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I get the honor of talking to some of the most amazing, strong and resilient people. Yvonne Morrow BSN, RN, CCP, care manager at Network Health
Inside Page 5 The Importance of Your Annual Wellness Visit Page 12 Is It Safe to Go to Your Doctor? Page 16 Coping with Stress and the Coronavirus
P U B L I C A T I O N
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L I F E , H E A LT H & W E L L N E S S
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Letter from the President and CEO
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Submitting a Claim for Reimbursement
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Access to Personal Health Management Services
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What Is an Annual Wellness Visit?
EDITORIAL STAFF President Coreen and CEO Dicus-Johnson Chief Administrative Officer Penny Ransom
The Importance of Completing a Health Risk Assessment
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Staying Active While Working from Home
COVER STORY
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12
Is It Safe to Go to Your Doctor?
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Using Your Member Portal
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Telehealth Services and MDLIVE®—What Are They?
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Visual Design Lead Debra Sutton
EDITORIAL BOARD
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The People Behind the Care Yvonne Morrow
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Strategic Marketing and Communications Coordinator Jon Race
What Does Fraud, Waste and Abuse (FWA) Mean in Health Care? Coping with Stress and the Coronavirus
18 17
Exchange of Information
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Notice of Privacy Practices
17
Member Rights and Responsibilities
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Taking Medications As Prescribed
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Health Care Decisions and Advance Care Planning – Why It Matters to Have It Now
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What Happens When Your Child Goes to College?
Balance is published by Network Health. The health information contained in Balance is meant to supplement, not replace, the advice of health care professionals. © 2020 Network Health. No portion of this newsletter may be reproduced without written permission from Network Health.
TELL US YOUR STORY If you have questions or suggestions or would like to tell us how Network Health improved your life, send us an email at marketing@networkhealth.com.
You can also write to us at: Network Health Attention: Jon Race 1570 Midway Pl. Menasha, WI 54952
HAVE A QUESTION?
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How to Stay Hydrated
Call our member experience team.
23
Stay Strong: Tips for Healthy Bones and Muscles
HOURS Monday, Wednesday–Friday: 8 a.m. to 5 p.m. Tuesday: 8 a.m. to 4 p.m.
BACK COVER
Know Someone Turning 65? Network Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. If you, or someone you’re helping, has questions about Network Health, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 800-826-0940. Spanish: Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Network Health, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 800-826-0940. Hmong: Yog koj, los yog tej tus neeg uas koj pab ntawd, muaj lus nug txog Network Health, koj muaj cai kom lawv muab cov ntshiab lus qhia uas tau muab sau ua koj hom lus pub dawb rau koj. Yog koj xav nrog ib tug neeg txhais lus tham, hu rau 800-826-0940. 2776-01-0720 2 | balance • S u m m e r 2 0 2 0
Melanie Draheim, Angela Keenan, Mallory Mueller, Alice Parks, Stacy Schwandner, Romi Norton, Kimberly Swanson, Theodore Regalia, Kacey Werner, Hannah Neylon
PLANS THROUGH AN EMPLOYER 800-826-0940 PLANS FOR INDIVIDUALS AND FAMILIES 855-275-1400 STATE OF WISCONSIN EMPLOYEES/MEMBERS 844-625-2208 Monday, Wednesday–Friday: 8 a.m. to 5 p.m. Tuesday: 8 a.m. to 4 p.m.
WANT MORE HEALTH TIPS? Check out our blog at networkhealth.com/grow-in-the-know.
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Letter from the President and CEO The coronavirus health crisis continues to impact the way we are living our lives. Even as we continue to adjust to our current circumstances, there is no denying that each of us has been impacted, sometimes in challenging ways. Please know you can count on Network Health. Our teams have been working hard from remote locations, just as if we were in the office. People like Yvonne Morrow, who you will read about in the following pages, and our care management team are working to ensure you continue receiving the exceptional service you deserve. That is the Network Health Hometown Advantage™. Our Hometown Advantage is not just a slogan or catchphrase. It is truly the way we operate. Our employees are from our members’–your–hometowns. We know we are serving our neighbors, friends and family so we make sure to get things right, the first time. Our mission is to create healthy and strong Wisconsin communities. We focus on making our hometown communities a better place to live by doing things like volunteering, sponsoring events, handing out care packages to hospital workers and donating to local charities. As we do our part to take care of those around us, our highest priority is your health and safety. This issue of Balance provides you with resources to help guide your health care decisions and awareness. Inside you will find a variety of information, tips and valuable articles that I hope you will find informative. Thank you for being a Network Health member and for providing us the opportunity to share our Hometown Advantage with you. Wishing you a fun, safe and, most importantly, healthy summer. Sincerely,
Coreen Dicus-Johnson President and Chief Executive Officer
Submitting a Claim for Reimbursement
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ost providers will send a claim for medical services directly to Network Health on your behalf. If the provider will not bill Network Health, then you may need to pay the provider directly and obtain a completed claim form and proof of your payment. You can then submit this documentation to Network Health for reimbursement. To receive reimbursement, the service must be covered under you plan and the reimbursement amount would be less any deductible or cost sharing for the service. The address for submitting a medical claim is on the back of your Network Health ID card. HMO plans underwritten by Network Health Plan. POS plans underwritten by Network Health Insurance Corporation or Network Health Insurance Corporation and Network Health Plan. Self-insured plans administered by Network Health Administrative Services, LLC. Copyright © 2020 MDLIVE Inc. All Rights Reserved. MDLIVE may not be available in certain states and is subject to state regulations. MDLIVE does not replace the primary care physician, is not an insurance product and may not be able to substitute for traditional in person care in every case or for every condition. MDLIVE does not prescribe DEA controlled substances and may not prescribe non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE does not guarantee patients will receive a prescription. Healthcare professionals using the platform have the right to deny care if based on professional judgment a case is inappropriate for telehealth or for misuse of services. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission. For complete terms of use visit https://www.MDLIVE.com/terms-of-use/.
