Balance Newsletter 2023

It Takes a Village

“That’s when we knew we were going to be okay with Network Health.”

- Jess Vander Zanden Network Health member

3 Taking Advantage of Your Member Portal

4 Diabetes Prevention Through the Prevent T2 Lifestyle Change Program

5 Addressing the Opioid Crisis

6 What’s the Difference Between Emergency Care, Urgent Care and Virtual Visits?

7 Human Papillomavirus (HPV) Vaccine Is Cancer Prevention

7 High Deductible Health Plans (HDHP) vs. Traditional Health Plans

E DITORIAL STAFF

Chief Administrative Penny Ransom Officer

Strategic Marketing Jon Race and Communications Coordinator

Graphic Designer Jami Greshay

EDITORIAL BOARD

Melanie Draheim, Angela Keenan, Mallory Mueller, Carisa Satorius, Romi Norton, Theodore Regalia, Laura Schneider

Balance is published by Network Health. The health information contained in Balance is meant to supplement, not replace, the advice of health care professionals.

11 Required Information for Members

BACK COVER

Do You Have a Child Turning 26?

Approaching 65? We’ve Got a Plan for You.

New Green Bay Packers Partnership

Partnering with the Green Bay Packers supports Network Health’s mission of creating healthy and strong Wisconsin communities. And, as the exclusive sponsor of the Packers’ Operation Fan Mail, we can help honor veterans in our communities who exhibit excellence and performance throughout their lives. We are grateful for our military service members and through this sponsorship, we’re able to show our appreciation.

The Green Bay Packers have a long tradition of excellence and performance, something Network Health stands behind. Watch for Network Health during this football season. If you’re a Packer fan, you’ll see more of us than ever before.

HMO and POS plans underwritten by Network Health Plan. Self-insured plans administered by Network Health Administrative Services, LLC.

4553-01-0623

© 2023 Network Health. No portion of this newsletter may be reproduced without written permission from Network Health.

HAVE A QUESTION?

Call our member experience team.

HOURS

Monday, Wednesday–Friday: 8 a.m. to 5 p.m. Tuesday: 8 a.m. to 4 p.m.

PLANS THROUGH AN EMPLOYER

800-826-0940

PLANS FOR INDIVIDUALS AND FAMILIES

855-275-1400

STATE OF WISCONSIN

EMPLOYEES/MEMBERS

844-625-2208

Monday–Friday: 8 a.m. to 4:30 p.m.

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

Taking ADVANTAGE of Your MEMBER Portal

Our goal at Network Health is to make it easy for you to manage your health insurance. We work hard to ensure you understand and are comfortable with your insurance plan. That’s why we created the Network Health member portal. Visit login.networkhealth.com to sign up or log in to your existing Network Health account. Once there, you’ll have access to a variety of tools and information.

Mailing Preferences

Choose which information you want to receive in the mail and which information you want to receive via email. You can go paperless for some communications and receive emailed information. Or, if there are communications you’d rather receive as hard copies through the mail, you can select that preference. The choice is yours.

To select your preferences, simply log in to the portal, click your name in the upper right corner and select Change . From there, you can choose email for any or all of the available categories. Make

Plan Information

the New Black Go Paperless

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 that keeps you well informed and provides plan information at your fingertips.

efits and coverage overview

ut-of-pocket expenses tracker laims detail and status

onthly explanation of benefit (EOB) statements ccess your mobile ID card (or request replacement hard copies) elect or update your personal doctor ecure messaging with our local member experience team nd more

More Resources

The member portal also provides seamless connections to other valuable ellness programs and tools*

harmacy benefits and claims information*

ommunication preferences

irtual visits our health questionnaire

The portal works great on your mobile phone and is built to be viewed 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.

*Not all Network Health plans have a wellness program or pharmacy benefit. Your portal will show information specific to you and your plan.

If you haven’t already registered, visit login.networkhealth.com. It’s quick and simple to set up your secure account.

