360 Health Questions and Answers

Transcription

1 SM 360 Health Questions and Answers Q1: What is 360 Health? A1: 360 Health is one of the industry s most comprehensive suite of health care management programs. It is designed to surround our members and their families with 360 degrees of preventive care resources, wellness information, savings and incentives and care management services. Rather than focusing only on disease management only, 360 Health encompasses the full range of tools and services for life management, as well. This helps members to: Manage and maintain their health Make more informed health care decisions Get the most value from their health care dollars 360 Health organizes our programs and resources into four categories: Health Resources, like online health and wellness information through MyHealth@Anthem Health Extras, like discounts on health-related products and alternative medicine therapists Health Guidance that includes online decision tools and phone support from registered nurses 24/7 Health Management offers disease management programs to those with ongoing conditions like diabetes, and case management for those coping with serious health issues like a severe illness or injury Q2: What makes 360 Health unique? A2: It s a revolutionary shift in how we think about the circle of support we've built for our members, how we think about their health and the care they need. And while there are four categories, 360 Health brings everything together in one consumer-friendly resource. The end result is: Better integration Health programs work together to support each individual s needs. Members can easily take advantage of different programs or levels of support as their health needs change. Plus, with all our programs in one place, members can more easily build their health literacy and gather information from many sources. Greater awareness - We're integrating the 360 Health programs and messaging throughout our marketing efforts and building a more robust presence for these programs in all our customer touch points. 7739EST (1/07)

2 Easy access - Members can enroll in most of our programs by phone or through our anthem.com Web site. Q3: Why did Anthem create 360 o Health? A3: We want to give our members the full range of information and services they need to manage their health, whether they re already healthy and want to stay that way or are living with a chronic condition that needs regular attention. And we want that information to be easy to find and use. Q4: What are the goals of the program? A4: Simple to help our members live healthier lives, successfully navigate the health care system and help them take full advantage of their health care benefits. When members become more engaged, more knowledgeable and in control of their own health issues, they will not only have a greater chance of being healthier, but they ll also attain the most value for the money they spend on health care. Q5: What are the specific components of 360 o Health? A5: 360 Health programs cover everything from preventive care resources, wellness information and savings and incentives to the full range of care management services. Designed to deliver the right services to the right members at the right time, 360 Health s four categories of health services are: Health Resources Health Resources give members access to a wide array of health and wellness information to help them better understand and manage their own health issues, conditions and treatments. This information is available through a powerful resource on anthem.com (MyHealth@Anthem), member communications like our newsletters, and a library of recorded health information that s available over the phone. Health Extras Health Extras give members opportunities for better health and more informed decisions by using interactive tools and assessments on MyHealth@Anthem, discounts on alternative health therapists and fitness club memberships and Staying Healthy reminders. Health Guidance Health Guidance provides members with guidance and support to assist them in managing their health and health care benefits 24 hours a day, 7 days a week. Members can compare hospitals on the quality of care they provide, talk to a registered nurse about a health concern or research better value alternatives for a drug they ve been prescribed. 2

3 Health Management Health Management programs serve members with chronic or acute conditions by helping them follows their physician s care plan and national clinical guidelines. With ongoing support provided by registered nurses and other health care professionals, members can make wiser health care decisions to improve their health and quality of life. The foundation of 360 Health is a comprehensive suite of programs that Anthem members can use. This includes disease management programs, robust online health information and assessments, maternity management, a 24-by-7 toll-free nurse line and a care management program for our highest risk members. Highlighted programs include: ConditionCare, disease management programs that: Offer a coordinated system of preventive, diagnostic and therapeutic measures intended to provide tailored assistance for individuals who have specific chronic conditions Target asthma, diabetes, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and coronary artery disease (CAD) Is highly personalized to address each member s specific needs and lifestyle challenges, and supports members throughout their course of care and helps reinforce the existing relationship between members and their physicians Help improve members quality of life, leading to more productive employees Online Health Information at MyAnthem.com Whether interested in health information, a fitness routine or a smoking cessation program, members can find a wealth of information by using the 360 Health online programs and tools. Some examples within our personalized resource center include: Drug interaction information Interactive exercise, nutrition and smoking cessation programs An A-Z encyclopedia on diseases, conditions, and health topics Access to the latest health care information A health risk assessment for users to receive a personalized risk assessment of seven conditions with detailed analysis of contributing risk factors including genetically pre-disposed medical conditions. Future Moms Maternity Management Program Helps expectant women establish a healthy lifestyle for a healthy pregnancy 3

4 Provides support and knowledge to expectant mothers and their family throughout the course of the pregnancy Obstetrical nursing support for expectant mothers Post-delivery follow up that includes post-partum depression assessment 24-Hour Nurse Line Health information hotline with access to a registered nurse 24/7 Hearing impaired services and language line services allow all members to communicate with ease Provides comfort and security that a nurse is always there Avoidance of costly Emergency Room visits Complex Care, care management program provides: Focused resources and outreach for our highest risk members Intensive support for members living with multiple health care issues A dedicated case manager who supports the member and each enrolled family member Coordination with the member and physician to personalize goals and care plans Q6: How does the MyHealth Record component of 360 o Health work? A6: One of the most innovative components of 360 Health is the MyHealth Record online personal health record. This tool empowers consumers to oversee their own health care records which they can access from any computer with an Internet connection. Members access MyHealth Record through our MyHealth@Anthem resource on anthem.com. To protect the privacy and confidentiality of members information, the tool is located in a secure area of MyHealth@Anthem. Members must first register in order to access this area. Then, they simply log in, click the MyHealth Record tab and enter their personal health information. (In the future, the MyHealth Record will be automatically loaded with members health information based on the membership and claims information in our database. This will be an optin tool, so members can control whether they want their record automatically populated.) Once the online record is complete, it empowers members to track and share their health histories with their doctors no matter where they are. 4

5 Q7: Are employers interested in 360 o Health? Have we piloted the program anywhere yet? A7: Absolutely. 360 Health was piloted with our Blue Cross and Blue Shield customers in the New York market and received very positive responses from employers. The New York plan reported a 2:1 return on investment for participating employers and a satisfaction rate of over 90%. We believe 360 Health can offer similar results to our employers in the Northeast, and we are committed to the program s long-term success. To summarize a few key points: The top-line differentiators for Anthem because of 360 Health: Proven experience. Only company to integrate all tools. First to be one program as opposed to many, creating simplicity. It s the simplest program backed by the greatest well of knowledge. The experience of supporting 34 million Americans is helping to shape and build 360 Health, more than any other company. Simple enough to reach the unique needs of 34 million Americans to help them in meeting their health care needs. Three year roll-out demonstrates unique commitment no one can change the health care system in a day. The top-line strengths of 360 Health: We have numerous health professionals behind the scenes to assist you. Simple solution to a complex offering. Personalized and customized for the member. Innovation due to size and amount of data. As members demand more control over their health care costs, they require more information that s organized, easy to access, and that gives them a better understanding of all the resources at their disposal. That s what 360 Health does. Administered by Health Management Corporation. Anthem Blue Cross and Blue Shield is the trade name of: In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Maine: Anthem Health Plans of Maine, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc; Compcare Health Services Insurance Corporation ("Compcare") underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Independent licensees of the Blue Cross Blue Shield Association. ANTHEM and 360 Health are registered trademarks. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. MyHealth@Anthem is a registered mark of Anthem Insurance Companies, Inc. 5

