Win an ipod touch! See page 7 for details. We ve got you covered with preventive care Stay-healthy tips for a brighter future Save money on your health care this year
Q&A with Customer Service Q. I have a high-deductible health plan with prescription coverage. How much will I pay for my prescriptions? A. The deductible on your health plan is like the deductible on your car insurance. You ll be responsible for your own medical expenses including prescriptions until you reach your annual deductible. The good news is that our plans help you save money: Our discounts average 45% or more on medical care and 25% on prescriptions. Plus, if you have a health savings account (HSA), you can use the money from your HSA to pay for all qualified* medical expenses. Be sure to show your Priority Health ID card whenever you fill a prescription. It gives you a discount and lets us tally the amount you ve paid toward your deductible. When you pick up a prescription, you ll pay the full, discounted amount until you reach your deductible. After you reach your deductible, you ll only be responsible for your copayment amount. (See your plan documents for details.) The most important aspect of my job is making members lives a little easier by providing accurate answers to their questions. I like to go the extra mile to resolve issues promptly and professionally. Lisa U., Customer Service Representative Contact Customer Service Call the phone number on the back of your Priority Health ID card. We re open Monday Thursday, 7:30 a.m. to 7 p.m., Friday, 9 a.m. to 5 p.m., Saturday, 8:30 a.m. to noon. You can also send a secure email by visiting priorityhealth.com/member and clicking on Contact us, found in the upper right-hand corner of the page. *Qualified medical expenses are defined by the Internal Revenue Service (IRS). $45 $15 $30 Cost Priority Health discount Your cost You ll automatically be able to take advantage of Priority Health discounts on prescriptions and medical care even if you haven t reached your deductible. 2 Health Journal Fall 2012
Spread the word about our plans for individuals and families Do you have friends or family who need health insurance? We can help. We offer excellent, affordable individual coverage. Our plans start as low as $42 for individuals and $92 for families. 1 MyPriority plans Our MyPriority SM individual and family plans offer affordable coverage options, including: PPO, health savings account (HSA) and short-term plans Annual check-ups covered at 100% Prescriptions Hospital stays Emergencies Supplemental plans are also available, including dental and accident coverage. To learn more: Call us toll-free at 855.MyPriority (855.697.7467) Medicare plans More people choose Priority Health Medicare Advantage plans than any other plan in Michigan. 2 Our plans include: Doctor visits and hospital coverage Emergency and urgent care Coverage in the U.S. and around the world Prescription drug coverage with a home delivery option Fitness membership and wellness tools (not included in Medicare Advantage coverage through an employer) We also offer Medigap (Medicare Supplement) plans, starting at less than $100 a month. 3 Search keyword: Medicare Visit priorityhealth.com for a free instant quote Talk with a local agent Search keyword: MyPriority New! MyPriority SM Dental Current MyPriority members can now add dental coverage during an open enrollment period from Oct. 1 to Nov. 30, 2012. Or add dental as part of your annual renewal. Search keywords: MyPriority Dental Priority Health is a health plan with a Medicare contract. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions apply. Benefits may change on Jan. 1 of each year. 1 Rates vary based on age, health and location. 2 According to January - April 2012 monthly enrollment reports from the Centers for Medicare and Medicaid Services. 3 Certain factors may affect your monthly premium costs: county of residence, age, gender, health status and use of tobacco products. Neither Priority Health Medigap plans nor agents authorized to sell Priority Health Medigap plans are connected with or endorsed by the United States government or the federal Medicare program. priorityhealth.com 3
Save on health care You can make the most of your health care dollar and stay healthier with these helpful tips. Learn more by doing a keyword search on each topic at priorityhealth.com/member. Get good information We ve updated our website with links to some terrific resources that can help you stay healthy and get the most from your health care dollars. They include: Choosing Wisely This campaign is being developed by doctors from nine medical specialties who recognize that many tests and procedures are overused. It includes Five things patients should question about a wide variety of issues, including antibiotics, bone density tests and more. Healthcare Blue Book If you ve ever wondered about fair prices for X-rays, lab work, surgery and more, this is the site for you. If you have a high-deductible health plan, you ll be especially interested to see the variations in prices you could pay for many basic services. Search keywords: smart health tips