Diabetes Prevention Through the Prevent T2 Lifestyle Change Program

Type 2 diabetes is a serious and potentially life-threatening medical condition. It can be managed and even prevented by lifestyle changes prior to and after diagnosis.

As part of our mission to create healthy and strong Wisconsin communities, Network Health has been working with our members to expand prevention efforts for Type 2 diabetes through the Prevent T2 diabetes prevention program.

Is Type 2 diabetes preventable?

The Prevent T2 diabetes prevention program consists of a one-year series of facilitator-led, group sessions for individuals with prediabetes or a predisposition for developing a Type 2 diabetes diagnosis. Prevent T2 is part of the National Diabetes Prevention Program which is led by the Centers for Disease Control and Prevention (CDC) and has been proven to prevent or delay Type 2 diabetes.

The program focuses on dietary changes, increased physical activity and behavior change strategies. The information given at the Prevent T2 meetings is designed to help individuals make small changes that lead to big differences in their health.

How often does the Prevent T2 class meet?

With 26 total sessions, Prevent T2 initially meets frequently and then tapers to a less frequent—but still impactful—schedule.

Here is what you can expect for session frequency.

Sessions 1-16 = once per week for four months

Sessions 17-20 = twice per month for two months

Sessions 21-26 = once per month for five months

Prevent T2 meetings also feature occasional guest speakers, including fitness experts, chefs, Network Health pharmacists and more, all working to keep you educated and motivated in a range of wellness and fitness strategies.

Should I sign up for the Network Health Prevent T2 Diabetes Prevention Program?

The Network Health Prevent T2 program drives incredible results. If you’d like to be included in the future, email NHpreventT2@networkhealth.com or fill out the online application at networkhealth.com/wellness/prevent-t2. If you’re curious about whether you are in an elevated-risk category for Type 2 diabetes, the CDC has an easy to use risk assessment tool that you can find at cdc.gov/ prediabetes/takethetest

For more information on Network Health preventive care services, reach out to us today.

Addressing the Opioid Crisis

By Ted Regalia, vice president of pharmacy benefits at Network Health

A nationwide effort to address the ongoing opioid crisis has made some progress, however, challenges still exist. The good news is, according to the American Medical Association, there has been a 44.4 percent decrease in opioid prescriptions between 2011-2020. Despite this progress, opioid related deaths continue to rise nationwide. Opioid use disorders can happen to anyone. These disorders include opioid addiction, which can interfere with a person’s health, well-being and quality of life, not to mention the hardship and strain it can cause to loved ones.

What are we doing to address the opioid use crisis?

Our members, providers and Network Health all have a role in keeping our communities safe.

Physicians or Prescribers

The State of Wisconsin has implemented a monitoring program that requires prescribers to consult a website any time they prescribe a controlled substance that includes opioids. This website displays prescriptions from other physicians and pharmacies across the U.S. and Wisconsin, so the prescriber has a full picture of the medications a patient is receiving. Furthermore, Wisconsin physicians are required to take continuing education classes on safe opioid prescribing.

Network Health

We have implemented quantity limits on new prescriptions for members who have not had an opioid in the last six months. In other words, if you are not a routine opioid user, you will be limited in the number of pills you can get at a time. This is important to prevent unused opioids sitting in the cabinet which could pose a risk for unintentional ingestion, overdoses or getting into the wrong hands. We have also put a prior authorization in place for cases where high-dose opioids are medically necessary.

Medication Assisted Treatments

For patients experiencing opioid use disorders, specialized physicians have several different medication therapies that may assist. Using medications in combination with counseling and behavioral therapies helps maintain recovery. If you are concerned about your opioid use, please contact your personal doctor to discuss the options you have available. To find out more about medication assisted treatment plan coverage, call the number on your member ID card.

Pharmacies

Wisconsin permits a pharmacist to dispense naloxone without a prescription. Naloxone is an opioid antidote and is a life saver in cases of opioid overdose. We strongly recommend you discuss naloxone with your physician and/or pharmacist. Ensure you teach those around you how to use naloxone in the event of an accidental overdose. Doing this can save lives.