6 SM Comparison Program Grid Health Resources Access Health & Wellness Information Health Extras Tools & Health Discounts Health Guidance Get Help When You Are In Need of Care Health Management Health Management & Coordination - Children s Health - Men s Health - Women s Health SpecialOffers@Anthem SM Anthem Rewards MyHealth@Anthem - Health Risk Assessment 24/7 NurseLine Future Moms Claims & Appeals Decision Support Tools Comprehensive Medical Management - Utilization Review, Case Management & Total Joint Program - Mental & Behavioral Health - Daily Health Tips - Alternative & Complementary Medicine AudioHealth Library Online Preventive Guidelines Healthy Solutions member newsletter Women s Health e-newsletter - LEAP Fitness Program - Condition Centers - Physician Pre-Visit Questionnaire - Child Health Manager & Pregnancy Planner - Message Center & Personal Health News - Depression & Anxiety Screening - Ready, Set, Stop! - Nutrition Center - Health Care Advisor - Treatment Cost Advisor - Hospital Comparison Tool - Coverage Advisor MyHealth Record Centers of Medical Excellence ADHD Program Depression Program ConditionCare - Asthma, Diabetes, Coronary Artery Disease, Heart Failure & Chronic Obstructive Pulmonary Disease - Kidney Disease ComplexCare NICU Transplant Program Staying Healthy Reminders Worksite Wellness 360 of services Everything from online capabilities, to complex care management. 360 Health has over 50 tools and services designed around you. In Connecticut, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans Inc. In Maine, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Maine, Inc. In New Hampshire, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of New Hampshire, Inc. Independent licensees of the Blue Cross and Blue Shield Association. Administered by Health Management Corporation. This information is for general guidelines only. Your doctor will provide specific recommendations for your individual health circumstances. Programs vary by state and region. Check with your sales representative for details. Anthem is a registered trademark. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 360 Health is a registered trademark. All other marks are the property of their respective owners. 7873EST (3/07)

7 SM Introducing A Revolution in Care Revolutionizing health care management. Introducing 360 Health. Designed to surround all of our members with 360 degrees of preventive care resources, wellness information, savings and incentives and care management services. We re not just talking disease management. This is more like life management. 360 Health is based on our belief that people who practice healthier lifestyles especially through diet and exercise generally live longer, more active lives. And they feel better. But some people, no matter how they choose to live, just get sick. So 360 Health can help those who are healthy stay healthy, and help those who are sick manage their illness and lead the healthiest lives possible. With customized services to suit every member s needs, 360 Health empowers your employees with the resources, tools, guidance and support to help them improve their health while decreasing your health care costs. To learn more about how 360 Health can complement your current health care benefits, talk with your Anthem Account Manager today. The four parts that make up 360 Health 360 Health organizes its programs and resources into four different categories: Health Resources Access and Wellness Information MyHealth@Anthem AudioHealth Library Online Preventive Guidelines Anthem Healthy Solutions Member Newsletters Health Extras Tools and Health Discounts Staying Healthy Reminders Worksite Wellness FluFree SM Anthem Rewards MyHealth@Anthem SpecialOffers@Anthem SM Health Guidance Helps Members When They Need Care 24/7 NurseLine Decision Support Tools MyHealth Record Future Moms Predictive Modeling Centers for Medical Excellence Attention Deficit Hyperactivity Disorder (ADHD) Program Depression Program Health Management and Coordination ComplexCare ConditionCare for asthma, diabetes, coronary artery disease, heart failure, chronic obstructive pulmonary disease, kidney disease Radiation Utilization Management Comprehensive Medical Management Total Joint Replacement Program Blue Distinction Transplant Centers SM Bariatric Program 7762EST 7738EST (1/07) In Connecticut, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans Inc. In Maine, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Maine, Inc. In New Hampshire, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of New Hampshire, Inc. Independent licensees of the Blue Cross and Blue Shield Association. Administered by Health Management Corporation. This information is for general guidelines only. Your doctor will provide specific recommendations for your individual health circumstances. Programs vary by state and region. Check with your sales representative for details. Anthem is a registered trademark. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 360 Health is a registered trademark.

8 SM Welcome to 360 Health Whether you re healthy or you ve got some medical problems, our 360 Health program surrounds you with the resources, tools, guidance and support to help you manage your health and make the right health care decisions for you and your family. 360 Health is organized into four different categories: Health Resources With Health Resources, you ve got access to all kinds of information that may help you stay healthy, manage a condition you have or learn more about particular topics and treatment options. Get your information a few different ways: log on to anthem.com, receive our free newsletter at home, even call a toll-free number to listen to more than 400 recorded messages about the latest health topics. Listen in English or Spanish. Health Extras Health Extras gives you interactive tools and access to discounts that can help you save money and learn more about keeping yourself and your family healthy. Take advantage of discounts on fitness club memberships, weight management programs, vitamins, child safety products and more. Use online tools like a BMI calculator, diet and exercise tracker and childhood immunization schedule. Sign up for our online fitness and nutrition program and earn prizes for making healthy choices. Health Guidance Real life doesn t follow a 9 to 5 schedule. That s why we re here 24/7 to give you health information when you need it. Got a general medical question? Concerned about your upcoming hospital stay? Just contact a registered nurse for answers, support and encouragement. Health Management Anyone living with a chronic disease like asthma, diabetes or coronary artery disease doesn t need additional complications or unanswered questions. We ll work with you, your doctor and other health care providers to help make sure you get the right care and support you need for your condition. Visit Anthem.com to learn more about how 360 Health can help you gain a greater level of health satisfaction: anthem.com > Members > Select your state A360_VASFLY_1503_ Health is administered by Health Management Corporation. Anthem Blue Cross and Blue Shield is the trade name of: In Connecticut: Anthem Health Plans, Inc. In Maine: Anthem Health Plans of Maine, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark. The Blue Cross and Blue Shield names and symbols are the registered marks of the Blue Cross and Blue Shield Association. 7773EST (3/07)

9 Looking for a new way to take charge of your health and health care? SM Whether you re really healthy or have some medical problems, our 360 Health program is here to help you take charge of your health and make the decisions that are right for you. Take all kinds of fun quizzes on the Web to see how healthy you are. Dial a toll-free number to talk with a registered nurse about medical concerns, 24/7. If you have a condition like asthma, get personalized support from a nurse. Plus, so much more. Take charge of your health with 360 Health. Visit us on the Web at anthem.com > Members > Select your state. In Connecticut, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans Inc. In Maine, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Maine, Inc. In New Hampshire, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of New Hampshire, Inc. Independent licensees of the Blue Cross and Blue Shield Association. Administered by Health Management Corporation. This information is for general guidelines only. Your doctor will provide specific recommendations for your individual health circumstances. Programs vary by state and region. Check with your sales representative for details. Anthem is a registered trademark. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 360 Health is a registered trademark. 7774EST (2/07)

10 Different life events. Three ways we can help. SM ConditionCare If you or a family member suffers from a chronic condition, we ve got a program that may be able to help improve your overall health. ConditionCare gives you tools and information that can help you manage symptoms related to pediatric and adult asthma, chronic obstructive pulmonary disease, pediatric and adult diabetes (Types I and II), heart failure and coronary artery disease. The program features: 24/7 toll-free access to registered nurses who can answer your health questions and support you. A health evaluation and consultation over the phone with a registered nurse, when needed, to help you manage your condition. Educational materials like care diaries, self-monitoring charts, self-care tips and more. These can help you take care of yourself, make positive lifestyle changes and possibly prevent further illness. To speak with a ConditionCare nurse, call Future Moms Pregnancy is a very exciting time! We know your goal is to have a healthy pregnancy and healthy baby. We want that for you, too. That s why we offer Future Moms, a voluntary program to help you take care of yourself and your baby before the big day arrives. When you join the Future Moms program, you ll receive: Your own health coach. This is a registered nurse with expertise in prenatal/postnatal care who will follow your pregnancy and give you individualized attention and support. You ll even get a questionnaire to evaluate your risk for preterm delivery. Toll-free access to a registered nurse line, 24/7, in case you ve got questions or concerns. Phone calls or mailers based on your pregnancy status, risk status, medical history and doctor s plan of care. Educational materials like a prenatal book that follows your pregnancy week by week. Also, materials to help you handle the unexpected. Lifestyle management, pharmacy, nutrition and behavioral health counseling. Postpartum support and guidance in areas like breastfeeding and depression. Call the Future Moms program toll-free from anywhere in the U.S. at NurseLine Health concerns don t follow a 9 to 5 weekday schedule. Sometimes you need answers to your health questions right away like the middle of the night or on weekends. The baby has a fever at 2 a.m. How high is too high? It s Saturday. Your son sprained his ankle in the big game. Ice or heat? Should he go to the ER? Don t worry. With 24/7 NurseLine, confidential health information from a registered nurse is just a phone call away. In Connecticut, call In Maine, call In New Hampshire, call For Spanish, call EST (2/07) In Connecticut, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans Inc. In Maine, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Maine, Inc. In New Hampshire, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of New Hampshire, Inc. Independent licensees of the Blue Cross and Blue Shield Association. Administered by Health Management Corporation. This information is for general guidelines only. Your doctor will provide specific recommendations for your individual health circumstances. Programs vary by state and region. Check with your sales representative for details. Anthem is a registered trademark. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 360 Health is a registered trademark.

