Member UpdateG E I S I N G E R H E A LT H P L A N K I D S

D E C E M B E R 2 0 1 3

IN THIS ISSUE

Pages 2 - 3 Formulary Updates

Page 4Tips for a Healthy Smile/GHP Kids Community Events

Page 5Network Updates/ Customer Service Corner

Page 6 Winter Safety

Page 7 After Hours CareOptions

Visit us online at GHPKids.com for

health and wellness information, the latest listings of

doctors and hospitals, and to search for pharmacies and

covered prescription drugs.

(KidsHealth) -- Kids don't always listen when you tell them to wash their hands before eating, after using the bathroom, or when they come inside from playing. But it's a message worth repeating — hand washing is by far the best way to prevent germs from spreading and to keep your kids from getting sick.

First Line of Defense Against Germs Germs can be transmitted many ways, including:

• touching dirty hands• changing dirty diapers• through contaminated water and food• through droplets released during a cough or a sneeze• via contaminated surfaces• through contact with a sick person’s body fluids

When kids come into contact with germs, they can unknowingly become infected simply by touching their eyes, nose, or mouth. And once they’re infected, it’s usually just a matter of time before the whole family comes down with the same illness.

Good hand washing is the first line of defense against the spread of many illnesses, from the common cold to more serious illnesses such as meningitis, bronchiolitis, influenza, hepatitis A, and most types of infectious diarrhea.

Washing Hands Correctly Here’s how to scrub those germs away.

Demonstrate this routine to your kids — or better yet, wash your hands together often so they learn how important this good habit is:

1. Wash your hands in warm water. Make sure the water isn’t too hot for little hands.

2. Use soap and lather up for about 20 seconds (antibacterial soap isn’t necessary — any soap will do). Make sure you get in between the fingers and under the nails where uninvited germs like to hang out. And don’t forget the wrists!

3. Rinse and dry well with a clean towel.To minimize the germs passed around your family, make frequent hand washing a rule for everyone, especially:

• before eating and cooking• after using the bathroom• after cleaning around the house

Continued on Page 5

Why is Hand Washing So Important?

Jorge Salcedo/iStock/ThinkStock

2 GHP Kids Member Update

Formulary updatesMembers can review the formulary online at www.GHPKids.com. The online formulary includes the most recent list of

covered drugs, as well as details on quantity limits, tiers, and pharmacy management procedures. When medications are not listed on a formulary, GHP Kids will not pay for them unless an exception is granted. Some drugs may require prior authorization. Members may call (866) 621-5235 from 8 a.m. to 6 p.m., Monday through Friday (TDD/TTY 711), with benefit questions or to request a printed formulary.

Brand Name Status TierPrior

AuthorizationQuantity

LimitDetailed Limits

Formulary Alternatives

BREO ELLIPTA Non-Formulary

Non-Formulary Yes No −

Advair Diskus, Foradil Aerolizer, Serevent Diskus, Spiriva,

Symbicort

BRINTELLIX Formulary 2 Yes No −

amitriptyline, amoxapine, bupropion, citalopram, desipramine, doxepin,

escitalopram, fluoxetine, fluvoxamine, imipramine, maprotiline, mirtazapine, nefazodone, nortriptyline,

paroxetine, sertraline, trazodone, venlafaxine, Cymbalta

BYETTA

Non-Formulary,

effective 1/1/2014

Non-Formulary,

effective 1/1/2014

Yes, for new starts only No − Bydureon*, Victoza*

DICLEGIS Formulary 2 Yes Yes 4 tablets per day NoneEXJADE Formulary 2 Yes No − None

GILOTRIF Formulary 2 Yes Yes 30 tablets per 30 days Tarceva*

INVOKANA Formulary 2 Yes Yes 1 tablet per day

chlorpropamide, glimepiride, glipizide IR, glipizide XL,

glipizide-metformin, glyburide, glyburide micronized,

metformin, pioglitazone, pioglitazone-glimepiride, pioglitazone-metformin, tolazamide, tolbutamide,

Januvia*, Janumet*

LIPTRUZET Formulary 2 Yes No −atorvastatin, fluvastatin, lovastatin, pravastatin,

simvastatin, Zetia

MEKINIST Formulary 2 Yes Yes

1 mg & 2 mg: 30 tablets per

30 days 0.5 mg: 90

tablets per 30 days

None

*Indicates Prior Authorization

GHP Kids Member Update 3

Formulary updates (continued)

