Summer 10
A publication for the policyholders of the Arkansas Blue Cross and Blue Shield family of companies
HEALTH INSURANCE
REFORM ANSWERS
Cal Kellogg, Ph.D., explains what you need to know about health insurance reform.
INSIDE 3 Out of the Blue 4 Health Insurance Reform & You 6 Good news for graduates! Arkansas Blue Cross extends health insurance coverage
8 Your health insurance, your health care, your future 12 Need more information before visiting a specialist? We can help! Lose weight The Healthy Weigh!
13 Chronic job stress and your waistline How much exercise do women really need?
16 Lifelong Health with Dr. David 18 Warning issued for “baby slings” Can breastfeeding save lives?
19 Redesigned PHS wins top scores in national review Food for thought: certain foods may keep aging brains healthy
20 From the Pharmacist — What’s in a drug name and
on Page 8 6
Good news for graduates!
12 Need more information before visiting
19
a specialist? We can help!
why did mine change?
21 The Doctor’s Corner 22 Financial Information Privacy Notice 23 Good for your community Customer Service telephone numbers
24 Good for you
Redesigned PHS wins top scores in national review
Summer 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.
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
care costs. Unfortunately, the new law does little to address the rising cost of medical services but adds new rules that will increase administrative requirements and new fees that will have to be funded. As we move into the implementation phase of the new health insurance reform bill, we will be focused on making coverage affordable for consumers. Arkansas Blue Cross remains committed to working with employ-
The enactment of new health insurance reform leg-
ers, providers of care (such as doctors and hospitals) and state and federal government agencies to reduce
islation has left many of our valued customers confused
the cost and wasteful use of medical services, which
and unsure of how the new law will affect them. We
leads to higher medical premium costs. We will contin-
are hearing questions concerning the changes that can
ue to participate in initiatives that keep people healthy
be expected as various provisions of the new law take
and help them manage chronic disease. And, we will
effect from employers, individuals and families, as well
work to develop new payment models so that health
as agents who market our products. And the confusion
care providers are rewarded for providing effective,
is certainly understandable as the law is far-reaching
high-quality care rather than more care. Also, we will
and complex. At Arkansas Blue Cross and Blue Shield,
take a fresh look at how we operate and seek greater
we are working every day to provide accurate answers
administrative efficiency.
to the questions you pose. We also are working with
In a period of rapid and radical change in health care,
various government agencies to clearly understand and
one thing remains constant. Arkansas Blue Cross is
effectively implement the regulations that will result
committed to providing our members with peace of
from the reform legislation passed by Congress.
mind, as we have done for more than 60 years. That
One of the most frequent questions we answer for
commitment is even more important in today’s uncer-
our members relates to cost. Our members are con-
tain health care environment. So if you have questions
cerned that, as a result of new regulations, their premi-
about how health insurance reform will affect your
um costs will rise. And that is a valid concern. There are
health care, we hope you will check our Web sites for
many provisions in the law that will increase the cost
our analysis. Or call us. We’re happy to hear from you.
of health insurance premiums for many people. After
In this rapidly changing health care environment, we
all, health insurance premiums are a reflection of health
haven’t forgotten who we work for every day. You. Blue & You Summer 2010
3
Health Insurance The Patient Protection and Affordable Care Act
(PPACA), which was signed into law on March 23,
quirements, which will come with the issuance of regu-
2010, ultimately will touch almost every American. The
lations, we are not able to accurately price the changes.
provisions of the law will be phased in throughout the next 10 years, with the most significant changes taking place in 2014. At this early stage, it is very difficult to predict what changes are in store for each of us. That is because there are numerous federal and state entities that must issue regulations, which will explain to insurance companies and others involved how the law will be implemented. The PPACA will make dramatic changes in the insurance marketplace. The new law will require all health insurance policies to contain new benefits. It will re-
4
you enrolled in it. Until we better understand the re-
quire that health insurers rate health plans in new ways. Many health industry suppliers will be called upon to pay new taxes to cover the uninsured, thereby increasing their costs. The new reform legislation did not contain substantial provisions to control medical costs, which are the primary drivers of premium costs. These facts taken together mean that for most Americans, the cost of health insurance will rise. By 2014, many Americans will be eligible for government subsidies, which will help offset those increases. In the meantime, those with private insurance should expect there to be some increase in cost as reform provisions are implemented. That being said, Arkansas Blue Cross and Blue Shield and its family of companies are committed to doing all we can to hold costs down and help our customers understand how they will be affected. With the understanding that the final rules are not in place, described in this article are the changes we believe will be required by the new law during the next 18 months, based on the kind of policy you have and when Blue & You Summer 2010
If you have health insurance through your employer and were enrolled before March 23, 2010 (at least one enrolled person): Insurance policies that were in place on the day the law was passed are considered “grandfatheredâ€? plans. The new requirements for these plans are more limited than for those sold after the law was enacted. Changes that members enrolled in grandfathered employer group plans can expect during the next six to 18 months may include: • New rules around pre-existing health conditions for children, which may mean that children who are
Reform & You insured under their parent’s health plan do not have
(More information on dependent coverage is in the
to meet any pre-existing condition waiting periods
article on Page 6.)
even if the parents are required to do so as a result
• Lifetime dollar limits will be removed on “essential
of some condition of their enrollment (late enroll-
benefits.” The rules and guidelines outlining what
ment, no prior creditable coverage, etc.).
benefits are considered essential have not been
• Dependents can continue coverage under a parent’s plan until their 26th birthday. Dependents are eligible
defined by the government as of this printing. • On most Arkansas Blue Cross plans, the lifetime
regardless of student or marital status. Dependents
maximum benefit is currently $5,000,000. This life-
also are eligible regardless of whether they are
time benefit would become unlimited.
claimed as a dependent on their parent’s tax return.
