Concierge fall 2015

L I F E , H E A LT H & W E L L N E S S

A PUBLICATION OF

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She’s very good at what she does

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and it’s nice that she can come visit me at home.

Network Health Medicare member, Lloyd Mahloch

inside LIFE

Detecting Osteoporosis

HEALTH Healthy Makeover for Your Holiday Meals

WELLNESS Stress Free Guide to the Annual Enrollment Period

Exclusive Reduced Rate for Network Health Medicare Advantage Members

The Band of the Royal Marines

Wednesday, February 10, 2016 at 7:30 p.m. Tickets $17 To claim this offer, register by November 1. Log on to www.foxcitiespac.com/onlineoffers and click on the Network Health logo. Select Find Tickets and type MEDICARE in the promo code field. Then, purchase your ticket by following the simple instructions that appear.

This offer is only valid for Network Health Medicare Members and their families. Not valid on previously purchased tickets. Valid while supplies last.

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life FEATURE 8 Care Paired with a Companion How Loyd Malach works together with his nurse care manager for better health

3 Your Guide to Open Enrollment 3 Breathe at Ease 4 Detecting Osteoporosis Learn How to Avoid Painful Breaks and Fractures

wellness

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11 Important Tests for Diabetics The Sooner the Better

5 Finding the Right Care Emergency vs. Urgent Care

12 Ensuring the Service You Deserve

6 Healthy Makeover for Your Holiday Meals 7 Common Questions About the Flu Shot 7 Access to One-on-One Support

13 Stress Free Guide to the Annual Enrollment Period BACK COVER Meet Penny Koehler

Y0108_671_091115 Accepted 09202015 EDITORIAL STAFF President and CEO Sheila Jenkins Chief Administrative Officer Penny Ransom Marketing Coordinator Cassie Ashman Graphic Designer Debra Sutton EDITORIAL BOARD Renee Corral, Colleen Davison, Sarah Dencker, Melanie Draheim, Jessica Fischer, Mark Geiger, Natalie Knaack, Teri Koepke, Joan Merwin, Barbara Ott, Dawn Rady, Chuck Rynearson and Jeanne Skinner Concierge is published quarterly by Network Health. The health information contained in Concierge is meant to supplement, not replace, the advice of health care professionals.

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© 2015 Network Health Insurance Corporation. No portion of this newsletter may be reproduced without written permission from Network Health Insurance Corporation.

Network Health Medicare Advantage Plans are MSA and PPO plans with a Medicare contract. NetworkCares is a PPO SNP plan with a Medicare contract and a contract with the Forward Health Wisconsin Medicaid Program. Enrollment in Network Health Medicare Advantage plans depends on contract renewal.

The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change January 1 of each year.

NetworkHealthMedicare.com

NetworkHealthMedicare.com 800-983-7587 / (TTY 800-947-3529) Monday - Friday, 8 a.m. - 8 p.m.

life 98

%

of Medicare members who join Network Health, stay.* That tells you something.

*Based on the percentage of Network Health Medicare Advantage (PPO) members who stayed in the plan for 2015, for coverage starting January 1, 2015.

Network Health 2016 Stress free guide to Medicare

Your Guide 2016 to Open Enrollment Stress free guide to Medicare

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I

t’s almost here—Medicare’s Annual Enrollment Period. This is the time of year your mailbox overflows with messages from different health plans all claiming they’re the best choice.

But, 98 percent of our members choose to stay with us*. That tells you something. Our members appreciate our straightforward approach to Medicare and our local, personal service. When you call us, you know you’re getting a real person right here in Wisconsin who will always go the extra mile to help you—because that’s what good neighbors do.

The Annual Enrollment Period begins October 15 and runs to December 7. During this time, you can make

Breathe at ease Breathe at ease

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N e t wo rk H e a l t h M e d i c a re . c o m

changes to your Medicare health care coverage and we can help you out with that.

To make things simple, we’ve included a special insert starting on page 13. Make sure to read this and all your plan materials carefully. Give us a call and we can walk you through any questions and help you find the right coverage for the right price.

If you’d like to change your plan, your health care concierge can help you with the process. To stay in the same plan, you don’t have to do anything. You’re all set.

Thank you for being a Network Health member—and remember, don’t hesitate to call us with any questions (See our phone number and hours on page 18).

If you’ve been diagnosed with chronic obstructive pulmonary disease (COPD), this program can help. Breathe at Ease is available to Network Health members at no cost. It’s held in the outpatient pulmonary rehabilitation department at St. Elizabeth Hospital, Mercy Medical Center, Affinity Medical Group New London and Calumet Medical Center.

