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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

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HSA Benefit Summaries effective 1/1/2012 (2012 amounts)

PW_E177187
Lumenos Open Access POS Consumer Driven Health Plans with Rx Copays  
For HSA plan designs, the incentives for Fully Insured groups are available as gift cards only, so the benefit summary language is different. Please select the benefit summary under the correct funding arrangement.  

Incentive Plans (Non-Embedded Deductible) 
Fully Insured Groups 
Self Funded Groups (ASO) 
Open Access POS CDHP w/Rx Copays GHSA177 
Open Access POS CDHP w/Rx Copays GHSA177 
Open Access POS CDHP w/Rx Copays GHSA178 
Open Access POS CDHP w/Rx Copays GHSA178 
 

Incentive Plans (Embedded Deductible) 
Fully Insured Groups 
Self Funded Groups (ASO) 
Open Access POS CDHP w/Rx Copays GHSA181 
Open Access POS CDHP w/Rx Copays GHSA181 
Open Access POS CDHP w/Rx Copays GHSA182 
Open Access POS CDHP w/Rx Copays GHSA182 
 
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