Health plan update [Vol. 1, no. 4 (Nov. 2000)]

Health Plan Update
A Publication of the Board of Regents of the University System of Georgia November 2000 Volume 1, No. 4

USG Health Plan Changes to Take Effect Jan. 1

The University System of Georgia's openenrollment period for health benefits has come to an end, and, hopefully, you have filled out and turned in an election form indicating your choice.
So what happens now? The choices you made will not take effect until Jan. 1, 2001. In the meantime, your human resources or payroll staff will be very busy recording the options selected by each employee and retiree, notifying the vendors who provide the plans and communicating the information to the Regents Central Office.
In mid-to-late December, you will receive an ID card for the health plan you selected and -- if you signed up for either the System's self-insured indemnity plan

(Blue Cross/Blue Shield) or the new Preferred Provider Organization (PPO) -- a separate ID card for the new prescriptiondrug benefits program. These cards and accompanying literature about the pharmacy-benefits program will provide you with toll-free phone numbers and a Web site for accessing provider directories and other useful information.
All plan participants will need to present their health-plan ID cards as proof of insurance on the first doctor visit in the new year and also whenever treatment is required at a hospital or other medical facility. The Express Scripts pharmacy card also should be presented to the pharmacist the first few times a prescription is filled after Jan. 1.

The Smart Consumer:
Tips on Minimizing Your Health-Care Costs

The recent changes in health-care coverage make it imperative for you to get actively involved in your own medical care. Your informed choices regarding which doctors to see, treatment options and medications can have a big impact on your wallet as well as your health. You are a health-care consumer, and just as with other types of purchases, it pays to be a savvy consumer.
Smart moves to keep in mind: Network as much as possible. If you
enrolled in the PPO, you have the option of going to a doctor or medical facility either in the PPO's network of providers or outside the network. That's up to you, and the freedom this aspect of the plan

affords is wonderful. But the trade-off is that your level of benefit coverage is not as high when you choose a non-network provider. Translation: you'll pay more. Go generic if you can. Brand-name medications will cost at least twice as much as generic ones under the new prescription-drug benefit program, and those that fall under the "non-preferred brand-name drug" category could cost you as much as six-and-a-half times more. Tell your pharmacist if you don't mind a generic substitution for the prescribed medication. Question your doctor's scribbles. Just because a doctor prescribes a brand-
See "Smart Consumer Tips" on page 2 ...

MedCall

24-Hour `Nurseline' Offers Free Health Advice, Information

Have you ever spent a sleepless night wondering whether your child's fever warranted a doctor's attention? Do you have questions about controlling your hypertension or suspect you might be lactose intolerant?
As of Jan. 1, 2001, if you enrolled in the University System of Georgia's new PPO or indemnity health plan during the open-enrollment period that has just ended, you will have access to free information and advice on a wide variety of health concerns through MedCall.
Never before available to USG employees, MedCall will offer a Health Information Line staffed by specially trained registered nurses 24 hours a day, seven days a week, as well as an audio library of tapes on more than 200 health-related topics (everything from "Abdominal Pain" to "Your Personal Fitness Plan").
In addition to answering questions about medical procedures, illnesses and the potential side effects of medications, MedCall nurses are equipped to refer callers to doctors, medical facilities, self-help groups and community agencies. They also can advise callers of any pre-certification requirements that may govern the treatment options being

discussed and will transfer a caller to the utilizationreview team when appropriate. Anyone suffering from one of the diseases covered by the University System's new Disease State Management Program (see separate article on Page 3) will be advised of this benefit and how it works.
If MedCall nurses don't have the health information you request immediately at hand, they will conduct any necessary research and try to call back with an answer within an hour. They also can mail or fax information
Smart Consumer Tips
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name drug doesn't mean he or she is opposed to substituting a less expensive, generic-equivalent. Be sure to discuss whether or not a generic would be appropriate for you. And if the doctor does not want any substitutions made, make sure he or she writes "dispense as written" (DAW) on the prescription, as this will make a difference at the cash register.

packets customized to a caller's individual concerns, including print versions of the tapes in the audio library.
This service is intended to offer information and support, not to diagnose illnesses. While nurses will help callers to assess their symptoms and suggest the options available, the final decision on whether to seek treatment or administer selfcare rests with the caller.
MedCall also can be a useful resource on wellness
See "MedCall" on page 3 ...
Always get pre-certified for emergencyroom visits if the crisis permits. Taking a moment to call MedCall (see separate story on this page) for pre-certification before you rush off to the emergency room will knock $20 off the PPO co-payment and save you even more if you are enrolled in the indemnity plan. Of course, you must use your judgment. Don't worry about pre-certification if the emergency is life-threatening!

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Cost of Living with Diabetes, Asthma, Other Chronic Diseases

Can be Reduced Through Careful Management

Do you or any of your immediate family members suffer from asthma or diabetes? If so, you know that they are long-term diseases demanding frequent attention, both in terms of lifestyle management and medical supervision. Lack of attention sooner or later can lead to a crisis, and medical crises are always expensive, not to mention dangerous and frightening.
However, a significant program enhancement for those who enrolled in the USG's PPO and indemnity health plans for the coming year can help you and your family live with these debilitating conditions.
UniCare's Disease State Management Program is designed to assist people suffering from diabetes, asthma, congestive heart failure and breast, lung or colorectal cancer. Strictly voluntary, this program supplements the medical care of patients by providing them with the tools needed to be knowledgeable about their disease and treatment plan and to improve control of their condition. By managing a

disease in this manner, UniCare is able to reduce the costs associated with it, limit the number of flare-ups of symptoms and, over the long term, improve the patient's clinical outcome.
Each participating patient is provided with wellness and prevention education tailored to the stage of their respective disease and their level of self-care and symptom management. Case managers advocate and monitor such things as changing diet and exercise habits, maintaining the frequency of doctor's visits and complying with a prescribed regimen of medication and physical therapy. As the patient learns to

better manage his or her condition, the acuteness of symptoms and the number of medical emergencies related to the disease are kept to a minimum, as are the associated costs.
The best part is, there's no charge for participation in the Disease State Management Program. Anyone enrolled in either the indemnity plan or the PPO can take advantage of the program at any time after Jan. 1, 2001. When you receive your health plan ID card in the mail in mid-to-late December, information on how to contact UniCare about this benefit will be included.

MedCall
Continued from page 2 ...
issues. Among the hundreds of three-to-fiveminute audio tapes available to callers are summaries on good nutrition, mammography, immunizations and tips for quitting smoking. Through the "nurseline," MedCall educates callers about the

importance of preventive measures such as regular check-ups.
MedCall's toll-free phone number will be listed on the back of the ID card you will be receiving in mid-to-late December for either the indemnity plan or the PPO.

Periodic health benefits updates are published by the Board of Regents' Office of Media and Publications, the Office of the Associate Vice Chancellor for Human Resources, and the Office of the Senior Vice Chancellor for Support Services to help USG employees make informed decisions about their healthcare benefits.
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