Care management

Our Benefit Interpretations Manual and our Medical Management Guidelines and Clinical Practice Guidelines for Members are tools we use to help us administer health benefits under your plan. Please consult your benefit plan document to find out what services are covered under your plan.

These policies and guidelines are not medical advice. You should always consult with your physician or other healthcare provider about your medical care and treatment. More information about these policies and guidelines are available in the links below.

Benefit Interpretation Manuals:

Continuity of Care for newly enrolled members is a health plan process that, under certain circumstances, provides members with continued care with a former, non-participating provider. Download the Continuity of Care document(s) below for more information.

California Forms:

If you have a special condition, our Centers of Excellence (COE) network provides help finding a doctor and medical center as well as help with understanding your illness. COEs are intended to complement local hospital and physician care by helping you get access to care.

The Centers of Excellence (COE) program providers and medical centers are independent contractors who render care and treatment to health plan members. The COE program does not provide direct health care services or practice medicine, and the COE providers and medical centers are solely responsible for medical judgments and related treatments. The COE program is not liable for any act or omission, including negligence, committed by any independent contracted health care professional or medical center.

Benefit Interpretation Manual and Medical Management Guidelines

Benefit Interpretation Manuals:

Continuity of Care Information and Forms

California Forms:

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