Effective January 1, 2015, unless otherwise noted, the
following member benefits changes and clarifications will be implemented for
several commercial programs for Pennsylvania members:
Type of benefit/service
Plans affected
Change/clarification
Precertification for BlueCard® providers effective July
1, 2014
POS ? Self-referred only
DPOS ? Self-referred only
PPO ? All
Language is being revised to indicate that BlueCard providers are now
responsible for obtaining precertification for inpatient admissions. However,
for all other covered services received from BlueCard providers, members will
still be responsible for obtaining precertification, if required. In addition,
members continue to be responsible for obtaining precertification for all
services that require precertification if they use a non-participating
provider.
Subrogation
HMO ? All
POS ? All
DPOS ? All
PPO ? All
Major Medical ? All
Hospitalization ? All
Freestanding Vision and Rx ? All
Language is being updated to allow Independence to better enforce its
subrogation rights and obtain reimbursement for its costs when a third party is
involved.
After-hours/home visits ? PCP copayment
HMO ? Non-Flex only
POS ? Non-Flex only
Language indicating separate copayments for after-hours visits and home visits
has been removed from the benefits booklet and the schedule of covered
services. The primary care physician (PCP) office visit copayment will apply
for these services.
Please call Customer Service at 1-800-ASK-BLUE with any
questions.