L I F E , H E A LT H & W E L L N E S S
A PUBLICATION OF
FA L L 2 0 17
Discovering What Really Matters Follow along as one insurance agent becomes a Network Health Medicare member
inside PAGE 6
Ensuring the Service You Deserve
PAGE 11
Where Does Your Health Insurance Dollar Go? PAGE 12 Join Us for Network Health’s Member Appreciation Events
Important 2018 Benefit Information Begins on Page 13
Exclusive Reduced Rates for Network Health Medicare Advantage Plan Members For ticket information, visit NetworkHealthMedicare.com/offers. Offers expire November 10. Fox Cities Performing Arts Center - Appleton, Wisconsin These limited-time ticket offers are for Network Health Medicare members and THE NUTCRACKER – December 17 at 1 p.m. their families only. Not valid on previously THE KING AND I – January 28 at 1 p.m. purchased tickets. While supplies last. Marcus Center - Milwaukee, Wisconsin THE SECOND CITY’S NON-DENOMINATIONAL CHRISTMAS SHOW December 1-2 at 7:30 p.m. FINDING NEVERLAND – February 24 at 2 p.m. and February 25 at 1 p.m.
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Knowledge at Your Fingertips Breaking Down Obstacles to Care The Dos and Don’ts of Medicare Fraud Values Line Evaluating New Technologies Do You Know How Health Plans Make Their Decisions?
6 Ensuring the Service You Deserve 8 Seven Ways to Avoid a Heart Attack 9 Understanding Respiratory Medications and How They Work 10 Measuring Our Success 10 Connect with Network Health Online 11 Where Does Your Health Insurance Dollar Go? 12 Join Us for Network Health’s Member Appreciation Events
FEATURE 22 DISCOVERING WHAT REALLY MATTERS
13 - 20 SPECIAL PULLOUT SECTION 2018 MEDICARE PLAN CHOICES AND BENEFITS
31 Home Telemonitoring
21 Yoga, Pilates, Tai Chi—Oh My
26 Help Prevent Opioid Abuse 27 Medication Therapy Management 28 How to Recognize Symptoms of Depression 29 Know Your Numbers 30 Common Questions About the Flu Shot 31 Member Rights and Responsibilities BACK COVER To us, you’re more than a Medicare member
Y0108_1231_091417 Accepted 09192017
EDITORIAL STAFF President and CEO Chief Administrative Officer Marketing Coordinator Lead Designer
Coreen Dicus-Johnson Penny Ransom Romi Norton Debra Sutton
ASK NETWORK HEALTH If you have questions about anything you read in this issue of Concierge, call customer service at 800-378-5234 Monday–Friday, 8 a.m. to 8 p.m. From October 1–February 14, we’re here every day, 8 a.m. to 8 p.m. You can also learn more at NetworkHealthMedicare.com.
Network Health offers TDD/TTY services for deaf, hard of hearing or speech-impaired individuals. Anyone needing these services should call 800-947-3529. Bilingual language assistance or translation services are also available. Callers may leave a message 24 hours a day, seven days a week. These services are offered to support Network Health’s Medicare-related programs and services, including utilization management.
Concierge is a biannual publication of Network Health. The health information contained in Concierge is meant to supplement, not replace, the advice of health care professionals. © 2017 Network Health Insurance Corporation. No portion of this newsletter may be reproduced without written permission from Network Health Insurance Corporation.
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 800-378-5234 (TTY 800-947-3529). 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 800-378-5234 (TTY 800-947-3529). 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 800-378-5234 (TTY 800-947-3529). 2 | C oncierge
NetworkHealthMedicare.com
life. health. wellness.
Knowledge at Your Fingertips
E
mmi® is a series of free, animated, interactive online programs that walk you through important information about a health topic, condition or procedure.
Maybe your doctor clearly explained what you need to know during your last office visit, and after you left the clinic, some of those details got a little fuzzy. Emmi programs can help answer your questions and make you feel more at ease about your health condition. The most important member of your health care team is you, so it’s essential you have the information you need. Even if you feel confident about managing your health, visit GoEmmi.com to verify you’re on the right track or maybe even learn some new helpful tips. Using Emmi is easy. Watch for the icon above at the end of articles throughout this edition of Concierge, to know what article topics are covered by Emmi. By visiting the links provided, or viewing Concierge online, you can interactively experience a variety of health topics. Watch them on your computer, smartphone or tablet as many times as you like.
Breaking Down Obstacles to Care
T
reatment plans are only helpful if you follow them. What if your doctor’s orders conflict with your religious beliefs or create tension with your cultural practices? What if you can’t afford the treatment? If you find yourself facing decisions between following your beliefs or your doctor’s instructions or you are struggling to pay for treatment, Network Health can help. Network Health’s care management team helps people overcome barriers to treatment requirements every day, including the following. n Beliefs and concerns about your condition and treatment n Access, transportation and financial barriers to obtaining treatment n Cultural, religious and ethnic beliefs that conflict with treatment Call 866-709-0019 (TTY 800-947-3529) to speak with a nurse who can help make your treatment plan fit your life. NetworkHealthMedicare.com
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life. health. wellness.
The Dos and Don’ts of PROTECT Medicare Fraud YOURSELF Medicare fraud costs American taxpayers billions of dollars each year and results in higher medical costs for everyone. As your health care partner, Network Health has some tips to help avoid Medicare fraud. Follow these dos and don’ts to keep your information safe.
DO
n Refuse and return medical supplies you didn’t order. Medicare doesn’t sell or mail supplies. If you receive unordered supplies, you may be the target of fraud. n Report the name of the company sending the supplies to Network Health. n Keep accurate records of all your health care appointments. n Read your explanation of benefits carefully and make sure all services listed are services you actually received. n Always watch your credit card and bank statements for any improper billing activity or fraudulent withdrawals. n Monitor your credit report regularly.
DON’T
n Don’t give your Social Security, Medicare, financial information, Network Health member ID number or credit card information to someone you don’t know. Only give your information to those who have provided you a medical service. n Don’t trust door-to-door salespeople or telemarketers selling health care services or durable medical equipment, like diabetic supplies or back braces. And, remember—free services do not require you to give out your plan or Medicare number. n Never sign blank insurance claim forms.
What do I do if I’m scammed?
Sometimes people do not report scams because they are ashamed or embarrassed. It is important to know, it’s not your fault. If you feel you are the victim of a Medicare scam, we are here to assist you. Call a member of our health care concierge team or email us at paymentintegrity@networkhealth.com.
R
emember, you can always call our Values Line to report and discuss activities or occurrences you believe are improper. The hotline is confidential, and you may report concerns anonymously. Your concerns will be investigated and appropriate action will be taken to address the problem.
The Values Line number is 800-707-2198
(TTY 800-947-3529) and can be reached 24 hours a day, seven days a week.
