• Introducing: Patient-centered medical homes, Page 4
Autumn 10
• Health insurance reform updates, Page 8 • Good for you starts with …, Page 26
SilverSneakers® Fitness Program participant Maudie Rogers exercises with her friends at the Northeast Arkansas Baptist Clinic Wellness Center. See story on Page 14.
A publication for the policyholders of the Arkansas Blue Cross and Blue Shield family of companies
INSIDE 3 Out of the Blue 4 Introducing: Patient-centered medical homes 7 Affordable health insurance plans for individuals John Selig, director of the Arkansas Department of Human Services, addresses the crowd at the 2010 Blue & You Fitness Challenge closing ceremonies.
8 11 12 14 16
17
18 20
on Page 28 11 New DentalBlue® plans available 14 21
SilverSneakers® dynamo New My Blueprint designed with members in mind
21 22 23 24 25 26 28 29 31 32
Autumn 10
is published four times a year by Arkansas Blue Cross and Blue Shield for the company’s members, health care professionals and other persons interested in health care and wellness.
and families How health insurance reform may affect you New DentalBlue® insurance plans available for all ages Can you keep the health insurance plan you have? SilverSneakers® dynamo inspires others Fall into fitness Take it easy with the sugar Lose weight The Healthy Weigh! Sodium overload Self-monitoring blood pressure helps patients keep it low Great options again for Medicare beneficiaries Tips to controlling bladder leakage Are you secure in your personal relationships? New My Blueprint designed with members in mind Lifelong Health with Dr. David Blood protein linked to Alzheimer’s disease From the Pharmacist — Medication safety and your children The Doctor’s Corner Good for you starts with … 2010 Blue & You Fitness Challenge results 2010 Best Practices Award winner Notice of Privacy Practices Notice to Medi-Pak Advantage (PFFS) members Customer Service telephone numbers Good for you
Editor: Kelly Whitehorn — BNYou-Ed@arkbluecross.com Assistant Editor: Jennifer Gordon Designer: Gio Bruno Photographer: Chip Bayer Contributors: Chip Bayer, Matthew Creasman, Damona Fisher, Kristy Fleming, Trey Hankins, Heather Iacobacci-Miller, Ryan Kravitz, Kathy Luzietti and Mark Morehead Vice President, Communications and Product Development: Karen Raley
Out of the
Blue
A message from our CEO and President, Mark White promises to you by being able to pay for both the anticipated and unanticipated expenses of medical care. Arkansas Blue Cross is a mutual insurance company. Our company has no stock or shareholders and is managed for the benefit of our members. The reserves that we maintain are separate from the funds used to operate the company and have been built throughout several decades. Reserves are a fundamental compo-
Our reserves are there to protect you … our member Throughout our lives, each of us will face — or per-
nent of pooling risk, which is a basic principle of insurance. Appropriate reserves are important for financial stability and allow us to provide the health coverage our members have relied on for more than 60 years. They
haps have faced — times when a little financial planning
also assure doctors, hospitals and other health care
goes a long way. Those unexpected events happen to
professionals that they’ll be paid for their services even
everyone and when faced with those moments, it helps
in a crisis situation.
to be prepared. Whether you are an individual or a corporation, it’s
We have a unique need to maintain reserves because we do not have access to the capital markets and can-
smart to plan for those “rainy days.” Arkansas Blue
not raise funds on an as-needed basis for such things
Cross and Blue Shield takes the responsibility of provid-
as new requirements by the government or improved
ing your health insurance coverage seriously and saving
information systems and technological advances that
for those times when you and others in our health plans
allow us to serve you more efficiently.
need financial backing in times of illness. We have to
The National Association of Insurance Commission-
make sure we save for those expenses. In our world,
ers (NAIC) sets a minimum requirement for reserves
these funds are called “reserves” and they are neces-
for insurance companies to protect our members from
sary to protect our members.
unanticipated disasters. These are minimum require-
In this time of policy changes and economic uncer-
ments, not recommended standards. Reserve levels
tainty, it’s never been more important than now that we
significantly higher than regulatory minimums are nec-
provide economic stability and peace of mind to you,
essary to make sure that if we experience an extended
our member. Think of reserves as protection. They keep
period of increased health care costs such as with a
our company financially sound and allow us to keep our
Reserves, continued on Page 6
Blue & You Autumn 2010
3
Introducing:
Home is a place of comfort
and warmth; a place of caring and rest. We all know that when we go “home” there will be people who
Patientcentered medical homes 4
care about our health, our happiness and our well-being.
Wouldn’t it be great if there was a doctor’s office that felt a little like home? Where getting the care you need wasn’t such a hassle? And where someone was… • Working to keep you healthy; not just taking care of you when you are sick? • Checking to be sure you get the preventive care you need? • Helping you manage your chronic health problems? • Arranging for any specialty care you need and keeping all of your doctors informed of the care you receive? • Caring for you and about you, just like at home? This new, innovative approach to health care is great and it is coming to a town near you. They are called patient-centered medical homes, and they are another reason that Arkansas Blue Cross and Blue Shield is good for you.
a new approach to health care Blue & You Autumn 2010
Arkansas Blue Cross will soon be piloting eight patient-centered medical homes located throughout Arkansas. The medical homes will be piloted for two years and, if
the doctor,” said Dr. Monson. In a medical home, the goal is to get sick patients in the clinic within 48 hours. How is that possible? By using a team approach — including Roberta Monson, M.D.
advanced practice nurses, dietitians, pharmacists and other health professionals —
You are part of the team Just like in a football game, it is important for everyone in a medical home “team” to have the same information. To make sure the “team” is working together, a care coordinator may be added to the staff to coordinate care between the patient, PCP, any specialists the patient
the needs of many patients will be met, sometimes with a telephone call or even through an e-mail. This allows the primary care physician (PCP) to focus on patients with more critical issues.
Frequent reminders when you are well added. The clinics selected to be Another way medical homes are medical homes already are estabdifferent is that they will be “reachlished, but according to Roberta ing out rather than reacting,” Dr. Monson, M.D., associate medical Monson said. Medical homes will director for Arkansas Blue Cross, call patients to come in for required they will be transvisits, shots, tests Wouldn’t it be formed to provide or checkups. This a new approach to if there “requested access” health care. was a doctor’s allows medical office where homes to make Quick access sure patients are someone was when you are sick working to keep up to date with “One of the bigflu shots, vaccines gest issues in the you ; or screenings for health care system not just taking diseases. And, the is that when people care of you when medical home will are well, they you are ? communicate these often don’t take the reminders with the preventive measures to keep them patients in many ways … whatever well, but when they are sick, they is convenient to the patient. have a hard time getting in to see successful, other locations may be
great
healthy sick
A care alert example A care alert notifies the care coordinator that Bob’s hemoglobin A1C has not been checked in six months.The care coordinator e-mails Bob to let him know he needs to come in to the medical home for his test. Bob e-mails back that he will do the testing during his regular visit with the diabetes counselor and other team members. Together they have brought Bob’s blood sugar levels down to near normal levels. might see, the pharmacy and the hospital if necessary. The care coordinator understands all the goals for the patient, follow any changes in care if the patient is hospitalized and will follow up if rehabilitation or home health care is needed. The care coordinator also will help Blue & You Autumn 2010
5
keep track of all the medications a
members. This is a change that is
patient may take to ensure there are
about them and for them,” said
no interactions. By making sure all
Dr. Monson.
medical personnel who work with a patient have their entire medical background, the care coordinator can assure that fewer mistakes are made. “This is an exciting time for our
6
State-of-the-art technology The medical homes will be using new technology that includes electronic medical records and a database that provides nationally recognized treatment options for specific conditions. This way the medical staff has the information they need to determine the best course of action for each patient. The technology also provides alerts regarding gaps in care for vaccinations or screenings that might otherwise go unnoticed.
Coming soon to a town near you! Arkansas Blue Cross is in the process of selecting the clinics to be transformed into medical homes and will share the locations in the next issue of Blue & You.
Quality care means better value The goal of the medical home is to treat patients with quality care that keeps them from getting chronic illnesses. For our members, that means lower medical costs in the long run through fewer emergency room visits, lower drug costs and better health overall. For participating physicians, that means more support through the team approach and the knowledge that they are making a real difference in the lives of their patients. Welcome home! Arkansas Blue Cross recognizes that a medical “home” should be just that ... a place of comfort and care. When you go to your medical home, you should know that your medical needs, whether you have a chronic illness or a stomach bug, will matter to the team who is your medical home family.