You, Our Members

You play the most important role. If you need pain control, make sure you are using additional treatment options, including other medications, physical therapy and other interventions suggested by your doctor, to help minimize your use of opioids. Also, make sure you are storing your pain medication in a safe, secure place. Do not share your medications with anyone else. And, if you have unused pain medication, make sure to dispose of it either at your pharmacy or follow disposal instructions provided by the U.S. Food and Drug Administration (FDA). Disposal instructions can be found on the FDA’s website, fda.gov

What’s the Difference Between Emergency Care, Urgent Care and Virtual Visits?

Emergency Care

An emergency is an illness, injury, symptom or condition so serious, that a reasonable person would seek care right away to avoid serious harm. You typically receive emergency care at the emergency room. Emergency care conditions include the following.

• Chest pain

• Trouble breathing

• Sudden numbness in an arm or leg

• Head or neck injury

Urgent Care

Urgent care is for an unexpected injury or illness that is not life threatening, but still needs attention quickly so it doesn’t develop into a serious problem. Urgent care is available at your personal doctor’s office, a walk-in clinic or an urgent care facility. Areas of urgent care include the following.

• Fever

• Vomiting

• Pink eye

• Sinus infections

• Cuts requiring stitches

• Allergic reactions

Virtual Visit

Another option if you are sick is a virtual visit with MDLIVE®. A virtual visit is a convenient way to get care through your computer, smartphone or tablet. All Network Health plans offer virtual visits as an alternative to urgent care visits for non-emergency medical conditions. As a Network Health member, you can even receive urgent care at home through Pivotal Health. Learn more at pivotalhealth.care/ locations. Appointments with behavioral health counselors, psychologists and psychiatrists are also available through MDLIVE. Areas of virtual care include the following and more.

• Behavioral health services

• C old and flu

• C ough

• Diarrhea

• Fever

• Headache

• Pink eye

• Nausea and vomiting

• Respiratory problems

• Urinary problems or UTI

Your coverage for each of these services varies depending on your plan. Be sure to call the member experience team at the number on the back of your member ID card or visit your member portal at login.networkhealth.com to verify your benefits.

Always Remember

If you or a loved one is hurt or ill, panic and confusion can make it difficult to know what to do. If you feel you’re experiencing a medical emergency, it’s important to get to the nearest emergency room or call 911. If it’s not an emergency, many times your personal doctor, a virtual visit, an urgent care or walk-in clinic can provide the care you need at a lower cost.

Human Papillomavirus (HPV) Vaccine Is

CANCER PREVENTION

Why does my child need the HPV vaccine?

The HPV vaccine protects against cancers caused by HPV infection. HPV is a common virus that infects teens and adults. About 14 million people, including teens, become infected with HPV each year. HPV infection can cause cervical, vaginal and vulvar cancers in women and penile cancer in men. It can also cause anal cancer, cancer of the back of the throat (oropharynx) and genital warts in both men and women.

When should my child be vaccinated?

All children who are 11 or 12 years old should get two shots of the HPV vaccine six to twelve months apart. Getting vaccinated on time protects preteens long before ever being exposed to the virus. People get HPV from another person during intimate sexual contact.

Some children may need three doses of the vaccine. For example, adolescents who receive their two shots less than five months apart will need a third dose for the best protection. Also, children who start the vaccine series on or after their fifteenth birthday need three shots given over six months. If your teen hasn’t received the vaccine yet, talk to their doctor about getting it as soon as possible.

Is the HPV vaccine safe for my child?

The HPV vaccination provides safe, effective and long-lasting protection against cancers caused by HPV. The vaccine has a reassuring safety record backed by ten years of monitoring and research.

Like any vaccine or medicine, the HPV vaccine can cause side effects. The most common side effects are mild and include pain/redness/swelling in the arm where the shot was given, dizziness, fainting, nausea and headache. Fainting after any vaccine, including the HPV vaccine, is more common among adolescents.

