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Benefits changes and clarifications for commercial members
							
																	
						
							Professional; Facility; Ancillary
						
					 
					
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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
		insured contracts.
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
of contracts
	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.