Reserves, continued from Page 3
the state.
flu epidemic or pandemic we can
essential for our members. The new
pay for the health care needs of
laws require that insurers accept
our members. The Arkansas state
all who apply for coverage, but the
Blue Cross is in the business to
insurance department monitors our
costs associated with the newly
protect our members from financial
solvency, and we work closely with
insured are unknown. The effects of
disaster when they need us the
them to ensure that we are provid-
this can be seen in the health insur-
most. We consider it our obligation
ing the highest quality health cover-
ance reforms in Massachusetts,
to ensure that our members have
age for our members while keeping
where the newly insured used more
peace of mind knowing they are
our rates as low as possible.
services than expected, leading to
covered in times of need. Keeping
higher costs and, ultimately, signifi-
healthy reserves is just one more
impact of health insurance reform
cant reductions in reserve levels
thing we do that is good for you.
makes a strong reserve level more
for all of the major health plans in
The uncertainty surrounding the
Blue & You Autumn 2010
The bottom line is that Arkansas
Affordable
health insurance plans
for individuals and families
Whether you are just starting out on your own, have
your choosing. All HSA contributions are tax-deductible,
recently married, started a family, emptied the nest,
which means your taxable income is reduced by the
retired early or are anywhere else along life’s highway,
amount contributed to the HSA each year. In addition to
Arkansas Blue Cross and Blue Shield has health insur-
seeing doctors and specialists with no referrals, preven-
ance plans to meet you right where you are in life.
tive benefits with no deductible and 100 percent cover-
For individuals and families under the age of 65 and not on Medicare, we have a variety of affordable health plans to meet your needs … big or small. We have health plans that are good for your budget, good for your health, good for your family and good for you.
Comprehensive Coverage Arkansas Blue Cross offers traditional health insurance plans with comprehensive major medical coverage and many features of a PPO (preferred provider organization) insurance plan. You may see doctors and specialists with no referrals. Preventive benefits are available with no deductible, and children’s preventive care is covered at 100 percent. These plans have prescription drug coverage and cover services when you have to stay in the hospital or when you receive hospital services and go straight home. These health plans also feature a variety of deductible options that can help you better control your monthly premium costs.
Health Savings Account Support Perhaps you like the tax advantages of a health savings account (HSA). Arkansas Blue Cross offers an HSAcompatible health insurance plan. It works together with a separate HSA, purchased from a financial institution of
age for children’s preventive care, this plan also provides prescription drug coverage and hospital coverage.
Short-Term Coverage If you are between jobs, do not have employersponsored insurance, or need to stretch between early retirement and Medicare eligibility, we also have shortterm health insurance plans that allow you to re-apply as needed to span your gap. Our short-term health insurance policy is designed to provide coverage for those who want protection against catastrophic events such as unexpected illnesses, diseases and accidents. You choose the deductible and the number of days (a minimum of 30 and a maximum of 182) you’ll need coverage. The process for securing the affordable health plan you need is as near as your independent or Farm Bureau agent, a telephone call (toll-free 1-800-3922583) or a Web page (arkansasbluecross.com/ Individual&FamilyPlans). For more than 60 years, Arkansas Blue Cross has been providing peace of mind for Arkansans in all seasons of life.
Blue & You Autumn 2010
7
How health insurance In the past few months, we’ve
learned more about how health
on those policies until the
insurance reform, or the Patient
age of 26. This allowed young
Protection and Affordable Care Act
adults graduating from col-
(PPACA), will affect you, our mem-
lege or high school in May to
ber. As promised, we are sharing
remain on their parents’ plans
this information so you can make in-
even if they were no longer
formed decisions about your health
students.
insurance coverage.
8
formed that they may remain
• For those who were not
If you have:
• A young adult living at home? • A child with a pre-existing health condition? • Been wondering what other benefits have changed?
This information is for you. ness or large corporation) ––
The provisions discussed in this
covered by their parents’ plans at
article are for fully insured individual
that time but are still 25 years of
enrolled on their parents’ policies
and group health plans for people
age or younger, there is an an-
as of May 2010 were previously
under age 65. They do not pertain
nual open enrollment period in
informed that they may remain
to self-insured health plans. Please
October 2010, during which
on those policies until the age
contact your human resources ad-
young adults can apply (or re-
of 26. This allowed young adults
ministrator if you are unsure if you
apply) on their parents’ plans.
graduating from college or high
have a self-insured or fully insured
° Dependents ages 18 and
school in May to remain on their
younger will be offered
parents’ plans even if they were
coverage regardless of their
no longer students.
health plan. Please review the following infor-
• Many young adults who were
mation and remember that it may
health condition, however,
• For those who were not covered
be different depending on whether
they are subject to medical
by their parents’ plans at that
you have an individual or family
underwriting and parents
time (or did not receive
medical insurance policy or if you
may pay a higher premium.
notification from the
have fully insured coverage through an employer.
Good news for parents of adult children under age 26 Most young adults up to the age of 26 now can have dependent coverage under their parents’ health plans. If you have an individual or family policy — • Young adults who were enrolled on their parents’ policies as of May 2010 were previously inBlue & You Autumn 2010
° Please be aware that depen-
employer sponsor
dents age 19 to 26 will have
to remain enrolled)
to pass medical under-
but are still 25
writing in order to qualify
years of age
for coverage. This means
or younger,
coverage may not be offered
an open enroll-
or extra premium may be
ment period will
charged based on medical
be held 30 days
conditions.
before each
° Coverage for approved
employer
dependents will become
group health
effective January 2011.
plan’s renewal
If you have a fully insured plan through an employer (small busi-
date to allow parents to add
reform may affect you dependents. Your human resources department or the employee who deals with your company’s health plan can provide you with the renewal date for your company plan. ° In some situations, adult dependents who are eligible for coverage under their own employer’s health plan may not be able to enroll for coverage as a dependent. ° If you work for an employer with fewer than 50 employees (considered a small employer group under the new federal law), your dependent must answer the medical questions on the application.
More information on the pre-existing health condition requirements and guaranteed issue What is a pre-existing health condition? A pre-existing condition is any health condition that existed before you applied for health insurance coverage or enrolled in a health plan.
age simply by applying and paying
What is “guaranteed issue”? It means that a health insurance company will accept anyone who applies for coverage (and pays the premium).
states that allow this practice use it
A little history … Health plans in many states traditionally have required that people who buy individual or family coverage on their own (not through an employer) meet certain health standards before offering insurance coverage. The process in which an insurance company evaluates the health condition of an applicant is called “medical underwriting.” Health insurance companies use medical underwriting to help manage the risk of the customers they insure to keep coverage affordable, in much the same way as auto insurance companies look at an applicant’s driving record before deciding whether to offer auto insurance. An applicant is not guaranteed cover-
the premium in either case. In the case of a health insurance applicant, the coverage may be offered at a higher rate or not offered at all if the applicant already has costly health conditions. This is not unlike people with poor driving records having to pay more or being denied auto coverage. Health plans operating in because they know that accepting too many of those who already have health problems will make health insurance more expensive for everyone. (Remember that insurance is about sharing risk across a lot of people.) In addition, in states where coverage is guaranteed regardless of any health conditions an applicant may have, people often have waited until they are sick or needed medical care to buy insurance. Can you imagine how expensive car insurance would be if you could buy a policy when your car was already wrecked? And when insurance costs a lot, people either can’t afford to buy it or won’t buy it. One of the provisions of the new health insurance reform law requires health plans to guarantee health insurance coverage to those who are 18 and younger in spite of any health conditions they may have (guaranteed issue) as long as Blue & You Autumn 2010
9
the premium is paid. This coverage is available during an annual enroll-
• During open enrollment, depen-
The lifetime dollar limit benefit is now unlimited. On most Arkansas
ment period held in the fall each
dents age 18 or younger will be
Blue Cross plans, the lifetime maxi-
year and becomes effective on
offered coverage regardless of
mum benefit previously ranged from
January 1 of the following year.
health condition, however, they
$1 million up to $5 million.
