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Member benefit changes and clarifications for commercial members

October 31, 2014

Effective January 1, 2015, unless otherwise noted, the following member benefits changes and clarifications will be implemented for several commercial programs for Pennsylvania members:

Type of benefit/service Plans affected Change/clarification Precertification for BlueCard® providers effective July 1, 2014 POS ? Self-referred only DPOS ? Self-referred only PPO ? All Language is being revised to indicate that BlueCard providers are now responsible for obtaining precertification for inpatient admissions. However, for all other covered services received from BlueCard providers, members will still be responsible for obtaining precertification, if required. In addition, members continue to be responsible for obtaining precertification for all services that require precertification if they use a non-participating provider. Subrogation HMO ? All POS ? All DPOS ? All PPO ? All Major Medical ? All Hospitalization ? All Freestanding Vision and Rx ? All Language is being updated to allow Independence to better enforce its subrogation rights and obtain reimbursement for its costs when a third party is involved. After-hours/home visits ? PCP copayment HMO ? Non-Flex only POS ? Non-Flex only Language indicating separate copayments for after-hours visits and home visits has been removed from the benefits booklet and the schedule of covered services. The primary care physician (PCP) office visit copayment will apply for these services.

Please call Customer Service at 1-800-ASK-BLUE with any questions.


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