Benefit language changes and clarifications for AmeriHealth Pennsylvania members

December 15, 2020

​Every year, AmeriHealth Pennsylvania evaluates our health plans to determine if language should be revised to more clearly describe the benefits provided in 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 January 1, 2021, changes.

Medical benefits

Type of benefit/service Plans affected Change/clarification

Chemotherapy and Experimental/Investigative services

HMO and POS self-referred

Language about FDA-approved drug usage. The language now addresses other off-label factors that may affect coverage for the drug. The off-label factors include dosage, frequency, and how the drug or service is administered.

Preventive definition

Large Group POS self-referred plans ONLY

Examples of preventive services have been removed. The medical policy defines what is considered a preventive service.

Prescription drug benefits

Type of benefit/service Plans affected Change/clarification

Coupon accumulations

HMO and freestanding drug

Language about the scope and description of the coupon accumulator program. The new language includes a broader description and more accurately reflects the program.

Providers can verify members' benefits and cost-sharing (i.e., copayment, coinsurance, deductible) using the Eligibility and Benefits Inquiry transaction on the NaviNet® web portal (NaviNet Open).

Please call Customer Service at 1-800-275-2583 with questions about these changes.

NaviNet® is a registered trademark of NantHealth.