If you are employed with a small
10
er as of Jan. 1, 2011.
are subject to medical underwrit-
business or large corporation and
ing and may have to pay a higher
are enrolled on a group policy, it’s a
premium. Medical underwrit-
little different. Your health insurance
ing simply means the child’s
coverage has been and will continue
health information may be used
to be guaranteed issue. This means
to evaluate the application. The
you are covered from when you
first open enrollment will be in
enroll and once the waiting period
November 2010, and coverage
established by your employer is sat-
will go into effect Jan. 1, 2011.
isfied. However, you may be subject
If you have a fully insured plan
to rules surrounding pre-existing
through an employer (small busi-
health conditions. This means you
ness or large corporation) ––
may have to wait for a certain period
• Your insurance plan will remove
of time (usually a year) before you
the pre-existing condition re-
have coverage for certain conditions
quirements for individuals age
unless you have been continuously
18 and younger at your group’s
covered by a group health plan for
health plan’s renewal date, begin-
the preceding 12-month period. For
ning in October.
example, if you had knee surgery
• There always has been guaran-
the month before you joined the
teed issue on group policies.
group policy, you may have to wait
Everyone is covered at the time
for a year before the policy will
of enrollment.
cover any more surgery or other treatments for that knee.
How has health insurance reform affected pre-existing health conditions requirements? And does Arkansas Blue Cross guarantee coverage for those age 18 and younger? If you have an individual or family policy — • Pre-existing health condition requirements will be removed for all individuals age 18 and youngBlue & You Autumn 2010
What are the rules on lifetime limits? If you have an individual or family policy — Lifetime dollar limit benefits have been removed. On most Arkansas Blue Cross plans, the lifetime maximum benefit previously ranged from $1 million up to $5 million. If you have a fully insured plan through an employer (small business or large corporation) ––
What are the rules on annual dollar maximums? For both individual or family policies and fully insured plans through an employer — There will be changes in your current benefits for ambulance, home health and durable medical equipment. These changes will be described in detail in your Certificate of Coverage or Evidence of Coverage policy, which will be provided to you when you renew your coverage. We’re working to keep you informed Changes to your benefits are based on our current understanding of PPACA. These changes have been made in good faith based on the interim final regulations released by the U.S. Department of Health and Human Services. Many of the regulations remain in a “comment” period; therefore, other changes could be coming. We will continue to keep you up to date. As your health insurance company, it’s our responsibility to help you understand the changes in your coverage. And, it’s our privilege to serve you.
New DentalBlue® insurance plans available for all ages Arkansas Blue Cross and Blue Shield has
maximum rollover
affordable dental coverage that gives you something
benefit allows
to smile about.
you to “roll over”
Our DentalBlue® insurance plans for individuals offer
a portion of your
a variety of valuable benefits — from essential preven-
unused calendar-
tive services to major restorative services. We offer the
year maximum to
three DentalBlue plans below for people of all ages.
the next year.
• DentalBlue BronzeSM provides basic, preventive
With DentalBlue,
care such as initial and periodic exams, prophylaxis
you’ll receive other
(teeth cleanings), fluoride treatments, X-rays and
important benefits including:
sealants.
• Freedom to choose any dentist.
• DentalBlue SilverSM covers these preventive ser-
• Maximum plan benefits when you visit a dentist in the DentalBlue participating provider network.
vices and adds minor restorative services such as
• No claim forms to complete when you choose a
fillings and simple extractions.
participating dentist.
• DentalBlue GoldSM covers preventive services,
So break out into a big toothy grin. With Arkansas
minor restorative services and builds in major restorative services including endodontics (root canals),
Blue Cross, you can afford to keep your teeth in tip top
oral surgery, surgical extractions, inlays, onlays,
shape. To find out more, contact your local independent
crowns, bridges, partials and dentures, implants and
or Farm Bureau agent or give us a call, toll free,
periodontics (treatment of gum diseases). An annual
at 1-800-392-2583.
DentalBlue Plans
BRONZE
SILVER
GOLD
Individual Deductible
$50
$50
$50
Calendar-Year Maximum
$1,000
$1,000
$1,000
Annual Maximum Rollover
No
No
Yes
What the plan pays after the deductible is met Preventive & Diagnostic
100%
100%
100%
Minor Restorative Services
Not covered
80%
80%
Major Restorative Services
Not covered
Not covered
50%
Implants
Not covered
Not covered
50%
Minor Services
Not applicable
6 months*
6 months*
Major Services
Not applicable
Not applicable
12 months
Waiting Periods
Rates Individual
$17.77
$21.68
$28.83
Individual + Spouse
$35.54
$45.97
$61.13
Individual + Child(ren)
$34.46
$44.97
$59.80
Family
$52.23
$67.95
$90.63
* The 6-month waiting period for Minor Restorative Services for DentalBlue Silver or DentalBlue Gold will be waived if: 1. Your DentalBlue application is received within 30 days of the termination date of your prior coverage; 2. You have had at least 6 months of prior continuous coverage for minor restorative benefits; and 3. You provide us with a copy of your Certificate of Coverage verifying your previous dental coverage within 30 days of your Dental Blue effective date. To be eligible for a DentalBlue insurance plan, you must be an Arkansas resident. Other eligibility rules may apply.
Blue & You Autumn 2010
11
Can you keep the health insurance plan you have? As a member of one of our
health insurance plans, you may be wondering if the insurance plan you currently have is a “grandfathered” plan or not. You may even be wondering what the term “grandfathered” means. Or, if it matters. Let us help you understand it better. The passage of the Patient Protection and Affordable Care Act (PPACA) on March 23, 2010, changed the way health insurance works. Let’s take a look
12
at how the law may affect you as parts of it begin to take effect.
What is a grandfathered plan? A grandfathered health insurance plan, whether it is a plan you bought yourself or one that you are enrolled in through your employer, is a plan that was in place on or before March 23, 2010. Simple enough. But what if you joined a company on June 1, 2010, and the company had an insurance plan that was in place as of March 23, 2010 (this plan had not been changed, you simply joined that plan)? Are you then part of a grandfathered plan? Yes. What is a non-grandfathered plan? A non-grandfathered plan is a new plan, either a plan you bought yourself or one that your employer Blue & You Autumn 2010
Making sense of “grandfathered” and “non-grandfathered” plans purchased, that went into effect
a cost. Some industry consultants
after March 23, 2010. A non-grandfa-
have said that adding preventive
thered plan also may be a plan that
services to health plans with no
ees to add dependents.
was changed in some way (even if
cost sharing (such as copayments)
The following will cause your em-
this plan was in place prior to March
could add as much as 3 to 4 per-
ployer to lose grandfathered status:
23, 2010) that caused the plan to
cent to the cost of health insurance
• Eliminating benefits or treat-
lose its grandfathered status.
coverage if the current plan did not
ments for certain types of
Changes that apply to all plans There are some changes that apply to all plans. It doesn’t matter whether they are grandfathered or not. Plans must: • Cover the dependents of policyholders until they are age 26. • Provide coverage for children under age 19 regardless of health status and must cover any pre-existing conditions for these children. • Offer health services defined as “essential” under the law with no lifetime dollar limits. In 2014, annual dollar limits will be eliminated for all health plans. (The federal government has not yet defined which services are essential.)
cover these services already.
conditions.
Is there a cost? Non-grandfathered health plans must provide coverage for a specific group of preventive (wellness) services to health plan members at no cost to the member; however, this enhanced coverage does have
If you have a grandfathered individual or family plan, should you keep it? • PPACA-mandated benefits are expected to drive rates up for non-grandfathered health plans. • Some industry consultants claim that premiums for new individual non-grandfathered plans may double in 2014. • The situation is fluid and uncertain. • The best approach is to be cautious. • In order to maintain your grandfathered status, you must keep the plan you have with a very few limited exceptions. If you have a grandfathered fully insured plan through an employer (small business or large corporation), what will happen? The following will not cause your employer to lose grandfathered status: • Changes made to comply with state and federal laws as well
as PPACA. • Allowing current or new employ-
• Increasing employees’ coinsurance by any amount. • Increasing employees’ contributions by more than 5 percent. • Other decreases in benefits with a very few limited exceptions. Although the final rules have not been determined as to what might cause a plan to lose its grandfathered status, we do know that if an employer makes changes in benefits or shifts costs to the employees the plan is likely to lose its grandfathered status.
One last thought It’s important to remember that if you like your health insurance plan the way it is, you should keep it unless you feel you would benefit by making changes. Be cautious. Remember, after you lose your grandfathered status, you can’t get it back.
