Earlier this year, we informed you that the preventive care initiative would continue in 2013 with streamlined requirements. To date, we’ve had an enthusiastic response to those changes, however; not everyone has taken advantage of this initiative which supports both the doctor-patient relationship and uses preventive medicine.
WHAT’S KEEPING YOU FROM RECEIVING $200?
Time is running out and you must complete all program requirements by December 31, 2013. The steps for completing the program are as follows:
Step 1. Register online for the program at www.healthchoiceok.com. Once you register, you will be provided the specific billing codes your provider must use for your free preventive services visit.
Step 2. Complete your free comprehensive preventive services visit.
Following the completion of these steps, you will receive your incentive payment of $200. Certain comprehensive metabolic and lipid tests are also covered at 100% of Allowed Charges once per calendar year. There is no copay or out-of-pocket cost to the member when services are provided by a HealthChoice Network Provider. Members are still encouraged to complete or update the free online health risk assessment (HRA) available through our website at www.healthchoiceok.com.
All HealthChoice members age 20 and older who are not enrolled in a HealthChoice Medicare Supplement plan or the HealthChoice USA plan are eligible to participate.
TAKE CONTROL OF YOUR HEALTH!!! Register today at www.healthchoiceok.com.
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Certain diagnostic imaging services such as MRI and CT scans require certification before the scan is performed. Your physician will generally obtain certification before scheduling your test. If certification is not obtained, you could be responsible for the cost of the scan.
MRI and CT scans that require certification from APS HealthCare are:
- MRI of Eye and Face
- MRI of Head/Brain
- MRI of Cervical, Thoracic, and Lumbar Spine
- MRI of Shoulder, Arm and Hand
- CT Scan of Eye and Face
- CT of Sinus
- CT of Head/Brain
- CT of Chest
- CT of Cervical, Thoracic and Lumbar Spine
To ensure your scan has been certified as medically necessary, contact your ordering physician. APS HealthCare can be contacted by calling toll-free 1-800-848-8121.
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Thinking About Quitting?
The first step to quitting tobacco is deciding you are ready to quit and then making a plan to do it. It’s okay to have mixed feelings about quitting. Don’t let that stop you! There will be times every day that you don’t feel like quitting. Just remember your reasons for quitting, that you want to quit and can quit – and your plan can help. Here is how to S.T.A.R.T.
Before you quit, figure out where to S.T.A.R.T.:
S= Set a quit date
T= Tell family, friends, and coworkers that you plan to quit and ask for their support
A=Anticipate and plan for the challenges you’ll face while quitting
R=Remove tobacco products from your home, car, and work.
T=Talk with your doctor about quitting or access free quit services through the Oklahoma Tobacco Helpline at 1-800-QUIT-NOW (1-800-784-8669) or online at www.OKhelpline.com
Just thinking about quitting may make you anxious, however; your chances of quitting more than double when you work with your doctor or by contacting the Oklahoma Tobacco Helpline.
Why is Quitting So Hard?
Many former smokers say that quitting was the hardest thing they ever did. Do you feel hooked? You’re probably addicted to nicotine. Nicotine is in all tobacco products. The more you smoke, the more nicotine you need to feel good. Soon, you don’t feel normal without nicotine It takes time to break free from nicotine addiction. It may take more than one try to quit for good. So don’t give up too soon. You will feel good again.
Quitting is also hard because smoking is a big part of your life. You enjoy holding cigarettes and puffing on them. You may smoke when you are stressed, bored, or angry. After months and years of lighting up, smoking becomes part of your daily routine. You may light up without even thinking about it, like with your morning coffee, when talking on the phone, driving, or when you are around other smokers.
When you quit you may even feel uncomfortable not smoking at times or in places where you usually have a cigarette. These times and places are called triggers. That’s because they trigger, or turn on, cigarette cravings. Breaking these habits is the hardest part of quitting for some smokers. Focus on the reasons you wanted to quit, like feeling healthier right away and for the rest of your life, being a great role model for you kids, grandkids, family, and friends. and not worrying about when you will get your next cigarette. Remember, the urge to smoke will pass in just a few minutes, try taking a quick walk, calling a friend or reading a book.
You can be a Quitter!
Quitting isn’t easy. It may take several tries, but you learn something each time you try. It takes willpower and strength to beat your addiction to nicotine. Remember that millions of people have quit smoking for good, some with help from their doctor or a free program like the Oklahoma Tobacco Helpline, some with a friend or on their own. You can be one of them – you can proudly declare yourself a quitter!