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Access to Personal Health Management Services By: Alice Parks, director of population health at Network Health
D
id you know Network Health offers personal wellness, care management and condition management services at no cost to you? Whether you or your child are dealing with an unexpected medical issue, a complex diagnosis, a chronic disease or just need a little help maintaining your health, we can help you manage your health to improve your sense of well-being and put you in control. Our wellness programs focus on quitting smoking and other tobacco products, eating healthier, controlling blood pressure and learning about easy ways to exercise. Our condition management programs help people with asthma, diabetes, heart disease, heart failure and chronic obstructive pulmonary disease. Our care management programs focus on assisting people with complex medical and behavioral health needs, including cancer, end stage renal disease and other life-threatening conditions. We’ll also assist you when you are discharged from a hospital stay to home, so you have a plan in place for a successful transition. Health management begins with a one-on-one conversation between you and one of our health coaches, condition managers or care managers. If you choose to participate, our team will work with you to help you manage your health conditions and meet your health goals. After learning more about you and your health concerns, your coach or manager can do the following.
• • •
Answer any questions you may have
•
Work with your health care providers to ensure they are aware of changes in your health
• • • •
Review your medications and treatment plans Inform you about the signs that your health condition is worsening and when to act, including when you should contact your health care provider
Ensure you and/or caregivers feel included in your health care decisions Help you set health care goals to maintain or improve your health Help you coordinate care with providers and community services Provide you with educational resources, specific to your diagnosis
If you feel you could benefit from wellness, condition or care management support, or would like to know about our programs, call 800-236-0208 (TTY 800-947-3529) Monday–Friday, 8 a.m. to 5 p.m. We may also see that you might benefit from our services based on claim information. In that case, we may reach out to you and offer services. You may opt out of health management at any time by calling the member experience number on your ID card.
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What Is an Annual Wellness Visit? A
n annual wellness visit is an appointment with your personal doctor to discuss your health history and receive a physical examination, preventive screenings and immunizations. Because some conditions don’t show early symptoms, staying up-to-date on preventive screenings is one of the most important things you can do for your health, now more than ever before. Your annual wellness visit performed by your doctor helps with the early detection of conditions that put your health at risk. During this appointment, your personal doctor provides a general review of your health and well-being and offers suggestions and information to help you live your healthiest life. By understanding your risk factors, in the event of an illness, you can seek early treatment which will ultimately save you money on your medical costs. In fact, by improving your health based on doctor’s suggestions, you may be able to avoid illness all together.
Network Health cares about your health and well-being, so your annual wellness visit is considered a preventive service and is covered by your Network Health plan when performed by an in-network provider.
The Importance of Completing a Health Risk Assessment
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health risk assessment (HRA) asks questions about your health and lifestyle habits. The answers you provide are used to create a personal health assessment summary and lifestyle improvement plan. This report can identify your health risks early and allows Network Health, yourself and/or your personal doctor to develop a customized care plan, lessen risks of health conditions and to adopt healthier habits so you can be your best self. Many people are unaware of their current health status, and, as a result, go years without paying attention to behaviors that can be modified to maintain or improve present health status. An HRA will give you a snapshot of your current health status to identify potential risks that could lead to a more serious and costly health condition. Start your HRA now by logging in to your Network Health account at login.networkhealth.com. Use the results from your health risk assessment and work with your doctor to determine what changes you can make to live your best life now.
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Staying Active While Working from Home
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here are a lot of benefits to working from home. There can also be some pitfalls. Whether you are working from home by choice or because of coronavirus-related reasons, staying active is essential for your physical and mental well-being. Here are some tips for staying active while working from home.
Put exercise on your schedule
It’s easy to push exercise to the bottom of your list and view it as something you can do later. Especially when you are busy. To make sure you have time to be active, schedule time for exercise just like you would for any meeting or to-do list item. Incorporate exercise into your schedule and treat it as a regular part of your day. Better yet, view it as a meeting you can’t miss with a very important person—you. 6 | balance • S u m m e r 2 0 2 0
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Go outside
Fresh air is good for you. It can make you feel happier, helps clear your mind and provides a change of scenery from your home office. Most importantly, it is easier to be active when you are outdoors. Here are some ways to get out of the house.
• • • •
Take the dog for a walk Walk with your kids to the park Check out local hiking trails Pick up a hobby that will make you go outside and move around, like running or photography
• •
Go for a bike ride Play a backyard game with a family member (cornhole, ladder ball, bocce ball, washer toss, etc.)
Get active inside, too
Weather is not always cooperative, maybe you don’t live near a park or hiking trails or maybe you are just thinking about what to do when winter comes. Well, you can still be active even if you can’t get outside. Setting up a mini home gym can be rather inexpensive. All you need are some dumbbells, a yoga mat, maybe an exercise ball and some sort of guide (apps, online video tutorials, books, etc.). You can find just about any type of workout with various intensity levels.
Here are some exercises you can do inside that require minimal to no equipment.
• • • • Incorporate movement into your daily life
Yoga Squats Jumping jacks Push ups
“
• • • •
Pilates Planks Burpees Jumping rope
Spending eight hours a day sitting at a desk isn’t good for your health. In fact, it has been linked to an increased risk of cancer, type 2 diabetes and heart disease. It’s relatively easy to find ways to limit your time sitting.
• • • • • •
Invest in a standing desk. They keep you from slouching and hunching over, which improves your overall posture. Take regular breaks. Treat them the same way you do exercise–put them on your schedule. Use a fitness tracker and be mindful of your steps. Set alarms on your phone to serve as reminders to take a break. Walk around during meetings. Take calls standing up.
Yvonne, RN
Nurse Care Manager at Network Health Whatever you do and however you do it, the important part is to get active and do something.
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Yvonne Morrow BSN, RN, CCP, care manager at Network Health 8 | balance • S u m m e r 2 0 2 0
The People Behind the Care O
Yvonne Morrow
ne of the factors setting Network Health apart from other insurance providers is our care management program. That we have a care management team is nothing out of the ordinary. The people who make up that team? Well, that’s a different story all together.