To join Breathe at Ease at St. Elizabeth’s Hospital, Affinity Medical Group New London or Mercy Medical Center, call Robyn West, RRT, at 920-831-1498 or 920-738-2558. To join at Calumet Medical Center, call Peggy Nolan, RRT, at 920-849-1816.

NetworkHealthMedicare.com

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life

Learn more ways to protect yourself from falls and fractures. Attend a Stepping On workshop.

Helpful instructors can teach you proven techniques to reduce your risk of falling. Call Sue Srnka at 920-628-7160, Monday - Friday, 8 a.m. - 5 p.m., to find classes in your area.

Detecting Osteoporosis D

id you know more than 40 million people in the United States either have or are at risk for osteoporosis? Osteoporosis is a disease which causes bones to thin, weaken and become more fragile. This can lead to bad brakes and painful fractures.

The good news is, osteoporosis can be detected and treated. A bone mineral density (BMD) test determines how much bone mineral content (calcium and other minerals) is present in a bone. The higher the mineral content, the denser the bone is. The denser the bone, the lower the risk of fracture.

What can a bone mineral density test tell you and how does it work?

BMD testing can alert you to any changes in bone density, diagnose osteoporosis, gauge effectiveness of measures taken to improve density, assess fracture risk and target steps that need to be taken. A bone scan is not the same as a BMD test.

The preferred method for measuring bone mineral density is with dual X-ray absorptiometry (DXA) or dual energy X-ray absorptiometry (DEXA).

Who should get a bone mineral density test?

Getting a BMD test is a good idea for women over 65 and men over 70. For women over 50 who have had a fracture, testing is recommended within six months of the bone fracture (unless a test was completed within the previous two-year period).

What are the risk factors for osteoporosis?

Depending on certain risk factors, your doctor may suggest a BMD test every two years. Below are other risk factors you should discuss with your primary doctor when deciding if you need a BMD test. v Short height (5 feet 4 inches or less) or loss of height v Low calcium and Vitamin D intake v Inactive lifestyle v Postmenopausal women v Decrease in hormone levels v Close relative with osteoporosis or history of broken bone(s) v Smoking v Drinking alcohol v Being the recipient of a transplant v History of a broken bone after age 50 Continued on next page ...

WHAT’S THAT?

The bones most likely to break due to osteoporosis are your vertebrae, hip, wrist, forearm and heel. These are the bones that receive density testing most often. The loss of bone mineral density increases each year.

DEXA - An X-ray which is pain-free and can be

completed in less than 30 minutes. Radiation exposure during testing is very low.

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NetworkHealthMedicare.com

health Having certain diseases or conditions can also be considered a risk factor. If you have any of the following conditions, talk with your doctor about them in relation to a BMD test. v Alcoholism v Allergies v Diabetes v Inflammatory bowel disease v Liver disease v Multiple sclerosis

v Anorexia nervosa v Cancer v Hyperparathyroidism v Lactose intolerance v Kidney disease v Rheumatoid arthritis

v Asthma v Cushing’s disease v Hyperthyroidism v Lupus v Lung disease

FINDING THE RIGHT CARE EMERGENCY VS. URGENT CARE

I

f you get hurt or become very ill, panic and confusion can make it difficult to know what to do. If you feel it’s an emergency, it’s important to get to the nearest emergency room or call 911. But, sometimes you might not be sure if it’s an emergency. If it’s not, many times your primary care doctor or a walk-in clinic can help.

Here are the answers to two of the most common questions we get about knowing what type of care you need.

What’s the difference between emergency care and urgent care?

Emergency care and urgent care are not the same. An emergency is an illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid serious harm. Urgent care is for an unexpected injury or illness that is not life threatening, but still needs attention quickly so you don’t develop a serious problem.

You typically receive emergency care at the emergency room. You may get urgent care at your primary doctor’s office, a walk-in clinic or an urgent care facility.

What if I’m not sure if it’s an emergency?

Knowing what to do before an emergency can help you make the right decision quickly. If you are not sure whether you should go to the emergency room, call your doctor. Network Health members can also call our 24-hour hotline to speak with a nurse or for advice.

Call the Network Health Nurse Line at 1-888-879-8960 for advice about symptoms and when to seek care (TTY 1-888-833-4271).

Don’t Forget to Ask Questions

Anytime you visit the emergency room, a walk-in clinic or see your primary doctor, don’t be afraid to ask questions.

Asking questions about your care is the best thing you can do to ensure your safety. If something doesn’t seem right or make sense, ask about it. Remember, there’s no such thing as a dumb question, especially when it comes to your health.

NetworkHealthMedicare.com

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health

Healthy Makeover

for Your Holiday Meals I t’s hard to believe Thanksgiving and Christmas are right around the corner. These holidays typically involve large meals and sweet treats. When you are trying to eat healthy, the holidays can make it difficult to stay on track. Here are a few ways to make your favorites lighter without losing the flavor everyone loves.

