The NALC Health Benefit Plan
HBR Report
Fredric V. Rolando, President • Brian Hellman, Director20547 Waverly Court Ashburn, VA 20149 - 888-636-NALC
Michael J. Gill Lawrence D. Brown, Jr., Chairman Randall L. Keller
Vol. 14-5 October 2014
Board of Trustees
Taking Care of Our Own.
Where Health and Service Come First.
The NALC Health Benefit Plan HBR Report October 2014
Director’s Report
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Importance of Handwashing
Handwashing is like a “do-it-yourself” vaccine—it involves five simple and effective steps (think-Wet, Lather, Scrub, Rinse, Dry) you can take to reduce the spread of diarrheal and respiratory illness so you can stay healthy. Regular handwashing, particularly before and after certain activities, is one of the best ways to remove germs, avoid getting sick, and prevent the spread of germs to others.
Whether you are at home, at work, traveling, or already sick, find out how good hand hygiene can protect you, your family, and others.
When should you wash your hands?
• Before, during, and after preparing food• Before eating food• Before and after caring for someone who is sick• Before and after treating a cut or wound• After using the toilet• After changing diapers or cleaning up a child who has used the toilet• After blowing your nose, coughing, or sneezing• After touching an animal, animal feed, or animal waste• After handling pet food or pet treats• After touching garbage
How should you wash your hands?
• Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap. • Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails. • Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice. • Rinse your hands well under clean, running water. • Dry your hands using a clean towel or air dry them.
For more Information to to www.cdc.gov/handwashing.
Keeping hands clean is one of the most
important things we can do to stop the
spread of germs and stay healthy.
The NALC Health Benefit Plan HBR Report October 2014
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Immunization Awareness
Immunizations
While immunizations have significantly reduced the incidence of many serious infectious diseases, vaccination rates for some diseases are not meeting national public health goals. Remember immunizations aren’t just for children. They are needed throughout our lifetime.
Vaccinations are an important step in protecting adults against several serious, and sometimes deadly, diseases:
• The need for vaccination does not end in childhood. Vaccines are recommended throughout our lives based on age, lifestyle, occupation, locations of travel, medical conditions and previous vaccines.
• The CDC updates vaccines recommended for adults each year based on the latest research on vaccine safety, effectiveness, and patterns of vaccine-preventable diseases.
• AHIP’s recommendations are also reviewed and approved by professional medical provider organizations, including the American College of Physicians, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and American College of Nurse-Midwives.
Vaccines can protect you from serious and sometimes deadly diseases:
• Vaccines are recommended for adults to prevent serious diseases such as influenza, shingles, pneumonia caused by pneumococcal bacteria, hepatitis, and whooping cough.
• Many of these diseases are common in the U.S., and all adults – even healthy ones – can benefit from vaccination.
• Some vaccines prevent cancer. Hepatitis B vaccine can prevent liver cancer that can develop after developing chronic hepatitis B. The HPV vaccine can prevent cervical and other types of cancer caused by human papillomavirus.
• Every year, thousands of adults in the U.S. needlessly suffer, are hospitalized, and even die from diseases that could be prevented by vaccines.
• Vaccination is important because it not only protects the person receiving the vaccine, but also helps prevent the spread of certain diseases to those who are most vulnerable to serious complications, such as infants and young children, elderly, and those with chronic conditions and weakened immune systems.
For adult and child vaccinations covered by the Plan, please see the NALC Health Benefit Plan Official Brochure (RI 71-009).
For more information go to http://www.nphic.org/niam.
The NALC Health Benefit Plan HBR Report October 2014
Healthcare Corner
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Easy ways to lower your out-of-pocket health care expense
1. Stay in network. Save big when you use a doctor, hospital or facility that’s part of the Cigna HealthCare Shard Administration OAP network. Chances are, there’s a network doctor or facility in your neighborhood. It’s easy to find quality, cost-effective care right where you need it. In fact, one thing you won’t find is higher costs.
2. Ask before you go. Your primary care doctor may be in the Plan’s network, but that doesn’t mean all other providers you may be referred to are participating. When your doctor gives you a referral, don’t be afraid to ask if the facility, lab or specialist is in our network. If you don’t, you may unintentionally go out-of-network and be surprised by a higher out-of-pocket costs than expected.
3. Know your plan - inside and out. If you go out-of-network for care, the costs can add up quickly. That’s because you’re paying full price - not the discounted price an in-network doctor or facility has agreed to accept. Plus, if the doctor or facility charges more than what the Plan will pay for out-of-network care, you will have to pay the difference.
4. Go with the Cigna Care Designation. You may save even more when you choose a Cigna Care Designation doctor or a Centers of Excellence hospital. Doctors in 22 medical specialties, including primary care, who achieve top results on measures of health outcomes and cost-efficiency earn the Cigna Care Designation. Centers of Excellence hospitals have also earned recognition for quality and cost-efficiency for certain procedures. Look for these designations in the online directory.
5. Get preventive care. Checkups, immunizations and screenings can help detect or prevent serious diseases and keep you in tip-top shape. Your primary care physician can help you coordinate what tests and shots are right for you, based on your age, gender and family history. Refer to the Plan brochure for specific benefits and coverage details.
6. Use an in-network urgent care center. If you need medical attention but it’s not serious or life threatening, you may not have to go to an emergency room (ER). An urgent care center provides quality care like an ER, but can save you hundreds of dollars. Visit an urgent care center for things like minor cuts, burns and sprains, fever and flu symptoms, joint or lower back and urinary tract infections.