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In accordance with current Centers for Disease Control and Prevention guidelines, for charges incurred on or after July, 1, 2013, HealthChoice members not covered on a Medicare Supplement plan are covered for routine immunizations and vaccinations at the pharmacy, as well as their physician’s office. In the past, these services were only covered under the health plan. Immunization and vaccination administration fees are also covered at 100%, if the service is provided by a Network Provider.
Participants are subject to non-Network benefits and can be balanced billed for amounts above the Allowed Charges when utilizing the services of a non-Network pharmacy.
Please note that free-standing ambulatory care clinics located inside the pharmacies, grocery stores, or supercenters may not be participating providers, and your services may not be covered at these locations. You should verify provider status by visiting the HealthChoice website or calling Member Services at 1-800-
The following immunizations/vaccinations are covered under the pharmacy plan when a Network Pharmacy is used:
||Rabies, Human Diploid
|Rabies, PF Chick-EMB Cell
|Smallpox (Vaccinia) Vaccine
||Tetanus, Diphtheria, Pertussis
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The Office of Management and Enterprise Services (OMES) Employees Group Insurance Division’s (EGID) rule regarding the effective date for newborn coverage changed for charges incurred on or after January 1, 2013. The new rule states that the effective date for newborns added to the Plan is the first of the month of their birth. However, for the remainder of 2013, EGID will continue to allow newborns to be added the first of the month of birth or the first of the month following birth.
For charges incurred on or after January 1, 2014, newborns must be added to coverage the first of the month of the child’s birth. Premiums must be paid for the birth month, and when one or more eligible dependents are currently covered, the newborn must be added to the same coverage, unless there is proof of other group coverage.
If you have questions, please contact EGID Member Services at 1-405-717-8780 or toll-free 1-800-543-6044, ext. 8780. TDD users call 1-405-949-2281 or toll-free 1-866-447-0436.
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Beginning January 1, 2014, the medications listed below will be removed from the HealthChoice Select Medication List and will no longer be covered. Listed to the right of the excluded medication(s) is a list of covered alternatives. If you are currently taking one of the drugs being excluded from coverage, talk to your doctor to see if a Preferred alternative medication is right for you.
Biologics – Injectable Tumor Necrosis Factor
Antagonists and Other Drugs for Inflammatory
|Cimzia, Simponi, Stelara, Xeljanz
|AUTONOMIC & CENTRAL NERVOUS
Interferon Beta Medications for Multiple
||Avonex, Extavia, Rebif
|Long-Acting Opioid Oral Analgesics
||Avinza, Exalgo, Kadian
||morphine sulfate ER, oxymorphone ER,
Nucynta ER, Opana ER, Oxycontin
Angiotensin II Receptor Antagonists + Diuretic
|Edarbi/Edarbyclor, Micardis/Micardis HCT,
irbesartan/HCTZ, losartan/HCTZ, valsartan/
Blood Glucose Meters and Strips
|Abbott (Freestyle, Precision) Bayer (Breeze,
Contour), Nipro (TRUEtrack, TRUEtest),
|Dipeptidyl Peptidase-IV inhibitors & Combos
||Jentadueto, Kazano, Nesina, Tradjenta
||Janumet, Janumet XR, Januvia, Kombiglyze,
|Incretin Mimetics (Glucagon-Like Peptide-1
|Beconase AQ, Omnaris, Rhinocort Aqua,
|flunisol ide, fluticasone propionate,
triamcinolone acetonide, Nasonex, Qnasl
Androgen Drugs (Topical Testosterone Products)
||Nutropin/Nutropin AQ, Omnitrope, Saizen,
|Genotropin, Humatrope, Norditropin
|OBSTETRICAL & GYNECOLOGICAL
|Bravelle, Follistim AQ
Ant iglaucoma Drugs (Ophthalmic
||latanoprost, travoprost, Lumigan, Travatan Z
Epinephrine Auto-Injector Systems
||EpiPen, EpiPen Jr
|Pulmonary Anti-Inflammatory Inhalers
||Alvesco, Flovent Diskus/HFA
||Asmanex, Pulmicort Flexhaler, QVAR
|Pulmonary Anti-Inflammatory/Beta Agonist
|Advair Diskus/HFA, Breo Ellipta
|Beta-2 Adrenergics (Short-Acting Inhalers)
||Maxair Autohaler, Proventil HFA, Xopenex
|Proair HFA, Ventolin HFA
Erectile Dysfunction Oral Agents
*These medications will not be covered unless
specific clinical criteria is met.
