AUTUMN 2013 A publication for the policyholders of the Arkansas Blue Cross and Blue Shield family of companies
Health Care Law
the HEALTH CARE LAW timeline OCT.1 2013 DEC.15 2013 JAN.1 2014
Online Marketplace opens
updates for everyone PAGES 4-10
Final day to buy health insurance for a January 1, 2014, effective date
New health insurance plans begin
MAR.31 2014 Last day to sign up for health insurance
Questions about the health care law? Email us! HCRinfo@arkbluecross.com
page
Call us! 1-800-310-3778 Come by! Find a location on page 27 Go online! arkansasbluecross.com MPI 1738 9/13
12
7 things to know about the health care law and our Medicare plans
Meet our UAMS Primary Care Scholarship recipients
New and upcoming generics
page
page
page
10
16
21
of 3
Out of the Blue
4
Health care law checklists: Steps you need to take
6
Learn how these medical students aiming to practice in rural Arkansas received help from Arkansas Blue Cross and Blue Shield. PAGE 16
Let us help you! The best ways to contact us
20
Come home to a medical home!
7
Large employers get delay on key parts of health care law
21
New and upcoming generics
8
Do you qualify for free health insurance?
22
Folic acid: Not just for women
9
Which health plan is right for you?
10
7 things to know about the health care law and our Medicare plans
11
Medicare annual election period October 15 through December 7
12
SilverSneakers keeps Conway man surrounded by friends
14
Blue News
16
UAMS students receive Arkansas Blue Cross and Blue Shield Primary Care Scholarship
18
Let us help you lose weight!
23
Blue & You Fitness Challenge winners!
24
Notice of privacy practices – Arkansas Blue Cross and Blue Shield and Health Advantage
26
Summary of Benefits and Coverage Notice
27
Women’s Health and Cancer Rights Act Customer Service telephone numbers
28
Blue & You Foundation awards 55 mini-grants to improve health in Arkansas
AUTUMN 2013
Health care law timeline
Blue &You 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. Health information from sources outside of Arkansas Blue Cross and Blue Shield do not necessarily represent the official position of the company.
EDITOR: Jennifer Sullivan – bnyou-ed@arkbluecross.com • DESIGNER: Ryan Kravitz • PHOTOGRAPHER: Chip Bayer CONTRIBUTORS: Will Ballard, Chip Bayer, Matthew Creasman, Damona Fisher, Kristy Fleming, Lauren Green, Trey Hankins, Heather Iacobacci-Miller, Jessica Kelley, Genny Kirchner, Kathy Luzietti, Wendy McCullar, Ben McVay, Mark Morehead, Alex Roberts, Lee Smith, Kelly Whitehorn and Stephen Wilson VICE PRESIDENT, COMMUNICATIONS and PRODUCT DEVELOPMENT: Karen Raley
2
on the cover BLUE & YOU AUTUMN 2013
72-year-old Charles Stacks works out at the Conway Regional Health and Fitness Center thanks to SilverSneakers
OUT BLUE
Helping everyone win under the health care law When the health care law passed in March 2010, Arkansas Blue Cross and Blue Shield staff members were already working to determine the impact various provisions of the new law would have on our customers. Based on our commitment to members and our history of 65 years of service to Arkansans, we are responsible to make certain that our members — and all Arkansans — continue to have understandable health insurance options. Early in the process, we notified our members that there would be winners and losers when the new law was fully implemented in 2014. We asked that they continue with their health insurance policies in place; these are called “grandfathered” policies under the new law. The law specifies that if a grandfathered policy is significantly modified or the coverage is dropped, the policyholder cannot get it back. Our small employer customers and those who buy coverage for themselves and their families took our advice. More than three-fourths of them maintained their grandfathered policy as the regulations that define the new law were being developed. Now that 2014 is at hand and the new Health Insurance Marketplaces are a reality, we have the advantage of hindsight to measure the success of our “grandfathering” initiative. For more than two-thirds of our individual and small employer customers, maintaining grandfathered status was a good financial decision. Under the new rules, these customers might have seen rate increases as high as 200 percent, but by maintaining their policy through the transition, they now have far greater flexibility.
a message from our President and CEO, MARK WHITE
At Arkansas Blue Cross, our goal is to make certain that everyone with a Blue Cross card wins in the new Health Insurance Marketplace.
Unfortunately, we have a number of customers who did not have the option of grandfathered coverage. Already, our staff is reaching out to these individuals and small group employers to assist them in evaluating cost-saving alternatives. If you have not been contacted by your agent or an Arkansas Blue Cross representative, expect to hear from us soon. At Arkansas Blue Cross, our goal is to make certain that everyone with a Blue Cross card wins in the new Health Insurance Marketplace. These will likely be uncertain times for people who want to buy health coverage, and like any new process or system, the new Health Insurance Marketplace may be very inefficient in the early years. Through this new era and the future, Arkansas Blue Cross recommits to our “fearless” and best efforts to provide the information, knowledge, experience and financial stability you require in fulfilling your health insurance needs.
AUTUMN 2013 BLUE & YOU
3
of 3
Out of the Blue
4
Health care law checklists: Steps you need to take
6
Learn how these medical students aiming to practice in rural Arkansas received help from Arkansas Blue Cross and Blue Shield. PAGE 16
Let us help you! The best ways to contact us
20
Come home to a medical home!
7
Large employers get delay on key parts of health care law
21
New and upcoming generics
8
Do you qualify for free health insurance?
22
Folic acid: Not just for women
9
Which health plan is right for you?
10
7 things to know about the health care law and our Medicare plans
11
Medicare annual election period October 15 through December 7
12
SilverSneakers keeps Conway man surrounded by friends
14
Blue News
16
UAMS students receive Arkansas Blue Cross and Blue Shield Primary Care Scholarship
18
Let us help you lose weight!
23
Blue & You Fitness Challenge winners!
24
Notice of privacy practices – Arkansas Blue Cross and Blue Shield and Health Advantage
26
Summary of Benefits and Coverage Notice
27
Women’s Health and Cancer Rights Act Customer Service telephone numbers
28
Blue & You Foundation awards 55 mini-grants to improve health in Arkansas
AUTUMN 2013
Health care law timeline
Blue &You 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. Health information from sources outside of Arkansas Blue Cross and Blue Shield do not necessarily represent the official position of the company.
EDITOR: Jennifer Sullivan – bnyou-ed@arkbluecross.com • DESIGNER: Ryan Kravitz • PHOTOGRAPHER: Chip Bayer CONTRIBUTORS: Will Ballard, Chip Bayer, Matthew Creasman, Damona Fisher, Kristy Fleming, Lauren Green, Trey Hankins, Heather Iacobacci-Miller, Jessica Kelley, Genny Kirchner, Kathy Luzietti, Wendy McCullar, Ben McVay, Mark Morehead, Alex Roberts, Lee Smith, Kelly Whitehorn and Stephen Wilson VICE PRESIDENT, COMMUNICATIONS and PRODUCT DEVELOPMENT: Karen Raley
2
on the cover BLUE & YOU AUTUMN 2013
72-year-old Charles Stacks works out at the Conway Regional Health and Fitness Center thanks to SilverSneakers
OUT BLUE
Helping everyone win under the health care law When the health care law passed in March 2010, Arkansas Blue Cross and Blue Shield staff members were already working to determine the impact various provisions of the new law would have on our customers. Based on our commitment to members and our history of 65 years of service to Arkansans, we are responsible to make certain that our members — and all Arkansans — continue to have understandable health insurance options. Early in the process, we notified our members that there would be winners and losers when the new law was fully implemented in 2014. We asked that they continue with their health insurance policies in place; these are called “grandfathered” policies under the new law. The law specifies that if a grandfathered policy is significantly modified or the coverage is dropped, the policyholder cannot get it back. Our small employer customers and those who buy coverage for themselves and their families took our advice. More than three-fourths of them maintained their grandfathered policy as the regulations that define the new law were being developed. Now that 2014 is at hand and the new Health Insurance Marketplaces are a reality, we have the advantage of hindsight to measure the success of our “grandfathering” initiative. For more than two-thirds of our individual and small employer customers, maintaining grandfathered status was a good financial decision. Under the new rules, these customers might have seen rate increases as high as 200 percent, but by maintaining their policy through the transition, they now have far greater flexibility.
a message from our President and CEO, MARK WHITE
At Arkansas Blue Cross, our goal is to make certain that everyone with a Blue Cross card wins in the new Health Insurance Marketplace.
Unfortunately, we have a number of customers who did not have the option of grandfathered coverage. Already, our staff is reaching out to these individuals and small group employers to assist them in evaluating cost-saving alternatives. If you have not been contacted by your agent or an Arkansas Blue Cross representative, expect to hear from us soon. At Arkansas Blue Cross, our goal is to make certain that everyone with a Blue Cross card wins in the new Health Insurance Marketplace. These will likely be uncertain times for people who want to buy health coverage, and like any new process or system, the new Health Insurance Marketplace may be very inefficient in the early years. Through this new era and the future, Arkansas Blue Cross recommits to our “fearless” and best efforts to provide the information, knowledge, experience and financial stability you require in fulfilling your health insurance needs.
AUTUMN 2013 BLUE & YOU
3
Health CARE LAW Checklists: Steps YOU need to take
With all the talk about health insurance and the changes coming up, you might be wondering what steps you need to take to be ready in 2014. Here is a quick checklist for each type of coverage we offer:
IF YOU HAVE A MEDICARE PLAN
1. Don’t worry! If you have a Medi-Pak
Supplement plan, no matter when you purchased your coverage – before or after the law was signed – you’ll still have the same benefits and security you have now. Read more on page 10. ®
2. IF YOUr EMPLOYER purchased YOUR HEALTH PLAN before April 2010
1. We’ve got this! You may have a grandfathered plan if no major
changes have been made to your health plan. Grandfathered plans are exempt from many of the regulations under the health care law.
2.
If you don’t know if your health plan is grandfathered, you can contact your human resources administrator.
3.
Your employer will be the one to decide if you keep your current health plan. They will be working closely with representatives of Arkansas Blue Cross and Blue Shield to determine if it is better to keep your current plan or switch to a new plan.
4. IF YOU PURCHASED AN INDIVIDUAL OR FAMILY PLAN before April 2010
4
BLUE & YOU AUTUMN 2013
If you want to shop for different coverage, read about the Medicare Annual Election Period, which runs from October 15 through December 7, on page 11.
If you are an employer, an agent or an Arkansas Blue Cross representative will be calling to help you weigh your options.
1. Relax! You have a grandfathered plan. Grandfathered plans are
exempt from many of the regulations under the health care law. If you like what you have, you can keep it.
2.
If you aren’t sure of the date you purchased your plan, call the customer service number on your ID card.
3.
Call your agent or give us a call at 1-800-310-3778. We will tell you if a less expensive plan is available under the new rules, if you will benefit from a new plan off the Health Insurance Marketplace, or if you should keep your current plan.
4.
If you want to find out if you might benefit from a newer plan, go to our website, arkansasbluecross.com. You can use the “Do I Qualify for a Tax Credit” online tool to get an estimate on any tax credit you might receive. Regardless of your estimate, however, call your agent or call us.
5.
Don’t give up your grandfathered plan without talking to an Arkansas Blue Cross representative or your agent. After you lose this plan, you cannot get it back.
IF YOUr health plan was purchased AFTER MARCH 2010 AND IS THROUGH A LARGE EMPLOYER
1. It’s all good! If your employer has more than 100 employees,
IF YOUr HEALTH PLAN WAS PURCHASED AFTER MARCH 2010 AND IS THROUGH A SMALL EMPLOYER
1. Find out more! Our team at Arkansas Blue Cross is working
IF YOU PURCHASED AN INDIVIDUAL OR FAMILY PLAN AFTER MARCH 2010
most of the changes to your health plan have already occurred.
2.
The big news for you and your employer is that you may qualify for free health insurance under the Arkansas Medicaid expansion. There is no penalty to your employer if you qualify. Find out more on page 8.
closely with your employer to determine the best option for you and your co-workers.
2.
You may qualify for free health insurance under the Arkansas Medicaid expansion. There is no penalty to your employer if you qualify. Find out more on page 8.
1. Keep reading! You have several options. you like what you have, you can keep that plan until 2. IfDecember 30, 2014. That gives you a whole year to work with your agent or an Arkansas Blue Cross representative to determine the best new health plan for you.
3.
If you want to explore your options, you have until March 2014 to purchase a new health insurance policy for coverage in 2014.
4.
Call your agent or call us at 1-800-310-3778, or go to our website, arkansasbluecross.com, to find out more about the health plans available. You can use the “Do I Qualify for a Tax Credit” online tool to find out if you could receive financial help on your health insurance premium.
5. Read the article “Let us help you” on page 6. 6. Trust us! You have coverage through Arkansas Blue Cross, a
company Arkansans have trusted for 65 years for affordable, reliable health insurance. We are dedicated to providing the best possible coverage and service to you.
