health insurance changes Page 2 pharmacist better management Page 4 Get to know your Let s talk about Putting the care in care WINTER 2013 Page 6

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1 WINTER 2013 Get to know your pharmacist better Page 6 Let s talk about health insurance changes Page 2 Kristin Weiler, Pharmacist Wayne Thompson Putting the care in care management Page 4 SECURITY HEALTH PLAN OF WISCONSIN INC PO BOX 8000 MARSHFIELD, WI

2 We re ready to help you understand health insurance changes Soon, almost everyone in America will be required to have health insurance. You or someone close to you may need to know how your health insurance might change. We will be here to help you. You might need to make choices. We ll help you through the process. There are major changes occurring in the health insurance industry. I want our members to know that we are preparing for those changes. Our members can count on us. We will continue to offer high-quality health care coverage, said Security Health Plan Chief Administrative Officer Steve Youso. Not everyone will need to make a change in their coverage. For those who do we want to make any transition as smooth as possible. Health care reform is the law called the Affordable Care Act. It says that as of January 1, 2014, most people must have insurance. They can get it through their employer. Or they can get it directly from an insurance plan such as Security Health Plan. Individuals and families whose income falls within certain limits will get help. They will qualify for help to pay their health insurance premiums and costs. In the coming months we ll keep you up-to-date on aspects of the Affordable Care Act that affect you. We ll alert you to any decisions or changes that you need to make. We ve created a special page at It will help you stay informed. On our website you ll find: On our website you ll find: Nearly all Wisconsin residents will be required to have health insurance. Those who will not include: people whose family income is so low they do not file a tax return people with a religious exemption American Indians people who are not lawfully present in the United States people who are incarcerated Health reform and you Straight facts, how the law affects individuals and families Basic facts about insurance An overview of health insurance, including a glossary of common terms Choosing health care coverage Information you can use to decide what coverage is right for you and your family Answers to your questions You ll find a guide to commonly asked questions. You can also questions to us at healthcarereform@securityhealth.org and we ll share our answers Links and more We ll direct you to other websites that will offer reliable information you can use to make your decisions Many people have health insurance through their employer. Starting October 1, those who don t will have a new way to buy health insurance. Health plans will be part of a new marketplace. Most people using this new system will buy their insurance online. People who are unable to enroll online will be able to get help. They will also be able to use paper forms to enroll. Security Health Plan expects to be among the insurance plans that are part of this marketplace. 2 Family Health Tips Winter 2013

3 Your feedback makes a difference Steve Youso Chief Administrative Officer We want to hear from you. Do you like the health care services and coverage you receive from us? Do you have ideas for us to serve you better? After January 1, 2014, health plans will be making some changes that may be good for you. Here are some of the changes. 1. You can no longer be denied insurance because of a medical problem. 2. Women will not be charged a higher premium because of their gender. 3. Insurance companies will no longer be able to put lifetime caps on benefits they pay out. 4. There will be limits on how much members will pay out of pocket for their health care expenses. The greatest impact of health care reform will be on two groups of people. First, people who buy an individual plan. Second, people who are covered by a small group plan. Youso said Security Health Plan will be there to help. We intend to be ready and able to help our members make the right health insurance decisions, Youso said. We will continue to provide health insurance coverage that makes sense for our members. As a Security Health Plan member you may soon receive a survey in the mail. The questions will ask about your experiences with your health plan and your doctors. The survey is called the Consumer Assessment of Healthcare Providers and Systems (CAHPS). It is mailed to some of our members each year. It gives you the chance to speak frankly. We won t know if you have filled out the survey. This survey is very important. Please take a few moments to respond to it. Your feedback helps make your health plan better. We ll receive the results of the survey. We use them: to build on the quality of service we provide to you to work with your providers to improve the value of health care services they provide to understand other ways we can meet your needs For example, in previous surveys members told us they want personal help from a nurse to coordinate their health care. So we expanded our Care Management programs to give you better personal service. We also know you like it that when you call our Customer Service line you speak with a person right here in Wisconsin. We want to hear your comments about what is good and not so good. We need to know what matters to you. Your answers are part of our national and state quality rankings. You know we care about giving great service to you and your loved ones. We also work to improve the health and well-being of the entire community. One of the ways we do this is by listening and responding to what you and others have to say. I hope you have a chance to be part of this survey. And I thank you in advance for your responses. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Winter 2013 Family Health Tips 3

