FAIRBANKS NORTH STAR BOROUGH SCHOOL DISTRICT FAIRBANKS URGENT CARE PA CLINIC PROGRAM

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1 FAIRBANKS NORTH STAR BOROUGH SCHOOL DISTRICT FAIRBANKS URGENT CARE PA CLINIC PROGRAM The Fairbanks Urgent Care PA Clinic Program is a special health benefit program for School District employees and eligible Dependents in Plan A. The program offers outpatient health care services provided by Physician s Assistants (PA s) and Nurse Practitioners (NP s) at the Fairbanks Urgent Care Center, located at 1867 Airport Way. The Fairbanks Urgent Care PA Clinic can be used for scheduled preventive care visits and minor acute care services. You may use the Fairbanks Urgent Care PA Clinic to obtain unscheduled treatment for minor illnesses and injuries. Use of the PA Clinic program is voluntary. You are not required to obtain services through the PA Clinic program. BEFORE YOU BEGIN USING THE PA CLINIC PROGRAM This benefit is only available to employees and eligible Dependents who have elected Plan A. Prior to using PA Clinic services, you MUST make sure all of the necessary paperwork for your or your eligible Dependent s coverage has been processed by Risk Management. Risk Management provides the PA Clinic with the official eligibility list. Only participants whose names are on this list are eligible for PA Clinic benefits. If you call the Fairbanks Urgent Care PA Clinic to schedule an appointment and your name is not on the eligibility list, you are not eligible for PA Clinic program benefits. Please call Human Resources at Ext 382. If you walk into the Fairbanks Urgent Care PA Clinic and your name is not on the eligibility list, you are not eligible for PA Clinic program benefits. Please call Human Resources at Ext 382. PA Clinic program benefits will not be processed retroactively. If services are provided by a Fairbanks Urgent Care PA Clinic provider while you are not eligible for the PA Clinic program, you will be financially responsible for the cost of your visit. Therefore, it is important to make sure you and your dependents are eligible for the PA Clinic program services PRIOR to your visit. Page 1 of 9 Effective: January 1, 2010

2 INSTRUCTIONS FOR SCHEDULED APPOINTMENTS Appointments may be scheduled for PA Clinic services at the Fairbanks Urgent Care building. The Fairbanks Urgent Care Clinic may also be used for walk-in visits. 1. Call 457-CARE ( ) to schedule an appointment. Identify yourself as a School District plan participant and request a PA Clinic appointment. 2. Fifteen minutes before your scheduled appointment, check in at the PA Clinic check-in station at the Fairbanks Urgent Care Center located at 1867 Airport Way. 3. A small co-payment fee will be collected, $10 per person, $20 for 2, but not more than $25 for 3 or more people per visit. 4. New patients to Fairbanks Urgent Care should plan to arrive 30 minutes early to complete registration paperwork. 5. After your visit, complete a satisfaction report and deposit it in the PA Clinic suggestion box at the appointment desk. INSTRUCTIONS FOR WALK-IN VISITS Walk-in services are available at the Fairbanks Urgent Care Clinic located at 1867 Airport Way. They are open 7 days a week, including most holidays, with the exceptions of Thanksgiving Day, Christmas Day and New Year s Day. Patients are seen on a first come, first served basis. 1. Walk in to the Fairbanks Urgent Care Clinic and identify yourself as a School District plan participant. Request to see a provider through the PA Clinic program. 2. A small co-payment fee will be collected, $10 per person, $20 for 2, but not more than $25 for 3 or more people per visit. 3. After your visit, complete a satisfaction report and deposit it in the PA Clinic suggestion box at the check-in desk. 4. Follow-up appointments, if necessary, may be scheduled with the provider of your choice. Visits outside the PA Clinic program may be covered under the regular health plan. See your health plan booklet for details. Page 2 of 9 Effective: January 1, 2010

