HealthChoice would like to clarify information included in a recent postcard sent to members of the HealthChoice Life Insurance Plan.
The opportunity to purchase one $20,000 unit of life insurance without completing a Life Insurance Application is available only
to current employees during the annual Option Period.
Former employees cannot increase life insurance coverage.
Information about this new option was made available to current employees in the Employee Benefit Options Guide during
the last Option Period. If you missed the opportunity to enroll in or increase your life insurance this past year, you must wait
until the next annual Option Period to increase your coverage.
HealthChoice would like to clarify information contained in the Use Correct Billing Forms article
from the 2009 Holiday issue of HealthVoice regarding the appropriate forms to be used for filing
claims. Dental services should be billed on an ADA 2006; physician/provider services should be billed
on a CMS 1500; and hospital and outpatient facility services should be billed on a UB-04. Items such as
cash register receipts, pull-apart forms, and accounts receivable billing statements are not appropriate.
HealthChoice Network Providers are required by contract to submit claims on your behalf using the
appropriate form. Non-Network providers are not required to submit claims on your behalf and may
not use the appropriate form. If this is the case, ask if they will submit the claim on your behalf using the
appropriate form or if they will provide a completed form to you so that you can file the claim yourself.
We apologize for any confusion this may have caused. If you have any questions, please contact EDS at
1-405-416-1800 or toll-free 1-800-782-5218. TDD users call 1-405-416-1525 or toll-free 1-800-941-2160.
For assistance with any outstanding claim issues, you can send an email containing the details of
your issue to EDSResolution@sib.ok.gov. For security reasons, please include the member
ID number in your email instead of the member's Social Security number.
Last July, the Oklahoma State and Education Employees Group Insurance
Board was presented the preliminary rate study for current and pre-Medicare
HealthChoice members. Actuaries for the Board recommended a 12% overall
increase in premiums for the 2010 plan year.
The Board was concerned that an increase of 12% would likely require other cost
cutting measures by employers, such as job layoffs. After reviewing several options, including
raising the deductible from $500 to as much as $1,000, it was decided that copays for office
visits and other services will increase from $25 to $50.
Pharmacy copays for Preferred medications costing $100 or less will increase from a
maximum of $25 to $30. Copays for Preferred medications costing more than $100 will be 25%
of the cost of the drug up to a maximum of $60 (currently $50).
Pharmacy copays for non-Preferred medications costing $100 or less will increase from a
maximum of $50 to $60. The copays for non-Preferred medications costing more than $100
will be 50% of the cost of the medication up to a maximum of $120 (currently $100).
The Board also directed its pharmacy benefits manager to contract for deeper discounts on pharmacy reimbursements.
With these plan design and reimbursement changes, the Board was able to lower
the overall premium increase to approximately 7.6%. While this decision was difficult, the
Board believed it was necessary given the realities of tight budgets and increasing health care costs.
Other 2010 Changes
Effective January 1, 2010, there will be changes to the HealthChoice Medicare
formulary. You should be aware that many brand-name drugs have been removed from the
formulary, because generic versions of the drugs have become available. You will be
responsible for the full cost of these non-formulary, brand-name drugs unless you file an
appeal and it is approved. If access to the brand-name medication is granted, you will pay the higher, non-Preferred copay.
Additionally, due to new CMS requirements, HealthChoice Medicare Supplement
members will no longer be responsible for the cost difference between a brand-name product and its generic alternative.
Dental Plan Changes
Effective January 1, 2010, the age guidelines for coverage of prophylaxis and fluoride treatments for children ages 0 through 12 will be as follows:
- Prophylaxis: 2 treatments per calendar year
- Fluoride: 2 treatments per calendar year
Fluoride treatments for members over age 12 will not be covered.
Since 1963, the president of the United States has declared February American Heart Month and
what better reason than a presidential decree to start taking care of your heart. Heart disease
is the leading cause of death in the United States as well as a major cause of disability. It is no
longer seen as just a man’s disease; it is also the number one killer of American women.
The most common type of heart disease is coronary heart disease, which is often discovered
in individuals after a heart attack. According to the American Heart Association, about every
25 seconds an American will have a coronary event and sadly about one person every minute will die.
In the fight against heart disease, a healthy diet and lifestyle are the best weapons you have.
Eat a heart-healthy diet
Only eat the number of calories you know you can burn up every day; however, be aware that
heart-healthy eating is not just about cutting back on your calorie intake. Most people need to add
more fruits and vegetables to their diet. Eating a diet that is rich in fruits, vegetables, whole grains
and low-fat dairy products can help protect your heart. Beans and peas provide low-fat sources of
protein and the oils in certain types of fish can aid in reducing your risk of heart disease.
Get physically active
A sedentary or physically inactive lifestyle is a major risk factor for cardiovascular disease. Most
Americans are not physically active enough to gain any health benefits. Swimming, cycling, jogging,
skiing, dancing, walking and dozens of other activities can help your heart. Everyone knows that physical
activity is beneficial but may not realize just how healthful it can be. Whether your activity is included
in a structured exercise program or just part of your daily routine, it all adds up to a healthier heart.
