Time is Running Out to Claim Your $200 Incentive
Earlier this year, we were excited to inform you that the H.E.L.P.CHECK preventive care initiative would continue in 2013 with streamlined requirements. To date, we’ve had an enthusiastic response to those changes, but not everyone has taken advantage of this initiative which places attention on the doctor-patient relationship and uses preventive medicine to address your health concerns. WHAT’S KEEPING YOU FROM RECEIVING $200? Time is running out and you must complete all program requirements by Dec. 31, 2013. As a reminder, the steps for completion are as follows:
Step 1. Register online for the H.E.L.P.CHECK program at www.healthchoiceok.com.
Step 2. Complete your free comprehensive preventive services visit.
Following the successful completion of these steps, you will receive your incentive payment of $200.
Certain comprehensive metabolic and lipid test are still covered at 100% of Allowed Charges once per calendar year. There is no copay or out-of-pocket cost to the member when services are provided by a HealthChoice Network Provider. Also, while no longer required to complete the program, members are still encouraged to complete or update the free online Health Risk Assessment (HRA) that is available by registering through our website at www.healthchoiceok.com.
All HealthChoice members age 20 and older who are not enrolled in a HealthChoice Medicare supplement plan or the HealthChoice USA plan are eligible to participate.
PLEASE NOTE: Detailed coding information is provided once you have registered online to participate.
TAKE CONTROL OF YOUR HEALTH! Register today at www.healthchoiceok.com.
Coverage is Provided Under the Pharmacy Plan for Current and Pre-Medicare Members
Effective July 1, 2013, members, both children and adults, who are not covered by Medicare, are allowed to obtain their routine immunizations and vaccinations at the pharmacy, in accordance with the current Centers for Disease Control and Prevention guidelines. In the past, these were available only under the health plan. The immunizations and/or vaccinations and the administration fees are also covered under the Pharmacy program at 100%, if the services are provided by a Network Pharmacy.
Participants are subject to non-Network benefits and can be balanced billed for amounts above the Allowed Charges, if utilizing the services of a non-network pharmacy.
The existing benefit for immunizations/vaccinations and their administration under the health plan shall remain the same.
Please note that under the Health Plan:
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Only Network Physicians/Providers/Pharmacists can provide these services.
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Mid-Level practitioners such as physician assistants or nurse practitioners practicing at a free- standing ambulatory care clinic located at a pharmacy may or may not be participating providers.
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NON-NETWORK PHARMACISTS ARE NOT RECOGNIZED AND are not covered.
Members should verify participating provider status at the time of service.
Immunizations/Vaccinations covered under pharmacy plan when a network pharmacy is used:
Anthrax Flu Haemophilus Influenzae
Hepatitis A Hepatitis B Human Papillomavirus
Influenza A Influenza HD Japanese Encephalitis
Measles Meningococcal Mumps
Pneumococcal Poliomyelitis Rabies, Human Diploid
Rabies, PF Chick-EMB Cell Rotavirus Rubella
Smallpox (Vaccinia) Vaccine Tetanus Booster Tetanus, Diphtheria, Pertussis
Typhoid Varicella Yellow Fever
Zoster
Certain diagnostic imaging services such as MRI and CT scans require certification prior to having the test done. This certification is usually obtained by the physician that orders your test prior to the test being scheduled. If certification is not obtained, you could be responsible for the cost of the test.
MRI and CT scans that require certification from APS HealthCare are:
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MRI of Eye and Face
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MRI of Head/Brain
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MRI of Cervical, Thoracic, and Lumbar Spine
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MRI of Shoulder, Arm and Hand
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CT Scan of Eye and Face
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CT of Sinus
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CT of Head/Brain
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CT of Chest
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CT of Cervical, Thoracic, and Lumbar Spine
To ensure your test has been certified as medically necessary contact your ordering physician. APS HealthCare can be contacted by calling toll-free 1-800-848-8121.
Thinking About Quitting?
The first step to quitting tobacco is to decide that you are ready to quit and then a make plan to do it. It’s okay to have mixed feelings about quitting. Don’t let that stop you. There will be times every day that you don’t feel like quitting. Just remember your reasons for quitting, that you want to quit and that you can quit – and your plan can help. Here is how to S.T.A.R.T.
