Every year, AmeriHealth Pennsylvania evaluates our health plans to determine if language should be revised to describe more clearly the benefits of each of these plans. Members are notified by mail of these changes.
All health plan amendments with the revised benefit language are available online.
Here is a summary of the 2022 changes.
Medical benefits
|
|---|
Type of benefit/service
| Plans affected
| Change/clarification
|
Gene Replacement Therapy
| ALL plans
| Language was updated
to identify and clarify Gene Therapy and Gene Replacement Therapies. The
language now addresses the broad term (Gene Therapy) or associated services
that may have genetic components and defines Gene Replacement Therapies as a
class of specialty drugs.
|
Dual Drug Coverage cost-share
| ALL plans
| Language was updated
related to drugs that could be covered under either the medical benefit (when
administered by a health care professional) or prescription drug benefit (when
self-administered). The language now clarifies that dual coverage drugs may
have different cost-shares.
|
Prescription drug benefits
|
|---|
Type of benefit/service
| Plans affected
| Change/clarification
|
Generic Contraceptive coverage
Effective date on or after
January 1, 2022, when your plan benefits renew
| ALL plans
| Language was updated
about the cost-share for generic contraceptives. The new language clarifies
that not all generic contraceptives are available at $0 cost-share.
|
Providers can verify members' benefits and cost-sharing (i.e., copayment, coinsurance, deductible) using the Eligibility & Benefits transaction within PEAR Practice Management on the PEAR portal.
Please call Customer Service at 1-800-275-2583 with questions about these changes.