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NetworkHealthMedicare.com
Evaluating New Technologies N
etwork Health evaluates new technology and new applications of existing technologies on a regular basis. This includes the evaluation of medical procedures, drugs and devices. Decision making on technologies is based on, but not limited to the following.
n n n n n n n n
U.S. Food & Drug Administration approval Manufacturer information Scientific evidence Peer-reviewed articles Opinion of contracted providers Risk/benefit analysis Government regulatory agencies Assessments performed by agencies specializing in technology
New technologies are reviewed by a group of participating physicians and health plan staff (Medical Policy Committee) who make recommendations for inclusion as a covered benefit. The following technology assessments have been reviewed over the past 12 months. n OPTUNE Device (The Optune device is a tumor treatment fields therapy [TTF] for glioblastomas, a type of brain tumor.) This technology remains experimental and investigational and was not recommended for coverage. n Flexitouch System for Lymphedema (The Flexitouch System is a programmable segmented pneumatic compression device.) This technology remains experimental and investigational and was not recommended for coverage. If you have a question about a technology assessment, contact our care management department at 800-236-0208 (TTY 800-947-3529), Monday–Friday, 8 a.m. to 5 p.m. Bilingual language assistance or translation services are available.
WHAT’S THAT? GLIOBLASTOMA A tumor that forms from supportive tissue of the brain and spinal cord.
LYMPHEDEMA An abnormal collection of high-protein fluid beneath the skin that occurs most commonly in the arm or leg, but also may occur in other parts of the body.
Do You Know How Health Plans Make Their Decisions?
V
isit NetworkHealthMedicare.com and click on Member’s Corner. Next, scroll down to Resources and click How Health Plans Make Their Decisions. You’ll learn important information about how decisions are made based on service and appropriateness of care. On the same page, you’ll also find helpful information on how to access our care management staff. Network Health assures access to Medicare Advantage care management and behavioral health care management associates for members seeking information about our case management and utilization management programs. To request a printed copy, or if you have any questions about Network Health’s utilization management process, decisions or criteria, call our care management department at 866-709-0019 (TTY 800-947-3529), Monday–Friday, 8 a.m. to 5 p.m.
NetworkHealthMedicare.com
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life. health. wellness.
Ensuring the Service YOU Deserve We believe that’s a big part of the reason 94 percent* of our members stay with us.
A
t Network Health, we make every effort to ensure you’re receiving the service you need and deserve. We believe that’s a big part of the reason 94 percent* of our members stay with us. But if concerns arise, we want to make sure you understand all your options.
If you do not agree with Network Health’s decisions about your care or what’s covered, you have the right to file a grievance or appeal. We have a team of member advocates who will work with you throughout this process.
How do I file a grievance?
If you’re dissatisfied with the service or quality provided by your plan or doctor, we’re here to work with you through any issues. You have the right to file a grievance (a formal complaint) about how Network Health provided services. Examples of situations appropriate for a grievance include the following. n Difficulty getting through on the phone n Concerns about the quality of care of services provided n Interpersonal aspects of care (for example, rudeness of a provider or staff) n Failure to respect your rights You can submit a grievance over the phone or in writing within 60 calendar days from the date of the event. Call a member of your health care concierge team or write to the address below.
Network Health, Attn: Appeals and Grievances P.O. Box 120, Menasha, WI 54952
Health Care Concierge Team 800-378-5234 (TTY 800-947-3529)
We will complete an investigation of your grievance as quickly as your case requires and send you a letter about this no later than 30 calendar days from the date we received your request. If we need more time to investigate the situation, we’ll let you know about that extension prior to the end of the initial 30-day period.
How do I file an appeal?
You have the right to file an appeal if you do not agree with Network Health’s decisions about your health care benefits. Examples of situations appropriate for an appeal include the following. n Network Health will not approve care it should cover. n Network Health is stopping care you still need. n Network Health has denied payment for services or items you have received and you think it should be covered. 6 | C oncierge
NetworkHealthMedicare.com
How are medicine appeals handled? Medicine appeals are reviewed by a Network Health Pharmacist and Network Health Medical Director, as needed. The pharmacist communicates with the prescribing provider if additional information is needed or discusses alternative covered medications.
Stacy Schwandner, Network Health customer service manager You can submit an appeal in writing within 60 calendar days from the date you receive the claim denial. Your written appeal should include your full name, member ID number and information about what you are appealing. You may also include any comments, documents, records or other information you would like Network Health to consider in its review. Call a member of your health care concierge team if you have questions, or send the written appeal to the address on page six.
Our pharmacists have a goal of addressing medicine appeals within four hours and have been successful over 90 percent of the time. This means better customer service for both physicians and our members.
Who may file an appeal?
You or someone you name to act for you (called your authorized representative) may file an appeal. To name your authorized representative, visit NetworkHealthMedicare.com. Click Member’s Corner, and select the Appointment of Representative form. Simply complete this form and send it to Network Health, ATTN: Medicare Advantage Plans, P.O. Box 120, Menasha, WI 54952, or call our health care concierge team.
What happens after I file an appeal?
If you appeal, we will review our decision. If payment for any of your claims is still denied after our review, we will automatically forward your appeal request to the Medicare contractor (MAXIMUS Federal Services) for an independent review. This process is provided by Medicare for a new and impartial review of your case outside of Network Health. If you disagree with that decision, you will have further appeal rights and you’ll be notified of those rights from MAXIMUS Federal Services. If you have questions about our member advocate team or filing a complaint, appeal or grievance, contact a member of our health care concierge team.
*Based on the percentage of Network Health Medicare Advantage (PPO) members who stayed in the plan for 2017, for coverage starting January 1, 2017. NetworkHealthMedicare.com
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life. health. wellness.
7
Seven Ways to Avoid a Heart Attack
When considering steps you can take to avoid a heart attack, you might think of the following commonly known lifestyle changes.
1 Avoid smoking
2
Check your blood cholesterol level
3
Monitor and control your blood pressure
4 Maintain a healthy weight
5
Eat a heart-healthy diet
6 Manage stress effectively
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ongratulations if you have taken any of these steps to decrease your risk of a heart attack. However, don’t forget another essential step—taking important medications to keep your heart healthy. Some medications, like statins and beta-blockers, can help control cholesterol and avoid a heart attack if taken as prescribed.