Brand Name Status TierPrior

AuthorizationQuantity

LimitDetailed Limits Formulary Alternative(s)

OSPHENA Formulary 2 Yes Yes 1 tablet per day Estring, Premarin Cream, Estrace Cream, Vagifem

PROCYSBI Formulary 2 Yes No − Cystagon

SIMBRINZA Formulary 2 No No − brimonidine, dorzolamide, Azopt

SIRTURO Formulary 2 Yes Yes

First fill: 56 tablets

Subsequent fills: 24 tablets

amoxicillin-clavulanic acid, clarithromycin, ethambutol,

isoniazid, levofloxacin, pyrazinamide, rifampin, Avelox

SUCLEAR Formulary 2 No No −

Peg-3350 with electrolytes, Peg-3350 with flavor packs, HalfLytely and Bisacodyl,

GoLYTELY, MoviPrep, Prepopik

TAFINLAR Formulary 2 Yes Yes

75 mg: 120 capsules per 30

days 50 mg: 120

capsules per 30 days

Zelboraf*

TECFIDERA Formulary 2 Yes Yes

240 mg: 60 capsules per 30

days 120 mg: 14

capsules per 7 days

Starter Pack: 60 capsules per 30

days

Copaxone, Betaseron

TIVICAY Formulary 2 No No −

TROKENDI XR Formulary 2 Yes No −

carbamazepine, divalproex, felbamate, valproic acid, topiramate, lamotrigine,

levetiracetam, oxcarbazepine, phenytoin, zonisamide, gabapentin, tiagabine,

ethosuximide, Lyrica, Gabitril, Dilantin, Phenytek

VICTOZAFormulary,

effective 1/1/2014

2, effective 1/1/2014 Yes Yes 9 mL per 30

days Bydureon*

ZUBSOLV Non-Formulary

Non-Formulary Yes Yes 34 day supply

per fill

buprenorphine/naloxone sublingual tablets*, Suboxone

Sublingual Film**Indicates Prior Authorization

GHP Kids Member Update 4

CHIP coverage runs for a full calendar year (12 months) from the first day of enrollment until one year later. You will receive a renewal letter and Renewal Form 90 days before the end of the benefit period. The renewal process is easy: We send you a form pre-filled with the information you provided when you applied. All you have to do is update it! You must complete the Renewal Form and return it to the Plan before the deadline or CHIP coverage will end on the date stated in the letter.

Renewal Info

Developing good oral health habits at an early age and scheduling regular dental visits helps children get a good start on a lifetime of healthy teeth and gums. Your child’s baby teeth are important for many reasons. They are placeholders for adult teeth, and will aid in jaw development, speech development, and allow your child to chew as he or she begins the transition to solid food. Begin each day by brushing your teeth in the morning and again before bed. Follow these tips to help build healthy teeth and gums:

• Clean a baby’s gums with a damp soft washcloth after feedings • Schedule your child’s first visit to a dentist by their first birthday• Additional visits every 6 months to ensure proper tooth development• Help children with brushing up to age 8 or until good habits are

established• Brush teeth for 2 minutes with a fluoride toothpaste• Limit sugary drinks and snacks• Drink water between meals• Limit 100% juice to 4 ounces per day, given only with a meal• Rinse the mouth after taking medication• Floss daily• Replace toothbrushes every 3 months

Don’t forget, National Children’s Dental Health Month is just a few months away, in February! Schedule a check-up today. To find a participating dental provider in your area, contact the Customer Service Team at (866) 621-5235.

Tips for a Healthy Smile

iStock/Thinkstock

GHP Kids Member Update 5

Continued from page 1

• after touching animals, including family pets• before and after visiting or taking care of any sick friends or relatives• after blowing one’s nose, coughing, or sneezing• after being outside (playing, gardening, walking the dog, etc.)

Don’t underestimate the power of hand washing! The few seconds you spend at the sink could save you trips to the doctor’s office. For more information, please visit http://kidshealth.org/parent/general/sick/hand_washing.html# ©1995- 2013. The Nemours Foundation/KidsHealth®. Reprinted with permission.

Why is Hand Washing So Important? (continued)

For the most recent listing of our participating primary and specialty care providers, please visit our website, GHPKids.com, or call the Customer Service Team at (866) 621-5235 from 8 a.m. to 6 p.m., Monday through Friday (TDD/TTY 711). Members can also use the website to search for hospitals, pharmacies and other service providers.