Currently, the Network Health Care Management team is made up of 15 people, with varying backgrounds and experience. All of them are, or have been at some point, a nurse or social worker. Hospice, ICU, neonatal, oncology, surgical, pediatric, you name it, and someone on the team has the experience. The team’s background also includes case managers, social workers, teachers and more. This collective experience, combined with our Hometown Advantage™, allows Network Health to provide support in ways above and beyond your health insurance coverage. The care management team is a close-knit group that truly enjoys working with and helping people. The team features people like Yvonne Morrow. A nurse at St. Elizabeth’s in Appleton for over a decade, Yvonne became a care manager at Network Health in 2008. And she hasn’t looked back since.
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We have an unbelievable team of experienced nurses and social workers who really care. They have such a wealth of experience and they work so hard. They are always doing their absolute best, and then some.
As a care manager, Yvonne’s area of expertise is oncology. The members she works with range from young children (through their parents) to the elderly. The link between them all is that they are dealing with some form of cancer. “Our oncology population is very complex,” Yvonne said. “And it can be challenging. But, I love my patients, my people. I get the honor of talking to some of the most amazing, strong and resilient people. I love my job.”
What do care managers do?
Network Health care managers provide a variety of services for members who are going through, or recovering from, medical issues. Put simply, they help coordinate members’ care. “We meet members at the point of whatever crisis they are undergoing, and we help,” said Yvonne. “A lot of times there are things members can’t do or don’t know about. So, we try to provide the resources they need to make sure they get the best care, and the right care. We deal with so many aspects of a person. The physical, the emotional, the psycho-social, the financial. Everything.” A care manager has a variety of responsibilities when it comes to patient care. Their duties can include assessing a member’s health status; creating a care plan and monitoring progress; collaborating with providers and community resources; educating members on self-care; and providing coaching and support. It may sound like a lot, but the Network Health team is more than up to it.
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Yvonne said.
“
“I’m still a nurse,” Yvonne said. “I did float nursing for ten years. Then I moved to hospice for a couple more. I loved it. Absolutely loved it. But, I needed to get something with more regular hours. A friend told me I should apply at Network Health, so I did. I’ve been here for 12 years now.”
The challenges and rewards
As much as Yvonne loves her job and the Network Health members she works with, it doesn’t come without challenges. “When I lose people, that’s hard. Even when you know you’ve been able to make their quality of life as good as possible, that you’ve done all you can. You’ve helped them. It’s hard. Working with the kids sometimes really, really gets to me, too. But I think, at least they have someone to talk to. I think I can help them get through this and to be successful with their goals. Then I have to get outside and listen to music or go running. Get away a bit and reset.” Not all challenges are related specifically to patients’ health. Dealing with the fact that some services aren’t covered by insurance can also be difficult for Yvonne. “Some things just aren’t covered. And that’s tough to deal with. But what I can do, is bring those concerns to Network Health and ask, ‘Is there something we can do?’ I can look at what my patients are going through and maybe there’s a trend or something that could lead to a change.” It was that mentality that allowed Yvonne to create change regarding the appeals process. The results of which have led to a more efficient process, less back and forth and, most importantly, less stress for members. “That’s the nice thing about care managers. We’re boots on the ground and we are directly interacting with our members and providers. We can see what’s going on.” Another challenge this year has been the coronavirus. Members who may already feel isolated and at risk are even more so because of the virus. “They have to be more diligent about not getting exposed,” Yvonne said. With a lot of interactions being done via phone and online, ensuring all the information gets to all the people it needs
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to can be a challenge. “A lot of my older patients don’t use smart phones,” said Yvonne. “So, it’s a matter of working with providers and families to make sure everyone understands everything.” However, according to Yvonne, being able to make a difference is the reward that makes it all worthwhile. “When someone says to you, ‘I would have never, ever made it without you.’ I mean, how can you do any better than that? The impact you can have on someone’s life and not really understand or know it. And then they just call you up and tell you. It validates what you do.” And, there is nothing better than hearing good news from a member. “When they call me and say, ‘Oh my God, I have no cancer!’ I get chills and it’s just so cool because it’s such an intimate thing.”
Getting involved
There are many ways for Network Health members to get involved with the care management team. Medical events such as scan approvals, certain diagnoses, inpatient stays and specific treatments can all be flagged as situations where someone could potentially benefit from care management services. “After a member has been in the hospital, our transition of care team will reach out to him or her and determine if additional care management needs are necessary,” Yvonne explains. “Some things just stand out–do they live alone? Is their treatment going to be particularly difficult? Certain diagnoses are automatic. Reports of
high ER utilization. They’re all signs that additional assistance may be needed.” She continues, “I have providers who will call me to make sure someone is on my radar. And sometimes people just go to our website and ask for a care manager.”
The Hometown Advantage™
Network Health is a different kind of insurance company. Serving the people, towns and communities of Wisconsin for more than 37 years has given us a different perspective than most insurance companies. We care about our members because they are us. They are our friends, our family and our neighbors. Care managers like Yvonne Morrow are well aware of this fact. And that is why she, and her care management teammates, are so good at what they do. “What I am most proud of,” Yvonne said, “is that if I ever needed a care manager, without a doubt, I would be in the best hands at Network Health. And that’s an awesome feeling. Knowing you can trust your team to have your back, and that they all strive for excellence–it’s amazing. I love the fact that we’re not like any other insurance company. I can’t tell you the number of times I’ve had people tell me, ‘I can’t believe you guys are calling me. I can’t believe you care.’ It is so cool that we stand apart like that.” “Network Health is different. That’s what I tell my people.”
Supporting Cast Snapshot Yvonne Morrow is just one of the many care managers who help our members daily. Here are a few more people behind the scenes.