AUTUMN 2013 BLUE & YOU
5
Health CARE LAW Checklists: Steps YOU need to take
With all the talk about health insurance and the changes coming up, you might be wondering what steps you need to take to be ready in 2014. Here is a quick checklist for each type of coverage we offer:
IF YOU HAVE A MEDICARE PLAN
1. Don’t worry! If you have a Medi-Pak
Supplement plan, no matter when you purchased your coverage – before or after the law was signed – you’ll still have the same benefits and security you have now. Read more on page 10. ®
2. IF YOUr EMPLOYER purchased YOUR HEALTH PLAN before April 2010
1. We’ve got this! You may have a grandfathered plan if no major
changes have been made to your health plan. Grandfathered plans are exempt from many of the regulations under the health care law.
2.
If you don’t know if your health plan is grandfathered, you can contact your human resources administrator.
3.
Your employer will be the one to decide if you keep your current health plan. They will be working closely with representatives of Arkansas Blue Cross and Blue Shield to determine if it is better to keep your current plan or switch to a new plan.
4. IF YOU PURCHASED AN INDIVIDUAL OR FAMILY PLAN before April 2010
4
BLUE & YOU AUTUMN 2013
If you want to shop for different coverage, read about the Medicare Annual Election Period, which runs from October 15 through December 7, on page 11.
If you are an employer, an agent or an Arkansas Blue Cross representative will be calling to help you weigh your options.
1. Relax! You have a grandfathered plan. Grandfathered plans are
exempt from many of the regulations under the health care law. If you like what you have, you can keep it.
2.
If you aren’t sure of the date you purchased your plan, call the customer service number on your ID card.
3.
Call your agent or give us a call at 1-800-310-3778. We will tell you if a less expensive plan is available under the new rules, if you will benefit from a new plan off the Health Insurance Marketplace, or if you should keep your current plan.
4.
If you want to find out if you might benefit from a newer plan, go to our website, arkansasbluecross.com. You can use the “Do I Qualify for a Tax Credit” online tool to get an estimate on any tax credit you might receive. Regardless of your estimate, however, call your agent or call us.
5.
Don’t give up your grandfathered plan without talking to an Arkansas Blue Cross representative or your agent. After you lose this plan, you cannot get it back.
IF YOUr health plan was purchased AFTER MARCH 2010 AND IS THROUGH A LARGE EMPLOYER
1. It’s all good! If your employer has more than 100 employees,
IF YOUr HEALTH PLAN WAS PURCHASED AFTER MARCH 2010 AND IS THROUGH A SMALL EMPLOYER
1. Find out more! Our team at Arkansas Blue Cross is working
IF YOU PURCHASED AN INDIVIDUAL OR FAMILY PLAN AFTER MARCH 2010
most of the changes to your health plan have already occurred.
2.
The big news for you and your employer is that you may qualify for free health insurance under the Arkansas Medicaid expansion. There is no penalty to your employer if you qualify. Find out more on page 8.
closely with your employer to determine the best option for you and your co-workers.
2.
You may qualify for free health insurance under the Arkansas Medicaid expansion. There is no penalty to your employer if you qualify. Find out more on page 8.
1. Keep reading! You have several options. you like what you have, you can keep that plan until 2. IfDecember 30, 2014. That gives you a whole year to work with your agent or an Arkansas Blue Cross representative to determine the best new health plan for you.
3.
If you want to explore your options, you have until March 2014 to purchase a new health insurance policy for coverage in 2014.
4.
Call your agent or call us at 1-800-310-3778, or go to our website, arkansasbluecross.com, to find out more about the health plans available. You can use the “Do I Qualify for a Tax Credit” online tool to find out if you could receive financial help on your health insurance premium.
5. Read the article “Let us help you” on page 6. 6. Trust us! You have coverage through Arkansas Blue Cross, a
company Arkansans have trusted for 65 years for affordable, reliable health insurance. We are dedicated to providing the best possible coverage and service to you.
AUTUMN 2013 BLUE & YOU
5
Let US HELP YOU! If you purchased health care coverage for you and your family on your own, whether it was purchased before or after the health care law was signed, we want to talk to you! Having a health plan review is the best way to get a clear understanding of how the health care law affects
you. Maybe you stay with what you have. Maybe you can get a tax credit through the Marketplace. Finding out is fast and easy! Get your health plan review before you make any big decisions about your health insurance. Call us. Call your agent. Come by. We can help.
Whether you want to call, visit or go online — Arkansas Blue Cross and Blue Shield wants to be sure you have the most affordable health plan options available to you.
Call us! Call our toll-free telephone number — 1-800-310-3778 — to talk to one of our Arkansas Blue Cross and Blue Shield representatives. We can walk you through the entire process, from identifying the most affordable health plan to enrollment. If you have an agent, they can help you too.
Come by! If you prefer to speak to someone face to face, you can visit your agent or one of our many offices throughout the state (see addresses and numbers on page 27). We can provide you with information on the health plans available to you and help you enroll. It’s easy, and you can ask all the questions you want.
6
BLUE & YOU AUTUMN 2013
Go online!
Selecting the right health plan with Arkansas Blue Cross is as easy as going online to our website, arkansasbluecross.com. You can even stay in your pajamas! On our main page, just select “Individual and Family Plans” or “Do I Qualify for a Tax Credit.”
Large employers get delay on key parts of health care law In July, the U.S. Department of Treasury postponed enforcement of two key parts of the Affordable Care Act: the employershared responsibility payments (the “play or pay” provisions), and the requirement to report minimum essential health insurance coverage until January 2015. The “play or pay” provisions require employers to offer “affordable” health insurance to both their employees and dependents or pay a penalty. If a full-time employee qualifies for and buys subsidized coverage on the Health Insurance Marketplace, the employer would owe a penalty for each subsidized employee.
The reporting provisions of the health care law require large employers (those with 50 or more full-time equivalent employees) to report whether they offer minimum essential coverage to their employees, the length of the waiting period, the monthly premium, the employer’s share of total allowed costs and the number of full-time employees. Arkansas Blue Cross will continue to provide our customers with reliable information regarding implementation of the health care law as it becomes available.
Our online experience will show you the many health plans available from Arkansas Blue Cross based on your income and family size. You can view the details of each health plan, sort them based on cost, choose to view only certain kinds of plans, and even compare up to three plans at once. If you have questions at any time, you can select a link to email or call an agent. It’s fast and easy! So what are you waiting for? With Arkansas Blue Cross, selecting the right health insurance has never been easier.
AUTUMN 2013 BLUE & YOU
7
Let US HELP YOU! If you purchased health care coverage for you and your family on your own, whether it was purchased before or after the health care law was signed, we want to talk to you! Having a health plan review is the best way to get a clear understanding of how the health care law affects
you. Maybe you stay with what you have. Maybe you can get a tax credit through the Marketplace. Finding out is fast and easy! Get your health plan review before you make any big decisions about your health insurance. Call us. Call your agent. Come by. We can help.
Whether you want to call, visit or go online — Arkansas Blue Cross and Blue Shield wants to be sure you have the most affordable health plan options available to you.
Call us! Call our toll-free telephone number — 1-800-310-3778 — to talk to one of our Arkansas Blue Cross and Blue Shield representatives. We can walk you through the entire process, from identifying the most affordable health plan to enrollment. If you have an agent, they can help you too.
Come by! If you prefer to speak to someone face to face, you can visit your agent or one of our many offices throughout the state (see addresses and numbers on page 27). We can provide you with information on the health plans available to you and help you enroll. It’s easy, and you can ask all the questions you want.
6
BLUE & YOU AUTUMN 2013
Go online!
Selecting the right health plan with Arkansas Blue Cross is as easy as going online to our website, arkansasbluecross.com. You can even stay in your pajamas! On our main page, just select “Individual and Family Plans” or “Do I Qualify for a Tax Credit.”
Large employers get delay on key parts of health care law In July, the U.S. Department of Treasury postponed enforcement of two key parts of the Affordable Care Act: the employershared responsibility payments (the “play or pay” provisions), and the requirement to report minimum essential health insurance coverage until January 2015. The “play or pay” provisions require employers to offer “affordable” health insurance to both their employees and dependents or pay a penalty. If a full-time employee qualifies for and buys subsidized coverage on the Health Insurance Marketplace, the employer would owe a penalty for each subsidized employee.
The reporting provisions of the health care law require large employers (those with 50 or more full-time equivalent employees) to report whether they offer minimum essential coverage to their employees, the length of the waiting period, the monthly premium, the employer’s share of total allowed costs and the number of full-time employees. Arkansas Blue Cross will continue to provide our customers with reliable information regarding implementation of the health care law as it becomes available.
Our online experience will show you the many health plans available from Arkansas Blue Cross based on your income and family size. You can view the details of each health plan, sort them based on cost, choose to view only certain kinds of plans, and even compare up to three plans at once. If you have questions at any time, you can select a link to email or call an agent. It’s fast and easy! So what are you waiting for? With Arkansas Blue Cross, selecting the right health insurance has never been easier.
AUTUMN 2013 BLUE & YOU
7
Do YOU qualify for
FREE ? health insurance
Changes under the new health care law will allow thousands of low-income Arkansans to qualify for free or low-cost private health insurance — even if they have health conditions — through the Arkansas Medicaid expansion. Maybe you purchased your health plan on your own. Maybe you have it through an employer. If you qualify for Medicaid, you are likely to receive an Arkansas Blue Cross and Blue Shield health insurance card that gives you the same access to doctors and hospitals at no cost to you — or your employer.
What’s covered? With Arkansas Blue Cross coverage through the Healthcare Independence Option (Arkansas Medicaid program), you’ll get the best care from the best doctors, and free checkups and cancer screenings.
Here’s what’s covered: • Doctor visits • Prescription drugs • Hospital stays • Surgeries • Free checkups
How it works: Your household and income determine whether you get free or very low-cost health insurance.
• Maternity and newborn care • Free screenings for certain cancers • Free birth control • X-rays and lab work
You will qualify for free or lowcost health insurance if you are at or below the following weekly or yearly incomes: NOTE: If you earn minimum wage and work 50 weeks per year, 40 hours per week you earn $14,500.
$1,957
Enroll now! You can purchase insurance right now that goes into effect as early as January 1, 2014.
8
BLUE & YOU AUTUMN 2013
Learn more by calling us at 1-855-625-0451 (8 a.m. to 5 p.m. Monday-Friday) or call your agent.
*Free or low-cost health insurance depends on the health plan you choose.
Which health plan is right for YOU? For a small percentage of our members, a more affordable health plan is available through the Health Insurance Marketplace. If this is your situation, Arkansas Blue Cross and Blue Shield has the answers you need to identify the most affordable health plan for you.
Metallic Plans
Plans on the Health Insurance Marketplace are divided into different levels based on their financial value — Bronze, Silver, Gold and Platinum — and are often referred to as Metallic Plans. The levels indicate the financial value of the plan. For instance, all Bronze plans are estimated to cover 60 percent of the medical costs for an average American.
Metallic Coverage LEVELS 100%
60%* 0%
BRONZE
Because the financial value of each level of health plan must fit within the parameters set by the federal government, there are fewer plan options available than in the past, however, each Bronze plan may offer different deductibles, coinsurance or even variations on benefit coverage, so you will benefit by talking with an agent or Arkansas Blue Cross representative to discuss your options before making a selection. On average, the lower the financial value of a health plan, the less you will pay in monthly premiums, but the more you will pay at the doctor’s office. Arkansas Blue Cross offers Bronze, Silver and Gold plans on the Marketplace.
70%* SILVER
80%
90%*
GOLD
PLATINUM
*
*NOTE: Percentage shows how much of your total health care costs this plan pays.
Affordable Options
Health insurance companies also can sell some individual health plans off the Marketplace that may be more affordable options than the Metallic Plans, especially if you are young and healthy. Arkansas Blue Cross offers Essential Blue Freedom as one of these options. Essential Blue Freedom offers $30 copayments for doctor’s office visits, $15 generic prescription drugs, a $1,000 deductible and $2,000 out-of-pocket maximum. Because it is not approved for the Marketplace, you will have a review of your medical history and you may have to pay the penalty for not purchasing a Metallic Plan. Don’t try to go it alone! Call us at 1-800-310-3778. We will walk you through the process and give you the confidence you need to make a great decision for you and your family.
AUTUMN 2013 BLUE & YOU
79
Do YOU qualify for
FREE ? health insurance
Changes under the new health care law will allow thousands of low-income Arkansans to qualify for free or low-cost private health insurance — even if they have health conditions — through the Arkansas Medicaid expansion. Maybe you purchased your health plan on your own. Maybe you have it through an employer. If you qualify for Medicaid, you are likely to receive an Arkansas Blue Cross and Blue Shield health insurance card that gives you the same access to doctors and hospitals at no cost to you — or your employer.
What’s covered? With Arkansas Blue Cross coverage through the Healthcare Independence Option (Arkansas Medicaid program), you’ll get the best care from the best doctors, and free checkups and cancer screenings.
Here’s what’s covered: • Doctor visits • Prescription drugs • Hospital stays • Surgeries • Free checkups
How it works: Your household and income determine whether you get free or very low-cost health insurance.
• Maternity and newborn care • Free screenings for certain cancers • Free birth control • X-rays and lab work
You will qualify for free or lowcost health insurance if you are at or below the following weekly or yearly incomes: NOTE: If you earn minimum wage and work 50 weeks per year, 40 hours per week you earn $14,500.
$1,957
Enroll now! You can purchase insurance right now that goes into effect as early as January 1, 2014.
8
BLUE & YOU AUTUMN 2013
Learn more by calling us at 1-855-625-0451 (8 a.m. to 5 p.m. Monday-Friday) or call your agent.
