HealthVoice

              A Newsletter Provided by He lthChoice He lthVoice
Oklahoma State and Education Employees Group Insurance Board
A Division of the Office of State Finance
Holiday Issue 2011
#2602
2012 Plan Changes
Introducing the HealthChoice
High Alternative and Basic Alternative Plans
HealthChoice High, High
Alternative, Basic, Basic
Alternative, S-Account,
and USA Plans
♦♦No limit on visits and treatment
days for mental health and
substance abuse.
♦♦Non-Network emergency room
visits will be covered at the
Network benefit level; however,
you are still responsible for non-covered
services and amounts
over Allowed Charges. For more
information on the emergency
room service, see Emergency
Room Benefits on page 3.
♦♦As an enhanced benefit for
Each year, tobacco use costs
the HealthChoice health plans and
their members approximately $52
million. Because of these costs,
HealthChoice is encouraging
you to stay or become tobacco-free
by freezing the deductibles
and out-of-pocket limits of the
HealthChoice High and Basic
Plans at 2011 amounts for non-tobacco
users. The HealthChoice
High Alternative and HealthChoice
Basic Alternative Plans are being
introduced for tobacco users.
Individual deductibles and out-of-pocket
limits for these two plans
are $250 higher than the High and
Basic Plans.
To enroll or remain enrolled in
the HealthChoice High or Basic
Plan for Plan Year 2012, you had
to attest that you and your covered
dependents are tobacco-free, show
proof of an attempt to quit using
tobacco, or provide a letter from
your doctor indicating it is not
medically advisable for you or your
covered dependents to quit tobacco.
If you did not complete
the tobacco-free
Attestation for Plan
Year 2012, you will
have an opportunity to
complete one during
the next annual Option Period for
Plan Year 2013.
HealthChoice members,
preventive procedures and many
other services will be covered at
100% of Allowed Charges with
no out-of-pocket costs when
using a Network Provider. This
means no-cost access to:
• Blood pressure, diabetes, and
cholesterol tests
• Breast, cervical, prostate, and
colorectal cancer screenings
• Osteoporosis screening
• Counseling from your health
care provider on topics
including quitting tobacco,
losing weight, eating healthy,
see 2012 Plan Changes on page 2
Deductibles Begin
Again in January
On January 1, 2012,
deductibles for the HealthChoice
health and dental plans start over.
Deductibles will not change for the
HealthChoice High, Basic, USA
and S-Account health plans for
2012. Deductibles for these plans
are as follows:
♦ The calendar year deductible for
the High and USA plans remains
$500 per individual and $1,500
per family in 2012. There is an
additional $100 copay for each
emergency room visit regardless of
the facility’s Network status. This
copay is waived only if you are
admitted or if death occurs prior to
admission. There is an additional
$300 copay for each confinement
in a non-Network hospital.
♦ The calendar year deductible
for the HealthChoice Basic Plan
remains $500 per individual and
$1,000 per family. The additional
emergency room and non-Network
hospital confinement copays do not
apply to the Basic Plan.
♦ The HealthChoice S-Account
Plan deductible remains $1,500 per
individual and $3,000 per family.
The deductible must be met before
any health or pharmacy benefits are
paid.
Deductibles for the new High
Alternative and Basic Alternative
plans are as follows:
♦ The calendar year deductible
see Deductibles on page 2
Moving? Let Us Know
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 OSEEGIB.
Please mail your change of
address information to:
Oklahoma State and Education
Employees Group Insurance
Board
P.O. Box 58010
Oklahoma City, OK 73157-8010
2
treating depression, and
reducing alcohol use
• Prescription tobacco cessation
products
• Vaccines for children and
adults
• Flu and pneumonia shots
• Screening for obesity and
counseling from your doctor
and other health professionals
to promote sustained weight
loss, including dietary
counseling from your doctor
• Screening for conditions that
can harm pregnant women
or their babies, including
iron deficiency, hepatitis
B, a pregnancy-related
immune condition called Rh
incompatibility, and a bacterial
infection called bacteriuria
• Special, pregnancy-tailored
counseling from a doctor to
help pregnant women quit
smoking and avoid alcohol use
• Counseling to support breast-feeding
and help nursing
mothers
HealthChoice High, High
Alternative, and USA Plans
♦♦HealthChoice is implementing
a family out-of-pocket limit for
the HealthChoice High, High
Alternative, and USA Plans. The
family out-of-pocket limit for
the High and USA Plans will be
$8,400 when using a Network
Provider and $9,900 when using
a non-Network Provider. The
family out-of-pocket limit for
the High Alternative Plan will be
$9,150 when using a Network
Provider and $10,650 when
using a non-Network provider.