Before you quit, figure out where to S.T.A.R.T.:
S= Set a quit date
T= Tell family, friends, and coworkers that you plan to quit and ask for their support
A=Anticipate and plan for the challenges you’ll face while quitting
R=Remove cigarettes and other tobacco products from your home, car and work.
T=Talk with your doctor about quitting or access free quit services through the Oklahoma Tobacco Helpline at 1-800-QUIT-NOW (1-800-784-8669) or online at www.OKhelpline.com
Just thinking about quitting may make you anxious; however, your chances of quitting more than double when you talk with your doctor or contact the Oklahoma Tobacco Helpline.
Why is Quitting So Hard?
Many ex-smokers say that quitting was the hardest thing they ever did. Do you feel hooked? You’re probably addicted to nicotine. Nicotine is in all tobacco products. The more you smoke, the more nicotine you need to feel good. Soon, you don’t feel “normal” without nicotine. It takes time to break free from nicotine addiction. It may take more than one try to quit for good. So don’t give up too soon. You will feel good again.
Quitting is also hard because smoking is a big part of your life. You enjoy holding cigarettes and puffing on them. You may smoke when you are stressed, board, or angry. After months and years of lighting up, smoking becomes part of your daily routine. You may light up without even thinking about it, like with your morning coffee or when you are talking on the phone, driving or are around other smokers. When you quit you may even feel uncomfortable not smoking at times or in places where you usually have a cigarette. These times and places are called “triggers.” That’s because they trigger, or turn on, cigarette cravings. Breaking these habits is the hardest part of quitting for some smokers. Focus on the reasons you wanted to quit, like you will feel healthier right away and for the rest of your life, you will be a great role model for your kids, grandkids, friends and family, you won’t have to worry about when you will get your next cigarette and you will have more money to spend. The urge to smoke will pass in just a few minutes, try taking a quick walk, call a friend or read a book.
You can be a Quitter!
Quitting isn’t easy, it may take several tries. But you learn something each time you try. It takes willpower and strength to beat your addiction to nicotine. Remember that millions of people have quit smoking for good, some with help from their doctor or a free program like the Oklahoma Tobacco Helpline, with a friend or on their own. You can be one of them – you can proudly declare yourself a quitter!
Members and dependents who enroll in the HealthChoice Dental Plan are eligible for orthodontic benefits for charges incurred after the first 12 consecutive months of coverage.
In cases where a new member or dependent has had previous group dental coverage, any continuing orthodontic services will be pro-rated according to HealthChoice Dental Plan rules. This change is for all orthodontic services incurred on or after January 1, 2014, including services for the treatment of temporomandibular joint disorder (TMD).
For more information or if you have questions concerning the new orthodontic benefit, please contact our dental claims administrator at 1-405-416-1800 or toll-free 1-800-782-5218.
2014 Formulary Changes
As of Jan. 1, 2014, the excluded medications shown below are not covered on the HealthChoice Select Medication list for non-Medicare members. All 48 unique drugs that are being removed from the select medication list have covered alternatives available.
A Prior Authorization review may be requested if a member is unable to take the Preferred alternative medications. A plan exception may be requested by contacting Express Scripts, Inc. toll-free at 1-800-753-2851.
The need for durable medical equipment (DME) such as wheelchairs, prosthetic devices, portable oxygen tanks, orthotics, implants and related services are increasing with the needs of the aging U.S. population. Unfortunately, the growing need for DME and related services has also increased the possibility of fraud, waste and abuse among DME suppliers. Medicare has identified DME fraud as a rapidly growing problem.
As a patient/member, your involvement is vital to exposing DME fraud. Reducing and/or eliminating DME fraud helps ensure that healthcare resources are appropriately utilized. The use of unnecessary medical equipment results in excessive costs to the healthcare system, ultimately limiting the availability of necessary medical supplies and equipment for the people who genuinely need it. The healthcare system continues to be very expensive and cannot afford the waste and/or abuse of services.
