Anthem becomes plan administrator

Transcription

1 OPEN ENROLLMENT EDITION Special Issue For All UK Benefits-Eligible Employees Spring 2013 Anthem becomes plan administrator We are happy to announce that Anthem has been chosen by the University of Kentucky as the new third-party administrator for the UK health plans beginning July 1, They replace Humana. Anthem will assist the UK health plans by processing claims, handling appeals and handling customer service. (As always, UK-HMO s provider network consists mainly of providers in UK HealthCare.) We are looking forward to this opportunity to work with Anthem. Because of this new relationship, we will be able to offer some new services to our members: 24/7 NurseLine Round-the-clock access to health information can be vital to your peace of mind and well-being. Can you treat the problem at home? Do you need to see your doctor? Or should you head straight to the emergency room? Making the right call can help you avoid needless worry and expense. And, most importantly, safeguard your health and the health of your family. Nurse coaches are available to talk with you about your general health issues any time of the day or night on a toll-free line. To reach the 24/7 NurseLine, call (toll-free). ConditionCare If you or someone you love has a chronic health condition, this service can help you get more out of life. ConditionCare nurses help people of all ages manage the symptoms of asthma and diabetes. They also work closely with adults who are dealing with chronic obstructive pulmonary disease (COPD), heart failure and coronary artery disease, as well as some types of cancers. If you or a covered family member have been diagnosed with skin, prostate, colon or breast cancer, ConditionCare can help you understand treatment options, manage side effects and symptoms, and feel better. With ConditionCare, you ll get the information you need to feel your very best day after day. ConditionCare nurses gather information from you and your doctor. Then, they create a personalized plan just for you. To learn more or enroll in ConditionCare, call (toll free). We may call to find out if ConditionCare can help you and ask you to sign up. For your protection, we ll verify your address or date of birth before talking about your health. ComplexCare You may need ComplexCare if you have more than one health issue or a condition that could mean frequent or high levels of health care. This program can partner you, your family and your doctors with a ComplexCare nurse and other experts to help you reach your personal health goals and avoid costly hospital re-admissions. You get toll-free, 24-hour access to ComplexCare nurses for personal education, along with preventive care and self-management tips. The nurses give you one-on-one attention and lifestyle coaching, help you make better decisions about your options, help you transition your care, and coordinate care between doctors and other health service providers. A nurse will contact you if you are eligible for the program. Future Moms We know your goal is to have a safe delivery and a healthy baby. Future Moms, a voluntary program, can help you take care of your baby before you deliver. (continued on next page)

2 (continued from front page) Register for Future Moms and you ll get: Toll-free, 24/7 access to a registered nurse who ll answer your questions and talk about pregnancy issues with you. A helpful book: Your Pregnancy Week by Week. Materials to help you know what to do if something unexpected happens. A questionnaire to check your risk of delivering too early. Useful tools to help you, your doctor and your Future Moms nurse-coach track your pregnancy and spot possible problems. Answers and support are just a phone call away. Enroll in the Future Moms program at no additional cost by calling (toll free). MyHealth Advantage MyHealth Advantage is a free service that helps keep you and your bank account healthier. Here s how it works: Anthem reviews your incoming health claims to see if they can save you money. They also check what medications you re taking and alert your doctor if they see a potentially dangerous drug interaction. Plus, they keep track of your routine tests and checkups reminding you to make these appointments by mailing you a MyHealth Note. MyHealth Notes summarize your recent claims. Staying Healthy Reminders Sometimes a gentle reminder can be the boost you need to help you be your healthy best. Our Staying Healthy Reminders are mailers that remind you about important preventive health screenings or exams based on your age or gender. Staying Healthy Reminders are already part of your health plan, so there s nothing to join and no extra cost. All you need to do is keep an eye on your mailbox! Benefits Open House Information Building Location Date Time Good Samaritan Hospital Main Conference Room B Monday, April 22 7 a.m. 9 a.m. University Health Service 1st Floor Tuesday, April a.m. -2 p.m. Peterson Service Building Loading Dock Wednesday, April 24 7:30 a.m. 11 a.m. and 10 p.m. 10:30 p.m. Chandler Hospital Room H133 Thursday, April a.m. 1:30 p.m. College of Agriculture Gorham Hall in the Good Barn Monday, April a.m. 2 p.m. Chandler Hospital (North lobby in front of Hospital Administration) Tuesday, April 30 6:30 a.m. 8:30 a.m. and 10:30 p.m. 11:30 p.m. Good Samaritan Hospital Main Conference Room B Thursday, May 2 11 a.m. 2 p.m. University Health Service 1st Floor Monday, May 6 7:30 a.m. -10 a.m. Main Administration Building Lexmark Public Room Tuesday, May 7 10 a.m. - 1 p.m. Sterlington/Alumni Park 2317 Alumni Park Plaza Thursday, May 9 11 a.m. 1:30 p.m. Scovell Hall Outside front lawn (weather permitting) or inside first floor hallway Friday, May a.m. 2 p.m.

