Healthline member newsletter

Consider Physical Therapy

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Do you experience symptoms of stress incontinence?

Many women believe the leakage of urine is a normal result of pregnancy, childbirth and aging; but this is not true. Exercises to strengthen the pelvic floor muscles may greatly reduce or even cure the problem.

Capital Health Plan has partnered with Tallahassee Memorial Outpatient Rehabilitation Services to provide a therapy program for urinary incontinence. Treatment includes strengthening exercises as well as education about posture, body mechanics and bladder fitness. Physical therapy can be an effective, non-invasive treatment option for those experiencing urinary leakage.

If you think you may benefit from physical therapy to treat your problem, consult your primary-care physician. When you are ready to schedule an appointment please call 431-6220.

Advantage Primetime - Understanding Your Prescription Drug Coverage

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Here are some important prescription drug changes to Capital Health Plan Medicare Advantage plans for 2011.

Capital Health Plan Advantage Plus (HMO)

Capital Health Plan Preferred Advantage (HMO)

There is a new Formulary (list of covered drugs which can change each year). Check your Annual Notices of Changes and Evidence of Coverage for changes in coverage, Tiers, and/or restrictions.

Copayments for Tier 1 generic drugs have been lowered. Check your Annual Notice of Changes and Evidence of Coverage for other changes to copayments/coinsurance.

The initial coverage limit has been raised from $2830 in 2010 to $2840 in 2011.

Members will now generally receive a 50% discount for covered name brand drugs in the coverage gap (donut hole).

There were no changes in catastrophic coverage in 2011.

Capital Health Plan Retiree Advantage (HMO)

 

There is a new Formulary (list of covered drugs which can change each year). Check your Annual Notices of Changes and Evidence of Coverage for changes in coverage, Tiers, and/or restrictions.

Some plans have made copayment changes. Check your Schedule of Retiree Advantage (HMO) Copayments for more details.

 

 

 

 

 

The Formulary and plan specific Annual Notices of Changes and Evidence of Coverage for each plan can be accessed on our website.

What stays the same:

Members still have access to our national network of pharmacies. You can look up network pharmacies on our website. All service area pharmacies are also listed in the Directory of Physicians, Services Providers and Pharmacies. For questions, call Member Services at 850-523-7441 or 1-877-247-6512 (TTY/TDD 850-383-3534 or 1-800-955-8771, 8:00 a.m. to 8:00 p.m., seven days a week. From March 1 through October 15 voice mail is available on weekends and holidays.

Capital Health Plan is a Health Plan with a Medicare contract. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2012.

High Risk Medications

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

Did you know that our bodies begin to respond differently to medications as we get older?

As we age, various changes occur throughout the body. For example, the liver or kidneys may not clear a medication from our system as efficiently as it once did. Likewise, receptors in the body may become more sensitive to certain drugs.

For these reasons, certain medications are considered high risk for individuals age 65 and older. Consult your physician to see if you are at risk.

 

An article in the February 2010 HealthLINE listed examples of these medications. You can access the article at www.capitalhealth.com/Members/Healthline under the topic “Medications”, or by visiting www.captialhealth.com and searching “High Risk Medications.”

Senior Games

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

Look out for the 2011 Senior Games! Capital Health Plan will once again support the active seniors in our community at the Capital City Senior Games on February 10-14, 2011. Registered athletes can be 50 years young and compete in events like track, swimming, softball, basketball, archery, billiards, and even table tennis. Prizes are awarded to winners in each of five age categories.

Check www.flasports.com for more information.

Generic Drugs - An Even Greater Value

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

Did you know your employer’s benefit plan offers you one of the best values on more than 350 generic maintenance medications for chronic conditions? Consider this:

  • You can get up to 30 tablets or capsules of a generic drug for a copay of $3.33 plus a dispensing fee *†

To take advantage of these low costs, get your prescription filled at any retail store in the Capital Health Plan pharmacy network.

You can feel confident choosing a generic drug:

  • Generic drugs are becoming the top choice among doctors and patients—more than 65% of prescriptions filled today are for generic drugs, and that percentage is growing.1
  • All generic drugs must be reviewed and approved by the U.S. Food and Drug Administration and meet the same quality and safety standards as brand-name drugs.2
  • Brand drugs cost an average six times more than generic drugs1—yet according to the FDA generics are just as safe and effective.

