south carolina 2015 ISSUE III Don t Let the Flu Take Hold of You Influenza is a very contagious viral infection. It s also called the flu. It can be serious and can lead to death. That s why you should get a flu vaccine every year. You can get it as a shot or a nasal spray. The flu vaccine is included in your health plan. There is no extra charge for you. These groups of people should get vaccinated each year: Children ages 6 months to 18 years; Pregnant women; People ages 50 and older; People of any age who have certain chronic medical conditions or immunosuppression, or who are receiving long-term aspirin therapy; People who live in nursing homes and other long-term care facilities; and People who live with or care for those at high risk for complications from flu. Source: Centers for Disease Control and Prevention, 2014-2015 Flu Season, retrieved from www.cdc.gov/flu/about/season/index.htm What s New With You? Has your address or telephone number changed recently? If so, please call us. The number is 1-888-588-9842. You can reach us Monday Friday, 8 a.m. 6 p.m. We want to know how we can contact you. It is important that we have your correct address and phone number. This way, we can keep you up to date about your health care coverage.
Member Rewards We re excited to offer extra benefits and special programs to our members. Things like: Healthy Rewards Program The Healthy Rewards Program will reward 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. You can use your gift card to buy healthy items. These include: vitamins, pain relief medicine, baby items and other over-the-counter items. Items that you can t purchase include alcohol, cosmetics and candy. Please see the chart on the next page. It has the full list of healthy behaviors you can complete to earn additional rewards. Diaper Rewards Program New moms and babies are eligible for diaper rewards for completing postpartum and well-child checkups. OTC $120 a year ($10/month) for over-the-counter drugs and supplies like diapers, vitamins and almost 100 other items. We ll ship them right to your home. Circumcisions WellCare of South Carolina covers circumcisions for newborns from birth to 6 months. 2 Member Newsletter
Healthy Behavior Reward Type Reward Reward Criteria Amount Children s Healthy Behaviors Well-Child Visit: 0 15 months Reloadable CVS Select Card $20 Members ages 0 15 months: Complete a well-child visit per periodicity schedule (reward for each visit, up to six visits). Annual Child Health Checkup: 3 6 years Reloadable CVS Select Card $20 Members ages 3 6 years: Complete an annual child health checkup visit (EPSDT). Annual Adolescent Checkup: 7 21 years Reloadable CVS Select Card $20 Members ages 7 21 years: Complete an annual adolescent checkup visit. Healthy Pregnancy Behaviors Prenatal and Postpartum Checkups Baby stroller or portable playpen N/A Pregnant members: Complete six prenatal visits and one postpartum visit. Adult Healthy Behaviors Annual Adult Checkup Reloadable CVS Select Card $20 Members ages 18 39: Complete a checkup every one to three years. Members ages 40 64: Complete a checkup every one to two years, based on risk factors. Member Newsletter 3
You Can Learn How to Live With Diabetes Maybe you ve been diagnosed with diabetes recently. Or maybe you ve had it for a while. Either way, there are some things you can do to control your diabetes. Eat well. Make a diabetes meal plan. Your health care team can help. Choose foods that are lower in calories, saturated fat, trans fat, sugar and salt. Eat foods with more fiber. These include fruits, vegetables, and wholegrain cereals and breads. Drink water instead of juice or soda. Be active. Find exercises that are safe for you. Your doctor can help. Set a goal to be more active most days of the week. Work to increase your muscle strength twice a week. Use stretch bands. Do yoga. Or try push-ups. Monitor your blood glucose (blood sugar) levels. Your blood glucose numbers should meet the normal target levels. But your doctor may help you set different targets. Get an A1C test at least twice a year. Your A1C number gives your average blood glucose for the past three months. This helps your doctor tell whether your diabetes control plan is working. Ask your doctor if you have any questions about your diabetes. Report any changes in your health. WellCare is here to help! We have a Diabetes Disease Management Program for our members. You can get one-on-one service from a nurse. He or she can send you information to teach you more about diabetes. For details, call Customer Service. The number is on the back page. Sources: National Diabetes Information Clearinghouse (NDIC), What I need to know about Eating and Diabetes, retrieved from www.diabetes.niddk.nih.gov/dm/pubs/eating_ez/index.aspx National Diabetes Education Program, 4 Steps to Manage Your Diabetes for Life, retrieved from http://ndep.nih.gov/publications/publicationdetail.aspx?pubid=4 4 Member Newsletter
