Extended Benefits When Coverage Ends
(For the Anthem Blue Cross-Administered Plans and the Mental Health and Substance Abuse Coverage. Extended benefits are not offered by the HMO plans.)
Hospitalization
If you or a covered dependent is hospitalized at the time coverage ends, your Anthem Blue Cross-administered medical plan and the Mental Health and Substance Abuse Coverage will continue benefits for the same illness until the earlier of the following events:
  • You or your covered dependent has recovered sufficiently to be discharged from the hospital by your doctor; or
  • The maximum plan benefits have been paid.
Disability
If you or a covered dependent is "totally disabled" when your coverage ends, your Anthem Blue Cross-administered medical plan and the Mental Health and Substance Abuse Coverage will continue benefits for treatment of the disabling condition for up to 12 months. For purposes of the Anthem Blue Cross-administered plans and the Mental Health and Substance Abuse Coverage, in the case of a dependent, "totally disabled" means being unable to perform all the regular and customary activities for a person of that age.
Benefits will end before the 12-month period if you or your dependent:
  • cease to be totally disabled;
  • fail to furnish satisfactory proof of continuing disability as required by the Plan;
  • receive maximum benefits from the Plan; or
  • become covered for the disabling condition under any other group health plan.
To be eligible for these extended benefits, your attending physician must certify the disability in writing and submit this statement within 90 days of the date on which coverage would otherwise end. Written proof of the continuing disability will be required every 90 days during the period for which extended benefits are available.