If Your Doctor, Medical Group, or Hospital Leaves Your Health Plan
You may receive a notice that your doctor, medical group, or hospital is no longer in your health plan.
Usually this means that you must change doctors, medical groups, or hospitals. But in some cases, you may be able to keep your doctor, medical group, or hospital for a limited time. This is called "completion of covered services."
To receive completion of covered services, you must call your health plan to ask for completion of covered services. Also, your doctor, medical group, or hospital must agree to keep you as a patient.
Only people with certain kinds of health problems or conditions can get completion of covered services:
| Type of Problem or Condition |
How long you get completion of covered services |
| Acute Condition (for example, pneumonia) |
As long as the condition lasts |
| Serious Chronic Condition (for example, severe diabetes or heart disease) |
No more than 12 months – usually until you complete a period of treatment, and your doctor can safely transfer your care to another doctor |
| Pregnancy |
During Pregnancy and immediately after the delivery (the post-partum period) |
| Terminal Illness |
As long as the person lives |
| Care of a Child under 3 years |
For up to 12 months |
| An already scheduled surgery or other procedure (for example, knee surgery or colonoscopy) |
The surgery or procedure must be scheduled to happen within 180 days of your doctor or hospital leaving your health plan |
If Your Health Plan Changes and You Lose Your Doctor, Medical Group, or Hospital
You may also qualify for completion of covered services if your health plan changes, and you are required to switch to a new plan. This is called "new health plan member" completion of covered services. The rules are the same as the rules described above.
- Completion of covered services is available if you get your health plan from your employer, your employer stops offering that plan and you have to change to a plan that does not have your treating doctor, medical group, or hospital.
- Completion of covered services is available if you buy your own individual health plan (either through Covered California or directly from the plan) and you have to change plans because your individual health plan is no longer available in the marketplace.
Check with your health plan to find out if you qualify for completion of covered services. Tell them the name of your doctor, medical group, or hospital, your medical condition, and the treatments you are receiving. If you have problems asking for completion of covered services or have any other questions, please call the Department’s Help Center at 1-888-466-2219.
Please refer to California Health and Safety Code section 1373.96 for more information on Completion of Covered Services.