WELLNESS ABROAD A Healthier Expat Life
Table of
CONTENTS
November 2015
Your Guide To: A Healthier Expat Life
03
How To Use Your Network and Save Money
09
Tiramisu Eggnog Truffle Recipe
05
Holiday Travel Musts
10
Do I Need A Probiotic?
06
Useful Apps for Travel
11
Provider Spotlight
07
Rejuvenate Your Travel Skin
12
Paris, City of Light
08
Apps Corner
13
Breaking News
2
H o w To U s e Yo u r N e t w o r k
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( a n d s a ve m o n e y ) aybe you’ve read that one of the best ways to save on health care costs is to “stay in network.” But you’re not sure what that means. You’re not alone. Many people find the term confusing. We’re here to help you understand.
A network is a group of health care providers. It includes doctors, specialists, dentists, hospitals, surgical centers and other facilities. These health care providers have a contract with us. As part of the contract, they provide services to our members at a certain rate. This rate is usually much lower than what they would charge if you were not a WellAway Limited member. And they agree to accept the contract rate as full payment. You pay your coinsurance or copay along with your deductible. Some plans do not offer any out-of-network benefits. For those plans, out-of-network care is covered only in an emergency. Otherwise, you are responsible for the full cost of any care you receive out of network. The information on this page is for plans that offer both network and out-of-network coverage.
Why out-of-network costs more
care
There may be times when you decide to visit a doctor not in the Aetna Passport network. If you go out of network, your out-of-pocket costs are usually higher. There are many reasons you will pay more if you go outside the network. Keep reading to learn more. The health plan pays less
Your Wellaway Limited insurance plan may pay part of the doctor’s bill. But it pays less of the bill than it would if you got care from a network doctor. Also, some plans cover outof-network care only in an emergency. Out-of-network rates are higher An out - of - network doctor sets the rate to charge you. It is usually higher than the amount your Wellaway Limited plan “recognizes” or “allows.” We do not base our payments on what the out-of-network doctor
bills you. We do not know in advance what the doctor will charge.
An out-of-network doctor can bill you for anything over the amount that Wellaway Limited recognizes or allows. This is called “balance billing.” A network doctor has agreed not to do that. Cost sharing is more
What you pay when you are balance billed does not count toward your deductible. And it is not part of any cap your plan has on how much you have to pay for covered services.
Many plans have a separate out-ofnetwork deductible. This is higher than your network deductible (sometimes, you have no deductible at all for care in the network). You must meet t h e
out-of-network deductible before your plan pays any outof-network benefits.
With most plans, your coinsurance is also higher for out-of-network care. Coinsurance is the part of the covered service you pay after you reach your deductible (for example, the plan pays 80 percent of the covered amount and you pay 20 percent coinsurance). You’ll have more work, too
We need to approve some medical procedures before they are done. We call this precertification.
Some common procedures that require pre-certification include non-emergency surgery, outpatient physical rehabilitation, inpatient hospice, CT scans, and MRIs. If you visit a network doctor, that doctor will handle pre-certification for you. If you go out of network, you must take care of pre-certification yourself. That means more time and more paperwork for you.
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How We Determine What To Pay For Out-of-Network Care
The plan you have determines how much you pay for out-ofnetwork care. The exact amount depends on: • The method your plan uses to set the “recognized” or “allowed” amount • The percent of the allowed amount to be paid by the plan (like 80 percent or 60 percent).
Your plan may base the allowed amount on: •
Medicare-based rates, which are determined and maintained by the government • “Reasonable,” “usual and customary” and “prevailing” charges, which are obtained from a database of provider charges
• Other types of rate schedules
To find the method and percent, check your plan documents. Or contact us at the toll-free number on your member ID card. If you would like to find a doctor in your network on your own, Please visit the Aetna search module at: http://goo.gl/cbF3K3 or scan the QR code. You can also contact your Wellaway Limited Concierge 24/7 at 1-855-773-7810 4
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Holiday Travel Musts
raveling is stressful. Packing and arriving to your destination as planned, has become more and more challenging. Holiday travel is ten times more exhausting. Not only do you need to arrive by the holiday to see your family and friends, airports and roads are flooded with people trying to do the same thing. Whether you are driving or flying this holiday season, we have put together some helpful tricks and tips to make your holiday travel bearable and perhaps even enjoyable!
