New plans and benefit changes
In 2012 we’re adding some new plan designs that support patient care by encouraging members to seek preventive care and manage chronic conditions.
HealthbyChoice
Our expanded suite of HealthbyChoiceSM plans will motivate members to adopt healthier lifestyles in exchange for lower out-of-pocket costs. The plans ask for physician documentation of key health measures: Tobacco use, BMI, blood pressure, cholesterol and blood pressure.
- Each of the four HealthbyChoice plans – Motivations, Incentives, Progressions and Achievements has its own form. (You may recognize the Incentives and Achievements plans.)
- The web-based format will automatically provide the appropriate form for your patient.
- We’ll reimburse you $30 for each online completed form. (No reimbursement for paper forms.)
You’ll find an overview of the HealthbyChoice programs in the provider manual.
PriorityValue includes no-cost primary care visits
PriorityValueSM is a new, lower-cost plan option for employers. It offers lower premiums than some traditional plans, yet allows members to see their primary care providers for office-visits with no copayment or deductible.
Medicare Advantage plan changes effective Jan. 1, 2012
The tables below outline some copayment and coverage changes that will become effective on Jan. 1, 2012, for most Priority Health Medicare Advantage plans. Note: The copayment chart may not apply to some employer-sponsored plans.
Copay updates:
| Benefit type | 2012 copayment |
|---|
| Cardiac rehabilitation |
$15 |
| Intensive cardiac rehabilitation |
$15 |
| Pulmonary rehabilitation |
$15 |
| Emergency care |
$10 (Priority)/$15 (Value and Select PPO) |
| Chiropractic |
$20 |
| Mental health – group therapy |
$15 |
| Psychiatric services – group therapy |
$15 |
| Diagnostic radiological services (high-tech
radiology) |
$100 |
| Outpatient substance abuse – group therapy |
$15 |
| Glaucoma screenings |
$0 for high-risk members (chronic condition and
family history) |
Program coverage:
| 2012 benefit | Program/coverage updates |
|---|
| Shower and bath bars (DME) |
Not covered |
| Spine Center of Excellence |
Authorization requirements
now apply |
| Formulary: high-risk medications |
Removed high-risk medications from the
Medicare formulary |
| CMS excluded Part D medications |
CMS excludes some medications from Part
D coverage. Members may purchase these
excluded medications using our contracted
discount. |
| Dental |
Benefits added |
| Fitness |
Silver and Fit program offers free gym
memberships and home-based equipment. |
Topics: HealthbyChoice, Priority Health updates
