See a doctor from home page 4

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1 Spring 2014 See a doctor from home page 4 Dining out without pigging out 4 tips for healthier eating page 3 page 2 Health Journal Spring

2 Questions? Contact us Free race entries and more: Be a Champion Call the phone number on the back of your Priority Health ID card. We re open Monday Thursday, 7:30 a.m. to 7 p.m., Friday, 9 a.m. to 5 p.m. and Saturday, 8:30 a.m. to noon. No English? We have translation services. No hable inglés? Comunicarse a el y pedir un traductor. Or send a secure anytime by visiting priorityhealth.com and clicking on Contact us. MyStory: Our members speak up Customer Service is always helpful. They answer the phone right away. You re not on hold, and they always answer your questions. They re so helpful in knowing what s covered and what s not. Rachel M. 2 Health Journal Spring 2014 We re looking for new Champions for Team Priority Health real people like you who want to improve their health and inspire others. If you re selected, you ll receive free team gear and entries into races and events. What do you have to do? We ll ask you to share your story, attend a few community events or races and spread the word about health and wellness. Apply at teampriorityhealth.com. Six perks exclusively for members From shopping for care to discounts on running shoes, Priority Health is a healthier approach to health care. Go to priorityhealth.com and search the keywords to learn more. Know the cost before the care. Compare cost and quality information for 200+ common procedures including surgery, labs and imaging tests. Keywords: blue book See a doctor from home. Skip the urgent care center when your doctor isn t in. Instead, get 24-hour access to doctors from the comfort of your home by going online or calling MDLIVE. Keywords: virtual doc Travel with confidence. See the world knowing you re covered for emergency and urgent care from Assist America. Keyword: travel Get account info on the go. Download our smartphone app for your ID card, copayments, deductible balance and one-touch access to Customer Service. Keyword: mobile Enjoy discounts. Show your ID card to save money at health clubs, sporting goods stores and more. Keyword: discounts Manage your chronic conditions. Get confidential and personal support over the phone from one of our highly trained clinicians. Keywords: case manager

3 Dining out without pigging out Amanda B., Priority Health Registered Dietitian Spring break travel usually means more restaurant meals. From huge portions to endless happy hour specials, dining out can do a real number on your healthy eating goals, right? Not if you follow these guidelines! Go online first. Whether you re dining at a chain restaurant or a local bistro, chances are the menu is online so you can choose healthy options ahead of time. Water is your best friend. Every glass of wine or margarita adds up, especially during happy hour. It s too easy to sip 500 calories an hour! Order a tall glass of bubbly water every other round. Learn to speak menu -ese. Skip dishes with words like creamy, crispy, sauce, gravy and flash-fried. Instead, opt for broiled, baked, steamed and small plates. Slow down! Put your fork down between bites. Take a sip of water. Ask your kids about their day. Making the meal more leisurely lets you notice if you re full before you clean your plate. Amanda B., Priority Health Registered Dietitian Join Amanda for a Facebook chat Meet Amanda and ask her your food and nutrition questions during our live Facebook chat on April 16, 2014, at 2 p.m. Like our Facebook page for a reminder. #priorityhealthchat Win prizes with Go to Facebook and search for MyGo Points for details about how to earn points and win prizes like tickets to local ballparks, zoos and race entries. Earn MyGo Points by scanning QR codes at these Priority Health-sponsored events: MAY 4 MAY 10 JUNE 8 JUNE 19 JUNE 28 JULY 5-12 Priority Health Walk at the Kalamazoo Marathon Fifth Third River Bank Run Grand Rapids Triathlon Maranda Park Parties kick-off Gran Fondo cycling event Traverse City Cherry Festival Health Journal Spring