Statins are very effective at lowering cholesterol levels. If left untreated, high cholesterol can lead to blockage in the blood vessels throughout the body, including the heart, which can result in a heart attack. Statins can prevent this, but only if they are taken consistently and as prescribed by your doctor. Approximately 50 percent of adults who are prescribed a statin either stop or are inconsistent with taking their medication as prescribed. If you are experiencing side effects, there may be ways to minimize them. Ask your pharmacist to run an interaction check to ensure you are not on medications or eating foods that can interfere with your statin. Changes to the dose, frequency or type of statin can also help to manage side effects. Talk to your doctor or pharmacist about ways to reduce side effects. Beta-blockers help by decreasing blood pressure, relaxing the heart and slowing the heart rate so it doesn’t have to work so hard to pump blood to vital organs and extremities. If you’ve had a heart attack, it’s likely your doctor will prescribe a beta-blocker to help prevent you from having another heart attack. If you are having difficulty remembering to take your medications, consider a pill organizer, setting an alarm to remind you or working with your pharmacy to find solutions such as 90-day supplies, automatic refills or home delivery. If you have problems affording medications, call a Network Health Pharmacist at 866-709-1724 (TTY 800-947-3529) to review potential solutions that may save on your medication costs. While both statins and beta-blockers can help you successfully avoid a heart attack, the most important step is taking your medication as prescribed by your doctor.
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Visit goemmi.com/NHPM17HEART for free, interactive programs on heart health. NetworkHealthMedicare.com NetworkHealthMedicare.com
Watch for your next issue of Concierge in spring of 2018.
Understanding Respiratory Medications and How They Work
W
hen you’re living with a chronic lung condition such as chronic bronchitis, emphysema, asthma and chronic obstructive pulmonary disease (COPD), even the simple act of taking a breath can be a struggle. One of the best ways to control respiratory conditions is to understand them and follow your doctor’s guidelines for medications. It’s also important to understand when to use them. Controller medications are long-term treatments taken on a daily basis, even when you don’t have symptoms. Controller medications are not for emergency use. Instead, they prevent attacks by gradually keeping your symptoms under control for a longer period of time. Think of controller medications as routine maintenance of your symptoms, because by taking them every day you will prevent flare-ups. Examples of controller medications include Flovent®, Pulmicort Flexhaler®, Advair®, Spiriva® and others. If you are unsure whether your inhaler is considered a controller medication, ask your physician or pharmacist.
Relief medications provide quick relief by opening the lungs and relaxing airway muscles. They can ease worsening symptoms or stop an attack, usually providing relief in about 10 minutes. While relief medications work fast, they only last about four to six hours. Examples of relief medications include Proair®, Proventil®, Ventolin®, Xopenex® and albuterol. If you are unsure whether your inhaler is considered a rescue medication, ask your physician or pharmacist. Inhalers deliver a measured dose of medication into your lungs and may be prescribed by your doctor to control your symptoms. It’s important that you use your inhaler correctly, so all the medication you need reaches your lungs. To make sure you are using your inhaler correctly, bring it to your next office visit or stop at your pharmacy and show your pharmacist how you use it. It may also be helpful to watch videos for additional tips and tricks for getting the most out of your inhaler therapy. If you find yourself using your relief inhaler frequently or notice worsening of your symptoms, ask your doctor about adding or adjusting a controller medication.
If you’ve been diagnosed with chronic bronchitis, emphysema or COPD, let us help. Breathe at Ease is Network Health’s proactive condition management program designed to help members avoid flare-ups, control symptoms and potentially improve their lung conditions. It’s intended to supplement a physician’s care with one-on-one support from a respiratory therapist. To learn more, visit NetworkHealthMedicare. com/Breathe or call 866-709-0019 (TTY 800-947-3529).
If you have any questions about your medications, check with your doctor or pharmacist now. When you’re short of breath, you’ll want to know how to treat your symptoms as quickly as possible.
Visit goemmi.com/NHPM17ASTHMA or goemmi.com/NHPM17COPD for free, interactive programs on asthma and COPD. NetworkHealthMedicare.com
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Measuring Our Success W
hen discussing Medicare Advantage coverage with friends and family, it’s important to compare apples to apples. You need to know both the coverage and service you’ll receive, because your choice is important to your quality of life and health. But, with so many companies and plans to choose from, how can you know you’re making the right choice?
Medicare rates all health and prescription drug plans each year, based on a plan’s quality and performance. Medicare’s CMS Star Rating Program helps you know how well your plan and providers are doing. You can use these Star Ratings to compare quality performance to other plans. For 2017, Network Health Medicare Advantage Plans received the following Overall Star Rating from Medicare.
NETWORK HEALTH SCORED 4.5 OUT OF 5 STARS. Some of the areas Medicare reviews for these ratings include the following. n How members rate the plan’s services and care n How well the plan’s providers detect illnesses and keep members healthy n How well the plan helps members use recommended and safe prescription medications New 2018 ratings are expected to come out in October. You can find out more about our Star Rating and other measures including quality and member satisfaction ratings from The Healthcare Effectiveness Data and Information Set (HEDIS®) and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey results at NetworkHealthMedicare.com/Why-Network-Health/Top-Coverage.php. You can also request a printed copy of these ratings by calling a member of our health care concierge team. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.
Connect with Network Health Online I
f you haven’t had the opportunity to visit Network Health’s secure member portal, this is a great time to do so. Visit NetworkHealthMedicare.com/ MyAccount to sign up and register. You can set up a simple member profile, send and receive secure messages with our health care concierge team, access SilverSneakers® and access MDLIVE® to use virtual visits. Be sure to visit often, as we will continue to add more content and benefit information that’s specific to you. As a valued member, we’d also like to hear from you about what you’d like to see in your secure member portal. Tell us your ideas and suggestions for what you’d like to see by sending an email to marketing@networkhealth.com. 10 | C oncierge
NetworkHealthMedicare.com
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Where Does Your Health Insurance Dollar Go?
E
ver wonder where your money goes when you pay for your monthly health plan premium or copayments for services? This question was asked at a recent Network Health Medicare Advisory Board meeting. We regularly hold meetings with this group of our Medicare members to find out how we’re doing and how we can improve. Members were curious how their monthly premium breaks down and where it all goes. We thought it was a great question, so we decided to share the answer with all of our members. Most of your typical health insurance dollar is used to pay for hospital and physician services that members are getting. Then, other parts of your dollar pay for prescription drugs members need and the administrative expenses required to run the plan. For each dollar you pay for your health insurance, you might be surprised about how little ends up at the health plan after those costs are covered. Generally, one or two percent ends up at the health plan as income, which can be used to offer new programs, benefits and services. When the cost of health care goes up, you might see your monthly premium or health insurance costs increase to cover the difference of continuing to cover care for our members.
The Typical Health Insurance Dollar
¢ 50 Hospital Services
¢ 27 Physician Services
¢ ¢ ¢ 12 9 2 Rx Admin Profit Expenses
Drugs
These values are rough estimates for any Medicare Advantage insurer. Individual categories presented could vary significantly depending on, but not limited to, factors like the year, the insurance company and external impacts.
