Independence has introduced new medical and pharmacy product portfolios that will be available to large group (51+) commercial fully insured and self-funded customers for 2018. The new portfolio options will be offered to new and renewing customers beginning with January 1, 2018, effective dates.
The new portfolios feature modern plan designs that were strategically developed to better manage health care costs. Plans in the portfolios include innovative product concepts and cost-management programs, such as site-of-service benefit differentials, tiered network plans, and a restricted drug formulary called Value Formulary.
Below are additional details on these new plans and plan design features:
- Site-of-service benefit differentials. New site-of-service plan designs allow members to save — in some cases hundreds of dollars — based on where they receive care. Services that members can save on include:
- – preventive colonoscopy
- – outpatient lab*
- – outpatient surgery
- – physical/occupational therapy*
- – routine/complex radiology*
- PPO tiered network plans. The new medical portfolio includes two PPO tiered network plan designs to meet the needs of customers. Acute care facilities and ambulatory surgical centers are grouped into one of two in-network tiers, based on cost and quality measures. With these options, members pay lower out-of-pocket costs when they receive care from tier 1 providers.
- New Value Formulary. All new plans will use the Value Formulary, a new comprehensive list of generic, brand, and specialty drugs. Drugs are included on the Value Formulary based on medical effectiveness, positive results, and value. Because the Value Formulary is restricted, some drugs may not be covered when there are alternative medications used to treat the same condition in a more cost-effective manner. More information about the new Value Formulary is available on our website.
To ensure our members have the best experience possible when seeking care, we will contact members who are enrolled in new site-of-service and tiered network benefit plans or one of the new Value Formulary prescription drug plans to help them make appropriate network choices for their care.
We will publish more detailed information in future Partners in Health UpdateSM articles to help you navigate these new plans when members present to your provider office for care.
*Available under PPO options only.