condition
Serious chronic conditionNo more than 12 months
PregnancyThree trimesters of pregnancy and immediate post-partum period
Terminal illnessAs long as the member lives
Pending surgery or other procedureMust be scheduled within 180 days of health care provider’s contract termination or member’s enrollment in Sharp Health Plan
Care of newborn child between birth and age 36 monthsNo more than 12 months

What you need to know

Your requested health care provider must agree to provide continued services to you, subject to the same contract terms and conditions and similar payment rates to other similar health care providers contracted with Sharp Health Plan. If your health care provider does not agree, Sharp Health Plan cannot provide continuity of care.

You are not eligible for continuity of care coverage in the following situations:

  • You are a newly enrolled member and had the opportunity to enroll in a health plan with an out-of-network option.
  • You had the option to continue with your previous health plan, but instead voluntarily chose to change health plans.
  • You have an Individual, Medicare, CalChoice, or CCSB (Covered California for Small Business) policy, and had the ability to choose a plan that allowed you to stay with your health care provider.


If you are unsure about your eligibility for continuity of care, please contact our Customer Care team at 1-855-995-5004.



 

Request additional visits with your current health care provider

To request continuity of care benefits, please complete both sides of the continuity of care form. One of our case managers will review the information you’ve provided, and contact you to assist with any needs.

Download English formDownload Spanish form

Mail your completed form to:

Attention: Medical Management
8520 Tech Way, Suite 200
San Diego, CA 92123

Or fax to:

1-619-740-8111