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Change Is In The Air: See What May Affect You In 2014

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

The federal law known as the Affordable Care Act (ACA) is bringing change to the health care market. The changes and timelines are different depending on the size of the employer that you work for. Additionally, Capital Health Plan is making changes too. During your next open enrollment, please note the changes that will be taking place.

Small Employer Plans (2-50 full-time equivalent employees) – effective on Small Employer Group renewal dates in 2014:

All small group plans will be Essential Health Benefit (EHB) compliant. You will be receiving new plan documents prior to your employer’s renewal date – watch your US Postal mail for the Capital Health Plan CD.

Essential health benefits (EHBs) include:

• Ambulatory patient services

• Emergency services

• Hospitalization

• Maternity and newborn care

• Mental health and substance abuse disorder services and devices

• Prescription drugs

• Rehabilitative, habilitative services, devices

• Laboratory services

• Preventive, wellness and chronic disease management

• Pediatric services including oral and vision care

• Plans will be modified to remove all pre-existing limitations.

Large Employer Plans (> 50 total full-time equivalent employees) - effective on Large Employer Group renewal dates in 2015 (due to delay in Employer mandate):

• The Affordable Care Act requires most people to have health care coverage that qualifies as "minimum essential coverage." Your Capital Health Plan employer health coverage does provide minimum essential coverage.

• The Affordable Care Act establishes a minimum value standard for benefits of a health plan. Your Capital Health Plan employer health coverage exceeds the minimum value standard for the benefits it provides.

All Plans that provide a Pharmacy benefit:

• Capital Health Plan is changing our Pharmacy Benefit Manager (PBM). Prime Therapeutics (Prime) will replace CVS/Caremark as the new PBM. This change will generally not affect the local pharmacy network, so the pharmacies that you are currently using will not change. Prime has a nationwide pharmacy network with over 50,000 pharmacies. Please review the new formularies (drug lists) carefully and note any changes to your current prescription drug requirements and tier levels. The formulary is located on our website at

• Due to these changes you will receive a new ID card for 1/1/2014 and may receive an updated card upon your employer group’s renewal date. Please watch your mail for your new ID cards.

It is our goal to be compliant with the ACA while causing the least amount of disruption to our members. Capital Health Plan is the only non-profit local health plan in the Big Bend area. Our offices are local, our Member Services department is local, and we live where you live. For more than 30 years, we have been providing members with comprehensive and affordable health care. We look forward to providing you and our community a health partnership that has continuing value.

New Pharmacy Benefit Manager in 2014

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Beginning January 1, 2014, Capital Health Plan will change its Pharmacy Benefit Manager (PBM) from CVS/Caremark to Prime Therapeutics (Prime) for processing of pharmacy claims. The nationwide pharmacy network will remain at over 50,000 pharmacies and is available to Capital Health Plan members that have a prescription benefit. Prime is the largest privately held PBM in the United States, serving over 21 million members.

Capital Health Plan, in partnership with Prime, is committed to taking care of our members prescription needs, quickly and efficiently. Our goal is to provide appropriate medical care and improved health outcomes.

Prime will start managing the pharmacy benefit beginning January 1, 2014 for Capital Health Plan members that have a prescription benefit. Members that have a prescription benefit through Capital Health Plan will receive new member identification cards through the U.S. mail prior to the end of this year. The new identification cards may be presented to any pharmacy in our network beginning on January 1. Please note that CVS/Caremark PBM will not process pharmacy claims for Capital Health Plan members beginning January 1, 2014. However, the CVS retail stores will remain in the network.

Additionally, beginning January 1, 2014, Prime Mail will be your new home delivery (mail) service. Generally, prescriptions with refills remaining at CVS/Caremark Mail will be automatically transferred to the Prime Mail Pharmacy.* Members that are currently using the services of CVS/Caremark Mail Order Pharmacy will receive information by mail prior to January 1, 2014, to help with the switch to Prime Mail.

There will also be a change in the Specialty Pharmacy to Prime Therapeutics Specialty Pharmacy on January 1, 2014. Generally, prescriptions with refills remaining will be automatically transferred from CVS/Caremark Specialty to Prime Specialty Pharmacy.* Members who have been using CVS/Caremark Specialty Pharmacy will receive new enrollment packages from Prime Therapeutics Specialty Pharmacy.

Our Members Services department is available to answer any questions or concerns you may have about this change.

*Prescriptions for controlled or compound drugs cannot be automatically transferred. A new prescription will be required.

2014 Plan Changes

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Our Pharmacy Benefit Manager (PBM) and our Formulary (list of covered prescription drugs) are changing January 1, 2014.

Prime Therapeutics will replace CVS/Caremark as the new PBM. The change will not affect the local Pharmacy Network. A nationwide pharmacy network will remain available with over 50,000 pharmacies. The changes will help us provide the quality, afforable care you’ve always counted on.