Use your discounts Use our HealthFit discounts to save while you shape up, lose weight and have fun at local fitness centers. Just show your Priority Health ID card for discounts on clothing and equipment at participating merchants, too! And check out the coupons in this newsletter for more savings opportunities. Search keyword: HealthFit Take care of #1 Be your healthiest and keep your chronic conditions (like asthma and diabetes) under control with our free health management programs. Plus, our health risk appraisal provides helpful tips and techniques for feeling your best. Search keywords: health help Be benefit savvy Every plan is different. You can make money-saving choices like buying generic instead of brand-name drugs or choosing an X-ray instead of an MRI. You'll find details of your health plan online. All you need to get started is the contract number from your Priority Health ID card. Search keywords: plan documents Get your ounce of prevention You can head off health issues before they become expensive, serious problems. Most preventive care won't cost you anything. Check out our Preventive Health Care Guidelines for details. Search keyword: preventive Thinking about surgery? We want you to have the facts about surgery and your treatment options, so you get the best results. Our free, online program helps you learn from the experts about any specific surgery you may be considering. Earn a reward just for trying it Use the program and you ll receive a code good for $25 ($10 for Medicare members) to spend in an online rewards store powered by Amazon. Choose from many health-related items yoga mats, DVDs, hand weights, health magazines and more. Keyword search: before surgery 4 Health Journal Fall 2012
Get and stay healthy for free See everything that s covered Get the full list in our 2013 preventive health care guidelines. Go to priorityhealth.com and search keyword preventive. When it comes to routine physicals and preventive screenings, we ve got you covered. We have a whole list of services that are free for most of our members. 1 What s covered at no cost? Preventive services like immunizations, screenings and lab tests that help prevent illness or find diseases or medical problems before you have symptoms are covered at 100%. Even if you haven t met your deductible, there s no cost, no copayment and no coinsurance for services like: Routine physical exams Well-child visits Colonoscopies Mammograms Cholesterol screenings Contraceptives and other women s health services 2,3 (screening for gestational diabetes; HPV testing; counseling for STIs; counseling and screening for HIV; breastfeeding support, supplies and counseling; and screening and counseling for interpersonal domestic violence) We recommend these services and more based on national recommendations and the latest medical research. Get informed before you visit your doctor When preventive services are done by an in-network provider, we ll pay 100% for most plans. 4 But if you already have a symptom or medical condition, you may need to pay part of the cost. Preventive care Diagnostic care Reason for service: To prevent health problems. You don t have symptoms. You have a symptom, or you re being checked because of a known health issue. Free flu shots What you ll pay: You won t pay anything. This is a medical claim. Your deductible, copayments and coinsurance may apply. We want to help you be your healthiest.that s why we recommend kids and adults of all ages get a flu shot. And for most members, flu shots are free when you use an in-network doctor or pharmacy. 4 There s no copayment or coinsurance, even if you haven t met your deductible. You can find all the locations where you can get free flu shots on our website. Search keyword: flu 1 For MyPriority SM members, some preventive services may not apply. Call the number on the back of your ID card for more information. 2 These services do not apply if you re in a grandfathered plan (a plan that hasn t been changed since Health Care Reform). Ask your employer or contact Customer Service at the number on the back of your ID card to see if your plan is grandfathered. 3 Group health plans sponsored by certain religious entities are exempt from offering coverage for contraceptive methods, or they may delay coverage. 4 If your employer s plan is grandfathered, you may have other costs. priorityhealth.com 5
