Part 8 – Other Health Plan Provisions (continued) WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 84  Your provider disenrolls from your health care network and you are a member who is receiving covered services for the situations listed below. If this is the case, this health plan will notify you that the health care provider is no longer part of the health care network.  You are undergoing a course of treatment for a serious and complex condition; you are undergoing a course of institutional or inpatient care; or you are scheduled to undergo non-elective surgery (including postoperative care). This health plan will also notify you of your right to request to continue to have benefits provided for covered services from that health care provider for up to 90 days after the provider disenrolls from your health care network or when the course of treatment is completed, whichever comes first.  You are pregnant and undergoing a course of treatment for the pregnancy. This health plan will also notify you of your right to request to continue to have benefits provided for covered services from that health care provider for up to 90 days after the provider disenrolls from your health care network or through your first post-partum visit, whichever is longer.  You are determined to be terminally ill. This health plan will also notify you of your right to request to continue to have benefits provided for covered services from that health care provider for as long as the covered services are needed.  Your provider is involuntarily disenrolled from your health care network and you are a member who is in the second or third trimester of pregnancy. In this case, this health plan will provide coverage for covered services you get from that health care provider for your pregnancy up through the first post-partum visit.  Your provider is involuntarily disenrolled from your health care network and you are a member with a terminal illness. In this case, this health plan will provide coverage for covered services you get from that health care provider for the terminal illness. (This coverage is continued only when the terminally ill member is expected to live six months or less as determined by a physician.) Services in a Disaster Blue Cross Blue Shield HMO Blue is not liable if events beyond its control—such as war, riot, national emergency, terrorist attack, public health emergency, pandemic, or natural disaster—cause delay or failure of Blue Cross Blue Shield HMO Blue to arrange for or coordinate access to health care services and coverage for its members. Blue Cross Blue Shield HMO Blue will make a good faith effort to arrange for or to coordinate health care services to be furnished in these situations. There may be times when Blue Cross Blue Shield HMO Blue provides coverage for services and/or supplies due to events beyond its control that are not described in this Subscriber Certificate. (See “Changes to Health Plan Coverage” in this Part 8 for more information.) Time Limit for Legal Action Before you pursue a legal action against Blue Cross Blue Shield HMO Blue for any claim under this health plan, you must complete the Blue Cross Blue Shield HMO Blue internal formal review. (See Part 10.) You may, but you do not need to, complete an external review before you pursue a legal action. If, after you complete the formal review, you choose to bring a legal action against Blue Cross Blue Shield HMO Blue, you must bring this action within two years after the cause of the action arises. For example, if you are filing a legal action because you were denied a service or you were denied a claim for coverage from this health plan, you will lose your right to bring a legal action against Blue Cross Blue Shield HMO Blue unless you file your action within two years after the date of the decision of the final internal appeal of the service or claim denial.