The 2014 Commercial Formulary is available online beginning on or after September 15, 2013. The 2014 Medicare Formulary is available online beginning October 1, 2013. Be sure to view the formulary to see if the 2014 changes affect your prescription drugs.

New health care regulations and decisions of your employer may have affected your group plan. When it’s time for your 2014 open enrollment, be sure to read your policy information thoroughly and work with your group administrator to understand all the changes.

Ask Dr. Nancy: Choosing Wisely

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Should routine Pap tests be done every year? According to the American College of Obstetricians and Gynecologists the answer is "no". Should my child have antibiotics for apparent viral respiratory illnesses (sinusitis, sore throats, bronchitis)? According to the American Academy of Pediatrics the answer is "no". Should I have a DEXA scan for osteoporosis screening if I am a woman under the age of 65 with no specific risk factors? You probably have guessed the answer is "no" according to the American Academy of Family Physicians.

These topics are recommendations among many from 26 of the nation’s leading medical specialty societies, representing 350,000 physicians, including the American Academy of Family Physicians, American College of Medicine, American
College of Cardiology, American College of Radiology, American Society of Clinical Oncology, American Gastroenterological Association, American Geriatrics Society and others. These are the societies which certify the credentials of physicians.

"Choosing Wisely" is an initiative of the American Board of Internal Medicine Foundation and Consumer Reports. The first nine medical specialty societies published their list of the "Five Things Physicians and Patients Should Question" in 2012 and now another 17 specialty societies have contributed their lists in February 2013. There are 130 tests and treatments identified which are done too often and in many cases can cause harm.

The goal is to make sure that patients are informed about what tests and procedures are most likely to be beneficial. More tests and treatments may not be the best thing for your health. The lists contain the recommendation and the reason for the recommendation. For example, "Computed tomography (CT) scans are not necessary in the routine evaluation of abdominal pain" in children. Additional information is that "Utilization of CT imaging in the emergency department evaluation of children with abdominal pain is increasing. The increased lifetime risk for cancer due to excess radiation exposure is of special concern given the acute sensitivity of children’s organs." A possible question might be, "So doctor, does my child really need that CT scan?" What are the options? What is the risk? What is the benefit? These are the questions and conversations that should happen to determine the next best step for the specific clinical situation. One size does not fit all.

Why now? As our understanding of disease and technology evolves, we discover that some interventions we thought were a good thing are no longer recommended as a good thing for everybody. Not all children with abdominal pain have signs and symptoms which require further testing with a CT scan. A history and physical by a skilled clinician is the best way to determine what the next steps should be.

The physicians from Capital Health Plan’s Quality Improvement Committee sent the recommendations from the first 9 medical societies to the physicians in our community who are certified by those societies. The additional recommendations will also be distributed and input solicited. The patient’s individual circumstances must always be taken into consideration but generally there is widespread agreement within our medical community that the reasoning behind the listed treatments and testing have merit.

What can you do? It is always a good idea to discuss treatment options with your primary care physician who is in a position to review those options in the context of your overall medical situation.

In addition, when you have a non-urgent health care choice to make, gather information. Healthwise®, a healthcare encyclopedia, is available to you through your Capital Health Plan membership. Healthwise® is a non-profit company, founded in 1975 with a mission to promote better health decisions by consumers. Healthwise® can be accessed through CHPConnect on the left side of the screen under "My Resources" and clicking on Healthwise® Knowledgebase. Learn the information you need to know to make good decisions.

You can read all of the recommendations at If you have any questions please call the Capital Health Plan Health Information Line. The nurses answering the Health Information line are available to assist you in planning for your physician’s office visit by answering your questions and providing health information on a wide variety of topics.

Dr. Nancy Van Vessem is board certified in internal medicine. She has developed innovative disease management and quality improvement programs promoting the use of best evidence medicine, propelling Capital Health Plan to national recognition for quality of care.

CHPConnect Gets a Face Lift!

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

CHPConnect, a secure information portal available to all Capital Health Plan members received a face lift during the Fall 2012. Newly added features include:

Healthy Conversations: Healthy Conversations offers fourteen different multi-media presentations on topics such as Diabetes, Improving Sleep, Smoking Cessation and Healthy Eating and Exercise. Each topic has embedded technology that adapts to your specific answers. The presentations are clear, concise and provide evidence- based information.

Health Trackers: With Health Tracker, you can track your health information while away from your physician’s office. You have the ability to track blood pressure, blood sugar, body mass index, cholesterol, Hemoglobin A1C, peak flow readings, pulse, temperature and weight. A graph or linear reading can be printed and taken to your next physician’s office visit.

Health Risk Appraisal: The Health Risk Appraisal (HRA) is a personal health questionnaire that evaluates your health risks and quality of life. Upon completion, you will receive a wellness score, and suggestions on how to improve your quality of life.

