Pennsylvania Bulletin

PA Bulletin, Doc. No. 04-828

NOTICES

Highmark Blue Cross Blue Shield; Guaranteed Issue PreferredBlue Individual PPO Plan; Rate Filing

[34 Pa.B. 2519]

   On April 19, 2004, the Insurance Department (Department) received from Highmark Blue Cross Blue Shield filing no. 1-GI/INGPPO-04-HBCBS for a rate increase of 15.1% and to modify the benefit level for the Guaranteed Issue PreferredBlue Individual PPO Plan in the western region. The following changes to the benefit design are being requested:

PreferredBlue PPO (Comprehensive Major Medical Preferred Provider--Guaranteed Issue)

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 --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 --$25,000 Maximum per
Calendar Year per
Individual for Prescription
Drugs, Separate from
Lifetime Maximum.

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

   The company requests an overall 15.1% increase amounting to $1.12 million annually and will impact approximately 1,300 contracts. The requested effective date is July 1, 2004.

   Unless formal administrative action is taken prior to July 14, 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. 04-828. Filed for public inspection May 7, 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	--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	--$25,000 Maximum per Calendar Year per Individual for Prescription Drugs, Separate from Lifetime Maximum.
Prescription Drug Out-of-Pocket Limit	--$3,000 in Coinsurance Expense for Covered Prescription Drugs per Member per Calendar Year.	--Same	--Remove $3,000 Out-of-Pocket Maximum.