Pennsylvania Bulletin

PA Bulletin, Doc. No. 04-704

NOTICES

Highmark Blue Cross Blue Shield; Medically Underwritten Direct Pay PPO Filing; Rate Filing

[34 Pa.B. 2246]

   On April 9, 2004, the Insurance Department (Department) received from Highmark Blue Cross Blue Shield filing no. 1-DPPPO-04-HBCBS for a rate increase of 6.8% and to modify the benefit level for the medically underwritten direct pay PPO Plan in the Western Region. The following changes to the benefit design are being requested:

DirectBlue PPO (Comprehensive Major Medical Preferred Provider)

Benefit Provision Before July 1, 2004 July 1, 2004 through
December 31, 2004 January 1, 2005

Contract Year Maximum for Medical --None for Medical --$1 million for Medical per Individual combined for In-Network and Out-of-Network; part of lifetime maximum --Same

Medical Deductible In-Network --None --$250 Medical Deductible In-Network for Individual and $750 for Family --Same

Prescription Drug Deductible --$50 Prescription Drug Deductible per Calendar Year per Individual --Same --$100 Prescription Drug Deductible per Calendar Year per Individual. No 4th quarter carryover.

Prescription Drug Calendar Year Maximum --No Calendar Year Maximum for Prescription Drug. --Same --$50,000 Maximum per Calendar Year per Individual for Prescription Drugs; separate from lifetime maximum.

--$3,000 in Coinsurance Expense for Covered Prescription Drugs per Member per Calendar Year. --Remove $3,000 Out-of-Pocket maximum.

   The company requests an overall 6.8% increase amounting to $1.15 million annually and will impact approximately 5,800 contracts. The requested effective date is July 1, 2004.

   Unless formal administrative action is taken prior to July 7, 2004, the subject filing may be deemed approved by operation of law.

   A copy of the filing is available on the Department's website: www.ins.state.pa.us. To access the filing, select ''Consumer Information'' on the left side. Under ''General Information,'' click on ''Notices.'' The PDF copy is at the ''Filing.pdf'' link following the name of the filing.

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

   Interested parties are invited to submit written comments, suggestions or objections to Cherri Sanders-Jones, Insurance Department, Insurance Product Regulation and Market Enforcement, Room 1311, Strawberry Square, Harrisburg, PA 17120, csandersjo@state.pa.us within 30 days after publication of this notice in the Pennsylvania Bulletin.

M. DIANE KOKEN,
Insurance Commissioner

[Pa.B. Doc. No. 04-704. Filed for public inspection April 23, 2004, 9:00 a.m.]

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Benefit Provision	Before July 1, 2004	July 1, 2004 through December 31, 2004	January 1, 2005
Contract Year Maximum for Medical	--None for Medical	--$1 million for Medical per Individual combined for In-Network and Out-of-Network; part of lifetime maximum	--Same
Medical Deductible In-Network	--None	--$250 Medical Deductible In-Network for Individual and $750 for Family	--Same
Prescription Drug Deductible	--$50 Prescription Drug Deductible per Calendar Year per Individual	--Same	--$100 Prescription Drug Deductible per Calendar Year per Individual. No 4th quarter carryover.
Prescription Drug Calendar Year Maximum	--No Calendar Year Maximum for Prescription Drug.	--Same	--$50,000 Maximum per Calendar Year per Individual for Prescription Drugs; separate from lifetime maximum.
	--$3,000 in Coinsurance Expense for Covered Prescription Drugs per Member per Calendar Year.		--Remove $3,000 Out-of-Pocket maximum.