Additional features of CHPConnect that are valuable in helping you take control of your health include:

Healthwise® Knowledgebase: The Healthwise® Knowledgebase uses a searchable medical encyclopedia providing descriptions of symptoms, pictures, and treatment options.

Lab Results: Within 3-4 weeks, certain lab results are available.

ID Cards: Lose your Capital Health Plan ID card? You can easily submit a request through CHPConnect to have a new card mailed to you.

Benefits: Have questions about your benefits? You can view your benefits and copayments from the Benefits and Eligibility tab in the left-hand navigation menu.

Registering as a CHPConnect user offers many advantages. With 24 hour and 7 days a week access, you can quickly retrieve answers to some very common questions. The health modules are evidence- based and provide thorough explanations to many common illnesses and diseases. Searching the Healthwise® Knowledgebase provides you with information so that you will be better informed at your next doctor’s visit.

How do I connect to CHPConnect?

Just follow these simple steps:

1. Go to our homepage.

2. In the top left box, click on the "New User?" link.

3. Fill in the registration form and choose a password (your password must be at least 6 characters; upper and lower case plus a number).

5. Within 3-4 business days, Capital Health Plan will send you an access code by mail.

6. Use your User ID, password, and access code to log in.

2013 Savvy Senior

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Capital Health Plan is proud to present our monthly Savvy Senior programs. These lunch and learn programs are designed to be educational and promote Living Well for older adults. The Physician Group of Capital Health Plan physicians, guest speakers, and other Capital Health Plan health care professionals will be presenting the programs this year.

The Savvy Senior program has become so popular we now hold it twice each month - on the first and third Fridays. We are very fortunate to have Anna Johnson-Riedel host the programs. They start at Noon and usually last an hour.
We invite you to come out, join the group, meet new friends, and become a Savvy Senior. It is open to the public and anyone is welcome to attend.

Upcoming programs:




April 5 & April 19 Disuse Atrophy: Use It or Lose It Henry Gunter, M.D.
May 3 & May 17 Chronic Kidney Disease Robert Chapman, M.D.
June 7 & June 21 Diabetes Suma Dondapati, M.D.
July 5 & July 19 High Blood Pressure James Thomas, M.D.
August 2 & August 16 Skin/Wound Clinic TBA
September 6 & September 20 Volunteer Leon LeKendra Cunningham
October 4 & October 18 TBA Tara Loucks, ARNP
November 1 & November 15 Eye Care Daniel Lazar, O.D.
December 6 & December 20 Falls & How to Prevent Them Sheetal Deo, M.D.

If you are unable to attend in person you can always view a Podcast of the program on our website by clicking here.

If you plan to attend please be sure to RSVP by calling 850-523-7441 or 1-877-247-6512 (TTY 850-383-3534 or 1-877-870-8943) 8:00 a.m. – 8:00 p.m., seven days a week, October 1 – February 14; 8:00 a.m. – 8:00 p.m., Monday – Friday, February 15 – September 30. State of Florida members call 1-877-392-1532, 7:00 a.m. – 8:00 p.m.

Nominate a Senior in Our Community!

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

The Silver Stars Celebration is one of Tallahassee’s premier senior recognition events, honoring a select group of people for their special contributions. The Tallahassee Senior Center, which spearheads the event, invites the community to nominate a senior for a Silver Star. Capital Health Plan is proud to be a major sponsor for the 2013 celebration which culminates in a festive awards dinner at the FSU University Center on May 19, 2013.

We bet you know some shining women and men who reach age 60 and just keep bringing more brightness into the world. Who can be a star? Your friends, neighbors, relatives who…

  • Since age 60 have accomplished outstanding achievements
  • Demonstrated exemplary service to others and our community
  • Are inspiring models of active aging

From athletes to caregivers, Silver Stars illuminate many paths in life. Past honorees include athletes, executive directors, community advocates, caregivers, volunteers, and entrepreneurs. If you know someone 60 or older whose life of service you admire, whatever the arena, share your appreciation! Nominate a senior star and let the whole community know.

Nominations are sought from the community and must be received by February 8. Send a nomination form or a letter of nomination - not to exceed 100 words - to: Silver Stars Nomination, Tallahassee Senior Center, 1400 N. Monroe St., Tallahassee, Florida, 32303. Be sure to describe the individual's outstanding achievements or contributions since reaching age 60. Include the nominee's and nominator's contact names and information, and be sure to get permission from the nominee. Nomination forms can be downloaded here.

Ask Dr. Nancy: Are You Young Inside? Your Blood Pressure is One Way to Know!

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Aging happens. You can see it in your face and in the wobble on your arms. But where aging matters most is inside your body because that is where disease quietly begins. Every cell in your body depends on blood flow to survive so your blood vessels are key to keeping all your cells healthy.

