Effective January 1, 2018, unless otherwise noted, the following member benefit changes and clarifications will be implemented for several commercial programs for AmeriHealth Pennsylvania members:

Type of benefit/service Plans affected Change/clarification Alternative therapies/ complementary medicine HMO POS/DPOS The definition of complementary medicine has been updated to recognize the National Institutes of Health definition as the acceptable definition. Chemotherapy HMO POS/DPOS Language has been updated to include biologics as a type of chemotherapy and to require reliable evidence in addition to U.S. Food and Drug Administration approval to support the coverage of a drug or biologic. Durable medical equipment (medical supplies) HMO POS/DPOS The definition of consumable medical supply has been added. Consumable medical supplies have been included in the benefit exclusion language. Additional examples of excluded supplies have been added to the list. Experimental/investigative services HMO POS/DPOS Language has been updated to clarify that reliable evidence is required to support coverage of a drug or biologic. Guest AdvantageSM Program HMO Language has been removed. Coverage is not provided for routine and preventive care outside the local AmeriHealth Pennsylvania HMO coverage area. Urgent care and emergency care services are not impacted by this change. Hearing aids/cochlear implants HMO POS/DPOS Exclusion language has been updated to clarify that cochlear electromagnetic hearing devices are not considered cochlear implants. Mental health (serious mental illness health care, alcohol, or drug abuse) HMO POS/DPOS Language has been added to more clearly explain the exclusions for certain treatments for mental health care and alcohol abuse and dependency to avoid redundancy with other exclusions. Methadone maintenance treatment HMO POS/DPOS Language has been added to address coverage of in-network methadone maintenance treatment at $0 member cost-sharing. For plans with a deductible, the deductible must be met before the $0 cost-sharing applies. Oral surgery (dental services) HMO POS/DPOS Language has been updated to clarify that when oral surgery services are available under a member?s dental plan, AmeriHealth has the right to seek recovery from the dental plan. Travel vaccines HMO POS/DPOS Language has been revised to more clearly explain the exclusion of coverage for vaccines for travel or employment purposes. Treatment of sexual dysfunction HMO POS/DPOS Language has been updated to clarify the sexual dysfunction benefit exclusion to identify scenarios that fall under this exclusion. Women?s preventive services (diagnostic mammography)

Effective on or after January 1, 2018, based on when the member's plan benefits take effect.

HMO POS/DPOS Language has been updated to remove diagnostic mammography as a preventive service.

Effective January 1, 2018, the following change applies to Pennsylvania members with an AmeriHealth prescription drug benefit:

Type of benefit/service Plans affected Change/clarification Drug tier exception process All plans with a pharmacy benefit The updated formulary exception policy defines which drug tiers are eligible for tier exceptions* and describes how member cost-sharing is applied if tier exceptions are approved. The updated policy also defines the criteria for requesting coverage of a non-formulary (non-covered) medication.

*Tier exceptions can only be requested for coverage of non-preferred drugs at the preferred drug tier for brand drugs or at the generic tier for generic products. Specialty drugs are not eligible for tier exception requests. Visit our website to read the policy.

Please call Customer Service at 1-800-275-2583 with any questions.