Understand your benefits and coverage Priority Health makes important information available to help you understand how your health plan works and maximize your benefits. This information is available for most members online and in print. To access the information, visit priorityhealth.com and type the keyword(s) provided below in the search box. For print copies, call Customer Service at the number on the back of your Priority Health ID card. Disease management programs Learn what programs are available to help you manage chronic illnesses, how to use the services and how to become eligible. Search keyword: programs Fraud and abuse Learn how you can help combat health care fraud and abuse. Search keyword: fraud Privacy statement Learn how Priority Health is committed to keeping your health information private. Search keyword: privacy Quality performance Review summary information regarding Priority Health s Quality Improvement Program performance and key quality results. Search keyword: accreditation Plan basics Review your Certificate of Coverage and Member Handbook for information about benefits, procedures, obtaining care and services, and providers who participate with your plan. Search keywords: coverage or handbook Prescription drug updates Priority Health regularly reviews new drugs to help make sure that you are receiving safe and effective care. If you take prescription drugs, it s important that you review our Approved Drug List occasionally in order to note changes or updates. Search keyword: drugs Rights and responsibilities Know what you can expect from Priority Health and what Priority Health expects from you. Search keywords: member rights Benefit decisions We want to make sure you get appropriate care and services (utilization management). If you have questions regarding our utilization management process and decisions, contact Customer Service at 888.389.6648, and they will contact a health management staff member to help. Know that all utilization management decisions are based on appropriateness of care and service and that no financial incentives exist for issuing denials. Search keyword: utilization 6 Health Journal Fall 2012
Our new Facebook app rewards your healthy moves On Facebook? Check out MyGo Points, our new app to promote health and wellness among Michigan residents while supporting local tourism. The app gives you the chance to earn points to win prizes by participating in events and Facebook challenges. Every point earned enters participants into a monthly prize drawing, with the opportunity to win the grand prize a Pure Michigan Ultimate Adventure Package to Crystal Mountain. Search keywords: MyGo Points Help us make Michigan healthier You re invited to attend free events as part of our new ShapeMichigan campaign, which will show highlights of the HBO documentary The Weight of the Nation and focus on issues relevant to community leaders, schools, employers and health care providers. In addition, shapemichigan.com provides a platform for organizations to share programs that are working in their community and allows individuals to share tips. Visit shapemichigan.com for more information. Win an ipod touch! Take our health risk appraisal and you ll automatically be entered to win an ipod touch with a fitness armband. (If you ve taken the appraisal since July 23, 2012, your name has been entered.) Whether you run marathons or you re just starting a fitness routine, the ipod will let you listen to music to help you stay moving. Plus, get workout plans, track your calories and more when you download apps to help you meet your fitness goals. Six winners were selected this summer, and six more winners will be selected on Nov. 16, 2012. Our summer winners were: Kimberly B., Oxford Paula C., Commerce Township Brian H., Wayland Denise H., Brighton Sarah J., Ypsilanti Kevin W., Roseville Expanded sleep apnea coverage We ve expanded coverage to make it easier and less expensive to be tested for sleep apnea. To learn more, ask your doctor or call Customer Service using the phone number on the back of your Priority Health ID card. Search keywords: sleep apnea Thank you, Priority Health, for my new ipod touch! I can t wait to use it while walking and biking! Denise H. priorityhealth.com 7
1231 East Beltline Ave. NE Grand Rapids, MI 49525 Health or wellness or prevention information HealthJournal is presented by Priority Health, 1231 East Beltline NE, Grand Rapids, MI 49525-4501. 2012. All rights reserved. HealthJournal and its graphic representation are trademarks. Reproduction without permission is strictly prohibited. No material in this issue may be reproduced without written permission. The publishers do not assume responsibility for unsolicited editorial material. HealthJournal is an information newsletter for customers of Priority Health. The information provided in this newsletter is intended to be used as a general guideline and should not replace the advice of your physician. Always consult your physician for individualized care. If you have any questions, please call the number on your identification card. Priority Health encourages physicians to discuss all treatment options with their patients regardless of benefit level or coverage. Your account. At your fingertips! When you access your account online at priorityhealth.com/member, you can see your claims, deductible balance, prescription history and more, including: Find a Doctor tool Doctor and hospital ratings Health risk appraisal Preventive health care advice Member discounts Support for surgery decisions Tips for managing chronic conditions Member handbooks to view or print Getting started is easy. All you ll need is the contract number from your Priority Health ID card. Search keyword: account Get the latest news, tips and information. Just like us on Facebook or follow @PriorityHealth on Twitter. 2012 Priority Health priorityhealth.com 6995A 10/12