Your Next Steps

  1. Ask your doctor if a generic is right for you.
  2. If so, have your doctor write a prescription for a value generic drug, including refills.
  3. Fill your prescription using any retail pharmacy in our network. Be sure to present your Capital Health Plan membership card in order to receive the discount.

A list of generic drugs available through this offer is available online. Visit www.capitalhealth.com and search “Value Generic Drugs” for more information. If you have questions, please contact Member Services at 850.383. 3311.

This discount is only available to CHP commercial (employer group) plan members (and Retiree Advantage members beginning in 2011). Capital Health Plan Advantage Plus and Preferred Advantage members should consult their plan specific Annual Notices of Changes and Evidence of Coverage for information on generic drug copayments.

*Copayment, copay or coinsurance means the amount a plan participant is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan. †Applies only to generic medications on the CVS Caremark Value Generic Drug List. Conditions often treated by generic medications on the list include high/low blood pressure, high cholesterol, diabetes and more. 1 IMS Health, 2009. 2FDA Web site: .

The amount of your savings will be based on your plan. Source: Generic Pharmaceutical Association Web site: http://www.gphaonline.org/about-gpha/about-generics/case.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

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It’s Not Too Late…Participate!

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

Join the thousands of Capital Health Plan members working to fight colon cancer.

As 2010 comes to a close, you may be reflecting on all your accomplishments of the past year. The Capital Health Plan Colon Screening Program has something to add to your list. CHP is ranked #1 in the nation for colon screening, and 27,138 of you helped. The ranking is a reflection of the number of Capital Health Plan patients, age 50-75, who participated in colon screening as compared to members in other health plans. This emphasizes the #1 priority CHP members make to staying healthy.

How did we get here?

A 1998 New York Times article declared that “Although colon cancer is the second-biggest killer among cancers in America, it is hardly the most talked about.” We’re proud to say this isn’t true at CHP where colon screening is a part of our daily focus.

Capital Health Plan members are committed to fighting colon cancer and have taken action. Each year more members participate by doing stool testing and colon exams (flexible sigmoidoscopy-“flex sigs” or colonoscopy). By utilizing the services that CHP offers, more and more members are taking steps to maximize their health.

How can you get involved?

During the busy holiday season, don’t let the priority of your health be overlooked. If you’re not up to date with screening, it’s not too late— participate!

The easiest and simplest way to get involved in colon screening, that won’t interrupt your pace this busy holiday season, is doing a stool kit. The test requires collection of only one small sample which can be tested for non-visible blood. Since there are no dietary or medication restrictions, this test allows you to easily and conveniently participate in screening, right from home. The completed kit can be sent to the Colon Screening Program for testing and your primary care doctor will automatically receive the result.

If you have not done a colon screening, and are 50-75, or are African American age 45-75, call 523-7350 and request a kit today.

We are proud of the care we give our patients, and we want to help you to be one of the thousands who make Capital Health Plan #1 in the colon cancer fight. Participate in screening now and give yourself something else to celebrate this holiday season….a healthy colon check.

Ask Your Local Member Services Representative

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 strives to provide our Members with outstanding customer service. This section of your Member newsletter focuses on answering general coverage or procedural questions that we receive on a regular basis.

Question:

What is a Primary Care Physician and how do I choose one for myself?

Answer:

One of the most important health care decisions you will ever make is selecting your primary care physician. This is your health care partner and central coordinator for everything pertaining to your good health. Primary care physicians include family physicians, internal medicine physicians and pediatricians.

The process for choosing your primary care physician is simple.

1) First, find a physician accepting new patients:

  • Access the CHP Physician Search Tool. Visit www.capitalhealth.com and on the homepage, under the phrase “Learn more about,” click on the word “Doctors”
  • On the Physician Search tool, click the “advanced search” link.
  • Use the drop down box in the category labeled “Accepting Patients” to choose “Yes”.
  • Check the box next to the words “Primary caregivers only” and then click “Go”. (If you want to narrow the search further, enter the zip code, city, medical group affiliation, and/or other search items accordingly.)
  • Review the list of primary care physicians accepting new patients and choose the one that you would like to have as your health care partner.

2) Then, notify your local Member Services Representative of your decision so our records will reflect your choice.

