Watch Your Weight, Eat Healthy and Move More

Transcription

1 ILLINOIS 2016 ISSUE I Watch Your Weight, Eat Healthy and Move More More and more people are overweight and obese. Overweight people are at higher risk for: Heart disease; Diabetes; Arthritis-related conditions; High blood pressure; and Some cancers. Limit fast food and junk food. Drink 8 cups of water daily. Snack on fruits and vegetables. Eat low-fat and reduced-fat foods. Talk with your primary care provider about diet and exercise plans to fit your needs. How can you control your weight? Here are some suggestions. Exercise at least 30 minutes a day. Do this five days a week. Try these exercises: Walking; Raking leaves; Riding a bike; Swimming; Running or jogging; or Climbing steps for 10 minutes. Eat a healthy diet: Eat a balanced breakfast. Include protein, whole grains, fruits and vegetables. Go for a swim. Take a jog around your neighborhood. Hula-hoop with your kids. Buy a jump rope and have fun! Take the stairs. Source: The National Institute of Diabetes and Digestive and Kidney Diseases, Weight-control Information Network, retrieved from

2 What Is the Healthy Behaviors Program? The Healthy Behaviors Program rewards you for taking steps that help you live a healthy life. When you complete a healthy behavior, we ll send you a $20 CVS Select Gift Card. Complete another healthy behavior, and we ll load another $20 onto your gift card. It s that simple. Start Earning Rewards Now! Harmony Health Plan members can start earning rewards now. When you complete your first healthy behavior, you will automatically get a $20 CVS Select Gift Card in the mail. Keep making the healthy choices shown on the chart. As you do, we ll add more rewards to your card. Money will be automatically reloaded to your card, so please keep it in a safe place. To check the balance available on your card, please visit 2 Member Newsletter

3 When You Get These Healthy Behavior Services We ll Give You These Rewards Healthy Behavior for New Members First Harmony primary care provider visit: See your PCP within 90 days of becoming a Harmony member Healthy Behaviors for Kids Newborn well-child visit: Take your child to wellness visits from birth to age 15 months (reward for each visit, up to six visits) Child health checkup: Take your child for checkups when he or she is between ages 3 and 6 (reward for each visit) Adolescent checkup: Take your child for checkups when he or she is between ages 7 and 21 (reward for each visit) Healthy Pregnancy Behaviors Prenatal care visits: and your Go to six PCP visits before your baby is born choice of a stroller or portable playpen Postpartum care visit: Visit your PCP after your baby is born (Go to all your PCP visits before and after your baby is born and get an extra $20 reward) Well-Woman Healthy Behaviors Cervical cancer screening (Pap test): For members ages Mammogram: For members ages Diabetes Healthy Behaviors Eye exam: For members with diabetes ages Blood sugar level control (HbA1C): Reach a level below 8 LDL ( bad cholesterol) level control: Reach a level below 100 Member Newsletter 3

4 ACT NOW! You Could Lose Your Medicaid Insurance Coverage As a Harmony member, you should know about the Illinois Medicaid Redetermination Project (IMRP). The project processes the backlog of Medicaid cases that require immediate redeterminations. It ensures that redeterminations will be processed in a timely way going forward. When you get a redetermination letter in the mail, take action before its due date. If you don t, you could lose your Medicaid coverage and your coverage with Harmony Health Plan. For more information and frequently asked questions about IMRP, go to tinyurl.com/hcu6wme. What is redetermination? It s a process to determine eligibility for Medicaid, All Kids, SNAP or cash assistance. This eligibility must be reviewed every year. Understanding Asthma and Allergies Allergies and asthma often go hand in hand. In fact, some research says they may be different versions of the same disease. The Allergy-Asthma Link The two conditions have similar symptoms. These include inflammation and increased mucus production. One disease can also make the other one worse. For instance, many people with allergies get sinus infections. These can cause asthma flare-ups. And allergy triggers like smoke, dust and mold can cause asthma attacks. Treating Both Problems If you have asthma and allergies, treat both diseases at the same time. You will need different medicines for each condition. Before you stop or start any medicine, talk with your primary care provider. 4 Member Newsletter