Additional covered alternatives may be available.
A Prior Authorization review may be requested if you are unable to take the Preferred alternative medications. A Plan exception may be requested by contacting Express Scripts, Inc. toll-free at 1-800-753-2851.
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The need for durable medical equipment (DME) such as wheelchairs, prosthetic devices, oxygen tanks, orthotics, implants, etc. is increasing in response to the aging of our population. Unfortunately, the growing
need for DME and related services has also increased the possibility of fraud, waste and abuse among DME suppliers. Medicare has identified DME fraud as a rapidly growing problem.
Reducing and/or eliminating DME fraud helps ensure that healthcare resources are spent appropriately. Unnecessary medical equipment results in excessive costs to the healthcare system, and limits the availability of medical supplies and equipment for people who genuinely need it. The healthcare system continues to be very expensive and cannot afford waste and/or abuse of services.
The following types of claims for DME may be indications of fraud, waste and/or abuse:
- A claim is filed specifically to obtain a higher reimbursement than allowed by law
- A claim is filed but the equipment is not medically necessary or is not delivered to the patient
- Equipment is returned to the supplier, but the supplier fails to credit Medicare
- A supplier misrepresents payment obligations to the patient or waives copayments or deductibles
owed by the patient
If you suspect HealthChoice and/or Medicare have been or are being defrauded by a DME company or any other healthcare entity or practitioner or you feel resources are potentially being wasted and/or abused, report your suspicions to the Oklahoma Office of Management and Enterprise Services (OMES) Employee Group Insurance Division (EGID) Compliance Officer immediately. You can report any suspected fraud activity by visiting the OMES EGID Compliance Officer in person or writing to:
OMES EGID Compliance Office
3545 NW 58 Street, Ste. 110
Oklahoma City, OK 73112
You may can email reports to firstname.lastname@example.org or call the antifraud hotline toll-free at 1-866-381-3815 toll-free.
Medicare fraud can be reported to the Department of Health and Human Services Office of the Inspector General Hotline toll-free at 1-800-447-8477 toll-free or via email to HHSTips@oig.hhs.gov.
Additional information on how to prevent Medicare fraud is available at www.StopMedicareFraud.gov.
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||31-90 Day Supply
||Up to $10
||Up to $25
||Up to $45
||Up to $90
||Up to $75
||Up to $150
||Copay per 30-Day Supply
||$100 - Preferred
|$200 - Non-Preferred
- A Family Out of Pocket Maximum of $4,000 has been added to the HealthChoice High, High Alternative, Basic, Basic Alternative, and USA Plans.
- This does not apply to the S-Account or any Medicare Supplement Plans
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In addition to the current vision care plans options listed in the Option Period Guide you receive in the mail, Vision Care Direct is also being offered for Plan Year 2014. To choose Vision Care Direct as your vision plan, please write Vision Care Direct in the vision plan section of your Option Period form, as it will not be listed as a selection.
Updated premium information and plan details are available online in each of the Option Period guides.
Premium information for all the vision plans offered for 2014 can be found at http://www.ok.gov/sib/Member/Premiums/index.html
Vision plan comparison charts, plan details, and contact information can be found at http://www.ok.gov/sib/documents/Vision_Grid.pdf
If you have any questions, please contact Member Services at 1-405-717-8780 or toll-free 1-800-752-9475. TDD users call 1-405-949-2281 or toll-free 1-866-447-0436.
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The annual Option Period for 2014 has arrived and now is the time to make plan selections that meet your changing needs. All current EGID plan members have received or will be receiving Option Period Materials at work or through the mail. The most up-to-date version of all Option Period material is also available on our website at www.
Please review the Plan Changes section of your 2014 Employee Benefit Options Guide or your 2014 Option Period Enrollment Packet where changes for the next plan year are highlighted.
If you have any questions, please contact Member Services at 1-405-717-8780 or toll-free 1-800-752-9475. TDD users please call 1-405-949-2281 or toll-free 1-866-447-0436.
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This month marks the tenth anniversary of the Oklahoma Tobacco Helpline’s launch. Since they opened their doors in 2003, more than 250,000 Oklahomans have accessed the services offered by
the Helpline to help them quit tobacco.
he Oklahoma Tobacco Helpline provides free smoking cessation services that include telephone coaching sessions and nicotine replacement products. Their services are available to any Oklahoman who has a desire to quit tobacco. The Helpline has a 34 percent quit rate for those who received multiple coaching calls, while those who choose to quit cold turkey only experience a 5 percent quit rate.