*Free or low-cost health insurance depends on the health plan you choose.
Which health plan is right for YOU? For a small percentage of our members, a more affordable health plan is available through the Health Insurance Marketplace. If this is your situation, Arkansas Blue Cross and Blue Shield has the answers you need to identify the most affordable health plan for you.
Metallic Plans
Plans on the Health Insurance Marketplace are divided into different levels based on their financial value — Bronze, Silver, Gold and Platinum — and are often referred to as Metallic Plans. The levels indicate the financial value of the plan. For instance, all Bronze plans are estimated to cover 60 percent of the medical costs for an average American.
Metallic Coverage LEVELS 100%
60%* 0%
BRONZE
Because the financial value of each level of health plan must fit within the parameters set by the federal government, there are fewer plan options available than in the past, however, each Bronze plan may offer different deductibles, coinsurance or even variations on benefit coverage, so you will benefit by talking with an agent or Arkansas Blue Cross representative to discuss your options before making a selection. On average, the lower the financial value of a health plan, the less you will pay in monthly premiums, but the more you will pay at the doctor’s office. Arkansas Blue Cross offers Bronze, Silver and Gold plans on the Marketplace.
70%* SILVER
80%
90%*
GOLD
PLATINUM
*
*NOTE: Percentage shows how much of your total health care costs this plan pays.
Affordable Options
Health insurance companies also can sell some individual health plans off the Marketplace that may be more affordable options than the Metallic Plans, especially if you are young and healthy. Arkansas Blue Cross offers Essential Blue Freedom as one of these options. Essential Blue Freedom offers $30 copayments for doctor’s office visits, $15 generic prescription drugs, a $1,000 deductible and $2,000 out-of-pocket maximum. Because it is not approved for the Marketplace, you will have a review of your medical history and you may have to pay the penalty for not purchasing a Metallic Plan. Don’t try to go it alone! Call us at 1-800-310-3778. We will walk you through the process and give you the confidence you need to make a great decision for you and your family.
AUTUMN 2013 BLUE & YOU
79
7 things to know about the health care law and our Medicare plans Some of our members with Medicare health plans (Medi-Pak® Supplement, Medi-Pak® Advantage and Medi-Pak® Rx) have concerns about the health care law. Here are 7 things we want you to know:
1.
If you have a Medi-Pak Supplement plan, no matter when you purchased your coverage – before or after the law was signed – you’ll still have the same benefits and security you have now.
2.
We don’t refer to Medicare plans as “grandfathered” or “non-grandfathered” because that part of the law doesn’t apply to those plans.
3.
If you want to change to your Medicare plan, you don’t have to shop on the Health Insurance Marketplace, or replace your Medicare coverage for Marketplace coverage. You can stay with Medicare and shop for coverage the same way you always have.
4. 5.
All Medicare plans, no matter when they are purchased, are not eligible for tax credits.
6.
If you’re in the donut hole, you’ll get even better coverage when buying Part D-covered prescription drugs. In 2014, under the standard gap coverage, you will pay 72 percent for generic drugs and 47.5 percent for brand name drugs.
7. 10
Your Medicare plan covers certain preventive services, like mammograms and colonoscopies with no out-of-pocket costs to you. You also can get a free yearly “Wellness” visit.
The law supports new initiatives to provide your doctor with additional resources to make sure that your treatments are consistent.
BLUE & YOU AUTUMN 2013
Medicare
Annual Election Period
October 15 t h r ough
December 7
Medicare’s Annual Election Period (AEP) begins October 15 and runs through December 7. During AEP, Medicare beneficiaries can purchase a Medicare Advantage plan and/or a Medicare Part D prescription drug plan. You also may switch from your existing plans. If you join a plan during AEP, or make changes to an existing plan, your new benefits will be effective January 1, 2014.
Affordable products and peace of mind
Arkansas Blue Cross and Blue Shield’s Medicare products offer members low monthly premiums. And, in 2014 you can expect the same great selection of Medicare products you’ve come to expect from us over the years. • $0 premiums for Medi-Pak® Advantage MA-PD Private Fee-for-Service (PFFS) (includes drug coverage) in 27 counties and affordable premiums in all Arkansas counties. Medi-Pak Advantage members have access to our extensive network of more than 7,000 doctors and hospitals across the state. In addition, Medi-Pak Advantage MA-PD members receive a free membership in the popular SilverSneakers® Fitness Program. • $0 premiums for Medi-Pak® Advantage MA (PFFS) (does not include drug coverage) in 50 counties. These plans offer all the health benefits of our Medi-Pak Advantage MA-PD plans, but do not include drug coverage. Members have the same access to our network of doctors and hospitals, and a free SilverSneakers membership. • Two Medi-Pak® Rx Prescription Drug Plans (PDP) – Basic and Premier – with competitively priced monthly premiums. More than 95 percent of Arkansas pharmacies are in our network. • Four Medi-Pak® supplement plans including Plan F, our most comprehensive supplement plan, and Plan N, one of our lowest-priced supplement plans.
Attention Medicare Advantage plan members
If you have a Medicare Advantage or Medicare Part D plan, before October, you will receive an Annual Notice of Change (ANOC), which will explain any changes to your current plan that will become effective in January. If you are satisfied with your current plan, you are not required to change anything. Every year, the Centers for Medicare and Medicaid Services (CMS) requires companies to inform members of these changes prior to AEP so they may shop their coverage.
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 website, arkansasbluecross.com/Medicare. We’d love to hear from you. If you have a friend or family member who will be looking for a Medicare Advantage or Part D plan this AEP, we hope you’ll recommend Medi-Pak Advantage and Medi-Pak Rx.
AUTUMN 2013 BLUE & YOU
11
7 things to know about the health care law and our Medicare plans Some of our members with Medicare health plans (Medi-Pak® Supplement, Medi-Pak® Advantage and Medi-Pak® Rx) have concerns about the health care law. Here are 7 things we want you to know:
1.
If you have a Medi-Pak Supplement plan, no matter when you purchased your coverage – before or after the law was signed – you’ll still have the same benefits and security you have now.
2.
We don’t refer to Medicare plans as “grandfathered” or “non-grandfathered” because that part of the law doesn’t apply to those plans.
3.
If you want to change to your Medicare plan, you don’t have to shop on the Health Insurance Marketplace, or replace your Medicare coverage for Marketplace coverage. You can stay with Medicare and shop for coverage the same way you always have.
4. 5.
All Medicare plans, no matter when they are purchased, are not eligible for tax credits.
6.
If you’re in the donut hole, you’ll get even better coverage when buying Part D-covered prescription drugs. In 2014, under the standard gap coverage, you will pay 72 percent for generic drugs and 47.5 percent for brand name drugs.
7. 10
Your Medicare plan covers certain preventive services, like mammograms and colonoscopies with no out-of-pocket costs to you. You also can get a free yearly “Wellness” visit.
The law supports new initiatives to provide your doctor with additional resources to make sure that your treatments are consistent.
BLUE & YOU AUTUMN 2013
Medicare
Annual Election Period
October 15 t h r ough
December 7
Medicare’s Annual Election Period (AEP) begins October 15 and runs through December 7. During AEP, Medicare beneficiaries can purchase a Medicare Advantage plan and/or a Medicare Part D prescription drug plan. You also may switch from your existing plans. If you join a plan during AEP, or make changes to an existing plan, your new benefits will be effective January 1, 2014.
Affordable products and peace of mind
Arkansas Blue Cross and Blue Shield’s Medicare products offer members low monthly premiums. And, in 2014 you can expect the same great selection of Medicare products you’ve come to expect from us over the years. • $0 premiums for Medi-Pak® Advantage MA-PD Private Fee-for-Service (PFFS) (includes drug coverage) in 27 counties and affordable premiums in all Arkansas counties. Medi-Pak Advantage members have access to our extensive network of more than 7,000 doctors and hospitals across the state. In addition, Medi-Pak Advantage MA-PD members receive a free membership in the popular SilverSneakers® Fitness Program. • $0 premiums for Medi-Pak® Advantage MA (PFFS) (does not include drug coverage) in 50 counties. These plans offer all the health benefits of our Medi-Pak Advantage MA-PD plans, but do not include drug coverage. Members have the same access to our network of doctors and hospitals, and a free SilverSneakers membership. • Two Medi-Pak® Rx Prescription Drug Plans (PDP) – Basic and Premier – with competitively priced monthly premiums. More than 95 percent of Arkansas pharmacies are in our network. • Four Medi-Pak® supplement plans including Plan F, our most comprehensive supplement plan, and Plan N, one of our lowest-priced supplement plans.
Attention Medicare Advantage plan members
If you have a Medicare Advantage or Medicare Part D plan, before October, you will receive an Annual Notice of Change (ANOC), which will explain any changes to your current plan that will become effective in January. If you are satisfied with your current plan, you are not required to change anything. Every year, the Centers for Medicare and Medicaid Services (CMS) requires companies to inform members of these changes prior to AEP so they may shop their coverage.
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 website, arkansasbluecross.com/Medicare. We’d love to hear from you. If you have a friend or family member who will be looking for a Medicare Advantage or Part D plan this AEP, we hope you’ll recommend Medi-Pak Advantage and Medi-Pak Rx.
AUTUMN 2013 BLUE & YOU
11
FAMILY
IS Where you
find it
If I can
SilverSneakers keeps Conway man surrounded by friends
T
hree years ago, Charles Stacks, a 72-yearold Medi-Pak® member, had to have a hand surgery that led to his retirement. At the same time, he was fighting a 12-year battle with throat cancer. As he dealt with, and continues to deal with these challenges, Charles remained true to the personal motto he’s been wearing on his bicep since 1959, “Love is life.” Once in the Navy and a truck driver for 40 years, the Greenbrier native spent his whole life moving. After his hand surgery, a doctor suggested Charles try SilverSneakers®, the nation’s leading exercise program designed exclusively for older adults. Charles, who lives just five minutes away from the Conway Regional Health and Fitness Center with his 92-year-old mother, jumped at the chance to try the innovative blend of physical activity, healthy lifestyle and socially oriented programming.
12
BLUE & YOU AUTUMN 2013
walk,
I will be there. – Charles Stacks “I started going to the classes as part of my therapy, but I really like the social aspect,” said Charles. “I enjoy living.” Indeed, Charles is known for being a giver and a bit of a joker. During class, he’s often the instructor’s unofficial assistant, helping latecomers get set up by grabbing a chair, exercise balls, bands and other items for them. After helping a latecomer during a recent session, Charles “accidentally” moved the box that was in the center of the circle with his foot. This shift in placement would give his team an advantage for a game later on! He also likes to find the flattest balls he can for the instructor so she has to work extra hard with her manual exercises. This year, Charles learned that, despite seven throat surgeries and 15 years of treatment, the cancer had moved to his lungs. While his illness has definitely affected his strength, he
still goes to classes five days a week. He attributes his perseverance to the strong mental and physical health he’s developed through the SilverSneakers program, as well as the many “girlfriends” (as he likes to playfully call his female classmates) that he has at the center. With one daughter in Maumelle and another in Michigan, Charles has found a family among his classmates and the staff, often calling to check in on any who miss a class. According to the program director, Tiffeny Crow, Charles always is the first to arrive and welcome other class members, and he’s the last to linger and visit with friends and staff. “For a man who had few roots, Charles has made a second home here with us,” Tiffeny said. “His experience with the program, his life, his warm personality… it’s all inspirational. We’re so grateful that he found us!”
SilverSneakers is available to Arkansas Blue Cross and Blue Shield Medi-Pak®, Medi-Pak® Advantage (PFFS) and Medi-Pak® Advantage PPO members at no additional cost to the member. Participants can visit wellness centers, YMCAs and Curves® locations all over the country.
For more information on SilverSneakers, call 1-888-423-4632, 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.
AUTUMN 2013 BLUE & YOU
13
FAMILY
IS Where you
find it
If I can
SilverSneakers keeps Conway man surrounded by friends
T
hree years ago, Charles Stacks, a 72-yearold Medi-Pak® member, had to have a hand surgery that led to his retirement. At the same time, he was fighting a 12-year battle with throat cancer. As he dealt with, and continues to deal with these challenges, Charles remained true to the personal motto he’s been wearing on his bicep since 1959, “Love is life.” Once in the Navy and a truck driver for 40 years, the Greenbrier native spent his whole life moving. After his hand surgery, a doctor suggested Charles try SilverSneakers®, the nation’s leading exercise program designed exclusively for older adults. Charles, who lives just five minutes away from the Conway Regional Health and Fitness Center with his 92-year-old mother, jumped at the chance to try the innovative blend of physical activity, healthy lifestyle and socially oriented programming.
