2013 FEP benefits feature new preventive care benefits and more

We’re providing an overview of the 2013 changes in our Federal Employee Program^® benefits. These changes include benefits for a range of preventive care services for adults age 22 and older — including the preventive services recommended under the Patient Protection and Affordable Care Act. Your patients’ FEP benefits are also impacted for prescription drugs, hospice care, urgent care and more.

We’ve outlined the 2013 benefit changes below.

The following changes apply to both the Standard and Basic Option benefit plans for services provided on or after Jan. 1, 2013.

Women’s care

• We now cover preventive care benefits to screen for human papillomavirus, also known as HPV, for females once per year. Previously, benefits for HPV screening were included in the benefit for cervical cancer tests.
• Women who are breast-feeding or nursing are covered for one breast pump kit per year when purchased through CVS Caremark.
• Women have full coverage for certain contraceptive services and voluntary sterilization procedures when performed by a preferred provider.
• Women have full coverage for generic contraceptive drugs and devices when purchased at a preferred retail or online pharmacy. Women with Standard Option benefits are also fully covered if the contraceptive drugs or devices are obtained through the Mail Service Pharmacy Program.
• Women are fully covered for over-the-counter contraceptive drugs and devices, provided they meet the Food and Drug Administration’s standard for OTC products. They also must be purchased at a preferred retail pharmacy with a physician’s prescription.

Specialty drugs
The cost-sharing for specialty drugs used to treat rare or uncommon conditions — and available only through a preferred retail pharmacy due to manufacturer restrictions — are now consistent with the Specialty Drug Pharmacy Program cost-sharing.

After-hours care
Benefits cover professional charges for after-hours care (shift differentials) when associated with services provided in a physician’s office.

Hearing aids

• Benefits for hearing aids and supplies for children up to age 22 have been increased up to a $2,500 limit per calendar year.
• Benefits for hearing aids and supplies for adults age 22 and older have been increased up to a $2,500 limit per three calendar years.
• Benefits for bone-anchored hearing aids for adults and children have been increased up to a $5,000 limit per calendar year.

Hospice care
Coverage is available for up to 30 consecutive days of inpatient hospice care in a licensed facility. Full benefits are provided when care is performed at a preferred hospice facility.

Residential treatment centers
We’ve clarified that benefits are not available for services performed or billed by residential treatment centers.

Organ transplants
Additional types of organ and tissue transplants are now covered.

Standard Option only
These changes apply only to Standard Option members for services incurred on or after Jan. 1, 2013:

• We modified the list of generic drug replacements included in our Standard Option Generic Incentive Program.
• Copayment for services provided at a preferred urgent care center is now $40 per visit.
• Copayment for continuous home hospice care, when performed by a preferred provider is now $250 per episode.

Basic Option only
The following changes apply only to Basic Option members for services incurred on or after Jan. 1, 2013:

• Copayment for outpatient physical, occupational and speech therapy by a preferred hospital is now $25 per day per facility. Benefits are limited to a total of 50 visits per person, per calendar year.
• Copayment for outpatient cardiac rehabilitation, cognitive rehabilitation and pulmonary rehabilitation by a preferred hospital is now $25 per day per facility.
• Copayment for certain outpatient surgical and treatment services is now $100 per day per facility when services are performed at a preferred facility.
• Copayment for certain outpatient diagnostic studies and radiological services is now $100 per day per facility.
• Benefits for diagnostic tests related to an accidental injury and performed in settings other than an emergency room or urgent care center may be subject to a copayment of $25, $75 or $100, according to the type of test performed and the provider billing for the test.
• We now provide full coverage for agents, drugs or supplies administered or obtained in connection with care at a preferred urgent care center.