NOTICES
Blue Cross of Northeastern Pennsylvania and Highmark Blue Shield; Rate Increase for Nongroup Major Medical; Rate Filing No. 753-MMNG-1/1/04
[33 Pa.B. 4866] Blue Cross of Northeastern Pennsylvania and Highmark Blue Shield submitted a filing requesting the Insurance Department's (Department) approval to increase the approved monthly rates by 20.65% for the Major Medical Nongroup Program for an effective date of January 1, 2004. Included in this filing are proposed benefit changes which include splitting the current $500 deductible into $250 deductible for medical services and $250 for Rx coverage with a three-tier copay structure (retail: $10 generic/$25 brand formulary/$45 nonformulary, mail services: $20/$60/$135) after the deductible is met. The plans have proposed removal of home health care, home infusion, skilled nursing facility care, private duty nursing care, respiratory therapy, pulmonary therapy and hospital inpatient care. In addition, the number of visits for physical therapy (20 visits), chiropractic care (20 visits), speech therapy (12 visits) and occupational therapy (12 visits) will be limited to the number of visits per calendar year as indicated. Currently, there is no limit on medically necessary therapy visits. The revised agreement will now only cover abortion services to avert the death of the mother or terminate pregnancies caused by rape or incest.
The 2004 rate filing for Nongroup Basic Blue Cross included a proposal to increase inpatient coverage from 60 days to 365 days and skilled nursing facility coverage of 60 days per calendar year. Also in this nongroup Basic Blue Cross filing, the number of the respiratory and pulmonary therapies visits will change from unlimited to 18 visits per calendar year. However, the requirement that the visits be within 90 days following an inpatient admission has been eliminated. The revised agreement will now only cover abortion services to avert the death of the mother or terminate pregnancies caused by rape or incest.
The filing will impact approximately 5,356 policyholders and will generate estimated additional revenue of $2.14 million.
Copies of the filing will be available for public inspection, by appointment, during normal working hours at the Department's regional offices in Harrisburg.
Interested parties are invited to submit written comments, suggestions or objections to Bharat Patel, Actuary, Life & Health Actuaries, Insurance Department, 1311 Strawberry Square, Harrisburg, PA 17120 within 30 days after the publication of this notice in the Pennsylvania Bulletin.
M. DIANE KOKEN,
Insurance Commissioner
[Pa.B. Doc. No. 03-1915. Filed for public inspection September 26, 2003, 9:00 a.m.]
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