11 Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In most of Missouri: RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-hmo benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. (serving Virginia excluding the city of Fairfax, the town of Vienna and the area east of State Route 123.). In Wisconsin: Blue Cross Blue Shield of Wisconsin ( BCBSWi ) underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ( Compcare ) underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Independent licensees of the Blue Cross Blue Shield Association. ANTHEM is a registered trademark. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 360 Health is a registered trademark. SC /07

12 Our Circle of Health Our Circle of Health 360 o Health is already part of your coverage. Look inside to see all the ways it surrounds you empowering you with great new tools, guidance and preventive health care ideas to help you achieve your personal healthy best.

13 360 o Health Gives You Four Levels of Added Support Health Resources Level one offers greater access to resources. The idea is that knowledge and preparation can be vital components of good health. Talk to a person about any claim status or to check if your doctor is in the network. Listen to hundreds of audio recordings on a whole host of health topics. Find information about the following topics by logging onto Click the Members tab on the top left of the screen, then choose your state and hit the Enter screen button. Choose the 360 o Health link and find Health Resources. Anthem s Customer Service, Monday Friday, 8am-8pm EST AudioHealth Library Daily Health Tips Preventive health tips and reminders Men s Health, Women s Health or Children s Health Mental and Behavioral Health Articles and online resources that help to illuminate the health of mind Online Preventive Guidelines Current standards and ideas about what you can be doing to prepare and prevent Alternative & Complementary Medicine Choices you may not realize you have in treating illness or nurturing wellness Members receive our Healthy Solutions member magazine free, which is full of cutting-edge health ideas Sign up for Women s e-newsletter for the latest topics about health for female members Health Extras Level two builds in key tools and discounts to maximize your health care potential and dollars. Find information about the following topics by logging onto Click the Members tab on the top left of the screen, then choose your state and hit the Enter screen button. Choose the 360 o Health link and find Health Extras. Or call Click on Anthem Rewards SM Click on SpecialOfficers@Anthem SM Health Risk Assessment - Gives you an extra level of knowledge about your health status and risk factors, as well as tips on what you can do to help improve your health today and in the future Lifetime Exercise Adherence Program (LEAP) Our online program helps you achieve better fitness Physician Pre-visit Questionnaire Prepares you to get the most from your doctors visits by arming you with a selection of sample questions to ask your doctor Child Health Manager & Pregnancy Planner Tools to help you build a healthy family Message Center & Personal Health News Receive personalized health information delivered to you securely online Ready, Set, Stop Online programs that can help you quit smoking Depression & Anxiety Screens Access to valuable, online information Staying Healthy Reminders Reminders can make the difference in getting to the doctor for the care you need Worksite Wellness Programs and tools available at work to support your healthy lifestyle Anthem Rewards is an easy-to-use online fitness and nutrition program that lets you earn points toward FREE gifts by striving toward health and wellness goals. SpecialOffers@Anthem gets you discounts and special services at a variety of health-related companies, like TruVision TM contact lenses and laser vision correction, Barnes & Noble.com, safety helmets from Troxel Cycling and Fitness, CPR courses at the American Red Cross even massage therapy!* * Vendors and offers are subject to change without prior notice. Anthem does not endorse and is not responsible for the products, services or information provided by the SpeciallOffers vendors. Arrangements and discounts were negotiated between each vendor and Anthem for the benefit of our members.

14 Health Guidance Level three offers actual guidance when you or your family needs it to help navigate to better health and wellness. What if I need to talk to a health professional after hours or on the weekends? What if I m pregnant? Is there a program to help me? A member of my family is facing some health issues and we need to figure out some things. Can you help me? I m a visual person and I d like to see my health information in front of me. I have so many different doctors and prescriptions. Can my health plan help me manage all of that? What if anyone in my family shows signs of depression or other mental health conditions? No problem. 360 Health is there with 24/7 NurseLine. Talk to a registered nurse any time, any day. Our Future Moms program gives mothers-to-be special guidance to help ensure a healthy pregnancy 360 Health has some terrific Decision Support Tools, including Health Care Advisor TM, Treatment Cost Advisor TM, Hospital Comparison Tool TM and Coverage Advisor TM. With 24-hour web access to MyHealth Record, you can view your claims and coverage options, and take more control over managing your benefits. MyHealth Advantage connects members and their doctors with important, upto-date information that may directly affect members health. Using data, we identify potential gaps in care and medication safety issues. 360 Health has programs to support you and your family s mental health, including programs for Depression and Attention Deficit Hyperactivity Disorder Call Customer Service in Maine at Call Customer Service at Click the Members tab on the top left of the screen, then choose your state and hit the Enter screen button. Choose the 360 Health link and find Health Guidance. Health Management Level four provides services to members with chronic or complex health issues, as they may benefit the most from additional help. Comprehensive Medical Management ConditionCare: Asthma Diabetes Coronary Artery Disease Heart Failure Chronic Obstructive Pulmonary Disease ComplexCare Transplant Program Neonatal Intensive Care Unit (NICU) This is another way 360 Health has you covered. We have dedicated people to help you get the most out of your benefits in a care setting, including Case Management and working with doctors and hospitals to help ensure that they are meeting recommended quality standards for your care. If you or a family member has any of these chronic conditions, we can work with you and your doctors, offering assistance from our registered nurses and lifestyle specialists. We may be able to help you identify high-risk health concerns before they reach advanced stages. If you have complex health needs, our team of specialized health professionals is on hand to help support you and your doctor, for better clinical outcomes. Through our relationship with Blue Cross and Blue Shield Association, an association of independent licensed Blue Cross and Blue Shield plans, if you need a transplant, you have access to Blue Distinction Centers for Transplant Services program. We can provide expertise and an added level of caring to mothers and newborns in the NICU. Our team of experienced NICU nurse case managers and neonatologists can help ensure collaboration between doctors and your family, focusing on appropriate treatment and follow up. Based on claims activity, our 360 Health team will reach out to members who may benefit from these special programs. Members can also call Customer Service to be considered, at Remember that the best resource if you have questions about your health is your doctor. 360 o Health is there to enhance the valuable doctor-patient relationship, adding a toolbox that you can tap into at whatever level you need. Visit Anthem.com and learn more about how 360 o health can help you gain a greater level of satisfaction. >Members (Select your state and click the Enter box)

15 Using the Internet has never been healthier. Log on today at anthem.com > Staying healthy is a lot easier when you have the right tools. That s why we created MyHealth@Anthem, an easy-to-use Web site that will help you: Learn how take care of your health Make smarter health care decisions Talk to your doctor more easily Be the healthiest person you can be Take control of your health with customized health tips and tools From up-to-the-minute medical alerts and articles to health quizzes and online calculators, you ll find everything you need to: Manage chronic and acute medical conditions. Online Condition Centers offer tips on how to deal with more than 35 specific conditions, including asthma and diabetes. Find out how much you know about common health problems. Take our online health quizzes for a reality check on your health smarts. Learn what your health risks are. Completing our easy online health assessment can be a real eyeopener. (Also available in Spanish.) Stay fit with LEAP, the Lifetime Exercise Adherence Program, developed by an Olympic coach, lets you measure and manage your fitness, or be guided by fitness and health experts. Build a safe, online health profile. Keep all your important medical information safe, sound and in one place. Use our secure online tools to make a personal, private health record. Visit online health centers tailored to men and women. Learn what both can do to prevent disease and stay healthy. Monitor pregnancy and track the growth of your children. Our special online tools make it easy. Sign up to get s on your favorite health topics. Use our secure message center to receive health news, drug alerts and tips based on your specific interests. Participate in online communities. Access 30 message boards where you can pose questions and receive answers to your health-related questions. The world of health news and information at your fingertips MyHealth@Anthem contains a wealth of health news and information. With just a few clicks, you ll have instant access to: Self-help programs to help you quit smoking and improve your eating habits Up-to-the-minute drug alerts, product launches and recalls Five online resource centers on: Advance Directives; Patient Safety; Race, Ethnicity and Health; Caregiver Resources; and Complementary and Alternative Medicine A complete medical dictionary with more than 57,000 definitions Healthfinder, with tips from the U.S. Department of Health and Human Services MedlinePlus, a resource from the National Library of Medicine at the National Institutes of Health Preventive Services Reminders from the Centers for Disease Control and Prevention And much, much more Thanks to MyHealth@Anthem, using the Internet has never been healthier. Take a tour today at anthem.com > MyHealth@Anthem Rev. (11/06) Anthem Blue Cross and Blue Shield is the trade name for the following: In Connecticut: Anthem Health Plans, Inc. In Colorado, Rocky Mountain Hospital and Medical Service, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky. In Maine: Anthem Health Plans of Maine, Inc. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. In Missouri: RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-hmo benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. Life and disability products are underwritten by Anthem Life Insurance Company (ALIC). RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Wisconsin: Blue Cross Blue Shield of Wisconsin ( BCBSWi ) underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ( Compcare ) underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Registered Marks Blue Cross and Blue Shield Association. MyHealth@Anthem is a registered mark of Anthem Insurance Companies, Inc. All other registered marks are the property of their respective owners.