It is important to tell the doctor or nurse if your child has any severe allergies, including an allergy to latex or yeast. The HPV vaccine is not recommended for anyone who is pregnant.

Where can I learn more?

Talk to your child’s doctor or nurse to learn more about HPV vaccination and the other vaccines that your child may need. You can also find out more about the HPV vaccine at cdc.gov/hpv

High Deductible Health Plans (HDHP) Traditional Health Plans vs.

There is a lot you need to consider when deciding which health plan is best for you. Network Health offers a variety of health insurance plans from which to choose. Often, the decision is between an HDHP and a traditional plan.

Generally speaking, HDHPs have low premiums but high deductibles. On the other hand, traditional health plans have higher premiums but lower deductibles. Deciding which plan is best for you comes down to your needs and budget.

Traditional health plans have lower deductibles, so they make a good option if you and/or members of your family go to the doctor often. It might also make sense if you expect major medical costs in the future, such as having a baby.

High Deductible Health Plan

• May not have copayments; which means you could pay the full cost until your deductible is met

• Higher deductible

• Lower premiums

• Often combines with a health savings account (HSA)

HDHPs have a high deductible that must be met before the plan starts paying its share. However, with its lower premiums, if you are healthy and do not go to the doctor often, an HDHP may save you money in the long run.

The above are general examples and may not be true in every case. However, when you are comparing these two types of plans, it is a good general place to start.

Regardless of what plan you choose, Network Health’s Member Experience Team will provide the same great customer service for which we’re known. We’ll help you make the most of your coverage.

Traditional Health Plan

• Has copayments until you meet your deductible; then you may pay coinsurance

• Lower deductible

• Higher premiums

• Health Savings Account (HSA) may not be as important

HPV vaccination is recommended at ages 11-12 to protect against cancers caused by HPV infection.

Members Patrick and Jessica Vander Zanden, and their daughters Kiki, Josie and Reagan

“There are a lot of people out there who really have a passion to help”

-Patrick Vander Zanden Network Health member

It Takes a Village

Of Jess and Patrick Vander Zanden’s three children, Josie has always been the easiest to put to bed. When it’s bedtime, she’d just go to her room, crawl into bed and go to sleep. A week or two after her third birthday, however, she was acting a little out of sorts. Something was just a bit off. She wanted her dad to lay in bed by her. Like any good father, Patrick agreed to do so.

An hour and fifteen minutes later, Patrick came downstairs carrying Josie. “I don’t know what’s wrong with her,” he said.

Josie’s fists were clenched, her arms were pulled in tight to her chest and she was shaking in a strange start-stop-start manner. She didn’t respond to Jess and Patrick when they talked to her. And her eyes were in a deep, odd stare.

It hasn’t been easy, and it’s a deliberate state of mind, but Jess and Patrick have made the adjustment.

“Now we focus on what she needs right now. And right now, the focus is strengthening her left side and working on her fine motor skills so she can do things like she should, like every other five-year-old,” said Jess.

“The fine and gross motor skills are the main deficits. And all that affects her day to day,” said Patrick. “Going to the bathroom, zipping up your jacket, wiping your nose. Everything that you and I take for granted is work for Josie. But cognitively, she tests high for her age. She’s very sharp.”

Treatment

After the results came back, the Vander Zandens began the arduous task of finding medications that would not only stop the seizures, but not have side effects as well.

By the time they got Josie to the emergency room that night, she was fine. She was tired, but she was talking and her appearance was back to normal. They took her to her doctor the next day and described what had occurred the night before. He told them Josie had a seizure and referred them to a neurologist.

A few days later, Josie had another seizure. Then another. And they kept occurring.

The neurologist ordered an EEG. When the results came back, they learned Josie had an abnormal brainwave pattern.

“The weird thing is, that brainwave pattern doesn’t cause seizures in everyone,” Jess said. “You might have that too and never have a seizure.”

