Effective January 1, 2013,
unless otherwise noted, the following member benefits changes and clarifications will be
implemented for several commercial programs for Pennsylvania members:
|Type of service||Plans affected||Change/clarification|
|Group premium change||All HMO, All POS, All PPO||Language is being revised to allow Independence Blue Cross premium adjustment flexibility at any time during the|
course of the benefit year upon mutual consent, not just on the anniversary dates. Note: This change applies only to fully
|Podiatry capitation removal||All HMO, All POS||Language is being revised to remove capitation from Podiatry. Members with HMO and POS products will have access to any podiatrist in the network with the required referral. DPOS products will not require a referral.|
|Amendments to termination provisions|
|All HMO, All POS, All PPO||Language is being revised to allow flexibility for termination of group contracts and migration to other plans. Note: This|
change applies only to fully insured contracts.
|Timely filing for PPO claims||All PPO||To be consistent across all managed care products, the time frame for commercial PPO members to submit a claim is being reduced from 24 months to 12 months.|
|Urgent Care Centers||All HMO, All POS, All PPO||New definitions and descriptions of the terms Urgent Care Center and Retail Clinic are being added to member booklets and contracts.|
|Women’s Preventive Health||All HMO, All POS, All PPO||As required by the Patient Protection and Affordable Care Act, language is being updated to state that preventive care|
services for women are now covered at 100 percent. The new language will include the following clarifications:
- All FDA-approved contraceptive methods are covered at the in-network level with no cost-sharing under the medical component and at the generic level under the pharmacy component of coverage at retail and mail-order pharmacies.
- Comprehensive lactation support and counseling during pregnancy and/or postpartum period with no in-network cost-sharing are covered. One hundred percent coverage for the in-network rentals of breast pumps is also provided (subject to precertification).
|Appeals process||All HMO, All POS, All PPO, All Traditional||The appeals process is being updated to reflect the external review process as required by the Patient Protection and|
Affordable Care Act.