Choose oven-roasted sweet potatoes.

Use less sodium.

Instead of serving candied yams (215 calories per halfcup), try oven-roasted sweet potatoes. A 3/4-cup serving of sweet potatoes brushed with a little canola or olive oil is only 100 calories.

Decrease the amount of sodium in your meals by using ‘no-salt added’ herbs, spices or citrus juices to your dish.

Opt for whole wheat dinner rolls.

Increase the amount of fiber, nutrients, flavor and texture with whole wheat. For every cup of white flour, substitute 7/8 cup of whole-wheat.

Skip the dark meat in your turkey.

It has about twice the fat of turkey breast and about 40 percent more calories.

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Swap in a healthy oil replacement.

For your baked treats, use mashed bananas instead of oil or butter. One cup of mashed bananas is a great substitute for one cup of butter or oil. It adds potassium, fiber and vitamin B6. You can also use applesauce as a replacement for oil (except in cookies).

Dig in without the guilt and leave the table feeling just as satisfied. You’ll be thankful you didn’t overdo it when January 1 rolls around.

NetworkHealthMedicare.com

Want more health tips? Check out our blog at copilotwi.com. We add helpful information about health and well-being every week, so be sure to visit often.

Common Questions About the Flu Shot T here’s a lot of great things about fall, but flu season isn’t one of them. Luckily, you can help protect yourself by getting your annual flu vaccine. Make sure you know the facts about the flu shot and read the answers to these common questions below.

Who should get a flu shot?

According to the Centers for Disease Control and Prevention (CDC), anyone over the age of six months should get a flu vaccine.

How does the flu shot work?

The flu shot is an injection, usually given in the arm, which contains an inactive vaccine made of a killed flu virus. Since the virus in the vaccine isn’t live, the shot enables your body to build up a resistance without actually giving you the flu.

Can I get the flu from the flu shot?

No, you cannot get the flu from the flu vaccine. According to the CDC, almost all people who receive a vaccine experience no side effects.

Where can I get a flu shot?

Call your health care concierge to find about the location most convenient for you. If you are a Network PlatinumSelect, Plus, Premier or NetworkCares member, make sure to attend our member appreciation events. You can get your flu shot there at no cost.

If you choose to get your flu vaccine during an appointment with your doctor, remember that anything else discussed with your doctor (other than the flu vaccine) can result in a charge, which may mean you need to pay a copayment, deductible or coinsurance.

Access to One-on-One Support t Network Health, our goal is to help our members get and stay healthy. But, unfortunately not all conditions can be cured. It’s important to us that our members know they have resources available that can help with their palliative care needs.

Our registered nurse care managers spend every day helping members take care of themselves. It’s like having your own personal nurse help with your condition.

Here’s what they do.

v Work with doctors to coordinate your care v Explain medical instructions v Provide guidance on how to avoid problems v Give tips on how to manage symptoms and pain v Call to follow-up and see how things are going

NetworkHealthMedicare.com

We have specific programs for many of the most serious chronic diseases, but our staff is available to anyone who has been diagnosed with a serious health problem. As a Network Health Medicare member, care management is offered to you at no additional cost. If you have questions about our care management services, call 920-720-1602 or 866-709-0019.

WHAT’S THAT?

PALLIATIVE CARE

The goal of palliative care is to provide the best possible quality of life for people facing the pain, symptoms and stresses of serious illness.

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COVER STORY

Now that Lloyd lives alone, he’s been working hard to maintain his independence and stay in his home–something that is very important to him.

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NetworkHealthMedicare.com

with a

When his wife passed away from cancer, Lloyd was left to care for himself. His Network Health case manager stepped in for added support and a little companionship along the way. t the end of a long and winding driveway in Kiel, WI, sits the home of a man named Lloyd Mahloch. At 83 years old, Lloyd used to share his countryside home with his wife, Doris. After Doris passed in September of 2014, he was left to care for himself.

“My wife passed away from lung cancer last September,” shares Lloyd. “You’re left alone all of a sudden and I’m trying to take care of myself. It’s been a big adjustment and I miss her a lot.”

Twelve years earlier, Lloyd experienced what life would be like without Doris when she was hospitalized with colon cancer. When she was met with a cancer diagnosis once again, she chose not to fight it like she had before. Beating cancer the first time took a lot out of her. Doris wasn’t ready to do it again.

“She got lung cancer and wouldn’t do chemo,” says Lloyd. “She did it the first time around and was so sick.

She lived almost two years with lung cancer.” Lloyd’s wife passed away at the age of 79 never having smoked a cigarette.