Where Do I Go to Get Care? Emergency vs. Urgent Care Your primary care provider (PCP) is your most cost-effective source of care. He or she is trained to coordinate all your health care. See your PCP for all nonemergency, nonurgent health care needs. What if you need care immediately but your health is not in serious danger? In that case, seek medical attention from an urgent care center. Some symptoms that can be treated at urgent care include: Fever without rash; Minor trauma such as a common sprain; Painful urination; Persistent diarrhea; Severe sore throat; and Vomiting. To find the nearest urgent care facility, visit our website, southcarolina.wellcare. com. Or call Customer Service. The number is on the back page. Do you feel you need emergency care? Then seek help right away at the nearest hospital. Some instances may include: Persistent chest pain; Persistent shortness of breath or wheezing; Severe pain, particularly in the abdomen or starting halfway down the back; Severe heart palpitations; Intestinal bleeding; Loss of vision; Head and eye injuries; and Broken bones or dislocated joints. It can be tough to know which issues are urgent and which are not. For advice, you can always contact your PCP. Or call our 24-hour Nurse Advice Line at 1-800-919-8807. Source: scripps.org, retrieved from www.scripps.org/news_items/4231- should-you-go-to-the-emergencyroom-orurgent-care Member Newsletter 5
Follow-Up After Hospitalization for a Behavioral Health Issue Have you or a loved one been hospitalized for a behavioral health disorder? If so, please remember to do the following before you leave the hospital: Ask questions so you can understand after-care instructions. Know your medications. When do you take them? What are their names? What do you do if you miss a dose? Schedule a follow-up appointment to be seen by your behavioral health provider. This should occur within seven days of leaving the hospital. Contact your behavioral health provider to help with care coordination. You may also call Customer Service to get help from our Care Management Program. It is no cost to you. Know Your Rights and Responsibilities As a WellCare member, you have the following rights: Get information about the organization. This includes its services, its practitioners and providers, and your member rights and responsibilities. Be treated with respect and dignity. Have your privacy protected. Work with providers to make decisions about your health care. Have a candid talk about medically necessary treatment options for your conditions. Cost and benefit coverage should not be considered. Voice complaints or appeals about the plan or the care it provides. Make recommendations about the plan s member rights and responsibilities policy. You also have the following responsibilities as a member: Supply information that the plan and its providers need to deliver care. Follow plans and instructions for care that you have agreed on with your doctor. Understand your health problems. Help set treatment goals that you and your doctor agree to. These are just some of the highlights. Visit southcarolina.wellcare.com for more information. Or look in your Member Handbook. 6 Member Newsletter
Find What You Need in the Member Handbook Your Member Handbook is a great resource. It s also available online 24/7. Just go to southcarolina.wellcare.com. In the handbook, you ll find information about all this and more: Benefits and services and exclusions from coverage; Co-payments and other charges you might be responsible for; Benefit restrictions about out-ofnetwork and out-of-service area providers; Language help; Filing claims; Doctors who are in our network; Primary care services; Specialty, behavioral health and hospital services; After-hours care; Emergency care when to use 911 or go to the emergency room; Getting coverage when out of the service area; Filing complaints; Filing appeals; and How we evaluate new technology. You may request hard copies of the handbook, member educational materials or other information. Just call Customer Service. The number is on the back page. You can also request materials in another format. This includes different languages, large print and audiotapes. There is no charge for this service. Always talk with your doctor(s) about the care that is right for you. This material does not replace your doctor s advice. It is based on third party sources. We are presenting it for your information only. It does not imply that these are benefits covered by WellCare. Also, WellCare does not guarantee any health results. You should review your plan or call Customer Service to find out if a service is covered. Call 911 or your doctor right away in a health emergency. Member Newsletter 7
200 Center Point Circle, Suite 180 Columbia, SC 29210 PRSRT STD U.S. Postage Paid Wellcare Health Plans Para solicitar este documento en Español, llame al Servicio al Cliente al 1-888-588-9842 (TTY 1-877-247-6272). SC028795_CAD_NEW_ENG State Approved 05042015 WellCare 2015 SC_01_15 64404 In This Issue We re pleased to bring you another newsletter issue. It s full of helpful ideas about ways to live healthier. There s much more inside. Take a moment to explore. As always, we wish you good health. Click or Call for the Latest Drug Coverage Updates Want to find the latest about the drugs we cover? Go to southcarolina.wellcare.com. You ll find our Preferred Drug List (PDL). You can learn about drugs we ve added or removed. You can also call us. Numbers to Know We re just a phone call (or click) away! Call Customer Service: 1-888-588-9842 TTY 1-877-247-6272 Monday Friday, 8 a.m. 6 p.m. Or visit southcarolina.wellcare.com Nurse Advice Line: 1-800-919-8807 24 hours a day/7 days a week 10867MD