• The dollar limits for some benefits in place today
Policies in place before March 23, 2010, are allowed
may be adjusted by the law. The benefits to which
to exclude coverage to dependents if they have ac-
this regulation applies have not been determined.
cess to their own coverage from another employer-sponsored health plan. This exception expires on Jan. 1, 2014.
If you had an individual or family medical policy in place March 23, 2010 (in which you were enrolled): Insurance policies that were in place on the day the law was passed are considered “grandfathered” plans. The new requirements for these plans are more limited than for those sold after the law was enacted. Changes that members enrolled in grandfathered plans can expect during the next six to 18 months may include: • Dependents can continue coverage under a parent’s plan until their 26th birthday. Dependents are eligible regardless of student or marital status. Dependents also are eligible regardless of whether they are claimed as a dependent on their parent’s tax return. (More information on dependent coverage is in the article on Page 6.) •
Lifetime dollar limits will be removed on
“essential benefits.” The rules and guidelines outlining what benefits are considered essential have not been defined by the government as of this printing. •
On most Arkansas Blue Cross
Reform, continued on Page 14
Blue & You Summer 2010
5
Good news for graduates!
Arkansas Blue Cross extends health insurance coverage Health and Human Services to prevent a disruption of services to our members. The following is information on how this affects you and your adult child depending on your health insurance plan:
6
To help our members who
have dependents who are graduating from high school or college this spring or may be “aging off” their parent’s medical policy, Arkansas Blue Cross and Blue Shield has extended health insurance coverage for most young adults up to age 26 who currently are covered by their parent’s individual or fully insured group plan. Although this provision of the health insurance reform law (the Patient Protection and Affordable Care Act) becomes effective on the renewal date of a member’s policy beginning Sept. 23, 2010, or after, Arkansas Blue Cross, along with 38 other independent Blue Plans, has extended dependent care coverage early (it began June 1) at the request of the U.S. Secretary of Blue & You Summer 2010
If you have an individual or family medical insurance policy • Dependents who currently are enrolled on their parent’s coverage as of May 2010, will be allowed to remain on that coverage as long as they are under age 26. Dependents are eligible regardless of student or marital status. Dependents also are eligible regardless of whether or not they are claimed as a dependent on their parent’s tax return. • There will be no rate impact on this change until renewal on plans already in place as of May 15 or before. However, a premium must be paid to cover the cost of the dependent. • Those dependents who are under age 26, and who lost eligibility for dependent coverage earlier, can apply to be added back to the plan at the effective date of the regulation, which is Oct. 1, 2010. • These dependents will be subject to medical underwriting.
• Standard pre-existing condition waiting periods will apply.
If you have a fully insured health care plan through an employer (small business or large corporation) • Dependents who currently are enrolled on their parent’s coverage (regardless of insurance carrier) as of May 2010, will be allowed to remain on that coverage as long as they are under age 26. These dependents are eligible regardless of student or marital status. Dependents also are eligible regardless of whether or not they are claimed as a dependent on their parent’s tax return. • Dependents who are under the age of 26, who were not covered under their parent’s plan as of May 2010, and who lost eligibility for dependent coverage earlier, can be added back to the group plan at the effective date of the regulation, which is the first renewal date beginning Oct. 1, 2010, or after. • A special 30-day open enrollment period for dependents who had previously aged off their coverage will be held for each group health plan beginning on their renewal date. You will receive
notification before the open
• A special 30-day open enrollment
• The provisions for adding depen-
enrollment period. Dependents
period for dependents who had
dents prior to plan renewal are
on COBRA due to “aging off”
previously aged off their cover-
as follows:
their parents’ coverage, who are
age will be held for each group
still younger than 26, also will be
health plan beginning on their
allowed to rejoin the group dur-
renewal date. You will receive no-
primary residence of the
ing open enrollment. They would
tification before the open enroll-
dependent.
again be eligible for COBRA
ment period.
when they reach the age of 26. • Policies in place before March 23, 2010, are allowed to exclude coverage to dependents if they have access to their own coverage from another employer-sponsored health plan. This exception expires on Jan. 1, 2014. • There is no premium rate impact until the group’s renewal. However, a family premium (employee/child) will continue to be charged. • If the current plan covers dependents to age 27, the change does not impact their plan (fully insured large group plans only). • Although this change will be made automatically, employer groups may choose to “opt out.”
If you are an employee of a self-insured group • Your employer will make the decision. Employers are being notified of this industry trend toward early implementation. • Without early implementation, the increase in dependent to age 26 coverage will take effect at renewal.
If you have an Arkansas Blue Cross dental plan through your employer • Dependent rules are the same as for the fully insured group health plans. • There is no premium rate impact until the group’s renewal. However, a family premium (employee/child) will be charged. • Although this change will be made automatically, employer groups may choose to “opt out.”
° Child must be unmarried. ° Parent’s home is the
° Parent provides bulk of the financial support. • After plan renewal, all dependents up to age 26 can be added regardless of their residence or marital status.
If you are a federal employee (FEP) • This change does not impact FEP members until Jan. 1, 2011.
Dental plans for individuals and families (if you purchased your own dental plan) • Dependents who are age 19 and aging off their parent’s plan can apply for an individual dental policy. If you are a state or public school employee in Arkansas • The change to cover dependents up to age 26 was implemented on April 1, 2010, and a 90-day open enrollment period was given to employees to add previously dropped dependents.