16 Log on and Take Control the health information section of anthem.com, can help you: Understand your health Make informed health care decisions Reach your health goals Condition Centers* Allergy Anxiety Arthritis Asthma Back & Neck Breast Health Cancer Prevention Child Health Cholesterol Chronic Fatigue Chronic Pain Cold & Flu Dental Depression Diabetes Erectile Dysfunction Eye Health Fibromyalgia Hair Loss Headache Heart Health Heartburn Hepatitis B&C Irritable Bowel Syndrome Kidney Health Memory Health Menopause Men s Health Men s Infertility Osteoporosis PMS Prostate Health Senior Health Sinusitis Skin Health Sleep Health STDs Stress Weight Women s Health Women s Infertility Yeast Infection *subject to change The Condition Centers provide personalized information to help you understand and manage common chronic and acute conditions. You can also sign up for reminders and newsletters about specific conditions of interest to you. For more information, visit our Web site at anthem.com Please note that there is some variation in programs by state and by plan. In Colorado: Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans, Inc. In Indiana: Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. In Kentucky: Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Maine, Inc. In Nevada: Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of New Hampshire, Inc. In Ohio: Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company. In Virginia: Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc. Independent licensees of the Blue Cross and Blue Shield Association. Registered marks Blue Cross and Blue Shield Association. MyHealth@Anthem is a registered mark of Anthem Insurance Companies, Inc. All other trademarks are the property of their respective owners (3/06) Better Manage Your Health with MyHealth@Anthem Condition Centers Powered by WebMD

17 Log on and Take Control WebMD, one of the world s leading sources for timely and trustworthy health and medical news and information, provides the valuable content available through the MyHealth@Anthem section of anthem.com. The information and tools available help consumers take an active role in managing their health. Use the WebMD Condition Centers to Benefit Your Health MyHealth@Anthem Condition Centers, provide access to information on more than 40 common chronic and acute health conditions. Through the Condition Centers you can access: The latest news on specific conditions Tips and information for understanding, managing and preventing a condition Interactive tools, quizzes and condition assessments The information in the Condition Centers can help you manage specific conditions and help improve your overall health by allowing you to: Address risk factors associated with a particular condition Manage existing chronic and acute conditions Explore medical treatment options Prevent costly complications to common health conditions Increase your understanding of treatment options Communicate more easily with health care providers More Tools and Information to Benefit Your Health Beyond the Condition Centers, MyHealth@Anthem and WebMD connect you to the Healthwise Knowledgebase, one of the most reliable health resources on the Web. You can access the information you need-in both English and Spanish-to make informed health care decisions. MyHealth@Anthem gives you the tools to: Test your health IQ. Simple health quizzes let you test your knowledge about common health conditions and ailments. Keep fit. LEAP, the Lifetime Exercise Adherence Program, created by an Olympic coach, lets you measure and manage your fitness, or be guided by fitness and health experts. Organize your health information. You can store personal and family health information safely and securely. Organizing your information lets you create a complete, portable health profile you can share with your doctor. Check your health risk level. An easy-tocomplete health risk assessment helps you understand your health risks and identify ways to lower them. Find prevention information for men and women. Health centers promote disease prevention and provide gender-specific health information and tools. Track pregnancies and early childhood development. Tools are available to let you manage, track and monitor your pregnancy and the health of your children ages six and younger. Get information about health topics of interest to you. A secure message center lets you receive health-related s with the latest news, drug alerts and health tips, based on your personal interests and profile. You can even take part in health-related courses featuring live learning events led by medical experts. Healthier Living is Just a Click Away Log on to anthem.com today to access MyHealth@Anthem. You ll find a wealth of information including a list of personalized Condition Centers designed to help you understand, manage and prevent your specific condition.

18 Got health questions? Easy access to health information is just a phone call away! 24 7 NurseLine You can reach the nurse line toll-free from anywhere in the U.S. In Maine, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Maine, Inc., an independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered mark. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. The information contained in this program is for general guidelines only. Your doctor will be specific regarding recommendations for your individual circumstances. Trade names of commonly used medications and devices are provided for ease of education but are not intended as particular endorsement. Your doctor may choose to use items not represented here. Recommended treatments may not be covered under your health plan. 7929ME (4/07)

19 Here to Help 24 7 You felt fine when you went to bed. Now you re up at 3 a.m. with a terrible cough and fever. That never happens, right? Well, sure it does. And that s just one of the reasons why we have nurses available to speak with you about your health issues 24 hours a day, seven days a week. Call us toll-free at to get information and support when you need it. Or is there a sensitive topic you d like to know more about? That s no problem. If you prefer, you can call and listen to recorded messages about hundreds of health-related topics in English and Spanish by accessing the AudioHealth Library. By keeping the wallet card inside this brochure handy, you ll have the information you need right at your fingertips. Here s how you can reach us: NurseLine For access to a live registered nurse 24 7, call and press 1. AudioHealth Library To access our AudioHealth Library, call and press 9 to hear further instructions. Or here they are now: Call and Press 2 to choose the AudioHealth Library. Enter the 4-digit topic number followed by the # sign (list attached). While you re listening to an AudioHealth Library message on your touchtone phone, you can: Stop the message any time to speak with a nurse (Press * and 0). Return to the main menu (Press * and 2). Go to the end of a message (Press * and 6). Start a message over (Press * and 7). Para una copia de este folleto, por favor llama a la Línea de Enfermeras al número en este folleto