Network Updates

GHP Kids Customer Service Team is the only phone number you need! Our specially trained Customer Service Representatives are committed to providing the best possible experience to our members, and are dedicated to helping GHP Kids members with any questions or concerns you may have. We asked our Customer Service Team Leaders about recent frequently asked questions:

Q: Who do I contact if I need to update our information?

A: You can call the Customer Service Team at (866) 621- 5235 (TDD/TTY: 711) Monday through Friday from 8:00 a.m. to 6:00 p.m. They will assist you in updating all necessary information.

Q: How do I know which services are covered?

A: CHIP includes complete health care coverage for your child, including:

• Immunizations• Routine check-ups• Prescription drugs• Eye care• Dental care from a participating

Dentaquest provider

• Up to 90 days hospitalization/year• Durable medical equipment• and much more

You can refer to your CHIP Member Handbook for complete details on your plan. If you are unsure whether something is covered, call the Customer Service Team for further assistance.

Q: Can I add another child for CHIP coverage?

A: If your family already has one child enrolled in CHIP, you can add another child in the family by notifying us. No additional financial information is required. We will need to make sure the child being added is under age 19, a Pennsylvania resident and a U.S. citizen. After that is determined, the child will be added.

If you have questions on any of the information provided to you about the plan, please contact the Customer Service Team at (866) 621-5235. They are available Monday through Friday from 8:00 a.m. to 6:00 p.m. TDD/TTY users should call 711. They will answer any questions you have or send you additional information.

Customer Service Corner

GHP Kids Member Update 6

(KidsHealth) -- Winter isn't a time to just stay indoors and wait for spring. There's a whole wonderland of sports out there for the entire family — sledding, snow-boarding, and skiing to mention a few. Plus, someone has to shovel the snow, right?

Once outdoors, however, take precautions to keep your family safe. In ice and snow, accidents can occur easily, and before you know it you might be on your way to the emergency room.

It's easy to keep safe — and stay fit — during the cold months. By following a few tips, you can have a great time, no matter how much white stuff piles up outside. At Home One way to stay healthy while cooped up inside is to make sure your family washes their hands. It’s especially important to wash after sharing toys, coughing, and blowing a runny nose to help prevent the spread of viruses.

Decided you’ve had enough of the indoors and you’re going to get the family outside to shovel the snow? Fine, but take care. Snow shoveling is strenuous work. It’s OK for older, school-age kids to help out, but young children should not be shoveling because they can strain their muscles from lifting heavy shovels full of snow.

Younger or older, kids sometimes have a tough time knowing when to come inside from the cold. To nip frost-bite in the bud, check on your kids regularly to make sure that mittens are dry and warm and noses aren’t too red. Dressing for the Cold If you’re going outside in the cold, stay safe — and warm. Make sure your kids have a snack before going out. The calories will give their bodies energy in the cold weather.

And protect your kids’ faces with sunscreen. The idea of a sunburn in January can seem odd, but snow can reflect up to 85% of the sun’s ultraviolet rays.

Kids should dress warmly in layers of clothes. If the top layer gets wet from snow or freezing rain, they can peel off some clothes down to a dry layer.

Avoid cotton clothing because it won’t keep the kids very warm. Stick with wool or other fabrics. Dress them in long underwear, a turtleneck, and a sweater and coat. Add

more layers depending on the temperature. Waterproof pants and jackets are great top layers because they don’t let the wetness seep into the other clothing. The cold-weather ensemble wouldn’t be complete without warm socks and boots to keep feet dry and a hat to top it off.

There’s no set amount of time kids should be allowed to stay out in the cold. However, when being cold becomes unpleasant, it’s time to go inside. Sometimes, though, kids may just need some dry gloves. It helps to have an extra pair of gloves or mittens tucked into their pockets if they plan to be outdoors for a while. In an Emergency Kids are at greater risk for frostnip and frostbite than adults, and the best way to prevent it is to make sure they’re dressed warmly and don’t spend too much time in extreme weather.

Frostnip is an early warning sign of the onset of frost-bite. It leaves the skin red and numb or tingly. After bring-ing your child inside, remove all wet clothing because it draws heat from the body. Immerse the chilled body parts in warm (not hot) water — 104-108°F (40-42°C) — until they are able to feel sensation again.

Frostbite occurs mostly on fingers, toes, ears, noses, and cheeks. The area becomes very cold and turns white or yel-lowish gray. If you notice frostbite, take your child imme-diately to the nearest hospital emergency room

For more information, please visit http://kidshealth.org/parent/firstaid_safe/outdoor/winter_safety.html ©1995- 2013. The Nemours Foundation/KidsHealth®. Reprinted with permission.