Blue & You Summer 2010
7
Your health insurance, your health Cal Kellogg, Ph.D., senior vice president and chief strat-
just need to be proactive. Rather than saying, ‘let it
egy officer for Arkansas Blue Cross and Blue Shield,
happen and then we’ll fix it,’ we should say, ‘let’s do
closely followed health insurance reform as the debate
what we can to prevent illness,’ because the prevented
was waged in Congress and has become an expert on
illness is the one that is the least expensive.”
the resulting Patient Protection and Affordable Care Act (PPACA). Blue & You recently sat down with Dr. Kellogg to discuss the overall effect the new law will have, not only on the lives of our members, but also on the lives of all Americans.
What were the goals of health care reform? Looking back, the initial goal of “health care” reform
8
2. Changes to Your Coverage There will be changes related to your health insurance coverage because of PPACA. We will keep you informed through Blue & You and our Web sites. “While reform will ensure that more Americans have health insurance,” Kellogg said, “the coverage will cost more, simply because of how the changes in the marketplace
legislation was to solve three problems, according
are structured by the new law.” He explained that under
to Dr. Kellogg.
reform, individual and family insurance plans will have
1. Get as many people as possible covered by
rules similar to the current small group insurance plans.
health insurance. 2. Address the overall cost of care.
“If you look at the current marketplace, premiums for small employer groups are about three times higher
3. Make sure Americans receive high-quality health care services. Kellogg said the new law addresses goal No. 1. However, “that means we have to work on the other two issues,” he said. “That can be done legislatively, or we will have to do that as an industry.”
What do our members need to know about health insurance reform? According to Kellogg, members need to keep three important points in mind: 1. Personal Responsibility As a consumer of health care services, it is important to take personal responsibility for your own health. This will benefit you and your family both financially and personally. “The current reform package doesn’t address the underlying causes of the increases in medical costs,” Kellogg said. “People can manage their own health to prevent illnesses by doing simple things like eating healthy, exercising and reducing stress — we Blue & You Summer 2010
Cal Kellogg, Ph.D.
h care, your future What you need to know about health insurance reform than for individual health insurance policies written for individuals and their families without an employer sponsor,” Kellogg explained. “This is because small group health insurance plans are “guaranteed issue,” which means that employees and their dependents can have coverage regardless of any health conditions they may have. In addition, premiums are based in part on the health conditions of all the employees on the group plan. So if there are a number of very sick people within a group, the group premiums will be higher.” Kellogg said the rates in Arkansas’ current individual
9
marketplace are some of the lowest in the United States because of the manner in which the laws in Arkansas allow health plans to calculate premiums.
to be “guaranteed issue” as well. For that reason, the
Currently, each state has its own set of laws and regula-
rates are expected to be closer to what we see in small
“While reform will ensure that more
tions that take into
Americans have health insurance,” Kellogg said, “the coverage will cost more, simply because of how the changes in the marketplace are structured by the new law.”
employer group health plans today.
account the unique
In addition, PPACA changes the process and the
circumstances that
factors that insurance companies currently use to set
may exist in its mar-
premium rates. Currently, older individuals generally pay
ketplace. “If you are
higher premiums than younger people because they
relatively healthy, you
are likely to need more medical services. But in 2014,
get a much lower
insurance companies will be limited in the difference
rate,” he said. “If you
in premium charged between an older person and a
are unhealthy, you
younger person. This works out well for you if you are
may have to pay a
older and not so well if you are younger.
surcharge, or you may
Also, in 2014, PPACA requires that each state estab-
not be offered indi-
lish health insurance exchanges or marketplaces where
vidual coverage in the
citizens can go to shop for insurance. At that time, Kel-
private marketplace.
logg said, a person who buys individual insurance and
You would still have access to the high-risk pool, where
whose household income is under 400 percent of the
the premium rates are closer to the premium rates for
federal poverty level will receive government subsidies
small employer groups.” But beginning in 2014, indi-
to help pay for their insurance coverage. Subsidies will
vidual insurance policies in Arkansas will be required
be available to people from 133 percent of the federal Blue & You Summer 2010
poverty level up to 400 percent of
to $250, but an older person
the federal poverty level on a sliding
paying $750 might move
scale. People who earn more than
down to $650 a month,” Kel-
400 percent of the poverty level will
logg said. “The impact is go-
not receive a subsidy. “If you are on
ing to vary a lot for people in
the lower end of the scale, you may
the individual policy market.”
not end up paying very much more
Kellogg said the new law
for your policy,” he said, “but if you
doesn’t have as much of
are on the higher end of the scale,
a direct impact on people
you may pay a significant amount.”
ages 65 and older. He noted
It is difficult to explain how the new health insurance reform law
immediate relief for prescrip-
will affect people financially, Kellogg
tion drug coverage and that the
said, because it depends on their
“donut hole” in prescription drug
situation. “Say I’m a 55-year-old
coverage would close by 2020.
with diabetes. In the current environment, if I get individual coverage
10
that they did receive some
it may be very expensive because of my health condition, or I might not be offered coverage at all in the private marketplace. But under the new law, I will be able to get coverage regardless of my health condition and it might be a little less expensive than it would otherwise have been. This is because of the new limits in the difference in premiums that the insurance company will be able to charge between an older, unhealthy person and a younger, healthy individual. Now, if I’m a single 22-year-old man, I might see my rates double or triple because of those same limits, plus the law’s inclusion of maternity and other medical services as essential benefits. “A young person’s membership premium might move from $90 up Blue & You Summer 2010
3. The Cost Issue Health insurance reform does not
insurance and have not been seeing primary care physicians as frequently as they should.” There will be a rise in premiums for young and healthy people who already have insurance. Because of this, some of these individuals may choose not
fix all the problems in the health
to pay the higher premiums and go
care system. There are still many
without coverage.
important issues to be addressed.