You may ask the question “How do I know it is DME fraud?” The following types of claim billing situations may be indications of fraud, waste, and/or abuse:
- A health care provider files a fraudulent claim for DME specifically to obtain more reimbursement than allowed by law
- Filing a claim for DME that was not delivered to the patient or was not medically necessary
- Deliberately billing Medicare for duplicate orders of DME that are never ordered
- The provider fails to credit Medicare for DME returned by the patient
- Misrepresenting the payment obligations of patients for DME or waiving co-payments or deductibles owed by patients
If you suspect HealthChoice and/or Medicare have been or are being defrauded by a DME company or any other healthcare entity or practitioner or you feel resources are potentially being wasted and/or abused, report your suspicions to the Oklahoma Office of Management and Enterprise Services (OMES) Employees Group Insurance Division (EGID) Compliance Officer immediately.
Report any suspected fraud activity by visiting the OMES EGID Compliance Officer in person or writing to:
OMES EGID Compliance Office
3545 NW 58th Street, Ste. 110
Oklahoma City, OK 73112
You may also email reports to antifraud@sib.ok.gov or call the antifraud hotline toll-free at 1-866-381-3815.
Medicare fraud can be reported to the Department of Health and Human Services Office of the Inspector General Hotline at 1-800-447-8477 toll-free or via email to HHSTips@oig.hhs.gov.
Additional information on how to prevent Medicare fraud is available at www.StopMedicareFraud.gov.
 HealthChoice offers a three-step plan to help our members become tobacco-free. Visit our homepage at www.healthchoiceok.com and select the "Be Tobacco-Free" banner tab, then select "click here" on the Be Tobacco-Free page. Select number 32 under the "Preventive Services for 2013" list for enhanced tobacco cessation benefits and information. It's as easy as 1-2-3.
Step 1 - Call 1-800-Quit Now (1-800-784-8669) to register and set up your initial three personal counseling sessions with a Certified Quit Coach. Five no-cost counseling sessions are available to HealthChoice members.
Step 2 - Make an appointment with your HealthChoice Network Provider for a no-cost comprehensive preventive care visit.
Step 3 - Use the HealthChoice tobacco cessation pharmacy benefit to fill your prescription products or obtain the covered over-the-counter cessation medications available for two 90-day periods, both benefits offered at no cost.
Long term success is only steps away! If you have any questions about the Quit Now program through the Tobacco Settlement Endowment Trust Fund, please call 1-800-Quit Now.
For HealthChoice health benefit questions, please contact HP Administrative Services (HP) at 1-405-416-1800 or toll-free 1-800-782-5218. TDD users call 1-405-416-1525 or toll-free 1-800-941-2160. For questions concerning medications or pharmacy benefits, please contact Express Scripts toll-free at 1-800-903-8113 TDD users call 1-800-825-1230.
The annual Option Period for 2014 is coming to a close. All current EGID plan members have received Option Period Materials at work or through the mail. The most up-to-date version of all Option Period material is also available on our website at www.healthchoiceok.com.
Please review the “Plan Changes” section of your 2014 Employee Benefit Options Guide or your 2014 Option Period Enrollment Packet where any changes from the 2013 plan are highlighted.
If you have any questions, please contact Member Services at 1-405-717-8780 or toll-free 1-800-752-9475. TDD users please call 1-405-949-2281 or toll-free 1-866-447-0436.
In addition to the current vision care plans options listed in the Option Period Guide you receive in the mail, Vision Care Direct is also being offered for Plan Year 2014. To choose Vision Care Direct as your vision plan, please write “Vision Care Direct” in the vision plan section of your Option Period form, as it will not be listed as a selection.
Premium information and plan details are updated on the online versions of the Option Period
Guides.
Premium information for all the vision plans offered for 2014 can be found at http://www.ok.gov/sib/Member/Premiums/index.html
Vision plan comparison chart, plan details, and contact information for all vision plans offered in 2014
can be found at http://www.ok.gov/sib/documents/Vision_Grid.pdf
If you have any questions please contact Member Services at 1-405-717-8780 or toll-free 1-800-752-
9475. TDD users call 1-405-949-2281 or toll-free 1-866-447-0436.
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