Now that Lloyd lives alone, he’s been working hard to maintain his independence and stay in his home—something that is very important to him. He relies on help from his

daughter who shops for his groceries, and a cleaning service that comes once a week to tidy up.

“I don’t want to move into a nursing home until I have to,” says Lloyd. “It costs a lot of money to live in those places and money runs short. I’m trying to take care of myself and I hope I can live here another 10 years.”

The complication of his medication routine is a portion of what Lloyd has had to manage in his wife’s absence. He suffers from congestive heart failure and is also a diabetic.

As a veteran, he receives his medications in the mail from The Office of Veteran Affairs (VA). After a blood sugar of 600 forced Lloyd to drive himself to the ER, he was given diabetes education and met with a dietician. When the changes he said he was making didn’t seem to help his blood sugar stabilize, Shelby Lewis, his Network Health case manager, thought it was time to try something else.

“I started making home visits to see how Lloyd was drawing up his insulin doses. I saw that he couldn’t read the syringes well and his dexterity was decreased, making holding the vial as he was drawing doses difficult,” explains Shelby. “He was not getting close to the prescribed dose without supervision.”

Lloyd does not qualify for any home health services

By Lisa Endl, Photography by Beth DesJardin, Trove Photography NetworkHealthMedicare.com

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COVER STORY

It’s also a double check that he is safe now that he lives alone and is out in the country away from neighbors.

and his family was unavailable to assist him with his medications. Shelby decided she would visit him on a regular basis to watch him draw up his doses and ensure he was getting the right amount of insulin.

“It’s also a double check that he is safe now that he lives alone and is out in the country away from neighbors,” says Shelby.

Shelby has also accompanied Lloyd to doctor’s appointments, helping him understand the doctor’s orders and how to follow them once at home. She spends time working with Lloyd on improving his diet to help control blood sugar levels.

“We discuss his diet in depth. I take a look in his fridge and we talk about better food choices he can ask his daughter to buy,” explains Shelby. “There is a list of good and bad carbohydrates written on the freezer door as a reference as well.”

Living alone—especially for the first time in nearly 60 years—can make anyone lonely. The companionship that comes along with Shelby’s regular visits is something Lloyd also appreciates.

“Lloyd has something to look forward to,” shares Shelby.

“He cleans and gets his supplies ready for my visit. I’m able to keep him company and guide him through his medications and doses. I feel better having that check every two weeks to ensure he is safe at home. By seeing his home environment I can help him with any safety issues he may have and encourage safe travel using his walker or cane.”

Shelby gets more out of the visits than just caring for Lloyd’s conditions. She is able to keep a closer eye on Lloyd

Lloyd appreciates the care and companionship he receives from Shelby. while making an important connection with her member.

Lloyd, who retired as a bus driver after almost 48 years, actually used to drive Shelby’s daughter to school. Shelby didn’t know him at that time, but her daughter expressed how much she enjoyed having him as her bus driver. Outside of her routine visits for work, Shelby has taken her two children to visit and spend time with Lloyd.

“I enjoy spending time with Lloyd, talking about his wife and helping him through the grieving process, on top of working together to manage his conditions,” says Shelby.

Lloyd appreciates the care and companionship he receives from Shelby. He looks forward to her visits and is glad it something she is able to do as part of her job.

“She’s very good at what she does and it’s nice that she can come visit me at home,” says Lloyd. “I enjoy getting a visitor for a couple hours every few weeks.”

Important Member Resources

D

o you know how health plans make their decisions? Visit NetworkHealthMedicare.com and click on the Member’s Corner section. Next, scroll down to the Resources heading and click How Health Plans Make Their Decisions. You’ll learn important information about service and appropriateness of care. On the same page, you’ll also find helpful information on to how access to our care management staff.

To request a printed copy, or if you have any questions about Network Health’s utilization management process, decision or criteria call our utilization management department Monday - Friday, 8 a.m. to 5 p.m. at 920-720-1602 (TTY 800-947-3529).

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NetworkHealthMedicare.com

wellness Important Tests for Diabetics

The Sooner the Better I f you have diabetes, you probably already know your condition can cause other health problems. But, did you know there are certain screenings available that can help you prevent complications? Here are some fast facts about common tests that can protect your health.

The test

When should you get it?

How can you prevent complications?

Why is it important?

Diabetics v Diabetic eye disease can affect should get a anyone with diabetes. comprehensive v Between 40-45 percent of dilated eye exam Americans with diabetes have at least once a some stage of diabetic year. Do not wait retinopathy, according to the for symptoms.

National Institutes of Health. v Early detection is very important because often times your retina can be badly damaged before you notice any change in vision.