Know your Airline, Know your Route
When to Travel
Anything can happen when you are traveling. Plan and think ahead of items that you may need and keep them on hand. While you should be prepared, be practical in what you are packing. Lugging around unneeded belongings will make getting around more difficult.
The hour at which you choose to travel can make a huge impact on the traffic you face. If you can plan your schedule according to these guidelines, you may avoid having to deal with lines and delays. If you can, leave the day of the holiday or days prior this is best. The day before the holiday is the busiest time.
If you are flying, make sure you arrive with plenty of time. Also check the airline’s restrictions and costs of checking bags. If you are driving, plan your route ahead of time and make note of any roadwork that may be going on at the time of your journey. Also, go back to basics and check your vehicle as well as the tire pressure. Plan for the unexpected
If you are flying, the earlier the flight the better. Did you know that Flight statistics show that planes traveling earlier in the day have a better on-time performance? And if your flight is canceled, you will have the option of taking a flight later in the day. Also, there will be fewer lines at security.
On an airplane, if you decide to check a bag, make sure you have all of your prescription medication, toiletries and an extra set of clothes on your carry on. In the unlucky instance that your bag is lost, you will have your essentials. Pharmacies and doctor’s offices are usually closed on holidays, so replacing medications is more challenging than usual.
If you are driving, it is best to head out when everyone is sleeping. Make sure to get plenty of rest and pack snacks. You can nap at your final destination. If you are traveling with children, they can sleep through the night and not deal with a boring car ride.
Avoid the Stress When flying… Avoid checking bags if possible. This assures you that you will have your belongings at your final destination and avoid baggage claim.
Driving, you may want to pack tire chains for snowy conditions, flashlights and a first aid kit.
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Holiday Travel Musts continued...
Do not wrap gifts prior to flying. These may need to get unwrapped for security purposes. If you can, ship your gifts ahead of time or order them online to be delivered to the recipient directly. Gift cards are also easy for travel. Pack earplugs and an eye mask if you would like to sleep or disconnect. It’s amazing how well they work and silence is guaranteed to help you relax. When driving…
Have a good playlist or music app prepared to amuse you, whether it’s personally on head phones, or for everyone on the trip. If traveling with children, make sure they have sufficient games or media to keep them entertained If traffic becomes an issue, or if your road trip is simply long, plan some fun stops to make the drive less cumbersome. Lastly, no matter what form of travel you are embarking on this year, it’s amazing how important food is to happiness. Pack your favorite snacks to keep you and your group fed and satisfied. Wellaway Limited wishes you a happy holiday season to you and your family and safe travels! •
Useful Apps for Travel FlightAware allows you to track the real-time flight status & tracking map of any commercial flight worldwide. It can also track general aviation in the United States & Canada.
Gate guru gives you airport amenity information, TSA wait times, airport tips, maps, full flight, hotel and car rental information at your finger tips.
Gas prices can vary by up to 20 cents per gallon or more. GasBuddy helps you find the cheapest gas prices with one tap.
Need to go, on the go? Search, view, rate, and add bathrooms! SitOrSquat by Charmin can help you find public restrooms near you or where you’re planning to travel.
FoodSpotting has the best user uploaded pictures of the most delicious dishes from all the local places around you.
Little Peanut on the Go lets you create packing and to-do lists, build care schedules to share with caregivers, and check in on your child’s day while away.