3 Highlights of UK-HMO Health Plans Effective July 1, 2013 Medical Services Choice of physician Choice of hospital Emergency/accident (or urgent) care UK-HMO UK-HMO participating provider(s) (consists primarily of UK HealthCare providers (Go to and open the link on the front page to the provider network directory.)) UK Albert B. Chandler Hospital, Kentucky Children s Hospital, and UK Good Samaritan Hospital $100 co-payment per emergency department visit, waived if admitted to hospital as inpatient or observation stay. $25 co-payment at Lexington Urgent Treatment Centers (Boardwalk, Custer Drive, Dove Run and Sir Barton Way); Nicholasville UTC (Bellaire Drive); and Georgetown (Oxford Drive). Berea Urgent Care (Brenwood Street); Frankfort Urgent Care (Kings Daughters Drive); and Georgetown Urgent Care (Osbourne Way, Suite 1) $15 co-payment at UK Twilight Children s Clinic Preventive care routine Pap smears, mammograms, PSA, screening colonoscopy and sigmoidscopy Routine child care and immunizations (through age 18) 100% covered Routine adult physical exam (19 years and above) Physician (primary care) office visits for diagnosis and treatment Physician (specialist) office visits for diagnosis and treatment Allergy injections Maternity care (physician) Prescription drugs Chiropractic; physical therapy; occupational therapy; acupuncture; pool therapy/exercise therapy; cardiac rehabilitation; pulmonary rehabilitation. Autism Outpatient mental/nervous care or substance abuse care rendered by licensed psychiatrists and psychologist Inpatient mental/nervous care or substance abuse care (acute care) Outpatient diagnostic tests, lab and X-ray, and other diagnostic tests (excluding HIGH COST below) Ambulatory hospital Ambulance (including Air Ambulance) Outpatient diagnostic testing (HIGH COST - MRI, MRA, CT, SPECT and PET scans) Outpatient surgery Hospital services, including semi-private room and board Hospital services, observation stay Skilled nursing Tobacco cessation counseling Durable medical equipment (DME), prosthetics, orthotics $10 co-pay (except allergy injections, see below) $30 co-pay $10 co-pay 100% covered. Inpatient co-pay will apply upon admission. Prescription drugs are covered under a separate plan through Express Scripts and UK employee benefits. $15 co-pay. 45 visits per plan year for all therapies combined If a member completes at least 24 cardiac or 24 pulmonary rehab visits, UK-HMO will reimburse them 50% of the co-pays for that specific service. $375 maximum monthly benefit for children 2 to 21 years of age for therapeutic, respite and rehabilitative care (unless receiving ABA therapy) $30 co-pay 100% covered after $200 co-pay 100% covered $75 co-pay. Non-emergent ambulance will only be paid when transported to UK Chandler or UK Good Samaritan hospitals. $50 co-pay $200 co-pay per admission $75 co-pay per observation stay 100% covered, 30-day limit 100% covered 20% co-insurance ($500 maximum out-of-pocket per plan year for these services combined, then covered in full) This is a partial listing and summary of benefits and services. For complete details of covered services, exclusions and benefit limitations, refer to the Certificate of Coverage booklet, which can be viewed at For the latest Open Enrollment information, including open house dates, times and locations, see the UK Employee Benefits website at

4 How to Enroll Current Member If you are currently a UK-HMO member, you do not need to re-enroll at open enrollment. Your health coverage will continue automatically. However, if you wish to add or cancel a dependent, you must make your change online through the myuk website at or complete the health plan form. You may also pick up a form from the UK Benefits office in 112 Scovell Hall or 375 Peterson Service Building. These locations are in Lexington or you can download a form online at You may enroll or make changes April 22 through May 10 for open enrollment. More information is available in the enrollment material you will be receiving via mail from UK Human Resources. New Member To enroll online, please follow these simple steps: Visit the myuk website at 1. Enter the Link Blue user ID and password. 2. Click on the Personal Information tab and then click on Family/Related Person to add any dependents and/or beneficiaries. a. After entering all dependents information, click review, then click save. 3. Click on Benefits and Payment tab and then click under Benefits Adjustment Reason Enrollments the Open Enrollment tab. Access UK-HMO website Please visit the UK-HMO website at ukhmo to find answers to all of your UK-HMO health plan questions. The UK-HMO website provides access to all of the following information: Benefit information including your Certificate of Coverage (COC). A link to the UK-HMO Provider Directory online search, which allows you to locate participating providers. A link to Anthem, which allows you to view your claims and authorizations and access health care information. Frequently asked questions (FAQs) regarding UK-HMO. 4. Select the plan you want to Add or Edit. You will then see the plan option. Highlight the plan you want to select and choose the level of coverage. 5. If you need to edit dependents, click select dependent. 6. If you have elected no dependents then the next screen will ask you to Add Plan to Selection. 7. Once all changes have been made then you will need to Review Enrollment, then click Save. 8. To view new and existing plan, click on Print New Plan Sections and print. If you d rather complete a health plan enrollment form, the form is available online at or at the UK Benefits office in 112 Scovell Hall or 375 Peterson Service Building. On this form: a. You will select a coverage level (i.e., employee only; employee + spouse or sponsored dependent; employee + child(ren); or employee + family). b. If you are covering dependents, you need to complete the section under additional enrollment information on the form. For additional questions, please contact the UK Benefits office at , Choose option 3, then choose option 1. Primary Care Access, which includes information about access to the primary care practice options available at UK HealthCare. Information about and links to the other health services available at UK HealthCare. UK-HMO current and past newsletters. UK-HMO pre-authorization lists. In the News UK-HMO information updates. ER Autopay Diagnosis code list. Please be sure to visit the UK-HMO website regularly for updated information.

