2008 annual benefit changes

(November 30, 2007) - Priority Health reviews and makes changes to benefits each year. Here's what's new for Priority Health plans that are effective January 1, 2008, or later.

For 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.

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

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Changes to coverage for short-term rehabilitative treatment

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

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 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

Members should monitor use of their chiropractic benefit
If members have a medical condition or mishap (like an accident or a stroke), they could quickly use up their 30-visit limit for combined chiropractic care and physical therapy and occupational therapy.

The amount members will pay depends on their plan:

PriorityHMO^SM

• If the plan has a deductible, members may need to meet it before coverage begins.
• Then, the copay for each visit will be the same amount you pay to see a primary care doctor or other primary care provider.
• In the past, there was a $200 cumulative limit on member copayments. This limit has been eliminated in 2008.

PriorityPOS^SM

• If members use a Preferred therapist or chiropractor, the primary care copay will apply after they meet their deductible (if applicable).
• If members choose an Alternate therapist or chiropractor, the coinsurance will be 50% of the charges.
  

PriorityPPO^SM

• If the member has a Health Savings Account (HSA), they'll need to meet the deductible before the copayment benefit begins.
• 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%.

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Changes to prescription coverage and contraceptive coverage

Changes to contraceptive coverage
If members have contraceptive coverage through Priority Health, coverage has been expanded to include contraceptive devices including IUDs and implantable contraceptive drugs.

Changes to standard prescription supply
Eastern Region members (formerly members of Care Choices) received 34-day refills on one-month prescriptions in 2007. They will now receive Priority Health's standard 31-day supply when filling a monthly prescription.

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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.

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Changes to out-of-pocket maximums

The out-of-pocket maximum may be changing in some plans.