HealthChoice S-Account Plan
♦♦The out-of-pocket limits are
being lowered to $3,000/
individual and $6,000/family.
♦♦Proof of a Health Savings
Account (HSA) is not required
to enroll.
♦♦HealthChoice has contracted
with American Fidelity Health
Services Administration to
make establishing and keeping
a Health Savings Account
easier and more convenient
for S-Account members. HSA
deposits are invested in a money
market account, and all interest
is applied to your account. The
monthly maintenance fee is
waived as long as you continue
to participate through OSEEGIB.
HealthChoice Life Insurance
♦♦You must submit a Life
Insurance Application to enroll
in or increase the amount of your
life insurance during Option
Period.
♦♦The maximum amount of
Supplemental Life insurance
you can carry is being increased
to $500,000 regardless of your
salary.
2012 Plan Changes –
continued from page 1
Deductibles –
continued from page 1
for the High Alternative Plan is
$750 per individual and $2,250 per
family in 2012. All other copays,
and benefits are the same as the
High Plan.
♦The calendar year deductible for
the Basic Alternative Plan is $750
per individual and $1,500 per
family. The additional emergency
room and non-Network hospital
confinement copays do not apply
to the Basic Plan.
♦The calendar year deductible for
the HealthChoice Dental Plan,
when using a HealthChoice
Network Provider, remains $25
per individual and $75 per family
for basic and major services. For
services received from a non-
Network provider, the deductible
also applies to preventive
services.
Register for
HealthConnect
HealthConnect is an online
benefit application designed to give
you quick and easy access to your
benefit information.
HealthConnect provides you
with:
• Member and dependent
coverage information
• A link to the tobacco-free
Attestation
• Access to ClaimLink
��� A secure messaging center
• Access to Frequently Asked
Questions
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.
3
Emergency Room Benefits
An emergency is defined as a
sudden and unexpected symptom
that you could reasonably expect
the absence of immediate medical
attention would result in placing
your health, or the health of others,
in serious jeopardy.
Non-Network Services
For charges incurred on or after
January 1, 2012, non-Network
services will be reimbursed and
subject to Network provider rates
and benefits. All non-Network
ancillary services incurred in
the emergency room setting on
the same day as the emergency
room hospital services will also
be covered at the Network rate
and benefits. You will still be
responsible for non-covered
services and amounts over
Allowed Charges.
High and High Alternative Plans
In addition to the deductible
and coinsurance required for
the High and High Alternative
Plans, there is an additional $100
emergency room copay for each
emergency room visit. This copay
is your responsibility regardless
of the facility’s Network or non-
Network status. This copay is
waived if you are admitted or
death occurs prior to admission.
If emergency treatment cannot
be provided and you are referred
to another emergency room for
treatment, the emergency room
copay is waived on the emergency
room that could not provide
treatment.
Basic and Basic Alternative Plans
The benefits of the Basic
and Basic Alternative Plans do
not require you to pay the $100
emergency room copay.
USA Plan
Benefits are identical to the
HealthChoice High Plan.
S-Account
In addition to the individual or
family deductible required for the
S-Account, there is an additional
$100 emergency room copay for
each emergency room visit. After
you meet the combined medical
and pharmacy deductible, you
are still responsible for the $100
emergency room copay.
All HealthChoice Pre-Medicare
Plans
If an inpatient admission
occurs as a result of an emergency,
you must notify the certification
administrator within one working
day of the admission.
Party Responsibly
Drinking is more prevalent during the holidays than any other time of
year. Holiday parties are a time to celebrate, but if someone you love gets
injured or dies from an alcohol-related accident, your holiday joy may
turn to holiday sorrow. Nearly-one third of all traffic fatalities in the U.S.
each year are caused by drunk drivers. Worst of all, they could have been
prevented. If you are having a holiday party or going to one, here are
some tips to protect yourself and others:
• Encourage conversation instead of drinking
• Don’t have an open bar – a responsible host needs to monitor
guests’ drinking
• Pace the drinks – a drink an hour is a good guide
• Push non-salty snacks
• Offer non-alcoholic drinks
• Stop serving drinks an hour before it’s time to leave
• Plan group activities like party games, not drinking games
• Men – rethink your third drink
Women – rethink your second
drink
• Don’t let your friends drive drunk
• If you are attending a holiday
party, designate a sober driver
before you arrive
Have a safe and happy holiday season!
Sign on to ClaimLink to
view your eligibility, benefits,
deductible, and claim status; view
and print your Explanation of
Benefits; request ID cards; print
temporary ID cards; and complete
the Health Risk Assessment.
