Transition of Care Service Requests For New Customers - (UM-35)

Cigna covers Transition of Care (TOC) requests for new enrollees to continue care from non‑participating providers at in‑network benefit levels for cases such as terminal illness, acute/chronic conditions in active treatment, pregnancy (generally 2nd/3rd trimester and postpartum, with some states allowing 1st trimester), hospital confinement, newborn care, preauthorized surgeries and certain ancillary services (ancillary review/exclusions and specific durations vary by state; TOC generally does not apply to IFPs absent state mandates). Key requirements: submit a Transition of Care Request Form plus brief history/treatment plan within 30 days of enrollment (60‑day grace), eligibility/benefits must be active, TOC approvals are time‑limited (standard up to 90 days unless pregnancy, Medical Director or state law extends), reviews occur within 8 business days of complete information (state timelines may differ), and services remain subject to plan benefit limits and state‑specific mandates.