NetworkHealthMedicare.com
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JOIN US FOR NETWORK HEALTH’S MEMBER APPRECIATION EVENTS Thank you for choosing Network Health for your Medicare Advantage Plan. We’d like to show our appreciation by inviting you to a member-exclusive event. Most events are 8:30 a.m. to 3 p.m. and include the following. n Detailed benefits presentations at 9 a.m., 10:30 a.m. and 1:30 p.m.* n Flu vaccinations n Updates on your plan benefits, including a new offering for dental coverage n Fitness benefit updates n Face-to-face service with a health care concierge n Guidance from local independent agents n Access to Network Health pharmacists
Date
Venue
Time
City
Tuesday, October 3
Roma Lodge
Tuesday, October 10
Washington County Fair 8 a.m. - 11 a.m. Park & Conference Center
Tuesday, October 10
Ozaukee Pavillion
1:30 p.m. - 4 p.m. W67N866 Washington Ave. Cedarburg
Wednesday, October 11
Loft and Chapel at Cedar Ridge
8 a.m. - 11 a.m.
Wednesday, October 11 American Serb Hall
8 a.m. - 11 a.m.
Address 7130 Spring St.
Racine
3000 Pleasant Valley Rd.
West Bend
W23827 Bluemound Rd.
1:30 p.m. - 4 p.m. 5101 W. Oklahoma Ave.
Waukesha Milwaukee
Reserve your spot online or by phone today (have your Network Health ID card handy). Visit NetworkHealthMedicare.com/MemberEvents or call 888-879-8960 (TTY 888-833-4271). A registration representative can assist you Monday–Friday, 8 a.m. to 8 p.m.
Tell a Friend About Network Health’s Medicare Seminars If you’re pleased with your Network Health Medicare Advantage Plan, tell your friends and family. Our member appreciation events are designed for existing members, but people interested in our Medicare plans can attend a free, no-obligation Medicare seminar, hosted by a local, independent agent. For a full list of Medicare open houses in northeast and southeast Wisconsin, visit NetworkHealthMedicare.com/newtomedicare/seminars or call 800-983-7587 (TTY 800-947-3529). 12 | C oncierge
NetworkHealthMedicare.com
SPECIAL PULLOUT SECTION SOUTHEAST WISCONSIN
Where you’re more than a Medicare member
2018 Medicare Plan Choices and Benefits John K., Germantown • Football fan • Volunteer • Network Health Medicare member
NetworkHealthMedicare.com
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life. health. wellness.
My 2018 Medicare PPO Plan Annual Review Agent name____________________________________________________________________________________ Agent phone number_____________________________________________________________________________
To ensure your current PPO plan continues to fit your needs for 2018, consider the following.
q I take prescription medications.
If you do, you’ll need a plan that includes drug coverage.
q My 2018 deductible for medications is___________________.
You can find the 2018 drug deductible for your current plan on page 17.
q My plan’s 2018 out-of-pocket maximum is________________.
You can find your 2018 out-of-pocket maximum on page 16. The out-of-pocket maximum is the yearly limit on your costs for _ medical services. This is one of the most important things to consider. To protect your pocketbook, pay attention to this amount.
q A fitness benefit is important to me. q I work out at a fitness center.
q I have a chronic condition and should be working out. q I have a heart condition. q I want to improve my health. If you’ve selected any of the above options, see page 16 to see if your plan includes SilverSneakers® in 2018.
q A dental benefit is important to me.
q I get a yearly exam and cleaning. q I need additional dental benefits due to my oral care. If you’ve selected this option, see page 16 to see if your plan includes this benefit for 2018.
q My primary care office visit copayment is_________________.
You can find your 2018 copayment on page 16. You’ll want to consider this amount if you visit your doctor often.
q My specialist visit copayment is___________________________.
You can find your 2018 copayment on page 16. You’ll want to consider this amount if you visit your specialist often.
Compare your needs to our plan summaries on the next page to see which plan is the best choice for you. For further details, review the plan comparison found on page 16.
Out-of-network/non-contracted providers are under no obligation to treat Network Health members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. 14 | C oncierge
NetworkHealthMedicare.com
WASHINGTON
WAUKESHA
OZAUKEE
MILWAUKEE
RACINE
Network Health Medicare Go (PPO)
This plan has a $0 monthly premium and includes medical and prescription drug coverage. It can be a good a match if you don’t use a lot of health care services and would rather pay copayments instead of a monthly premium.
Network Health Medicare Anywhere (PPO)
This plan offers low copayments. It has great medical coverage and prescription drug coverage to help you pay for your medications. If you’re looking for a plan with comprehensive coverage at an affordable price, this plan may be a good fit for you.
The Benefits of Our PPO Plans • The freedom to choose any provider who accepts Medicare beneficiaries • You’ll pay less when you use our broad network of providers, including more than 1,600 primary care providers, 11,150 specialists and 50 hospitals • No referrals needed Co-owned by Froedtert Health and Ministry Health Care, part of Ascension, we understand the importance of quality health care, and we believe it should be convenient. NetworkHealthMedicare.com
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life. health. wellness.
A QUICK SUMMARY
Network Health Medicare Go (PPO)
Premium
$0 per month (Includes drug coverage)
IN-NETWORK
Network Health Medicare Anywhere (PPO) OUT-OF-NETWORK
IN-NETWORK
OUT-OF-NETWORK
$22 per month (Includes drug coverage)
$5,900 per year combined (in and out-of-network) Primary Care Office Visit $10 per visit $20 per visit
$4,500 per year combined (in and out-of-network) $5 per visit $15 per visit
Specialist Visit
$45 per visit
$55 per visit
$42 per visit
$55 per visit
Urgent Care
$45 copayment $395 copayment for days 1-4. You pay nothing for days 5 and beyond.
$45 copayment $395 copayment for days 1-5. You pay nothing for days 6 and beyond.
$45 copayment $295 copayment for days 1-4. You pay nothing for days 5 and beyond.
$45 copayment $395 copayment for days 1-4 .You pay nothing for days 5 and beyond.
Emergency Room
$80 per visit
$80 per visit
$80 per visit
$80 per visit
Ambulance
$275 copayment
$275 copayment
$250 copayment
$250 copayment
Outpatient Services
$395 copayment per visit
$395 copayment per visit $350 copayment per visit
$395 copayment per visit
Annual Wellness Visit with Lab Tests
$0 copayment
$15 copayment
$15 copayment
Maximum Out-of-Pocket
Hospital Stays
$0 copayment
Plan covers all Medicarecovered preventive services $15 copayment at $0 $0 days 1-20, $167 days $0 days 1-20, $167 days 21-57, 58 and beyond $0 21-57, 58 and beyond $0
Plan covers all Medicarecovered preventive $15 copayment services at $0 $0 days 1-20, $167 days $0 days 1-20, $167 days 21-49, 50 and beyond $0 21-49, 50 and beyond $0
X-rays
$35 copayment
$45 copayment
$20 copayment
$45 copayment
MRI/CT
$125
$140
$125
$140
SilverSneakers®
$0
$0
$0
$0
Annual Dental Exam and Cleaning
Not included with Network Health Medicare Go
$30 copayment
Not available
Preventive Services Skilled Nursing Facility
WHAT’S THAT?