4 Putting the care in care management Weston Wayne Thompson had major colon surgery. Margie Straka was one of the first people to visit him in the hospital. Straka isn t a family member. She isn t a neighbor or a former co-worker. She had never met Thompson in person. Straka is one of Security Health Plan s Care Managers. She is a registered nurse with special training to work oneon-one with members who have chronic health concerns. Sharon and Wayne Thompson Care Management helps match members health care needs with the right health care providers or services. Nurses like Straka help craft a plan that helps members gain control of their health. Listening skills are essential to a care manager, Straka said. I ll ask, How are you feeling? I m listening closely to the sound of the answer that I get. People will sometimes say OK. But I can tell by the way they say it that there s more that they aren t saying. So I ll ask more questions to try and find out what s really going on. This approach worked well with Thompson. I like to say she s my sweetheart. I wouldn t know what I would do without her, Thompson said. She s helped me so much. It s the little things like her coming to the hospital that say, You re not a number you re a person. If I have questions she ll come back with answers. If she says she ll call back you can believe she ll get back. Straka began working with Thompson when he was diagnosed with heart failure. Later he was found to have COPD, a serious lung disease that makes breathing difficult. He has since developed colon cancer and needed to have some of his colon and intestine removed. One of the things I like about Margie is that she doesn t pull punches or sugarcoat, Thompson said. If I m not following my plan she ll chew me out just like she s your mother. Straka laughs at Thompson s motherly description. It took me a long time to get Wayne to start exercising. But between his wife and me, we got him walking, she says. Thompson, 70, is a retired maintenance worker. He sings the praises of Security Health Plan to the members of his coffee club or anyone else who will listen. And he says many have taken his advice. I have a friend who has health problems and Margie is his care worker. I tell him, You better leave her alone. I saw her first. Care Management Program Do you have many health problems and take a lot of medications? Our nurse care managers will work with you to understand your health care needs. We will match you with the right providers or community services. We will help you find a primary care provider We ll create a plan of care that is just for you Our care management team includes registered nurses, social workers, physicians, pharmacists and physical therapists 4 FAMILY HEALTH TIPS Winter 2013

5 Program aims to reduce high cholesterol, heart disease Heart disease is sometimes called the silent disease. Most people don t know they have a problem until they have an actual heart event, said Disease Management Team Leader Brenda Anderson, R.N. Security Health Plan supports a national effort to reduce the number of deaths caused by heart disease LDL (bad) cholesterol is the main source of cholesterol buildup and blockage in the arteries. This is a leading cause of heart disease. Some members have been identified at high risk because they have high cholesterol. We will send these members information on ways to lower their cholesterol. This will lessen their risk of a heart attack. These members can also talk with Security Health Plan nurses. We will help them lower their cholesterol through diet, activity and medication. We ll help them work within the health care system. We ll work with them to manage their condition, Anderson said. Our goal is to help them lower their LDL cholesterol to less than 100. Then we ll help them keep their level below 100. Exercise is very important to reduce the risk of heart disease, Anderson said. And working with your health care provider you can set goals you can reach. You don t have to run a marathon or bike across Wisconsin, she said. Make a plan to walk three times for 10 minutes this week. Then add a few more minutes each week. Soon you will reach the goal of 30 minutes, five days per week. Learn more about the national campaign against heart disease and stroke. Visit One in a Million Hearts at millionhearts.hhs.gov Disease Management Program Through this program we help you with the conditions listed below. We help you stay current with your care and your providers. Adult and child asthma care Adult diabetes care Adult heart care (such as high blood pressure, cholesterol, heart failure or heart attack) Tobacco cessation COPD Depression Care Management for our members Security Health Plan exists for its members plain and simple. We have programs to help you deal with all of your health concerns. We work with you to keep you out of the hospital. To learn more or join one of these programs call Winter 2013 Family Health Tips 5

6 Get to know your pharmacist better When I complete a review and help a patient find an alternative medication that is more cost effective they like to save money I m looking out for them and their overall health. Kristin Weiler, Pharmacist Neillsville You should get to know your pharmacist better, and he or she should get to know you better. This relationship can be an important link in your health care, said Patrick Burt, assistant director of pharmacy services at Security Health Plan. If at all possible use a single pharmacy and get to know your pharmacist, Burt said. It s important that you clearly understand the medicines you are taking. You need to know how to take them and why you are taking them. Your pharmacist can help you with that. Your pharmacist may have a more complete knowledge of your medications than your doctor, said Weiler. This is especially true if you see more than one doctor or go to more than one clinic. It s also true if you take over-the-counter medications. These drugs may pose no risk alone but may have a harmful effect when mixed with other more potent drugs. She said doctors may be unaware of a medicine s cost. They might not know whether there is a less-expensive drug that will work. The doctor is focused on whether a drug addresses symptoms. If you take multiple medications you may want to have a comprehensive medication review, Burt said. This service is free to members. A pharmacist will review your medicines. He or she is trained to look for duplications or conflicts and to answer any questions you may have. The pharmacist will help you get the best results from your medicines and keep your costs down. Ask your pharmacist if he or she can review your medicines. If not, we have a list of pharmacists who do medication reviews. If you use a different pharmacist for the Kristin Weiler graduated from the University of Wisconsin-Madison pharmacy program. She wanted to be a community pharmacist just like her father. She has reached that goal and is now working at Sniteman Pharmacy in Neillsville. I saw my father get to know his customers by name and not just by prescription, she said. By the time I received my Doctor of Pharmacy I knew that s what I wanted. Understand your pharmacy For members with a drug benefit, the Formulary Guide will help you find a list of drugs covered by Security Health Plan. To learn more visit: 6 Family Health Tips Winter 2013

