As previously communicated in a Partners in Health UpdateSM article, Independence has introduced new medical and pharmacy product portfolios that will be available to Pennsylvania large group (51+) standard plans for 2020. The new portfolio options will be offered to new and renewing customers beginning with January 1, 2020, effective dates.
Medical benefits
Listed below are details of new and updated medical benefits:
- Cost effective site-of-service benefit differentials. New site-of-service benefits allow members to save on cost-sharing (i.e., copayment, deductible, and coinsurance) when accessing care, based on where that care is received. Additional services that members can save on include:
- biotech/specialty injectable drugs
- infusion therapy
- Observation room copayment. An observation room copayment, equal to the emergency room copayment in most cases, is being added to certain plans when that service is part of an emergency room visit or an inpatient stay. The member will not have more than two copayments when the observation room copayment is applied.
- Multiple copayments in an office setting. When multiple services are performed in an office setting, a copayment will be applied to each clinical service. For example, if an X-ray is taken during an office visit, the member will have one copayment for the office visit, and one copayment for the X-ray.
Telemedicine benefits
Telemedicine provides easy access to members when their primary care physician (PCP) is not available. Updates include:
- MDLIVE®. Members have access to board-certified physicians 24 hours a day, 7 days a week. Cost-share amounts will be lowered on most plans for this service beginning January 1, 2020.
- Penn Medicine OnDemand. Independence has partnered with Penn Medicine to bring a virtual primary care pilot to fully insured commercial members.* Advantages to this new pilot include:
- easy registration through the myPennMedicine app or online;
- access available as audio only or with video;
- results of each encounter can be shared with the member’s PCP.
*This benefit is available only to fully insured commercial members in the tri-state area.
Pharmacy benefits
Members can get up to a 90-day supply of maintenance medications at Walgreens pharmacies for the same cost-sharing as mail order.
Learn more
Additional information about these benefit additions and changes will be communicated in future Partners in Health Update articles.