PPO
PPO stands for preferred provider organization. It’s a type of plan where you have the freedom to choose any doctor that accepts Medicare beneficiaries. You do not need a referral for most Medicare-covered services. 16 | C oncierge
IN-NETWORK
Doctors, hospitals, pharmacies and other health care providers that have agreed to provide members of a certain insurance plan with services and supplies at a discounted price. NetworkHealthMedicare.com
OUR PLAN DRUG COSTS INITIAL COVERAGE
When your coverage starts, you pay a deductible and copayments until total drug costs (what you and Network DRUG DEDUCTIBLE Health pay) reach $3,750. 30-Day 30-Day Network Health $260 for tiers Supply 3, 4 and 5 only Supply Medicare Go Standard Preferred (PPO) Pharmacy Pharmacy $4 for Tier 1 $2 for Tier 1 $14 for Tier 2 $8 for Tier 2 $47 for Tier 3 $42 for Tier 3 $91 for Tier 4 Network Health $200 for tiers 3, $84 for Tier 4 27% for Tier 5 27% for Tier 5 4 and 5 only Medicare
Anywhere (PPO)
90-Day Supply Preferred $5 for Tier 1 $20 for Tier 2 $105 for Tier 3 $210 for Tier 4 Tier 5 not available
90-Day Supply Standard $10 for Tier 1 $35 for Tier 2 $118 for Tier 3 $228 for Tier 4 Tier 5 not available
COVERAGE GAP
You enter the coverage gap when total drug costs reach $3,750.
You pay 44% and Network Health pays 56% for generic drugs. For brand name drugs, you pay 35%, Network Health pays 15% and the drug company pays 50%.
CATASTROPHIC COVERAGE
You enter catastrophic coverage when what you pay and what the drug company pays reaches $5,000.
You pay the greater of $3.35 or 5% of the cost for generic drugs and $8.35 or 5% of the cost for brand name drugs.
Make Your Choice
If you are happy with your current plan, do nothing. You will be automatically enrolled for 2018.
To change plans Call 866-623-1855 (800-947-3529) and we can complete the short enrollment form for you. Visit us online at NetworkHealthMedicare.com/shortenrollmentform, or contact your agent for assistance. Bring this with you to your Network Health Member Appreciation event and talk with an agent.
“
When I signed up for Network Health, I called my (doctor) office and asked the billing department who they liked to deal with the most. Who was the easiest to deal with? They said Network Health.
“
-Bob D., Network Health Medicare member NetworkHealthMedicare.com
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PPO MEMBER EXTRAS SILVERSNEAKERS® FITNESS
Improve your health and live the life you want with SilverSneakers Fitness. The program is included in most Network Health Medicare Advantage PPO Plan benefits and gives you membership at 13,000+ gyms nationwide. This program is designed for all fitness levels and abilities, providing the fitness support you need. Visit SilverSneakers.com to find a location near you.
HEARING AID
For 2018, Network Health will offer a hearing aid discount program with Simpli Hearing, LLC. Members will find quality brand name hearing aids discounted to $1,220-$1,985. The discount program includes a one-year warranty, three office visits, one pack of batteries and one year of loss and damage insurance. For details visit NeworkHealthMedicare.com/hearingaid.
COVERAGE THAT TRAVELS WITH YOU
When visiting another U.S. state, you can get care at the same cost you would back home. Regardless of which state you visit, every provider who accepts Medicare beneficiaries is considered in-network. Traveling outside the U.S., you have coverage up to $100,000 for emergency situations.
In-network when you travel
COVERAGE FOR YOUR SMILE
Protect your teeth and gums with routine preventive dental care. We partner with Delta Dental to include dental care with many* of our Medicare Advantage Plans. For a $30 copayment, you can receive one cleaning and one exam per year. Add a dental rider to any of our plans for more comprehensive coverage, for $35 per month. Refer to the Summary of Benefits for more details. * Not available with Network Health Medicare Go (PPO). For other plans, you must use in-network provider.
MDLIVE® VIRTUAL VISITS
Consult with a board-certified doctor by phone, secure video or MDLIVE App— anytime, from anywhere. Virtual visits are a convenient, no cost way to get care for covered health services that include the diagnosis and treatment of non-urgent medical conditions through electronic means. MDLIVE offered through Network Health, was designed as an alternative to expensive urgent care visits or waiting to get an appointment with your primary care physician for non-emergency medical conditions.
Virtual visits are provided at no cost to you as part of your plan.
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NetworkHealthMedicare.com
HOME TELEMONITORING
At Network Health, we understand managing an ongoing medical condition like heart failure is challenging. That’s why we offer the home telemonitoring benefit. If you’ve been diagnosed with heart failure, this benefit can help you track your health with an easy-to-use monitoring system and phone calls from a member of the home health care team. Your doctor will be involved throughout your care.
IN-HOME HEALTH ASSESSMENTS
Network Health offers in-home health assessments where a doctor or nurse comes to your home to review your medications and talk about any health concerns you may have. The health care professional can also refer you to our care management team for health plan services that can help you stay healthy. We provide these visits at no cost to members who qualify.
NURSE LINE
Network Health’s Nurse Line is available when you have health care questions any time of the day or night. This free 24-hour phone service is available 365 days a year through Health Dialog. The nurse advice line can be accessed by calling 888-879-8960 (TTY 888-833-4271). Health Dialog has been providing services for more than 20 years, and the nurses you speak with can help answer your medical questions.
HEALTH MANAGEMENT
If you have certain health conditions, you’ll have access to a team of registered nurses who can provide information and educational resources to help you manage your condition. • Help to monitor your disease and offer opportunities for you to successfully manage your health. • Support communication between you and your doctor. • Offer educational workshops, like Healthy Living with Diabetes, Living Well with Chronic Conditions and Stepping On (a falls prevention program). • Promote healthy lifestyle behaviors such as exercise and eating right. • Review medications, treatments and answer your questions. • With your permission, work with a caregiver or family member to educate them about your condition so they can best care for you.
HEALTH CARE CONCIERGE SERVICE
Dealing with health insurance can be stressful and confusing. So, we provide friendly, personal service to every one of our members. These caring professionals help with any concerns you may have and get your questions answered. Our health care concierges are just a phone call away, and all customer service calls are answered right here in Wisconsin.
If you don’t understand something, it’s our job to make it easier. Call 800-378-5234 (TTY 800-947-3529). We’re available Monday–Friday, 8 a.m. to 8 p.m. And from October 1–February 14, we’re here every day, 8 a.m. to 8 p.m. The products and services described include value-added discounts that are only available to Network Health Medicare Advantage plan members. These discounts are value-added and not part of our Medicare contract or your plan coverage. NetworkHealthMedicare.com
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NetworkPrime (MSA) NetworkPrime is a Medicare Medical Savings Account (MSA) plan. Here’s how it works.