Maintain a healthy weight
Today, 65% of American adults over age 20 are overweight or obese according to statistics from the
American Heart Association. As you age, you put on weight that is mostly fatty tissue. This leads to
high blood pressure, high cholesterol, and diabetes which all increase your chances of heart
disease. Determine if your weight is healthy, and work on getting into a healthy weight range. Even
small amounts of weight loss can be beneficial.
A lot can be done to protect you from heart disease. Prevention is the key to living a longer healthier
life. Eating right, physical activity, and maintaining a healthy weight are all very important prevention
measures. Talk to your doctor about heart disease prevention so you can enjoy a longer, healthier life.
Source: American Heart Association and Centers for Disease Control and Prevention
Transient Ischemic Attacks or TIAs are a form of mini-stroke. They are caused by blood clots in the brain or by a build-up
of plaque in the arteries (atherosclerosis). A TIA has the same symptoms as stroke, but symptoms last only a few minutes
and generally disappear quickly with no damage to the brain.
If you have one or more TIAs, this may mean that you’re a candidate for a full-blown stroke. Symptoms can include:
- Trouble seeing in one or both eyes
- Numbness or weakness on one side of the body
- Trouble speaking or understanding speech
- Loss of your ability to control your movements or balance
If you experience any of these symptoms, you need to seek immediate medical attention.
When you see your physician, make sure he/she is aware of any risk factors you may have regardless of
whether they are controllable or not. Risk factors that can be controlled include:
- High blood pressure
- High Cholesterol
- Smoking
- Heart disease
- Carotid artery disease
- Diabetes
- Overweight
- Heavy use of alcohol
Risk factors that can’t be controlled include:
- Age 55 or older
- Gender – Males tend to have more TIAs than women
- Race – African Americans are at increased risk because of their tendency to develop high blood pressure and diabetes
- Family history
Treatment for TIAs varies depending on your past medical history, and current condition. After performing
tests such as a physical examination or one of many scans available such as an MRI or CT scan, your physician
may recommend drug therapy or surgery to reduce your risk of stroke.
Medications that help decrease the likelihood of stroke include anti-clotting drugs such as aspirin or Plavix, or
blood thinning drugs such as heparin and warfarin (Coumadin). There are also preventive surgeries that your
physician may decide are appropriate for you.
Your physician will most likely recommend lifestyle changes to help prevent a future TIA or stroke such as:
- Quitting smoking
- Limiting your alcohol intake
- Maintaining a healthy weight and getting exercise regularly
- Eating more fruits and vegetables
- Limiting your sodium intake
- Limiting your intake of cholesterol and saturated fat
By following the advice of your physician, and maintaining a healthy lifestyle, you can lessen your risk of TRIs or stroke, and live a longer, healthier life!
Sources: Mayo Clinic, and National Institute of Neurological Disorders and Stroke
Peripheral artery disease (PAD) is the most common type of peripheral vascular disease. Generally, PAD
is caused by atherosclerosis. Atherosclerosis occurs when fatty deposits (plaques) build up in the arteries
throughout the body and cause the passage ways to narrow. When atherosclerosis affects the arteries that
carry blood to the legs, arms, stomach, or kidneys, it’s known as PAD.
The most common symptom of PAD is painful cramping in the hips, thighs, or calves when walking, stair
climbing, or exercising. The cramping will usually go away when exercising stops. The cramping is caused when
the body’s muscles don’t get the blood they need because of blood vessel blockage. As PAD progresses, pain may
even occur when at rest (ischemic rest pain) and be intense enough to disrupt sleep.
Although many people with PAD experience no symptoms, others often relate their symptoms to different health problems.
Some of the signs and symptoms of PAD include:
- Numbness or weakness
- Coldness in a lower leg or foot, when compared to the other leg
- Open sores on your toes, feet or legs that won't heal
- A change in the skin color of your legs
- Hair loss on your feet and legs
- Changes in your toenails
There are several risk factors for developing PAD including:
- Smoking
- Diabetes
- Obesity
- High blood pressure
- High cholesterol
- Age over 50
- A family history of PAD
Some facts from the American Heart Association about PAD include:
- Pain caused by PAD occurs in the body’s muscles, not the joints.
- PAD increases the risk of heart attack and stroke.
- Smokers have a greater risk of developing PAD than nonsmokers.
- High blood pressure and/or high cholesterol increase risk of PAD.
- Left untreated, PAD can lead to gangrene and amputation.
- PAD is easily diagnosed in a simple, painless way.
There are two major goals when treating peripheral artery disease. The first goal is to manage the symptoms, such
as leg pain, so that physical activities can be resumed. The second goal is to reduce the risk of heart attack and stroke
by stopping the progression of atherosclerosis. For many people, these goals can be accomplished with lifestyle
changes. Quit smoking! This is the single most important thing people can do to reduce the complications and
progression of atherosclerosis. In the event lifestyle changes are not enough, additional medical treatment may be needed.
Remember, leg pain, numbness, or other symptoms shouldn’t be dismissed as a "normal part of aging." Call your
doctor and make an appointment. Early diagnosis and treatment of PAD helps preserve the health of your limbs and
decreases your risk of heart disease, stroke, and other health problems.
Sources: American Heart Association, Mayo Clinic
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