5 UK-HMO Open Enrollment The UK Health Benefit Open Enrollment period that allows UK employees to sign up or switch their health benefits will be held April 22 through May 10, Changes made during the Open Enrollment period will go into effect July 1, If you have any questions regarding your plan, contact: Customer Service: (toll free) UK Human Resources Benefits Office: (Choose option 3,then choose option 1) New Kentucky Clinic maps now available in print and online In the interest of helping our patients and visitors find their destinations easily and with as little stress as possible, new Kentucky Clinic interior maps have been developed. The primary feature of the booklets is large, easy-to-read maps of each floor of the Clinic building. Map booklets are available at information desks and in racks throughout the building. You may also request a copy by mail by calling or In addition to the printed versions, the maps are available online at ukhealthcare.uky.edu/ky- Clinic-Maps. A clickable list of clinics allows you to select your destination and get a printable version of the appropriate map. Chandler Retail Pharmacy opening April 24 Located in Chandler Hospital Pavilion A, just off the Floor 1 concourse near Surgery Waiting, this new pharmacy will serve employees, patients and the public. In addition to prescription medications, overthe-counter remedies will also be available, many at discount prices over regular retail. Hours are 7:30 a.m. to 9 p.m. Monday Friday, 9 a.m. to 5 p.m. Saturdays and 1-5 p.m. Sundays. The pharmacy can be reached at , and prescriptions may be faxed to UK HealthCare shares information on quality online Because we believe our patients have the right to understand the quality of care we provide, UK HealthCare has launched a series of Web pages that list measures for which external agencies hold us accountable as well as measures that show how we are performing in key components of quality: patient survival, quality of care, patient safety, efficient care and patient centeredness. To see the data and learn more, visit ukhealthcare.uky.edu/quality. Kentucky Clinic South mammography is moving To optimize care and offer patients access to an integrated, comprehensive breast care team and the most superior breast imaging available, Kentucky Clinic South mammography services have moved to our main UK HealthCare campus as of April 1. We will now see all diagnostic and screening mammography patients in the UK Comprehensive Breast Care Center on the second floor of the Whitney-Hendrickson Building. Free parking is still available. To make an appointment, call New treatment available for overactive bladder If you find yourself repeatedly rushing to the bathroom, we may be able to help. Botox was recently approved by the FDA for treatment of overactive bladder. Call today to learn how Botox could improve your life.

6 University of Kentucky Health Care Plans 2333 Alumni Park Plaza, Suite 200 Lexington KY First Class U.S. Postage Paid Lexington KY Permit Number 51 Special Issue For All UK Benefits-Eligible Employees HealthBeat is published by the UK Health Care Plans office. The information is intended to educate members of UK-HMO about subjects pertinent to their health and health coverage, not as a substitute for consultation with a personal physician. Writing, editing and design for HealthBeat provided by UK HealthCare Communications & Advertising. Don t forget to update your address when moving When you move, it is important that you fill out an updated health benefits enrollment form with your new address and forward it to: University of Kentucky Employee Benefits Office 112 Scovell Hall Lexington KY The staff will forward the information to UK-HMO, and this will enable us to ensure that you receive important information during the plan year. The health benefits enrollment form is available to you at enrollmentforms.html. If you are moving outside the UK-HMO service area, you must notify the UK Employee Benefits office and make arrangements for health insurance coverage within 30 days of your move date. Otherwise, you may find yourself with an unnecessary lapse in health insurance coverage and at financial risk for all of your health care expenses. You can also change your address by going to and logging in using your Link Blue username and password. Choose your Personal Information and change your address. This will transfer this change of address information to the UK Benefits office and then on to Anthem. If you move out of the area and will need to change insurance plans, it is always a good idea to contact the UK Benefits office at , option 3 and option 1 to discuss this with them. UK-HMO Monthly rates Regular full-time employee eligible for university contribution Employee NOT eligible for university contribution Employee Only Employee + Child(ren) Coverage levels Employee + Spouse (See UK Benefits website for retiree rates at Employee + Family [Spouse & Child(ren)] $26 $130 $253 $373 $483 $724 $965 $1,208 UK-HMO UK Regional Health Plan