6
REJUVENATE Your “Travel Skin”
A
s all of us globetrotters know too well, all forms of traveling can be hard on the skin. Whether you travel up to 100 hours a month, or find yourself in the car too much due to city traffic, your skin simply does not look as fresh and bright as it can. I know that when I fly for over 5 hours consecutively, I need to make a conscious effort to keep myself hydrated by drinking plenty of water. On long car rides I make sure to reapply sunscreen to my face and exposed areas. I really wanted to know more effective ways to keep my skin looking fresh upon arriving to my final destination. I wanted to know to defeat what I call “travel skin”. Thankfully, Dr. John Layke of Beverly Hills MD explains the causes of skin issues when traveling and has some excellent advice to improve these problems. There are several factors that cause dry and dull skin when traveling. Dr. Layke says these are: • Dry recirculated air takes moisture out of the skin • Stress causes pronounced sagging • Dehydration causes flaking and creasing • Reduced circulation causes dullness & blotchiness • Fluid retention causes eye bags and puffiness
These are the very best tips for how to revive your skin post travel: 1. Renewing your skin tone Your skin can become very dull or blotchy and we often simply think that this can be from dehydration. However, this is caused by lack of circulation which can often occur when seated too long. “Hydrotherapy is the process of exposing your skin to quick temperature fluctuations in the shower.” Explains Layke. He recommends using lukewarm water because hot water can strip the skin of moisture. Once ready, use hot water for 1-2 minutes and then switch to the coldest temperature you can stand. Switching from extreme temperatures causes the blood vessels to dilate and increase blood flow which will carry needed oxygen and nutrients back into skin. This can feel invigorating and the effects are usually instant for most people who try it!
2. Reviving Puffy Eyes The dreaded puffy eye makes us all look tired and older. Once again, this is caused by staying still for a long time. Fluid can settle under your eyes, creating dark circles and bags. To reduce inflammation, put your eye cream in the refrigerator for at least an hour before applying. The coldness of the cream constricts the blood vessels under your eyes, which will greatly help.
7
Rejuvenate your “Travel Skin” continued...
Dr. Layke even suggests to his patients that they do this with anti-aging serums and creams. This helps with instant tightening. 3. Brightening a Tired and Dull Complexion Due to dehydration, dry air and low blood flow, many times our skin can become gray or purplish. Thankfully, this is easy to fix. It is recommended that after stretching and rehydrating with a minimum of 6 ounces of water, dip a washcloth into a mixture of cold milk and ice cubes. Wring out the excess liquid and lay over face for 5 minutes. Then rinse and apply usual products. This is effective because the lactic acid in the milk acts as a brightener and helps skin to retain moisture. This, with the coldness helps to revive your complexion quickly. 4. Double up on Moisture Traveling should not be considered a day to follow your normal skin care regiment. Layke suggests doubling up on your usual moisturizing amount. You should first apply an amount and allow it to settle. Then apply a more liberal amount to seal in the moisture and nutrients. I hope you have found these tips helpful for your skin care plans on future trips or long days. These are simple remedies to keep in mind while on the go. Try them out, you may be amazed by the results you have! •
Apps Corner
WellAwa y Limited’s Picks
See a dermatologist, right from your phone.
Taking skincare to the next level, Spruce offers dermatologist appointments virtually through your phone. Once you’ve chosen a certified dermatologist through the app (each doctor’s profiles are available to choose from) users can then share skin issues, information and photos through the app. Whether you have an acne breakout or a skin rash, you can send photos or details regarding your condition immediately through the app. Within 24 hours, you will receive a personalized skincare treatment plan and prescriptions, if any are needed. The virtual skincare consultation and treatment plan is available for $40 for those who want to bypass a trip to the dermatologist office. *Please note that this is not covered by Wellaway Limited policies
mydistriKt Your guides are local, enthusiasts and tourists, who also went through your city and tell you all the tips, good addresses, the corners to see or avoid, posting photos, articles and videos. Simply select the area in which you are located or search by keywords, and you will discover the distriKts created nearby. Keep your personal distrikt private or share it publicly for others to find and see. People can connect with your profile based on the locations you share. Share your favorite spot to hangout or find new ones you may not have discovered before. When traveling you can find local hangouts and avoid tourist traps or bad areas, explore hidden gems or just get off the beaten path.
What’s App and Viber are 2 applications allow you to text anyone you want (which application) and even to call (only on Viber) anywhere. Note: Anywhere ... where there is a good connection. While the app works well with a phone subscription, they are really more reliable if you are on wifi. What’s App available for iPhone, Android, BlackBerry, Windows Phone and some Nokia (S40 and Symbian) Viber available on iOS, Android, Windows Phone, BlackBerry, Bada and Nokia
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Tiramisu Eggnog Truffle
The classic dessert gets a holiday twist with eggnog flavors and an opulent presentation.
