AlaskaCare Wellness News | October 2018

Q: What does the AlaskaCare Employee Health Plan Open Enrollment and Halloween have in common?

A: They both happen on Wednesday, October 31, 2018. 

This year’s Open Enrollment which runs October 31, through November 21, brings with it good news and a few important changes. 

Here are some highlights:

• Lower deductibles! AlaskaCare will continue to offer the same choice of quality medical plans in 2019 with decreased deductibles!
  
  AlaskaCare is pleased to announce your medical plan deductibles will decrease by $100 for an individual and $200 for a family, effective January 1, 2019.
  
  This reduction is possible because of cost saving initiatives implemented over the past two years and excellent plan experience.
  
  
• Effective January 1, 2019, OptumRx will become the State of Alaska’s pharmacy benefits manager and will administer prescription drug benefits for both the employee and retiree AlaskaCare health plans.
• AlaskaCare has expanded coverage for habilitative services. Habilitative services help you keep, learn, or improve skills and functioning for daily living. The new, expanded benefit will include coverage of applied behavioral analysis, physical, speech, and occupational therapy as part of treatment for those with Autism Spectrum Disorder. This is an addition to other mental health benefits and medical services used to diagnose and treat autism.

The elections you choose during Open Enrollment are effective January 1, 2019.

Effective January 1, 2019, OptumRx will become the State of Alaska’s pharmacy benefits manager and administer the prescription drug benefits for the employee and retiree AlaskaCare health plans.

Beginning October 31, 2018, the new OptumRx team will be ready to take your calls, answer your questions, assist you with your prescriptions and make sure you are ready for the transition. You can contact OptumRx Member Services at (855) 409-6999 (TTY 711). Representatives will be available 24 hours a day, 7 days a week.  In the meantime, your AlaskaCare pharmacy services will continue to be managed by Aetna’s pharmacy benefit manager, CVS/Caremark, until the end of 2018.

Who is OptumRx and how does the change affect me?

• Look for additional information and a new Pharmacy ID card in the mail from OptumRx this November.
• Your pharmacy co-payments will remain the same.
• The formulary may change, so you will want to check to see how your medication is covered. Beginning October 31st, OptumRx representatives will be available to answer your questions.
• The Division is working to ensure that the transition will be as seamless as possible.
• OptumRx is one of the largest pharmacy benefit managers (PBM) in the U.S., serving more than 13.5 million people through a national network of more than 67,000 community pharmacies.

Have a new rash you can’t explain, a nagging cough or sinus pain? Teladoc professional medical consults are available to you 24/7/365!  

To utilize your new benefit, AlaskaCare Employees can begin by registering for a Teladoc account. 

There are three ways to register:

1. Online: Teladoc.com/Aetna.
2. Mobile App: Teladoc.com/mobile.
3. Phone: (855) TELADOC (835-2362).

The State of Alaska has partnered with SurgeryPlus to provide a supplemental surgical travel benefit for AlaskaCare Employees and their eligible dependents.

With SurgeryPlus, AlaskaCare members with non-emergency surgical needs now have access to a network of 100% Board Certified Surgeons in many major metropolitan areas across the United States. When you need to travel for a medical procedure, a dedicated Care Advocate will assist you with everything from evaluating and choosing a surgeon, scheduling appointments, coordinating travel, transferring medical records, and reviewing benefits. The SurgeryPlus enhanced travel benefit can be utilized for hundreds of non-emergency surgeries. There is no fee for using the benefit and your AlaskaCare Health Plan will waive 100% of your coinsurance when you utilize the SurgeryPlus Provider Network and Travel Concierge Service for surgical services. However, services are still subject to your normal annual plan deductible, and coordination of benefits does not apply. 

To learn more, call a Care Advocate at (855) 715-1680.

October is National Breast Cancer Awareness Month

It's time to focus on breast cancer risks, the value of screening and early detection, and treatments options available to both women and men.

Breast cancer: it’s a scary thought and all too many women assume that it won’t happen to them. However, every two minutes a woman is diagnosed with breast cancer. If your doctor recommends a mammography, mark it off your “To-Do” list right away. Get it scheduled. It just might save your life.

Breast cancer occurs mainly in women, but men can be affected too. Many people don't realize that cancer can develop in men's breast tissue as well. Don’t forget to do your monthly self-exams and if you find anything unusual, consult your doctor as soon as possible.

To learn more about breast cancer, visit Cancer.org or call the American Cancer Society Help Line at (800) 227-2345.

To find out more about your AlaskaCare Employee plan's preventive and diagnostic benefits, contact the Aetna Concierge at (855) 784-8646.

“We accept most major insurance carriers.” You may hear this when you call a health care provider’s office to inquire about their network status. Aetna is a major insurance carrier, so it is understandable why a covered member might take the provider’s response as a green light to proceed with scheduling an appointment. But what is the provider really trying to say? What does the statement, “We accept most major insurance carriers” really mean?

In most cases, the provider is saying that they recognize the top 5-10 largest health insurers in the marketplace (including Aetna). As a courtesy to you, they will agree to submit insurance claims on your behalf to those identified as major insurance carriers and will only request that you pay your plan’s cost share at the time of the visit. While accepting most major insurance carriers may prove to be great marketing and a good way to generate new business for the provider, there’s no guarantee it’s going to be good for you!

Accepting and agreeing to bill most major insurance carriers does not translate to being in-network, contracted, or preferred with your insurance plan. It would be more straightforward if the provider’s office communications included the language “We will accept all, but are only contracted and in-network with A, B, and C insurance companies.” Since they usually do not, you could run the risk of balance billing. Balance billing means you are charged directly for any fees over and above what your insurance plan allows, and you will be responsible for 100% of the provider’s bill.

No contract with your AlaskaCare plan = No discounts for you!

When choosing a medical or dental provider, always research their network status prior to receiving services to make sure they are in-network, contracted, or preferred with your AlaskaCare plan. Remember, even if a provider was in-network in 2018, it does not guarantee that they will renew their contract for the following year. The subtle change from a contracted provider to non-contracted one who “accepts all major insurance carriers” could go unnoticed. It’s always in your best interest to do your research before you schedule your next appointment. Get informed, use the provider locator tools at AlaskaCare.gov or contact the Aetna Concierge at (855) 784-8646 or Moda Health/Delta Dental of Alaska at (855) 718-1768—they speak your language!

Considering Quitting Smoking? Wondering how you will manage nicotine withdrawal? The people at Alaska's Tobacco Quit Line will help you for free!

Call (800) QUIT-NOW.

Recipe of the Month

Wonton Soup

GET THE RECIPE >> 

Exercise of the Month

The Bird Dog

This exercise improves muscle balance and coordination

TRY THE EXERCISE >>

Health Fact of the Month

Exercise Your Brain—Go Dancing!

Both your heart and your brain benefit from exercise. Studies show that regular, moderate exercise for 30 minutes helps fight the effects of aging on the brain.

No grueling workouts required, just turn on the music and focus on your choreography, one, two, three, cha-cha-cha! 

Vitamin D

Vitamin D is important for strong bones and may contribute to overall good health. Alaskans should select foods that are high in vitamin D, such as Alaska salmon, and should talk with their health care provider about vitamin D and the risks and benefits of supplementation.

LEARN MORE >> 

Not sure if that cold is worth the trip? 
Call the Aetna Nurse line, 24 hours, 7 days a week.

Call (800) 556-1555