7 Pharmacist Kristin Weiler chats with Security Health Plan member Chuck Boyer. HIPAA: our commitment to your privacy Your health is personal and we work hard to protect your information. It s our policy and practice. It s also the law. review, you can still use your regular pharmacy to fill prescriptions. Call Security Health Plan s pharmacy customer service at benefit The Formulary Guide is updated by the fifth business day of each month. It also lists which drugs require prior authorization or a formulary exception review. There is a federal law called the Health Insurance Portability and Accountability Act (HIPAA). This law gives you rights over your records. It applies to most doctors, nurses, pharmacists, hospitals and health plans. It also applies to Medicare and Medicaid. Because of HIPAA, you can: Ask to see and get a copy of your health records even if you haven t paid your bill Add corrections to your health records Ask that certain people not be given details about your health or treatment Decide if you want to let your health information be used for certain purposes, such as marketing Get a report on when and why your information was shared or used File a complaint if you think your rights or privacy laws have been violated Ask to be contacted at a place other than at home Why we might share records There are some good and approved reasons to use or share health information. Your provider or health plan may need it: To follow the law. For instance, your provider may need to report flu and other public health risks For coordinating your treatment and care To pay providers For checking out the quality of treatment, providers and institutions Your health information can t be used or shared without your written permission. This can only happen if the HIPAA law allows it. Always on alert We protect your private health information. It matters to you, and it matters to us. We can answer any questions you might have about your rights, our responsibilities and the steps we take to keep your information safe. We will never ask you for your ID numbers, Social Security numbers or passwords. Say no if someone calls claiming to represent us and asks for this type of information. If this happens, please call our Compliance Hotline at or Winter 2013 Family Health Tips 7

8 We want to give you the most value. Wendy is a benefit specialist. She has five tips to get concerns resolved sooner and with less hassle: Getting the most from customer service 1 The best times to call In the morning before 9 a.m., or after 3:30 p.m. The busiest times are 9:30 to 11 a.m. and 12:30 to 1:30 p.m. 2 Have your information ready You may have a question about an item on your Personal Health Statement. Make sure you have your statement and your ID card ready. Keep in mind Personal Health Statements are not bills. They explain how your plan covered a health care service. 3 Have specific details handy You may call to find out about coverage for a procedure. Make sure your doctor gives you the exact name of the procedure and the name of the facility or provider involved. This will help us get an answer sooner. 4 Authorize ahead of time Members are often upset to learn that we must have permission to discuss a loved one s health issue or claim. This even applies to your spouse or child who is age 18 or older. But you can arrange for an adult family member or friend to discuss your health concerns. Ask us to send you a Family and Friends authorization form. Once it s signed and returned we can talk. 5 Save time go online Much of the information you want is available with the click of a mouse. You can order new ID cards or check your subscriber number. You can review your Personal Health Statement. You can find out about your benefit limits and request forms and documents. Simply go to Security Health Online at You ll need to register on the website. Then you can see your information whenever you want. Have a question that needs to be answered? us at shpcsweb@securityhealth.org Wendy R., Customer Service Agent You ll get a secure response within two business days. Of course, you can call us too at How to reach us If you have any questions, you can reach Security Health Plan Customer Service by phone or . Phone: (TTY: ) shpcsweb@securityhealth.org Website: New address? Let us know by calling our Customer Service Department. Our office hours are Monday through Friday, from 7 a.m. to 5:30 p.m. You may also leave a message after hours and your call will be returned. When leaving a message, please state your name, date of birth and subscriber number. We will return your call as soon as possible. It is important to keep your address and phone number up to date with ForwardHealth. You can make updates by calling your county human services office. You can find the phone number online at Or log into your long account at Family Health Tips is published for members of Security Health Plan of Wisconsin, Inc. Information in Family Health Tips comes from a wide range of medical experts. Models may be used in photos and illustrations. If you have any concerns or questions about specific content that may affect your health, please contact your health care provider. Copyright 2013 Security Health Plan of Wisconsin, Inc. 8 FAMILY HEALTH TIPS Winter 2013

9 Winter 2013 Help us serve you better This newsletter highlights several ways that we re connecting with you, to give you the highest quality service. If we could improve one area of service what would you recommend? Please let us know. You can also provide feedback at

10 ATTENTION: DAVE MUELLER NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES BUSINESS REPLY MAIL FIRST-CLASS MAIL PERMIT NO 110 MARSHFIELD WI POSTAGE WILL BE PAID BY ADDRESSEE SECURITY HEALTH PLAN PO BOX 8000 MARSHFIELD WI