12
BLUE & YOU AUTUMN 2013
walk,
I will be there. – Charles Stacks “I started going to the classes as part of my therapy, but I really like the social aspect,” said Charles. “I enjoy living.” Indeed, Charles is known for being a giver and a bit of a joker. During class, he’s often the instructor’s unofficial assistant, helping latecomers get set up by grabbing a chair, exercise balls, bands and other items for them. After helping a latecomer during a recent session, Charles “accidentally” moved the box that was in the center of the circle with his foot. This shift in placement would give his team an advantage for a game later on! He also likes to find the flattest balls he can for the instructor so she has to work extra hard with her manual exercises. This year, Charles learned that, despite seven throat surgeries and 15 years of treatment, the cancer had moved to his lungs. While his illness has definitely affected his strength, he
still goes to classes five days a week. He attributes his perseverance to the strong mental and physical health he’s developed through the SilverSneakers program, as well as the many “girlfriends” (as he likes to playfully call his female classmates) that he has at the center. With one daughter in Maumelle and another in Michigan, Charles has found a family among his classmates and the staff, often calling to check in on any who miss a class. According to the program director, Tiffeny Crow, Charles always is the first to arrive and welcome other class members, and he’s the last to linger and visit with friends and staff. “For a man who had few roots, Charles has made a second home here with us,” Tiffeny said. “His experience with the program, his life, his warm personality… it’s all inspirational. We’re so grateful that he found us!”
SilverSneakers is available to Arkansas Blue Cross and Blue Shield Medi-Pak®, Medi-Pak® Advantage (PFFS) and Medi-Pak® Advantage PPO members at no additional cost to the member. Participants can visit wellness centers, YMCAs and Curves® locations all over the country.
For more information on SilverSneakers, call 1-888-423-4632, 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.
AUTUMN 2013 BLUE & YOU
13
Arkansas Blue Cross and Blue Shield and Health Advantage receive Health Plan Accreditation
NEWS
Creshelle R. Nash, M.D., M.P.H., has joined Arkansas Blue Cross and Blue Shield as the medical director for Medi-Pak Advantage Dr. Nash was a consultant to the Arkansas Minority Health Commission and previously was their medical director. She also has been an assistant professor for the Inaugural Faculty at the Clinton School of Public Service and assistant professor in both the College of Public Health and the Department of Internal Medicine at the University of Arkansas for Medical Sciences. She is a member of the American Public Health Association, the National Medical Association, the Arkansas Public Health Association, a past executive board member for the Arkansas Medical, Dental and Pharmaceutical Association, a member of the South Central Public Health Leadership Institute Alumni Association and the Arkansas Medical Society.
She has been honored by Creshelle R. Nash, M.D., M.P.H. the Pearls Foundation and Chi Eta Omega Chapter of Alpha Kappa Alpha Sorority, Inc., as a Brown Girls Rock VIP honoree for Service and Contributions in Health, the Royal Knight Society, Inc., Outstanding Public Service Award, and Sister Friend’s United, Inc., Women of Excellence Award, business leader honoree.
Arkansas Blue Cross and Blue Shield and Health Advantage recently were granted health plan accreditation from URAC, a health care accrediting organization that establishes quality standards for the health care industry. URAC’s Health Plan Accreditation standards require a comprehensive review of an organization’s operations, including: network management; quality improvement; credentialing; member protection and utilization management. Companies must pass reviews of all of these sections to receive accreditation.
“We are very pleased to be recognized in the industry for providing outstanding services,” said Mike Brown, Arkansas Blue Cross executive vice president and chief operating officer. “Our mission to bring quality health plan services to our members always has guided our business practices, and each division in the company demonstrated this by helping Arkansas Blue Cross achieve health plan accreditation.”
A second ArkansasBlue store opens in Pine Bluff Mike Brown, executive vice president and chief operating officer; Mark White, president and chief executive officer; and Dwayne Pierce, regional executive; join Pine Bluff Mayor Debe Hollingsworth (center), and members of the Pine Bluff Chamber of Commerce in cutting the ribbon to officially open the ArkansasBlue health insurance store in Pine Bluff.
She has served in the community through the Arkansas Department of Health’s Minority Health Advisory Council and its breast cancer control program; the Arkansas Commitment internship and leadership programs; and the Philander Smith College National Youth Sports Program.
Night at the Museum! Arkansas Blue Cross and Blue Shield members enjoyed free admission to the Museum of Discovery in Little Rock during the Arkansas Blue Cross sponsored “A Night at the Museum/Pajama Party” on June 1. Arkansas Blue Cross employees Carl Carter, Micki Smith and Will Ballard visit with Katie and Megan Bayer at the museum.
14
BLUE & YOU AUTUMN 2013
Residents of Pine Bluff and southeast Arkansas are able to speak face to face with health insurance experts who can advise them about affordable health plans and more at the new ArkansasBlue office located at 509 Mallard Loop Drive in Pine Bluff (across from Walmart on Highway 63). Health insurance experts at ArkansasBlue will provide Arkansas Blue Cross and
Blue Shield members and insurance shoppers with information about Arkansas Blue Cross insurance plans, advice on which plan best covers them and fits their budget, as well as assistance with questions or concerns they may have about purchasing or choosing health insurance. ArkansasBlue also will provide visitors with information on dental and other insurance plans.
And, with the full implementation of the Patient Protection and Affordable Care Act (PPACA) approaching in 2014, visitors who have purchased individual or family health insurance plans will be able to come for a health insurance review to see how new regulations will impact their health insurance coverage and cost.
AUTUMN 2013 BLUE & YOU
15
Arkansas Blue Cross and Blue Shield and Health Advantage receive Health Plan Accreditation
NEWS
Creshelle R. Nash, M.D., M.P.H., has joined Arkansas Blue Cross and Blue Shield as the medical director for Medi-Pak Advantage Dr. Nash was a consultant to the Arkansas Minority Health Commission and previously was their medical director. She also has been an assistant professor for the Inaugural Faculty at the Clinton School of Public Service and assistant professor in both the College of Public Health and the Department of Internal Medicine at the University of Arkansas for Medical Sciences. She is a member of the American Public Health Association, the National Medical Association, the Arkansas Public Health Association, a past executive board member for the Arkansas Medical, Dental and Pharmaceutical Association, a member of the South Central Public Health Leadership Institute Alumni Association and the Arkansas Medical Society.
She has been honored by Creshelle R. Nash, M.D., M.P.H. the Pearls Foundation and Chi Eta Omega Chapter of Alpha Kappa Alpha Sorority, Inc., as a Brown Girls Rock VIP honoree for Service and Contributions in Health, the Royal Knight Society, Inc., Outstanding Public Service Award, and Sister Friend’s United, Inc., Women of Excellence Award, business leader honoree.
Arkansas Blue Cross and Blue Shield and Health Advantage recently were granted health plan accreditation from URAC, a health care accrediting organization that establishes quality standards for the health care industry. URAC’s Health Plan Accreditation standards require a comprehensive review of an organization’s operations, including: network management; quality improvement; credentialing; member protection and utilization management. Companies must pass reviews of all of these sections to receive accreditation.
“We are very pleased to be recognized in the industry for providing outstanding services,” said Mike Brown, Arkansas Blue Cross executive vice president and chief operating officer. “Our mission to bring quality health plan services to our members always has guided our business practices, and each division in the company demonstrated this by helping Arkansas Blue Cross achieve health plan accreditation.”
A second ArkansasBlue store opens in Pine Bluff Mike Brown, executive vice president and chief operating officer; Mark White, president and chief executive officer; and Dwayne Pierce, regional executive; join Pine Bluff Mayor Debe Hollingsworth (center), and members of the Pine Bluff Chamber of Commerce in cutting the ribbon to officially open the ArkansasBlue health insurance store in Pine Bluff.
She has served in the community through the Arkansas Department of Health’s Minority Health Advisory Council and its breast cancer control program; the Arkansas Commitment internship and leadership programs; and the Philander Smith College National Youth Sports Program.
Night at the Museum! Arkansas Blue Cross and Blue Shield members enjoyed free admission to the Museum of Discovery in Little Rock during the Arkansas Blue Cross sponsored “A Night at the Museum/Pajama Party” on June 1. Arkansas Blue Cross employees Carl Carter, Micki Smith and Will Ballard visit with Katie and Megan Bayer at the museum.
14
BLUE & YOU AUTUMN 2013
Residents of Pine Bluff and southeast Arkansas are able to speak face to face with health insurance experts who can advise them about affordable health plans and more at the new ArkansasBlue office located at 509 Mallard Loop Drive in Pine Bluff (across from Walmart on Highway 63). Health insurance experts at ArkansasBlue will provide Arkansas Blue Cross and
Blue Shield members and insurance shoppers with information about Arkansas Blue Cross insurance plans, advice on which plan best covers them and fits their budget, as well as assistance with questions or concerns they may have about purchasing or choosing health insurance. ArkansasBlue also will provide visitors with information on dental and other insurance plans.
And, with the full implementation of the Patient Protection and Affordable Care Act (PPACA) approaching in 2014, visitors who have purchased individual or family health insurance plans will be able to come for a health insurance review to see how new regulations will impact their health insurance coverage and cost.
AUTUMN 2013 BLUE & YOU
15
The ScholarS
Health
care
in t h e
heartland
University of Arkansas for Medical Sciences (UAMS) College of Medicine classmates Justin Allen and Megan Busch were both greeted with good news this summer — $20,000 worth of good news to be exact. Justin and Megan were named the 2013 Arkansas Blue Cross and Blue Shield Primary Care Scholarship recipients, each awarded a $20,000 scholarship for their commitment to providing health care in rural Arkansas.
“Becoming a doctor has been the plan since I was in eighth grade,” Justin said. “Growing up in a rural community definitely helps you appreciate the relationships you form with people in that setting.” Justin grew up in Mt. Vernon, a sleepy town in central Arkansas that totaled 148 people at the last census count. Growing up in Mt. Vernon shaped Justin’s decision to become a primary care physician and to focus on Arkansas’ rural population. For Justin, the Arkansas Blue Cross and Blue Shield Primary Care Scholarship will help him accomplish his goal. “This scholarship means the world to me,” he said. Megan’s career ambitions weren’t always as clear. Born and raised in Little Rock, it wasn’t until she completed undergrad and moved to the small town of Warren that Megan realized her desire to work amongst the state’s rural population. In Warren, Megan had a job working for one of the town’s primary care physicians and learned firsthand the incredible importance of a small-town doctor. “You’re the first person they go to with any type of problem. You’re the person following everything. From head to toe, from baby to grandma, you experience continuity of care that other specialists just don’t get to see,” she said. “The doctor I worked with was a hero to the whole town. I saw how much that one person contributed to the town.” Two years later, when she returned from Warren to UAMS in Little Rock, Megan knew her career’s trajectory.
16
Megan Busch (left) and Justin Allen were named recipients of the 2013 Arkansas Blue Cross and Blue Shield Primary Care Scholarship.
BLUE & YOU AUTUMN 2013
“I came back to Little Rock and totally changed my views about what I wanted to do in the field of medicine,” Megan said. Like Justin, she wanted to provide primary care to rural Arkansans.
THE
SCHOLARSHIP
SPECS NAME: Arkansas Blue Cross and Blue Shield Primary Care Scholarship RECIPIENTS: 2 each year AMOUNT: $20,000 Next year, both Justin and Megan will begin their residency and take one step closer to becoming a primary care physician in rural Arkansas. And the $20,000 scholarship will go a long way toward helping them get there.
The ScholarSHIP
Justin and Megan use a bag-valve mask on a mannequin at the UAMS patient simulation center.
According to Tom, the average debt for a UAMS College of Medicine student was $139,044 in 2012.
FOLLOW UP ON LAST YEAR’S
For future primary care physicians, medical school is a painstaking and rigorous challenge that has to be overcome. So is financing it.
WINNERS
That’s why scholarship opportunities like the Arkansas Blue Cross and Blue Shield Primary Care Scholarship are important. Tom G. South, assistant dean of medical student admissions at UAMS, said the newly founded Arkansas Blue Cross scholarship is among the very largest available to UAMS students.
Last year, the inaugural Arkansas Blue Cross scholarship winners were Christina “Lauren” Monteith and Josue Gutierrez.
“We see an increasing number of students graduating with a lot of debt,” Tom said. “The scholarship allows students to divert the money that would’ve gone to paying back those student loans to their practice and patients.”
good for you events and activities saturday, october 20
Join Arkansas Blue Cross’ BlueCares Team for the Komen for a Cure walk. Our team will be handing out goodies to walkers. We look forward to supporting finding a cure for breast cancer with Central Arkansans.
saturday, december 1
City Mouse, Country Mouse, Christmas House! Arkansas Blue Cross is hosting a special showing of City Mouse, Country Mouse, Christmas House at the Arkansas Arts Center. Round up the family and enjoy a FREE night of the arts. Tickets can be picked up at ArkansasBlue, located in the Shackleford Crossing shopping center, while supplies last. Check our Web site for details.
spring 2013
saturday, november 10
Get ready for a happy, healthy holiday season with P. Allen Smith! Join us at the ArkansasBlue insurance store, from 9 a.m. to 1 p.m. for healthy food growing and cooking demonstrations, and activities with SilverSneakers®* instructors. *SilverSneakers® is a registered mark of Healthways, Inc. The SIlverSneakers® Fitness Program is provided by Healthways, Inc., Healthways is an independent company that operates separately from Arkansas Blue Cross and Blue Shield.
Although spring is months away, now is the time to plan for the Blue & You Fitness Challenge. Start forming your team or group and plan to register for the 2013 Challenge. The Blue & You Fitness Challenge is an exercise contest (March 1 – May 31) that encourages participants to work toward the public health recommendation of adult physical activity 30 minutes each day, most days of the week.