  • Call CHP Member Services at (850) 383-3311 - or -
  • Log on to your CHPConnect account and make your selection. This automatically sends a secure message to the Member Services staff; your selection will then be completed that evening. (You can register for a CHPConnect by visiting www.capitalhealth.com and clicking on the link titled
    in the left hand column.)

Member Services: Five days a week 8 a.m. – 5 p.m.

850.383.3311 or 800.390.1434

Medicare Member Services: Seven days a week 8 a.m.– 8 p.m.

850.523.7441 or 877.247.6512

TTY/ TTD: 850.383.3534 or 800.955.8771

Privacy Notice

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

(Gramm-Leach-Bliley Act)

To Our Members:

Capital Health Plan knows that the way we conduct our business offers us the opportunity to earn your respect and trust. Our members are our reason for being. To that end, we believe our members have the right to privacy and that their non-public personal, financial and health information should be kept confidential.

Our practices to protect your privacy are not new. However, laws now require we notify you annually about our privacy policy concerning:

  • What kind of personal information we collect about you and how we obtain it
  • How we use your personal information
  • What kind of personal information about you we release to other companies
  • How we protect your personal information

This Privacy Notice is provided to help you better understand how we protect your non-public personal, financial and health information. If you have questions about our privacy policy, please feel free to contact us. If you are one of our members you can call Member Services at 383-3311. If you are an employer representative you can call the Marketing Office at 523-7333.

What Kind Of Personal Information Do We Collect And How Do We Obtain It?

Generally, the information includes your name, address, phone number, social security number, date of birth, age, sex, height and weight, occupation, health habits, and general medical information. It could also include accident and injury dates. Most of this information is provided by you.

We obtain personal information about you from the following sources:

  • Information you provided us, or an affiliate, on an application form for health plan coverage;
  • Information your physician or other health care practitioner provided us;
  • Information your employer provides us;
  • Information received from other sources.

How Do We Use Your Personal Information? We use your personal information to perform transactions and functions necessary to implement and administer the health plan benefits purchased from us. On occasion, your personal information is used for reporting or other functions required or permitted by law.

What Kind Of Personal Information About You Do We Release? We may share any of the information we collect about you (as described above) with our affiliates, namely our health business partners. We may disclose any of the information we collect about you to other parties, including vendors and governmental agencies retained to audit medical records and billings. However, the type and the amount of information we share with others is limited to what is necessary to implement and administer the health plan you have with us, or as otherwise permitted or required by law. We may disclose any of the information we collect about you (as described above) to companies that perform other services on our behalf, including administrative services.

How Do We Protect Your Information? We maintain physical, electronic, and procedural safeguards to protect your personal information. We access and use your personal information to the extent necessary to administer the health plan services you are entitled to. We establish confidentiality agreements with contracted parties that receive nonpublic personal financial and health information about you. We restrict access to your non-public personal, financial and health information to those employees who need to know that information to administer the product or service you purchased from us.

Original approval 10/23/2001, revised 6/05, reviewed 9/6/2007. Revised/Approved by Compliance Committee 8/25/09

Reducing Fat in Your Holiday Recipes

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

Whatever you celebrate, the holidays are a time for feasts. Many of us dig out favorite recipes for cookies, pies, soups, and holiday meats. Delicious as they are, these recipes do not always have the healthiest ingredients. Luckily, there are things you can do to improve your holiday diet while still enjoying your favorite dishes.

Cut down on saturated and transfats

The first step toward making holiday recipes healthier is to cut down on saturated and transfats. Saturated fats are solid at room temperature and are found in butter, lard, and most animal products. Transfats are found in partially hydrogenated oils.

Eating too much of these fats leads to high cholesterol and can increase your risk of heart disease and stroke. Plus, high-fat foods are also high in calories, so reducing the fat content of a dish usually also makes it lower in calories.