Some proponents of the new law
While the new health insurance
have said there will be a windfall
reform law deals with access to
for the insurance companies with
insurance, Kellogg said it doesn’t
all the new people in the system,
address the problem of increasing
but Kellogg said it doesn’t neces-
medical costs. And there is still a
sarily work out that way. “Yes, there
question of whether our medical
will be new people in the system,
system will have the capacity to
but they may not be as healthy,
serve everyone.
and that is going to drive costs,” he
“We are estimating that 500,000
explained. “Our experience is that
previously uninsured Arkansans will
folks who have not had insurance,
be able to get coverage,” he said.
and then get coverage, tend to use
“There may be problems with being
their coverage quite a bit, which
able to see doctors as quickly, or
creates higher volume. You take all
scheduling appointments as easily.
those things together and we could
In rural areas, it may be even more
run into some supply problems.”
of an issue, because there are fewer physicians. It also may be a little bit tighter with the addition of new Medicaid patients who have not had
Advice to Members Kellogg suggested members not make any significant changes in their
coverage until there is more information about the regulations. “The law has been passed, but the regulations that define the law really don’t exist yet. And, until they exist, we don’t really know exactly how things will work.” For example, Kellogg said, the law discusses “essential benefits,” which are medical services that every health insurance plan in the country will be required to cover, but the regulations don’t exist to explain which benefits are considered “essential.” We have to understand the details in the regulations before you start making changes. Kellogg said that for the next six to 18 months the law is in the implementation stage, which will include some minor changes and explanation of the law through regulations. “You are not going to see major changes until 2014, when these significant structural changes will happen to the insurance market.”
Making the Most of It Going forward, Kellogg said, Arkansas Blue Cross will focus on ways to effectively pay for benefits and to provide information to help customers find the most effective treatments and the places with the best outcomes. “And we want to pay providers — not for the number of services they provide — but for the outcomes that they generate for their patients,” he said. “We can help people identify where there is waste in the system and get rid of it. And, if we do all these things in a relatively short time, then we can lessen the cost impact that reform will otherwise have on our members.” Implementation Kellogg said that Arkansas Blue Cross is working to understand the regulations as quickly as they are announced and will implement them in a timely, organized fashion with minimal disruption. “Hopefully, for our members, transitions will be as painless as possible and they hardly will notice that they’ve happened,” he said, “unless it’s a situation where they have the opportunity to extend coverage for their child or whatever the situation might be and then we will have a process for doing that.” “We also are going to try to keep employer groups informed of what it
will take to comply, including the implications for them and positives and negatives for some of the choices they may make,” he said. “So, hopefully, that will help our members if they have employer coverage. Employers are going to be struggling to understand this; this isn’t their business, this is our business, so we’d better be the experts on it and help them.”
What is the Silver Lining? Kellogg said that under reform many previously uninsured people will now have access to coverage. “And, beginning in 2014, if you have a lower income, there will be significant government subsidies and it won’t cost you as much for insurance. For those groups it is positive.” But that silver lining isn’t for everyone. “For the rest of the folks, the subsidies have to come from taxes, so the increased tax burden will be out there,” Kellogg said. “And for people who are at or above 400 percent of the federal poverty level, they won’t get any subsidy and there will be added costs.” But Kellogg said the efforts to change health care have only just begun. “The other positive is now that the issue of access has been addressed, we can focus on other major issues, like cost and quality,” he said. “I guess that is the biggest positive.”
Blue & You Summer 2010
11
Lose weight We can help! The Healthy Weigh!
Need more information before visiting a specialist? If you are planning a visit to the doctor and need a little more information on what medical care may be appropriate for you, Physician
Connection can help. Physician Connection allows you (as a member) to find quality information for a specific health condition or physician
The Healthy Weigh! Education
specialty. Quality information is available
12
Physician Connection is avail-
for health conditions such as preg-
able exclusively for members to
nancy, diabetes, heart, eye and
help you make informed health
respiratory conditions. The quality
decisions. It’s available in the
information also is available for
secure My Blueprint sections of
the following specialties: allergy/
our Web sites — arkansasblue-
immunology, cardiology, endocri-
cross.com, healthadvantage-
nology, family practice, internal
hmo.com and blueadvantagear-
medicine, neurology, obstetrics/
kansas.com. Visit the home
gynecology, ophthalmology, oto-
page to register or log in.
Program is free for members of Arkansas Blue Cross and Blue Shield, 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
laryngology, pediatric medicine,
enrollment form and return it in the
pulmonary diseases and urology.
self-addressed, postage-paid envelope
What is quality information? Medical experts have established guidelines that most informed practitioners believe physicians should follow in many — but not all — situations. Quality measures show how often physicians in our network (as a group) provide frequently recommended treatments to their patients. Within Physician Connection on our Web sites, under the section called “Quality measures for my physician’s specialty,” you can select a physician specialty, read the recommended treatment options (quality measure) for specific conditions, and review a graph that shows how often physicians in that specialty followed the recommended treatment (quality measure) for their patients. In a similar section on our Web sites called “Quality measures for my health condition,” you can select a health condition (such as diabetes) and review the graph that shows (by specialty) how often physicians who treat diabetes followed the recommended treatment (quality measure) for their patients. Blue & You Summer 2010
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.
Chronic job stress and your waistline Are you stressed out at work? Worried about job
snacks were the first to go from vending machines. Em-
security? Feeling like you have little control? Chronic
ployees noted that they did not take time to exercise or
stress may be adding to employees’ waistlines, accord-
eat better in order to remain at their desks.
ing to a recent study conducted by the University of Rochester Medical Center.