Blue & You Autumn 2010
13
SilverSneakers dynamo inspires others ®
Who inspires you? Celebrities?
Professional athletes? Our service
men and women? At the Northeast Arkansas Baptist Clinic Wellness Center in Jonesboro, many folks are inspired by Maudie Rogers, a tiny 89-year-old lady whose dedication to her own fitness has changed the lives of those around her. If you don’t know Maudie, the best way to find her at the Wellness Center is to look down. She will be the one wearing the silver and purple sneakers she won in the “100 Miles in 100 Days” SilverSneakers® exercise competition in 2009. She came in second in the state, logging
14
862 miles on the treadmill, exercise Maudie Rogers
bicycle, in water aerobics classes and in the Muscle Strength and Range of Motion (MSROM) class in a little more than three months. She even beat her son, Robert Rogers, who attends SilverSneakers classes in Cabot! Maudie also recently was recognized as one of the top five national finalists for the 2010 Richard L.
Maudie stops to chat with her exercise buddies, Betty Foster (left) and Lavinda Counce (right).
Swanson Inspiration Award, which recognizes SilverSneakers participants whose healthy behavior has made a difference in his or her own life and inspired others. Maudie was one of nearly 200 nominees for this year’s award. Maudie has participated in the SilverSneakers Fitness Program since the Wellness Center began offering it in 2007. SilverSneak-
Blue & You Autumn 2010
ers is the nation’s leading exercise
for me,” Maudie said. “I’ve not only
SilverSneakers, please contact your
program designed exclusively for
made friends but I’ve managed
health plan provider. For more infor-
older adults. The program offers an
to keep myself in shape. It’s good
mation regarding the SilverSneakers
innovative blend of physical activity,
for our bodies and outstanding for
Fitness Program visit silversneakers.
healthy lifestyle and socially orient-
people like us to get together. I
com or call 1-888-423-4632.
ed programming.
think the world of the program and I
“Maudie is an inspiration to our gym members as well as our com-
look forward to each visit.” Maudie’s friends in SilverSneak-
munity,” said Kara Fowler, the Silver-
ers also have rallied to her side as
Sneakers Fitness Program instructor
she tackles another rough time
at the Wellness Center. “She shows
in her life — a battle with cancer.
up to class early and visits with her class members and other gymgoers. She always has a smile on her face and strives to do her best.” Maudie always was aware of her health, and made healthy choices, but it was tragedy that brought her to the gym. Five years ago her
Many folks are inspired by Maudie Rogers, a tiny 89-yearold lady whose dedication to her own fitness has changed the lives of those around her.
husband, Aaron,
Although she has never smoked, Maudie was diagnosed last year with lung cancer. It has been difficult lately for her to exercise, but she comes to classes as often as she can. “The class has been my support group; they’ve all been great,” Maudie said. Maudie’s spirit
passed away and soon after she fell
has inspired others in the class to
and broke her shoulder. Determined
push themselves harder.
to get her strength back, she laced
“I’ve never met anyone quite like
up her sneakers and headed to the
Maudie,” said Betty Foster, Maudie’s
Wellness Center.
close friend. The two met in the
“I felt stronger all over,” she re-
MSROM class and became fast
membered. In fact, Maudie credits
friends, often riding together to
the MSROM class for helping her
the gym.
maintain a healthy and independent lifestyle. “SilverSneakers has been great
About the Healthways SilverSneakers® Fitness Program SilverSneakers was founded in 1992 and is the nation’s leading exercise program designed exclusively for older adults, offering an innovative blend of physical activity, healthy lifestyle and socially-oriented programming. This unique program is available to Medi-Pak and Medi-Pak Advantage (PFFS) members at no additional cost at wellness centers, YMCAs and Curves® locations in all 50 states, Puerto Rico and D.C. For more information on SilverSneakers, call 1-888-4234632 or visit silversneakers.com. SilverSneakers® is a registered mark of Healthways, Inc. The SilverSneakers Fitness Program is provided by Healthways, Inc., an independent company that operates separately from Arkansas Blue Cross and Blue Shield.
“She is an inspiration,” added Lavinda Counce, another friend. To find out if you are eligible for Blue & You Autumn 2010
15
Lose weight The Healthy Weigh! The Healthy Weigh! Education Program is free for members of Arkansas Blue Cross and Blue Shield,
Fall into fitness
Fall is in the air. Now that the temperature is dropping, it’s the perfect
time to take your fitness back outdoors. Take advantage of the crisp air
16
and enjoy the fall foliage by going on a hike. Other fun fall activities are biking, rollerblading and even playing flag football. Even better, you can enjoy these outdoor activities with your family.
Take it easy with the sugar Sugar added to foods makes them taste sweeter, but your health can sour from too much of it. The American Academy of Family Physicians suggests how you can limit added sugar: • Cut back on candy, desserts, baked goodies and other sweet treats. • Stick to fresh and healthy foods, such as vegetables, fruit, whole grains and lean forms of protein. • Drink water instead of sweetened drinks. • Avoid foods that are processed. • Opt for lower-sugar recipes when baking. • Substitute applesauce (unsweetened) or an artificial sweetener, instead of sugar. Blue & You Autumn 2010
Health Advantage (except state and public school employees*), Blue Cross and Blue Shield Service Benefit Plan (Federal Employee Program), Medi-Pak Advantage (PFFS) and eligible members of BlueAdvantage Administrators of Arkansas. To enroll, complete the attached enrollment form and return it in the self-addressed, postage-paid envelope included in this magazine. The program starts when you enroll. After enrollment, you will begin to receive information through the mail, which you can read in the privacy of your own home and at your own pace. The program is completely voluntary, and you may leave the program at any time. If you have further questions about the program, call the Health Education Program’s toll-free number at 1-800-686-2609. * Our state and public school members can access the “Nourish” program through Life Synch.
Simply complete, sign and return the attached enrollment form in the selfaddressed, postage-paid envelope to join The Healthy Weigh!
Sodium overload
According to the Centers for Disease Control and Prevention (CDC), American
adults consume an average of 3,466 milligrams (mg) of sodium (salt) each day. This is twice the recommended limit. While some sodium is necessary, too much can lead to high blood pressure, a major risk factor for both heart disease and stroke. The CDC estimates that about 77 percent of the sodium consumed comes from processed and restaurant foods. The 2005 Dietary Guidelines for Americans recommend less than 2,300 mg of sodium per day. Specific groups — those with high blood pressure, middle-aged adults and African-Americans — should consume less than 1,500 mg per day. Source: The Centers for Disease Control and Prevention
Self-monitoring blood pressure helps patients keep it low According to a study by British researchers, patients with high blood pressure were able to more effectively control their condition through home monitoring. When properly trained, patients who monitored their own blood pressure and adjusted their medications ac-
to be involved in setting up patients’ schedules. However, the study’s initial results are very positive. Patients who managed their own blood pressure by taking daily readings saw their systolic blood pressure drop an average of 12.9 points during a six-month period, while patients
cording to physician guidelines
on standard care saw an average
experienced greater reductions
drop of only 9.2 points during the
in blood pressure during a six to
same period.
12-month period than did patients
After a year, the self-managed
who received standard care.
patients’ systolic pressure dropped
High blood pressure is a major
17.6 points, as compared to 12.2 points
risk factor for things like heart attack,
for the standard-care patients.
heart failure, stroke and kidney failure and
The self-managing patients who partici-
should be treated with the utmost care. While this discovery represents a hopeful new treat-
pated in the study were trained in the proper use of automated blood pressure monitors and taught how to
ment option for patients with high blood pressure,
transmit their readings to their physician through auto-
researchers involved in the study also point out it is not
mated modems.
without drawbacks. Not everyone is well suited or even willing to partici-
Source: National Institutes of Health
pate in self management, and family doctors will need Blue & You Autumn 2010
17
Great options again for
Medicare
beneficiaries
18
Blue & You Autumn 2010
If you are a Medicare beneficiary, November 15 is
Pak Advantage MA-PD plans, but do not include drug
an important date for you. From November 15 until
coverage. Members have the same access to our
December 31, Medicare beneficiaries can purchase a
network of more than 6,000 doctors and hospitals
Part D prescription drug plan or Medicare Advantage
throughout Arkansas, and a SilverSneakers member-
plan. You also can change the plan you have. The fed-
ship also is included.
eral government’s Centers for Medicare and Medicaid
• Two Medi-Pak Rx prescription drug plans (PDP) with
Services (CMS) calls this time period the Annual Elec-
competitively priced monthly premiums –
tion Period (AEP). If you join a plan during AEP, or make
Basic at $31.30 and Premier at $83.50. More than 95
changes to an existing plan, your new benefits will be
percent of Arkansas pharmacies are in our network.
effective Jan. 1, 2011.
