---
kind: "section"
citation: "29 U.S.C. § 1185g"
title: "29"
title_heading: "Labor"
number: "1185g"
heading: "Continuity of care"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/29/1185g"
units:
  - "Chapter 18 — Employee Retirement Income Security Program"
  - "Subchapter I — Protection of Employee Benefit Rights"
  - "Subtitle B — Regulatory Provisions"
  - "Part 7 — group health plan requirements"
  - "Subpart B — Other Requirements"
---

# §1185g. Continuity of care

- (a) **Ensuring continuity of care with respect to terminations of certain contractual relationships resulting in changes in provider network status—**
  - (1) **In general—** In the case of an [individual](/usc/29/1301.md?p=a-14-C-ii-V) with benefits under a [group health plan](/usc/29/1167.md?p=1) or [group health insurance coverage](/usc/29/1191b.md?p=b-4) offered by a [health insurance issuer](/usc/29/1191b.md?p=b-2) and with respect to a health care provider or facility that has a contractual relationship with such plan or such issuer (as applicable) for furnishing items and services under such plan or such coverage, if, while such [individual](/usc/29/1301.md?p=a-14-C-ii-V) is a continuing care patient (as defined in [subsection (b)](#b)) with respect to such provider or facility—
    - (A) such contractual relationship is terminated (as defined in paragraph (b));
    - (B) benefits provided under such plan or such [health insurance coverage](/usc/29/1191b.md?p=b-1) with respect to such provider or facility are terminated because of a change in the terms of the participation of the provider or facility in such plan or coverage; or
    - (C) a contract between such [group health plan](/usc/29/1167.md?p=1) and a [health insurance issuer](/usc/29/1191b.md?p=b-2) offering [health insurance coverage](/usc/29/1191b.md?p=b-1) in connection with such plan is terminated, resulting in a loss of benefits provided under such plan with respect to such provider or facility;

    the plan or issuer, respectively, shall meet the requirements of [paragraph (2)](#a-2) with respect to such [individual](/usc/29/1301.md?p=a-14-C-ii-V).

  - (2) **Requirements—** The requirements of this paragraph are that the plan or issuer—
    - (A) notify each [individual](/usc/29/1301.md?p=a-14-C-ii-V) enrolled under such plan or coverage who is a continuing care patient with respect to a provider or facility at the time of a termination described in [paragraph (1)](#a-1) affecting such provider or facility on a timely basis of such termination and such [individual](/usc/29/1301.md?p=a-14-C-ii-V)’s right to elect continued transitional care from such provider or facility under this section;
    - (B) provide such [individual](/usc/29/1301.md?p=a-14-C-ii-V) with an opportunity to notify the plan or issuer of the [individual](/usc/29/1301.md?p=a-14-C-ii-V)’s need for transitional care; and
    - (C) permit the patient to elect to continue to have benefits provided under such plan or such coverage, under the same terms and conditions as would have applied and with respect to such items and services as would have been covered under such plan or coverage had such termination not occurred, with respect to the course of treatment furnished by such provider or facility relating to such [individual](/usc/29/1301.md?p=a-14-C-ii-V)’s status as a continuing care patient during the period beginning on the date on which the notice under [subparagraph (A)](#a-2-A) is provided and ending on the earlier of—
      - (i) the 90-day period beginning on such date; or
      - (ii) the date on which such [individual](/usc/29/1301.md?p=a-14-C-ii-V) is no longer a continuing care patient with respect to such provider or facility.
- (b) **Definitions—** In this section:
  - (1) **Continuing care patient—** The term “continuing care patient” means an [individual](/usc/29/1301.md?p=a-14-C-ii-V) who, with respect to a provider or facility—
    - (A) is undergoing a course of treatment for a serious and complex condition from the provider or facility;
    - (B) is undergoing a course of institutional or inpatient care from the provider or facility;
    - (C) is scheduled to undergo nonelective surgery from the provide or facility, including receipt of postoperative care from such provider or facility with respect to such a surgery;
    - (D) is pregnant and undergoing a course of treatment for the pregnancy from the provider or facility; or
    - (E) is or was determined to be terminally ill (as determined under [section 1395x(dd)(3)(A) of title 42](/usc/42/1395x.md?p=dd-3-A)) and is receiving treatment for such illness from such provider or facility.
  - (2) **Serious and complex condition—** The term “serious and complex condition” means, with respect to a participant or beneficiary under a [group health plan](/usc/29/1167.md?p=1) or [group health insurance coverage](/usc/29/1191b.md?p=b-4)—
    - (A) in the case of an acute illness, a condition that is serious enough to require specialized medical treatment to avoid the reasonable possibility of death or permanent harm; or
    - (B) in the case of a chronic illness or condition, a condition that—
      - (i) is life-threatening, degenerative, potentially disabling, or congenital; and
      - (ii) requires specialized [medical care](/usc/29/1191b.md?p=a-2) over a prolonged period of time.
  - (3) **Terminated—** The term “terminated” includes, with respect to a contract, the expiration or nonrenewal of the contract, but does not include a termination of the contract for failure to meet applicable quality standards or for fraud.

## Source credit

(Pub. L. 93–406, title I, § 718, as added Pub. L. 116–260, div. BB, title I, § 113(c)(1), Dec. 27, 2020, 134 Stat. 2871.)

## Notes

### Statutory Notes and Related Subsidiaries

### Effective Date

Section applicable with respect to plan years beginning on or after Jan. 1, 2022, see section 113(e) of div. BB of Pub. L. 116–260, set out as a note under section 9818 of Title 26, Internal Revenue Code.