If the pressure in your blood vessels is higher than it should be, that causes damage. First to your heart which is working harder than it should, and down the line to the blood vessels which become stiff to counteract the increased pressure. This is what ages your blood vessels and causes "hardening of the arteries". Silently, you are set up for heart failure, heart attack, kidney failure and stroke. The best defense is to take action to know if you are at risk and to do something about it.

It’s easy. Adults should have their blood pressure measured every two years because blood pressure increases with age. Just visit your primary care physician. If your blood pressure is high at the beginning of the visit, have it retaken at the end of the visit.

The top number, called the systolic pressure, is over the bottom number, called the diastolic pressure. The result will be something like this: 120/80. These numbers are a reflection of the condition of your heart and blood vessels. If that top number is 100 to 120 and the bottom number is 60 to 80, then jump around your kitchen and give yourself a big "Yoo Hoo" because you have just ticked off a significant health risk. But get it checked again in two years because time marches on and you need to keep track of how you are doing.

If the systolic pressure is greater than 140 and the diastolic pressure is greater than 90, then you are in the danger zone. It is time to change your lifestyle. You have heard this before: weight reduction, physical activity, cutting down on alcohol consumption to 2 drinks a day or less for men and 1 drink a day or less for women, healthy diet, and limiting sodium all work to reduce blood pressure. They work together to reduce the speed of aging.

Treatment with medication is also important if your blood pressure stays elevated. There are numerous choices and the right choice for any individual depends on the characteristics of that individual. For instance, a diabetic person would typically be treated with a drug in the ACE inhibitor class.

The most common reason for poor control of hypertension is not taking the prescribed medication. If you are not taking your medication, tell your primary care physician the truth. The situation will become impossibly snarled if you don’t fess up and get on a higher dose of a medication that you weren’t taking correctly to begin with. Another reason is sleep apnea. If your oxygen level is falling when you sleep, your blood vessels react to that stress. The main thing to do is to take medication as prescribed and follow up with your physician.  


Capital Health Plan has a goal for its members to have the best blood pressure control in the nation which means that 90% of people with hypertension (high blood pressure) have their blood pressure controlled to a level which reduces health risk, <140/90. Currently that measure is at 70% which means we have a way to go and we won’t get there without your help. Mostly, however, do it for yourself because you are the primary beneficiary of aging well and avoiding disease.


Dr. Nancy Van Vessem is board certified in internal medicine. She has developed innovative disease management and quality improvement programs promoting the use of best evidence medicine, propelling Capital Health Plan to national recognition for quality of care.

New Name, Same Quality of Care

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Physician Group of Capital Health Plan Logo

Capital Health Plan is pleased to introduce the Physician Group of Capital Health Plan at our Governors Square and Centerville locations. This group of Capital Health Plan primary care physicians is exclusive to Capital Health Plan members. Their new name will better assist members in distinguishing Capital Health Plan’s staff physicians from the Capital Health Plan affiliate physicians.

Why all the excitement?

The Physician Group of Capital Health Plan is currently designing a website where members can learn about the staff physicians and convenient services available at our Governors Square and Centerville locations. Members will also have access to the Patient Portal (NextMD) from this website. With the Patient Portal, members may send secure messages to their physician or nurse, make routine appointments online, and request prescription refills.


Primetime Advantage: Coverage Outside of Service Area

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Members often ask about coverage if they should become ill or have an injury while temporarily away or traveling outside the Capital Health Plan service area. If you are a Capital Health Plan Medicare Advantage (HMO) plan member

and you are outside the service area on vacation, visiting family, at your mountain or beach house, on a cruise or outside the service area for any reason, you are covered for emergencies anywhere in the world and urgently needed care anywhere in the United States.

If you have an emergency get help as quickly as possible. Call 911 or go to the nearest emergency room or hospital. Call for an ambulance if you need it. You do not need to get approval or a referral first from your Primary Care Physician. We do ask that you or someone else call Member Services to let us know about your emergency within 48 hours, if possible. Urgently needed care is also covered and is for a non-emergency, unforeseen medical illness, injury, or condition, that requires immediate medical care. Our plan covers urgently needed care that you get from any provider when you are outside our service area.

Follow up care does need to be coordinated through your Capital Health Plan network of providers. If you are given a prescription or need a refill while out of the area but in the United States, you may use one of over 62,000 network pharmacies nationwide to fill the prescription using your Capital Health Plan identification card. You can register at to locate a participating pharmacy in the area you are in or call Member Services to assist you in locating a pharmacy. Members may also use any LabCorp facility in the country. To locate a LabCorp facility in the area you are in go to or call Member Services.

If you are traveling outside of the country for an extended length of time, call Member Services and ask them about the Blue Card World Wide program.

Enjoy worry free travel wherever you are going!