Medicare MSA Plans Have Two Parts This is a another Medicare Advantage Plan which covers your hospital and medical care (known as Medicare Parts A and B). Once you’ve paid a certain amount for health care (called the deductible), the plan begins paying.
High-Deductible Health Plan
Medical Savings Account
NetworkPrime has a $5,100 deductible and a $0 monthly premium.
This is a special savings account used for health care costs. Once a year, Network Health deposits money into your account, and you can use this money to pay for health care before you meet the deductible. Medicare deposits $2,000 into this account once a year.
BENEFIT
NetworkPrime
Premium Deductible
$0 $5,100 You pay nothing for Medicare-covered services after you meet your deductible. This amount is prorated based on the month you enroll. Network Health will deposit $2,000 into your account prorated based on when you enroll. If you disenroll for any reason during 2018, you’ll be asked to pay back a prorated amount based on the date you disenroll. All Medicare-covered services are billed at the Medicare-approved amount until you reach the deductible. You pay nothing after you reach your deductible.
Annual Deposit from Network Health Services (like hospital stays, doctor visits and emergency room visits)
WHAT’S THAT?
MEDICARE MSA PLAN
This is a special type of Medicare Advantage Plan that combines a high-deductible health insurance plan with a medical savings account. MSA plans are offered by private companies like Network Health and work with Medicare to provide your coverage. You can use the medical savings account to pay for health care services, while the high-deductible plan limits your out-of-pocket costs. 20 | C oncierge
NetworkHealthMedicare.com
Yoga, Pilates, Tai Chi—Oh My W
ith so many exercise options available, what is the best for you? Let’s take a look at some popular exercise options and their benefits.
Tai Chi – Focuses on moving your body gently and slowly,
with deep breathing and meditation. Tai Chi will help with stress relief, increasing flexibility, balance and mindfulness.
Yoga – Specific body positions used for health and relaxation
with a focus on breath control and simple meditation. Yoga will increase your strength, flexibility, mental clarity and provide stress relief.
Pilates – Designed to improve your physical strength, flexibility, posture and enhance mental awareness. With Pilates you’ll focus on using your core (back, abdomen and hips) to improve your posture.
Water Exercise Classes – Exercising in a pool provides
resistance to increase your strength without strain on joints and muscles. This is a great option for those with arthritis pain or those who may be recovering from surgery.
Zumba – Zumba combines motivating, fast and slow rhythm
music, with unique dancing and strength exercises. This helps with coordination and is a fun, easy, high-energy workout. These exercise options are great ways to gain strength and balance, especially through the fall and winter when many of us are less active. Staying strong, steady and flexible will help to avoid sudden falls and the resulting injuries.
Consult your doctor before trying a new exercise class NetworkHealthMedicare.com
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COVER STORY
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To view a video of our members, Dick and Marti, visit our blog CoPilotWI.com
NetworkHealthMedicare.com
discovering
really what
matters
Follow along as one insurance agent becomes a Network Health Medicare member From the moment you meet Network Health Medicare members Dick and Marti Norton, you realize they have a zest for life and have discovered what really matters to them. Throughout their lives, they’ve always found opportunities to do what they love and have always found joy in their work. Retirement isn’t any different. Now they have more time to do what they enjoy, and it certainly keeps them busy. Marti ended up choosing Network Health for both her and Dick after her long career working in the insurance industry. It all started when Marti went to work helping out in an insurance office of a family friend. She learned a lot and the position grew as she gained more experience. By Romi Norton, Photography by Beth DesJardin, Trove Photography
NetworkHealthMedicare.com
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COVER STORY
“I
stuck with it because I was having a good time,” Marti said. “I wrote a lot of long-term care policies, but I enjoyed it more when the advantage plans came along. Then we really had to guide people, because everybody said ‘I don’t understand’.” Marti kept working because she felt it was important to be there for her clients. They would call her back every year, wondering if they should change plans. Most often, she would give the same words of advice, “No, unless something major has happened in your life. This policy is going to work just fine.” Marti believes that her clients stayed with her because they knew they could call her to get answers to their questions and they trusted her. She really understood the insurance business. “When I needed to make my own decision, I could see that it worked. Network Health always emphasized exercise, eating well and staying active, and I think that’s what I was looking for. That made sense to me,” Marti explained. Since Dick had retired several years before Marti, she had seen first-hand how well the plan worked for him. It’s the dependability and one-on-one help that keeps them coming back every year. Ten years ago, it was that same dependability that really came through for the couple when Dick suffered an embolic stroke. “We never got up to the out-of-pocket maximum when he had his stroke,” Marti said. “It’s amazing really, with all of the care he received and all of the follow up, we just didn’t have to worry.” Dick continued, “I kept watching the bills come in and was so surprised at the coverage I was getting. That was a huge relief. I was sure when I went to Mayo Clinic and came back that I would get a big bill. The bill was so small; the rest was all covered. That’s impressive.” Not only are they grateful for their coverage, they are extremely grateful for the care they received at Mercy Medical Center in Oshkosh. Dennis Laundrie, MD, was the provider that selected the right care at the right time,
providing a successful outcome for Dick’s stroke. In fact, the only long-term effect of his stroke is aphasia, which he originally sought treatment for with a speech therapist in Stevens Point. Subsequently, it has been greatly improving with time. “I’m better,” Dick explained. “I went from a highpowered, strong man to where I just couldn’t talk. It was so frustrating; I knew the concepts but I couldn’t get it out. Then suddenly, I’m getting better. I can think more logically and things make more sense. I can express myself better.” Marti continued, “Your doctor swears that if you weren’t in such great physical condition, it could have been a disaster.” Marti served on the board at the Mercy Foundation, where Dick was able to share his story for a local fundraiser. At this event, Dr. Laundrie approached Dick and said he remembered him. It was great to be able to express thanks to the doctor that was there to help him when he needed it most. “I was grateful he had his stroke after he had already retired. I kept working for a long time after that so he really had to figure out how to get along independently. He was at home, which was restful for him. He had to get his own lunch and sometimes even think about what to plan for dinner. That was good for him,” Marti said. “With something that important, you have to keep things going,” Dick said. “You have to have something to look forward to. You can’t say you’re retired and do nothing. You can’t sit around and watch television and let things pile up. I had to get out there and do stuff.” Marti and Dick are now thoroughly enjoying retirement. They are as busy as ever and continue to spend their days doing what they love. For Dick, that’s woodworking, exercising and working on projects around the house. Marti is involved with Master Gardeners at Parkview Prairie and serves on a fund development committee at the Samaritan Center in Menasha. “It’s really rewarding,” she says. “I was very impressed with
WHAT’S THAT?
