11/21/2011
Update on implementation of the Self-administered Chemotherapy medication mandate
To meet the requirements of House Bill 1517, the Washington Self-administered Chemotherapy mandate, we'll cover prescribed, self-administered anti-cancer medication as explained below, according to the following schedule:
- Non-HSA groups: Zero dollar ($0) cost-share for members
- New groups: Beginning Jan. 1, 2012
- Existing groups: Upon renewal on or after Jan. 1, 2012
- Non-HSA Individual: Zero dollar ($0) cost-share for members
- Jan. 1, 2012: Across the board (i.e., both new and renewing Individual members)
- Individual HSA/HSA 100: Revising the prescription medication benefit to include coverage for brand and non-formulary self-administered chemotherapy medications under prescription plan benefits. Combined medical/prescription deductible and out-of-pocket maximum apply and benefits covered at Category 1 coinsurance levels.
- Jan. 1, 2012: Across the board (i.e., both new and renewing Individual members)
There will be no changes to Asuris HSA Healthplan 2.0SM for groups. Generic, brand and non-formulary self-administered chemotherapy medications, including oral, are already covered under existing prescription drug benefits, subject to the common medical deductible and standard coinsurance. Benefits are subject to the out-of-pocket maximum.
Self-insured groups aren't required to comply with this legislation. Groups that would like to opt in will need to accept our zero member cost-share benefit design.
Group contracts and benefit booklets will be updated to reflect this coverage. Individual members will receive a letter and Summary of Changes describing how their policy will be impacted by this mandate and other 2012 changes. You can see samples of these letters in our recent communication regarding Individual plan changes for 2012.
This approach is a change from what was previously announced. We apologize for any disruptions or re-work this may cause, but we trust that the enhanced benefit in some plans will be welcome news.
If you have any questions, please talk to your Asuris Sales contact.
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