CDCHP is updating the AvidCare HMO contract. The following changes will take effect at the time of your re-enrollment in 2005:

•Routine adult physicals will no longer be copayment-free. Your usual visit fee will apply.  •Small groups (2 to 50) will be able to select a $15, $20, or $25 copayment.

•Routine eye exams (such as by an optometrist) will no longer be covered by the base plan every 24 months. Your group may add an optical rider to continue to cover this service. Simple vision screenings provided at a primary care physican (PCP) visit will still be covered, and annual eye exams will still be provided for diabetic patients.

•An inpatient hospitalization copayment of $500 will apply to all AvidCare plans.

•The annual copayment limit for family coverage will be reduced from four to two

•The inpatient hospital copayment will apply to inpatient physical rehabilitation, but that copayment will be waived for members being transferred from a hospital to rehabilitation for continued care of the same condition.  Inpatient rehab is still limited to 60 days per year.

•Skilled nursing facility (SNF) stays will be limited to 45 days per year. The inpatient hospital copayment will apply unless the member is admitted to the SNF within three days of being discharged from a hospital and the SNF care is in lieu of hospitalization.

•The private duty nursing benefit has been removed.

•A $75 facility copay will be charged for outpatient surgery at hospitals or freestanding facilites.

•Inpatient mental health stays will be limited to a maximum of 60 days per lifetime.•Inpatient chemical dependency and detoxification will be limited to seven days per calendar

•Copayments will increase for outpatient mental health care beyond the fourth visit. Visits five through 20 will cost $50 for individual therapy and $35 for group therapy.

•The coinsurance for durable medical equipment (DME) will increase from 20% to 50%. Prior authorization will be required for all rented DME and purchases of items costing $500 or more.

•Diabetic DME, such as blood glucose monitors and insulin pumps, will continue to be covered for the usual visit copayment. The visit copayment will also be charged for diabetic supplies, e.g. insulin, oral agents, urine strips. (These formerly cost the copayment 20%, whichever was less)

•Physical therapy, occupations therapy, and speech therapy will be subject to a combined limit of 30 visits per diagnosis per calendar year. Visits must occur within a 60-day time limit per injury or illness.

Please note: The selection of drug riders available to small groups with AvidCare is also changing for 2005 and will be limited to the following:

•$10 generic/$30 preferred brands/$50 non-preferred drugs, $1,000 annual limit on drug coverage

•$10 generic/$30 preferred brands/$50 non-preferred drugs, $2,000 annual limit on drug coverage

•50% coinsurance on all covered drugs

•$10 coverage for generic drugs only