Every year, Independence 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.
In an effort to provide you with information affecting your Independence
patients, the following is a summary of this year’s member benefit
language changes and clarifications,
effective January 1,
2020:
Type of benefit/service
|
Plans affected
|
Change/clarification
|
Acupuncture
|
HMO
POS/DPOS
EPO
PPO
|
Language has been updated to remove examples of when acupuncture can be
used. Acupuncture treatment is based on medical necessity and guided by medical
policy.
|
Inpatient/Birthing Center
|
HMO
POS/DPOS
EPO
PPO
|
Language has been updated to replace the term “Maternity/Obstetrics
Care Facility” with “Inpatient/Birthing Center” in the
Schedule of Covered Services document.
|
Effective January 1, 2020, the following changes apply to
members with an Independence prescription drug benefit:
Type of benefit/service
|
Plans affected
|
Change/clarification
|
Convenience packs
|
HMO
POS/DPOS
EPO
PPO
|
Language has been updated to state that “convenience packs” are
not covered under the pharmacy benefit. Convenience packs contain two or more
drug products in one package. These packs have a unique national drug code.
They may include low-cost generic prescription drugs, common over-the-counter
products, and/or products not approved by the U.S. Food and Drug
Administration.
|
Tier descriptions
|
HMO POS/DPOS
PPO
|
Language has been updated to clarify that the non-preferred and specialty
drug tiers include generic drugs. Non-preferred drugs generally have one or
more generic or preferred brand options in the same drug class. They are
subject to the Non-preferred drug cost-sharing (i.e., copayment, deductible,
and coinsurance). Some generic drugs are in the Specialty tier and have
Specialty drug cost-sharing.
|
Split fills
|
HMO
POS/DPOS
EPO
PPO
|
Language has been updated to clarify that “split fill” (i.e., a
single prescription dispensed in two amounts) is applicable for the first fill
and subsequent fills during the first three months of therapy. The
first amount is dispensed right away, but the second amount can be delayed if a
different dose is needed or if there are negative side effects. Cost-sharing is
prorated for each amount of the split fill.
|
Please call Customer Service at 1-800-ASK-BLUE (1-800-275-2583) with
any questions.