EMBOLIC STROKE
A blood clot or plaque fragment that forms somewhere in the body (usually the heart) and travels to the brain. Once in the brain, the clot travels to a blood vessel small enough to block its passage. The clot lodges there, blocking the blood vessel and causing a stroke. About 15 percent of embolic strokes occur in people with atrial fibrillation (Afib). Source: stroke.org 24 | C oncierge
NetworkHealthMedicare.com
“
It’s amazing really, with all of the care he received and all of the follow up, we just didn’t have to worry. - Marti Norton
“
the leadership some years ago when it first started and I still am.” They also participate in Learning in Retirement. “We go to that from time to time. We don’t go to all of them, since we don’t want to be overscheduled by any means, but we go to the ones that are of interest to us. It’s a nice way to stay involved and learn things you don’t know a lot about. That’s something we’ve learned from Network Health, too. Stay involved. And we do,” Marti said. When asked what they enjoy most about this part of their life, they both agree. “It’s the freedom to get up in the morning and do what you want to do,” Dick explained. They’re thrilled to have family close by too, and because of that, they remain very close to their adult children and grandchildren. They are thankful they have the ability to see them and be a part of their daily lives. They enjoy traveling and realize that Network Health helps them experience worry-free travel. Marti commented, “We know that no matter where we go, if something happens, we’re covered just like we are at home.” “We’ve learned how important it is to do what matters. Over the years, what matters has changed, but we continue to have fun and live our days doing what matters to us today,” Dick said. And that is something we should all do.
WHAT’S THAT?
APHASIA
An impairment of language, affecting the production or comprehension of speech and the ability to read or write. Source: aphasia.org. NetworkHealthMedicare.com
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Help Prevent Opioid Abuse N
o one likes talking about substance abuse, but it’s a growing problem in Wisconsin. According to the Wisconsin Department of Health and Human Services, more people died from opioid overdoses than car crashes in 2015. Opioids are narcotic medications that are used to treat mild to severe pain and any of us could fall victim to a dependency on opioids if they are not taken as directed.
Do you have any of the following medications in your house?
Oxycodone Morphine Fentanyl Meperidine
Hydrocodone Codeine Hydromorphone Methadone
These prescription painkillers are some of the most commonly used opioids. If you have been prescribed opioids, use them only until pain is manageable with non-narcotic pain relievers. Keep opioid medications locked up, and dispose of unused medications as soon as they are no longer needed. Resist the urge to save them “just in case.” And, beware of propoxyphene. It’s an opioid that was removed from the market several years ago and shouldn’t be used at all.
Make sure you are disposing of the drugs properly. Flushing or draining the drugs can contaminate our water supply. Instead, you can get rid of unused prescription medications by doing the following.
Dropping them off at a local police department (call ahead to make sure you know exactly what they accept) Use the Wisconsin DEA’s mail-back program Attend a drug take back event
To learn more about how to return unused opioids, visit doseofrealitywi.gov/drug-takeback. If you have questions or would like to speak with a representative from Network Health, please email us at QI@networkhealth.com.
Visit goemmi.com/NHPM17OP for free, interactive programs on opioids. 26 | C oncierge
NetworkHealthMedicare.com
Medication Therapy Management I
t is estimated that 1.5 million preventable adverse events occur every year due to medication-related problems. These adverse events can be serious, leading to hospitalization or death. To address and prevent these issues, Medicare encourages outreach to eligible members through a Medication Therapy Management (MTM) program. The MTM program is free, offered confidentially over the phone and has provided many benefits for our members. New this year, our Network Health Pharmacists are collaborating with our outside vendors to conduct MTM calls. Many members are grateful and have benefited from the program. It’s provided assistance with the cost of medication, managing side effects and helping members better understand their medications or conditions. While we encourage you to keep a good working relationship with your physician and local pharmacist, we hope to provide a valuable experience by allowing you to take as much time as you need, asking questions and discussing any concerns you may have. As a Network Health Medicare Advantage member, you may be eligible to participate in our MTM program at no cost to you. Eligibility is based on the number of medications you are taking, number of medical conditions and your annual medication costs.
What members are saying
“
If you meet the eligibility requirements, you are automatically enrolled in the MTM program and will receive the following, at no cost to you. An introductory letter that tells you how to get started. An offer to participate in a comprehensive medication review with a pharmacist. This review will help you get the best results from your medicines. You will receive a phone call from the pharmacist and can discuss your medications in the privacy of your home. You will receive a letter after your review, recapping the discussion to share with your health care providers. If you are not eligible, but are interested in the program, just reach out to us at 800-378-5234 (TTY 800-947-3529) Monday–Friday, 8 a.m. to 8 p.m. We are happy to assist you in coordinating a meeting with a pharmacist and the service will still remain cost-free.
Mom had a good checkup and the APNP listened to what I had to say regarding my conversation with you on med side effects. Today, my mom told me she could tell the difference in her pain without the morning and noon doses of tramadol. Thanks again for your follow up and concern. I am very appreciative to have you to discuss my thoughts and concerns for helping my mom. -Member’s son
“
Visit goemmi.com/NHPM17MED for a free, interactive program on medications. NetworkHealthMedicare.com
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How to Recognize Symptoms of Depression
D
ealing with depression and mental health concerns can feel isolating, but if you’re living with these medical conditions, you’re not alone. According to the National Institute of Mental Health, approximately 16.1 million adults suffer from major depression. There’s a good chance you or someone you know is struggling, or has struggled, with depression at some point in their lives.
Feelings of sadness and depression are normal, especially in reaction to a loss or changes in life. But when feelings of intense sadness, helplessness, hopelessness or worthlessness last for days or weeks, it’s time to talk to someone. This is especially true if these feelings keep you from your normal routine.
Doctors can be a great resource in treating depression, but first you have to recognize the symptoms.
Teletherapy is a new, convenient and affordable way to receive behavioral health care. Through your phone or computer, you can connect with a licensed therapist from the comfort of your home using MDLIVE® behavioral health services. Access MDLIVE by logging in to My Account at NetworkHealthMedicare.com and clicking on the MDLIVE Virtual Visits link. This service is available to all Network Health Medicare Advantage members at no cost.
n n n n n n n n n n n
Insomnia, early morning wakefulness or excessive sleeping Difficulty concentrating, remembering details and making decisions Fatigue and decreased energy Feelings of guilt, worthlessness and/or helplessness Feelings of hopelessness and/or pessimism Irritability, restlessness Loss of interest in activities or hobbies once pleasurable Overeating or appetite loss Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment Persistent sad, anxious or “empty” feelings Thoughts of suicide or suicide attempts
As the days shorten this fall and the weather turns cold and dreary, be on the lookout for signs of depression in yourself and those around you. Seasonal affective disorder is a very real thing, and other forms of depression can feel even more overwhelming when winter rolls around. If you or a loved one has symptoms of depression, talk to your doctor as soon as possible. There are many types of treatment depending on your situation, including medication, light therapy, talk therapy and others. The sooner treatment begins, the more effective it is and the sooner you or your loved one will feel better.