One conclusion that the study made is that employers should “focus on strengthening wellness programs
Researchers found that workers who suffered from
to provide good nutrition, ways to deal with job de-
chronic job stress had a higher Body Mass Index (BMI)
mands and more opportunities for physical activities
than less stressed workers. According to the study,
that are built into the regular workday without penalty.”
workers dealing with chronic stress tended to look “forward to going home and ‘vegging out’ in front of the
Sources: University of Rochester Medical Center,
TV.” And, when layoffs were occurring, the unhealthiest
msnbc.com
How much exercise do women really need? We’ve all heard the standard 30 minutes a day, most
to prevent weight gain,
days of the week recommendation. But recent research
middle-aged women would
shows that may not be enough for women as they age.
need to aim for a minimum of
According to a study in the Journal of the American
21 METs per week. To hit those
Medical Association, middle-aged women may actually
MET requirements in less time,
need closer to 60 minutes a day of moderate-intensity
up the intensity of your work-
exercise. Don’t be discouraged so quickly. The study
outs, which will allow you to
uses Metabolic Equivalent (MET) hours. To put it into
meet the MET requirements
perspective, 1 MET would be equivalent to lying in bed
in less than an hour a day.
for an hour while running at 6 mph would equal approximately 10 METs.
Source: Health.com
So, in order to meet the 60-minute recommendation Blue & You Summer 2010
13
Reform, continued from Page 5 plans, the lifetime maximum benefit is currently
(This benefit is already offered by Arkansas Blue
$5,000,000. This lifetime benefit would become
Cross and Health Advantage.)
unlimited.
14
If you were enrolled in a health plan through your employer effective April 1, 2010, or after: For more recently effective health plans, a number of changes apply during the next six to 18 months. These changes may include: • New rules around pre-existing health conditions for children, which may mean that children who are insured under their parent’s health plan do not have to meet any pre-existing condition waiting periods even if the parents are required to do so as a result of some condition of their enrollment (late enrollment, no prior creditable coverage, etc.). • Dependents can continue coverage under a parent’s plan until their 26th birthday. Dependents are eligible regardless of student or marital status. Dependents also are eligible regardless of whether they are
• Access to any in-network primary care physician or pediatrician who is accepting new patients. (Already available.) • Direct access for women to obstetricians/gynecologists without a referral. • Preventive services identified by the U.S. Preventive Services Task Force will be covered with no member cost-sharing (copayments, deductibles or coinsurance.) The specific services that will be covered have not yet been identified.
If you were enrolled in a family or individual medical policy on April 1, 2010, or after: For more recently effective health plans, a number of changes apply over the next six to 18 months. These changes may include: • New rules around pre-existing health conditions for children which may mean that children who are in-
claimed as a dependent on their parent’s tax return. (More information on dependent coverage is in the article on Page 6.) • Lifetime dollar limits will be removed on “essential benefits.” The rules and guidelines outlining what benefits are considered essential have not been defined by the government as of this printing. • On most Arkansas Blue Cross plans, the lifetime maximum benefit is currently $5,000,000. This lifetime benefit would become unlimited. • The dollar limits for some benefits in place today may be adjusted by law. The benefits to which this regulation applies have not been determined. • Emergency services must be covered at the innetwork coinsurance or copayment level even if you receive the services at an out-of-network facility.
Blue & You Summer 2010
For more information on health insurance reform, go to our Web sites or call Customer Service (telephone numbers found on Page 23).
sured under their parent’s health plan do not have to
network facility. (Arkansas Blue Cross already offers
meet any pre-existing condition waiting periods even
this benefit.) • Access to any in-network primary care physician or
if the parents are required to do so. • Dependents can continue coverage under a parent’s plan until their 26 birthday. Dependents are eligible th
regardless of student or marital status. Dependents
pediatrician who is accepting new patients. (Already available.) • Preventive services identified by the U.S. Preventive
also are eligible regardless of whether they are
Services Task Force will be covered with no member
claimed as a dependent on their parent’s tax return.
cost-sharing (copayments, deductibles or coinsur-
(More information on dependent coverage is in the
ance). The specific services that will be covered have
article on Page 6.)
not yet been identified.
• Lifetime dollar limits will be removed on “essential
• Direct access for women to obstetricians/gynecolo-
benefits.” The rules and guidelines outlining what
gists without a referral will be included in all policies.
benefits are considered essential have not been
In addition to the new requirements described above,
defined by the government as of this printing. • On most Arkansas Blue Cross plans, the lifetime maximum benefit is currently $5,000,000. This lifetime benefit would become unlimited. • The dollar limits for some benefits in place today may be adjusted by law. The benefits to which this regulation applies have not been determined. • Emergency services must be covered at the innetwork coinsurance or copayment level even if you receive the services at an out-of-
PPACA includes additional regulations that may impact members. These provisions include: • New appeals processes will be established. • The federal Department of Health and Human Services will create a Web site to facilitate consumer and small group health plan shopping. • State ombudsman programs will be established. • Over-the-counter drugs not prescribed by a physician can no longer be reimbursed from a flexible spending account or HRA. These are the changes you can expect in the next six to 18 months. As regulations are clarified, Arkansas Blue Cross will notify you of those provisions that impact your policy. Most importantly, we will keep you informed of the impact these changes may have on your rates. The most substantial changes will be implemented in 2014. Those provisions will change where and how you buy insurance, how it is priced and how you pay for it. As regulations are issued, Arkansas Blue Cross will provide you with as much information as possible to help explain health insurance reform and its impact on the health care industry. Please visit our Web sites or contact us with any questions you may have. Blue & You Summer 2010
15
Lifelong Health
with Dr. David
death from heart disease is significantly greater than David A. Lipschitz, M.D., Ph.D.
