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Benefits changes and clarifications for commercial members 

November 1, 2012    


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 servicePlans affectedChange/clarification
Group premium changeAll HMO, All POS, All PPOLanguage 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
insured contracts.
Podiatry capitation removalAll HMO, All POSLanguage 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
of contracts
All HMO, All POS, All PPOLanguage 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 claimsAll PPOTo 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 CentersAll HMO, All POS, All PPONew definitions and descriptions of the terms Urgent Care Center and Retail Clinic are being added to member booklets and contracts.
Women’s Preventive HealthAll HMO, All POS, All PPOAs 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 processAll HMO, All POS, All PPO, All TraditionalThe appeals process is being updated to reflect the external review process as required by the Patient Protection and
Affordable Care Act.




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Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.