5 Pictured: Gloria Owens Care Manager Helps Turn a Member s Life Around Gloria Owens wasn t sure what kind of help she needed. She was 72 years old. She had lost a leg due to circulation problems. She had many other medical issues, too. Then Gloria started working with a WellCare care manager. The manager knew exactly how to help. Gloria s care manager saw there was more going on than just physical issues. Gloria also had severe depression. She was isolated at home. Her care manager knew that this was a big part of Gloria s total health. Creating a Care Plan The care manager developed a care plan to treat all Gloria s issues, including her depression. The plan included physical therapy, occupational therapy, a home health aide and a nurse. Gloria was anxious about traveling to visit certain doctors. So the care manager rode the bus with her. She also helped Gloria get some care in her own home. Making a Fresh Start These days, Gloria has her confidence back. She is enjoying life again. She s even started walking with the help of a walker. She praises her care manager for helping her. It s a job, but she went beyond that. She got to be my friend, says Gloria. At 72, I learned how to love myself. Life is a joy and I m going to have fun. Watch a video of Gloria Owens on YouTube at tinyurl.com/gloriaowens. Do you think the Care Management Program could help you? Call Member Services. The number is on the back page. Member Newsletter 5

6 CAHPS : Health Care Quality From Your Point of View What is CAHPS? It stands for Consumer Assessment of Healthcare Providers and Systems. It s a survey. It asks members what they think about the care they get. You may get a CAHPS survey by mail or over the phone. If you do, please complete it. It can help us improve our services. It also tells providers how they re doing. Survey topics may include: Access to the care you or your child needs; Providers communication; Our customer service; and How much your primary care provider knows about care received from other providers. Do you have questions? Call Member Services at CAHPS is a registered trademark of the Agency for Healthcare Research and Quality. To learn more about CAHPS, its products and its services, visit Click or Call for the Latest Drug Coverage Updates Want to find the latest about the drugs we cover? Stop by our website, tinyurl.com/gv9nr8j. You ll find our Preferred Drug List (PDL). You can learn about drugs we ve added or removed. You ll also find changes to any drug requirements or coverage limits. You can also call us for updates. 6 Member Newsletter

7 We Welcome Your Feedback Harmony invites you to join our Enrollee Advisory Committee. You can help us make Harmony better. The committee meets quarterly. It reviews Harmony s member communications. It discusses ways to reach members, evaluate provider access, identify problems and evaluate Member Services. Most importantly, committee members give feedback on the plan s performance from their own perspectives. The Right Care in the Right Setting Harmony s Utilization Management (UM) Program s decision-making is based only on appropriateness of care, service and existence of coverage. Harmony does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM decision-makers do not encourage decisions that result in underutilization. If you have questions about the Utilization Management Program or coverage decisions, or you need language assistance, please call Member Services at TTY users call You may also review the Utilization Management Program section of your Member Handbook. You may call to ask for materials in a different format. This includes other languages, large print and audiotapes. There is no charge for this. Always talk with your doctor(s) about the care that is right for you. This material does not replace your doctor s advice. Also, Harmony does not guarantee any health results. You should review your plan or call Member Services to find out if a service is covered. Call your doctor right away, or if it is a life threatening emergency call 911 or go to the nearest emergency room. Member Newsletter 7

8 Harmony Health Plan, Inc. 29 North Wacker Drive, Suite 300 Chicago, IL PRSRT STD U.S. POSTAGE PAID WELLCARE HEALTH PLANS Para solicitar este documento en Español, llame al Servicios para Miembros al (TTY ). IL031925_CAD_NEW_ENG Internal Approved WellCare 2016 IL_10_ Don t Miss Our Upcoming Events Get the Harmony Health Plan Community Outreach events calendar. Call , ext. 3 or go to tinyurl.com/pun7ggk. Numbers to Know We re just a phone call (or click) away! Call Member Services: TTY Monday Friday, 8 a.m. to 5 p.m. Or visit Nurse Advice Line: hours a day/7 days a week 10867MI