Julie
Kristen
Jodie
Sheila
Nurse care manager, 11/2 years at Network Health I’ve been a nurse for five years. Prior to that, I was a teacher for 13 years. When my husband passed away from cancer, I resigned as a teacher and went back to school for nursing. We had so many outstanding nurses who helped with his care, I felt strongly that I needed to give back. RN oncology care manager, 7 years at Network Health I’ve been a nurse for 24 years, many of which I worked in home care. The last five of those years I was a hospice nurse. I love helping our members through challenging times, providing a listening ear when needed. There’s nothing better than knowing you put a smile on someone’s face or hearing the joy in a member’s voice when they tell me their cancer is in remission.
Laurie
RN care manager, 8 years at Network Health I was a nurse for seven years prior to coming to Network Health. I had experience in medical/surgical, urology, internal medicine and doing patient education on chronic conditions such as diabetes, hypertension and asthma. I love working at Network Health because our whole team strives to do their best for our members.
n e t w o r k h e a l t h . c o m
Social work care manager, 1 year at Network Health I’ve been a social worker for 21 years. I earned a master’s in social work and all my work experience has been in some form of case/care management. I enjoy the caring culture at Network Health and I really enjoy helping people meet their goals and getting them connected with resources. RN care manager, 5 years at Network Health I’ve been working in the medical field for the past 20 years in various roles. I’ve done long term care, acute rehab, inpatient hospital-medical/oncology, post anesthesia care and pediatrics. I was also a hospice RN for five years. The best thing about Network Health is knowing our members receive the same care my family does.
Tracy
RN care manager, 7 years at Network Health I worked in acute hospital care for over 17 years. My coworkers make Network Health a great place to work. One of the things I like about my job is I’m able to talk to our members without any time pressures or interruptions. When we are working with a member, we’re allowed to give them the attention they need and deserve.
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Is It Safe to Go to Your Doctor?
Doctor offices are reopening, and hospitals are resuming nonurgent and emergency procedures. Which prompts the question … is it safe to go back?
H
ospitals have designated care units to treat coronavirus patients. Doctors and nurses who are treating these patients do not also treat non-coronavirus patients, and in most cases, dedicated entrances exist for the designated coronavirus unit. Doctor offices are limiting the number of people allowed in the office by spreading out appointments and/or having patients wait in their cars until it is time to see the doctor. Waiting room seats are more spread out and community items such as magazines have been removed. If you plan to visit your doctor’s office or have a scheduled hospital procedure, here are some things to think about. Even though doctor offices and hospitals have reopened, there is still a chance of contracting coronavirus in those facilities, so be sure to use caution.
• • • •
Practice social distancing Wear a face mask Make sure you wash your hands before and after your visit Use hand sanitizer during your visit, especially after interacting with high-contact areas such as door handles and elevator buttons • Refrain from touching your eyes, mouth and nose
Call first.
Make sure your doctor’s office is, in fact, seeing patients now. Also, ask what types of precautions they want patients to take when visiting, as different clinics may have different procedures.
Consider a virtual visit.
Can your health issue be addressed using telehealth services from your doctor or MDLIVE®? Whether an initial visit or a follow-up appointment, telehealth services may be used to avoid in-person visits to the doctor.
Weigh the risk.
Does the risk of contracting the virus outweigh the risk of other health issues worsening without treatment?
If having surgery, be prepared to go alone.
Visitors are still not allowed in most pre- and post-surgery areas. Also, plan in advance how you will connect with friends and family afterward.
Be prepared for doctors and nurses to interact a bit differently.
Handshakes and other physical contact will be limited, if not non-existent. Doctors and nurses will be wearing masks and conversation may be kept to a minimum to limit the time you are in the office.
Ultimately, if you have a condition that requires you to see a doctor, it’s important to go. Doctors and nurses are doing everything they can to reduce risk and keep you safe. You must do the same. Talk to your personal doctor about your medical concerns, and together you can decide whether an in-person visit is a good idea or whether you may be a good candidate for a video or telephone visit.
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Using Your Member Portal O
ur goal at Network Health is to make it easy for you to manage your health insurance. We know health insurance can be overwhelming, and we work hard to ensure you understand and are comfortable with your insurance plan. The member portal is your personalized online account where you can find information specific to your health insurance plan. It is a secure, password-protected account providing plan information at your fingertips.
• Benefits and coverage overview • Out-of-pocket expenses tracker • Claims detail and status • Your mobile ID card • View your Explanation of Benefits online and elect to • • • • •
not receive paper copies in the mail Find a Doctor search and ability to select your personal doctor Secure messaging with our local member experience team Updates from Network Health FAQs And more
The member portal also provides seamless connections to other valuable resources.
• Wellness programs and tools • Pharmacy benefits and claims • •
information Virtual doctor visits Your health risk assessment
The portal is also mobile responsive and viewable on any device at any time. That means you have access to your important insurance information wherever you go–the pharmacy, doctor’s office or even on vacation. Just visit login.networkhealth.com.
If you haven’t already registered, visit login.networkhealth.com. It’s quick and simple.
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Telehealth Services and MDLIVE — What Are They? I ®
n the past few months, the use of telehealth services has skyrocketed. Originally developed to help people save time and money, these services can now serve as an alternative to in-person doctor visits, which is great for people who have coronavirus concerns.
What are telehealth services?
Also referred to as virtual visits, telehealth services are a great way to save time and money when you experience non-emergency symptoms. By using your phone, smartphone, tablet or computer, you can connect for treatment of a wide range of conditions. You can also get prescriptions filled, if needed. Essentially, telehealth services are designed as an alternative to urgent care visits or personal doctor visits for non-emergency medical conditions.
Why and when would you use telehealth services? The two main reasons for using telehealth services are below.
1. You have a non-emergency question or illness and your personal doctor is unavailable.
2. You need to see a doctor but have concerns about coronavirus and an in-person visit.
What do telehealth services cost?