As a result of the seizures, Josie experiences a persistent weakness in her left side. She also has deficits with her fine motor skills and speech. She’s improved enough over the last two years that she no longer needs physical therapy. But Josie is still receiving occupational and speech therapy.

The Prognosis

Many children outgrow their seizures as they get older. Others may continue to have them into adulthood. The fact of the matter is it varies from child to child.

“Unfortunately, we don’t know,” said Jess. “We’ve talked to Josie’s neurologist and asked when do you think we’ll know? What’s going to happen? His response was, ‘We’re in a long-term relationship here. Take a little step back and we’ll look at things in six-month blocks.’ It took a while, but I’m finally able to think that way. I used to get into all the ‘what ifs.’ What if she’s in middle school and she’s still having seizures? What if she wants to play softball? How is that going to work? What if she does … whatever? What if?”

By Jon Race

“It was a world we weren’t really ready for. That first med she was on, literally within a couple days she was like a different kid. She became super defiant, super aggressive. Plus, she kept having seizures,” Jess said. Jess and Patrick called Josie’s doctor and explained the situation. “Right away we tried a different drug,” said Jess. “That helped manage the seizures temporarily. We had a little bit of a gap. But then we started noticing other stuff going on with her. It’s like she had no awareness of her body. Things like fine motor delays, where picking things up was almost like she didn’t have strength in her hands.”

The Vander Zandens began to address all the other challenges Josie was having along with the seizures. They received a referral to the CP Center in Green Bay for an evaluation for physical and occupational therapy. Josie also began speech therapy at Bellin Health.

“The seizures are now in a place where they are well managed. But there’s still a lot she is working on,” said Jess.

Changing Health Insurance

About a year after Josie’s first seizure, Patrick changed jobs. They lived in De Pere and he was commuting to Oshkosh every day.

Photographs by Beth DesJardin, Trove Photography

“Her eyes,” said Jess. “I still remember her eyes—and she’s five now, so this was two years ago—I still remember seeing her eyes.”

“I was getting home and would get to see the kids for about 30 minutes before they went to bed. It just wasn’t working.”

Normally, a job change isn’t all that problematic. You make the change, and you move on. But Jess and Patrick had a lot to be concerned about. They were currently getting insurance through Patrick’s employer. A new job meant they would have a new health plan.

“Josie was four. It was kind of during the worst time, so we were really scared to switch insurance,” Jess said.

Jess was working at Network Health at the time and wanted to get some information before Patrick officially changed jobs. She reached out to a Network Health pharmacist and asked some questions about Josie’s medications. She learned that the profile of drugs Josie was on would cost them about $1,200 a month under Network Health’s insurance.

But the pharmacists looked into alternatives and found an equivalent generic form of Josie’s medication. The downside was that it was in pill form. Josie’s current medication was liquid. But if four-year-old Josie was okay swallowing a pill, they might be able to make the switch.

“The pharmacist even worked out the equivalent dosage and everything. I showed the doctor what we had and he agreed if Josie would swallow the pill that we could switch to the generic. Well, Josie had no issues with it, so we switched. We’re talking $5 a month versus $1,200. That’s a huge difference,” Jess said.

“And that was all because of the pharmacists,” said Patrick. “We wouldn’t have known any of that. We wouldn’t have been able to do that. And the crazy thing is, those pharmacists do stuff like that every day for all Network Health members. Part of their job is helping people save money.”

“That’s when we knew we were going to be okay with Network Health,” said Jess.

Josie has two sisters, Kiara (who prefers to go by Kiki) is nine and Reagan is two. Their involvement cannot be underestimated.

“Josie and Reagan are starting to have a little bit more of a bond. Because Josie was struggling with so many things, they almost needed the same kind of care. But now Josie is acting more like a big sister, which has been fun to watch. And Kiki is really motherly and caring. She’s always helping out with little things. Early on we had to keep a log by Josie’s bedside. Kiki was ‘If anything happens, I’ll write it down.’ She was kind of like a third adult in the room,” Jess explained. But it’s more than just family.

