Under the Patient Protection and Affordable Care Act, also known as Health Care Reform, members should not becharged any cost-sharing (i.e., copayments, coinsurance, and deductibles) once their annual out-of-pocket limit foressential health benefits has been met. These limits are based on the member's benefit plan. While individual andgroup benefit limits may be lower, they cannot exceed the following amounts:

• Individual: $6,350
• Family: $12,700

Once members have reached their out-of-pocket maximum for essential health benefits, providers should not collectadditional cost-sharing. To verify if members have reached their out-of pocket maximum for essential health benefits,providers should use the Eligibility and Benefits Inquiry transaction on the NaviNet^® web portal. However, due to ourtransition to a new operating platform for AmeriHealth members, the process differs depending on whether the member has been migrated. Thesteps are outlined below.

For migrated AmeriHealth Pennsylvania members

Once on the Eligibility and Benefits Details screen, the member's current out-of-pocket expense (AccumulatedAmount) and the maximum dollar limit (Threshold Amount) will be displayed at the bottom of the screen in the BenefitAccumulator section.

For non-migrated members

Once on the Eligibility and Benefits Details screen, providers will first need to select the Additional Copays link toverify the copayment maximums and secondly select the Dollar Accumulators link to view the total out-of-pocketamount accumulated to date.

If your office is not yet NaviNet-enabled, you can sign up by going to NaviNet and selecting Sign Up at thetop right.

If you have any questions about this change, please call Customer Service at 1-800-275-2583 for providers inPennsylvania and Delaware and at 1-888-YOUR-AH1 (1-888-968-7241) for providers In New Jersey. If you haveany questions regarding NaviNet transactions, please call the eBusiness Hotline at 215-640-7410 for providers inPennsylvania and Delaware and at 609-662-2565 for providers in New Jersey.

Note: Cost-sharing amounts are available to members through their benefit materials or by logging on to our securemember website.

NaviNet^® is a registered trademark of NaviNet, Inc.