Kidney screening Diabetics should v Early detection is very important to have a urine test make changes before kidney This test helps that looks for a you learn your failure. protein called risk for kidney v About one third of people with albumin once a disease. diabetes develop kidney disease, year. according to the Centers for Disease Control and Prevention. v Failing kidneys lose their ability to filter out waste products, causing kidney disease. v When kidney disease is diagnosed early, several treatments can keep kidney disease from getting worse.

Dilated retinal eye exam This helpful screening detects signs of diabetic retinopathy

Because everyone’s health needs are unique, make sure to check with your doctor for specific guidelines.

NetworkHealthMedicare.com

WHAT’S THAT?

v Control blood sugar v Control blood pressure

v Control blood sugar and blood pressure. v Know what symptoms to look for. The first symptoms of kidney disease often include the following.

• Fluid build up • Loss of sleep • Poor appetite • Upset stomach • Weakness • Headache

DIABETIC RETINOPATHY

A group of eye conditions that can cause vision loss or even blindness.

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wellness

Ensuring the Service You Deserve t Network Health, we make every effort to ensure our members are receiving the service they need and deserve. We believe that’s a big part of the reason 98 percent of our members stay with us.* But if concerns arise, we want to make sure you understand all your options. If you do not agree with Network Health’s decisions about your care or what’s covered, you have the right to file an appeal. If you believe any of the following, you can file an appeal. v Network Health will not approve or give you care it should cover. v Network Health is stopping care you still need. v Network Health has denied payment for services or items you received that are not covered, and you think they should be covered.

You must file your appeal in writing within 60 calendar days after the date of the denial. Although, if you have a good reason for missing the deadline, we can give you more time.

Who may file an appeal?

You or someone you name to act for you (called your authorized representative) may file an appeal. You can name a relative, friend, advocate, attorney, doctor or someone else to act for you. If you’d like to do this, you and the person you choose must sign, date and send us a statement naming that person to act for you. To learn how to name your authorized representative, call your health care concierge.

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How do I file an appeal?

You can send us your appeal by faxing it to 920-720-1908 or writing to us at the address below.

Network Health Insurance Corporation Attn: Appeals and Grievances P.O. Box 120, Menasha, WI 54952 What happens after I file an appeal?

If you appeal, we will review our decision. After we review our decision, if payment for any of your claims is still denied, we will automatically forward your appeal request to the CMS Contractor (MAXIMUS Federal Services) for an independent review. This process is provided by Medicare for a new and impartial review of your case outside of Network Health. If you disagree with that decision, you will have further appeal rights and you’ll be notified of those rights from MAXIMUS Federal Services.

How can I file a complaint?

If you’re dissatisfied with the service or quality provided by your plan, we’re here to work with you through any issues. You have the right to file a grievance (a formal compliant) about how Network Health provided services. Examples of situations appropriate for a grievance include the following. v Difficulty getting through on the phone v Concerns about the quality of care of services provided v Interpersonal aspects of care (for example, rudeness of a provider or staff) v Failure to respect your rights You can submit your grievance over the phone or in writing within 60 calendar days from the date of the event.

Call us at 800-378-5234 (TTY 800 947-3529), Monday - Friday, 8 a.m. to 8 p.m. or write to Network Health Insurance Corporation, P.O. Box 120, Menasha, WI 54952.

We will complete a full investigation as quickly as your case requires and let you know the results no later than 30 calendar days from the date we received your request. If we need more time to make a determination, we’ll let you know about that extension within 24 hours.

NetworkHealthMedicare.com

2016

Stress free guide to the Annual Enrollment Period Follow the simple steps in this guide to make sure you’re in the right plan for 2016

NetworkHealthMedicare.com

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STEP 1

Know Your Needs

Everyone’s health care and insurance needs are different. To find the plan that fits you best, consider the following questions.

w Are you eligible for a Medicare Advantage plan?

To qualify, you’ll need to live in the plan’s service area

and have Medicare Parts A and B. Check out the map to see Network Health’s service area.+

w Do you take prescription medications?

OCONTO SHAWANO PORTAGE

If yes, you’ll need a plan that includes drug coverage.

w Do you want your own personal health care concierge?

With Network Health, you have direct

access to your own customer service professional located right here in Wisconsin.

OUTAGAMIE WINNEBAGO

BROWN

MANITOWOC

WAUSHARA* CALUMET MARQUETTE GREEN FOND DU LAC LAKE SHEBOYGAN

+NetworkPrime (MSA) is available throughout the State of Wisconsin. *Network PlatinumSelect and Network PlatinumPlus are not available in Waushara county.

STEP 2

KEWAUNEE

WAUPACA

DODGE

Do Your Research

Each health plan offers different coverage. When shopping for health insurance, make sure to think about the following important questions.

w What is the out-of-pocket maximum?