Here are some recipe changes that can help cut down on fat:

If a recipe calls for… Replace it with…
Sour cream Plain low fat or nonfat yogurt, or nonfat sour cream
Cream or whole milk Reduced fat or skim milk
Whipping cream Imitation whipped cream (made with skim milk)
Cheese Low fat or nonfat cheese
Ground beef Extra lean ground beef or turkey
Bacon or sausage Canadian bacon or lean ham
Chicken or turkey with skin, duck, or goose Skinless chicken or turkey
Beef (chuck, rib, or brisket) Beef (round or loin; trimmed of excess fat)
Pork (spareribs or untrimmed loin) Pork tenderloin
Whole eggs Egg whites or egg substitutes
Chorizo sausage Turkey or tofu sausage

Replace Bad Fats with Good Fats

You can replace saturated and transfats in your recipes with monounsaturated and polyunsaturated fats. Mono- and polyunsaturated fats are plant based fats such as canola, safflower, and olive oil. Monosaturated fats protect against heart disease. If a recipe calls for butter or lard, try substituting it with a “good fat” oil.

More tips for making holiday recipes a little healthier:

  • When making soups and stews, prepare them ahead of time and then chill them. The fat will float to the top and harden. Remove the hardened layer of fat before reheating.
  • When making muffins or quick breads, use 3 ripe, well-mashed bananas, instead of ½ cup of butter or oil. Another option is to substitute a cup of unsweetened applesauce for a cup of butter, margarine, oil, or shortening.
  • When making pie crust, use only ½ cup of margarine for every 2 cups of flour. Use soft margarines (liquid or tub types), because they tend to have less transfats than hard or stick margarine.

CHP Health Coaching Can Help

For more information about improving your overall diet, call a CHP Health Coach. Health Coaches are specially trained healthcare professionals, such as nurses, dietitians, and respiratory therapists. They are available by phone, anytime, 24 hours a day, 7 days a week, at no charge to you.

To talk to a Health Coach, call 850-383-3400. You can also get information online at www.capitalhealth.com and scroll to login to Health Coaching.

 

Capital Health Plan #1 Medicare Plan in the Nation!

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 Ranked Number One Medicare Plan in the Nation

-- Honored with top national awards by National Committee for Quality Assurance and Centers for Medicare and Medicaid Services --

TALLAHASSEE, Fla. – Capital Health Plan (CHP) a local, non-profit health plan announces that its Medicare Advantage Plan is ranked number one in the nation according to “NCQA’s Health Insurance Plan Rankings 2010-2011 – Medicare” published by the National Committee for Quality Assurance (NCQA). The Medicare Advantage Plan has ranked in the top tier in past years*, but is now the first ever Florida health care plan to be ranked number one.

"We are honored to receive the number one ranking from NCQA. It is a reflection of the commitment of our local physicians and clinical staff to consistently deliver quality medical care,” said Dr. Nancy Van Vessem, Capital Health Plan chief medical officer. “Collaboration between Capital Health Plan, physicians and members has led to continued success measured by consistently excellent results on quality and member satisfaction scores.”

Capital Health Plan serves Tallahassee and the surrounding counties, but the plan brings the entire state of Florida attention with its achievements. The Centers for Medicare and Medicaid Services (CMS) awarded CHP with five out of five stars for its Medicare Advantage health plan. Star ratings show how well each plan performs in a particular category, ranging from 1 star, meaning "poor" quality, to 5 stars, meaning "excellent" quality. The system was designed to help patients and their families more easily make decisions regarding Medicare services.

“As the only health care plan in Florida to receive such a commendable rating, we are committed to being a leader and continually improving Medicare services and patient care,” said John Hogan, CEO of Capital Health Plan. “The rankings we received from both the Centers for Medicare and Medicaid Services and the National Committee for Quality Assurance are a testament to the dedication of our staff and medical community to excellent care for our members.”

NCQA uses HEDIS®, CAHPS® and NCQA Accreditation standards scores to calculate plan rankings. These scores reflect the results of consumer surveys and the plan’s success in prevention and treatment compared to other plans. Medicare health plans voluntarily report their scores to NCQA using data from HEDIS® and CAHPS® in categories related to access to care, overall satisfaction, prevention and treatment.

CHP’s commitment to member satisfaction shows in the outstanding results of member surveys. CHP Connect, a secure, online personal health record, helps members take control of their health. CHP Health Coaching gives members access to online web modules and 24/7 advice from health care professionals to guide them through important medical decisions. Capital Health Plan’s local member services department consistently delivers efficient, expert service.

* U.S. News/NCQA “America’s Best Health Insurance Plans” 2005-2009 (annual). “America’s Best Health Insurance Plans” is a trademark of U.S. News & World Report.