• Four Medi-Pak supplement plans, including Plan F,
our most comprehensive supplement plan, and Plan Medi-Pak Choice, a selection of products you N, one of our lowest-priced supplement plans, which can count on is ideal for Medicare beneficiaries who don’t mind For 2011, Arkansas Blue Cross and Blue Shield will cost sharing for physician office and emergency continue to offer Arkansans the same great selection room visits during the year. of Medicare Advantage and Medicare prescription drug plans, as well as Medicare supplement plans, you’ve Attention Medicare Advantage plan members come to expect from us. If you have a Medicare Advantage or Medicare Part D For 2011, Arkansas Blue Cross will offer: plan (prescription drug plan), during Oc• $0 premiums for Medi-Pak Advantage Call your local tober, you will receive an Annual Notice MA-PD private fee-for-service (PFFS) Medi-Pak Choice of Change (ANOC), which will explain (includes drug coverage) in 27 counties licensed agent or any changes to your current plan that and affordable premiums in all Arkan1-800-392-2583 to will become effective in January. If you sas counties. Medi-Pak Advantage MAlearn more. are satisfied with your current plan, PD plans are Medicare PFFS plans, you are not required to change anything. Every year, which combine all the benefits of original Medicare CMS requires companies to inform members of these (Part A hospital and Part B medical) with valuable changes prior to AEP so that those who would like to extras. Medi-Pak Advantage members have access shop their coverage have the opportunity to do so. to our extensive network of more than 6,000 doctors and hospitals across the state. When you use these doctors and hospitals, you’ll have lower outof-pocket costs than when you visit out-of-network providers. In addition, Medi-Pak Advantage MA-PD members receive a membership in the popular SilverSneakers® Fitness Program at no additional cost. • $0 premiums for Medi-Pak Advantage MA (PFFS) (does not include drug coverage) in 52 counties. These plans offer all the health benefits of our Medi-
If you would like to learn more about our Medicare plans Call your local Medi-Pak Choice licensed agent or 1-800-392-2583 to learn more. You also can visit our Web site, arkansasbluecross.com/MedicarePlans. If you have a friend or family member who doesn’t have our Part D prescription drug plan or Medicare Advantage plan, we hope you’ll recommend Medi-Pak Rx and Medi-Pak Advantage during AEP! Blue & You Autumn 2010
19
Laughing, sneezing, coughing … leaking Tips to controlling bladder leakage room when you have little urine in your bladder. This is urge incontinence or overactive bladder. The good news for individuals who suffer from both types of bladder leakage is that there are treatments and medications to help decrease or eradicate the problem. Women who suffer from stress incontinence can do simple exercises to strengthen the pelvic floor and the muscles that control the bladder and urethra. Following are tips to improve bladder health: 1. Kegel exercises to improve pelvic floor muscle strength.
If a good joke, a bad cold or a unexpected cough
make you a little nervous … you might be one of the 13
20
million Americans who experience bladder leakage. Bladder control (or urinary incontinence) symptoms can range from mild leaking to uncontrollable wetting. It can happen to anyone, but it becomes more common with age. Most bladder control problems happen when muscles are too weak or too active. If the muscles that keep your bladder closed are weak, you may have accidents when you sneeze, laugh or lift a heavy object. This is stress incontinence. If bladder muscles become too active, you may feel a strong urge to go to the bath-
2. Decrease or eliminate caffeinated beverages. 3. If you are overweight, losing weight might relieve pressure on the bladder. (A new study published in the journal, Obstetrics & Gynecology, suggests that overweight women often can improve bladder control problems by losing 5 to 10 percent of their body weight.) 4. Eat a fiber rich diet and drink plenty of water to prevent constipation. 5. See your physician if symptoms persist. Visit womenshealth.gov for more information.
Are you secure in your personal People who feel insecure in their relationships may
ages 18 to 60, and found an association between
be more at risk for cardiovascular disease and other
“avoidant attachment” — people who feel unable to get
health problems, according to a new study.
close to others or have others depend on them — and
In fact, those who felt insecure in relationships or avoided getting close to others appeared to have a greater risk of developing several chronic diseases. Researchers studied survey data from 5,645 adults, Blue & You Autumn 2010
chronic pain, such as frequent or severe headaches. People who were insecure in their relationships had further risks. “Anxious attachment” — a tendency to worry about rejection in relationships, feel overly needy
New My Blueprint designed with members in mind what you will find when you log in to My Blueprint. The newly redesigned site features: • A customer service corner that allows you to easily order new ID cards or print temporary ID cards when you are in a hurry. • A claims center that gives you a quick update on the status of the most recent claims, or you can view the claims history for you and your dependents.
When you visit the member self-service center
of our Arkansas Blue Cross and Blue Shield Web site, you want to find what you are looking for quickly and with the least amount of hassle. We kept this and you in mind when we redesigned your member site, known as My Blueprint. If you have used the self-service center in the past, you’ll now find a redesigned, easier-to-use site. If you have never registered to use the site, there’s no time like the present. And, if you are just curious about what you might find behind My Blueprint or if you are unsure how to regis-
• Access to your Personal Health Record, which features claims data along with personal information you enter on your own. • Your Personal Health Statements, which updates you on recent claims, provides information about health benefits, and much more. • Information on physician cost and physician specialty quality. • A benefit summary and coverage information. • And much more. Log in to My Blueprint today. It’s one more way that Arkansas Blue Cross is good for you.
ter, view our quick demos at arkansasbluecross.com. Select the My Blueprint link or the “Register Now” link from the left side of the home page to get to the page to view demos on how to register or get a quick view of
relationships? and find that others are reluctant to get close — was associated with a wide range of health problems, including heart-related diseases, such as stroke, heart attack and high blood pressure. Anxious attachment also was linked to a higher risk of chronic pain and ulcers. The study was recently published in the journal Health Psychology.
Source: American Psychological Association
Blue & You Autumn 2010
21
Lifelong Health
with Dr. David
population was obese; today the prevalence is close to 33.8 percent. And a total of 68 percent of the population are either overweight or obese. Most alarming is the fact that type 2 diabetes is David A. Lipschitz, M.D., Ph.D.
markedly increased in both overweight and obese persons. Weight gain leads to metabolic syndrome in which the ability of insulin to pump glucose out of the blood and into cells is impaired. In a significant percentage of the population this leads to elevated blood sugars and type 2 diabetes. Type 2 diabetes is often related to choices of diet and lifestyle and can be controlled by diet.
22
In many overweight individuals, type 2 diabetes may remain undetected for years, but complications caused by the disease insidiously develop. Complications include elevated cholesterol, heart disease, stroke, peripheral vascular disease, kidney damage, severe eye disease, and damage to the nervous system leading to peripheral neuropathy, which causes burning, numbness and tingling in the arms and legs. Blockages to tiny blood vessels in the lower leg, together with impaired nerve function, can cause ulcers that do not
Managing diabetes with lifestyle changes In the past 25 years, the prevalence of obesity has
heal, which can lead to amputation. The solution of this major health threat is to commit as
increased at alarming rates. Obesity is defined using
a nation to se-
the body mass index (BMI) that is calculated by divid-
rious lifestyle
ing weight by height squared. Using this measure-
changes.
ment, normal weight individuals have a BMI between
Whether
19 and 24. Those with a BMI between 25 and 30 are
overweight,
overweight (pleasantly plump) and those above 30 are
obese,
considered obese. In 1990, less than 15 percent of the
or recently
Blue & You Autumn 2010
Know your numbers Fasting Blood Sugar Normal: Below 100 Prediabetes: 100-125 Diabetes: Above 125
Editor’s Note: David A. Lipschitz, M.D., Ph.D., is nationally recognized as a leader in the field of geriatrics. Arkansas Blue Cross and Blue Shield is honored to have him as a contributor to Blue & You magazine.