3 SPECIAL PROGRAM FEATURES No claim forms necessary at the PA Clinic! If you identify yourself as a School District employee or Dependent eligible for the PA Clinic program and pay your $10 copayment, claims processing by the Welfare & Pension (WPAS) Claims Office is eliminated. No Deductibles! Services provided through the PA Clinic program, including any associated lab and x-ray charges, are covered at 100% after the co-payment. Your only out-of-pocket cost is the co-payment. Keeps costs down! The plan receives negotiated discounts for services obtained through the PA Clinic program. Using the PA Clinic program helps keep health plan costs down for both the School District and School District employees. APPOINTMENTS A special, dedicated telephone line exists for School District employees and their eligible Dependents to use. Call 457-CARE ( ) to make PA Clinic program appointments at the Fairbanks Urgent Care Center. The appointment line is open to take calls beginning at 7:00 AM, Monday Friday, and from 10:00 AM 7:00 PM on Saturday and Sunday. This number is printed on the back of your Health Plan ID card for your convenience. If you have a sudden onset of illness and call the PA Clinic by 9:00 AM, every effort will be made to schedule an appointment the same day. Your choice of appointment times and provider are necessarily limited to accomplish this exclusive plan feature. Alternatively, you may walk in and obtain PA Clinic program services at the Fairbanks Urgent Care Center located at 1867 Airport Way, from 7 AM 9 PM, Monday through Friday; and 10:00 AM 7:00 PM Saturday, Sunday and on Memorial Day, July 4 th and Labor Day. New patients to the Fairbanks Urgent Care PA Clinic should arrive 30 minutes early (first visit only). A little extra time is necessary on the first visit to prepare a new patient chart. When you schedule your appointment, notify the clinic staff if multiple family members will be visiting at the same time, or if the visit involves multiple medical needs. A longer block of time will be scheduled for these types of visits. To obtain a physical exam, you must make an appointment. If you wish to obtain PA Clinic program services for treatment of a minor illness or injury, you may either call to make an appointment with the Fairbanks Urgent Care Center or simply walk in to their 1867 Airport Way location during regular business hours. Be sure to inform the clinic if you need to cancel your appointment. Chronic no-shows will lose the ability to schedule appointments. CO-PAYMENT REQUIREMENTS $10 per person per visit $25 if 3 or more family members visit the clinic at one time Page 3 of 9 Effective: January 1, 2010

4 You will be asked to make your co-payment before treatment is rendered. Follow up visits (e.g. removal of stitches; visits to the lab for tests not completed during the initial PA visit, etc.) will not require additional co-payments. When returning to the clinic for additional testing, be sure to identify yourself as a School District PA Clinic program participant at the check in desk. If the services cannot be provided under the PA Clinic program, the co-payment will be refunded and services will be considered for coverage under the regular health plan. Referrals to other medical professionals or facilities are made consistent with providing optimal medical care. PA Clinic program co-payments may NOT be applied against any individual or family deductibles under the regular health plan, but may be reimbursed through a medical flexible spending account. SUMMARY OF BENEFITS - PA CLINIC PROGRAM There are two types of services available through the Fairbanks Urgent Care PA Clinic: 1. Preventive Care Services The following preventive care services are available through the PA Clinic program at a minimal cost by calling to schedule your appointment: Physical exams Prostate specific antigen testing Pap smears Mammograms Children & Adult inoculations Children s sports physicals Please note: Coverage for the above mentioned Preventive Care Services are limited under the regular health plan administered by WPAS. Please see the Schedule of Benefits in your Health Benefit Plan book. 2. Minor Care Services for Illness & Injury - Many services covered by the regular health plan can also be obtained through the PA Clinic program. Negotiated discounts for minor and routine medical care, lab and x-ray fees help offset the added cost of enhanced preventive care coverage. Services generally covered by our regular health plan or the PA Clinic program include: Office calls for colds, flu, minor illnesses Accidents, (not including work-related or automobile accidents) X-ray and laboratory services Page 4 of 9 Effective: January 1, 2010

5 Minor surgery You can utilize the PA Clinic program or you may see any medical provider to obtain these services. SCOPE OF SERVICES PREVENTIVE CARE Limited coverage under the regular health plan see the Schedule of Benefits. Adult Physicals The PA Clinic program covers physical exams, including lab and x- rays as recommended by the American Medical Association (AMA). Following your physical exam, the PA or Nurse Practitioner may refer you to another provider, or you may wish to discuss the findings with your primary care provider. At your request, your test results will be sent to your designated provider. Expenses following a physical exam which represent treatment of a covered condition will be considered for payment under the regular health plan. See the Schedule of Benefits. Mammograms and Prostate Specific Antigen Testing The Fairbanks Urgent Care PA Clinic program covers these tests along with the review of test results, when ordered as part of a physical exam. Frequency Limitations for Adult Physical Exams, Mammograms & Prostate Tests Employee or Spouse Age Under Age 40 Age Age 50 or older Exam Frequency Once every 5 years Once every 2 years Once per year Frequency limitations apply to normally healthy adults over the age of 21 and are based upon medical standards for your age group. The clinic staff will exercise their professional judgment and may order these examinations or tests on a more frequent basis, depending on individual patient circumstances. Pap Smear An annual routine pap smear is covered for employees and eligible dependents through the Fairbanks Urgent Care PA Clinic program. Children s Immunizations - The plan covers children s immunizations such as: Smallpox Measles Hepatitis Mumps Rubella Chicken Pox Tetanus Page 5 of 9 Effective: January 1, 2010