To give our members access to the care they need, through December 31, 2020, Network Health will cover all coronavirus telehealth services for a $0 copayment. In addition, telehealth services performed by primary care, behavioral health and OBGYN providers are covered at a $0 cost to you. Other visits are subject to your plan’s deductible, copayment and/or coinsurance. Telehealth services from out-of-network providers for Health Maintenance Organization (HMO) members will not be covered.
What is MDLIVE?
Network Health partners with MDLIVE to provide telehealth services to our members. Available 24 hours a day, seven days a week, MDLIVE allows members to connect with a board-certified physician or pediatrician for treatment of a wide range of conditions. MDLIVE providers can help you with more than 50 non-emergency medical, behavioral health and dermatological issues, from colds, anxiety and sinus infections, to acne, psoriasis and more. As many clinics now offer telehealth visits, you should always check with your personal doctor first before using MDLIVE. However, if you’re personal doctor is not available, online doctor visits through MDLIVE are a convenient and affordable alternative.
How can I sign up for MDLIVE? Set up your Network Health MDLIVE account in one of four ways. Register for MDLIVE today, so your account is ready when you need it.
Log in to your member portal at login.networkhealth.com and click Virtual Visits to create your username and password. Once you’ve set up your MDLIVE account, you’ll be able to seamlessly access it from your member portal.*
Text NETWORK to 635483 to be walked through step-bystep registration on your phone.
Download the MDLIVE app on your smartphone or tablet. Open the application and follow the instructions to create an account.
Call 877-958-5455 and an MDLIVE customer service representative will set up an account with you on the line.
*Members of the State of Wisconsin Group Health Insurance Program will skip this step and can register at MDLIVE.com/nhcommercial
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Are other provider telehealth services covered for a $0 copayment?
Yes, all coronavirus and primary care telehealth services are covered for a $0 copayment. This applies to all telehealth providers for point-of-service (POS) plans and in-network providers for HMO plans. HMO plans do not cover telehealth services with out-of-network providers. So, if you are experiencing non-emergency symptoms but have coronavirus concerns regarding a visit to a doctor’s office, think about the benefits of telehealth. Call, login or jump on your computer for a virtual visit from the comfort of your own home.
What Does Fraud, Waste and Abuse (FWA) Mean in Health Care? By: Juan Gonzalez, auditor special investigations at Network Health and Nichole Stebane, auditor payment integrity at Network Health
Fraud is knowingly and willfully executing, or attempting to execute, a scheme to defraud any health care benefit program or to obtain (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program. Waste is the over-utilization of services, or other practices that result, directly or indirectly, in unnecessary costs. Waste is generally not considered to be caused by criminally negligent actions, but rather the misuse of resources. Abuse includes actions that may, directly or indirectly, result in unnecessary costs, improper payment or payment for services that fail to meet professionally recognized standards of care or services that are medically unnecessary. Understanding the meaning of FWA can help you identify when it may occur in health care. Examples of FWA include the following. • Billing for an office visit that did not happen • Mailing diabetic supplies to members that were not ordered • Providing excessive or unwarranted services • Prescribing oxycodone when not medically necessary or in excessive amounts • Seeing several physicians to get multiple prescriptions to sell illegally • A prescriber falsifying information not consistent with a person’s medical history to prescribe a drug These are just a few examples of ways that FWA may occur in health care. It’s important to be aware of FWA. Each year, billions of dollars are improperly spent because of FWA. When such inappropriate and unethical behavior occurs, it drives up the costs of health care, wastes tax payer money and puts a larger burden on the health care system in general. Combatting FWA is everyone’s responsibility. If, by chance, you think FWA has occurred, report it to Network Health by calling the number on the back of your member ID card or anonymously by calling the Values Line at 800-707-2198.
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life. health. wellness.
By: Katie Meiers RN, BSN, BA - supervisor of care management at Network Health
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he coronavirus outbreak has been stressful for many people. Fear and anxiety about the pandemic can be overwhelming for some, often causing strong emotions in both adults and children. It is important to realize these feelings are not out of the ordinary. According to the Centers for Disease Control and Prevention (CDC), signs and symptoms of stress during a disease outbreak can include the following. • Fear and worry about your own health and the health of your loved ones Changes in sleep or eating patterns • Diffi culty sleeping or concentrating • Worsening of chronic health problems • Worsening of mental health conditions • Increased use of alcohol, tobacco or other drugs •
Everyone reacts differently
How you respond to the coronavirus pandemic greatly depends on your background, personality, the community you live in, your mental make-up and more. In other words, how you react is directly related to everything that makes you, you. According to the CDC, people who may respond more strongly to the stress of a crisis include the following. • Older people and people with chronic diseases who are at higher risk for severe illness from the coronavirus • Children and teens • People who are helping with the response to the coronavirus, like doctors, other health care providers and first responders • People who have mental health conditions, including problems with substance use
Ways to cope with stress The CDC recommends several ways to handle and cope with stress. • Take breaks from watching, reading or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting. Take care of your body. • Take deep breaths, stretch or meditate • Try to eat healthy, well-balanced meals • Exercise regularly • Get plenty of sleep •
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• Avoid alcohol and drugs • Make time to unwind. Try to do some activities you enjoy. • Connect with others. Talk with people you trust about your concerns and how you are feeling.
Take care of your mental health
It is normal to feel stress, worry and anxiety during a crisis such as a pandemic. Being aware of and taking care of your emotional health can help you think clearer and react better to the events going on around you. And, that’s a good thing for you and your family.
• Take care of your mind. • Garden • Keep your mind active • Revisit a hobby - like knitting, puzzles or painting • Practice mindfulness Support your friends and family
It is a good idea to check in with friends and family on a regular basis. Face-to-face communication may not be possible, but virtual communication can help you and your loved ones feel less lonely and isolated. You can stay in touch the following ways. • Telephone – Share your experiences. • Email – Share photos or what you’re up to. • Snail mail – Write a letter, send a card or a care package. • Text – Set up group chats with friends, family and neighbors • Video chat – There are numerous free apps and software available to use for one-on-one or group chatting. Join or create a virtual book or movie club. • Social media – Use Facebook, Snapchat or Instagram to share your feelings, stories, jokes or memories with family and friends. • Live streams – Schedule time to watch live streams of faith services or art performances together. • Visit – Visit outside from a safe distance wearing masks. Remember, everyone is different. Every one of your friends and family members–including you–are handling the coronavirus pandemic a little differently. Some are handling it better than others. If you can, reach out and help those in need. If you are struggling, reach out and ask for help. Take comfort in the support of others.
