HealtheNet Update on Eligibility

HealtheNet Update on Eligibility Response Screen for Independent Health

Independent Health began to charge a member cost share on medications that are administered in an office/outpatient facility setting. This change was applied to the following plans:

  • Select Medicare Advantage plans
  • Select Exchange Plans (Platinum, Gold, Silver, Bronze)

To determine if the member has a cost share for the plans indicated above, the following message has been added to the Eligibility Response in the Additional Information section under Plan Benefit Detail:

Message for Medicare plans when applicable:

"Office/Outpatient Administered medications: 20% coinsurance will apply when administered in an office or outpatient setting (in addition to the office visit copay)"

Message for Exchange plans when applicable:

"Office/Outpatient Administered medications –member cost share may apply when administered in an office or OP hospital setting (in addition to the office visit copay). Contact plan for cost share information."

Please reference the screen shot below:

Medicare Plans:

Exchange Plans: