We wish you a healthy and safe holiday season.

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1 INSIDE: Employee Profile Getting Care Taking Your Medicines Safely Fall/Winter We wish you a healthy and safe holiday season. If you have any questions about your health benefits, please call us today. Customer Service hours a day, 7 days a week

2 New Year s Day Año Nuevo A colon cancer screening, such as a colonoscopy, is recommended for men and women ages years old. Se recomienda un examen de cáncer de colon (colonoscopía) para hombres y mujeres entre las edades de años. To help control your blood pressure: Eat foods that are low in salt, and eat fresh fruits and vegetables. Keep active by taking a 10-minute walk, 3 times a day, 5 days a week. Talk to your doctor at each visit about your blood pressure. Presidents Day Día de los Presidentes Martin Luther King Day Día de Martin Luther King Spring Begins Empieza la Primavera Valentine s Day Día de San Valentín Doctor s Day Día del Médico Para ayudar a controlar su presión arterial: Consuma alimentos bajos en sal, coma frutas y verduras frescas. Manténgase activo caminando 10 minutos, 3 veces al día, 5 días a la semana. En cada consulta hable con su médico sobre su presión arterial. your medicine list so your doctor can review it with you. Visite a su médico por lo menos una vez al año para revisar su condición de salud. Lleve su lista de medicamentos para que el médico la revise con usted. St. Patrick s Day Día de San Patricio César Chávez Day Día de César Chávez Enjoy your 2017 Cal MediConnect Calendar! Your 2017 calendar was sent with this newsletter. It has help tips, benefit information and much more. Use it to plan a Healthy New Year! Cal MediConnect 2017 Calendar/Calendario March Marzo 2017 Colorectal Cancer Awareness Month Mes de concientización del Cáncer Colorrectal Sun / Dom Mon / Lun Tue / Mar Wed / Mié Thu / Jue Fri / Vie Sat / Sáb February Febrero 2017 Sun / Dom Mon 5 / Lun Tue 6 / Mar Wed 7 / Mié Thu 8 / Jue Fri / 9 Vie Sat / 10 Sáb January Enero Sat Sun / Dom Mon / Lun Tue / Mar Wed / Mié Thu / Jue Fri / Vie / Sáb Visit your doctor at least one time each year to review your health condition (s). Bring Employee Profile - Anais Beltran My name is Anais Beltran and I have been at Community Health Group (CHG) for a little over two years now and I absolutely love working for this company. I started off in the Customer Service Department and now I am in the Medicare Services department. Being a Medicare Services Specialist has been by far the most rewarding job I have had the pleasure of doing. I love the flexibility of the job and I absolutely love having a connection with our members. The CHG team makes it easy for us to provide access to quality care to our members. When I am not at work I love spending time with my family and friends. The relationship I have with my grandparents gives me a better perspective on what our Cal MediConnect (CMC) members need and the issues they face. In my spare time I love playing soccer, watching movies and cooking meals for my family. All in all, I consider myself a very lucky person to not only have a strong support system at home but to also have it at work. Getting Care People do not always get sick during normal business hours, that is why many doctor offices and clinics are open evenings and Saturdays. Do not spend hours in the emergency room when your doctor can help you more quickly! Except in an emergency, always call your doctor first. Someone is usually on call to help you in the evening or on weekends. 2

3 New members: get an initial health exam! Your first appointment with your new doctor is called an initial health exam. It is a very important meeting! Why? It helps the doctor: Learn about you before you get sick. Look at your past or ongoing health issues. Go over any drugs you are taking. Tell you what checkups, shots or tests you need. Study your family s medical history. Call your doctor for an initial health exam today! For help making your first exam, call our Customer Service Department. Customer Service hours a day, 7 days a week Did you know that your Cal MediConnect benefit also covers MTS bus and trolley day passes for your medical appointments? CHG provides more than one type of transportation option for our Cal MediConnect members. If you have a confirmed medical appointment with one of our CHG providers, you may call us to request MTS bus and trolley passes so you can get to your appointment. The MTS Access program is for people with physical, cognitive and visual disabilities. If you qualify for the MTS Access program, we can provide you with tickets to ride the MTS Access buses and trolleys to medical appointments. To find out if you qualify for the MTS Access program you can call Medical Transportation Management (MTM) at for more information. If you would like to request MTS bus and trolley, or MTS Access tickets for your medical appointment, please call CHG Customer Service, at Please call at least seven business days in advance to make sure that the tickets arrive to your home on time via US Mail. 3

