PACE / PACENET PROGRAM

PROVIDER BULLETIN

NEW LEGISLATION

CARDHOLDER IMPACT

December 26, 2003

 

On January 1, 2004, new PACE/PACENET legislation becomes effective.

PACE recognizes that many providers assist cardholders in answering PACE or PACENET questions. The following is a brief overview of how the new legislation affects both potential and current cardholders.

 

PACE Single applicant    - Increased to $14,500   PACENET Single   - Increased to $23,500

            PACE Married applicant  - Increased to $17,700   PACENET Married - Increased to $31,500

 

·         Co-Pays: 

Generics                        PACE - $6.00;    PACENET -  $8.00

Single-source / Brand     PACE - $9.00;    PACENET - $15.00

 

 

·         PACENET claims processing 

Example: Cardholder enrolls with an effective date January 1, 2004; does not use PACENET benefit until March 1. A deductible of $120.00  ($40 X 3 months) must be paid before the PACENET reimbursement.

o        ALL PACENET claims are subject to PACE edits.

 

PPB-03-016