Chronic Illness Support Program (CISP)
Dedicated plans for chronic conditions
Do you have a hard time paying medical bills? Do you avoid calling your PCP because you are worried about the cost? With CISP, some of these worries are alleviated by your benefits. Through CISP, routine and usual care for select chronic conditions are supported by reducing your out-of-pocket costs!
Receive reduced out-of-pocket medical & pharmacy services for select chronic conditions
CISP removes financial barriers (Copays, deductible, coinsurance) for select services for Members with certain chronic conditions and enables them to receive reduced out-of-pocket medical and pharmacy services for these conditions when received from – or provided by – an in network provider.
Our Medical Management Team is composed of registered nurses, licensed social workers, a registered dietician, and navigators/chronic care professionals who support Members’ overall health through a spectrum of services.
Services provided at no additional out-of-pocket costs
Prescription drug benefit
(when filled through home delivery)
- $0 Cost for specific Tier 1 generic medications used to treat the chronic illness.
- For Select Tier 2 medications, the deductibles are waived and your cost share is reduced according to your plan design.
- For Select Tier 3 medications, the deductible is waived and your cost share is reduced according to your plan design.
Medical services
$0 Cost when performed by a network provider for the following services (unless otherwise noted)
Asthma
- Office visits to a PCP for routine management of Asthma/COPD/Emphysema.
- Immunotherapy for Members diagnosed with Asthma.
- Inhaler adjuncts (e.g., spacer).
- Pulmonologist consultation and management of Asthma, COPD or Emphysema.Pulmonary function test once per year; home oxygen therapy assessment.
- Asthma education.Asthma only: Up to $75/year for environmental (home) assessment (requires Prior Approval).
- Lab services that are linked to Asthma or COPD primary diagnosis code and considered routine for the management of the diagnosed condition.
Coronary Artery Disease
- Office visits to a PCP for routine management of CAD.
- Cardiology consultation and routine management of CAD.
- Cardiac rehabilitation related to CAD at 50% reduction in cost-sharing.
- Electrocardiogram (ECG)
- Cardiac rehabilitation (deductible is waived and the coinsurance is reduced by half).
- Lab services linked to a hyperlipidemia primary diagnosis code and considered routine for the management of CAD.
Diabetes
- Office visits to a PCP for routine management of Diabetes.
- Endocrinology consultation and management of Diabetes.
- Podiatry consultation for routine diabetic foot care.
- Nutritional counseling, Diabetes education, and behavioral modification counseling.
- Annual diabetic eye exam.
- One glucometer each year as specified on the formulary.
- Glucose test strips listed on the formulary: up to 50 every 30 days or 450 every 90 days at $0 out-of-pocket cost.
- Lab services linked to a Diabetes primary diagnosis code and considered routine for the management of Diabetes.
COPD Chronic Obstructive Pulmonary Disease
- Office visits to a PCP for routine management of Asthma/COPD/Emphysema.
- Inhaler adjuncts (e.g., spacer).
- Pulmonologist consultation and management of Asthma, COPD or Emphysema.
- Pulmonary function test once per year; home oxygen therapy assessment.
- Pulmonary rehab and ongoing exercise program.
- Lab services that are linked to Asthma or COPD primary diagnosis code and considered routine for the management of the diagnosed condition.
Hypertension
- Office visits to a PCP for routine management of Hypertension.
- Office visits for consultation and management specifically for a diagnosis of Hypertension with cardiology or nephrology specialists.
- Lab services that are linked to a Hypertension primary diagnosis code and considered routine for the management of Hypertension.