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Exchange of Information E
ffective coordination of care depends upon clear and timely communication among the providers and facilities caring for you. This communication allows better decision-making regarding treatments and decreases the potential for unwanted medication interactions since many medical conditions can be related to another condition or can result from the treatment of another condition.
When your personal doctor refers you to a specialist, information is often shared as allowed by privacy laws. However, if you choose to seek services outside your personal doctor’s organization or from community organizations, your personal doctor may not be aware of all services, tests or treatments you have received. Whenever you receive a service outside of your personal doctor’s office, ask whether that information is being sent to your doctor. You can also ask for a copy of the information, so you can send it yourself if you choose. When you see your personal doctor, discuss all visits and treatments you have had with other providers since your last office visit. It is important to keep your personal doctor informed so he or she can see the complete picture of your health care and be alert for possible new or adverse reactions. Ensuring the exchange of information also helps avoid unnecessarily repeating tests, leads to improved outcomes and increases patient safety. Think of your personal doctor as your copilot, helping you navigate the way to a healthier you.
Notice of Privacy Practices
T
here are numerous laws and regulations governing how your medical information may be used and disclosed. The same is also true for how you can access this information. Network Health works hard to protect the privacy of your confidential health information. This includes all oral, written and electronic protected health information across our organization. To that end, Network Health embraces a Notice of Privacy Practices which is followed by all employees of our workforce, regardless of geographical location. This notice describes how medical and financial information about you may be used and disclosed and how you can get access to or limit sharing of this information. Our Notice of Privacy Practices can be found online at networkhealth.com/legal/notice-of-privacy-practicescommercial. We strongly encourage you to review it. If you have any questions regarding this notice or our commitment to privacy, please contact our member experience team.
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Member Rights and Responsibilities
A
s a Network Health member, you have certain rights and responsibilities. To learn more about how we provide you with service that respects your rights, visit our website at networkhealth.com//legal/member-rights-and-responsibilities. If you get coverage through your employer, you can also call the member experience team at 800-826-0940 (TTY 800-947-3529) Monday, Wednesday – Friday, from 8 a.m. to 5 p.m. and Tuesday from 8 a.m. to 4 p.m. to request a hard copy. If you buy insurance on your own, you can call the member experience team at 855-275-1400 (TTY 800-947-3529) Monday, Wednesday – Friday, from 8 a.m. to 5 p.m. and Tuesday from 8 a.m. to 4 p.m. to request a hard copy.
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Taking Medications As Prescribed By: Anna Peterson Sanders, pharmacist at Network Health
W
hat words come to mind when you think of a healthy lifestyle? Fruits and vegetables, exercise, weight management, adequate sleep, handling stress or not smoking? All those choices are great to incorporate into our daily lives, but medication adherence is an important piece of the puzzle that’s often missed when creating and sustaining a healthy lifestyle. Lack of medication adherence—which is taking your medications as prescribed by your doctor—leads to an estimated 125,000 American deaths per year and costs the health care system almost $300 billion annually due to extra doctor visits, emergency room visits and hospitalizations. Medications can be helpful to cure conditions, manage chronic disease states and prevent complications. Take statins as an example. These important medications, when taken by people with diabetes or high cholesterol, help prevent complications such as heart attacks and stroke. Living your best life should include following your medication regimen. Here are some suggestions for making it an easy habit.
Tips for remembering to get your medications • Ask your doctor or pharmacist about receiving a 90-day supply instead of a 30-day supply of medications. See if your pharmacy has automated text or call refill reminders. Ask your pharmacy about syncing up your medication refills so you can pick them up at the same time.
• •
Tips for remembering to take your medications • Use a pill box to organize your medications and keep it in a convenient spot, such as your kitchen or bathroom. • Download an app for your smartphone that reminds you to take your medications throughout the day. • Some pharmacies offer monthly bubble packing of medications for a small charge, providing a convenient
way to organize and keep track of your medications. • If you use a daily controller inhaler, putting it next to your bed can be a good reminder to take it first thing in the morning and last thing at night (if you take it twice daily).
Changing site of care • Coronavirus has changed a lot of practices, and many people don’t feel comfortable going to a provider’s
office to receive injections or infusions. • A nurse can provide one-on-one infusion care in the convenience of your own home, limiting your interaction with other people and environments. If you are interested, ask your provider about setting up home infusion services. Ask your doctor or pharmacist if you can do your own injection at home. Certain subcutaneous medications, • like Cimzia®, Dupixent®, Fasenra®, Nucala® and Orencia®, can be obtained through the pharmacy benefit and self-administered at home.
Addressing financial concerns • If cost is a barrier to obtaining your medications, speak with a local Network Health pharmacist about your
concerns by calling 888-665-1246. • Websites like GoodRx.com allow you to see prices at different pharmacies and may offer coupons to reduce the cost further. • Patient assistance programs may be available through the manufacturer. Visit rxassist.org to find more information about a specific medication. • For additional resources in your community (including food, housing, transportation and mental health), visit navigator.aafp.org.
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life. health. wellness.
Health Care Decisions and Advance Care Planning – Why It Matters to Have It Now By: Alice Parks, director of population health at Network Health
What is advance care planning?
Advance care planning is a way for you to plan and make decisions now, to guide your health care in the future if you are ever unable to speak for yourself or make your own decisions. So, while you may not have heard of advance care planning, it affects each of us.
Why is advance care planning important?
