Continuity of Care

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. 

• New Member Transition of Care Request     English