Ingredients
Preparation
Whisk 1 1/3 cups sugar, 1/4 cup water, 1/4 cup rum, 3 tablespoons brandy, yolks, and nutmeg in metal bowl. Set bowl over saucepan of simmering water (do not allow bottom of bowl to touch water). Whisk constantly until mixture thickens and candy thermometer inserted into mixture registers 140°F for 3 minutes, about 5 minutes total. Remove bowl from over water. Whisk mascarpone, 1 container at a time, into warm custard until blended. Using electric mixer, beat whipping cream, vanilla, 1 tablespoon brandy, and 1 teaspoon rum in large bowl until cream holds peaks. Fold in mascarpone mixture. Bring 1 cup water to simmer in small saucepan. Remove from heat. Add 2 tablespoons sugar and espresso powder; stir to dissolve. Mix in liqueur. Submerge 1 biscuit in espresso mixture, turning to coat twice; shake excess liquid back into pan. Place dipped biscuit, sugared side facing out, around bottom side of 14-cup trifle dish, pressing against side of dish (biscuit may break).
1 1/3 cups plus 2 tablespoons sugar 1 1/4 cups water 1/4 cup plus 1 teaspoon dark rum 4 tablespoons brandy 12 large egg yolks 1/2 teaspoon ground nutmeg 4 8-ounce containers mascarpone cheese* 2 cups chilled whipping cream 2 teaspoons vanilla extract 6 1/2 teaspoons instant espresso powder 7 tablespoons KahlĂşa or other coffee liqueur 2 6.15-ounce or four 3.5-ounce boxes Champagne biscuits or Boudoirs (about 60 crisp ladyfinger cookies)* 1 cup semisweet chocolate chips, finely ground in processor Chocolate Leaves Repeat with enough biscuits to go around bottom sides of dish once. Dip more biscuits and arrange over bottom of dish to cover. Spoon 2 cups mascarpone mixture over biscuits; spread to cover. Sprinkle 1/4 cup ground chocolate over, making chocolate visible at sides of dish. Repeat with more biscuits dipped into espresso mixture, mascarpone mixture, and ground chocolate in 2 more layers each. Cover with 1 more layer of dipped biscuits and enough mascarpone mixture to reach top of trifle dish. Sprinkle remaining ground chocolate over, covering completely. Cover and chill overnight. Gently press stem end of largest chocolate leaves around edge of trifle. Fill center with smaller leaves. (Can be made 8 hours ahead; chill.) *Available at Italian markets, specialty foods stores, and some supermarkets.
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Do I Need A Probiotic?
Y
ou may have heard of probiotics on TV, in magazines or from your doctor. You may even take a probiotic now…but do you know what they are and how they can affect your body and health? With the plethora of promises made by mainstream ads funded by a multi-billion dollar industry, we thought it was important to give our members some insight and basic information about probiotics. What are Probiotics? The World Health Organization (WHO) defines probiotics as live organisms (bacteria or yeast) which, when administered in adequate amounts, confer a health benefit. Ads promise that probiotics help with digestion, strengthen immunity to curb colds and flus, promote weight loss and protect against periodontal disease. Should we believe these ads? And are all probiotics good for us? About Probiotics These days, probiotics come in a range of forms, including, capsules, yogurts, fermented milks, powders or fruit drinks. The most commonly used probiotics are lactobacillus and bifidobacteria as well as certain yeasts. As common as these products are, they are not regulated by the FDA and anything these brands claim, such as that probiotics “support good digestive health” are basically unproven. Generally, probiotics are thought to be pretty safe to take. There are concerns with infants and patients that have compromised immune systems. There have been reported side effects such as, fatigue, itching, diarrhea and over stimulation of the immune system. About the Gastrointestinal System and probiotics Over 10 trillion tract and can bacteria is
microbes, 500 species- live in the GI weigh up to 3 pounds. This needed to maintain GI health and their composition is based on
factors l i k e age, diet and disease. An inappropriate immune response to certain bacteria may help contribute to several diseases such as Irritable bowel syndrome (IBS) and Inflammatory Bowel Disease (IBD). It is thought that probiotics rebalance the microflora in the colon and modify the gut’s immune response. 10
Do I Need A Probiotic? continued...
