the mix - summer 2016 - family health plan edition

SUMMER2 0 1 6

Add kids’ checkups to your summer checklist

Learn about our Sprout pregnancy program

Get tips for handling asthma and diabetes

Have a Question? Call Us. • Hours: Monday through Friday, 8 a.m. to 8 p.m.• ICP-Medicaid: 1-877-933-8480• MMAI-Medicaid and Medicare (Duals): 1-866-951-0264• Both: TTY users call 711 or 1-800-526-0844 (Illinois Relay).


Have a Question? • 1-877-633-2526, Monday through Friday, 8:30 a.m. to 5 p.m. (TTY: 711)• HealthAllianceConnect.org

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Stir in Some Healthcare TipsThe Mix, our newsletter for Health Alliance Connect Medicaid members, reminds you it’s always a great time to connect to the care you need and use your benefits to their fullest.

Kick off your summer with this Mix:

Mix in HealthHealth Alliance Connect helps make sure

you get the care you need from start to

finish. That means you’ll have a primary care

physician (main doctor, also called PCP)

who focuses on all your health needs. And

you might be eligible for other services and

support to help you meet your goals. Plus,

all your health records stay in one place.

A summer checkup checklist

The ins and outs of our pregnancy program

Tips to help control asthma

Steps to help keep diabetes in check




Mix in Health

Put Checkups on Your Summer Checklist

Yearly Checkup Doctors will help you know if your kids have any health issues and when they need certain vaccines. Your kids can also get sports physicals at the doctor’s office if they need them to join school teams. We cover yearly physicals and follow-up care for those under 21.

Dental VisitMake sure to take your kids to the dentist, too, and help them keep up healthy habits, like brushing twice a day, flossing daily and cutting out soda. We cover teeth cleaning and orthodontic services for those under 21.

Summer break means more than sunshine, swimming and outdoor sports. Between all the bike rides and ball games, add checkups to your kids’ summer to-do lists. Make sure to take your children to the doctor, dentist and eye doctor before school starts this fall.

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Vision ExamTake your children to an eye doctor to make sure they are seeing clearly. Not being able to see can make reading and learning difficult. We cover regular eye exams and glasses as needed for those under 21.

Have a happy and healthy summer!




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Helping You and Your Sprout Stay HealthyFinding out you’re having a baby can be both exciting and a little scary. You might be worried about all you need to do to take care of yourself and the baby.

We can help. Join Sprout, our free pregnancy program. When you sign up, a case manager will call you to talk about what you need. He or she will be there for you during your pregnancy to answer your questions and help you get needed care along the way.

Get Started TodaySign up for Sprout by calling 1-877-633-2526 (TTY 711). We want to help you take the best care of yourself and your little sprout right from the start.

Earn RewardsYou can get rewards for going to your prenatal doctor visits. We will give you cards to take to each visit. Have your doctor sign the card. Then send it to us to get:

• A pack of diapers after each office visit

• A gift card, which you can use at many major online stores, after six office visits

• A stroller or swing if you go to all your visits




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Why do I need prenatal care?Prenatal care can save your baby’s life. It’s that important. Babies whose moms do not get prenatal care are five times more likely to die and three times more likely to have a low birth weight than babies born to mothers who get care, according to womenshealth.gov.

Don’t risk it. Get the prenatal care you and your baby need.

Prenatal To-Do ListHere are some things you should do as soon as you know you’re pregnant.

• Make an appointment to see your doctor as soon as you can.

• Sign up for RallySM, our online wellness tool, at HealthAlliance.org.

• Don’t use tobacco or drink alcohol. It might be hard to quit, but everything that goes into your body also goes into your baby’s body. Alcohol, tobacco and other drugs can hurt or even kill the baby. If you need help quitting or have questions about your pregnancy, call us at1-877-633-2526.




Keep Up on Diabetes Testing

Controlling your diabetes is about more than just your blood sugar level. Diabetes can affect your health in other ways, so you need certain tests and exams to make sure you are as healthy as possible.

The American Diabetes Association recommends getting the services below each year. Call your doctor to see which ones you still need to get this year.

• A1C test—two to four times a year with a goal of less than 7 percent

• Blood pressure check—at each doctor visit with a goal of less than 140/90

• Retinal eye exam—once a year

• Urine test for protein—once a year

• Foot exam—once a year (more often if you have foot problems)

• Flu shot—once a year

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Asthma doesn’t have to hold you back. Even though there isn’t a cure, there are things you can do to control it. Health Alliance Connect can help you get the treatment and medicine you need to stay out of the emergency room and keep doing the things you want to do.