If you have feelings that you may want to hurt yourself or someone else, please DIAL 911 or call the crisis counselors at 800-273-8255 where you’ll be connected to a skilled, trained counselor at a crisis center in your area 24 hours a day, seven days a week.
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NetworkHealthMedicare.com
KNOW YOUR NUMBERS
BLOOD PRESSURE If you are older than 60
If you are younger than 60
If you have diabetes or chronic kidney disease
150/90
140/90
140/90
High blood pressure is common among Americans—nearly one in three U.S. adults has high blood pressure, according to the American Heart Association. Unfortunately, this leads to an increased risk for developing serious health conditions. DON’T BE THE ONE IN THREE
Knowing your numbers and being informed can help you manage risk factors and bring blood pressure under control.
WHAT SHOULD I DO IF I HAVE HIGH BLOOD PRESSURE?
Talk to your doctor. Together, you can decide what steps you need to take to achieve levels that are healthy for you. If your initial blood pressure taken at your doctor’s office is higher than usual, be sure to have it rechecked before you leave.
HOW TO CONTROL YOUR RISK FACTORS n n n n n
Lose weight. If you’re overweight, losing even five pounds can help lower your blood pressure. Get active. Regular physical activity can help lower your blood pressure and keep your weight under control. Don’t use tobacco and limit alcohol. Smoking or chewing tobacco can raise blood pressure. If you smoke, quit. And, only consume alcohol in moderation because too much is a contributing factor of high blood pressure. Eat a healthy diet. A diet rich in whole grains, fruits, vegetables, low-fat dairy and low in sodium has been shown to help lower blood pressure. Reduce stress. Stress can raise blood pressure temporarily and may lead to overeating and tobacco or alcohol use. If you often feel overwhelmed or stressed, it’s important to identify it and take steps to reduce it.
Visit goemmi.com/NHPM17HTN for free, interactive programs on hypertension. NetworkHealthMedicare.com
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Common Questions About the Flu Shot I
n the United States, flu season begins as early as October, lasting through the winter and sometimes until the end of May. According to the Centers for Disease Control and Prevention (CDC), it’s impossible to predict what the upcoming flu season will be like in terms of timing, severity and length. The best way to prevent the flu is by getting a flu shot. You can also take everyday measures to prevent getting the flu. For instance, keep your distance from people who are sick and wash your hands to reduce the spread of germs. Learn the facts about the flu shot by reading answers to common questions listed below.
Who should get a flu shot?
According to the CDC, anyone over the age of six months should get a flu vaccine.
How does the flu shot work?
The flu shot is an injection, usually given in the arm, which contains an inactive vaccine made of a killed flu virus. Since the virus in the vaccine isn’t live, the shot enables your body to build up a resistance without actually giving you the flu.
Can I get the flu from the flu shot?
No, you cannot get the flu from the flu vaccine. According to the CDC, almost all people who receive a vaccine experience no side effects.
Where is the vaccine available?
Flu vaccines are available at most doctor’s offices, clinics, pharmacies and even many employers. You don’t need to schedule an office visit with your doctor to get a flu vaccine. Many clinics and pharmacies set aside special days and times to give the vaccine. You can also get the quadrivalent (four strand) flu shot at one of our Network Health Medicare member events in October. See page 12 to find the member event closest to you.
Can I get the nasal spray instead of the shot? The CDC recommends that the live attenuated influenza vaccine (LAIV), also known as the nasal spray flu vaccine or FluMist, not be used during the 2017-2018 flu season. As a result, the nasal spray flu vaccine will not be covered as a preventive immunization under Network Health plans.
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In addition to the flu shot, the Centers for Disease Control and Prevention (CDC) also recommends the pneumonia vaccine for all adults 65 years or older. There are two vaccines available. Talk to your doctor to see which one is right for you.
Visit goemmi.com/ NHPM17FLU for free, interactive programs on flu vaccine.
NetworkHealthMedicare.com
Home Telemonitoring t Network Health, we understand managing an ongoing medical condition like heart failure is challenging. That’s why we’re offering the home telemonitoring benefit.
WHAT IS HOME TELEMONITORING?
If you’ve been diagnosed with heart failure, this benefit can help. Your doctor will be involved throughout your home telemonitoring process. By participating, you will receive the following. n An assessment from one of our home health care team members n An easy-to-use monitoring system that will regularly record and send your weight, blood pressure, pulse and oxygen level to help monitor your condition. The system will be delivered and set up by a home health care team member who will teach you how to use it. n Personal attention and phone calls from home health care team members, with results sent directly to your doctor n Help setting and achieving healthy goals n Educational materials
WHAT IS THE COST?
This is a covered benefit and there is no cost to Network Health Medicare Advantage (PPO) members who qualify.
HOW CAN HOME TELEMONITORING HELP ME?
This benefit can help you stay where you want to be—in your own home. Heart failure is one of the leading causes of hospitalization in people 65 and older. By taking advantage of this benefit, you’ll learn how to better manage and control your symptoms. And, it will help you avoid hospitalization and emergency room visits.
HOW DO I SIGN UP?
To learn more about Network Health’s telemonitoring benefit, call your health care concierge or customer service at 800-378-5234 (TTY 800-947-3529) Monday–Friday, 8 a.m. to 8 p.m.
Visit goemmi.com/NHPM17HF for free, interactive programs on heart failure.
Member Rights and Responsibilities Do you know your rights and responsibilities as a Network Health member? To learn more about how we provide you with service that respects your rights, go to NetworkHealthMedicare.com, select Member’s Corner and scroll down to the link titled Your Rights and Responsibilities. You can also call customer service at 800-378-5234 (TTY 800-947-3529), Monday–Friday, 8 a.m. to 8 p.m. to request a hard copy of this information. NetworkHealthMedicare.com
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SE
Health and Wellness or Prevention Information
To us, you’re more than a Medicare member
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It fits my values. It’s the personality of the people. It’s a feeling. Makes a huge difference. You’re dealing with real people. Richard C., Network Health Medicare member
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Everything is pretty much laid out with what you’re going to be getting. They don’t beat around the bush, they stay true to facts. Sue L., Network Health Medicare member
Network Health Medicare Advantage plans include MSA and PPO plans with a Medicare contract. Enrollment in Network Health Medicare Advantage Plans depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change January 1 of each year. You must continue to pay your Medicare Part B premium. MSA plans combine a high deductible Medicare Advantage plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins. Medicare MSA plans don’t cover prescription drugs. If you join a Medicare MSA plan, you can also join any separate Medicare Prescription Drug plan. There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary. Contact the plan at 800-378-5234 (TTY 800-947-3529) for additional information.