Usually, only you can make important decisions about your health. There are situations where you may not be able to do so, such as an accident or illness that causes confusion or affects your ability to communicate your wishes to your health care team. It’s hard to think about that type of situation, but if it were to happen, who would you want to make health decisions for you? How would that person know what your wishes are? The talk about advance care planning helps prepare your health care providers and the person you choose to make your health care decisions by discussing what is important to you and what you value in life. It allows you to decide the care you want to receive if you become unable to speak for yourself. You can leave instructions that take your values and preferences into account and eliminate uncertainty for your doctors and family members. Advance care planning instructions can give peace of mind to you, your family and those making important decisions on your behalf.
When is the ideal time to have the talk?
You may not need to use an advance care plan for a while, but it’s important to have a plan in place. The best time to talk about it is when you feel well and can clearly state your wishes. Like a retirement plan, things can change, so you might need to revisit it occasionally and have more discussions with your personal doctor and family. Remember, your advance care plan is only used when you are unable to make your own health care decisions. At that point, your appointed decision maker will reference your wishes, values and beliefs before making health care decisions on your behalf.
How is advance care planning different than an advance directive?
The two are related, but an advance directive is different than advance care planning. An advance directive is a legal document that becomes effective if you are incapacitated and unable to speak for yourself. Advance directives include the following. • A living will – This allows you to specify whether or not you would like to receive emergency treatments, such as CPR, artificial nutrition or hydration, use of ventilators or comfort care, that could be offered if you are dying or permanently unconscious. • Durable power of attorney – A durable power of attorney allows you to name a health care proxy—a person who knows your wishes and will make treatment decisions for you if you are unable to do so. • Do not resuscitate (DNR) or do not intubate (DNI) orders. We recommend regularly reviewing and updating legal documents. Make sure to discuss any changes with your personal doctor and family. Want more information? Talk with your personal doctor, a social worker or call a member experience representative at 800-826-0940 (TTY 800-947-3529) and request to speak with a care manager.
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What Happens When Your C child is away at school is a virtual doctor visit using MDLIVE. Set up your child’s account prior to school starting so he or she is prepared for an unexpected illness.
I
t has been a bit of a wild ride this past spring and summer, but that has not slowed down time –the fall college semester is just around the corner. As you prepare for your child to start or go back to school, you may have a few questions regarding health insurance coverage. It’s important to understand the health care options available to you and your child(ren).
You can sign up for MDLIVE in one of four ways.
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Some things to keep in mind as the school year approaches.
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•
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Get a summer physical. Have your child get a summer physical before the school year starts. Time his or her annual wellness visit to coincide with the start of the fall semester so you know your child is healthy and ready to begin the school year. This is also a good time to make sure all vaccinations are up to date. Use the school’s health clinic. Most, if not all, college campuses have on-campus health clinics providing convenient and cost-efficient services to enrolled students. These services can include general medical care; illness and injury care and prevention; immunizations; physical exams; and a variety of procedures. Note that not all college health clinics are the same. You should check with your child’s school to see what services are available. Use MDLIVE®. An option for non-emergency care while your
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If your child is 18 or older, have him or her log in to his or her own member portal at login.networkhealth.com and click Virtual Visits. Once the MDLIVE username and password is set up, it will be easily accessible from the member portal. If your child is under 18, you will set up the account from your own member portal. Text NETWORK to 635483 to be walked through step-by-step registration on your phone. Download the MDLIVE app on your smartphone or tablet. Open the application and follow the instructions to create an account. Call 877-958-5455 and an MDLIVE customer service representative will register you over the phone.
Obtain necessary authorizations.
If your child is 18 or older, his or her health information is protected and confidential. If parents, insurance or university administration would like access to your child’s health information, he or she has to first sign an Authorization to Release Medical Records form. These forms are available from health clinics. Network Health recommends having a discussion with your child about what providing the
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Child Goes to College? authorization means for him/her, as well as you the parent(s). Network Health has Personal Health Information forms available at networkhealth.com, select Employer Plans and Member Resources from the drop-down. Under Forms, you will find the Protected Health Information Form to complete and return to Network Health. This allows you to call and discuss your child’s coverage and plan information if it’s ever needed.
It’s important to remember, if you plan to follow up on behalf of your child, you must be identified as an authorized representative. College is a life-changing time in anyone’s life. There are a lot of new responsibilities, people, schedules, and for many students, it is the first time they are on their own. However, that doesn’t mean they don’t need help from their parents. Especially when it comes to their health. Make sure your child–and you–start the school year prepared.
Make sure you understand your coverage.
If your child is covered under a Point-of-Service (POS) plan, he or she has benefits outside the Network Health service area. If your child is covered under a Health Maintenance Organization (HMO) plan, he or she has coverage for emergency care received in a hospital-based emergency room outside the Network Health service area, until he or she can be safely moved to a Network Health participating facility. A Network Health participating provider must provide any follow-up care or regularly scheduled office visits. If that isn’t possible and your child must visit a doctor or hospital outside our network, the provider must call our utilization management team at 800-236-0208 or 920-720-1600 for prior authorization before the appointment. One of our nurses or doctors will review the request and determine if your child can receive care from an out-of-network provider.
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* Check your plan documents to confirm your coverage includes MDLIVE virtual visits before using.
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life. health. wellness.
How to Stay Hyd Hydrated rated By: Morgan Radlinger, CWP - wellness coordinator at Network Health
W
ater makes up about 60 percent of our bodies. Dehydration occurs when you lose more fluids than you consume. If you don’t replace lost fluids, your body can’t carry out its normal functions. Maintaining fluid levels is especially important during the summer months when you lose more fluids due to heat and sweat.
Signs of DEHYDRATION
THE BIG QUESTION How much water is enough?
The Institute of Medicine’s recommendations suggest that everyone’s needs are different— eight glasses a day isn’t necessarily accurate. Exceptions include anyone with certain medical conditions, athletes and those taking part in prolonged physical activities or whose living conditions are in extreme heat. People often think they are hungry when they really need water.
DRY MOUTH
How do you avoid dehydration?