• Average urgent care center cost: $135
• Average hospital ER cost: $1,553
The NALC Health Benefit Plan HBR Report October 2014
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If you are waiting for your heart to tell you if you have high blood pressure, you may end up waiting too long.
Dizziness, headaches, nosebleeds, blood spots of the eye and shortness of breath-all of these used to be considered signs of high blood pressure. But, studies have shown that for first stage high blood pressure these symptoms may not appear. The only way to know if you have high blood pressure is to make an appointment with your doctor and get it checked.
Even if you think you feel okay, not keeping your blood pressure in check is a dangerous risk. High blood pressure can damage the heart and coronary arteries and can lead to heart attack, heart disease, congestive heart failure, aortic dissection and atherosclerosis- fatty buildups in your arteries that cause them to harden.
If you have been diagnosed with high blood pressure, you may be eligible for the Alere Disease Management program. Work one-on-one with an experienced nurse and receive guidance on reducing the risks associated with high blood pressure. Your nurse will provide you with the knowledge, tools and motivation you need to meet your health goals. The program is completely confidential and available when it’s convenient for you - including night and weekend hours. Plus, participation is free it is part of your benefits through the NALC Health Benefit Plan High Option.
Call us toll free at (866) 956-6252 or enroll at www.NALCAlereHealth.com.
Healthcare Corner
HIGH BLOOD PRESSURE:
Systolic pressure of 140 or higher(top number)
14090
Diastolic pressure of 90 or higher
(bottom number)
The NALC Health Benefit Plan HBR Report October 2014
Pharmacy Corner
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Manage Your Health and Your Money with Generics
Q. What’s the difference between generic and brand-name medicines?
A: All the money you save. Each time you fill a prescription, you could save money by asking for a generic medicine. That could add up to big savings in just a short time. Research shows that you can save an average of 30% to 80%1 when you fill your prescriptions with a generic drug instead of a brand-name drug.
To see if a generic is available for a drug you are currently taking or considering, visit www.caremark.com/ countongenerics. Or, log onto Caremark.com and click “Find Savings and Opportunities” to find out how much you can save.
Q. Are there any other differences between generic and brand-name medicines?
A: Yes, the name and how they look are different, not how they work. When the patent of a brand-name medicine expires, other drug manufacturers can make and sell the same medicine. This medicine is sold under its chemical name, which is why it is called a “generic”. Like their brand-name counterparts, all generic medicines are tested and approved by the U.S. Food and Drug Administration (FDA) before they can be sold to consumers.
FDA-approved generic medicines are as safe and effective as brand-name medicines. In the United States, trademark laws do not allow a generic medicine to look exactly like its brand-name counterpart. Therefore, you can expect a generic medicine to be a different color or a different shape than its brand- name counterpart. However, the way it looks has no effect on how the medicine works. In fact, generics are often made by the same company manufacturing the brand-name drug.
Q. Are generics safe and effective?
A: Yes. The FDA makes sure of it. The FDA puts each generic medicine through a rigorous quality control review process to ensure that generics are as safe and effective as the original brand-name medicine. Both brand-name and generic drug facilities must meet the same standards of good manufacturing practices. The FDA inspects more than 3,500 pharmaceutical manufacturing facilities each year to monitor how the medicines are made, processed, tested, packaged, and labeled.
To gain FDA approval, generic medicines must prove they are exactly like their brand-name equivalents in:
• Safety • Identical active ingredients • Performance (how it works in the body) • Strength (e.g., 10 mg, 20 mg) • Dosage form (pill, liquid, cream, etc.)
The NALC Health Benefit Plan HBR Report October 2014
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Q. Why do generic medicines cost less?
A: Research and development are already complete. Generics cost less because their manufacturers do not have to spend the hundreds of millions of dollars it takes to complete research and development on the new original medicine.The brand manufacturer makes that investment, along with the millions of dollars needed to market and advertise the new medicine. Therefore, it costs the generic manufacturer less to develop the same medicine. The savings are passed on to you!
Visit www.caremark.com/countongenerics to learn more, including a list of generic drugs available to treat common conditions.
Q. How can you save money?
A: To save money on your prescriptions, ask for generics:
• Ask your doctor to prescribe generics and allow generic substitution at your local pharmacy.
• Say “yes” if your pharmacist asks whether you would like the generic equivalent of the brand-name medicine your doctor prescribed.
• If there is no generic equivalent for a brand-name medicine you are prescribed, ask your doctor if there’s a generic alternative2 available to treat your condition and if it would be right for you.
1 The amount of your savings will be based on your benefit plan. Source: Generic Pharmaceutical Association’s website:www.gphaonline.org.
2 A “generic alternative”is a therapeutic alternative utilizing a generic drug to treat the same condition.
NALC Health Benefit Plan 1-888-636-NALCRecorded Benefit Information 1-888-636-NALC Prescription Drug Program 1-800-933-NALCCaremark SPS 1-800-237-2767 OAP Network Providers 1-877-220-NALC Precertification 1-877-220-NALCFraud Hot Line 1-888-636-NALC Mental Health / Substance Abuse 1-877-468-1016
NALC Health Benefit Plan20547 Waverly CourtAshburn, VA 20149
The NALC Health Benefit Plan HBR Report October 2014
Washing hands with soap and water is the best way to reduce the number of microbes on them in most situations. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of microbes on hands in some situations, but sanitizers do not eliminate all types of germs.
Hand sanitizers are not as effective when hands are visibly dirty or greasy.
How do you use hand sanitizers?• Apply the product to the palm of one hand (read the label to learn the correct amount).• Rub your hands together.• Rub the product over all surfaces of your hands and fingers until your hands are dry.
Effectiveness of Hand Sanitizers