Clinics chosen for federal initiative page 6
Bringing doctors to rural Arkansas Meet the first Arkansas Blue Cross and Blue Shield Primary Care Scholarship recipients ... page 4
Health Care Reform update page 8
Teen drivers are safer now page 20
Each year, students who are studying to be primary care physicians compete for the scholarship, which comes from interest earned on a $1 million grant given by Arkansas Blue Cross to UAMS. “One of the primary considerations of our students is trying to get them to go to rural underserved communities,” Tom said. “We have a tremendous need for physicians to stay in Arkansas and to locate their practices in the rural parts of the state.”
Lauren is currently a family medicine resident in El Dorado.
Tom said the large debt burden taken on by medical school students each year is problematic. When faced with mounting student loans, medical school students are often attracted to careers as higher-wage specialists.
Josue is in the family medicine resident program in Lincoln, Neb. (Although Josue was matched out of state, he remains committed to returning to Arkansas upon completion.)
The partnership between UAMS and Arkansas Blue Cross will continue to encourage students to choose primary care and help improve the health of the state’s rural population.
MPI 1129 9/12
For more information, call toll free 1-800-686-2609, or visit blueandyoufitnesschallenge-ark.com.
AUTUMN 2013 BLUE & YOU
17
The ScholarS
Health
care
in t h e
heartland
University of Arkansas for Medical Sciences (UAMS) College of Medicine classmates Justin Allen and Megan Busch were both greeted with good news this summer — $20,000 worth of good news to be exact. Justin and Megan were named the 2013 Arkansas Blue Cross and Blue Shield Primary Care Scholarship recipients, each awarded a $20,000 scholarship for their commitment to providing health care in rural Arkansas.
“Becoming a doctor has been the plan since I was in eighth grade,” Justin said. “Growing up in a rural community definitely helps you appreciate the relationships you form with people in that setting.” Justin grew up in Mt. Vernon, a sleepy town in central Arkansas that totaled 148 people at the last census count. Growing up in Mt. Vernon shaped Justin’s decision to become a primary care physician and to focus on Arkansas’ rural population. For Justin, the Arkansas Blue Cross and Blue Shield Primary Care Scholarship will help him accomplish his goal. “This scholarship means the world to me,” he said. Megan’s career ambitions weren’t always as clear. Born and raised in Little Rock, it wasn’t until she completed undergrad and moved to the small town of Warren that Megan realized her desire to work amongst the state’s rural population. In Warren, Megan had a job working for one of the town’s primary care physicians and learned firsthand the incredible importance of a small-town doctor. “You’re the first person they go to with any type of problem. You’re the person following everything. From head to toe, from baby to grandma, you experience continuity of care that other specialists just don’t get to see,” she said. “The doctor I worked with was a hero to the whole town. I saw how much that one person contributed to the town.” Two years later, when she returned from Warren to UAMS in Little Rock, Megan knew her career’s trajectory.
16
Megan Busch (left) and Justin Allen were named recipients of the 2013 Arkansas Blue Cross and Blue Shield Primary Care Scholarship.
BLUE & YOU AUTUMN 2013
“I came back to Little Rock and totally changed my views about what I wanted to do in the field of medicine,” Megan said. Like Justin, she wanted to provide primary care to rural Arkansans.
THE
SCHOLARSHIP
SPECS NAME: Arkansas Blue Cross and Blue Shield Primary Care Scholarship RECIPIENTS: 2 each year AMOUNT: $20,000 Next year, both Justin and Megan will begin their residency and take one step closer to becoming a primary care physician in rural Arkansas. And the $20,000 scholarship will go a long way toward helping them get there.
The ScholarSHIP
Justin and Megan use a bag-valve mask on a mannequin at the UAMS patient simulation center.
According to Tom, the average debt for a UAMS College of Medicine student was $139,044 in 2012.
FOLLOW UP ON LAST YEAR’S
For future primary care physicians, medical school is a painstaking and rigorous challenge that has to be overcome. So is financing it.
WINNERS
That’s why scholarship opportunities like the Arkansas Blue Cross and Blue Shield Primary Care Scholarship are important. Tom G. South, assistant dean of medical student admissions at UAMS, said the newly founded Arkansas Blue Cross scholarship is among the very largest available to UAMS students.
Last year, the inaugural Arkansas Blue Cross scholarship winners were Christina “Lauren” Monteith and Josue Gutierrez.
“We see an increasing number of students graduating with a lot of debt,” Tom said. “The scholarship allows students to divert the money that would’ve gone to paying back those student loans to their practice and patients.”
good for you events and activities saturday, october 20
Join Arkansas Blue Cross’ BlueCares Team for the Komen for a Cure walk. Our team will be handing out goodies to walkers. We look forward to supporting finding a cure for breast cancer with Central Arkansans.
saturday, december 1
City Mouse, Country Mouse, Christmas House! Arkansas Blue Cross is hosting a special showing of City Mouse, Country Mouse, Christmas House at the Arkansas Arts Center. Round up the family and enjoy a FREE night of the arts. Tickets can be picked up at ArkansasBlue, located in the Shackleford Crossing shopping center, while supplies last. Check our Web site for details.
spring 2013
saturday, november 10
Get ready for a happy, healthy holiday season with P. Allen Smith! Join us at the ArkansasBlue insurance store, from 9 a.m. to 1 p.m. for healthy food growing and cooking demonstrations, and activities with SilverSneakers®* instructors. *SilverSneakers® is a registered mark of Healthways, Inc. The SIlverSneakers® Fitness Program is provided by Healthways, Inc., Healthways is an independent company that operates separately from Arkansas Blue Cross and Blue Shield.
Although spring is months away, now is the time to plan for the Blue & You Fitness Challenge. Start forming your team or group and plan to register for the 2013 Challenge. The Blue & You Fitness Challenge is an exercise contest (March 1 – May 31) that encourages participants to work toward the public health recommendation of adult physical activity 30 minutes each day, most days of the week.
Clinics chosen for federal initiative page 6
Bringing doctors to rural Arkansas Meet the first Arkansas Blue Cross and Blue Shield Primary Care Scholarship recipients ... page 4
Health Care Reform update page 8
Teen drivers are safer now page 20
Each year, students who are studying to be primary care physicians compete for the scholarship, which comes from interest earned on a $1 million grant given by Arkansas Blue Cross to UAMS. “One of the primary considerations of our students is trying to get them to go to rural underserved communities,” Tom said. “We have a tremendous need for physicians to stay in Arkansas and to locate their practices in the rural parts of the state.”
Lauren is currently a family medicine resident in El Dorado.
Tom said the large debt burden taken on by medical school students each year is problematic. When faced with mounting student loans, medical school students are often attracted to careers as higher-wage specialists.
Josue is in the family medicine resident program in Lincoln, Neb. (Although Josue was matched out of state, he remains committed to returning to Arkansas upon completion.)
The partnership between UAMS and Arkansas Blue Cross will continue to encourage students to choose primary care and help improve the health of the state’s rural population.
MPI 1129 9/12
For more information, call toll free 1-800-686-2609, or visit blueandyoufitnesschallenge-ark.com.
AUTUMN 2013 BLUE & YOU
17
Blue &You Foundation awards 55 mini-grants to improve health in Arkansas From food pantries to summer camps to community gardens — there are many ways Arkansans can live healthier lives with a little bit of funding to make it happen. That’s why the Blue & You Foundation for a Healthier Arkansas began awarding $1,000 minigrants to health-improvement programs throughout the state that needed a financial boost. The Foundation recently awarded $1,000 mini-grants to 55 programs in Arkansas. “This year’s recipients will be conducting a wide variety of healthy activities in their communities,” said Patrick O’Sullivan, executive director of the Blue & You Foundation. “From nutrition and exercise
2
to medical and mental health, these programs help bring communities together in positive ways to improve the health of Arkansans.” The Blue & You Foundation was established in 2001 by Arkansas Blue Cross and Blue Shield to help 2 support community MINIGRANTS organizations that are implementing programs to improve the health of Arkansans. In its first 12 years of grant making, the Blue & You Foundation has awarded more than $16 million to 381 health-improvement projects in Arkansas.
The mini-grant recipients for 2013 are:
3
9
10 15
3
10
4
MINIGRANTS
MINIGRANTS
4
1
MINIGRANTS
North Central Arkansas Bald Knob: H. L. Lubker Elementary — Cardio Rebounder Trampolines Batesville: City of Batesville — Eat Well, Play Hard, Make It Balance Independence County Hometown Wellness Coalition —Physical Activity Fun Southside Elementary School — Step Up to Good Health University of Arkansas Community College — Get ACTIVE Heber Springs: (The) CALL in Cleburne County — CPR and Pediatric First Aid Materials Mountain View: Stone County Hometown Health Planning Coalition, Inc. — Family Care Fair Pleasant Plains: Midland High School — Step Up to Good Health Searcy: White County Medical Center — A Day of Caring White County Single Parent Scholarship Fund, Inc. — Scholarship Fund Northeast Arkansas Augusta: ARcare — ARcare Healthy Weight Initiative DeWitt: Grand Prairie Charitable Christian Medical Clinic — Patient Medications and Clinic Maintenance Jonesboro: Westside Consolidated School District #5 — Stabilizing Learners’ Lives Marianna: Lee County Cooperative Clinic — Regional Health Education Fair Memphis: Boy Scouts of America, Chickasaw Council — Summer Camp Scholarships (serving Jes Lere-Hama Corp., Memphis — Drug Abuse Awareness and Healthy Lifestyle Choices Northeast Arkansas)
5
7 MINIGRANTS
4
6
MINIGRANTS
5
1
Central Arkansas Bryant: Bryant Parks and Recreation — Bishop Parks Community Garden Cabot: Cabot Crisis Pregnancy Center — Empowered! Sexual Risk Avoidance Hot Springs: Lupus Foundation of America, Inc., Arkansas Chapter—Public Awareness of Lupus in Arkansas Project North Little Rock: Academy of Creative Arts at Shorter College — Fresh Start Whole Food Nutrition Program Amboy Community Food Pantry — School’s Out: Extra Cereal for the Kids In Your Hands Ministries, Inc. — Nutritional Outreach for Kids We Care Adult Day Care Center, Inc. — Mental Stimulation and Sensory Awareness Therapeutic Program Little Rock: Arkansas Association of Health System Pharmacists — Health and Wellness Education Arkansas Insurance Department — AHELP: Motivate, Move, Maximize Arkansas Workers’ Compensation Commission — AHELP Initiative Compassion Works for All — Family Re-Unification Broadcasts Forest Park Elementary PTA — Centennial Athletic Pavilion and Track Jack Stephens Youth Golf Academy, Inc. — Summer Outreach Program Leukemia & Lymphoma Society — Light the Night Walk Village Commons — Healthy Foods Community Dinner
18
Northwest Arkansas Fayetteville: Public Education Foundation — Roadrunner Day Peace at Home Family Shelter — Building Bridges domestic violence intervention Hartford: Hartford School District — Community Health Fair Mena: Quality of Life Outreach, Inc. — Outreach Resource Guide Morrilton: Conway County Literacy Council — Safety Baby Showers Ozark: Ozark School District — Play Equipment Perryville: Perryville School District — The PHS School and Community Garden Russellville: Arkansas Tech University — Safe Spring Break Health and Wellness Fair Van Buren: North Park Baptist Church — AEDs for NPKidz
6
Newport: Jackson County Learning Center — Healthy Lifestyles Oil Trough School District — Step Up to Good Health Paragould: Center for Fathers & Families — Healthy Lifestyles Mission Outreach of NEA, Inc. — Charitable Medical Clinic
Southwest Arkansas Arkadelphia: Clark County Strategic Plan — Clark County Adolescent Summer Fitness Challenge Camden: Christian Health Center — Service Expansion Program Hope: Our Lady of Good Hope Catholic Church — Food Pantry Kirby: Kirby School District — Sugar Sugar Everywhere Magnolia: Bethlehem Missionary Baptist Church — Community-Wide Vacation Bible School Calhoun Heights Community Outreach, Inc. — Summer Enrichment Program Texarkana: Texarkana Arkansas Police Department — P.R.I.D.E. Academy SouthEAst Arkansas Monticello: Southeast Arkansas Education Service Cooperative Foundation — Effectively Conducting Physical Fitness Assessments on School Age Children Pine Bluff: Southeast Arkansas Medical Education Foundation, Inc., Pine Bluff — Health Literacy Awareness New Morning Star Children & Families Development Services Center, Inc.— Healthy Choices Star City: Lend A Hand of Lincoln County — Emergency Food Assistance Program Nonprofit and charitable organizations, schools and government institutions in Arkansas are eligible to apply for two different programs: a $1,000 mini-grant program (available again in early 2014), and a regular grants program of $5,000 to $150,000 with an application deadline of July 15, 2014. Grant guidelines and the online applications can be found at blueandyoufoundationarkansas.org. The Blue & You Foundation is an independent licensee of the Blue Cross and Blue Shield Association and serves the state of Arkansas.