To access ClaimLink, use the
following steps:
1. Click ClaimLink in the top
menu bar of the HealthChoice
website at www.sib.ok.gov or www.
healthchoiceok.com.
2. Click To Access ClaimLink
click here at the bottom of the
article about online services for
HealthChoice members.
4. You will be routed to
ClaimLink where you can register
or sign-in.
5. Follow the on-screen
instructions to register, and you
will be on your way to accessing
your claims information.
Check Out ClaimLink
Please Note: The launch dates listed above are subject to change based on new or ongoing legal issues between
the brand and generic manufacturers.
Medications Now Available in Generic Form
New generic medications are now available for the brand-name medications listed below. If you take
any of these brand-name medications, please note that choosing a generic medication costs you less. If you
decide to continue using the brand-name medication, you are responsible for the cost difference between the
brand-name and generic medication, in addition to the appropriate medication copay. HealthChoice Medicare
Supplement members are not responsible for this cost difference, but they are responsible for the higher, non-
Preferred medication copay.
Brand-Name
Medication
Generic Medication Treatment
Launch
Date
Alsuma sumatriptan injection Migraine/cluster headaches Aug 2011
Amrix
cyclobenzaprine HCL extended-release
capsules Muscle relaxant May 2011
Concerta
methylphenidate hydrochloride extended
release tablets ADHD May 2011
Elestat Ophthalmic epinastine HCL ophthalmic solution Allergic conjunctivitis May 2011
FemHrt 1-5 ethinyl estradiol and norethindrone Hormone replacement Feb 2011
Lipitor atorvastatin Cholesterol Nov 2011
Lybrel levonorgestrel and ethinyl estradiol Birth control June 2011
Rythmol SR propafenone SR 225mg, 325mg, 425mg
capsules Abnormal heart rhythm Jan 2011
Seasonique ethinyl estradiol & levonorgestrel Birth control Aug 2011
Sular 8.5mg, 17mg,
25.5mg, & 34mg nisoldipine High blood pressure Jan 2011
Uroxatral alfuzosin hydrocholoride Benign prostatic hyperplasia July 2011
Vfend voriconazole 50mg & 20mg Serious fungal infections Feb 2011
Zyprexa and
Zyprexa Zydis olanzapine Schizophrenia Oct 2011
Maternity Benefit
HealthChoice maternity
benefits include:
♦♦Hospital and delivery with
prenatal and postnatal care
♦♦Prenatal lab work
♦♦The Mommy & Me Program
♦♦One skilled nurse home health
visit if the delivery is at home or
in a birthing center; certification
is required or a 10% penalty is
applied
Newborns have limited
coverage for a routine birth for the
first 48 hours following a vaginal
delivery or for the first 96 hours
following a C-section delivery
without an additional premium. A
separate calendar year deductible
and coinsurance is applied.
There are no benefits
for services in addition to
the routine hospital stay if
the newborn is not enrolled
for the month of birth. This means
you are responsible for any charges
over and above the Plan’s payment
of the limited newborn benefit
regardless of the facility’s Network
or non-Network status. To enroll
the newborn, you must complete an
Insurance Change Form within 30
days following the birth.
For more information,
call HP Administrative
Services, LLC 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.
4
It’s Flu Season Again – Protect Yourself!
According to the Centers for
Disease Control and Prevention,
the single best way to protect
yourself against the flu is to get
vaccinated at the start of each flu
season. While the influenza vaccine
does not eliminate the risk of the
flu, it does decrease the chance of
getting the virus. The composition
of the flu vaccine changes yearly
depending on which strains of the
virus are considered to be most
prevalent. The Advisory Committee
on Immunization Practices
recommends getting immunized
annually. There are two main types
of flu vaccines currently used:
♦♦“Flu Shot” – uses inactive
(killed) viruses which are
injected into the body.
♦♦Nasal Spray Flu Vaccine –
or LAIV (“Live Attenuated
Influenza Vaccine”). The vaccine
was approved by the U.S. Food
and Drug Administration for
use in healthy people between
5 years to 49 years of age who
are not pregnant. It is made with
live, weakened strains of the flu.
For flu prevention, anyone over
6 months of age can be given the
vaccine. However, the following
high-risk groups are strongly
urged to be vaccinated and will be
given priority status in regards to
a limited number of flu vaccines.
