For Your Benefit - Fall 2016

Fall 2016

FOR BENEFIT

HealthAlliance.org

Understand Your Plan, Good for a First Down

You should never have to punt when it comes to health care. That’s why we give you the tools you need to better understand your coverage and helpful tips to use it to its fullest.

Whether it’s fourth-and-inches or fourth-andlong, knowing how your health plan works isn’t something you want to give up on. So keep your offense on the field, and let’s go for it with this issue of For Your Benefit.

Touchdown, E

-Deliv

ery Choose e-de livery when yo u log on to YourHe althAlliance.o rg for a faster w ay to access yo ur Explanation o f Benefits (EO Bs) and some other m aterials, depe nding on your plan type. It’s quic k, easy and secure, so we’d say that ’s a win.

Give a Gold Star Have you had a great experience with somebody at Health Alliance? If so, you can give that person a Gold Star as a special way to say thanks. We’ll share your story with that person and his or her manager and peers. And we might even use it in ongoing employee recognitions. You can thank someone today at HealthAlliance.org/GoldStar.

Here’s a peek at this issue’s lineup.

• Overview of what qualifies you for a special enrollment period • Inside look at case management and health coaching • Breakdown of in- and out-of-network care guidelines • Tasty tailgating recipe

Certain Life Changes

Could Score You an SEP (Special Enrollment Period)

You can usually only make a plan change once a year, but certain situations could qualify you for a special enrollment period (SEP), allowing you to make a plan change outside of your normal enrollment period.

Check out the image to the right for examples of what might qualify you for an SEP and some examples of what won’t.

Each SEP has its own rules and timeframe, and some plans might have different SEPs, so check your plan materials or call the number on the back of your ID card for more info.

IT’S GOOD!

• Having a baby • Adoption • Gaining citizenship • Marriage

MISSED! • Internal job transfer • Not paying your premium • Choosing to end your coverage • Buying a vacation home

These are examples, not a complete list. Check your plan materials for your plan’s specific SEPs.

Health Coaches, Case Managers Draw Up Big Plays for Your Health

If you’re trying to make a healthy lifestyle change or dealing with an ongoing health issue, like a high-risk pregnancy or major illness, health coaches and case managers can help you create a game-winning strategy.

These programs are not a substitute for care from your doctor.

We team up with you and your doctor to make sure your game plan is working.

To learn more or add a health coach or case manager to your health team at no extra cost to you, call 1-800-851-3379, ext. 8112.

✔ Help you reach nutrition, weight management and physical activity goals ✔ Help you know what it takes to manage a chronic disease

✔ Help you transition from hospital to home ✔ Coordinate care across multiple providers ✔ Help you manage long-term health issues

✔ Teach self-care and lifestyle skills ✔ Give you educational materials and resources ✔ Keep you, your providers and your caregivers connected ✔ Help you make the most of your healthcare benefits ✔ Give you over-the-phone support

Don’t Fumble Your Healthcare Coverage

It’s important to know how your plan’s in- and out-of-network coverage works. That way, you won’t run up unexpected costs.

Your health plan gets discounts from in-network doctors, hospitals and pharmacies and passes those discounts to you. Out-of-network providers don’t give these discounts to your plan.

When your plan saves money, you do, too. Generally, the amount you pay for in-network copays and coinsurance is lower than what you pay for out-of-network care. You also have separate deductibles and separate out-of-pocket maximums for in- and out-of-network care, and they will be lower in-network.

For out-of-network care, most plans only pay up to the Maximum Allowable Charge (MAC)*, which is based on how much Medicare would pay in a similar situation. You have to pay anything over that amount, and it does not apply to your out-of-pocket maximum.

*Some self-funded plans might base their payments on something other than the MAC. Check your plan materials. ^Your in- and out-of-network coverage might not be the same.

Check your plan materials.

You have healthcare coverage.

You are sick.

Is it urgent/ an emergency?

Yes

No

You have in- and out-of-network coverage.^

Is your doctor in-network?

Yes

You will pay in-network coinsurance or copays, plus anything left on your in-network deductible.

You won’t have coverage.

No

Are you on an HMO plan?

Yes

Are you OK with paying out-of-network costs?

Yes You will pay anything over the MAC*, plus coinsurance or copays and anything left on your out-of-network deductible.

No

No

Find an in-network doctor at YourHealthAlliance.org.

301 S. Vine St. Urbana, IL 61801

Southwest Layered Bean Dip Servings: 12 Serving size: About 1/2 cup

Ingredients

1 16-ounce can nonfat refried beans, preferably spicy 1 15-ounce can black beans, rinsed 4 scallions, sliced 1/2 cup prepared salsa 1/2 teaspoon ground cumin 1/2 teaspoon chili powder 1/4 cup pickled jalapeĂąo slices, chopped 1 cup shredded Monterey Jack or cheddar cheese 1/2 cup reduced-fat sour cream 1 1/2 cups chopped romaine lettuce 1 medium tomato, chopped 1 medium avocado, chopped 1/4 cup canned, sliced black olives (optional)

Preparation 1. Combine refried beans, black beans, scallions, salsa, cumin, chili powder and jalapeĂąos in a medium bowl. Transfer to a shallow 2-quart microwave-safe dish. Sprinkle with cheese.

2. Microwave on high until the cheese is melted and the beans are hot, 3 to 5 minutes.

3. Spread sour cream evenly over the hot bean mixture. Then scatter with lettuce, tomato, avocado and olives (if using). com-ILFYB-0616

Nutrition 145 calories; 7 g fat; 3 g saturated fat; 15 g carbohydrate; 7 g protein; 5 g fiber; 12 mg cholesterol; 332 mg sodium; 255 mg potassium; 2 g sugar.

(Recipe from eatingwell.com)