BLUE & YOU AUTUMN 2013
AUTUMN 2013 BLUE & YOU
19
Blue &You Foundation awards 55 mini-grants to improve health in Arkansas From food pantries to summer camps to community gardens — there are many ways Arkansans can live healthier lives with a little bit of funding to make it happen. That’s why the Blue & You Foundation for a Healthier Arkansas began awarding $1,000 minigrants to health-improvement programs throughout the state that needed a financial boost. The Foundation recently awarded $1,000 mini-grants to 55 programs in Arkansas. “This year’s recipients will be conducting a wide variety of healthy activities in their communities,” said Patrick O’Sullivan, executive director of the Blue & You Foundation. “From nutrition and exercise
2
to medical and mental health, these programs help bring communities together in positive ways to improve the health of Arkansans.” The Blue & You Foundation was established in 2001 by Arkansas Blue Cross and Blue Shield to help 2 support community MINIGRANTS organizations that are implementing programs to improve the health of Arkansans. In its first 12 years of grant making, the Blue & You Foundation has awarded more than $16 million to 381 health-improvement projects in Arkansas.
The mini-grant recipients for 2013 are:
3
9
10 15
3
10
4
MINIGRANTS
MINIGRANTS
4
1
MINIGRANTS
North Central Arkansas Bald Knob: H. L. Lubker Elementary — Cardio Rebounder Trampolines Batesville: City of Batesville — Eat Well, Play Hard, Make It Balance Independence County Hometown Wellness Coalition —Physical Activity Fun Southside Elementary School — Step Up to Good Health University of Arkansas Community College — Get ACTIVE Heber Springs: (The) CALL in Cleburne County — CPR and Pediatric First Aid Materials Mountain View: Stone County Hometown Health Planning Coalition, Inc. — Family Care Fair Pleasant Plains: Midland High School — Step Up to Good Health Searcy: White County Medical Center — A Day of Caring White County Single Parent Scholarship Fund, Inc. — Scholarship Fund Northeast Arkansas Augusta: ARcare — ARcare Healthy Weight Initiative DeWitt: Grand Prairie Charitable Christian Medical Clinic — Patient Medications and Clinic Maintenance Jonesboro: Westside Consolidated School District #5 — Stabilizing Learners’ Lives Marianna: Lee County Cooperative Clinic — Regional Health Education Fair Memphis: Boy Scouts of America, Chickasaw Council — Summer Camp Scholarships (serving Jes Lere-Hama Corp., Memphis — Drug Abuse Awareness and Healthy Lifestyle Choices Northeast Arkansas)
5
7 MINIGRANTS
4
6
MINIGRANTS
5
1
Central Arkansas Bryant: Bryant Parks and Recreation — Bishop Parks Community Garden Cabot: Cabot Crisis Pregnancy Center — Empowered! Sexual Risk Avoidance Hot Springs: Lupus Foundation of America, Inc., Arkansas Chapter—Public Awareness of Lupus in Arkansas Project North Little Rock: Academy of Creative Arts at Shorter College — Fresh Start Whole Food Nutrition Program Amboy Community Food Pantry — School’s Out: Extra Cereal for the Kids In Your Hands Ministries, Inc. — Nutritional Outreach for Kids We Care Adult Day Care Center, Inc. — Mental Stimulation and Sensory Awareness Therapeutic Program Little Rock: Arkansas Association of Health System Pharmacists — Health and Wellness Education Arkansas Insurance Department — AHELP: Motivate, Move, Maximize Arkansas Workers’ Compensation Commission — AHELP Initiative Compassion Works for All — Family Re-Unification Broadcasts Forest Park Elementary PTA — Centennial Athletic Pavilion and Track Jack Stephens Youth Golf Academy, Inc. — Summer Outreach Program Leukemia & Lymphoma Society — Light the Night Walk Village Commons — Healthy Foods Community Dinner
18
Northwest Arkansas Fayetteville: Public Education Foundation — Roadrunner Day Peace at Home Family Shelter — Building Bridges domestic violence intervention Hartford: Hartford School District — Community Health Fair Mena: Quality of Life Outreach, Inc. — Outreach Resource Guide Morrilton: Conway County Literacy Council — Safety Baby Showers Ozark: Ozark School District — Play Equipment Perryville: Perryville School District — The PHS School and Community Garden Russellville: Arkansas Tech University — Safe Spring Break Health and Wellness Fair Van Buren: North Park Baptist Church — AEDs for NPKidz
6
Newport: Jackson County Learning Center — Healthy Lifestyles Oil Trough School District — Step Up to Good Health Paragould: Center for Fathers & Families — Healthy Lifestyles Mission Outreach of NEA, Inc. — Charitable Medical Clinic
Southwest Arkansas Arkadelphia: Clark County Strategic Plan — Clark County Adolescent Summer Fitness Challenge Camden: Christian Health Center — Service Expansion Program Hope: Our Lady of Good Hope Catholic Church — Food Pantry Kirby: Kirby School District — Sugar Sugar Everywhere Magnolia: Bethlehem Missionary Baptist Church — Community-Wide Vacation Bible School Calhoun Heights Community Outreach, Inc. — Summer Enrichment Program Texarkana: Texarkana Arkansas Police Department — P.R.I.D.E. Academy SouthEAst Arkansas Monticello: Southeast Arkansas Education Service Cooperative Foundation — Effectively Conducting Physical Fitness Assessments on School Age Children Pine Bluff: Southeast Arkansas Medical Education Foundation, Inc., Pine Bluff — Health Literacy Awareness New Morning Star Children & Families Development Services Center, Inc.— Healthy Choices Star City: Lend A Hand of Lincoln County — Emergency Food Assistance Program Nonprofit and charitable organizations, schools and government institutions in Arkansas are eligible to apply for two different programs: a $1,000 mini-grant program (available again in early 2014), and a regular grants program of $5,000 to $150,000 with an application deadline of July 15, 2014. Grant guidelines and the online applications can be found at blueandyoufoundationarkansas.org. The Blue & You Foundation is an independent licensee of the Blue Cross and Blue Shield Association and serves the state of Arkansas.
BLUE & YOU AUTUMN 2013
AUTUMN 2013 BLUE & YOU
19
Come homE to a MEDICAL homE! Do these sound familiar? A loved one comes home from a doctor visit and is confused about which medications to take—or even what the doctor said.
You saw a specialist or had a test, but your family doctor didn’t get a report back.
You had to go to the emergency department because your primary doctor had no appointments available for a week.
by Randal Hundley, M.D., Arkansas Blue Cross and Blue Shield
Your diabetes is not well controlled, but your doctor doesn’t have the resources to help you manage your condition except during actual office visits, rather than working with you throughout the year.
The Patient Centered Medical Home (PCMH) is a model for improving primary care and fixing some other shortcomings of our medical system. A PCMH is not a place — it is a concept. A PCMH is a medical practice that has embraced a new way of caring for patients, with a focus on the “triple aim” of improving health, improving patient experience and lowering cost. While there is no single definition of a PCMH, there are several key ingredients to transforming a medical practice into a medical home.
These include: A team approach to care – A medical home is led by a physician, often collaborating with an advanced practice nurse or physician assistant. Unlike a traditional practice, where the staff is focused on helping the providers, in a medical home everyone (including the receptionist, medical assistant, nurse and medical technician) works and communicates as a team to identify and address the patients’ needs. Shared decision-making – Rather than always telling patients what they need, a medical home will, whenever possible, present patients with options and information for making a decision. The patient’s deepest wishes and concerns will be taken into account, and the ultimate decision is made by the patient.
20
BLUE & YOU AUTUMN 2013
Care coordination – In a traditional practice, the patient gets great care from the doctor at the time of a visit or when they call the office for help. In a medical home, the staff reaches out to patients between visits, making sure specialist appointments are made and kept, and looking for missed treatment opportunities through the use of electronic medical records and other software. For example, a care coordinator in the practice might find that a patient qualifies for a pneumonia vaccine but has not gotten it. The receptionist then may contact the patient to come in and get this vaccination — possibly preventing a serious illness. In addition, there is great attention to getting medications and follow up right when a patient goes home from a hospitalization. We know that miscommunication often occurs during transitions from hospital to home.
Continuous improvement – A medical home strives to improve the quality of care and lower the cost of care through tracking and analyzing data, and by providing better access to care through extended hours, urgent care availability, and 24/7 phone access. Patients are actively invited to give feedback to the practice on how it can improve.
At Arkansas Blue Cross and Blue Shield, we believe that the PCMH is a big part of improving our health care delivery system. Starting in 2010, we gave extra support and reimbursement to several practices around the state to help transform them into PCMHs. These clinics met rigorous criteria to ultimately become recognized by a
national accreditation body as true patient centered medical homes. We now are working to increase the number of PCMHs in Arkansas. We look forward to a time when every patient will have a place to call home — medical home, that is!
NEW and upcoming generics The following medications may be available soon (or now!) in generic form. Ask your pharmacist if there is a generic available for your prescription. Generic medications are the same as their brand-name counterparts. You can learn more about generics on the U.S. Food and Drug Administration’s website, fda.gov. Brand name Generic Use Generic Release Patanase Olopatadine Nasal allergy 2013 Advicor Niacin and Lovastatin High cholesterol 2013 Bromday Bromfenac Eye swelling and pain 2013 Lidoderm Lidocaine Pain patch 2013 Aciphex Rabeprazole Acid reflux 2013 Cymbalta Duloxetine Antidepressant and pain 2013 Locoid lipocream Hydrocortisone Itching Late 2013 Vanos Fluocinonide Psoriasis Late 2013 Vivelle-Dot Estradiol Menopause Late 2013 Loestrin 24 Fe Ethinyl Estradiol Birth control Early 2014 and Norethindrone Renvela tabs Sevelamer Chronic kidney disease Early 2014 Actonel Risedronate Osteoporosis 2014 Detrol LA Tolterodine Overactive bladder 2014 Kapvay Clonidine High blood pressure 2014 Lunesta Eszopiclone Sleep agent 2014 Nexium Esomeprazole Acid reflux 2014 Viracept Nelfinavir Antiviral 2014 Avelox Moxifloxacin Antibiotic 2014 Micardis Telmisartan High blood pressure 2014 Micardis HCT tabs Telmisartan and High blood pressure 2014 hydrochlorothiazide Renagel Sevelamer Chronic kidney disease Late 2014 Intuniv Guanfacine High blood pressure Late 2014 Tazorac gel Tazarotene Psoriasis Late 2014
AUTUMN 2013 BLUE & YOU
21
Come homE to a MEDICAL homE! Do these sound familiar? A loved one comes home from a doctor visit and is confused about which medications to take—or even what the doctor said.
You saw a specialist or had a test, but your family doctor didn’t get a report back.
You had to go to the emergency department because your primary doctor had no appointments available for a week.
by Randal Hundley, M.D., Arkansas Blue Cross and Blue Shield
Your diabetes is not well controlled, but your doctor doesn’t have the resources to help you manage your condition except during actual office visits, rather than working with you throughout the year.
The Patient Centered Medical Home (PCMH) is a model for improving primary care and fixing some other shortcomings of our medical system. A PCMH is not a place — it is a concept. A PCMH is a medical practice that has embraced a new way of caring for patients, with a focus on the “triple aim” of improving health, improving patient experience and lowering cost. While there is no single definition of a PCMH, there are several key ingredients to transforming a medical practice into a medical home.
These include: A team approach to care – A medical home is led by a physician, often collaborating with an advanced practice nurse or physician assistant. Unlike a traditional practice, where the staff is focused on helping the providers, in a medical home everyone (including the receptionist, medical assistant, nurse and medical technician) works and communicates as a team to identify and address the patients’ needs. Shared decision-making – Rather than always telling patients what they need, a medical home will, whenever possible, present patients with options and information for making a decision. The patient’s deepest wishes and concerns will be taken into account, and the ultimate decision is made by the patient.
20
BLUE & YOU AUTUMN 2013
Care coordination – In a traditional practice, the patient gets great care from the doctor at the time of a visit or when they call the office for help. In a medical home, the staff reaches out to patients between visits, making sure specialist appointments are made and kept, and looking for missed treatment opportunities through the use of electronic medical records and other software. For example, a care coordinator in the practice might find that a patient qualifies for a pneumonia vaccine but has not gotten it. The receptionist then may contact the patient to come in and get this vaccination — possibly preventing a serious illness. In addition, there is great attention to getting medications and follow up right when a patient goes home from a hospitalization. We know that miscommunication often occurs during transitions from hospital to home.
Continuous improvement – A medical home strives to improve the quality of care and lower the cost of care through tracking and analyzing data, and by providing better access to care through extended hours, urgent care availability, and 24/7 phone access. Patients are actively invited to give feedback to the practice on how it can improve.
At Arkansas Blue Cross and Blue Shield, we believe that the PCMH is a big part of improving our health care delivery system. Starting in 2010, we gave extra support and reimbursement to several practices around the state to help transform them into PCMHs. These clinics met rigorous criteria to ultimately become recognized by a
national accreditation body as true patient centered medical homes. We now are working to increase the number of PCMHs in Arkansas. We look forward to a time when every patient will have a place to call home — medical home, that is!