diagnosed with type 2 diabetes, the key element to a longer, healthier and disease-free life is a better diet and exercise. If diabetes is diagnosed, supervision by an expert dietitian and exercise physiologist or trainer also is highly recommended. Learn everything possible about the diabetic diet. Know how, when and what to eat to assure predictable blood sugar levels. Under the supervision of a qualified dietitian, it becomes readily apparent that being a diabetic is not a life sentence to dull and tasteless food! A diabetic diet can be nutritious, filling and delicious while simultaneously reducing excessive calorie intake. For all overweight adults, weight loss achieved by a combination of diet and exercise will assure a longer and healthier life, and for diabetics it may either reduce or eliminate reliance on medications and prevent side effects. Exercise must include 30 minutes of aerobic
Blood protein linked to
Alzheimer’s disease
High levels of a blood protein (called clusterin) have
activity daily and strength training with weights at least
been linked to the development of Alzheimer’s dis-
three times per week. This form of resistance training
ease, according to new research.
reduces fat and builds muscle, which is far more metabolically active. With rates of obesity and diabetes on the rise, a reaf-
This new finding could be the beginning of detecting the disease before it takes hold. Although it may be five years from now before doctors can use this
firmation and
information for an actual test, it is a big step in the
commitment
fight against Alzheimer’s.
to improving
Alzheimer’s is the most common form of dementia,
lifestyle and
which causes a decrease in brain functions particularly
maintaining
related to memory, thinking, language, understanding
healthy habits
and judgment. Those affected with Alzheimer’s may
is the only
behave inappropriately in social situations and have
solution to
difficulty controlling their emotions.
reverse a po-
Thanks to this scientific breakthrough, there is hope
tentially disas-
that in a few years Alzheimer’s could be diagnosed in
trous future.
the very early stages for earlier treatment options.
Blue & You Autumn 2010
23
Medication safety
and your children
24
As the father of three children
is as sharp as a tack. As parents, we
young children, check to make
all under 4 years old, I understand
know that it just takes an instant for
sure they are in child-resistant
how difficult it is to keep an eye
the unthinkable to happen.
packaging.
on children in hopes of preventing
This is why it is so important to
The CDC also recommends that
them from getting into what they
keep your medications out of the
you put the poison control number,
have been told not to get into. I also
hands of children. The Centers for
1-800-222-1222, on or near every
understand how much they look up
Disease Control and Prevention
home telephone and save it on your
to the adults in their lives and want
(CDC) estimates that there are
cell phone.
to mimic what they do at every op-
98,000 emergency department
portunity. The favorite saying of my
visits each year for children less
tions somewhere out of the reach
nearly 2-year-old daughter is, “Me,
than 5 years old who found and ate
of children (place purses out of
too!” If you have children, or are
or drank medications in the absence
reach if you carry medicine in them)
around children, then you know that
of adult supervision. The CDC of-
and have the phone number for poi-
they always are watching, learning
fers the following tips to lessen the
son control readily available. While
and mimicking.
chance of this happening to one of
it may not be possible to keep our
your loved ones.
eyes on our children all the time, we
• Never leave children alone with
can take steps to make our homes
My 3-year-old son consistently asks about the vitamins that my
I implore you to put your medica-
wife takes. He even pretends that
medicines. If you are giving or
safer for our children, especially
some of his treats are vitamins.
taking medicine and you have
when it comes to keeping medica-
While this is cute, it makes me a
to do something else, take the
tion out of their hands.
little nervous. What if he actually got
medicine with you.
For more information on medica-
his hands on some of the real adult-
• Do not leave medicines out after
strength vitamins and took them be-
using them. Store them in medi-
cdc.gov/ncidod/dhqp/medication-
cause he wanted to be like mommy
cine cabinets or other childproof
safety.html
and daddy? He shouldn’t be able to
cabinets.
cdc.gov/ncidod/dhqp/ps_forParents.
open that bottle, but I know that he
• When purchasing medicines for
tion safety please visit:
html
From the
Pharmacist
by Brandon Griffin, Pharm D., Arkansas Blue Cross and Blue Shield
Blue & You Autumn 2010
The
Doctor’s
Corner
Counting down the top 10 ways to stay healthy Number 10 Take your vitamin D. Studies show that most American adults have low levels of vitamin D (sunlight is necessary for the body to make the active form of vitamin D). Low levels of vitamin D have been associated with increased risk of heart disease, some cancers, high blood pressure, migraine headaches, memory problems, rheumatoid arthritis, inflammatory bowel disease, and other health issues. The U.S. Food and Drug Administration recommends that adults take 200-600 IU of vitamin D-3 every day. Number 9 Get a flu shot every year. New research has found an additional benefit from flu vaccine. Studies indicate that for as long as one year after a flu shot, the risk of a heart attack is reduced by 50 percent! Number 8 Floss every day. Gum disease has been associated with an increased rate of stroke, heart disease, rheumatoid arthritis, premature labor and worsening diabetes.
Number 7 Wash your hands frequently. The most common way a person becomes infected with a virus is from hand-to-hand contact. Wash your hands frequently, especially before eating, and pay particular attention during the cold and flu season. Number 6 Eat fish once a week. Eating fish that is high in omega-3 fatty acids once a week has been shown to reduce the risk of stroke and heart attacks by one-third. Taking omega-3 fatty acid supplements is a good alternative. Fish high in omega-3 include salmon and tuna. Walnuts and soy are also high in omega-3 fatty acids. Number 5 Get enough sleep. Studies show that people who get less than 7-8 hours of sleep per night are at a much higher risk for heart attack, stroke, sudden death, high blood pressure, diabetes, obesity, and memory problems.
Number 4 Know yourself. If you have a medical condition such as high blood pressure, diabetes or asthma —
by Ray Bredfeldt, M.D., Regional Medical Director Northwest Region, Fayetteville
learn about your condition. People who work with their doctor are more likely to receive recommended care for their condition.
Number 3 Take a walk. Be sure to engage in moderate exercise (such as brisk walking) for 30 minutes at least five days per week. Studies show that the more time you spend sitting, the shorter your life expectancy. Number 2 Maintain a healthy weight. Being overweight is not only associated with heart disease and diabetes, but evidence strongly indicates that overweight people are more likely to die from many types of cancers. Number 1 Don’t smoke. Smoking-related diseases cause an estimated 440,000 deaths in the United States each year and cost the nation more than $150 billion annually in health care costs. Contact your local chapter of the American Lung Association for help in quitting smoking. Blue & You Autumn 2010
25
good for you
starts with …
At Arkansas Blue Cross and Blue Shield, we recognize that every one of us is in Customer Service, and we
have a saying — “good for you starts with me.” For many of our employees, serving others doesn’t end with the workday or the work place. Here are just a few examples of how this dedication to helping people has spread to reach all Arkansans. Kiwanis Club for nearly 25 years.
David Bridges
26
her doctor — almost five years after
A deep love of Arkansas mo-
“Additionally I serve on the board
her diagnosis. She has participated
tivates David Bridges in almost
of the Arkansas Rice Depot. That’s a
in the Race for the Cure before and
everything he does — whether it’s
statewide organization that’s really
after her diagnosis. The Race in
in his job as Arkansas Blue Cross
helping a lot of people in need,”
2009 marked her five-year anniver-
executive vice president of Op-
David said.
sary of being a survivor. “She is my When the
erations and
hero for always having a positive
president
Susan G.
outlook and facing the challenge
and CEO of
Komen Race
with an optimistic attitude.”
HMO Part-
for the Cure
ners, Inc., or
came to cen-
volunteering
tral Arkansas,
in his per-
David was
sonal life.
asked to be a
“As the song says,
David Bridges (with his sons) participates in the Three Miles of Men.
team captain for the
Arkansas runs deep in me,” said
Arkansas Blue Cross Three Miles of
David. “I always want to do things
Men. He’s done it every year since.
to make our communities better.”
“Ironically, after doing this for
David spends much of his free
three or four years, my wife, Sha-
time working with non-profit orga-
ron, was diagnosed with breast
nizations and charities. He has held
cancer,” he said. “So it meant even
leadership positions with the Boy
more to me.”
