2023 Benefit Changes for Access PPO Members

The following benefit changes apply to CarePartners of Connecticut’s Access PPO members and are effective for dates of service on or after Jan. 1, 2023, upon the plan’s effective or renewal date:

  • Reduced maximum out-of-pocket (MOOP) costs for combined in- and out-of-network services to $8,950 (in-network only MOOP unchanged at $4,900).
  • Reduced copay for outpatient mental health care to $20 per visit (in-network).
  • Reduced copay for outpatient rehabilitation services to $30 per visit (in-network).
  • Reduced copay for outpatient substance abuse services to $20 per visit (in-network).
  • Reduced copay for outpatient surgery at an ambulatory surgical center (ASC) to $200 per day (in-network).
  • Increased copay for outpatient surgery at an acute care hospital to $300 per day (in-network).
  • Increased over the counter (OTC) benefit to $65 per quarter and expanded eligible purchases to participating retailers.
  • Reduced copay for Pulmonary rehabilitation services to $20 per visit (in-network).
  • Reduced copay for annual Diabetic Retinopathy to $0 (in-network).
  • Copays for outpatient diagnostic labs, tests, or x-rays will not apply if performed and billed as part of an urgent care visit (copays already waived if part of an office visit).
  • Applicable office visit copay will apply to surgery services performed during an office visit.
  • Covered Continuous Glucose Monitors (CGMs) includes therapeutic and adjunctive CGMs.
  • Covered therapeutic CGMs will be limited to FreeStyle Libre products.
  • Part B Insulin will be covered at copay of $35 per month when used with insulin pump.
  • Part D Insulin will be covered at copay of $35 for one month (30-day) supply.
  • Tier 6 Vaccine drugs will be covered at $0 copay in all stages (already covered at $0 copay in the initial coverage stage).

Please note that this is only a summary of benefit changes. Before services are rendered, providers are reminded to check member benefits and cost-share amounts using CarePartners of Connecticut’s secure Provider portal or other self-service tools, even for members seen on a regular basis.