First Priority Health--BlueCare HMO Individual Conversion Rate Filing; Rate Filing [38 Pa.B. 3953]
[Saturday, July 19, 2008]By filing No. H-1423-FPH NGConver-10-01-2008, First Priority Health requests approval to increase the BlueCare HMO Individual Conversion rates by an average of 12.6%. This filing will affect approximately 1,300 monthly members and will generate additional revenue of approximately $574,450 annually. The requested effective date of the change is October 1, 2008.
This filing also proposes to make the following benefit changes:
* Primary Care Physicians/Pediatric Preventive Care--Copay changed from $10 per visit to $20 per visit.
* Specialist/Outpatient Mental Health--Copay changed from $10 to $40 per visit.
* Emergency Room--Copay changed from $25 to $100 per visit.
* Inpatient Hospitalization/Skilled Nursing Facility/Inpatient Mental Health/Substance Abuse--Benefit changed from 100% coverage with no copay per visit to $100 copay per admission.
* Outpatient Surgery (facility fees)--Benefit changed from 100% coverage with no copay to $100 copay in SPU, hospital outpatient department or free-standing surgical facility.
* Home Health/Home Infusion Therapy--Copay changed from $20 to $15 per visit.
* Outpatient Diagnostic, MRI, MRA, CTSCAN, PET SCAN--Benefit changed from 100% coverage with no copay to $75 copay per test/scan.
* Physical/Speech/Occupational Therapy--Benefit changed from 100% coverage with no copay to $40 per visit per provider.
* DME/Orthotics/Prosthetics--from 100% coverage up to $2,500 combined calendar year max to 100% coverage up to $5,000 combined calendar year max.
* Diabetic Supplies--from $8 copay to $20 per script for equipment and supplies.
In addition, the rates will be changed from 4 tiers to 5 tiers by separating out the rates for Parent/Child and Parent/Children. The previous changes are being made in order to provide affordable and adequate health care coverage to the members and bring more personal accountability.
Unless formal administrative action is taken prior to September 25, 2008, the subject filing may be deemed approved by operation of law.
A copy of the filing is available on the Insurance Department's (Department) web site 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 Department's Harrisburg Regional office.
Interested parties are invited to submit written comments, suggestions or objections to Rashmi Mathur, Insurance Department, Insurance Product Regulation and Market Enforcement, Room 1311, Strawberry Square, Harrisburg, PA 17120, rmathur@state.pa.us within 30 days after publication of this notice in the Pennsylvania Bulletin.
JOEL SCOTT ARIO,
Insurance Commissioner[Pa.B. Doc. No. 08-1351. Filed for public inspection July 18, 2008, 9:00 a.m.]