20 AudioHealth Library: Topic Listing Abdominal Problems 1600 Appendicitis 1451 Constipation 1618 Crohn s Disease 1260 Dehydration 1452 Diarrhea 1605 Diverticulosis and Diverticulitis 1402 Food Poisoning 1608 Gallbladder Disease 2154 Gallbladder Surgery 1612 Gastroesophageal Reflux Disease 1610 Heartburn 1952 Hepatitis 1403 Hernia 1603 Inflammatory Bowel Disease 1611 Irritable Bowel Syndrome 2576 Kidney Stones 1462 Nausea and Vomiting 1609 Rectal Problems 1613 Ulcers 2257 Urinary Incontinence in Women 1291 Urinary Tract Infections Allergies 1000 Allergies 2770 Drug Allergies 1002 Food Allergies 1007 What About Allergy Shots? Back and Neck Pain 1450 Low Back Pain 1463 Herniated Disk 2174 Low Back Problems, Surgery for 1457 Neck Pain Bone, Muscle and Joint Problems 1030 Arthritis 1780 Bunions 2103 Bursitis and Tendon Injury 1781 Calluses and Corns 2104 Carpal Tunnel Syndrome 1038 Fibromyalgia 1039 Gout 1784 Heel Spurs 1031 Juvenile Rheumatoid Arthritis 1033 Lupus 2106 Muscle Cramps and Leg Pain 2259 Osteoarthritis 1032 Osteoporosis 1034 Rheumatoid Arthritis 2169 Rotator Cuff 1456 Sports Injuries 2105 Strains, Sprains, Fractures and Dislocations 2151 Surgery for Carpal Tunnel Syndrome 1461 TM Disorder Cancer 1105 Cancer Pain 1110 Colon Polyps 1113 Colorectal Cancer 1120 Women s Cancer 1124 Lung Cancer Chest, Respiratory and Circulatory Problems 1981 Asthma in Teens and Adults 1908 Atrial Fibrillation (irregular heartbeats) 1983 Bronchitis 1915 Cardiac Rehabilitation 1903 Causes of Heart Attack 1900 Chest Pain 1976 Chronic Obstructive Pulmonary Disease (COPD) 1400 Colds 1907 Heart Failure 1980 Emphysema 1455 Fever 1904 Heart Attack Prevention 1401 Influenza (Flu) 1648 Laryngitis 1910 Mitral Valve Prolapse 1911 Pacemakers 1986 Pneumonia 1406 Sinusitis 1459 Sore Throat and Strep Throat 1081 Stroke Rehabilitation 1460 Swollen Lymph Nodes 1912 Varicose Veins 1407 Viral and Bacterial Infection Chronic Conditions 1060 ALS (Lou Gehrig s Disease) 1061 Alzheimer s Disease 1950 Chronic Fatigue Syndrome 2570 Chronic Kidney Disease 1063 Epilepsy 1953 Hepatitis B 1909 High Blood Pressure 1832 High Cholesterol 2623 Iron Deficiency Anemia 1959 Living with HIV Infection 1065 Multiple Sclerosis 1066 Parkinson s Disease 1512 Prediabetes 2550 Thyroid Problems 1508 Type 1 Diabetes 1500 Type 2 Diabetes 1501 Type 2 Diabetes: Living with Complications 1502 Type 2 Diabetes: Living with the Disease 1503 Type 2 Diabetes: Recently Diagnosed Ear, Nose and Throat 1516 Diabetic Retinopathy 1453 Dizziness and Vertigo 1264 Ear Infections 1640 Earwax 1646 Hearing Loss 1641 Inner Ear Infection (Labrynthitis) 1644 Meniere s Disease 1643 Swimmer s Ear 1650 Tonsillitis Eye Problems 1700 Eye Problems 2152 Cataract Surgery 1709 Cataracts 1710 Color Blindness 1703 Contact Lens Care 1708 Eye Infections 1705 Eye Injuries 1717 Floaters and Flashes 1712 Glaucoma 1711 Macular Degeneration 1716 Laser Surgery for Nearsightedness 1713 Strabismus 1707 Styes 1702 Vision Tests First Aid and Emergencies 1750 Animal and Human Bites 1761 Burns 1255 Choking 1762 Cuts 2337 Frostbite 1901 Heart Attack 1759 Heat Exhaustion and Heat Stroke 2256 Hypothermia 2203 Importance of CPR Instructions 1751 Insect and Spider Bites and Stings 1458 Nosebleeds 1763 Poisoning 1764 Puncture Wounds 1766 Removing Splinters 1752 Snake Bites 1067 Stroke 1754 Tick Bites Headaches and Nervous System Problems 1062 Bell s Palsy 1515 Diabetic Neuropathy 1068 Guillain-Barre Syndrome 1064 Encephalitis 1405 Migraine Headaches 1404 Tension Headaches Home Health Medicines and Supplies 2000 Bulking Agents and Laxatives 2007 Cold and Allergy Remedies 2003 Cough Preparations 2002 Decongestants 1270 How to Take a Temperature 2001 Pain Relievers 1758 Self-Care Supplies Infant and Child Health 1250 ADHD 1251 Bed-wetting 2753 Bottle-feeding 1254 Chickenpox 1278 Childhood Rashes 1256 Circumcision 1257 Colic 1258 Croup 1261 Diaper Rash 1080 Dyslexia 2436 Fetal Alcohol Syndrome 1253 Fever, Age 3 and Younger 1267 Fifth Disease 1268 Growth and Development of the Newborn 1269 Hand-Foot-Mouth Disease 1837 Healthy Eating for Children 1272 Impetigo 1274 Measles 1275 Mumps 1280 Pinworms 1259 Reye s Syndrome 1283 Roseola

21 1284 Rubella (German Measles) 1287 Sudden Infant Death Syndrome (SIDS) 1288 Teething 1247 Temper Tantrums 1292 Thrush 1289 Thumb-Sucking 1290 Toilet Training 1293 Urinary Tract Infections in Children Infectious Diseases 1408 Avian Influenza (Bird Flu) 1951 Infectious Mononucleosis 1956 Tuberculosis 1965 West Nile Virus Living Healthy 1279 Immunizations 1295 Health Screenings 1830 Living a Balanced Lifestyle 1831 Guidelines for Eating Well 1833 Be Physically Active 1834 Healthy Weight 1835 Mind-Body Connection 1838 Alcohol and Drug Problems 1841 Be Tobacco-Free 1846 Managing Stress 1853 Healthy Snacks 1964 Relaxation Skills 2204 Accident and Injury Prevention 2428 Treatment for Alcohol Use Problems 2435 Teen Alcohol and Drug Abuse Medical Tests and Procedures 1506 Home Blood Sugar Monitoring 1532 Exercise Electrocardiography 1533 Complete Blood Count (CBC) 1534 Chest X-ray 1535 Chorionic Villus Sampling 1536 CT Scan of the Body 1537 Electroencephalogram 1538 Electrocardiogram 1539 Electromyography (EMG) 1540 Barium Enema 1541 Upper Gastrointestinal (GI) Series 1542 Magnetic Resonance Imaging 1546 Lung Function Tests 1547 Abdominal Ultrasound 2155 Cystoscopy 2156 Dilation and Curettage 2157 Episiotomy 2158 Surgery for Hemorrhoids 2159 Hernia Surgery 2160 Hip Replacement Surgery 2162 Arthroscopy 2163 Knee Replacement Surgery 2164 Laparoscopy 2165 Ear Tubes 2171 Tonsillectomy and Adenoidectomy 2503 Shared Decisions about Surgery Men s Health 1128 Prostate Cancer 1545 Prostate-Specific Antigen Test (PSA Test) 2031 Hair Loss 2032 Erection Problems 2034 Benign Prostatic Hyperplasia (Enlarged Prostate) 2036 Testicular Problems 2167 TURP for BPH 2173 Vasectomy Mental Health Problems and Mind-Body Wellness 1069 Bipolar Disorder 1070 Schizophrenia 1071 Dementia 1230 Domestic Violence 1240 Child Maltreatment 1845 Stress Management 2051 Obsessive-compulsive Disorder 2052 Eating Disorders 2055 Panic Attacks and Panic Disorder 2057 Depression 2059 Grief 2063 Social Anxiety Disorder 2066 Suicide Partnership with your doctor 1201 Patients Bill of Rights 1202 Caregiver Secrets 1800 Skills for Making Wise Health Decisions 1801 Work in Partnership with your Doctor 1802 Finding a Doctor Who Will be a Partner Senior Health 1836 Seniors Staying Active and Fit 2004 Medication Problems in Seniors 2006 Medications and Older Adults 2240 Hospice Care 2245 Care at the End of Life 2251 Nutrition for Older Adults 2261 Skin and Nail Problems in Seniors Sexual Health 1848 Sexually Transmitted Diseases 1957 HIV Infection and AIDS 2307 Chlamydia 2308 Genital Herpes 2309 Genital Warts 2310 Gonorrhea 2311 Syphilis 2315 Trichomoniasis 2600 Birth Control Skin Problems 1129 Skin Cancer 1273 Lice and Scabies 1755 Blisters 1785 Ingrown Toenails 2330 Acne 2332 Boils 2333 Cold Sores 2334 Dandruff 2336 Atopic Dermatitis 2338 Hives 2343 Rashes 2344 Psoriasis 2346 Fungal Infections 2349 Shingles 2352 Sunburn 2353 Warts Sleeping Disorders 2400 Sleep Problems 2403 Sleep Apnea 2406 Snoring Women s Health 1107 Breast Health 1111 Ovarian Cancer 1112 Polycystic Ovary Syndrome 1211 Multiple Pregnancy: Twins or More 1504 Gestational Diabetes 1531 Breast Biopsy 1544 Pelvic Exam and Pap Test 1548 Ultrasound for Normal Pregnancy 2033 Infertility 2039 Sexual Dysfunction in Women 2172 Tubal Ligation and Tubal Implants 2312 Pelvic Inflammatory Disease 2426 Pregnancy, Precautions During 2640 Bacterial Vaginosis 2643 Yeast Infections 2650 Menopause 2651 Hormone Therapy 2670 Missed or Irregular Periods 2672 Endometriosis 2673 Uterine Fibroids 2674 Hysterectomy 2675 Bleeding Between Periods 2677 Functional Ovarian Cysts 2678 Menstrual Cramps 2679 Dysfunctional Uterine Bleeding 2680 Toxic Shock Syndrome 2700 How to Make a Healthy Baby 2701 Home Pregnancy Test 2702 Abortion 2704 Danger signs during pregnancy 2705 Normal Pregnancy 2706 Symptoms and Stages of Labor 2708 Diet During Pregnancy 2709 Exercise During Pregnancy 2710 Rubella and Pregnancy 2714 Amniocentesis 2717 Miscarriage 2719 Stretch Marks 2720 Cesarean Section 2723 Pelvic Organ Prolapse 2724 Premenstrual Syndrome 2725 Pregnancy, Symptoms and Stages of 2750 Postpartum Depression 2751 Breast Feeding 2752 Complications after delivery 2754 Labor, Delivery, and Postpartum Period 2755 Mastitis While Breast-Feeding 2756 Rh Sensitization During Pregnancy 2757 Weaning Be sure to keep this wallet card with you. You can reach the nurse line toll-free from anywhere in the U.S NurseLine Nurses are available 24 hours a day, 365 days a year.

