As previously communicated in Partners in Health Update, AmeriHealth announced there is no member cost-sharing ($0) for certain preventive services provided to certain members. These new cost-sharing rules are mandated by the Federal Health Care Reform act known as the Patient Protection and Affordable Care Act of 2010.

The $0 copayment does not apply to problem-focused services. Problems that can easily be assessed and dealt with as part of the preventive services, such as blood pressure or cholesterol management, do not meet the criteria for collection of a copayment. However, if the member is experiencing a significant problem that requires a problem-focused service that could not be handled as part of the preventive services, such as a breast mass, uncontrolled diabetes requiring adjustment of medications, and follow-up at a shorter interval than would be normally anticipated, it would allow for cost-sharing.

For questions regarding member benefits, log on to the NaviNet? web portal and select Eligibility and Benefits Inquiry from the Plan Transactions menu. You can also use the Provider Automated System by calling 1-800-275-2583.

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