Changes to Benefits for our Commercial Fully Funded Members

Posted on May 28, 2019

Effective July 1, 2019, the following covered benefits for our Fully Funded Commercial members will be adjusted:

• Sleep Studies – the limit of two sleep studies per calendar year is removed.
• Maternity Admissions to Out-of-Plan and PHCS Hospitals for PPO and POS Plans only require prior authorization. Without prior approval, you may have a reduction of benefit.
• Human Leukocyte Antigen Testing – coverage is no longer limited to one test per member per lifetime. Health New England will cover the costs for testing for A, B, or DR antigens, or any combination of those. All other uses of HLA testing are covered when Medically Necessary.
• Behavioral Health and Substance Abuse Disorder Services through Teladoc® benefit is being added for members age 18 and older, non-emergency issues. The following covered benefit was adjusted recently, and we are communicating to our members in the upcoming April 2019 notice.
• Compression Stockings – up to three pairs of Medically Necessary compression stockings per calendar year will be covered but prior approval is required. Effective July 1, 2019,
• Health New England will not cover the following:
• Suit Therapy or the home use of a suit therapy device to treat any condition including, but not limited to, cerebral palsy or other neuromuscular conditions.

Categories: Provider Newsletter