CP Center

The CP Center in Green Bay is where Josie went for physical therapy and is currently going for occupational therapy. The Center is a non-profit organization offering therapy and life skills services and programming for physical, cognitive, developmental and sensory conditions.

“The therapists at the CP Center have been amazing,” Jess added. “Josie loves, loves being there. She just turned five in April and I feel like now we’re finally seeing the gains from all this work she’s been putting in. She’s coming back to who she is.”

“It’s crazy how good they have been,” Patrick said. “If I win the PowerBall, I’m calling up the CP Center and asking them what they need. You need another wing? Okay. Whatever you want. They are just so amazing.”

The Doctors

The Vander Zandens consider themselves lucky when it comes to the doctors they have worked with.

“Josie’s neurologist is known for seizure management. He’s so good at educating and breaking it down from a parent perspective. Yet he’s really relatable to Josie. He does a great job with her,” Jess said.

Josie’s personal doctor at the Prevea Allouez Health Center in Green Bay received similar praise. “We go through him for everything, Jess said. “Working with him has been such a good experience. He was the one who referred us to Josie’s neurologist. And he helped us find an orthopedic doctor to help with Josie’s limp. But it all comes back to him and we work together.”

Josie is also still receiving speech therapy through Bellin Health. “It’s hard to find a pediatric speech therapist,” Jess said. “There just aren’t that many around. But we were lucky enough to find a great one at Bellin Health.”

“We’ve gotten really good care. The CP Center and Prevea doctors. And Bellin for her speech therapy. They are all in-network for us. And they have been amazing,” Jess said.

De Pere Community Center

Josie has participated in numerous programs at the De Pere Community Center over the last year or so. Everything from dance to sports to art classes.

The Support System

The list of people and organizations the Vander Zandens have relied on for support is a long one. And they know they wouldn’t be where they are without that support.

“It’s definitely a ‘it takes a village’ type of thing. And we are very fortunate in that regard. So many friends and family,” said Patrick.

“It’s hard to find a place that you feel comfortable dropping off a child like Josie because you don’t know what to expect,” Jess said. “But the De Pere Community Center is something different. They know about Josie and her story and they welcome her. All parts of her. If she’s tired or not having a great day, you’re not going to see the best side of her. But they’ve wrapped their arms around her and accepted her. It’s been really good for Josie.”

“We can’t not recognize all that support. We are not short on people who want to help Josie. We are so thankful,” said Jess.

Froedtert Mail Order

It may sound a bit odd to reference a mail order prescription service as part of a support system, but for Jess and Patrick, it truly is.

“We do Froedtert mail order,” Jess said. “It’s a benefit we have access to through Network Health’s insurance. It’s something the Network Health pharmacist alerted us to when they counseled us on her drug set up.”

“Prior to that we would have to try to work through chain pharmacies, which was challenging because most don’t have Josie’s meds readily available, posing risks of not getting them on time. The switch to the mail order pharmacy eliminated long waits at the pharmacy and confusion regarding which drugs need to, or can be, filled and on what timeline. The mail order pharmacist will literally call us on our cell phones. You just don’t get that experience typically. We have what we need when we need it. It’s been a relief for us,” Jess explained.

“And UPS delivers it right to our door,” Patrick said. “The mail order prescription service was a huge change for us when we switched to Network Health.”

Network Health

Beyond just the pharmacists, Jess and Patrick are appreciative for the service they’ve received from Network Health.

Lessons Learned

Despite their situation and everything they’ve been through, the Vander Zandens remain positive.

“We are grateful,” Jess said. “Things could always be worse. She’s still in therapy working on these deficits. She continues to close the gap but it’s a slow road.”

“In the beginning it felt like a low simmering stress in my gut. All the time. You’re always worried because you don’t know how it’s going to turn out. But in the end, I think it has affected me positively. It makes you realize you have a lot of strengths. That our family had it in us to deal with this scary thing,” said Patrick.

“From a parent perspective, it really has made us pause and focus on what’s important,” Jess added. “It’s easy to get into a flow of life and just go. But this has really caused us to pause and think about what’s most important for all three of our girls and what they need to be successful.”