They are:
♦♦Adults over 65 years of age
♦♦Children between 6-23 months
of age
♦♦All children and adults with
underlying chronic medical
conditions; i.e., diabetes, heart
or lung disease, cognitive
dysfunction, spinal cord injuries,
seizure disorders, or other
neuromuscular disorders
♦♦All children and adults with
weakened immune systems due
to illness or medication
♦♦Residents of nursing homes and
long-term care facilities
♦♦Healthcare workers involved in
direct-patient care
♦♦Children on chronic aspirin
therapy
♦♦Women who will be pregnant
during the influenza season
When there is ample flu
vaccine to treat high-risk groups,
vaccination is also highly
recommended for adults between
50 to 64 years of age and for
caregivers and household contacts
of those identified in the high-risk
groups listed previously.
People who should not receive
the flu vaccine, and are advised to
speak with a physician for more
information, are:
♦♦People who have a severe allergy
to chicken eggs (the influenza
vaccine is currently produced
through incubation in fertilized
chicken eggs)
♦♦People who are sick with a fever
♦♦People who have developed
Guillain-Barré syndrome (GBS)
within 6 weeks of getting a
previous influenza vaccine
♦♦People who have had a severe
reaction to an influenza vaccine
in the past
♦♦Children less than 6 months of
age
HealthChoice High, High
Alternative, Basic, Basic
Alternative, USA, and S-Account
Members:
All vaccines are covered under
your plan’s health benefit at 100%
of Allowed Charges. Vaccines
must be obtained from a health
provider who is recognized by
HealthChoice. Your provider may
charge for an office visit or for
the administration of the vaccine;
these charges are subject to your
plan’s copays, deductibles, and
coinsurance. If you use a non-
Network provider, you can be
balance billed for amounts above
Allowed Charges.
Certain pharmacists have
contracted with HealthChoice to
provide health services. Vaccines
administered by these pharmacists
are covered under your plan’s
health benefit. To find a pharmacist
that is contracted to provide health
services, visit the HealthChoice
website at www.sib.ok.gov or www.
healthchoiceok.com. Click Find a
Provider, then select HealthChoice
Medical and Dental Providers.
Click Specialty Search, then
choose Pharmacist from the list of
specialties. You can also contact
HealthChoice 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.
Vaccines obtained at a walk-in
clinic, pharmacy, etc., typically
are not covered by HealthChoice.
HealthChoice High, High
Alternative, Basic, Basic
Alternative, and S-Account
Members:
County health departments
throughout Oklahoma are offering
flu vaccines to members at no cost.
For All Medicare Members With
Part B:
Flu and pneumococcal
vaccines are covered at 100% if
your provider accepts Medicare
assignment.
The flu vaccine is widely
available, so go get yours today!
5
He lthVoice
3545 NW 58 Street, Suite 110
Oklahoma City, OK 73112
www.sib.ok.gov or www.healthchoiceok.com
1-405-717-8780 Toll-free 1-800-752-9475
TDD 1-405-949-2281 Toll-free 1-866-447-0436
A Newsletter Provided by He lthChoice
Presorted
Standard
U. S. Postage
PAID
Okla. City, OK
Permit #1067
This publication was printed by the Oklahoma State and Education Employees Group Insurance Board, a division of the Office of State Finance, as authorized by 74 O.S., Section 1301 et seq. 113,500 copies have been
printed at a cost of $0.077 each. Copies have been deposited with Publications Clearinghouse of the Oklahoma Department of Libraries.
Holiday 2011
Walking Tale
This is a letter we received
from Robert W. of Oklahoma City,
one of our HealthChoice Walking
Club members, reprinted as it was
received.
Since joining the Health
Choice walking club a little
over a year ago and I have
logged over 1,000 miles. It
along with the health mentoring
program, sponsored by the
state, has enabled me to lose
about 20 pounds and improve
my numbers in a several
important health categories.
It is always exciting to
get the little rewards that
are sent out each time I log
another 100 miles, but even
more than that, I think it is the
accountability of keeping track
of my miles walked that makes
me successful.
Working for the Oklahoma
Health Care Authority, here
at Shepherd Mall, we have a
wonderful opportunity to walk
anytime, regardless of weather
conditions. That, combined
with the treadmill at my fitness
center and walking at home has
enabled me to log a lot of miles.
I am now 68 years old and
feel as good as I did when I was
40. I don’t take my good health
for granted and am thankful
God has helped me maintain
and improve it.
I have recommended the
Walking Club to a number of
coworkers and plan to keep
walking as long as I can. I
really enjoy it.
HealthChoice Walking Club
participants receive a logbook to
record dates and distances walked.
Members send their logbook pages
to HealthChoice at the end of each
100 miles walked (up to 1,000
miles) to receive a free gift.
Join the HealthChoice Walking
Club like this member did and start
improving your health today. It’s
easy to enroll, just go online to
www.healthchoiceok.com or call
toll-free 1-800-318-BEOK (2365)
for more information.