4 Doctors available 24/7 online and by phone Get treated by a doctor without leaving home for $45 or less! Next time you re sick and your doctor isn t available, skip the urgent care or emergency room. Get treated at home 24 hours a day, seven days a week. Our new virtual visits from MDLIVE let you see a board-certified doctor over the phone or through an online video chat anytime, anywhere. Virtual visits are a great option if you re: Considering the ER or urgent care for a non-emergency Needing care when your doctor s office is closed, including nights, weekends and holidays Traveling 4 Health Journal Spring 2014 Remember, your primary care doctor is the first person you should call when you re sick. They know you and your health, so they re the best choice. They may also have options for you to get care quickly, even when their office is closed. Virtual visits are affordable You ll pay your specialist visit copayment (but never more than $45). If you have a high deductible plan and haven t met your deductible, you ll pay $45 (copayments/coinsurance apply after you ve met your deductible). Register today before you get sick Set up your MDLIVE account now. That way, when you need care, you can quickly log in to schedule a visit. Be sure to register each of your dependents, too. To register or schedule a visit priorityhealth.com/virtualdoc Call MDLIVE at What do virtual visits treat? Use virtual visits for non-emergencies, like: Cold and flu Fevers Respiratory infections Sinus infections Sore throats

5 5 reasons to love virtual visits Where should you get care? Save time and money by knowing your choices for medical care. clip & save NO LONG WAITS There s no waiting room! It takes about 15 minutes from the time you request a visit until you re speaking with a doctor. CONVENIENT CARE Skip the ER when you re sick with a non-emergency in the middle of the night. LOCAL PRESCRIPTIONS The doctor can send prescriptions directly to your local pharmacy. QUALITY CARE MDLIVE doctors are U.S. Board Certified and state-licensed. SAFE AND SECURE Virtual visits through MDLIVE are private and HIPAA compliant. 1. Call your doctor first. They know your medical history, so they can help you decide whether you should go to their office or get help elsewhere. All of our doctors have someone to answer your call 24 hours a day. 2. Consider virtual visits for non-emergencies. When your doctor isn t available, try MDLIVE for non-emergency care like a sore throat or sinus infection. Call MDLIVE at or go to priorityhealth.com/virtualdoc. 3. Go to urgent care centers. Sprained ankles, most burns and minor wounds requiring stitches can be treated quickly at urgent care centers during evenings and weekends. Find one with our Find a doctor tool at priorityhealth.com. 4. Visit emergency rooms only for serious medical situations. For chest pain, trouble breathing, excessive bleeding or if your doctor sends you, call 911 or go to the emergency room immediately. Be sure to follow up with your doctor if you get care somewhere else. Enroll in an individual plan any time as long as you qualify The annual open enrollment for buying individual health insurance ends March 31. But did you know you can still apply after that depending on your situation and life events? It s called special enrollment and here are examples that qualify: Marriage New child (includes adoption) Permanent move to a new area Involuntary loss of other health insurance (like job loss or divorce) Income change Keep in mind that you re typically eligible for special enrollment for 60 days from the date of the qualifying life event, so don t delay. Learn more at mypriority.com or call Health Journal Spring

6 Reconstructive surgery following breast cancer If you have surgery for breast cancer, we ll consult with you to determine coverage for the following services: Reconstruction of the breast on which the mastectomy was performed Surgery and reconstruction of the other breast to produce a symmetrical appearance Prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas This is in compliance with the Women s Health and Cancer Rights Act of Information about your costs for these benefits is included in your coverage documents and any applicable riders included in your Priority Health plan. Board member nominations We re accepting nominations for our Board of Directors. Nominees must have Priority Health HMO or POS coverage. Send résumés and letters of interest by March 31, 2014, to: Board Nominations MS 1345 Priority Health 1231 E. Beltline NE Grand Rapids, MI Help avoid fraud, waste and abuse Our compliance program helps us detect and prevent fraud, waste and abuse. You can help by: Checking your medical bills and claim activity summaries to make sure you were only charged for services you received. Never giving your Social Security number, health plan information or banking information to someone you don t know. Knowing that free services do not require you to give your Priority Health ID card to anyone. If you have questions or suspect fraud or abuse, tell us. You don t have to give your name, address or phone number. Contact us in the way that s most convenient: Call Customer Service at , Monday Thursday 7:30 a.m. 7 p.m., Friday 9 a.m. 5 p.m. or Saturday 8:30 a.m. noon. Call our Compliance Department at , 8:30 a.m. 5 p.m. Call the Compliance Helpline at This third-party organization is open 24 hours a day, and they ll report your concern to us. Use the Fraud, Waste and Abuse Report form on priorityhealth.com. Keywords: report fraud Contact us by mail at Fraud and Abuse Program, MS 3175, 1231 E. Beltline NE, Grand Rapids, MI or fax Schedule your free preventive care See our 2014 Preventive Care Guidelines, which lists care that s recommended to keep you and your family healthy. Then, call your doctor to schedule an appointment. We re committed to improving the health and lives of our members. That s why the care listed in our guide is free to you when it s done for preventive purposes by an in-network provider.* If you have a service performed along with a preventive visit for diagnostic reasons (to monitor, diagnose or treat a health problem), you may have costs. Keyword: preventive *If your plan is grandfathered (hasn t changed since March 23, 2010), you may have costs. 6 Health Journal Spring 2014