22 SM Peace of Mind 24 7 Health concerns don t follow a 9 to 5 weekday schedule. Sometimes you need answers to your health questions right away like the middle of the night or the weekend: The baby has a fever at 2 a.m. How high is too high? It s the weekend. Your son sprained his ankle in the big game. Ice or heat? Should he go to the ER? It s 7 a.m. and you re about to take your first dose of a new medication. But you forgot to ask the doctor at yesterday s appointment if it s ok to continue taking your daily multivitamin. Don t worry. For answers to questions like these and more, our 24/7 NurseLine is there for you and your family. Call the 24/7 NurseLine anytime to speak with a registered nurse who is trained to help you make more informed decisions about your health situation. For confidential health information, a nurse is just a phone call away. In Connecticut, call In Maine, call In New Hampshire, call For Spanish, call EST (2/07) Sensitive Topic? No problem. Not everyone is comfortable discussing their health concerns with someone else. If you prefer, call the AudioHealth Library and listen to confidential recorded messages about hundreds of health topics in English and Spanish (Connecticut) (Maine) (New Hampshire). For Spanish, call In Connecticut, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans Inc. In Maine, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Maine, Inc. In New Hampshire, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of New Hampshire, Inc. Independent licensees of the Blue Cross and Blue Shield Association. Administered by Health Management Corporation. This information is for general guidelines only. Your doctor will provide specific recommendations for your individual health circumstances. Programs vary by state and region. Check with your sales representative for details. Anthem is a registered trademark. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 360 Health is a registered trademark.

23 SM 24/7 NurseLine Health information with just a call. Health concerns don t follow a 9 to 5 weekday schedule. They happen in the middle of the night, during vacation and while traveling for business. As if that s not frustrating enough, determining whether a problem requires medical attention or self-care isn t always clear. That s why we offer our 24/7 NurseLine. Members can call anytime, 365 days a year, and speak with qualified registered nurses to make informed decisions about the kind and level of care they may need. This gives your business a total health solution, because making informed health care decisions can reduce time lost on the job and optimize costs of care. HealthLine Audiotape Library For those who aren t comfortable discussing their health concerns with someone else or those just looking for more information on a health topic, there s the HealthLine Audiotape Library. Accessible by phone with more than 400 recorded health topics. Anthem s 24/7 NurseLine goals: Help lower health care costs by giving callers medical information that may assist them in deciding which level of care to seek Help provide seamless integration with our other health management programs Help increase member satisfaction with their health care plan 7742EST (1/07) In Connecticut, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans Inc. In Maine, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Maine, Inc. In New Hampshire, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of New Hampshire, Inc. Independent licensees of the Blue Cross and Blue Shield Association. Administered by Health Management Corporation. This information is for general guidelines only. Your doctor will provide specific recommendations for your individual health circumstances. Programs vary by state and region. Check with your sales representative for details. Anthem is a registered trademark. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 360 Health is a registered trademark.

24 HealthySolutions ISSUE 1, 2007 Your Maine Plan Newsletter anthem.com Jump Into Health We put the tools you need at your fingertips Managing Risks: Radiation Exposure What we re doing to keep you safe and help you get the tests you need Signs to Watch...2 Utilization Management...3 About Prior Authorization...6 Healthy Communities...7

25 Screenings Stop Colorectal Cancer Before It Starts Colorectal cancer is the second leading cause of cancer-related deaths among men and women. It is also the most detectable, and 90 percent treatable when found early. Most colorectal cancers begin as polyps (growths). Cancer can be prevented if the polyps are removed before they become cancerous. This is why regular screenings are so important. Regular screenings, beginning at age 50, could save your life. There are several options. Talk to your doctor about which is best for you. Options include one or a combination of: 1 Annual home fecal occult blood testing (FOBT). 1 Sigmoidoscopy every five years. 1 Double contrast barium enema every five years. 1 Colonoscopy every 10 years. Please refer to your contract documents for complete information about benefits, limitations, and exclusions. Guidelines IMMUNIZATIONS: WHAT S NEW? Vaccines offer safe, effective protection from infectious diseases. The Centers for Disease Control and Prevention consider immunizations one of the best ways to protect against diseases. Vaccines can protect you, your family members, friends, and community. Ask your doctor about new vaccines and updated recommendations: 1 Rotavirus: Ages 2, 4, and 6 months. 1 Annual influenza: Children ages 6 to 59 months. 2 HealthySolutions 1 Varicella (chickenpox): Ages 12 to 15 months and 4 to 6 years. 1 Human papillomavirus (HPV): Females age 11 or Tdap (tetanus, diphtheria, and pertussis): Adults ages 19 to 64. For a copy of our Prevention Guidelines and Immunization Schedule, log on to anthem.com>members>select Your State>Health Information>Preventive Care. To receive a hard copy, call (800) , ext Adolescent Health Signs You Shouldn t Ignore Many teenagers see a sip of beer or a puff of marijuana as a rite of passage. However, for many it leads to problematic substance use that controls their lives. Alcohol and drug use by teens can affect learning, health, and personal relationships. Warning signs include: 1 Sudden changes in personality. 1 Loss of interest in favorite activities. 1 Sudden decline in performance or attendance at school or work. 1 Changes in friends and reluctance to talk about new friends. 1 Poor personal grooming habits. 1 Forgetfulness and difficulty paying attention. 1 Sudden irritability, nervousness, or giddiness. 1 Increased secretiveness. Don t underestimate your ability to make a difference. Surveys have shown that teens with parents who set rules and discuss the behavior that they expect have much lower rates of substance abuse than those whose parents take a hands-off approach. If you think a teen has a substance use problem, get help. Contact your physician, health care provider, or the customer service telephone number on your ID card for resources that can help Brand x Images (top left, top right), 2007 photos.com (bottom right)

26 Patient Safety Coordination of Care It is important to let your doctor know if you are receiving treatment from another health care professional. This will allow your treatment to be coordinated and help improve your overall care. It can also help avoid any treatment which may impair your recovery. Coordination of care is especially important if you are taking medications so as to reduce the risk of dangerous drug interactions. Coverage Breast Reconstruction Surgery Benefits and the Women s Health and Cancer Rights Act of 1998 If you are receiving covered benefits for a mastectomy, you should know that the Women s Health and Cancer Rights Act of 1998 provides for: 1 Reconstruction of the breast(s) on which a covered mastectomy has been performed; 1 Surgery and reconstruction of the other breast to produce a symmetrical appearance; 1 Prostheses and treatment of physical complications related to all stages of a covered mastectomy, Appeals including lymphedema (swelling). Prior Authorization is not applicable to such prostheses. The manner in which services are provided is between you and your physician. Coverage is subject to all of the terms and conditions stated in your member certificate, including any applicable deductible, copayment, and coinsurance. You may be entitled to additional benefits as mandated by state law. Check your member certificate for details. External Review Rights for MAINE Members As a health plan member, you have the right to voice complaints or file appeals about your health plan or the care you are provided. This includes the right to request an independent, external review through the Maine Bureau of Insurance. Before going to an external review, you must normally complete at least the first level of the internal appeal/grievance processes for utilization review determinations. Please note that the external review process is only available for members of fully insured health plans or self-insured governmental health plans that are not subject to ERISA. What Is Utilization Management? Utilization management is a review process that helps manage health care resources and maximize the effectiveness of care. This process helps determine the most appropriate settings and resources for treating a particular medical condition. 1 Utilization management decisions are based solely on the appropriateness of care and services. 1 Individuals who make utilization review decisions do not receive compensation or incentives to deny care; nor do the individuals who supervise them, including upper management, medical directors, utilization review managers, and licensed utilization management staff. 1 The plan does not specifically reward for denial of services, nor do we offer incentives to encourage denial of services. For more information about utilization management, call toll-free (800) , weekdays except holidays, from 8 a.m. to 5 p.m. At other times, please leave a message on the confidential voice mail system. Our utilization management staff will return your call on the next business day. anthem.com 3