a man’s. In many women, coronary artery disease is different from that found in men. Women tend to deposit cholesterol and fats uniformly throughout their arteries, whereas men tend to have more localized disease. This may make women less prone to a massive heart attack, but more likely to have different symptoms, including potentially fatal abnormal heart rhythms. Prior to menopause, estrogens protect the heart from the ravages of a sedentary and stressful lifestyle, unhealthy diets, elevated cholesterol levels and smoking. However, after
16
menopause, the protection disappears and hormone replacement therapy seems to make the problem worse rather than better. As women grow older, heart attacks become more common, but the symptoms are quite different from our stereotypic expectations. Most Americans imagine a heart attack to be preceded by a sudden crushing, centralized chest pain that feels as if the chest is in a vice. This is rarely the case. For many women, chest pain is not the initial symptom. Instead, symptoms
For women, heart attack prevention and education are key In recent years, American women have become in-
can be extremely varied, including a sudden shortness of breath, palpitations, nausea and vomiting, or feeling clammy and
creasingly aware that heart disease is not just a “man’s
ill. If chest
issue.” Before menopause, a woman’s risk of heart
pain does
attacks is lower than a man’s. But post-menopause, the
occur, it
risk slowly increases, and within a decade both sexes
frequently
have similar statistics. We now know that in the last
is atypical,
two decades of life, a woman’s risk of heart attack and
meaning it
Blue & You Summer 2010
For many women, chest pain is not the initial
symptom. Instead, symptoms can be extremely varied, including a sudden shortness of breath, palpitations, nausea and vomiting, or feeling clammy and ill.
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.
doesn’t fit the classic description of pain associated
lifestyle of diet, exercise and stress management. If
with a heart attack. It may be in the back or abdomen
medical concerns are present, such as high blood pres-
and is often attributed to a muscle strain or indigestion.
sure and elevated cholesterol, they should be treated
Frequently there is no pain at all or merely a feeling of
and managed.
pressure or tightness across the chest or throat.
In addition to prevention, women need to be more
Heart attacks with atypical symptoms or no chest
informed and aware of the initial symptoms of heart
pain are frequently misdiagnosed, or diagnosed after it
attacks. Do not ignore a sudden shortness of breath,
is too late. A recent report published in a major medical
sweating, nausea, vomiting or unexplained palpitations.
journal showed that pain-free heart attacks, particularly
Never ignore an unusual pain such as a heaviness or
common in older women, are three times more likely to
tightness in the chest, pain in the back, arm or abdo-
be fatal than those with typical symptoms.
men, particularly if you have never had anything like this
There are some very important lessons to be learned
before. The sudden onset of any of these symptoms
from this information. Women must remember that
is best handled by taking an aspirin and calling 911; it
they are not immune to heart disease. From a young
could save your life. When it comes to issues of the
age, all women must pay attention to a heart-healthy
heart, it is far better to be safe than sorry!
Blue & You Summer 2010
17
Warning issued for “baby slings” The U.S. Consumer Product Safety Commission (CPSC) has issued a
infant’s chin downward to his or her
warning concerning the use of infant
chest, making breathing difficult and
carriers known as “baby slings.”
possibly causing a slower suffoca-
A baby sling is a soft fabric carrier
tion. Children with breathing prob-
• Do not allow the sling to cover the child’s face. • Do not carry the child too low in the sling. • Do not carry the child hunched,
with a padded shoulder strap con-
lems and a low birth weight are at a
with his/her chin touching
necting to a hammock-style cradle
higher risk.
the chest.
that is worn by an adult. The warning
The CPSC has not issued a recall
• Do not carry the child with his/her
was issued after three infants suf-
on baby slings, but advises parents
face pressed tightly against the
focated in baby slings in 2009.
to take special care when using the
wearer of the sling.
Babies younger than four months old have very weak neck muscles
device. Specifically, parents should: • Place the child’s chin up
and can’t control their heads. An
with his/her face clearly
infant can suffocate in as little as two
visible.
minutes if the strap from a baby sling
18
Also, baby slings can force an
covers his/her nose and mouth.
• Check on the child often.
Can
breastfeeding
save lives?
Nearly 900 babies could be saved
Breastfeeding is thought to protect
each year, along with billions of dol-
against stomach viruses, ear infec-
mothers breastfed their babies for
lars, if 90 percent of U.S. women
tions, asthma, juvenile diabetes,
six months. Medical costs have
fed their babies only breast milk
sudden infant death syndrome and
climbed since then, and breast-
for the first six months of life, ac-
even childhood leukemia.
feeding rates have increased only
cording to a cost analysis published
The $13 billion in estimated
slightly. About 43 percent of U.S. mothers
in the April issue of the journal
losses includes an economist’s cal-
Pediatrics.
culation partly based on lost poten-
do at least some breastfeeding for
tial lifetime wages — $10.56 million
six months, but only 12 percent fol-
per death.
low government guidelines recom-
The analysis studied the prevalence of 10 common childhood illnesses, costs of treatment, includ-
The methods were similar to
ing hospitalization, and the level of
a widely cited 2001 government
disease protection other studies
report that said $3.6 billion could
have linked with breastfeeding.
be saved each year if 50 percent of
Blue & You Summer 2010
mending that babies receive only breast milk for six months. Source: Pediatrics, Associated Press
Redesigned PHS wins top scores in national review ment is designed to help members
evaluator in the financial services
Shield’s new Personal Health State-
understand a complex industry in
industry, conducted this first-ever
ment — a redesign of the traditional
everyday language.
national evaluation of the EOB. The
Arkansas Blue Cross and Blue
Explanation of Benefits (EOBs) — earned a first-place finish, as well as a designation of “Excellent,” during a recent national review of insurance companies’ EOBs. The EOB, which is generated each
It helps members: • Understand claims and how they were handled. • Monitor out-of-pocket costs
evaluation gave 68 percent of EOBs failing grades. Arkansas Blue Cross, however, was deemed innovative for recognizing the importance
(deductibles, copayments,
of this member communication
coinsurance)
and transforming its EOBs into
time a member’s doctor or hospi-
• See benefits and how they work.