6 Polio Diphtheria Typhoid NOTE: Age limitations apply to pediatric care available through the PA Clinic program. Well child care, including immunizations, is provided for children above age 2. Children s Sports Physicals May be obtained through the Fairbanks Urgent Care PA Clinic program. Wellness and Health Promotion Counseling - May be obtained through the Fairbanks Urgent Care PA Clinic program. SCOPE OF SERVICES MINOR CARE FOR ILLNESS & INJURY You may utilize the Fairbanks Urgent Care PA Clinic program or you may obtain services from another health care provider and submit claims under the regular health plan. The PA Clinic program is not intended to supersede or create a conflict between you and your primary doctor/health care provider. Routine Minor Care - Coverage includes treatment for conditions such as: Treatment of colds, flu, strep throat and other minor illnesses. General medical care for minor accidents (provided they are not work-related or due to automobile collisions). Illness assessment and treatment, including treatment of minor infections. Injury assessment and treatment, including short term and/or urgent care. Minor surgery, suturing of minor lacerations on the trunk or extremities (not on the face), mole and wart removal, etc. Lab tests and x-rays and ordered as part of a PA Clinic program visit and performed by the Fairbanks Urgent Care Clinic and/or their medical provider partners (currently, the partners include the Breast Cancer Detection Center (BCDC) and Aurora Imaging). Initial diagnosis and referral to physician as needed. NOTE: Age limitations apply to pediatric care available through the PA Clinic program. Children under the age of one are not eligible for PA Clinic program services. The clinic staff will exercise their professional judgment in deciding when to refer you to other medical providers. Referrals under this agreement will be made to the health care provider of your choice. At your request, lab test results, X-rays, etc. will be sent to your designated health care provider. Page 6 of 9 Effective: January 1, 2010

7 SERVICES NOT COVERED BY THE PA CLINIC PROGRAM The following services are not covered by the PA Clinic Program, but may be covered under your regular health plan administered by WPAS. X Treatment by a Medical Doctor. The Physician s Assistant or Nurse Practitioner may make referrals to a Medical Doctor. X Treatment of infants (before the first birthday). X Health maintenance exams on children under age two. X Removal of subcutaneous skin lesions. X Weight management programs. X MRI s, Colonoscopies or Sigmoidoscopies. X Lab tests, X-rays or medical supplies not prescribed as a result of a PA Clinic program visit. X Treatment of patients who are not medically stable. X Treatment for chronic conditions. Chronic is defined as a disease that is long term, generally incurable, and non-episodic. Examples: Arthritis Arteriosclerosis Asthma Cerebral Palsy Chron s Disease Congenital Heart Disease Cystic Fibrosis Diabetes Heart Failure Hypertension Inflammatory Bowel Disease Lupus Recurrent Migraine Headaches Renal Failure Rheumatoid Arthritis Seizures Ulcerative Colitis The services listed below are not covered by the PA Clinic Program and are usually not covered by your regular health plan administered by WPAS: X Employer required physical exams. X Occupational accidents or illnesses. Do NOT seek treatment through the PA Clinic program for ANY work-related injuries or illnesses. X Body piercing of any kind, unless medically necessary. Page 7 of 9 Effective: January 1, 2010

8 X Treatment for substance abuse. X Reversal of sterilization procedures. EMERGENCY ROOM PENALTY: As per the Health Benefit Plan Book, a penalty of $150 is applied to each emergency room visit that occurs during the hours of operation of the Fairbanks Urgent Care Center (7 AM 9 PM, Monday through Friday; and 10:00 AM 7:00 PM Saturday, Sunday and on Memorial Day, July 4 th and Labor Day. This penalty is not applied: In the case of a life threatening emergency, or if a reasonable person could consider the situation a life-threatening emergency, If the participant is admitted to the hospital as a bed patient, or If the participant is taken to the emergency room by a third party, who is not a member of the participant s immediate family. The Emergency Room Penalty does not apply to the deductible or the out-of-pocket limit. Page 8 of 9 Effective: January 1, 2010

9 SATISFACTION SURVEY We want to make sure employees and family members are satisfied with the care provided through the PA Clinic Program. Satisfaction surveys are available at the check-in station of the Fairbanks Urgent Care Center PA Clinic. You are strongly encouraged to complete this form. It will assist us in monitoring services provided through this PA Clinic program. QUESTIONS OR COMMENTS Questions or comments about the PA Clinic program may be directed to your Benefits Coordinator in Human Resources by calling , extension 382. Questions, comments or concerns over the quality of patient care may be directed to Stefanie Sisk, Contract Manager for the Fairbanks Urgent Care Center at Medical confidentiality will be maintained at all times. Page 9 of 9 Effective: January 1, 2010