Plan Year 2010 Information
for Non State Groups

Changes to Plan A in 2010:

• The annual deductible maximum will increase from $50 to $150 per person and from $100 to $300 per family for services. Copayments for office visits do not count toward the annual deductible.
• The annual coinsurance maximum will increase from $1,100 to $1,200 per person and $2,200 to $2,400 per family. After the coinsurance maximum is met, eligible services are covered at 100 percent for the remainder of the calendar year.
• The Quest Lab Card, which provides a way to save you money on outpatient laboratory tests, is now included on Plan A as well as Plan B.

Changes to Prescription Drug Coverage:

• The State is implementing the Performance Drug List for certain high blood pressure (ACE/ARB's), stomach acid reducers (PPI) and cholesterol lowering (HMGs) drugs.
• For these three classes of drugs, you must try a generic drug before you can be approved for a non preferred brand name drug. The claim system will review each member's history to determine if a generic has been tried.
• Those currently using a non preferred drug affected by this change will be notified by Caremark.

Changes to Dental Coverage:

• Plan deductible is increased to a maximum of $50 per person and $150 per family. The deductible now applies to both basic and major restorative care.
• Basic restorative services are now covered by a new value-based plan design! This plan design encourages members to seek preventive care services. Basic benefits are 50% for all basic restorative services regardless of the provider. However, those who have had at least one preventive or office visit for cleaning or exam of their teeth in the preceding 12 month period will qualify for the enhanced benefit level.
• For members that qualify for the enhanced benefit level, coinsurance for basic restorative services is 20% when performed by Delta PPO providers and 40% for Delta Premier and non network providers.