7 Understanding your benefits We make important information available online and in print to help you understand how your health plan works. Visit priorityhealth.com and type the keyword(s) below in the search box. For print copies, call Customer Service at DISEASE MANAGEMENT PROGRAMS Learn what programs are available to help you manage chronic illnesses, how to use the services and how to become eligible. Keyword: programs PLAN BASICS Review your coverage documents and member handbook for information about benefits, procedures and much more. You ll find the benefits and services included and excluded from coverage, copayments and other charges, restrictions on services outside the network, how to submit claims and how we evaluate new technology for inclusion as a covered benefit. You ll also find information about in-network doctors, getting primary care and specialty care like behavioral health and hospital services, getting care after normal office hours and receiving emergency care, including when you re out of our service area. Keywords: coverage documents, handbook PRESCRIPTION DRUG UPDATES We regularly review new drugs to help make sure you re receiving safe and effective care. If you take prescriptions, please review our Approved Drug List occasionally to note changes or updates. We also provide information about our prescription coverage and pharmacy management procedures. Keyword: prescriptions PRIVACY STATEMENT Learn how we re committed to keeping your health information private. Keyword: privacy GRIEVANCE PROCEDURE Get information about how our grievance procedure works. Keyword: grievance QUALITY PERFORMANCE Review summary information regarding our Quality Improvement Program performance and quality results. Keyword: accreditation RIGHTS AND RESPONSIBILITIES Know what you can expect from us and what we expect from you. Keywords: member rights BENEFIT DECISIONS Our goal is to cover care that meets high medical standards and is also cost effective. This is called utilization management. If you have questions regarding our process or decisions, contact Customer Service at , and they ll contact a health management staff member to help. Know that all utilization management decisions are based on appropriateness of care and service and that no financial incentives exist for issuing denials. Keyword: utilization Health Journal Spring

8 1231 East Beltline Ave. NE Grand Rapids, MI Get the latest news, tips and information. Just like us on Facebook or on Twitter and Pinterest. Health and wellness or prevention information Health Journal is presented by Priority Health, 1231 East Beltline NE, Grand Rapids, MI All rights reserved. Health Journal and its graphic representation are trademarks. Reproduction without permission is strictly prohibited. No material in this issue may be reproduced without written permission. The publishers do not assume responsibility for unsolicited editorial material. Health Journal is an information newsletter for the customers of Priority Health. The information provided in this newsletter is intended to be used as a general guideline and should not replace the advice of your physician. Always consult your physician for individualized care. If you have any questions, please call the number on your ID card. Priority Health encourages physicians to discuss all treatment options with their patients regardless of benefit level or coverage. DRIVE AND SAVE $ As a Priority Health member, you have free access to valuable information from Healthcare Blue Book. You ll find fair prices of more than 200 common procedures from surgery to labs to imaging tests along with reviews of hospitals and doctors. You could save hundreds, or even thousands, in out-of-pocket expenses. Keywords: blue book 8 Health Journal Spring Priority Health 8050A 02/14