27 Heart Health Know Your Numbers Knowing your numbers is an excellent start to keeping your heart healthy. According to the American Heart Association, normal blood pressure is defined as less than 120/80 and high blood pressure is defined as 140/90 or higher. Your total cholesterol should be less than 200. Low-density lipoprotein (LDL), or bad cholesterol (because it can clog your arteries), levels depend on your overall risk for heart disease and should generally range between less than 160 (if you don t have any risk factors for heart disease) and less than 100 (if you have known heart disease). It s best to talk with your doctor to determine what your target levels should be. High-density lipoprotein (HDL), or good cholesterol, levels should be greater than 50 in women and 40 in men. Triglycerides, a form of fat, should be less than 150. High triglycerides, like high cholesterol, can put you at risk for heart disease. Managing the Risks of Radiation Exposure How to get the imaging tests you need, when you need them. Advanced imaging tools such as Computerized Axial Tomography (CAT scans) and Magnetic Resonance Imaging (MRI) can be the key to identifying underlying health conditions. But did you know that the American College of Radiology (ACR) estimates 20 percent to 30 percent of advanced imaging tests are not medically necessary? Unnecessary advanced radiology procedures may contribute to increased radiation exposure; false positives leading either to more testing or unnecessary surgery; and exposure to higher radiation levels.* Anthem Blue Cross and Blue Shield s radiation safety program is designed to improve the quality, safety, and appropriateness of advanced imaging services for members. Imaging Services Requiring Prior Authorization For some Anthem benefit plans, National Imaging Associates (NIA) must be contacted for a prior authorization before services are rendered in a nonemergency outpatient situation. The authorization will help ensure that the service being requested is the most appropriate approach to treatment. These services are: 1 Computerized Tomography (CT scans). 1 Magnetic Resonance Imaging (MRI, MRA, MRS). 1 Nuclear Cardiology. 1 Positron emission Tomography (PET scans). Participating providers will obtain prior authorization for these nonemergency outpatient services when necessary. However, when the provider ordering or rendering these services is not a participating provider in the local network, or when a member is receiving these services out-of-state (even when the out-of-state provider participates with the local Blue Cross and Blue Shield plan), our health benefit plans require that members, not providers, obtain prior authorization for these services. Members with questions should contact the toll-free customer service number on the back of their member ID card. *European Commission, Radiation Protection Report 118, Referral guidelines for imaging. Directorate General for the Environment of the European Commission, Your Rights and Responsibilities Your health is a three-way relationship that includes you, the people who provide your care, and us. That s why it s important for everyone to understand and respect your member rights. We have a written statement of your rights and responsibilities. We take this statement very seriously and we share it with the people who provide your care. You ll find a complete list of your rights and responsibilities on our Web site at anthem.com. You may also request a copy by calling us at the telephone number on the back of your member ID card. 4 HealthySolutions

28 SM MyAnthem Clicks 24/7 Quick, easy answers are at your fingertips when you log on to anthem.com eyewire 2007 (left), stockbyte 2006 (left), stockbyte 2007 (right) photos.com (right) M yanthemsm, the personalized member Web site at anthem.com, lets you access membership, benefit, and health information 24/7, 365 days a year. MyAnthem is the quickest way to find answers to your questions and get the most from your health benefits. Using the latest safety features to protect your privacy and personal health information, MyAnthem lets you and registered family members: 1 Find network doctors. 1 Look at your current and past claims. 1 Check your coverage and benefits. 1 Change primary care physicians. 1 Print a temporary member ID card. 1 Request a permanent member ID card. 1 Change passwords. 1 Update your address. 1 Sign up to receive s. 1 Organize your personal health information. Take control MyAnthem gives you the resources and tools to take charge of your health, help you make better decisions, and communicate more successfully with your doctor. MyHealth@Anthem MyHealth@Anthem connects you to the Healthwise Knowledgebase through WebMD, where you ll find a variety of timely, trustworthy tools and health information in English or Spanish. MyHealth Record MyHealth Record gives you a place where you can record your doctor s visits and keep track of any appointments and medications you re taking. It s a great way to stay organized and keep your personal health information handy. You can even receive valuable information from WebMD based on the kinds of medical claims you ve filed. SpecialOffers@Anthem SM SpecialOffers@Anthem SM gives you access to discounts on a wide variety of healthy living products and services. Cool tools to help you choose Make better health care choices with these tools: 1 Healthcare Advisor TM tells you how certain hospitals are rated and guides you on treatment options. 1 PharmaAdvisor TM, if you ve got prescription drug coverage with us, tells you about more than 11,000 drugs, including comparisons, side effects, and interactions. 1 CoverageAdvisor TM helps you understand what health care services you are likely to need and their cost. 1 Treatment Cost Advisor TM lets you see how much things can cost. Register today and join the click! To sign up for MyAnthem, visit anthem.com and click Register. Prescriptions Did you know generic drugs may save you money? A generic is just like its brand-name version because it: 1 Goes through the same eight-stage review and approval process by the Food and Drug Administration (FDA) and meets the same safety, purity, and potency standards. 1 Has the same active ingredients in the same dosage form and strength. 1 Is equal in strength, safety, and effectiveness. 1 Is absorbed and used by your body the same way. Generics: 1 May be a different color, shape, and size. 1 Cost less. (Because they re based on an existing FDAapproved brand-name drug, the manufacturer doesn t have to pay as much for researching and developing the generic version. Plus, they don t advertise generics. All that keeps generics less expensive.) Request a generic today! Talk to your doctor or pharmacist about whether a generic is an option for you. For information about Anthem s Generic Select Program, call (800) anthem.com 5

29 Children s Health What s a Parent to Do? Tips for a healthy family Soccer practice, art class, homework sound familiar? Americans are working longer hours and have busy family schedules. It can be a challenge to make healthy choices. What s the best advice? Make small changes every day. Before you know it these changes will become habits. Here are some tips to try with your family: 1 Try a new fruit serve in bite-size pieces with yogurt. 1 Switch to 1 percent or skim milk. 1 Keep healthy snacks on hand fruit, pretzels, plain popcorn, small boxes of cereal. 1 Have cut-up vegetables with lunch instead of chips. 1 Take a walk after dinner. 1 Pop in a CD and dance. 1 Do sit-ups in front of the TV. 1 Play old favorites with your kids like hopscotch, jump rope, or Simon Says. Understanding Prior Authorization A little knowledge may help you get through the pharmacy faster. From time to time, your doctor may prescribe a medication that requires prior authorization. Prior authorization is the process of obtaining approval for certain prescriptions or refills before they may be approved for payment. It helps promote utilization of prescription benefits that are safe and cost-effective. When your doctor has prescribed a medication for you that requires prior authorization, your pharmacist will receive an electronic message at the point-of-sale. What happens at the Pharmacy? Your pharmacist will call Anthem s pharmacy benefit manager at (800) Customer service representatives are available Monday through Friday, 8:30 a.m. to midnight, and Saturday and Sunday, 9 a.m. to 7 p.m., Eastern Time. Your pharmacist will need to provide the following information: 1 Your name. 1 Your health plan ID number. 1 Your medication name. 1 Your doctor s name and phone number. If the plan benefit approval criteria are met, an authorization will be entered to allow your claim to process immediately. If more information is needed, a representative may contact your doctor. Once the relevant information is received from your doctor, and if the benefit approval criteria are met, the prior authorization will be approved. If the plan benefit approval criteria are not met, the claim will be sent to your health plan for review. If the health plan concludes the benefit should be denied, it will issue denial letters to both you and your doctor that clearly outline the appeals and/or grievance process. Medications Requiring Prior Authorization The following is a sample listing of medications requiring prior authorization. Accutane Flolan Nexium Testopel Aciphex Forteo Pegasys Testred Actiq Gleevec Peg-Intron Thalomid Amevive Growth hormones Penlac Topamax Androderm Humira Prilosec Trelstar AndroGel Infergen Protopic Tysabri Android IntronA Provigil Xeloda Ambien CR IVIG products Raptiva Xolair Arthrotec Kineret Rebetron Zelnorm Botox Lunesta Remodulin Blood Glucose Byetta Lupron Renagel Test Strips (other than Accu-check and Celebrex Lyrica Rituxan Lifescan/One Touch Delatestryl Methitest Roferon A Product lines) Elidel Mobic Rozerem Enbrel Myobloc Testim Please note: Other drugs may require prior authorization, according to your health benefit coverage. Examples may include ADHD medications, oral contraceptives, growth hormones, or certain acne medications. Due to varying health benefit plans, inclusion of a drug and related items on the drug list/formulary is not a guarantee of coverage. Please refer to your contract documents for a description of coverage, limitations, and exclusions. 6 HealthySolutions

