Skip to content Priority Health
Sections

Benefit changes for 2008 announced

(November 30, 2007) - Priority Health reviews and makes changes to benefits each year to enhance our products and to meet the needs of members and employers. Here's what's new for Priority Health plans that are effective January 1, 2008, or later.

These changes may not apply to plans that are funded directly by an employer, known as "self-funded" plans.

More details
For complete details about these and other changes, see our 2008 coverage documents (Certificate of Coverage, insurance policy or coverage agreement), which will be available January 1, 2008. You can then request the documents that apply to your plan by calling us at 800 446-5674.

Jump down to:
Changes to chiropractic care, occupational therapy, and other short-term rehabilitative treatments
Changes to prescription coverage and contraceptive coverage
Changes to student riders
Changes to out-of-pocket maximums

Changes to coverage for short-term rehabilitative treatment

"Short-term rehabilitative treatment" includes physical therapy, occupational therapy, spinal manipulations, chiropractic care, speech therapy, biofeedback, cardiac rehabilitation and pulmonary rehabilitation.

How many visits will be covered?
Beginning in 2008, we'll cover up to 90 short-term rehabilitative service visits. This can include
  • Up to 30 visits for physical and occupational therapy (including biofeedback and spinal manipulation by a chiropractor or osteopathic provider)
  • Up to 30 visits for speech therapy
  • Up to 30 visits for cardiac rehabilitation and pulmonary rehabilitation

Why should I avoid using my chiropractic benefit too quickly?
If you have a medical condition or mishap (like an accident or a stroke), you could quickly use up your 30-visit limit for combined chiropractic care and physical therapy and occupational therapy.

How much will I pay for short-term rehabilitative treatment with my PriorityHMO plan?
If your PriorityHMOSM plan has a deductible, you may need to meet it before coverage begins. Then
  • Your copay for each visit will be the same amount you pay to see your primary care doctor or other primary care provider.
  • In the past, there was a $200 cumulative limit on your copay. This limit has been eliminated in 2008.

How much will I pay for short-term rehabilitative treatment with my PriorityPOS plan?
If your PriorityPOSSM plan has a deductible, you may need to meet it before coverage begins. Then
  • If you use a Preferred health care provider, your "primary care" copay will apply after you meet your deductible.
  • If you choose an Alternate health care provider, the coinsurance you pay will be 50% of the charges. Priority Health will pay the other 50%.

How much will I pay for short-term rehabilitative treatment with my PriorityPPO plan?
  • If your PriorityPPOSM plan has a Health Savings Account (HSA), you'll need to meet your deductible before your copayment benefit applies.
  • If you choose an in-network therapist or chiropractor, your copay will be the same amount you pay to see your primary care doctor or provider.
  • If you choose an out-of-network therapist or chiropractor, you may need to meet your deductible before coverage begins. Once you meet your deductible, the coinsurance you pay will be 50% of the charges and Priority Health will pay the other 50%.

Changes to prescription coverage and contraceptive coverage


Contraceptive medications and devices
If you have contraceptive coverage through Priority Health, your coverage has been expanded to include contraceptive devices including IUDs and diaphragms, implantable and injectable contraceptive drugs. After members meet their deductibles, Priority Health will cover 50% of the cost.

Standard 31-day prescription supply
With Priority Health prescription coverage, all current members will receive a 31-day supply when filling a monthly prescription unless the employer purchases a 34-day supply rider.


Changes to student riders

Beginning in 2008, full-time students between the ages of 19 and 25 who take a leave of absence from school due to illness or injury will be covered.

Changes to out-of-pocket maximums

Most Priority Health plans have a maximum amount of coinsurance that you'll need to pay over the course of a plan year. If you reach this amount in a plan year, Priority Health will pay 100% of your eligible health care bills. This out-of-pocket maximum may be changing in some plans.

Last modified 03/20/08