4 Taking Your Medicines Safely Medicines can help you stay healthy and control pain. However, they can be harmful when you take them the wrong way or if the pharmacy gave you the wrong medicine. Here are some tips to keep in mind: Know your medicines You should be able to answer these key questions about all the medications you are taking: What is the name of this medicine? Why am I taking it? How much of it should I take? How often should I take it? Are there any medicines, beverages or foods I should avoid? What should I do if I experience side effects? Make a list of your medicines Keep a list of all prescriptions, over-the-counter medicines, vitamins, dietary supplements, herbs and any other substance you take. Share this list with your doctor. It is important for your doctor to know what you are taking to make sure you are safe. Check the labels When you pick up a new prescription or a refill from the pharmacy, check the label. Make sure the medicine is the one you have been prescribed. Ask questions Do not be afraid to ask questions. Talk to your doctor or pharmacist if: Your pills look different than usual. The drug name is different than before. The directions listed are different than what you remember. You experience side effects when taking the medicine. You are not sure about how to take the medicine. Remember to bring all your medicines with you when you go to the doctor. Ask your doctor to go over each medicine with you. Taking a medicine incorrectly is dangerous and can cause life-threatening problems. When you are unsure about any of your medicines, ask a doctor, pharmacist or telephone advice nurse. They are more than happy to help you. 4

5 Find and treat cancer early! Quality Counts! We care about the quality of care and service you receive. We have a Quality Improvement Program that helps us look at how we are doing. Screening is the best way to find cancer early. Get a mammogram to detect breast cancer. Women who are over 40 years of age should get mammograms. Get a Pap smear test to detect cervical cancer. This test also checks women for some sexually-transmitted diseases. See your doctor every year to talk about your health care and your need to get a mammogram and Pap smear. Call Customer Service if you need help making an appointment with your doctor or have questions about your benefits. Customer Service hours a day, 7 days a week We look at the health of our members and set up special programs to improve care. Our current goals are to: Help members who have asthma or diabetes. Increase the number of members who get: mammograms immunizations Encourage follow-up visits for members taking Attention-Deficit Hyperactivity Disorder (ADHD) drugs. For more information, please call our Corporate Quality Coordinator, Daphne Cheney at (619)

6 Control your diabetes A test called A1c is the best way to see how you have been controlling your blood sugar. The test shows the average amount of sugar that has been in your blood over the past three months. This is different than the finger-stick test that shows your blood sugar level at that time. The goal is an A1c test result of less than 7%. Talk to your doctor about your blood sugar levels. Uncontrolled blood sugar can affect many organs in your body. Eye infections and blindness are more common in people with diabetes. If you notice a change in vision or pain in or around your eyes, visit your doctor. Heart disease is the major cause of death among people with diabetes. Visit your doctor if you start having any shortness of breath, dizziness or fast heart beats. Diabetes is the leading cause of kidney failure. Visit your doctor to check the status of your kidneys. See your doctor if you are urinating more 6 often. Frequent urination occurs if your blood sugar is high and not necessarily due to kidney failure. You could even experience decreased urination. Diabetes also affects your nerve function, especially in your legs and feet. If you start having loss of feeling in your legs or feet, visit your doctor. Take control of diabetes! Exercise at least a couple of times a week for 30 minutes. Talk to your doctor before you start to make sure you do not have special exercise needs. Eat healthier. The diet for people with diabetes is simply a healthy eating plan. Select healthy foods, low in fat and moderate in calories. It is a healthy diet for everyone! Visit your doctor at least twice a year. Your doctor can help you keep your diabetes under control.

7 One call Customer Service One rep One solution There are many things our Customer Service Team can help you with. Please call us with your questions and concerns. We can help you: Understand your health plan benefits Access doctors and other providers Change primary care doctors or office location Solve a problem with service or care Get a prescription filled Navigate the health care system No problem is too big or small. We have a caring and experienced Customer Service staff waiting for your phone call. Customer Service hours a day, 7 days a week How long do you have to wait for an appointment? Here are the standards for waiting times: Urgent Appointments Wait Time For services that do not need prior approval For services that do need prior approval 48 hours Non-Urgent Appointments Primary care appointment Wait Time Specialist appointment Appointment for other services to diagnose or treat a health condition Behavioral Health Services with physician and non-physician mental health care providers 96 hours 10 business days 15 business days 15 business days Wait Time Non-life threatening emergency Within 6 hours Urgent care Within 48 hours 10 business days Routine care In an emergency, call 911 or go to the nearest emergency room. Please call Customer Service if you need help accessing health care. 7

