Continuity of Care

We want to be sure that you continue medically necessary treatments if you are new to Medicare, or are switching from another Medicare insurance plan. To qualify, you must be receiving covered services from a previous health insurance plan at the time that you move to Clover. These are known as Continuity of Care Benefits. ( Español )

Fill out the form below to submit your request electronically. If you would like help in submitting this information, please call member services at
1-888-778-1478 (TTY 711).

Subscriber and plan information


I have my Clover ID number



Birth date




Conditions

Are you scheduled for surgery or hospitalization after your effective date with Clover?






Are you receiving a course of chemotherapy, radiation therapy or other cancer therapy?






Are you receiving rehabilitation services (e.g., after major surgery or health event)?






Are you currently receiving dialysis treatment?






Are you a candidate for an organ transplant?






Are you receiving specialty prescription medications or ongoing intravenous infusions?






Are you pregnant and in the second or third trimester of pregnancy?






Are you expecting more than one baby, do you have diabetes or other illness that would complicate your pregnancy?
Do you have any other condition(s)?






Signature



If you are the authorized representative, you must sign above and provide the following information.





How do I appoint a representative?