The yearly limit on your costs for medical services. And, it is one of the most important things to consider. To protect your pocketbook, make sure to pay attention to this amount.

w What is the plan’s deductible?

Some plans have a deductible (the amount you pay before the plan begins paying). Our Network

PlatinumPlus and Network PlatinumPremier plans offer a $0 deductible.

w What doctors and hospitals can I go to?

You can save money by visiting in-network doctors and hospitals that have a contract with Network Health. To search doctors, visit NetworkHealthMedicare.com and click Find a Doctor. Or, call us for a hard copy list. With NetworkPrime, you don’t have to worry about in-network. Any provider that accepts Medicare should also accept NetworkPrime.

w Are my drugs covered?

Before choosing a plan, make sure to review the list of covered drugs (called a formulary).

This will help you understand what your prescription medications will cost. Visit NetworkHealthMedicare.com and click Look Up Medications to search the most up-to-date list.

Or, call us for a hard copy.

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NetworkHealthMedicare.com

All costs listed are for in-network services.

A QUICK SUMMARY Deductible Premium

Network PlatinumPlus (PPO) Network PlatinumPlus Network PlatinumSelect (PPO) Pharmacy (PPO)

Network PlatinumPremier (PPO) Network PlatinumPremier Pharmacy (PPO)

$150 $0 per month (Includes drug coverage) $4,900 per year combined (in and out-of-network)

$0 $76 per month With drug coverage: $107 per month $3,400 per year combined (in and out-of-network)

Primary Care Office Visit

$16.25 per visit

$15 per visit

Specialist Visit Urgent Care Hospital Stays

$50 per visit $16.25 copayment $300 copay per day for days 1-5. $80 copay per day for days 6-20.

You pay nothing for days 21 and beyond. $75 per visit $250 copayment $395 copayment per visit $0 copayment

$40 per visit $15 copayment $150 copay per day for days 1-20.

You pay nothing for days 21 and beyond.

$0 per visit $0 per visit $0 each day for a Medicarecovered stay

$75 per visit $250 copayment 20% coinsurance per visit $0 copayment

$65 per visit $0 copayment $0 per visit $0 copayment

Out-of-Pocket Maximum

Emergency Room Ambulance Outpatient Services Annual Wellness Visit with Lab Tests Preventive Services Platinum Fitness

$0 $194 per month With drug coverage: $275 per month $1,900 per year in-network; $5,000 per year (combined in and out-of-network) $0 per visit

Plan covers all Medicare-covered Plan covers all Medicare-covered Plan covers all Medicare-covered preventive services at $0 preventive services at $0 preventive services at $0 ** Up to $432 per year toward a full Up to $432 per year toward a full Up to $432 per year toward a full gym membership for health club gym membership for health club gym membership for health club providers available in our network. providers available in our network. providers available in our network. **Other health club providers are available in our network. Participating YMCAs in Wisconsin.

Network PlatinumSelect (PPO)

This plan has a $0 monthly premium and includes medical and prescription drug coverage. It can be a good match if you don’t use a lot of health care services and would rather pay copayments instead of a monthly premium.

Network PlatinumPlus (PPO) or Network PlatinumPlus Pharmacy (PPO)

This plan offers a $0 deductible, low copayments and a low out-of-pocket maximum. It has great medical coverage and is available with prescription drug coverage to help you pay for your medications. If you’re looking for a plan with comprehensive coverage at an affordable price, this plan may be a good fit for you.

Network PlatinumPremier (PPO) or Network PlatinumPremier Pharmacy (PPO) If you’d rather not pay copayments when you use health care services, this plan provides that option. You’ll pay more for your monthly premium, but you’ll pay $0 for most services when you use them. Drug coverage can be included, too. If you don’t like having a copayment every time you visit the doctor, or if you go to the doctor a lot and need care often, you might want this plan.

WHAT’S THAT?

PPO

PPO stands for preferred provider organization. It’s a type of plan where you have the freedom to choose any doctor, but you’ll pay less when you use doctors and hospitals in the plan’s network.

NetworkHealthMedicare.com

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NetworkPrime (MSA)

Once again, Network Health is offering a Medicare Medical Savings Account (MSA) plan that puts you in control of your health care dollars. Here’s how it works.

This is a unique Medicare Advantage plan which covers your hospital and medical care (known as Medicare Parts A and B). Once you’ve paid a certain amount for health care (called the deductible), the plan begins paying.

Medicare MSA Plans Have Two Parts

High-Deductible Health Plan

NetworkPrime has a $5,000 deductible and a $0 monthly premium.

Medical Savings Account

This is a special savings account used for health care costs. Once a year, the plan deposits money into your account, and you can use this money to pay for health care before you meet the deductible.