When to take Probiotics As mentioned before, probiotics are used to help with a variety of GI problems, including IBS and IBD. For IBS patients, probiotics may help decrease the symptoms of gas and bloating by restoring normal bacterial balance. Some studies have shown that the composition of bacteria in patients with IBS is different from healthy people. For patients suffering from IBD, some studies have shown that probiotics reduced the risk of antibiotic associated diarrhea but other studies have found that it works no better than a placebo. More research is needed. If you find that your digestion or gastrointestinal health is not up to par, reach out to your doctor, probiotics may be an easy solution to your problems. There is an increasing interest in the relationship between gut bacteria and overall human health and diseases. Science and research has shown that there are future indications for the use of probiotics in mood disorders, obesity, autism and dementia. At this time, probiotics should be considered as a supplement to conventional therapy. •
Provider Spotlight Mount Sinai Medical Center 4300 Alton Road, Miami Beach, FL 33140 Founded in 1949, Mount Sinai Medical Center is the largest private independent not-forprofit teaching hospital in South Florida. Mount Sinai’s Centers of Excellence combine technology, research and academics to provide innovative and comprehensive care in cardiology, neuroscience, oncology and orthopedics. Among a select few statutory teaching hospitals in the state, Mount Sinai is the hospital of choice for those who seek the level of expertise and care that only a teaching hospital can offer, and the commitment to quality has been continuously recognized by U.S. News & World Report.
305-674-2121 Main number 305-674-2200 Emergency room
Wellaway Limited is honored to work with such a great institution and have them as a part of our broad network of excellent top-rated providers. For an appointment with a MSMC provider, please contact use your ConciergeCare service.
SOURCE: taken from MSMC website http://www.msmc.com/about-us/
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Paris, Ville Lumière As the capital of France, Paris is considered one of the most beautiful cities in the world. It is a city like no other in the world. The world admires Paris for its food, its fashion, its beautiful architecture, its romantic atmosphere and so much more. Time spent in Paris can be the adventure of a lifetime! Whether you’re a fashion addict, a lover of fine cuisine or simply an adventurous tourist, you will surely find what you’re looking for in the City of Light. Paris has been famous for its restaurants and gastronomy, not to mention its incredible architecture but it also has been an international capital of high fashion. From the Pyramid of the Louvre Museum to the shopping on Rue de Rivoli, passing by the cobbled streets in the Marais, the catacombs or the beautiful Luxembourg Garden, the city is full of treasures which are waiting to be discovered. Furthermore, Paris is the perfect example of melting pot. People from all educational and cultural backgrounds have found their place in the City of Light. Whether you are simply a tourist exploring or future expatriate, the city will welcome you with open-armed. For these reasons, Paris will always be a very special place. The WellAway Team.
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BREAKING NEWS ALERT
Superbugs
S
What are they and what do we do?
