2026 CODAC Benefit Summaries and Carrier Flyers

TRANSITIONAL CARE

Certain eligible expenses that would have been considered at the tier 1 benefit level by the prior Claims Administrator, but that are not considered at the tier 1 benefit level by the current Claims Administrator, may be paid at the applicable tier 1 benefit level, subject to the Reasonable and Allowed Amount, if the Covered Person is currently under a treatment plan by a Physician who was a member of this Plan’s previous PPO but who is not a member of the Plan’s current PPO in the Employee’s or Dependent’s Network area. In order to ensure continuity of care for certain medical conditions already under treatment, the tier 1 medical plan benefit level may continue for 90 days for conditions approved as transitional care. Examples of medical conditions appropriate for consideration for transitional care include, but are not limited to: • Cancer if under active treatment with chemotherapy and/or radiation therapy. • Organ transplants for patients under active treatment (e.g., seeing a Physician on a regular basis, being on a transplant waiting list, or being ready at any time for a transplant). • Being an Inpatient in a Hospital on the Covered Person’s Effective Date. • Post-acute Injury or surgery within the past three months. • Pregnancy in the second or third trimester and up to eight weeks postpartum. • Behavioral health (any previous treatment).

You or Your Dependent must call HealthSCOPE Benefits within 90 days prior to Your Effective Date or within 90 days after Your Effective Date to see if You or Your Dependent is eligible for this benefit.

Routine procedures, treatment for stable chronic conditions, treatment for minor Illnesses, and elective surgical procedures will not be covered by transitional level benefits.

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