8 New Pharmacy Safety Features for Narcotic Drugs On January 1, 2017, Community Health Group will add new safety features at the pharmacy. The new features will make the use of narcotic drugs safer. Narcotics are used to treat pain and include medicines such as hydrocodone (Norco, Vicodin ), oxycodone (OxyContin ), morphine sulfate (MS Contin ), hydromorphone (Dilaudid ) and fentanyl (Duragesic ). Safety Feature #1: An alert will go to the pharmacy when the total amount of a prescribed narcotic reaches a certain level. The pharmacist must get information from your doctor before filling the prescription. Feature #2: When a patient is prescribed two medications that should not be taken together, the pharmacist is alerted. For example, if you are taking buprenorphine to treat narcotic addiction and your doctor prescribes a narcotic pain medication, the pharmacist must check with your doctor before filling the prescription. We are working with our CHG members and their doctors ahead of time to begin the approval process. This will reduce delays in getting needed medications. If you have concerns, please talk to your doctor. Our Care Coordination Program What is it? It is a program where our case managers and care coordinators help you manage and access your health care. This team works with you to answer any questions that you have on your health benefits, and to develop care plans created to keep you healthy. Every Cal MediConnect member has a care coordinator to help them navigate their healthcare, access preventive care and promote a healthy lifestyle. If you would like to connect with your coordinator, please call for more information. 8

9 Nondiscrimination Notice Community Health Group complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Community Health Group does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Community Health Group: Provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language Interpreters Written information in other formats (large print, audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages If you need these services, contact the Customer Service Department at If you believe that Community Health Group has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Lolita Pintado-Samaniego, Grievance and Appeals Manager, telephone number (619) , Fax (619) , Lsaman@chgsd.com. You can file a grievance in person, by mail, fax, or . If you need help filing a grievance Lolita Pintado-Samaniego, Grievance and Appeals Manager, is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, , (TDD). Complaint forms are available at index.html 9

10 ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1- Call (TTY: (TTY: ). ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1- Llame al (TTY: ). (TTY: ) (TTY: 1- (TTY: ) ). PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (TTY: ) :. (TTY: ) CHÚ Ý: N u b n nói Ti ng Vi t, có các d ch v h tr ngôn ng mi n phí dành cho b n. G i s (TTY: )., : (TTY ( ) ): :, (TTY: ). :, ( : ). ) :.( : LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau (TTY: ). : (TTY: )., (TTY: ) :, (TTY: ) ' : (TTY: ) (TTY: :,,, (TTY: ). 10 H5172_MultilanguageInsert Accepted

11 Get Your Flu Shot! Language Assistance Program October marks the beginning of the flu season, but it is not too late to get your flu shot. Every year thousands of people get sick with the flu. People can end up in the hospital from the flu. The flu is different every year, so it is important to get a new shot every year, especially if you have diabetes, asthma, high blood pressure, a heart condition or are over age 65. Your Cal MediConnect benefit covers the flu shot at no cost to you. Make an appointment with your doctor or local pharmacy to get your shot. To be healthy, it is important to be able to get information about your health plan, medical treatment and medications. It is also important to understand what your doctors and other health care people tell you. For this reason we offer free help to our members in these areas: Interpretation Services Face-to-face Interpreter services at medical appointments. Please let us know at least five days before your appointment to arrange for in-person services. Interpreter over the telephone. Call Customer Service toll free at: to get this service. Teletypewriter (TTY-Text Telephone Telecommunication Device for the Deaf) Call toll free at to get this service. Health Plan Information We print health plan information in English, Arabic, Spanish, Tagalog and Vietnamese. We also provide materials in enlarged print format, audio recordings and braille. 11 Please call us if we can help you with language assistance services!

12 Report Health Care Fraud! Help us save valuable health care resources by reporting fraud. If you think a Community Health Group employee, member or provider is involved in fraud, we urge you to report it. Examples of fraud are: Using someone else s card to get care or services. Doctors giving care that is not needed. Please report anything that does not seem right to you. Fraud & Abuse Hotline You can leave a message 24 hours a day, 7 days a week. Community Health Group has been named one of the region s 2016 Top Workplaces by The San Diego Union-Tribune.