Personal Health Statements that
tal files a claim, is the primary way
• Have a better understanding of
are understandable and useful
Arkansas Blue Cross communicates with its members. The goal was to simplify and personalize the benefit statement so members will under-
discounts on services. • Know how to contact their health insurance plan. • Have a quick understanding of
consumer tools. The DALBAR report evaluates EOBs according to clarity, content and design. Three DALBAR designa-
stand exactly what is happening with
how much they owe and
tions are used: Excellent: 80-100
their claims and their benefits.
to whom.
points, Very Good: 70-79 points and
DALBAR, a leading third-party
Good: 60-69 points.
The new Personal Health State-
Food for thought:
Certain foods may keep aging brains healthy Eating a Mediterranean diet may
• More fish, less meat
mental abilities every three years
help keep your brain healthy as
• Olive oil
during a 15-year period. Those who
you age, findings from an ongoing
• Moderate wine
scored highest in following a Medi-
study show.
• Whole grains
terranean diet were least likely to
• Nuts and seeds
suffer cognitive decline, the study
A “Mediterranean diet” encourages the following:
The study included 4,000 adults
• Vegetables
aged 65 and older who were given
• Fruits
series of tests to examine their
authors found. Source: National Institutes of Health
Blue & You Summer 2010
19
What’s in a drug name
and why did mine change? stems include suffixes like -mab for
inhibitor that hit the market in Febru-
names: the chemical name, the
monoclonal antibodies, such as inf-
ary 2009, became confused with
generic name and the brand name.
liximab. Names that include stems,
the similar-sounding drug name
Each name is subject to different
chemistry roots or other coded
Casodex®. The FDA committee
rules and regulations.
information are easier to remember
recommended a name change for
and give clues to the drug’s use.
Kapidex® and effective April 2010, it
chemical structure of the drug. It
These names, however, may sound
became Dexilant®.
does not have to be preapproved by
or look alike and can contribute to
any organization. Chemical names
medication errors.
Every drug usually has three
The chemical name specifies the
a drug name after it was approved
The brand name is created as
was in 2005, when the Alzheimer’s
soon as a generic name has been
medication Reminyl® was confused
established. To minimize confusion
with the diabetes drug Amaryl® and
ated when a new drug is ready for
between drug names that look or
one person died. The Alzheimer’s
marketing. It is selected by the U.S.
sound alike, the FDA rejects about
medicine now is called Razadyne.
Adopted Names (USAN) Council,
one-third of an average of 400 possi-
The need to change a drug’s
whose expertise is recognized by
ble brand names submitted based on
name does not happen often and
the U.S. Food and Drug Administra-
similarities with other drug names.
usually occurs within the first year
are primarily used by researchers but not in medical practice. The generic name usually is cre-
20
The last time the FDA changed
tion (FDA), according to principles
Still, confusion from similar-
a drug is marketed. The complex
developed to ensure safety, con-
sounding drug names does occur.
procedure of giving each drug a
sistency and logic. These names
To monitor the situation, the FDA
chemical, generic and brand name
typically are used by health care
has a medication errors committee
does not always eliminate confu-
professionals.
that occasionally recommends a
sion. However, the pharmaceutical
name change.
companies, the USAN Council and
Generic names are made using an established stem, or group of
The most recent name change
letters, that represents a specific
happened this year. Kapidex
drug class. For example, the USAN
(dexlansoprazole), a proton pump
From the
®
the FDA all share one basic goal — to create a name for each drug that easily distinguishes it from other drug names, ensuring patient safety.
Pharmacist Source: fda.gov Blue & You Summer 2010
by Trey Gardner, Pharm D., Arkansas Blue Cross and Blue Shield
The
Doctor’s
Corner
Drugs used to treat high blood pressure also may keep dementia away ACE-inhibitors are commonly used to treat high blood pressure, but evidence now indicates that these same medications also may prevent the worsening of dementia. Researchers recently discovered that people who take “centrally active” ACE-inhibitors (examples are captopril and lisinopril) had memory function that declined 65 percent less when compared to those not taking these same medications. Of course, more research needs to be completed, but for someone with dementia who already is taking high blood pressure medications, switching to one of these medications might be something to consider.
No smoking! Two new studies have determined that smoking bans in public places significantly reduces the rate of heart attacks. The studies found that the overall rate of heart attacks in cities that have banned smoking in public places has decreased by as much as 36 percent during a threeyear study. Exposure to smoke (or smoking) can cause blood vessels of the heart to constrict, which can cause a heart attack. One of the studies, published recently in the Journal of the American College of Cardiology, estimated that a nationwide smoking ban in public places could prevent more than 150,000 heart attacks each year. No link between cell phones and brain cancer Someone may have sent you an e-mail or some sort of “document” that suggests that radio waves from cell phones cause an increase in brain cancer. Scientists have found no evidence that radio waves can damage a cell’s DNA, which would be necessary for cancer to occur from cell phones. Now, a new study gives further assurances of
by Ray Bredfeldt, M.D., Regional Medical Director Northwest Region, Fayetteville
the apparent safety of cell phones related to radio waves and brain cancer. Researchers have found no increase in the rate of brain cancer in four different countries during the 10 years after a significant increase in cell phone use occurred in those countries.
