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Option Period has begun. Be familiar with your current
coverage so you can review and compare any benefit or plan changes for next
year.
Also,
if you or your dependents are enrolled in the pre-Medicare HealthChoice High or
Basic Plan and will continue the coverage next year and do not use tobacco, you
need to complete the tobacco-free
attestation.
If you do not complete the attestation, your coverage will be moved to an
alternative HealthChoice plan with a higher deductible and out-of-pocket
maximum for 2017. For information about becoming tobacco-free, visit the Be Tobacco-Free page of the
HealthChoice website.
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HealthChoice will begin covering ostomy bags and wafers
under both the medical and pharmacy benefits Oct. 1. The change comes because
the bags and wafers are most often provided by medical supply companies.
Obtaining these supplies through a network medical supply
company will be more convenient for members and allow for a smooth insurance
billing process. Policy provisions, including deductible and coinsurance, will
apply. Certification is not required.
Currently, HealthChoice covers ostomy bags and wafers
only under the pharmacy benefit. Other ostomy supplies, such as adhesive
removers, skin barrier wipes, rings, pastes, powders, etc., are covered only
under the medical benefit. HealthChoice will continue to cover ostomy bags and
wafers under the pharmacy benefit when obtained through a retail pharmacy.
If you have questions on the medical benefits for ostomy
supplies, please call the medical claims administrator at 405-416-1800 or
toll-free 800-782-5218. TDD users call 405-416-1525 or toll-free 800-941-2160.
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Considered the most serious of all childhood
rash and fever illnesses, measles is a highly contagious illness caused by a
virus that spreads from person-to-person through the air or direct contact with
infected surfaces. The virus can be contracted up to two hours after an
infected person has sneezed or coughed. In fact, the measles virus is so contagious that one infected person will infect 90
percent of unprotected people around them.
Measles can
lead to hearing loss, pneumonia, seizures, encephalitis, brain damage and
death. Long-term complications include a rare, but fatal, degenerative disease
of the central nervous system that causes behavioral and intellectual
deterioration and seizures that develop years after the original infection.
Due to widespread vaccination coverage
through federal immunization programs and state law requirements for children
in schools and day care facilities, the spread of measles has been effectively
controlled and limited in children in the United States. According to the
Centers for Disease Control and Prevention, the reduction in cases is greater
than 99 percent compared with the pre-vaccine era when measles was a common
childhood disease.
Although measles was declared “eliminated”
(no transmission for at least 12 months) in the U.S. in 2000, a record 668
cases from 23 different outbreaks in 27 states were reported in 2014. In 2015,
189 cases were reported from 24 states and the District of Columbia. The case
numbers reported as of September 2016 include 54 people from 16 states who have
measles.
Most cases in the U.S. are caused by infected
American travelers who bring the disease home from other countries where it is
still common. Those who contract the virus are typically unvaccinated or have
unknown vaccination status. Worldwide, an estimated 20 million people get
measles and 146,000 die from it each year.
U.S.
residents can also be exposed to measles at venues with large numbers of
international visitors, such as tourist attractions and airports. The majority
of cases reported in 2015 were from an outbreak linked to two theme parks in Southern
California. Most of those who were infected had chosen not to get the measles
vaccine.
Have you heard of herd immunity?
The higher the rate of vaccination, the lower
the risk of infection. A high vaccination rate within a community or common
group of people, such as a school or workplace, produces a “herd effect.” This
means the risk of infection is lessened by the increase in mass immunity. More
than 90 percent of a community’s population must be immune or vaccinated
against measles to maintain herd immunity.
Measles Vaccine and Recommendations
The measles vaccine is a combination vaccine
that protects against measles, mumps and rubella. It is referred to as the MMR
vaccine, which has proven to be safe and effective. If needed, there is also a
combination vaccine that contains both MMR and varicella (chickenpox) vaccines
for children 12 months through 12 years old.
As part of the routine childhood immunization
schedule, the CDC recommends all children get two doses of the MMR vaccine
starting at 1 year of age. The first dose can be given at 12-15 months and the
second dose at 4-6 years. Children beyond kindergarten age who missed these
doses may be required to complete them for school entry unless they obtain an
exemption or provide evidence of immunity.
Adults who were
born before 1957 are automatically considered immune. However, the CDC
recommends at least one dose of the MMR vaccine if you were born after 1956,
have never had the measles and are without documentation of vaccination or laboratory
evidence of immunity, or without documented evidence of a past diagnosis of
measles.
