Medicare Plan Benefit Changes Effective July 1, 2013

For other benefit information, see the individual Medicare Health Plan sections.

ALL MEDICARE AND NON-MEDICARE HEALTH PLANS

Wellness Benefits:  To encourage exercise and smoking cessation, the GIC is implementing two new benefits:

    • Gym membership reimbursement benefits of at least $100 per family.  Some plans supplement this amount. 
    • Tobacco and smoking cessation counseling benefits will be standardized across all plans to include individual or group counseling via phone or face to face up to 300 minutes with no copayment.  There are no restrictions to counseling access, and no requirement to complete a smoking cessation program or treatment (including nicotine replacement products) as a pre-condition of access to counseling.

Portable Oxygen Concentrators will be covered under the Durable Medical Equipment benefit.

State and Federal Mandates: 

    • Hearing Aids covered up to $2,000 per ear per person for children up to age 22 per 36-month period.
    • Cleft Lip and Cleft Palate coverage for children under age 18.  Includes medical, dental, oral and facial surgery; surgical management; and follow-up care for the treatment of cleft lip and cleft palate.
    • Oral Cancer medications will be covered on a basis no less favorable than covered for intravenously administered or injected cancer medications.
    • Women’s Preventive Care, as required by federal health care reform,  not subject to deductibles or copays

MEDICARE HEALTH PLAN

UniCare State Indemnity Plan/Medicare Extension (OME)

Mental Health and Substance Abuse Benefits Carrier:  The GIC has selected Beacon Health Strategies as the new mental health carrier.  There are no mental health and substance abuse benefit changes and Beacon will work with members and their providers to ensure a smooth transition.

This information provided by the Group Insurance Commission.