In fiscal year 2012, nearly 39,000 people contacted the Helpline for tobacco cessation services. While many Oklahomans have access to cessation services through their health insurance plan, approximately 40 percent of Helpline callers are uninsured. Additionally, more than 60 percent of callers have an annual income that is less than $20,000.
The Helpline is primarily funded by the Oklahoma Tobacco Settlement Endowment Trust (TSET) in partnership with the Oklahoma State Department of Health, the Oklahoma Health Care Authority, the Oklahoma Employees Group Insurance Division, and the Centers for Disease control and Prevention.
Smoking-related illnesses are the leading cause of preventable death in Oklahoma. According to figures
from the Centers for Disease Control and Prevention, 6,200 Oklahomans die each year from smoking related illnesses. Smoking kills more people than alcohol, AIDS, car crashes, illegal drugs, murders, and suicides combined. Smoking costs Oklahoma nearly $1.2 billion in related healthcare costs; however, it is estimated that Helpline services are saving Oklahoma an average of $18 million in medical costs each year.
“Stopping tobacco use is one of the most important things that Oklahomans can do to improve their health,” said Dr. Terry Cline, Secretary of Health and Human Services. “After a decade, the Oklahoma Tobacco Helpline continues to be a great investment to move the needle and make a large-scale impact on the health and prosperity of our state.”
If you’ve been thinking about quitting tobacco, don’t wait any longer. For more information, call the Oklahoma Tobacco Helpline at 1-800-QUIT NOW (784-8669) or visit their website at OKhelpline.com.
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The Oklahoma Tobacco Settlement Endowment Trust (TSET) was created in 2000 by a voter-approved amendment to the Oklahoma Constitution. Its mission is to improve the health and quality of life of all
Oklahomans through accountable programs and services that address the hazards of tobacco use and other health issues.
In addition to the Oklahoma Tobacco Helpline, TSET also funds the award-winning, public education campaign, Tobacco Stops With Me. This campaign serves to promote the Oklahoma Tobacco Helpline
through educational messages that focus on the dangers of tobacco and secondhand smoke. It is estimated that the Tobacco Stops With Me campaign has touched the lives of nearly two-thirds of Oklahomans.
“Through strategic, evidence-based efforts like the Oklahoma Tobacco Helpline, TSET is working to create a healthier environment in our state,” said Tracey Strader, TSET executive director. TSET also supports ground-breaking research at the Stephenson Cancer Center, the Oklahoma Tobacco Research Center, and the Oklahoma Center for Adult Stem Cell Research.
Additionally, TSET funds numerous grants to Oklahoma communities to support efforts to promote tobacco use prevention and improved physical activity and nutrition. TSET grants also work to promote
tobacco cessation best practices into hospitals and tobacco cessation among Medicaid recipients and those receiving treatment for behavioral health disorders.
“Our investments help people stop using tobacco and reduce premature deaths and costly chronic medical conditions, including those aggravated by smoking and toxic secondhand smoke,” commented Tracey Strader.
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There is a trend among some physicians in Oklahoma to move to a concierge practice model which is also known as a private physician practice model.
Typically, concierge medicine is a fee-for-service health care delivery system that is characterized by a direct, financial relationship between private physicians and their patients. In many cases, private practice physicians collect a retainer from their patients in addition to filing claims for covered services.
HealthChoice members should be aware that charging a retainer in association with HealthChoice covered services is a violation of the provider’s contract with HealthChoice. This kind of contract violation will result in the termination of the provider contract. Once contracts are terminated, all HealthChoice claims will be reimbursed at the non-Network rate.
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Register for HealthConnect
HealthConnect is an online benefit application designed to give you quick and easy access to your benefit information. In the coming months, we will be adding new features. You can access HealthConnect from our website at www.sib.ok.gov or www.healthchoiceok.com.
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If you are a current employee, you should notify your Insurance/Benefits Coordinator of your new address. They will see that your new information is forwarded to HealthChoice.
If you are a former employee, you must notify HealthChoice in writing. You can download a Change of Address Form from our website at www.sib.ok.gov or www.healthchoiceok.com or send a letter to EGID.
Please mail your change of address information to:
P.O. Box 58010
Oklahoma City, OK 73157-8010
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