Scouts of America, worked in sever-
Thankfully, after surgery, radiation
al Salvation Army capital campaigns
treatments and medication, Sharon
and been involved in the Downtown
was given a clean bill of health by
Blue & You Autumn 2010
Jim Bailey Jim Bailey, Arkansas Blue Cross senior vice president for National Business, doesn’t get a lot of free time, but what time he does have goes to Junior Achievement of Arkansas, where he has served on the board since 2001. “Junior Jim Bailey devotes community a Achievement touches about 14,000 students across the state,” said Jim. “It is a program in which
students — elementary through
lot of these organizations in Arkan-
said. “For example, we sponsored
high school — are taught basic
sas that help people just would not
workshops to show teachers how
economic principles, from how to
be there,” he said. “That’s why I
to integrate movement into the
balance a checkbook to how a busi-
think it is so important for people to
classroom.”
ness operates.”
serve their communities.”
Jim also served on the Conway Chamber of Commerce for two years, on the board of the American Lung Association for four years, on the board of the Arkansas Sports Hall of Fame for two years, chaired the Baptist Foundation Bolo Bash (luncheon and golf tournament) in 2009, and currently works with the Miss Arkansas Scholarship Foundation, a program designed to help young women with scholarship opportunities that are available through the Miss Arkansas Pageant. “Numerous young ladies have gone through that system to further their education,” Jim said. “Many have gone on to law school. One is in her last year of medical school. Money earned through the Miss Arkansas Pageant helped fund part of that education
time to several activities.
and we’re very proud of that.
“Without the people volunteering their time and without the funds, a
And, while she can’t stand to hear someone say that they couldn’t
Linda Kyzer When Linda Kyzer hears someone share a story like, “My family and I went to Disney World and I sat on a bench because I couldn’t keep up,” it breaks her heart. Just about everything Linda does at Arkansas Blue Cross and Blue Shield is fitness related. She serves on the Blue & You Fitness Challenge core committee, is involved with the employee wellness program, and negotiates discounts with wellnessrelated businesses for Arkansas Blue Cross members. “I’m passionate about people living an active lifestyle and living an independent life,” she said. “I love to see people succeed.” Linda also is vice chair of the Governor’s Council on Fitness. “Our main goal is to promote physical activity and through that improve the health of Arkansans,” she said. The council partners with other entities to promote fitness all across the state. “We provide money, education, and sometimes labor to help them be more successful,” Linda
keep up with their family, she loves it when they come back later and say, “This year they couldn’t keep up with me.” “It’s a big thrill to me — it sometimes moves me to tears — to hear of people’s success,” Linda said. “It’s an emotional thing with me.”
27
Linda Kyzer participating in the 2008 Little Rock Marathon.
Blue & You Autumn 2010
2010 Blue &You Fitness Challenge Results Fourteen groups and four students
schools and student organizations in
ing the Challenge on Facebook® and
took home awards from the closing
Arkansas piloted the contest, with
Twitter. Winners of the Challenge and
ceremonies of the 2010 Blue & You
almost 200 students participating,
pictures from the media conference
Fitness Challenge.
ranging in ages from 13 to 17. Four
are posted on Facebook.
This was the seventh year for the Challenge, an exercise contest held
schools had individual winners.
The Challenge is hosted by Ar-
Also new for 2010, the Challenge
kansas Blue Cross and Blue Shield,
from March 1 through May 31. A total
joined the world of social media.
the Arkansas Department of Health
of 168 groups participated, including
Challenge participants received daily
(ADH) and the Arkansas Department
11,342 individuals, representing 44
motivational messages by follow-
of Human Services (DHS).
states and logging 523,083 checkpoints. Each checkpoint represented at least 30 minutes of exercise, which translates — at a minimum — to 261,541.5 hours of exercise. Groups ranged in size from two to Winners of the Blue & You Fitness Challenge at the closing ceremonies event.
more than 1,538 participants.
28
For the very first time, several
The Data Warehousing Institute names Arkansas Blue Cross a 2010 Best Practices Award winner At Arkansas Blue Cross and Blue
Practices Award in the Enterprise
ensures that their employees are
Shield, Customer Service means
Data Warehousing category for the
getting the right care at the right time
more than a friendly voice at the oth-
company’s use of the Blue Health
and at the right place.
er end of the telephone — it extends
Intelligence (BHI) data warehouse,
to helping our members find doctors
which is housed at the Blue Cross
sas Blue Cross’ commitment to a
that meet their needs, negotiating
and Blue Shield Association.
best practice development approach,
discounts with health care provid-
The goal of BHI is to provide great-
“This award demonstrates Arkan-
which was done in this case using
ers and even working with 19 other
er health care transparency — infor-
the new national BHI data ware-
Blue Plans to create the largest data
mation about the quality and price of
house to support health care decision
warehouse of its kind in the health
health care services — by delivering
making at both the employer and
insurance industry.
data-driven information about health
member level,” said Joseph Smith,
care trends and best practices. BHI
senior vice president of Private Pro-
recognized for being a part of this
gives employers more information
grams and chief information officer
effort to improve health information
about the value of their benefits by
for Arkansas Blue Cross.
technology by The Data Warehousing
providing cost and demographic
Institute.
trends. Employer groups also benefit
and research … just another way
from BHI because the data provides
Arkansas Blue Cross is good for you.
Arkansas Blue Cross recently was
From more than 40 entries, Arkansas Blue Cross received the Best Blue & You Autumn 2010
insight into health care trends and
Improving health care reporting
Notice of Privacy Practices
Arkansas Blue Cross and Blue Shield and Health Advantage THIS NOTICE DESCRIBES HOW CLAIMS OR MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. By law, Arkansas Blue Cross and Blue Shield and its affiliated company, Health Advantage, are required to protect the privacy of your protected health information. We also must give you this notice to tell you how we may use and release (“Disclose”) your protected health information held by us. Throughout this notice, we will use the name “Arkansas Blue Cross” as a short-hand reference for not only Arkansas Blue Cross and Blue Shield, but also for its affiliated company, HMO Partners, Inc., d/b/a Health Advantage. Please note that although we are combining this privacy notice in this way for convenient, short-hand reference, and to make it more efficient to inform you about your privacy rights, these companies remain separate companies, each with their own operations, management and compliance responsibilities. Arkansas Blue Cross must use and release your protected health information to provide information: • To you or someone who has the legal right to act for you (your personal representative) • To the Secretary of the Department of Health and Human Services, if necessary to make sure your privacy is protected, and • Where required by law. Arkansas Blue Cross has the right to use and release your protected health information to evaluate and process your health plan or health insurance claims, enroll and disenroll you and your dependents, and per-
form related business operations. For example: • We can use your protected health information to pay or deny your claims, to collect your premiums, or to share your benefit payment or status with other insurer(s). • We can use your protected health information for regular health care operations. Members of our staff may use information in your personal health record to assess our efficiency and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of benefits and services we provide. • We may disclose protected health information to your employer if your employer arranges for your insurance and serves as Plan Administrator. If your employer meets the requirements outlined by the privacy law, we can disclose protected health information to the appropriate department of your employer to assist in obtaining coverage or processing a claim or to modify benefits, work to control overall plan costs, and improve service levels. This information may be in the form of routine reporting or special requests. • We may disclose to others who are contracted to provide services on our behalf. Some services are provided in our organization through contracts with others. Examples include pharmacy management programs, dental benefits, and a copy service we use when making copies of your health record. Our contracts require these business associates to appropriately protect your information. • Our health professionals and customer service staff, using their
best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care. An example would be your spouse calling to verify a claim was paid, or the amount paid on a claim. Arkansas Blue Cross may use or give out your protected health information for the following purposes, under limited circumstances: • To State and other federal agencies that have the legal right to receive Arkansas Blue Cross data (such as to make sure we are making proper claims payments) • For public health activities (such as reporting disease outbreaks) • For government health care oversight activities (such as fraud and abuse investigations) • For judicial and administrative proceedings (such as in response to a subpoena or other court order) • For law enforcement purposes (such as providing limited information to locate a missing person) • For research studies that meet all privacy law requirements (such as research related to the prevention of disease or disability) • To avoid a serious and imminent threat to health or safety • To contact you regarding new or changed health plan benefits By law, Arkansas Blue Cross must have your written permission (an “authorization”) to use or release your protected health information for any purpose other than payment or health care operations or other limited exceptions outlined here or in the Privacy regulation. You may take back (“revoke”) your written permission at Privacy, continued on Page 30
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Privacy, continued from Page 29
any time, except if we have already acted based on your permission.