NetworkPrime deposits $2,000 into this account once a year.

BENEFIT Premium Deductible

NetworkPrime $0 $5,000

Annual deposit Network Health puts into your savings account

Network Health will deposit $2,000 into your medical savings account (prorated based on when you enroll).

Services like hospital stays, doctor visits and emergency room visits

All Medicare-covered services are billed at the Medicare-approved amount until you reach the deductible. You pay nothing after you reach your deductible.

Engage wellness program

This is an optional benefit. You’ll get a Fitbit® Zip™ and up to $75 in gift card rewards for making healthy choices. This program is available for a monthly payment of $6.20.

WHAT’S THAT?

MEDICARE MSA PLAN

This is a special type of Medicare Advantage plan that combines a high-deductible health insurance plan with a medical savings account. MSA plans are offered by private companies like Network Health and work with Medicare to provide your coverage. You can use the medical savings account to pay for health care services, while the high-deductible plan limits your out-of-pocket costs.

NetworkCares (PPO SNP)

Did you know we also offer a plan for Medicare members with special needs? If you receive both Medicare and Medicaid, you may be eligible. This plan includes medical and drug coverage, plus eye and dental benefits and your own health care team. To learn more, call 800-983-7587 (TTY 800-947-3529), Monday through Friday, 8 a.m. to 8 p.m.

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NetworkHealthMedicare.com

Cost for a One-Month Supply of Drugs INITIAL COVERAGE

Network PlatinumSelect Network PlatinumPlus Pharmacy

COVERAGE GAP

CATASTROPHIC COVERAGE

You pay 58% and Network Health pays 42% for generic drugs. For brand name drugs, you pay 45%, Network Health pays 5% and the drug company pays 50%.

You pay the greater of $2.95 or 5% of the cost for generic drugs and $7.40 or 5% of the cost for brand name drugs.

When your coverage starts, you You enter the coverage pay copayments until total drug gap when total drug You enter catastrophic costs (what you and Network Health costs reach $3,310. coverage when what pay) reach $3,310 you pay reaches $4,850. $200 drug deductible for tiers 3, 4 and 5 You pay 58% and Network You pay the greater of $2.95 Health pays 42% for generic or 5% of the cost Preferred Non-Preferred drugs.

For brand name for generic drugs and $7.40 Pharmacy Pharmacy drugs, you pay 45%, Network or 5% of the cost $2 for Tier 1 $4 for Tier 1 Health pays 5% and the drug for brand name drugs. $8 for Tier 2 $13 for Tier 2 company pays 50%. $42 for Tier 3 $45 for Tier 3 $85 for Tier 4 $90 for Tier 4 28% for Tier 5

Network PlatinumPremier Pharmacy

Preferred Pharmacy $2 for Tier 1 $8 for Tier 2 $42 for Tier 3 $85 for Tier 4

Non-Preferred Pharmacy $4 for Tier 1 $13 for Tier 2 $45 for Tier 3 $90 for Tier 4

33% for Tier 5

WHAT’S THAT?

NETWORK PHARMACIES

We have contracts with pharmacies to provide you prescription drugs. That means you must use these network pharmacies for your drugs to be covered.

See our Pharmacy Directory for a list, or click Search Pharmacies on our website at NetworkHealthMedicare.com.

STEP 3

TIER

This is the cost-sharing level that a drug is assigned to.

Generally, the higher the tier the more you pay.

Tier 1 - Preferred generic $2 or $4 Tier 2 - Non-preferred generic $8 or $13 Tier 3 - Preferred brand $42 or $45 Tier 4 - Non-preferred brand $85 or $90 Tier 5 - Specialty 28% or 33%

Make Your Choice

w If your current plan is still the best fit, then you’re all set.

There isn’t anything else you need to do.

Any changes to your plan will start on January 1.

w If you think you want to switch to one of our other plans, call your health care concierge or Network Health agent and he or she will help you out.

The benefit information provided is a brief summary, not a complete description of benefits. Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. You must continue to pay your Medicare Part B premium unless otherwise paid for by Medicaid or by another third party. The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary. Contact the plan at 800-378-5234 (TTY 800-947-3529) for additional information.

NetworkHealthMedicare.com

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MEMBER EXTRAS

As a Network Health member, you’ll also have access to the following at no additional cost.

NO WORRIES WHILE TRAVELING

If you like to travel to visit family and friends, or head south for the winter, you can relax knowing you’re still covered when you’re away from home. w We cover emergency care worldwide up to a certain amount. w When you’re outside Wisconsin, anywhere in the U.S., you can get care at the same cost you would at home.