30 2007 stockdisc (left), 2007 photodisc, Inc. (right) Healthy Communities... Because We Care Anthem is all around you, supporting health activities and initiatives throughout the region. Physician Performance healthy community is A more than the number of doctors or hospital beds, or the waiting time at the local emergency room. It s people, health organizations, and businesses working together to make towns and cities stronger, better, and more vibrant. In Maine, Anthem Blue Cross and Blue Shield does its part to support healthier communities through employee volunteerism, charitable contributions, and corporate social responsibility. We help sponsor the Miles for Smiles mobile dental program providing high-quality dental services and education to kids in rural Maine. Our statewide Health Care Leadership Conferences bring Making Quality Count people together to promote physical activity and healthy eating. We re helping to ensure that Maine children get a healthy start in life by buying vaccines for the Maine State Immunization Program. And we re funding scholarships for students in nursing and allied health professions in the University of Maine system. The Anthem Quality Insights SM Program evaluates and rewards health care institutions and physicians based on measures related to preventive care, quality of care, clinical outcomes, patient safety, and patient satisfaction. The program rewards eligible participating hospitals and primary care physicians throughout Connecticut, Maine, and New Hampshire who meet or exceed certain performance measures. To learn more about the program, including the 2006 measurement year results, visit anthem.com. Care to comment? Complete the member survey. Chronic Conditions Programmed for Success Helping us fulfill our mission to improve the lives of the people we serve and the health of our communities, our chronic disease and preventive education programs target individuals with conditions like asthma, cardiovascular disease, diabetes, or depression. The goal of these programs is to help members with chronic diseases learn how to manage their conditions. This includes dealing with lifestyle and medication issues, as well as managing more than one disease or condition. How do you get involved in these programs? We identify members likely to benefit from them, based on claims history. If you re identified, you ll receive educational materials, reminder calls for health screenings and immunizations, special newsletters, and more. The programs are entirely voluntary. If you prefer not to participate, you may opt out at any time. anthem.com 7

31 Service Care management can help Anthem Blue Cross and Blue Shield s care management program is here to help when you have a serious medical condition or sudden medical event. This free, voluntary, and confidential program teams you, your family, and your doctors with a care manager to support you with your health concerns by telephone, at your convenience. Care managers help by listening to your questions and explaining things clearly. They may suggest ways to help improve your recovery and understand your benefits. For more information, call toll-free (800) Health This new program has you covered from all angles: prevention to chronic care. Anthem Blue Cross and Blue Shield recently announced 360 Health, the most robust benefits management and information resource program in the industry to actively address preventive care, health improvement, and care coordination for our members. The program integrates all care management programs and tools into a centralized, consumer-friendly resource that assists members in navigating the health care system and using their health benefits, and provides information to help them access medically necessary, high-quality medical treatment. Under 360 Health, members who traditionally do not take full advantage of their health benefits can now go to a single place to find information on Anthem s unique health coaching program, discounts on gym memberships, health workshops, and seminars available exclusively to Anthem members. Through the program, Anthem will focus its resources on the 20 percent of members who are most at risk, while helping to improve the effectiveness of health and wellness programs for the remaining 80 percent. For more information about 360 Health, log on to anthem.com photodisc, inc. (this page), 2007 michael rastall/luckypix (cover) Contact Information: Maine Editor, Marketing Communications, 2E090, Anthem Blue Cross and Blue Shield, 2 Gannett Drive, South Portland, ME , EditorME@anthem.com MH Published by McMurry All rights reserved. No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement not take the place of the recommendations of your health care provider. Consult your physician before making major changes in your lifestyle or health care regimen. McMurry makes no endorsements or warranties regarding any of the products and services included in this publication or its articles. Anthem Blue Cross and Blue Shield 2 Gannett Drive South Portland, ME PRSRT STD U.S. POSTAGE PAID Saratoga Springs, NY Permit #383 In Maine, Anthem Blue Cross and Blue Shield is the trade name of Anthem HealthPlans of Maine, Inc., an independent licensee of the Blue Cross and Blue Shield Association. Registered marks of the Blue Cross and Blue Shield Association. MyHealth@Anthem is a registered mark of Anthem Insurance Companies, Inc. SM Anthem Quality Insights is a service mark of Anthem Insurance Companies, Inc. All other trademarks are the property of their respective owners. MH Issue 1, 2007

32 NOTE TO EMPLOYER GROUP: These are excerpts from Anthem.com as follows: Anthem.com > Member > Select Maine and enter > 360o Health > Health Extras Health Extras Tools and Health Discounts Our helpful reminders, interactive tools and member discounts will help you save money as you learn more about keeping yourself and your family as healthy as possible. Please check your member booklet or ask your group administrator if you have coverage for all of the following services. Staying Healthy Reminders These postcards and phone calls remind you and your family when it s time for certain preventive care or screenings like immunizations, mammograms and colorectal cancer screening tests. If you have hypertension, you ll receive reminders for certain tests and medication refills. Worksite Wellness Your employer may offer you at-work education on various health topics. Programs include fitness and nutrition, health seminars, worksite health screenings, employee health assessments and Internet-based programs. FluFree SM To see if you have coverage for flu and pneumonia shots, check you plan documents. Or call the service number on your member ID card. Anthem Rewards This easy-to-use online fitness and nutrition program is a fun way to stay active, eat right and feel better. Earn points toward free gifts. MyHealth@Anthem Visit today and take advantage of: Health risk assessments Learn your overall health status. Identify your health risks. Compare. your health status to the national averages of your peers. Improve your health and lifestyle. LEAP Fitness Program Create online fitness programs and personalized activity plans Condition Centers Access in-depth, condition-specific health assessments and personalized treatment options. Check out the Condition Centers for allergy, anxiety, diabetes, prostate health, breast health and more. Physician Pre-Visit Questionnaire Make the most out of your next doctor s visit. This tool will help you ask the right questions and communicate effectively with your doctor. Child Health Manager and Pregnancy Planner Track your children s doctor visits, immunization records and any medical concerns you have. If you re expecting, track your pregnancy check-ups, tests, progress and more. Message Center and Health News Receive health-related secure s with current news, drug alerts and health tips based on your personal health interests. Depression and Anxiety Screening Answer general questions about depression and anxiety. Based on your responses, a nurse care manager may follow up with you to offer support and discuss treatment options. Ready, Set, Stop! Developed by a former smoker, this 10-session smoking cessation program lasts four weeks. It s based upon solid behavioral change science and combines conventional smoking cessation with an interactive Web experience. Special Offers@Anthem SM Access discounts on healthy living products and services.

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34 It feels good to get a great discount. Especially at SpecialOffers@AnthemSM. Visit us at anthem.com > Members > Connecticut (Maine) > SpecialOffers@Anthem 7556CTME (11/06)