It’s important to see one doctor for your asthma so he or she can get to know your asthma and your needs. Go in for an asthma checkup at least every six months.

Here are some things to talk about with your doctor.

• If you have been to the emergency room for your asthma

• If you feel like you are having more symptoms (tell him or her as early as possible)

• If you’ve missed work or school because of asthma

• If you are using quick relief meds (inhaler or nebulizer) more than three or four times a day

• If you aren’t taking your meds as prescribed and why (cost, side effects, etc.)

Stay on Top of Your Asthma

A Health Alliance Connect case manager can also help you stay on top of your asthma. He or she can go over your treatment plan with you, try to help you get meds if you can’t afford them and answer your asthma questions.

If you are interested in working with a case manager or have questions about your asthma, call 1-877-633-2526 (TTY 711).

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What you’re about to read on the next few pages, a piece we call Essentials, is a tool we send you once a year.

It explains:

• Howtofindanswersonlineandgethelpinanotherlanguage

• Quality improvement and health and wellness info

• Your rights and responsibilities as a member

• Other need-to-know info

Check it out, and if you have any questions, call the number on the back of your ID card.

Essentials

Member Services Is Here to Help1-877-633-2526, TTY 711, Monday through Friday 8:30 a.m. to 5 p.m. CT.

We can help you with questions about claims, coverage, appeals, pharmacy issues, preauthorization, utilization management and information about the doctors, clinics and hospitals we work with. We can also give you printed versions of any of the information on our website. After normal business hours, leave a message, and your call will be returned the next business day. Please note that all non-urgent review requests received after normal business hours will be recorded as being received the next business day.

?Find Answers Online

Find answers to your questions online anytime at HealthAlliance.org. It has information about your coverage and our processes, such as:

• Our most recent HEDIS® and CAHPS® scores

• Medical and pharmaceutical management policies and procedures, including how we review new technology

• Howtofileacomplaintorappeal, including your right to involve an external review organization

• Whichbenefitsandservicesareincluded and excluded from your coverage in and out of the service area

7 HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

• How to get emergency care, primary care, specialty care and behavioral health services during and after normal business hours in and out of service area

• How to get information about in-network physicians and hospitals

Register* and log in at YourHealthAlliance.org today to:

• Learn how to submit a claim

• Check the status of a claim

• View the Drug Formulary, evaluate drug interactionsanddeterminefinancial responsibility for prescriptions

• Viewyourdeductibleandfindyour copayments or coinsurance

• Read the Health Alliance notices of privacy practices

Visit HealthAlliance.org, or sign up for a username and password by going to YourHealthAlliance.org and registering as a member.

*If you don’t have Internet access, you can get printed copies of the materials on the Health Alliance website by calling Member Services.

We Speak Your LanguageIf you are more comfortable speaking a language other than English, try our telephone translation service, Language Line. We provide access to interpreters who speak 200 different languages. Simply call the Member Services number listed on the back of your member ID card and tell them which language you speak.

Si usted necesita un interprete para traducir esta información, por favor llamar al teléfono gratis 1-877-633-2526 y pregunte por la “Language Line.” Si usted necesita documentos tradujeron a un idioma diferente, usted puede solicitar que llamando 1-877-633-2526.

Better Service, Better Care To view our Quality Improvement program, go to HealthAlliance.org, open the More menu and choose “Our Numbers” under Education.

Health and Wellness

Health Alliance offers disease management programs for members with asthma, diabetes and high blood pressure. The case management program serves members who need help managing a chronic or complicated health condition or navigating the healthcare system. For more information or to enroll in any of these programs, members or their caregivers may call 1-800-851-3379, extension 8112.

PharmacyBenefits and Management ProceduresThe Health Alliance Drug Formulary lists the preferred and most-used brand-name drugs. It also has information on other pharmacy management procedures and processes, such as generic substitution, step therapy, preauthorization, managed dose limits and other limits or quotas.

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To view the Drug Formulary online, log in at YourHealthAlliance.org. Choose “PrescriptionDrugBenefits”fromtheYourBenefitssection,andthenclicktheYourDrugBenefitsbutton.Youmayrequestapaper copy of the Drug Formulary or any other pharmacy materials on the website by calling the Health Alliance Pharmacy Department at 1-800-851-3379, option 4.

Physicians may request a Medical Exception for a medication on behalf of a member or request more information by calling the Health Alliance Pharmacy Department at 1-800-851-3379,option4.Specificinformation required from the provider is detailed in our online Drug Formulary. The Medical Exception decision may be appealed by calling Health Alliance Pharmacy at 1-800-851-3379, option 4.

