Section 153.04 - Access to Continuity of Care(1) For an Insured who: (a) is receiving an Active Course of Medical Treatment from a health care provider for a Serious Disease, including but not limited to cancer or cystic fibrosis, that if disrupted in the course of such medical treatment would pose an Undue Hardship to the Insured; and(b)1. began this Active Course of Medical Treatment before being enrolled in a Limited, Regional or Tiered Provider Network plan where the provider is not part of the Limited, Regional or Tiered Provider Network; or2. began this Active Course of Medical Treatment before being enrolled in a Tiered Provider Network plan where the provider is in the highest cost-sharing tier; the Carrier shall provide coverage for those medically necessary and covered Health Care Services that are part of that Active Course of Medical Treatment provided by that health care provider, to the extent required by 211 CMR 153.04(2).(2) A Carrier to which 211 CMR 153.04(1) applies shall provide coverage for the health care provider's covered Health Care Services for the duration of the Active Course of Medical Treatment during the Plan Year if: (a) the Insured's employer offers the Insured only a choice of Limited, Regional or Tiered Provider Network plans in which the health care provider is not part of any of the offered Limited, Regional or Tiered Provider Networks or a choice of Tiered Provider Network plans in which the health care provider is in the highest cost-sharing tier; and(b) that health care provider is a Comprehensive Cancer Center, Pediatric Hospital or Pediatric Specialty Unit; and(c) that health care provider is providing the Insured with an Active Course of Medical Treatment that is not available from another provider in the Provider Network of the Insured's Health Benefit Plan.(3) For covered Health Care Services provided under 211 CMR 153.04 from a provider that is not in the Provider Network of the Insured's Health Benefit Plan, patient cost-sharing shall be at the lowest cost-sharing level applicable to those covered Health Care Services in the Health Benefit Plan, and reimbursement shall be based on median in-network rates of the specific health care provider in that Carrier's private Health Benefit Plans in a manner consistent with data filed by that Carrier with the Division of Health Care Finance and Policy; provided, however, that if the specific health care provider does not participate in any other Health Benefit Plan of the Carrier, then based on negotiated rates. For covered Health Care Services provided under 211 CMR 153.04 by a provider in the highest cost-sharing tier of a Tiered Provider Network plan, patient cost-sharing shall be based on the second-highest cost-sharing tier in that plan.(4) Notwithstanding 211 CMR 153.04(2), for an Insured who, before May 2, 2012: (a) began an Active Course of Medical Treatment from a health care provider that is a Comprehensive Cancer Center, Pediatric Hospital or Pediatric Specialty Unit for a Serious Disease, including but not limited to, cancer or cystic fibrosis, that if disrupted in the course of medical treatment would pose an Undue Hardship to the patient; and(b)1. began this Active Course of Medical Treatment before being enrolled in a Limited, Regional or Tiered Provider Network plan where the provider is not part of the Limited, Regional or Tiered Provider Network; or2. began this Active Course of Medical Treatment before being enrolled in a Tiered Provider Network plan where the provider is in the highest cost-sharing tier; the Carrier shall provide coverage for those medically necessary and covered Health Care Services that are part of that Active Course of Medical Treatment provided by that health care provider until April 30,2013 at the patient cost-sharing levels and reimbursement rates required by 211 CMR 153.04(3).