Cigna and University of California Health reached a new agreement keeping UC in network, ending months of uncertainty for patients across the state. The protection that mattered most during those months is one many Californians have never heard of.
The dispute was broad. Contracts covering UC Davis Health, UCSF Health, UCLA Health, UC Irvine Health and UC San Diego Health were set to expire June 30, and Cigna members with Commercial Open Access Plus, PPO, HMO and LocalPlus plans faced losing in-network access, though UC employees and retirees were not affected. Cigna and UC Health announced an agreement in principle with a short extension while finalizing terms, and individual campuses confirmed agreements through late June and July.
State law requires health plans to let patients in active treatment for specific conditions keep seeing a terminated or out-of-network provider temporarily, at in-network cost sharing. The requirement is set out in Health and Safety Code Section 1373.96, and it applies whenever a contract ends, not only in high-profile disputes.
The critical detail is that nothing about it happens automatically. The patient has to ask.
Conditions That Qualify Under State Law
The statute lists specific circumstances rather than granting a general right to keep any doctor.
Qualifying conditions include an acute condition, a serious chronic condition, pregnancy, terminal illness, care of a newborn child between birth and age 36 months, and performance of a surgery or other procedure that was authorized as part of a documented course of treatment and is recommended to occur within 180 days of the contract's termination date. Maternal mental health conditions are also covered.
Durations differ by condition and are defined in statute. Care for an acute condition continues for the duration of that condition. A serious chronic condition is generally covered for up to 12 months. Pregnancy coverage extends through the pregnancy and the immediate postpartum period. Terminal illness is covered for the duration of the illness. Newborn care is limited to 12 months from the contract termination date.
A serious chronic condition is defined as a medical problem that is serious in nature and either persists without full cure, worsens over an extended period, or requires ongoing treatment to maintain remission or prevent deterioration. Cancer treatment, dialysis, and organ transplant care commonly fall within these categories.
Elective care that has not yet begun generally does not qualify. The protection is for finishing something already underway.
Steps to Request It from a Health Plan
The process is a request, a review, and a decision, and the patient starts it.
The first step is calling the number on the back of the insurance card and asking specifically for continuity of care. Plans are required to disclose the request process in their evidence of coverage, and most publish a continuity of care request form on their website. During the dispute, UC Davis Health told patients that Cigna must approve forms completed by the patient for specific conditions covered by law, and offered to help complete the portions the health system could.
Documentation from the treating clinician is what carries the request. Useful items include the diagnosis, the current treatment plan, dates of recent and upcoming appointments, how long treatment is expected to continue, and a statement explaining why continuity with this specific provider matters clinically. Plans commonly ask whether the patient has been seen by that provider within the past 12 months.
Timelines are regulated. Plans must decide more quickly when a condition is urgent, and must notify the patient of the decision in their preferred form of communication.
Two things frequently surprise patients. The out-of-network provider must agree to the plan's contract terms and payment rates for the continuity period, and if the provider declines, the plan is not required to approve continued care. And a patient admitted to the hospital when a contract lapses remains covered until discharge, though the plan may transfer them to an in-network facility if the transfer can be done safely.
Limits Worth Understanding Before You Need Them
These protections are real, and they are narrow. Understanding the boundaries prevents a false sense of security.
They are time-limited. A serious chronic condition capped at 12 months means a patient with a lifelong condition eventually transitions to a new provider regardless. Planning that transition early is better than discovering the deadline.
They are also condition-specific. A patient who simply likes their longtime primary care doctor and has no qualifying condition does not have a legal right to continued in-network coverage after a contract ends.
Which regulator oversees a plan depends on the plan type. The Department of Managed Health Care regulates HMOs and some PPOs and operates a Help Center at 1-888-466-2219. The California Department of Insurance regulates other PPO products and can be reached at 1-800-927-4357. Patients denied continuity of care can file a complaint with the appropriate regulator, and may also have a right to independent medical review.
Self-funded employer plans, which cover a large share of California workers, are governed by federal law rather than state law and are generally not subject to these requirements. Employees can ask their human resources department whether their plan is self-funded.
Preparing for the Next Contract Fight
Network disputes are becoming more frequent as hospitals and insurers argue over reimbursement, and patients typically get weeks of warning through letters from both parties. In this case, UC said it was seeking single-digit increases to cover inflation, medical supply costs and employee cost-of-living raises, while neither side disclosed the final terms.
The useful response to such a letter is not to wait and hope. Anyone in active treatment should call their plan immediately to ask about continuity of care, and should ask their clinician's office whether it has a designated staff member handling these requests, since large systems usually do.
Patients should keep copies of everything: the plan's notice, the completed request, the date submitted and the decision. One aftereffect is easy to miss. Because Cigna began reassigning HMO members to primary care physicians outside UC during the dispute, HMO members may need to request PCP reassignment back to their previous doctor rather than assuming it happens automatically. PPO members generally need to take no action.
Nobody should cancel a scheduled procedure or stop treatment while a request is pending. Delaying care carries its own risk, and emergency care is covered regardless of network status under both state and federal law.
The bottom line: the Cigna and UC Health contract was resolved; California law protects patients in active treatment for specific conditions for limited periods; the protection must be requested rather than assumed; clinician documentation determines the outcome; and HMO members reassigned during a dispute may need to ask to be moved back.
Key Questions Answered
What is continuity of care? A California requirement that health plans let patients in active treatment for specific conditions keep seeing a terminated or out-of-network provider temporarily at in-network cost sharing.
Which conditions qualify? Acute conditions, serious chronic conditions, pregnancy, terminal illness, care of a newborn between birth and 36 months, maternal mental health conditions, and certain already-authorized surgeries recommended within 180 days.
How long does it last? It varies by condition. Acute conditions are covered for their duration, serious chronic conditions generally up to 12 months, pregnancy through the immediate postpartum period, and terminal illness for the duration of the illness.
Is it automatic? No. The patient must request it from the health plan, and the plan must approve it based on the clinical situation.
What documentation helps? The diagnosis, current treatment plan, recent and upcoming appointment dates, expected treatment duration, and a clinician statement on why continuity with that provider matters.
Can a provider refuse? Yes. The out-of-network provider must accept the plan's contract terms and rates for the continuity period.
What if an HMO member was moved to a new primary care doctor? That reassignment does not reverse itself. Members who want to return to their previous physician generally need to request it.