Know Your Rights and Responsibilities

You have the right to:

• Receive all services that the Health Alliance is required to provide per our agreement with Illinois Healthcare and Family Services.

• Be treated with respect and with due consideration for your dignity and privacy.

• Receive information about the organization, its services, its practitioners, and provider and member rights and responsibilities.

• Receive information including enrollment notices, informational and instructional materials in a manner that may be easily understood.

• Participate with providers in making decisions about your health care.

• Receive treatment options and alternatives presented in a manner appropriate to your condition and ability to understand.

• Refuse treatment to the extent of the law and to be told of the outcome.

• Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.

• Voice concerns, complaints or appeals about the organization and the care it provides and to receive prompt answers.

• Formulate advance directives.

• Appealtoorfiledirectlywiththe Department of Health and Human Services(HHS)Officeof CivilRights (OCR) any complaint of discrimination, on the basis of race, color, national origin, age, or disability in the receipt of health care services.

• Exercise your rights without retaliation.

• Receive a copy of your medical records and request the records be amended or corrected.

• That you will not be balanced billed.

• Reasonable accommodations.

You have a responsibility to:

• TreatyourPCPandofficestaff with courtesy and respect.

• Supply information (to the extent possible) that the organization and its practitioners and providers need in order to provide care.

• Follow plans and instructions for care that you have agreed to with their practitioners and providers.9

• Understand your health problems and participate in developing mutually agreed upon treatment goals, to the degree possible.

• Decide about having medical treatment or procedure before it begins.

• Help your PCP obtain your medical records.

• Not seek care from a specialist, unless referred by your PCP.

• Not seek care in an emergency room for conditions that are not life-threatening without contacting your PCP.

• Keep all scheduled appointments and be on time.

• Follow the rules and regulations of Health Alliance.

Health Alliance Ensures Reasonable Access to ServicesHealth Alliance employees never encourage decisions that result in underutilization of care. Wedonotgivefinancialinducementsorsetquotas for issuing denials of coverage or care; nor do we keep statistics identifying individual providers and their denial rates. Coverage decisions made by our medical directors, nurse coordinators, pharmacy coordinators and pharmacists are based only on appropriateness of care and service and the existence of coverage.Therearenoincentives,financial or otherwise, to encourage barriers to care and services.

Switching from Pediatric to Adult CareIf you’re ready to switch from pediatric (child) to adult health care or have a child who is ready, there are lots of options. Pediatricians typically see children from birth to age 18, but you can stay with your pediatrician if the relationship works. You can choose a primary care physician (PCP) who works in family practice, general practice or internal medicine. To change your PCP or get a list of in-network doctors, call Member Services at 1-877-633-2526 or log in at YourHealthAlliance.org.

We Respect Your PrivacyTo see our website privacy policy or our notice of privacy practices, please call Member Services. This information is also available on any of our websites at the bottom of the page.

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301 S. Vine St.Urbana, IL 61801

Programs like the Summer Food Service Program, funded by the federal government, help kids who get free or specially priced meals during the school year, keep getting meals during summer break.

To find free summer meals in Illinois, call 1-800-359-2163. And you can find local food banks using the food bank locator at feedingamerica.org.

Summer Meals Programs Feed Children

Don’t forget to stay in touch!Just like your friends and family, we need to know if you move or get a new phone number. That way, we can keep in touch, send you important info about your plan and make sure you get your copy of The Mix.

You can also connect with us on social media. We’ll keep you in the loop on news and events, plus give you healthy living tips and info.

Facebook.com/HealthAlliance Twitter: @Health_Alliance Pinterest.com/HealthAlliance

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Please call 1-877-633-2526 and tell us what changed (TTY users call 711). Or send an email with your name, address and phone number to [email protected].

VEE NTCALENDAR

2016

For more community events, visit our website, HealthAllianceConnect.org.

Carle Playing It SafeChampaign County Fairgrounds1302 N. Coler Ave. | Urbana, ILJune 4, 2016 | 9:30 a.m.–2 p.m.

Healthy Food Kiosk PartyCRIS Healthy Aging Center309 N. Franklin St. | Danville, ILJune 8, 2016 | 10 a.m.–1 p.m.

Civil War Tech Germy GermsAbraham Lincoln Presidential Library112 N 6th St. | Springfield, IL June 4, 2016 | 10 a.m.Free with reservation

Monday Night Movie TriviaCarmike Ovation 10415 Detroit Dr. | Bloomington, ILJune 27, 2016 | 7-9 p.m.

the mix - summer 2016 - family health plan edition

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