Contract Filings 00-9

Bulletin

DATE:

March 8, 2000

TO:

Small Group Health Maintenance Organizations

RE:

Contract Filings

Bulletin No: Life and Health 00-9

We would like to bring to your attention revisions that will be required of the small group

contracts issued or renewed on or after July 1, 2000. These revisions were published in the

Maryland Register on October 22, 1999. Notice of Final Action was published in the Maryland

Register on January 28, 2000.

We recommend that these changes be made through an amendment rider which will be

attached to the group policy and certificate. Please specify the form number and date of approval

of the policy to which the amendment rider will be attached. To ensure approval by July 1,

2000, the filings must be received by this Administration by May 1, 2000.

Revisions Required By COMAR 31.11.06

♦ New benefit for annual chlamydia screening test. See COMAR 31.11.06.03A(33).

♦ Prescription Drug Benefit

New requirement for Carriers to cover drugs through an open formulary, consisting of

generic, preferred brand-name, and non-preferred brand-name drugs. See COMAR

31.11.06.03E(2).

New three tier copayments for prescription drugs:

1. $15 for generic drugs;

2. $20 for preferred brand-name drugs; or

3. $30 for non-preferred brand-name drugs.

See COMAR 31.11.06.05H(3).

Revised cost sharing for up to a 90-day supply of maintenance drugs dispensed in a

single dispensing of a prescription:

1. For generic maintenance drugs, one $30 copayment;

2. For preferred brand-name maintenance drugs, one $40 copayment; and

3. For non-preferred brand-name maintenance drugs, one $60 copayment.

See COMAR 31.11.06.05H(5).

non-preferred brand-name drugs.

See COMAR 31.11.06.05H(3).

Revised cost sharing for up to a 90-day supply of maintenance drugs dispensed in a

single dispensing of a prescription:

1. For generic maintenance drugs, one $30 copayment;

2. For preferred brand-name maintenance drugs, one $40 copayment; and

3. For non-preferred brand-name maintenance drugs, one $60 copayment.

See COMAR 31.11.06.05H(5).

March 8, 2000

Page 2

Deleted the prohibition against a carrier reimbursing a health care practitioner in an

amount that is less than the cost to the practitioner for oncology drugs used in treating a

patient in the practitioner’s office. See COMAR 31.11.06.03E(3).

♦ Smoking Cessation Exclusion

Modified Exclusion #39 to delete smoking cessation. Added new Exclusion #52 for

services related to smoking cessation. See COMAR 31.11.06.06B(39) and (52).

We are enclosing copies of the changes to the small group regulations published October 22,

1999. Please note that the above summary does not include all changes to the regulations; it

details only the changes which are required by July 1, 2000. Changes that were required by

November 1, 1999 were detailed in Bulletin 99-18.

Please contact Ellen Woodall, Supervisor, Managed Care Unit at (410) 468-2226 if you have

any questions regarding these filings.

____________________________________

Donna B. Imhoff

Associate Commissioner