The CDC
recommends two doses at least four weeks apart for adults born after 1956
without evidence of immunity who are at high risk, such as international
travelers, health care workers, teachers or students at post-high school
educational institutions. You may also be at high risk for measles due to your
lifestyle or health conditions.
Before any international travel, the CDC
additionally recommends infants 6-11 months receive one dose of the MMR
vaccine. Children 12 months and older should get two doses at least four weeks
apart.
If you are planning international travel,
check with your doctor at least one month before to make sure you are current
on your routine vaccines. You may need to visit a travel clinic to receive
other necessary vaccines since not all primary health care providers stock
travel vaccines. If you live in Oklahoma, access this link for international
travel clinics and pharmacies in the state.
If you choose not to vaccinate, you in turn
affect your community, not just yourself or your family. However, you should
not get the MMR vaccine if you are pregnant, ill, have a compromised immune
system or had a previous life-threatening allergic reaction to the vaccine or
its components. Talk to your doctor before vaccination, especially if you have
health conditions or plan to become pregnant.
Source: CDC.gov, Oklahoma State Department of Health
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Medical identity theft disrupts lives, damages credit ratings, and wastes health care and taxpayer dollars. The damage can even be life threatening if the wrong information ends up in personal medical records.
Medical identity theft occurs when someone steals your personal information (your name, Social Security number, HealthChoice or Medicare identification number) to obtain medical care, buy prescription drugs or submit fraudulent billings to your insurance company.
To prevent medical identity theft, you should deter, detect, defend and report.
Deter: Protect your personal information through prevention.
- Guard your HealthChoice, Medicare and Social Security numbers. Treat them like you would treat your credit cards.
- If it’s free, they don’t need your number. Be suspicious of anyone who offers you free medical equipment or services and then requests your HealthChoice or Medicare ID number.
- It’s illegal, and it’s not worth it. Do not let anyone borrow or pay to use your ID cards or your identity.
Detect: Watch out for these common fraud schemes.
- Just walk away from anyone who approaches you in parking lots, shopping centers or other public areas and offers free services, groceries, transportation or other items in exchange for your ID numbers.
- Simply hang up the phone if someone calls you claiming to be conducting a health survey and asks for your HealthChoice or Medicare number.
- Never give your information to callers who claim to be from Medicare or Social Security and ask for payment over the phone or internet. They may want to steal your money.
Defend: Check your medical bills, explanations of benefits, Medicare summary notices and credit reports.
- Were you charged for any medical services or equipment that you did not get?
- Do the dates of services and charges look unfamiliar?
- Were you billed for the same thing twice?
- Does your credit report show any unpaid bills for medical services or equipment you did not receive?
- Have you received any collection notices for medical services or equipment you did not receive?
Report: Contact a compliance officer if you suspect health care fraud or medical identity theft.
If you suspect that EGID has been defrauded, is being defrauded or that resources have been wasted or abused, report the matter to the EGID compliance officer immediately. You can report suspicious acts or claims by:
- Visiting the compliance officer in person.
- Sending a report in writing to:
EGID Compliance Officer
3545 NW 58th St., Ste. 110
Oklahoma City, OK 73112
- Emailing a message to antifraud@sib.ok.gov.
- Leaving a report in the secure drop box outside the EGID Board Room, Floor 5.
- Calling the EGID toll-free hotline at 866-381-3815.
For more information on how to prevent Medicare fraud, visit www.StopMedicareFraud.gov.
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HealthChoice will discontinue the wellness initiative
program H.E.L.P.Check on Jan. 1, 2017. The $200
incentive payment will no longer be available for an annual preventive care
visit after this year.
HealthChoice will still cover two preventive care visits
for members ages 18 and older at 100 percent of allowable fees when you use a network
provider. For a full listing of free preventive services, visit the Preventive Services
page of the website.
H.E.L.P.Check and the $200 incentive
payment are still available through this year. If you are age 20 or older and
a primary member of the HealthChoice High or Basic Plan or High Deductible
Health Plan, you must register for the program at https://gateway.sib.ok.gov/helpcheck and
complete your comprehensive preventive care visit with a network provider by
Dec. 31, 2016.
H.E.L.P.Check is not available to
members enrolled in the HealthChoice Medicare supplement or USA plans.
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