Take folic acid prior to pregnancy For many years, doctors have recommended that women take folic acid (vitamin B9) during pregnancy to help prevent birth defects. Now, evidence suggests that taking folic acid prior to getting pregnant has definite advantages. Women thinking about getting pregnant should probably start taking folic acid up to one year prior to becoming pregnant. A recent study discovered that women who take folic acid before getting pregnant reduce their risk of having a premature baby by 50 to 70 percent. The recommended preconception dose of folic acid is 400 micrograms per day.
Blue & You Summer 2010
21
Arkansas Blue Cross and Blue Shield Financial Information Privacy Notice
At Arkansas Blue Cross and Blue
Shield and its affiliates (including HMO Partners, Inc. d/b/a Health
information. Improper access and
products.
use of confidential information by an
• Information related to the fact
employee can result in disciplinary
Advantage), we understand how
that you have been or currently
action up to and including termination
important it is to keep your private
are a member.
of employment.
information just that — private. Because of the nature of our business, we must collect some
Sharing of Information Arkansas Blue Cross and its
Disclosure of Privacy Notice Arkansas Blue Cross and its
affiliates do not disclose, and do not
affiliates recognize and respect the
wish to reserve the right to disclose,
privacy concerns of potential, current
non-public personal information about
and former customers. Arkansas Blue
you to one another or to other parties
Cross and its affiliates are committed
except as permitted or required by
to safeguarding this information. As
law. Examples of instances in which
required by state regulation, we must
Arkansas Blue Cross and its affiliates
notify our members about how we
affiliates only compile information
will provide information to one
handle non-public financial information
necessary for us to provide the
another or other third parties are:
of our members. If you would like
personal information from our members, but we also are committed to maintaining, securing and protecting that information.
22
purchase and use of our
Customer Information Arkansas Blue Cross and its
services that you, our member, request from us and to administer your business. We collect non-public
• To service or process products that you have requested. • To provide information as per-
to review the Financial Information Privacy Notices for all Arkansas Blue Cross members, you can visit our Web
personal financial information (defined
mitted and required by law to
site at arkansasbluecross.com or call
as any information that can be tied
accrediting agencies.
the appropriate Arkansas Blue Cross
back to a specific person and is
• To provide information to com-
affiliate company to receive the Privacy
gathered by any source that is
ply with federal, state or local
Notice. Our customer service areas
not publicly available) about our
laws in an administrative or
are open from 8 a.m. to 4:30 p.m.,
members from:
judicial process.
Central time, Monday through Friday.
• Applications for insurance coverage. The application includes information such as name, ad-
How We Protect Your Information Arkansas Blue Cross and its
To receive a copy of the Privacy Notice, members should call: Arkansas Blue Cross —
dress, personal identifiers such
affiliates use various security
1-800-238-8379.
as Social Security number, and
mechanisms to protect your personal
Health Advantage — 1-800-843-1329.
medical information that you
data including electronic and physical
Self-funded group members should
authorize us to collect.
measures as well as company
call Customer Service using the toll-
policies that limit employee access
free telephone number on their
to non-public personal financial
ID card.
• Payment history and related financial transactions from the
Blue & You Summer 2010
We love to hear from you! May we help? For customer service, please call:
Heart-healthy walking Arkansas Blue Cross and Blue Shield employees
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
raised more than $8,000 for the American Heart Associ-
Pharmacy questions
1-800-863-5561
ation 2010 Central Arkansas Heart Walk, which was held
Specialty Rx Pharmacy questions
1-866-295-2779
April 17 at the North Shore River Walk in downtown North Little Rock. Mike Brown, executive vice president and chief operating officer, served as the overall Central Arkansas Heart Walk chairman and launched thousands of participants for the 5K, including more than 300 Arkansas Blue Cross employees.
BlueAnn leads Anti-Drug Walk in Arkadelphia For the 12th year, BlueAnn Ewe helped lead the annual “Just Say No” drug prevention walk hosted by Perritt Primary School in Arkadelphia. On April 9, BlueAnn helped lead the fight against drugs with hundreds of elementary students, high school and college mentors, parents, teachers and administration staff, and community supporters during the 23rd year of the event. Community and state leaders greeted the walkers, pledging their support in the fight against drugs. Clark County Sheriff’s Office staff, Arkadelphia Police Department officers and members of the Arkadelphia Fire Department Rescue Unit participated as well.
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) 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
Related Web sites:
blueandyoufoundationarkansas.org blueannewe-ark.com
Blue & You Summer 2010
23
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.
24 Know Your Exposure
New Tools for Small Groups
To protect our members from overexposure to ioniz-
Effective June 1, Arkansas Blue Cross and Blue
ing radiation used in medical imaging, Arkansas Blue
Shield and Health Advantage will introduce two new
Cross and Blue Shield and its family of companies
services for small group (2-50) customers.
are including a calculation of a member’s equivalent
eBill Manager is an electronic billing service that
dose of radiation from medical procedures in the
can replace the traditional paper invoice. Only em-
new Personal Health Statements. The information,
ployer groups that have signed up for Blueprint for
supplied by National Imaging Associates (NIA), is
Employers will be able to access this new service.
based on claims data from health care providers.*
eBill Manager will be available to all new groups
It is important to talk with your doctor about your
sold on or after June 1, and to all renewal groups
medical imaging choices. This additional information
on their anniversary date beginning June 1. Elec-
can help you make informed health care decisions.
tronic applications for new employees (e-apps) will
Your doctor can explain the need for a medical imag-
be available for all small groups who are registered
ing procedure based on the benefits and potential
for Blueprint for Employers effective June 1, 2010,
risks involved.
regardless of their anniversary date.
* Claims data is provided to 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.
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.
Blue & You Summer 2010