Patrick added, “It’s also made me realize that there are a lot of people in the world, in our community, who want to do good and want to help others. Everyone we’ve dealt with at Network Health, the people at the CP Center and the De Pere Community Center, all the doctors … there are a lot of people out there who really have a passion to help.”

“We’ve had no problems with billing,” Jess said. “Everything makes sense and if I have a question, I get answers. With our previous plan, that just wasn’t the case.”

“And, we’ve had things denied, but we got a call from the nurse explaining what it was and they walked us through it. Our previous insurance we just got the denial. They didn’t explain it. And that just made an already stressful situation worse. With everything we’ve gone through, when it comes to Network Health, I’ve never felt not heard or not listened to,” said Jess.

“It’s been a long journey. And Network Health has been a big part of it,” Patrick added.

Required Information for Members

There are several organizations that exist to help improve the quality of health care across the United States, including the National Committee for Quality Assurance (NCQA), the Wisconsin Office of the Commissioner of Insurance (OCI) and the Centers for Medicare & Medicaid Services (CMS). They use a variety of performance measurement tools and regulations to help ensure consumers are protected and receive quality health care services. These organizations also require health insurance companies to provide information to their members on these specific topics.

• Access to Network Health Care Management Employees and Services

• Ensuring You Receive the Service You Deserve

• Falls/Osteoporosis

• T he Importance of Exchanging Information

• Keep Yourself Safe from Medicare Fraud

• K now Your Member Rights and Responsibilities

• Network Health’s Focus on Quality

• Submitting a Claim for Reimbursement

• W hat is Population Health Management?

You can find a downloadable PDF of this information at networkhealth.com/required-info. If you do not have access to the internet and need a hard copy of the NCQA information, please call our member experience team at the number on the back of your ID card.

“Network Health has helped every step of the way. With Josie’s seizures, I feel we have touched every service of Network Health. Pharmacy, claims, member experience … it’s pretty crazy,” Patrick said.

Do You Have a Child Turning ?

If you, your child or someone you know is turning 26 soon and won’t be enrolling in an employer’s group plan, make sure you review Network Health’s Individual and Family Plans. We offer a variety of plans to ensure excellent coverage, along with the high-quality service you’ve come to expect.

A few things to keep in mind when someone ages off a parent’s plan...

• If a dependent is covered by a parent’s Health Insurance Marketplace plan, they can stay on the parent’s plan until coverage ends December 31, even if they turn 26 mid-year.

• If a dependent is covered by a parent’s job-based plan, their coverage will usually end during or shortly after their 26th birthday month. Check with the plan or parent’s employer for the exact date.

• When aging off a parent’s job-based plan, dependents qualify for a Special Enrollment Period (SEP) to buy health insurance. The SEP starts 60 days before coverage is lost and ends 60 days after.

• Enrolling before losing coverage – The new Marketplace plan can start as soon as the first day of the month after coverage is lost.

• Enrolling after losing coverage – The new Marketplace plan can start the first day of the month after a plan is chosen.

Our plans are easy to understand and affordable. We can provide the information needed to help you choose the plan that’s best for you. Making sure you keep up on your preventive medical tests, appointments and procedures, as well as dental care, is vital in maintaining a healthy you.

If you or someone you know is turning 26 and will be shopping for health insurance for the first time, visit networkhealth.com/individual/available-plans or call 844-635-1322. We’ll help you make the decision that’s

Approaching 65? We’ve Got a Plan for You.

If you or someone you know is turning 65, make sure you review our Medicare Advantage plans. You will receive the same exceptional one-on-one service you’ve experienced for years and we make enrolling in a Medicare plan easy. As good as Original Medicare is, it will not cover all your health care expenses. Most people who are eligible for Medicare choose to get their benefits through private health insurance companies to help cover costs. With a Network Health Medicare Advantage Plan, you’ll get extra benefits that Original Medicare doesn’t cover.