Part 8 – Other Health Plan Provisions (continued) WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 81 Continuity of Care Access for Cancer and Pediatric Facilities When you enroll in a tiered network plan under a group contract and your group is a small employer group, you may be eligible for continuity of care coverage if you are receiving an active course of care for a serious illness that you began before your effective date in the tiered network plan. To be eligible for this continuity of care coverage, you must meet all of the following conditions:  You began an active course of care for a serious illness (such as cancer or cystic fibrosis) at a comprehensive cancer or pediatric facility on or after May 1, 2012 but before your effective date in the Blue Cross Blue Shield HMO Blue tiered network plan. A “comprehensive cancer or pediatric facility” means: Dana-Farber Cancer Institute, Boston Children’s Hospital, Shriners Hospitals for Children (Boston and Springfield), Nashoba Valley Medical Center, and Massachusetts Eye and Ear Infirmary.  You would normally pay the highest in-network cost share amount for covered services furnished at the comprehensive cancer or pediatric facility where you are receiving your care; or the comprehensive cancer or pediatric facility is not in the health plan’s network.  Your active course of care, if it were disrupted, would cause you an undue hardship. This means, for example, a disruption could endanger your life, or cause you suffering or pain, or result in a substantial change to your treatment plan. If you meet all of the conditions stated above, you are eligible for this coverage until the end of the 12-month period that starts on the subscriber’s effective date in the Blue Cross Blue Shield HMO Blue tiered network plan, but only when your group offers you a choice to enroll only in a tiered network plan in which your comprehensive cancer or pediatric facility is at the highest cost share level or it is not part of the health plan’s network; and your care is not available from another provider in the health plan’s network. If you think you are eligible for this coverage, you or your health care provider must send a completed continuity of care form to Blue Cross Blue Shield HMO Blue. You can get a copy of this form by calling customer service at the toll free phone number that is shown on your ID card. Or, you can log on to the Blue Cross Blue Shield HMO Blue Web site at www.bluecrossma.org. Just follow the steps to request a form. If Blue Cross Blue Shield HMO Blue determines you are eligible for this coverage, your cost share amount will be at the second highest in-network cost share level when the comprehensive cancer or pediatric facility is at the highest cost share level. Or, your cost share amount will be at the lowest in-network cost share level when the comprehensive cancer or pediatric facility is not part of the health plan’s network. If Blue Cross Blue Shield HMO Blue determines you are not eligible for this coverage, you must pay the cost share amount you would normally pay for covered services furnished at a comprehensive cancer or pediatric facility. Disagreement with Recommended Treatment When you enroll for coverage in this health plan, you agree that it is up to your health care provider to decide the right treatment for your care. You may (for personal or religious reasons) refuse to accept the procedures or treatments that are advised by your health care provider. Or, you may ask for treatment that a health care provider judges does not meet generally accepted standards of professional medical care. You have the right to refuse the treatment advice of the health care provider. Or, you have the right to seek other care at your own expense. If you want a second opinion about your care, you have the right to coverage for second and third opinions. (See Part 5.)