uperbugs are bacterial infections that cannot be treated using two or more types of antibiotics. Any species of bacteria can turn into a superbug. The single leading factor contributing to this problem is the misuse of antibiotics. “What the public should know is that the more antibiotics you’ve taken, the higher your superbug risk,” says Eric Biondi, MD, who runs a program to decrease unnecessary antibiotic use. “The more encounters you have with the hospital setting, the higher your superbug risk.” You may hear about these terrible cases from time to time on the news but most people do not realize how common these untreatable and stubborn sicknesses have become. According to the CDC, each year about 2 million people get sick from a superbug. About 23,000 people die. The most noteworthy outbreak this year was of CRE (carbapenem-resistant enterobacteriaceae) linked to contaminated medical tools sickened 11 people at two Los-Angeles area hospitals. Two people died, and more than 200 others may have been exposed. What is being done about this? How will we control these bacterial strains from becoming more potent and how will drug companies d e v e l o p antibiotics to fight these strains? Under t h e president’s plan, hospitals would need to establish antibiotic stewardship programs to focus doctors on properly prescribing antibiotics.Only about half of hospitals currently have programs like this. In 2017, Medicare and Medicaid services will be expected to make this a requirement for eligibility for reimbursements. This will of course help push providers to have these departments and programs and use them. Studies have shown that hospitals that use these programs saw a decrease in antibiotic acquisition costs, which of course would help the providers as well as the patients. New antibiotics are always going to be needed but development has slowed by 80 percent over the last 20 years due regulations and of course, what is m o r e lucrative for pharmaceutical companies. Research and testing is costly and d r u g companies will make more off of consumers selling medications patients will need to take for long periods of time, even perhaps for the rest of their lives, such as medications for blood pressure, cholesterol and diabetes. In an attempt to lure the companies to invest more time and money in antibiotics, in 2012 the Generating Antibiotic Incentives Now Act was passed, which gives the pharmaceutical giants an extra five years to sell a new entrant exclusively 13
before generics can be produced. They are also able to get a fast- track approval by the FDA. According to Pew Charitable Trusts, 36 antibiotics are currently in the U.S. pipeline. There are eight drugs in the final trials, four or 5 of which are likely to make it to market. Antibiotics used in the food we eat is also a huge contributor to the problem. The president’s plan also call for food producers to limit the use of medically important antibiotics and to eliminate use to make produce and livestock larger. This is why eating organic foods has become so common. The public has become more aware that the use of these antibiotics (and not to mention hormones) in food is extremely unhealthy. To protect yourself from superbugs, do not abuse antibiotics and be sure to always inform your doctor(s) of your history with antibiotics and your concerns about it. Make an effort to eat organic, antibiotic and hormone free foods. Here are some of the growing superbug threats identified in the 2015 Whitehouse report. Urgent Threat: Carbapenem-Resistant Enterobacteriaceae (CRE) What is it? It’s a family of bacteria normally found in your gut. But many types of CRE are resistant to all antibiotics, including carbapenem, which is usually the last resort. E. coli is an example. How do you get it? Healthy people usually don’t get this type of infection. Most cases are in people who are in the hospital or a medical care facility, like a nursing home. The bacteria can be hard to remove from medical tools that are placed into the body, such as catheters, breathing tubes, or viewing scopes, even after cleaning. That’s what happened in California, after doctors unknowingly used contaminated endoscopes on patients. Why is it a concern? They can cause life-threatening blood infections. Some research says that up to 50% of patients who are sick from CRE die because of it, according to the CDC. Urgent Threat: Clostridium difficile (C. diff) What is it? It’s a type of bacteria that can live in your intestines. Usually, it does no harm. But some things can cause it to overgrow, triggering serious problems. How do you get it? Most people who get a C. diff infection are getting medical care. The biggest risk factor is taking antibiotics. While antibiotics may cure the bacteria that are making you sick, the drugs can also knock out the healthy bacteria in your digestive tract. Then C. diff takes over. Serious Threat: MRSA What is it? MRSA stands for methicillin-resistant Staphylococcus aureus. .It is a type of bacteria that cannot be treated with penicillin. Many healthy people have staph on their skin and in their nose and it doesn’t make them sick. But you can spread it to others. How do you get it? This infection most often happens to people in the hospital, often after surgery. It can infect a wound and spread to surrounding tissues and your blood. But new strains have emerged outside medical settings. There have been recent concerns about MRSA outbreaks among athletes, including in schools. The bacteria can spread easily with skin-toskin contact. Your risk is higher if you have a cut. • 14
Wellness Abroad is published as a service for members of WellAway Limited. WellAway Limited is an industry-leading membership service that provides benefit-rich coverage and support to expatriates as they adjust to their new lives abroad. WellAway Limited offers expats the first Affordable Care Act (ACA/Obamacare) compliant healthcare product. The newsletter is intended to provide general wellness information. It is not intended to provider personal medical advice, which should be obtained directly from a healthcare provider. Š 2015. Printed in Bermuda.
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