Staying Safe During Winter Fun

Marzanna Syncerz/iStock/ThinkStock

GHP Kids Member Update 7

GHP Kids knows that health concerns can occur at any time. That’s why we offer our members dependable after hours care options that meet their needs, no matter the time of day. We want all members to be aware of the program and options designed to help them stay healthy. When you need medical treatment and your PCP office is closed, consider one of the following options:

• Tel-A-Nurse - Discuss your symptoms and health concerns with qualified professionals without a trip to a health care facility. This member service offers 24/7 medical advice given by nurses via phone or secure online chat at GHPKids.com. This service is free and requires no referral from your doctor. Speak to a Tel-A-Nurse any time by calling (877) 543-5061.

• Urgent Care Facilities - These types of facilities ensure that you see a doctor in person. Participating locations can treat more serious situations like sprains, strains, lacerations, fractures and even receive minor surgeries. These sites often have more flexible schedules, often including night and weekend hours.

• Convenient Care Facilities - physicians and certified nurse practitioners work extended hours at participating clinic sites to meet a variety of schedules. No appointments are required, and waiting times are generally shorter than the emergency room. Turn to these sites when you need treatment for a minor illness or injury, such as colds and flus.

For more information or to locate a participating facility near you, visit our website, GHPKids.com or call the GHP Kids Customer Service Team at (866) 621-5235 from 8 a.m. to 6 p.m., Monday through Friday (TTY: 711).

Quality Care Around the Clock

iStock/ThinkStock

Protect Yourself From Insurance Fraud In an effort to protect you from health insurance fraud, Geisinger Health Plan maintains an Anti-Fraud Program designed to help detect and eliminate fraud and abuse. Fraud and abuse take on many forms. Some examples include, but are not limited to:

• Selling or sharing one’s insurance identification number or information so false claims can be filed • An employer who enrolls subscribers who do not work for his or her business under a group service agreement• Using a member identification number that is not your own to receive treatment

Protect yourself. Use discretion when providing your health insurance information (including your member identification number). Never release your information in exchange for free services or gifts. If you suspect fraud or abuse, you can contact us in any of the ways listed below. You may remain anonymous.

• E-mail at FA@thehealthplan.com• Telephone, using the customer service team number listed on the back of your ID card.• Or send written correspondence to:

Geisinger Health PlanAnti-Fraud Program100 North Academy AvenueDanville, PA 17822-3220

100 North Academy Avenue Danville, PA 17822-3240

NON-PROFIT ORG.U.S. POSTAGE

PAIDGeisinger

Welcome new members!

Welcome to CHIP, brought to you by GHP Kids. You will receive a Member Update four times a year. Each update will contain information about benefits, health issues, and new physicians who have recently joined the Health Plan.

You can also find important information by visiting our Web site, GHPKids.com, or by calling the customer service team at (866) 621-5235 Monday – Friday, 8 a.m.- 6 p.m. TTY/TDD users call the Pennsylvania Relay at 711.

For additional resources from the Commonwealth of Pennsylvania, please visit: http://www.chipcoverspakids.com/chip-resources/resources-for-consumers

A copy of the Pennsylvania Insurance Department’s Notice of Privacy Practices is available online at: http://www.chipcoverspakids.com/assets/media/pdf/privacy_notice.pdf

Important insurance fraud information: To help protect you from health insurance fraud, GHP Kids maintains an Anti-Fraud Program to help detect and eliminate fraud and abuse. One of the best ways to help us is to protect yourself. Call us or e-mail FA@thehealthplan.com for information on how to protect yourself.

Please let us know if your phone number or address has changed recently. Accurate information helps us serve you better! Call the Customer Service Team at (866) 621-5235 to update your information.

GHP Kids Member Update is published quarterly. Comments are welcome.

Please write:EditorGHP KidsMember Update 100 North Academy AvenueDanville, PA 17822-3240or e-mail: memberupdate@thehealthplan.com

Si necesita ayuda para traducir esta información, por favor comuníquese con el departamento de Servicios a miembros del Geisinger Health Plan al 1-866-621-5235. Estos servicios están disponibles de lunes a viernes, de 8:00 a.m. - 6:00 p.m. Usuarios del sistema TTY deberán llamar al 711.

HPGOV08 njpCHIP MU December 2013