In-network when you travel

SUPPORT TO KEEP YOU HEALTHY

w Services like home health assessments and health coaching are provided at no cost. w Access to programs, workshops and educational materials that can help you manage conditions like COPD, diabetes and heart disease. w Help from a team of registered nurses who can personally work with you to manage your health.

HEALTH CARE CONCIERGE SERVICE

Your own, personal health care concierge right here in Wisconsin. You’ll have a direct line to this person, and he or she can act on your behalf and assist you in any way you need–making Medicare that much easier.

QUESTIONS? If you don’t understand something, it’s our job to make it easier. Call 800-378-5234 today. TTY users call 800-947-3529. We’re available Monday – Friday, 8 a.m. to 8 p.m.

(From October 1 – February 14, we’re here every day, 8 a.m. to 8 p.m.)

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NetworkHealthMedicare.com

CONDITION MANAGEMENT PROGRAMS

If you have a health condition, you also have access to a team of registered nurses who can provide information and educational resources to help you manage your condition.

Here are a few things they do. w Offer educational workshops and events in your community w Healthy Living with Diabetes workshop w Living Well with Chronic Conditions workshop w Falls prevention workshop called Stepping On w Help you monitor your condition and offer opportunities for you to successfully manage your health w Promote healthy lifestyle behaviors such as exercise and eating right w Support communication between you and your doctor w With your permission, work with a caregiver or family member to educate them about your condition so they can best care for you

ONE-ON-ONE HELP

Our care management program connects you with a Network Health registered nurse who works with you to– w Review medications and treatments and answer any questions you may have w Help you develop your own support system and a personal health record w Inform you about signs your health is worsening, and when you should contact your doctor w Work with your health care providers to make sure they’re aware of changes to your health

$0 FOR SERVICES TO KEEP YOU HEALTHY

If you’re a Network PlatinumSelect, Plus, Premier or Cares member, did you know many preventive services are 100 percent covered? That’s right. Services that help you avoid getting sick–like immunizations, screenings, tests and your annual wellness visit–often won’t cost you anything.

To learn more, call your health care concierge or visit the Member’s Corner section of NetworkHealthMedicare.com. In the Discover Healthy Benefits section, you’ll find a helpful checklist that explains what services might be recommended for you.

WHAT’S THAT?

PREMIUM

The set monthly amount you pay for your plan.

MEDICAREAPPROVED AMOUNT

Medicare sets specific amounts a doctor or health care provider can be paid.

NetworkHealthMedicare.com

DEDUCTIBLE

The amount of money you must pay, not including premiums, before the insurance company begins paying for services.

OUT-OF-POCKET MAXIMUM This is the yearly limit on your total costs for medical services.

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1570 Midway Pl. Menasha, WI 54952 Health or Wellness or Prevention Information

Meet Penny Koehler

To help you get to know the Network Health team a little bit better, watch for a feature on a different associate in every issue of our newsletter.

P

enny Koehler is an important part of the Network Health team. Each fall, she helps organize and facilitate Network Health’s community meetings throughout Wisconsin. At the meetings, people have an opportunity to learn about our Medicare Advantage plans and see which plan is the best fit for them. Penny understands that Medicare can be confusing, but she’s here to help.

What should everyone know about the Annual Enrollment Period?

“This is the one time of year that everyone can change their Medicare health plan. Make sure to review your current plan and the changes to it (be on the lookout for your Annual Notice of Changes packet in the mail). If you decide your coverage needs have changed, you don’t have to look far, because Network Health has many affordable plan options to choose from.”

What is the most important thing to consider when comparing plans?

“When comparing plans, make sure you know what doctors you can see. Some plans may restrict your access to doctors. At Network Health, you don’t have to worry about that since you have the freedom to choose any doctor, but you’ll pay less when you use doctors and hospitals in our network. It’s also important to consider the prescription drug coverage a plan offers. Remember— if you do not add prescription drug coverage when you are first eligible (and you do not have coverage that’s as good as or better than Medicare Part D coverage) and you choose to add it later, you will have to pay a penalty.”

How can you be sure you are in the right plan for the upcoming year?

“All Network Health Medicare Advantage plans offer great coverage and personal, local service. As long as you make sure you have drug coverage included (if you need it), you can’t go wrong.”

How are Network Health Medicare plans different?

“First and foremost is our customer service. We’re located right here in Wisconsin and have real people answering your calls, helping you with your health insurance needs. Beyond that, our plans are different because Network Health strives to offer unique benefits like our wonderful travel benefit–great coverage no matter where you are in the United States.”

How does Penny spend her free time?

“In the fall, I like going for rides to see the colors.

My son is also in a fall baseball league, so that keeps my husband Andrew and I pretty busy this time of year. Plus, we have two dogs, Ivan and Marshall (both beagle mixes) who are always ready to be walked and enjoy the outdoors.”