The best way to avoid dehydration is to drink water. Certain foods, such as fruits and vegetables, also provide water. Remember, alcoholic and caffeinated beverages, such as coffee and soda, will pull water from your body and promote dehydration.
FATIGUE
Use these easy tips to help you stay hydrated. Choose water instead of sugary drinks. Soda, energy drinks, sports drinks and other sweetened drinks contain a lot of calories from added sugars and few nutrients. Adults and children take in about 400 calories per day as beverages—drinking water can help you manage your calories and stay hydrated.
DARK URINE
Always have hydration easily accessible. Whether you’re on a run, a bike ride or sitting at your desk at work, keep healthy beverages close. Don’t forget to grab something before heading outdoors. Consider your wallet. You can save money by drinking water at home or when eating out. If you are craving flavor, try adding fresh fruit, such as lemon, berries, cucumber or mint. This helps make it more exciting while sticking to a budget. Eat foods that hydrate. The Institute of Medicine estimates that 20 percent of our water intake comes from food. As a hydrating alternative to water, try foods that are made of more than 80 percent water like lettuce, broccoli, watermelon, grapefruit, carrots, apples and even yogurt.
THIRST
DIZZINESS
If you drink alcoholic beverages, do so in moderation. That means up to one drink per day for women and up to two drinks per day for men. Remember, alcohol is not calorie free and just like coffee, it’s a diuretic, which means it is not hydrating. Your body will crave water even more after drinking dehydrating beverages.
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networkhealth.com
Stay Strong:
Tips for Healthy Bones and Muscles
By: Morgan Radlinger, CWP - wellness coordinator at Network Health
Everyone knows that exercise builds muscle and helps you stay healthier, but did you know it also makes your bones stronger?
B
ones play multiple roles in the body by providing structure, protecting organs, storing calcium and anchoring the muscles that help you move, breathe and pump blood through your body. Healthy muscles help you move freely and help keep joints in good shape. Bone health is affected by factors such as gender, age, race, family history and hormone levels, but it can also be impacted by certain medications, how much calcium is in your diet and your levels of exercise. The best bone and muscle building exercises are ones that are weightbearing and offer resistance. Weight-bearing exercises include walking, jogging, hiking, climbing stairs, playing tennis and dancing. Resistance exercises include activities like lifting weights, rowing or Pilates.
Young men and women who exercise regularly achieve greater peak bone mass than those who do not.
Exercise can also help you maintain muscle strength, coordination and balance, all of which help to prevent falls and related bone fractures. Among older adults, falls are the leading cause of injury deaths and hospital admissions for trauma. Working to build strong bones and muscles when you are younger can help you lower your risk for osteoporosis and prevent fall-related injuries.
Tips for healthy bones and muscles Pack your lunch. Establish healthy eating habits. Eating a balanced diet will help you manage your weight and provide a variety of nutrients for your muscles and overall health. Include plenty of calcium in your diet. Calcium helps keep your bones healthy and enables your blood to clot, your muscles to contract and your heart to beat. Your bones and teeth store 99 percent of the calcium in your body. Add vitamin D. Most residents in Wisconsin don’t get enough Vitamin D from the sun. Taking a vitamin D supplement will help you meet the daily recommended amounts. Good sources include oily fish, mushrooms, eggs and fortified foods such as milk and cereal.
Practice injury prevention. To help prevent sprains, strains and other muscle injuries, listen to your body and don’t overwork your muscles. Warm up and cool down, wear the proper protective gear and drink a lot of water. Don’t smoke and don’t drink excessively. If you do smoke, consider a program to help you quit. Drink alcohol in moderation and limit consumption to one drink per day. Test your bone mineral density. A bone density test (or DEXA scan) uses an x-ray to estimate how dense or thick your bones are. The scan measures the amount of calcium and minerals in a part of your bone. The more minerals you have, the stronger and denser the bone likely is and, therefore, your bone is less likely to break from a fall.
Include both weight-bearing and resistance exercises in your routine. High impact weight-bearing exercises are best and you can mix your cardio with simple resistance training moves like squats, push-ups and free weights.
Looking for more assistance?
Email our health coaches at healthcoaching@networkhealth.com. networkhealth.com
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PRESORT STD US POSTAGE PAID PERMIT 1033 GREEN BAY, WI
1570 Midway Pl. Menasha, WI 54952
MAILED ON 8/26/20
Know Someone Turning 65?
N
etwork Health offers health insurance options for all stages of your life. Whether you have insurance through your employer or you purchase it through the Health Insurance Exchange (also known as the Marketplace), you can continue receiving high quality medical coverage from Network Health after you turn 65 and become eligible for Medicare.
When am I eligible for Medicare?
3 months before turning 65
There is a seven-month window when you can enroll in Medicare.
your birthday month
3 months after your birthday
You may have a lifetime penalty if you don’t enroll during the initial enrollment period, depending on your current coverage.
What’s the difference between Original Medicare and a Medicare Advantage plan? Original Medicare is federal health insurance for people 65 and older, people with disabilities and/or people with certain conditions. Original Medicare is broken into two parts. Medicare Advantage plans cover everything Original Medicare covers, and more.
Original Medicare Part A Hospital Insurance
You can add
Medicare Advantage Plan
Part B Medical Insurance
A
Medicare Supplement Insurance Policy
Part D Prescription Drug Coverage
C
Part C Combines Part A and Part B
or
May include, or you may be able to add Part D Prescription Drug Coverage (Most Part C plans cover prescription drugs. You may be able to add drug coverage to some plan types if it’s not already included.)
Sometimes, Medicare Supplement plans look like a great deal because of what you’ve been paying for health insurance coverage. When you compare the coverage of a Network Health Medicare Advantage Plan to a Medicare Supplement plan, you’ll be surprised how much you get for the premium. Some Medicare Advantage Plans even offer extra benefits like drug coverage, vision, hearing or dental.
Call the Network Health sales team at 800-983-7587 for answers to your Medicare questions.