1026 Keystone Health Plan West, Inc. filing no. 1A-CHK-07-KHWP; forms and rates for new direct pay conversion HMO for Kids Plan; rate filing

INSURANCE DEPARTMENT

Keystone Health Plan West, Inc. Filing No. 1A-CHK-07-KHPW; Forms and Rates for New Direct Pay Conversion HMO for Kids Plan; Rate Filing

[37 Pa.B. 2667]
[Saturday, June 9, 2007]

   On May 14, 2007, by filing No. 1A-CHK-07-KHPW, Keystone Health Plan West, Inc. (KHPW) requested approval of forms and rates for Direct Pay Conversion HMO for Kids Plan. KHPW will convert members currently covered under the Caring Program for Children at Cost HMO group contract to this new conversion plan. The change would increase the premium rates for members effective September 1, 2007. The filing requests an increase of about 9.0% of current group premium, or an average of $8.45 per member per month. This will affect about 3,200 members and will produce additional premium income of $324,000 annually.

   In addition, KHPW has requested to include the following benefit changes in the Direct Pay Conversion HMO for Kids Plan from the current Caring Program for Children at Cost HMO group contract:

   *  A $10 copayment for PCP visits is being added.

   *  A $15 copayment for specialist visits is being added.

   *  A $25 copayment for mental health visits is being added.

   *  A $25 copayment for emergency room visits is being added (charge waived upon child's admittance).

   *  The $5 copayment for prescription drugs is moving to a $10/$18 copayment for generic/brand prescription drugs (2x copayment for mail order drugs).

   *  A $5 copayment for each of outpatient speech therapy, occupational therapy and physical medicine is being added.

   *  The 60 visit limit for therapies is moving to a 20 visit limit for each of outpatient speech therapy, occupational therapy and physical medicine visits.

   *  Coverage for hearing devices and exams is being removed.

   *  Coverage for dental and vision benefits is being removed.

   A copy of the filing is available on the Insurance Department's website at www.ins.state.pa.us. Under the Quick Links section, click on the link ''Rate Filings Published in the PA Bulletin.''

   Copies of the filing are also available for public inspection, by appointment, during normal working hours at the Insurance Department's Harrisburg office.

   Interested parties are invited to submit written comment's, suggestions or objections to Rashmi Mathur, Actuary, Bureau of Accident and Health Insurance, Insurance Department, 1311 Strawberry Square, Harrisburg, PA 17120, within 30 days after publication of this notice in the Pennsylvania Bulletin.

RANDOLPH L. ROHRBAUGH,   
Acting Insurance Commissioner

[Pa.B. Doc. No. 07-1026. Filed for public inspection June 8, 2007, 9:00 a.m.]