Personal Health Record (PHR)
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If you have a health benefit plan issued by Arkansas Blue Cross or Health Advantage on or after October 1, 2007, you have a Personal Health Record (PHR). Your PHR contains a summary of claims submitted for services you received while you are or were covered by your health benefit plan, as well as non-claims data you choose to enter yourself. Your PHR will continue to exist, even if you discontinue coverage under your health benefit plan. You have access to your PHR through the Arkansas Blue Cross or Health Advantage Web sites. In addition, unless you limit access, your physician and other health care providers who provide you treatment have access to your PHR. Certain information that may exist in the claims records will not be made available to your physician and other health care providers automatically. To protect your privacy, information about treatment for certain sensitive medical conditions such as HIV/ AIDs, sexually transmitted diseases, mental health, drug or alcohol abuse or family planning will be viewable by you alone, unless you choose to make this information available to the medical personnel who treat you. Similarly, non-claims data, such as your medical, family and social history, will only appear in your PHR if you choose to enter it yourself. It is important to note, that you have the option to prohibit access to your PHR completely, either by electronically selecting to prohibit access or by sending a written request to prohibit access to the Privacy Office at the address below.
Special Note on Genetic Information
We are prohibited by law from collecting or using genetic information for purposes of underwriting, setting premium, determining eligibility for benefits or applying any pre-existing Blue & You Autumn 2010
condition exclusion under an insurance policy or health plan. Genetic information means not only genetic tests that you have received, but also any genetic tests of your family members, or any manifestations of a disease or disorder among your family members. Except for preexisting condition exclusions, we may obtain and use genetic information in making a payment or denial decision or otherwise processing a claim for benefits under your health plan or insurance policy, to the extent that genetic information is relevant to the payment or denial decision or proper processing of your claim.
Your Rights Regarding Medical Information About You
You have the right to: • See and get a copy of your protected health information that is contained in a designated record set that was used to make decisions about you. • Have your protected health information amended if you believe that it is wrong, or if information is missing, and Arkansas Blue Cross agrees. If Arkansas Blue Cross disagrees, you may have a statement of your disagreement added to your protected health information. • Receive a listing of those getting your protected health information from Arkansas Blue Cross. The listing will not cover your protected health information that was given out to you or your personal representative, that was given out for payment or health-care operations, or that was given out for law enforcement purposes. • Ask Arkansas Blue Cross to communicate with you in a different manner or at a different place (for example, by sending your correspondence to a P.O. box instead of your home address) if you are in danger of personal harm if the information is not kept confidential. • Ask Arkansas Blue Cross to limit
how your protected health information is used and given out to pay your claims and perform health care operations. Please note that Arkansas Blue Cross may not be able to agree to your request. • Get a separate paper copy of this notice.
To Exercise Your Rights
If you would like to contact Arkansas Blue Cross or Health Advantage for further information regarding this notice or exercise any of the rights described in this notice, you may do so by contacting Customer Service at the following toll-free telephone numbers: Arkansas Blue Cross 1-800-238-8379 Health Advantage 1-800-843-1329 You also may get complete instructions and request forms from our companies’ Web sites, which are: www.arkansasbluecross.com www.healthadvantage-hmo.com
Changes to this Notice
We are required by law to abide by the terms of this notice. We reserve the right to change this notice and make the revised or changed notice effective for claims or medical information we already have about you as well as any future information we receive. When we make changes, we will notify you by sending a revised notice to the last known address we have for you or by alternative means allowed by law or regulation. We will also post a copy of the current notice on Arkansas Blue Cross and Health Advantage Web sites.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with Arkansas Blue Cross or its affiliated company, Health Advantage, or with the Secretary of the Department of Health and Human Services. You may file a complaint with Arkansas Blue Cross or its affiliated company, Health Advantage, by writing to the following address:
Privacy Office ATTN: Privacy Officer P.O. Box 3216 Little Rock, AR 72201 We will not penalize or in any other way retaliate against you for filing a complaint with the Secretary or with us. You also may file a complaint with the Secretary of the U.S. Department of Health and Human Services. Complaints filed directly with the Secretary must: (1) be in writing; (2) contain the name of the entity against which the complaint is lodged; (3) describe the relevant problems; and (4) be filed within 180 days of the time you became or should have become aware of the problem.
We love to hear from you! May we help? For customer service, please call:
Little Rock Number (501)
Toll-free Number
Medi-Pak members
378-3062 1-800-338-2312
Medi-Pak Advantage members
1-877-233-7022
Medi-Pak Rx members
1-866-390-3369
Arkansas Blue Cross members
378-2010 1-800-238-8379
Pharmacy questions
1-800-863-5561
Specialty Rx Pharmacy questions
1-866-295-2779
Health Advantage members
378-2363 1-800-843-1329
Pharmacy questions BlueAdvantage members
1-800-863-5567
378-3600 1-888-872-2531
Pharmacy questions
1-888-293-3748
State and Public School members 378-2364 1-800-482-8416 Federal Employee members
378-2531 1-800-482-6655
Looking for health or dental insurance? We can help! For individuals, families and those age 65 or older
378-2937 1-800-392-2583
For employer groups 378-3070 1-800-421-1112 (Arkansas Blue Cross Group Services, which includes Health Advantage and BlueAdvantage Administrators of Arkansas)
Notice to Medi-Pak Advantage (PFFS) members Effective Jan. 1, 2010, the Human Immunodeficiency Virus (HIV) screening is covered for people with Medicare Advantage who are pregnant and/or at increased risk for the infection, including anyone who asks for the test. Medi-Pak Advantage (PFFS) covers this test one time every 12 months or up to three times during a pregnancy. This lab test is covered at the same member cost-sharing amount as any other covered lab service. Please reference your Summary of Benefits or Evidence of Coverage for more details on lab services cost sharing. If you have any questions or need more information, please see the Medicare Web site at cms.gov or call
Prefer to speak with someone close to home? Call or visit one of our regional offices: Pine Bluff/Southeast Region 1800 West 73rd St. Jonesboro/Northeast Region 707 East Matthews Ave. Hot Springs/South Central Region 100 Greenwood Ave., Suite C Texarkana/Southwest Region 1710 Arkansas Boulevard Fayetteville/Northwest Region 516 East Milsap Rd., Suite 103 Fort Smith/West Central Region 3501 Old Greenwood Rd., Suite 5 Little Rock/Central Region 320 West Capitol Ave., Suite 900
1-800-236-0369 1-800-299-4124 1-800-588-5733 1-800-470-9621 1-800-817-7726 1-866-254-9117 1-800-421-1112
You can contact customer service through our Web sites:
arkansasbluecross.com healthadvantage-hmo.com blueadvantagearkansas.com blueandyoufoundationarkansas.org
1-877-233-7022 (TTY 1-888-844-5330). Blue & You Autumn 2010
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At Arkansas Blue Cross and Blue Shield, we are always looking for new ways to be "Good for You." Here are some of our latest accomplishments.
32 Know Your Exposure
Find A Doctor
To protect our members from overexposure to ion-
Arkansas Blue Cross and Blue Shield offers you
izing radiation used in medical imaging, Arkansas Blue
extensive networks of doctors and hospitals serving
Cross and Blue Shield and its family of companies are
all 75 counties of Arkansas with more than 9,300
including a calculation of a member’s equivalent dose
participating health care providers. To find a doctor
of radiation from medical procedures in your Personal
or hospital, select the “Need a provider?” link on
Health Record behind My Blueprint. The information,
the main page of any of our Web sites (see a list
supplied by National Imaging Associates (NIA), is
of Web sites on page 23). You can either search by
based on claims data from health care providers.*
using your medical plan ID card number or you can
It is important to talk with your doctor about your
select a health plan from a list provided. By filling in
medical imaging choices. This additional information
the next form, you can choose a doctor or specialist
can help you make informed health care decisions.
by location, specialty, gender or language prefer-
Your doctor can explain the need for a medical imag-
ence. You also can select a hospital or facility by
ing procedure based on the benefits and potential
type or location.
risks involved. * Claims data is provided to National Imaging Associates (NIA) from Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas at regular intervals. If a claim has not been filed or was not paid, if the patient has had a lapse in coverage or if the employer group has opted not to participate, there may be information on exposure to ionized radiation that is not factored into this calculation.
Blue & You Autumn 2010
NIA provides prior authorization services for outpatient diagnostic imaging services for Arkansas Blue Cross, Health Advantage and BlueAdvantage. NIA is an independent company that operates separately from these companies.