NEW and upcoming generics The following medications may be available soon (or now!) in generic form. Ask your pharmacist if there is a generic available for your prescription. Generic medications are the same as their brand-name counterparts. You can learn more about generics on the U.S. Food and Drug Administration’s website, fda.gov. Brand name Generic Use Generic Release Patanase Olopatadine Nasal allergy 2013 Advicor Niacin and Lovastatin High cholesterol 2013 Bromday Bromfenac Eye swelling and pain 2013 Lidoderm Lidocaine Pain patch 2013 Aciphex Rabeprazole Acid reflux 2013 Cymbalta Duloxetine Antidepressant and pain 2013 Locoid lipocream Hydrocortisone Itching Late 2013 Vanos Fluocinonide Psoriasis Late 2013 Vivelle-Dot Estradiol Menopause Late 2013 Loestrin 24 Fe Ethinyl Estradiol Birth control Early 2014 and Norethindrone Renvela tabs Sevelamer Chronic kidney disease Early 2014 Actonel Risedronate Osteoporosis 2014 Detrol LA Tolterodine Overactive bladder 2014 Kapvay Clonidine High blood pressure 2014 Lunesta Eszopiclone Sleep agent 2014 Nexium Esomeprazole Acid reflux 2014 Viracept Nelfinavir Antiviral 2014 Avelox Moxifloxacin Antibiotic 2014 Micardis Telmisartan High blood pressure 2014 Micardis HCT tabs Telmisartan and High blood pressure 2014 hydrochlorothiazide Renagel Sevelamer Chronic kidney disease Late 2014 Intuniv Guanfacine High blood pressure Late 2014 Tazorac gel Tazarotene Psoriasis Late 2014
AUTUMN 2013 BLUE & YOU
21
Folic Acid: Not Just for Women Folic acid is mostly known as being very important for women during pregnancy, but did you know that folic acid, or folate, provides major health benefits for everyone? Folate is a water-soluble B vitamin found naturally in food and folic acid. Folate enables our bodies to make DNA and other genetic material. Studies have shown that folate can keep the brain young and decrease the risk of several forms of cancer. Taken in combination with other B vitamins, it can prevent stroke and anemia. A deficiency can lead to an increased risk of depression, dementia and heart disease. Folate is found in many foods, including: • Green leafy vegetables like spinach, broccoli and asparagus • Bananas, strawberries, oranges and tomatoes • Peanuts, fish, eggs and organ meats like kidney and liver • Enriched flour foods like bread, bagels and pasta The amount of folate you should consume varies depending on your age and ranges from 65 micrograms for infants to 600 micrograms for pregnant women.
22
LIFE STAGE
RECOMMENDED MICROGRAMS
Birth to 6 months 7-12 months 1-3 years 4-8 years 9-13 years 14 years and up Pregnant women Breastfeeding women
65 80 150 200 300 400 600 500
BLUE & YOU AUTUMN 2013
Let us lose weight! HELP YOU
Are you trying to lose weight, but feel like you are losing the battle? If so, you aren’t alone. Let Arkansas Blue Cross and Blue Shield help you win at losing! For free! The Healthy Weigh education program is available to most of our members.* To join, complete and return the enrollment form included in this magazine. We’ve even provided a self-addressed, postagepaid envelope! It’s that easy! Members will receive free information each month by mail, including:
WINNERS! You walked, you ran, you worked out … and you met the Challenge! A total of 126 groups took on the Blue & You Fitness Challenge this year, including 8,495 individuals logging 198,616 hours of exercise!
The winners of the 2013 Blue & You Fitness Challenge are: Group Category 1 (Under 10 participants) Delta AHEC – Helena
Group Category 8 (30-39 participants) Lamar Elementary – Lamar
Group Category 2 (10-11 participants) The Ten Wonders – Clinton
Group Category 9 (40-60 participants) Northwest Arkansas Community College – Bentonville
• Guides on weight loss, fitness and maintaining a healthy weight • Information on fun activities • Recipes and menus • Tips on buying groceries and eating out • Information on walking • Healthy eating tips for grandchildren
Group Category 3 (12-14 participants) Arkansas State Plant Board – Little Rock
• Strength-training information • A portion-size placemat
Group Category 5 (17-19 participants) CMI – Little Rock
Want to know more? Call the Health Education Program’s toll-free number: 1-800-686-2609. *The Healthy Weigh! health education program is available to most members of Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas. Members with Medi-Pak® supplement and Medi-Pak Rx health plans and Arkansas state and public school employees are not eligible. Some BlueAdvantage members may not be eligible. Check your benefits for more information or call Customer Service to find out.
Representatives from several of the winning organizations were in attendance at the Blue & You Fitness Challenge wrapup held July 16 at the Little Rock Convention Center. The organizations represented are, (front row) left to right; Delta AHEC, Helena; The Ten Wonders, Clinton; Lamar Elementary, Lamar; Simmons First National Bank, Pine Bluff; CMI, Little Rock; Arkansas State Plant Board, Little Rock; Arkansas Children’s Hospital, Little Rock; (back row) Pace Industries, Fayetteville; and Transportation Security Agency, Little Rock.
Group Category 4 (15-16 participants) National Park Service – St. Paul, Minnesota
Group Category 6 (20-23 participants) ACHI – Little Rock Group Category 7 (24-29 participants) Arkansas Best Federal Credit Union – Fort Smith
Group Category 10 (61-86 participants) Nucor Yamato Steel – Blytheville Group Category 11 (87-150 participants) Transportation Security Agency — Little Rock Group Category 12 (151-275 participants) Pace Industries — Fayetteville Group Category 13 (400+ participants) Simmons First National Bank — Pine Bluff
For more information about the Blue & You Fitness Challenge, log on to BlueAndYouFitnessChallenge-ark.com.
Student Winners: Grand-prize (won a
Walmart gift card toward the purchase of a bike)
Saphire Zambrana of Kimmons Junior High School PE4life in Fort Smith
Runners-up (received fitnessrelated gift bags and gift cards) Tommy Ford of Harrisburg High School in Harrisburg Deandre Alexander of Watson Chapel Junior High FBLA in Pine Bluff AUTUMN 2013 BLUE & YOU
23
Folic Acid: Not Just for Women Folic acid is mostly known as being very important for women during pregnancy, but did you know that folic acid, or folate, provides major health benefits for everyone? Folate is a water-soluble B vitamin found naturally in food and folic acid. Folate enables our bodies to make DNA and other genetic material. Studies have shown that folate can keep the brain young and decrease the risk of several forms of cancer. Taken in combination with other B vitamins, it can prevent stroke and anemia. A deficiency can lead to an increased risk of depression, dementia and heart disease. Folate is found in many foods, including: • Green leafy vegetables like spinach, broccoli and asparagus • Bananas, strawberries, oranges and tomatoes • Peanuts, fish, eggs and organ meats like kidney and liver • Enriched flour foods like bread, bagels and pasta The amount of folate you should consume varies depending on your age and ranges from 65 micrograms for infants to 600 micrograms for pregnant women.
22
LIFE STAGE
RECOMMENDED MICROGRAMS
Birth to 6 months 7-12 months 1-3 years 4-8 years 9-13 years 14 years and up Pregnant women Breastfeeding women
65 80 150 200 300 400 600 500
BLUE & YOU AUTUMN 2013
Let us lose weight! HELP YOU
Are you trying to lose weight, but feel like you are losing the battle? If so, you aren’t alone. Let Arkansas Blue Cross and Blue Shield help you win at losing! For free! The Healthy Weigh education program is available to most of our members.* To join, complete and return the enrollment form included in this magazine. We’ve even provided a self-addressed, postagepaid envelope! It’s that easy! Members will receive free information each month by mail, including:
WINNERS! You walked, you ran, you worked out … and you met the Challenge! A total of 126 groups took on the Blue & You Fitness Challenge this year, including 8,495 individuals logging 198,616 hours of exercise!
The winners of the 2013 Blue & You Fitness Challenge are: Group Category 1 (Under 10 participants) Delta AHEC – Helena
Group Category 8 (30-39 participants) Lamar Elementary – Lamar
Group Category 2 (10-11 participants) The Ten Wonders – Clinton
Group Category 9 (40-60 participants) Northwest Arkansas Community College – Bentonville
• Guides on weight loss, fitness and maintaining a healthy weight • Information on fun activities • Recipes and menus • Tips on buying groceries and eating out • Information on walking • Healthy eating tips for grandchildren
Group Category 3 (12-14 participants) Arkansas State Plant Board – Little Rock
• Strength-training information • A portion-size placemat
Group Category 5 (17-19 participants) CMI – Little Rock
Want to know more? Call the Health Education Program’s toll-free number: 1-800-686-2609. *The Healthy Weigh! health education program is available to most members of Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas. Members with Medi-Pak® supplement and Medi-Pak Rx health plans and Arkansas state and public school employees are not eligible. Some BlueAdvantage members may not be eligible. Check your benefits for more information or call Customer Service to find out.
Representatives from several of the winning organizations were in attendance at the Blue & You Fitness Challenge wrapup held July 16 at the Little Rock Convention Center. The organizations represented are, (front row) left to right; Delta AHEC, Helena; The Ten Wonders, Clinton; Lamar Elementary, Lamar; Simmons First National Bank, Pine Bluff; CMI, Little Rock; Arkansas State Plant Board, Little Rock; Arkansas Children’s Hospital, Little Rock; (back row) Pace Industries, Fayetteville; and Transportation Security Agency, Little Rock.
Group Category 4 (15-16 participants) National Park Service – St. Paul, Minnesota
Group Category 6 (20-23 participants) ACHI – Little Rock Group Category 7 (24-29 participants) Arkansas Best Federal Credit Union – Fort Smith
Group Category 10 (61-86 participants) Nucor Yamato Steel – Blytheville Group Category 11 (87-150 participants) Transportation Security Agency — Little Rock Group Category 12 (151-275 participants) Pace Industries — Fayetteville Group Category 13 (400+ participants) Simmons First National Bank — Pine Bluff
For more information about the Blue & You Fitness Challenge, log on to BlueAndYouFitnessChallenge-ark.com.
