Chronic Illness Support Program. If you have been diagnosed with hypertension (high blood pressure), diabetes, asthma, chronic obstructive pulmonary/lung disease (COPD or emphysema), or coronary artery disease (CAD), you can benefit from our Chronic Illness Support Program. We included these five conditions in this program because medical experts agree there is strong evidence that these enhanced covered services will help our Members manage these conditions for better overall health. Chronic illness means that you will always have the diagnosis, even if you do not have any symptoms. Chronic illnesses are different from illnesses that are expected to resolve or go away. For example, gestational diabetes is not included in this program because it usually goes away when the baby is born and is not a chronic illness. This program provides reduced Out-of-Pocket Costs (Copayments, Coinsurance, and Deductibles) when performed by a Network Provider. Select Tier 1, Tier 2 and Tier 3 preferred medications will also have reduced Out-of-Pocket Costs. The drugs selected as part of the Chronic Illness Support Program will be designated on our formulary and must be filled through the Home Delivery Program described in section 2.G.7 in order to receive the reduced cost- sharing of the Chronic Illness Support Program. All other drug tiers and drugs not designated on our formulary under the Chronic Illness Support Program are not included as part of this program. Talk with your Provider about whether or not alternatives to higher tier drugs are available. The Chronic Illness Support Program includes Medically Necessary services for routine treatment of the above five conditions. Prior Approval requirements may apply for some services. Refer to Section 2.F for more information. The program includes:
Chronic Illness Support Program. (CISP) SAMPLE If you have been diagnosed with hypertension (high blood pressure), diabetes, asthma, chronic obstructive pulmonary/lung disease (COPD or emphysema), or coronary artery disease (CAD), you may benefit from our Chronic Illness Support Program. CISP Benefits only apply to outpatient office visits and do not apply to services rendered in the emergency department, urgent care center and inpatient or ambulatory surgical centers. Chronic illness means that you will always have the diagnosis, even if you do not have any symptoms. Chronic illnesses are different from illnesses that are expected to resolve or go away. For example, gestational diabetes is not included in this program because it usually goes away when the baby is born and is not a chronic illness. This program provides reduced Out-of-Pocket Costs (Copayments, Coinsurance, and Deductibles) when services are performed by a Network Provider. Select Tier 1, Tier 2 and Tier 3 preferred medications will also have reduced Out-of-Pocket Costs according to your plan design. Select medications are designated on our formulary as Chronic Illness Support Program (CISP) medications and must be filled through the Home Delivery Program described in section