Student Winners: Grand-prize (won a
Walmart gift card toward the purchase of a bike)
Saphire Zambrana of Kimmons Junior High School PE4life in Fort Smith
Runners-up (received fitnessrelated gift bags and gift cards) Tommy Ford of Harrisburg High School in Harrisburg Deandre Alexander of Watson Chapel Junior High FBLA in Pine Bluff AUTUMN 2013 BLUE & YOU
23
Notice of Privacy Practices — Arkansas Blue Cross and Blue Shield and Health Advantage
24
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 coverage and serves as Plan Administrator. and its affiliated company, Health Advantage, If your employer meets the requirements (sometimes referred to in this notice for outlined by the privacy law to ensure adequate convenience as a group as “Arkansas Blue separation between the employer and the Cross”) are required to protect the privacy of health plan itself, we can disclose protected your protected health information. We must health information to the appropriate health also give you this notice to tell you how we may plan administrative department of your use and release (disclose) your protected health employer to assist in obtaining coverage or information held by us. processing a claim or to modify benefits, work to control overall plan costs, and improve Throughout this notice, we will use the name service levels. This information may be provided “Arkansas Blue Cross” as a shorthand reference to the appropriate health plan administrative for not only Arkansas Blue Cross and Blue Shield, department of your employer in the form of but also for its affiliated company, HMO Partners, routine reporting or special requests. Inc., d/b/a Health Advantage. Please note that • We may disclose to others who are contracted although we are combining this privacy notice in to provide services as business associates on this way for convenient, short-hand reference, and our behalf. Some services are provided in our to make it more efficient to inform you about your organization through contracts with others. privacy rights, these companies remain separate Examples include pharmacy management companies, each with their own operations, programs, dental benefits, and a copy service management and compliance responsibilities. we use when making copies of your health Arkansas Blue Cross must use and release record. Our contracts require these business your protected health information to provide associates to appropriately protect your information: information in compliance with applicable • To you or someone who has the legal right to privacy and security laws. act for you (your personal representative) • Our health professionals and customer • To the Secretary of the Department of Health service staff, using their best judgment, may and Human Services, if necessary to make disclose to a family member, other relative, sure your privacy is protected, and close personal friend or any other person you • Where required by law. identify, health information relevant to that person’s involvement in your care or payment Arkansas Blue Cross has the right to use and related to your care. Examples of such releases release your protected health information to of your protected health information could evaluate and process your health plan or health include your spouse calling to verify a claim insurance claims, enroll and disenroll you and was paid, or the amount paid on a claim, or an your dependents, and perform related business adult child inquiring about explanation of benefit operations. forms received by an elderly parent who is ill For example: or impaired and unable to address their own • We can use and disclose your protected health health insurance or health plan business. information to pay or deny your claims, to collect your premiums, or to share your benefit Arkansas Blue Cross may use or give out your protected health information for the following payment or status with other insurer(s). purposes, under limited circumstances: • We can use and disclose your protected • To state and other federal agencies that have health information for regular health care the legal right to receive Arkansas Blue Cross operations. Members of our staff may use data (such as to make sure we are making information in your personal health record proper claims payments). to assess our efficiency and outcomes in • For public health activities (such as reporting your case and others like it. This information disease outbreaks). will then be used in an effort to continually • For government health care oversight activities improve the quality and effectiveness of (such as fraud and abuse investigations). benefits and services we provide. • For judicial and administrative proceedings • We may disclose protected health information (such as in response to a subpoena, law to your employer for health plan administration enforcement agency administrative request or purposes, including health care operations other court order). of the health plan, if your employer arranges • For law enforcement purposes (such as for your insurance or funds the health plan providing limited information to locate a BLUE & YOU AUTUMN 2013
missing person or in response to any federal or state agency administrative request that is authorized by law). • 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 treatment, payment or health care operations or other limited exceptions outlined here or in the Privacy regulation or other applicable law. Once you have given your permission for us to release your protected health information you may take it back (revoke) at any time by giving written notice to us, except if we have already acted based on your original permission. To the extent (if any) that we maintain or receive psychotherapy notes about you, most disclosures of these notes require your authorization. Also, to the extent (if any) that we use or disclose your information for our fundraising practices, we will provide you with the ability to opt out of future fundraising communications. In addition, most (but not all) uses and disclosures of medical information for marketing purposes, and disclosures that constitute a sale of protected health information, require your authorization. Personal Health Record (PHR) 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 websites. 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 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 pre-existing 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. This may include an electronic copy in certain circumstances if you make this request in writing. • 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 Post Office 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. (continued on page 26)
AUTUMN 2013 BLUE & YOU
25
Notice of Privacy Practices — Arkansas Blue Cross and Blue Shield and Health Advantage
24
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 coverage and serves as Plan Administrator. and its affiliated company, Health Advantage, If your employer meets the requirements (sometimes referred to in this notice for outlined by the privacy law to ensure adequate convenience as a group as “Arkansas Blue separation between the employer and the Cross”) are required to protect the privacy of health plan itself, we can disclose protected your protected health information. We must health information to the appropriate health also give you this notice to tell you how we may plan administrative department of your use and release (disclose) your protected health employer to assist in obtaining coverage or information held by us. processing a claim or to modify benefits, work to control overall plan costs, and improve Throughout this notice, we will use the name service levels. This information may be provided “Arkansas Blue Cross” as a shorthand reference to the appropriate health plan administrative for not only Arkansas Blue Cross and Blue Shield, department of your employer in the form of but also for its affiliated company, HMO Partners, routine reporting or special requests. Inc., d/b/a Health Advantage. Please note that • We may disclose to others who are contracted although we are combining this privacy notice in to provide services as business associates on this way for convenient, short-hand reference, and our behalf. Some services are provided in our to make it more efficient to inform you about your organization through contracts with others. privacy rights, these companies remain separate Examples include pharmacy management companies, each with their own operations, programs, dental benefits, and a copy service management and compliance responsibilities. we use when making copies of your health Arkansas Blue Cross must use and release record. Our contracts require these business your protected health information to provide associates to appropriately protect your information: information in compliance with applicable • To you or someone who has the legal right to privacy and security laws. act for you (your personal representative) • Our health professionals and customer • To the Secretary of the Department of Health service staff, using their best judgment, may and Human Services, if necessary to make disclose to a family member, other relative, sure your privacy is protected, and close personal friend or any other person you • Where required by law. identify, health information relevant to that person’s involvement in your care or payment Arkansas Blue Cross has the right to use and related to your care. Examples of such releases release your protected health information to of your protected health information could evaluate and process your health plan or health include your spouse calling to verify a claim insurance claims, enroll and disenroll you and was paid, or the amount paid on a claim, or an your dependents, and perform related business adult child inquiring about explanation of benefit operations. forms received by an elderly parent who is ill For example: or impaired and unable to address their own • We can use and disclose your protected health health insurance or health plan business. information to pay or deny your claims, to collect your premiums, or to share your benefit Arkansas Blue Cross may use or give out your protected health information for the following payment or status with other insurer(s). purposes, under limited circumstances: • We can use and disclose your protected • To state and other federal agencies that have health information for regular health care the legal right to receive Arkansas Blue Cross operations. Members of our staff may use data (such as to make sure we are making information in your personal health record proper claims payments). to assess our efficiency and outcomes in • For public health activities (such as reporting your case and others like it. This information disease outbreaks). will then be used in an effort to continually • For government health care oversight activities improve the quality and effectiveness of (such as fraud and abuse investigations). benefits and services we provide. • For judicial and administrative proceedings • We may disclose protected health information (such as in response to a subpoena, law to your employer for health plan administration enforcement agency administrative request or purposes, including health care operations other court order). of the health plan, if your employer arranges • For law enforcement purposes (such as for your insurance or funds the health plan providing limited information to locate a BLUE & YOU AUTUMN 2013
missing person or in response to any federal or state agency administrative request that is authorized by law). • 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 treatment, payment or health care operations or other limited exceptions outlined here or in the Privacy regulation or other applicable law. Once you have given your permission for us to release your protected health information you may take it back (revoke) at any time by giving written notice to us, except if we have already acted based on your original permission. To the extent (if any) that we maintain or receive psychotherapy notes about you, most disclosures of these notes require your authorization. Also, to the extent (if any) that we use or disclose your information for our fundraising practices, we will provide you with the ability to opt out of future fundraising communications. In addition, most (but not all) uses and disclosures of medical information for marketing purposes, and disclosures that constitute a sale of protected health information, require your authorization. Personal Health Record (PHR) 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 websites. 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 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 pre-existing 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. This may include an electronic copy in certain circumstances if you make this request in writing. • 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 Post Office 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. (continued on page 26)
AUTUMN 2013 BLUE & YOU
25
(continued from page 25)
Breach Notification In the event of breach of your unsecured health information, we will provide you notification of such a breach as required by law or where we otherwise deem such notification appropriate. 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’ websites: arkansasbluecross.com 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 also will post a copy of the current notice on Arkansas Blue Cross and Health Advantage websites. 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.
26
BLUE & YOU AUTUMN 2013
Last revision 5/13
Annual Notice
2014 Summary of Benefits and Coverage – available November 15 for individual/family policyholders As required by the Patient Protection and Affordable Care Act (PPACA), the Summary of Benefits and Coverage (SBC) (OMB Control Numbers 1545-2229, 1210-0147 and 0938-1146) provides information regarding coverage specifications and limitations that apply to the health insurance plan you have selected. Before the end of each year, Arkansas Blue Cross and Blue Shield provides members who are under age 65 and have individual/ family health insurance policies* with an SBC. This official communication includes information about the coverage provided by your health insurance plan in a summary format for the upcoming year. Beginning November 15, 2013, you may access this information: • Online in the “Benefits” section of the Arkansas Blue Cross secure member self-service center, My Blueprint, at arkansasbluecross.com • By calling Arkansas Blue Cross Customer Service at 1-800-238-8379 to receive a printed version After that date, you also may log on to arkansasbluecross.com/sbc and enter your member number (found on your member ID card) into the SBC locator tool to review the document online and print it. If you make changes to your Arkansas Blue Cross health plan benefits that differ from your current coverage, a new SBC will be created for you within seven work days of our receipt of your change request. It will be available to you in the same manner described above. *These are members who do not have health insurance through an employer, a Medicare health plan, or Short-Term Blue product. Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas members who receive health coverage through an employer group will get their SBC from their employer group plan administrator at the appropriate time.
Women’s Health and Cancer Rights Act The Women’s Health and Cancer Rights Act of 1998 introduced changes in insurance coverage for mastectomy. In accordance with the law, all group and individual health plans that provide medical and surgical benefits for mastectomy will cover reconstructive breast surgery, including: • Reconstructive surgery on the breast on which the mastectomy was performed. • Reconstructive surgery on the unaffected breast needed to “produce a symmetrical appearance.” • Prostheses and treatment of complications of any stage of a mastectomy, including lymphedema (post-surgical fluid buildup). These provisions apply to all policies issued by Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas and are subject to the applicable copayments, coinsurance, benefit limitations, exclusions and benefit maximums. If you have questions about your insurance coverage, contact your group benefits administrator or a customer service representitive at your local Arkansas Blue Cross office.
CUSTOMER SERVICE NUMBERS 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 1-800-863-5567 BlueAdvantage members 378-3600 1-888-872-2531 • Pharmacy questions 1-888-293-3748 Federal Employee members 378-2531 1-800-482-6655
Prefer to speak with someone close to home? Call or visit one of our offices near you: • ArkansasBlue
— Little Rock 2612 S. Shackleford Rd., Suite J 1-501-378-2222
• Fayetteville
516 East Millsap Rd., Suite 103
• Fort
Smith 3501 Old Greenwood Rd., Suite 5 1-866-254-9117
• Hot
Springs 100 Greenwood Ave., Suite C
• Jonesboro
707 East Matthews Ave.
• Little
Rock 601 Gaines Street
Looking for health or dental insurance? We can help!
• ArkansasBlue
For individuals, families For employer groups*
• Texarkana
378-2937 1-800-392-2583 378-3070 1-800-421-1112
*Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas
1-800-817-7726
— Pine Bluff 509 Mallard Loop Drive 1710 Arkansas Boulevard
1-800-588-5733 1-800-299-4124 1-800-421-1112 1-800-236-0369 1-800-470-9621
Visit our websites for more information:
arkansasbluecross.com • healthadvantage-hmo.com • blueadvantagearkansas.com • blueandyoufoundationarkansas.org
AUTUMN 2013 BLUE & YOU
27
(continued from page 25)
Breach Notification In the event of breach of your unsecured health information, we will provide you notification of such a breach as required by law or where we otherwise deem such notification appropriate. 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’ websites: arkansasbluecross.com 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 also will post a copy of the current notice on Arkansas Blue Cross and Health Advantage websites. 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.
26
BLUE & YOU AUTUMN 2013
Last revision 5/13
Annual Notice
2014 Summary of Benefits and Coverage – available November 15 for individual/family policyholders As required by the Patient Protection and Affordable Care Act (PPACA), the Summary of Benefits and Coverage (SBC) (OMB Control Numbers 1545-2229, 1210-0147 and 0938-1146) provides information regarding coverage specifications and limitations that apply to the health insurance plan you have selected. Before the end of each year, Arkansas Blue Cross and Blue Shield provides members who are under age 65 and have individual/ family health insurance policies* with an SBC. This official communication includes information about the coverage provided by your health insurance plan in a summary format for the upcoming year. Beginning November 15, 2013, you may access this information: • Online in the “Benefits” section of the Arkansas Blue Cross secure member self-service center, My Blueprint, at arkansasbluecross.com • By calling Arkansas Blue Cross Customer Service at 1-800-238-8379 to receive a printed version After that date, you also may log on to arkansasbluecross.com/sbc and enter your member number (found on your member ID card) into the SBC locator tool to review the document online and print it. If you make changes to your Arkansas Blue Cross health plan benefits that differ from your current coverage, a new SBC will be created for you within seven work days of our receipt of your change request. It will be available to you in the same manner described above. *These are members who do not have health insurance through an employer, a Medicare health plan, or Short-Term Blue product. Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas members who receive health coverage through an employer group will get their SBC from their employer group plan administrator at the appropriate time.
Women’s Health and Cancer Rights Act The Women’s Health and Cancer Rights Act of 1998 introduced changes in insurance coverage for mastectomy. In accordance with the law, all group and individual health plans that provide medical and surgical benefits for mastectomy will cover reconstructive breast surgery, including: • Reconstructive surgery on the breast on which the mastectomy was performed. • Reconstructive surgery on the unaffected breast needed to “produce a symmetrical appearance.” • Prostheses and treatment of complications of any stage of a mastectomy, including lymphedema (post-surgical fluid buildup). These provisions apply to all policies issued by Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas and are subject to the applicable copayments, coinsurance, benefit limitations, exclusions and benefit maximums. If you have questions about your insurance coverage, contact your group benefits administrator or a customer service representitive at your local Arkansas Blue Cross office.
CUSTOMER SERVICE NUMBERS 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 1-800-863-5567 BlueAdvantage members 378-3600 1-888-872-2531 • Pharmacy questions 1-888-293-3748 Federal Employee members 378-2531 1-800-482-6655
Prefer to speak with someone close to home? Call or visit one of our offices near you: • ArkansasBlue
— Little Rock 2612 S. Shackleford Rd., Suite J 1-501-378-2222
• Fayetteville
516 East Millsap Rd., Suite 103
• Fort
Smith 3501 Old Greenwood Rd., Suite 5 1-866-254-9117
• Hot
Springs 100 Greenwood Ave., Suite C
• Jonesboro
707 East Matthews Ave.
• Little
Rock 601 Gaines Street
Looking for health or dental insurance? We can help!
• ArkansasBlue
For individuals, families For employer groups*
• Texarkana
378-2937 1-800-392-2583 378-3070 1-800-421-1112
*Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas
1-800-817-7726
— Pine Bluff 509 Mallard Loop Drive 1710 Arkansas Boulevard
1-800-588-5733 1-800-299-4124 1-800-421-1112 1-800-236-0369 1-800-470-9621
Visit our websites for more information:
arkansasbluecross.com • healthadvantage-hmo.com • blueadvantagearkansas.com • blueandyoufoundationarkansas.org
AUTUMN 2013 BLUE & YOU
27
AUTUMN 2013 A publication for the policyholders of the Arkansas Blue Cross and Blue Shield family of companies
Health Care Law
the HEALTH CARE LAW timeline OCT.1 2013 DEC.15 2013 JAN.1 2014
Online Marketplace opens
updates for everyone PAGES 4-10
Final day to buy health insurance for a January 1, 2014, effective date
New health insurance plans begin
MAR.31 2014 Last day to sign up for health insurance
Questions about the health care law? Email us! HCRinfo@arkbluecross.com
page
Call us! 1-800-310-3778 Come by! Find a location on page 27 Go online! arkansasbluecross.com MPI 1738 9/13
12
7 things to know about the health care law and our Medicare plans
Meet our UAMS Primary Care Scholarship recipients
New and upcoming generics
page
page
page
10
16
21