For Your Benefit - WA Fully Insured Spring 2018

BENEFIT

SPRING 2018 | FI

FOR

HEALTHALLIANCE.ORG

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Power Up Your Health Explore our blog to unlock your journey to better health. Go to Blog.HealthAlliance.org for all these features and more.

Learn how to save Ask For Generics.

big

on

your

meds

with

Discover our disease resources to manage asthma, blood pressure, cholesterol and diabetes.

Find food

healthy labels,

Read team

personal stories from and other employees.

Follow

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living tips on exercising, reading going to the doctor and more. our

community

on social media for daily and health-related tips.

outreach

recipes

Begin your quest and connect to all of your plan information and materials on our member site, YourHealthAlliance.org.

Go paperless by accessing member materials and more •

Sign

•

Print

•

Manage vision

•

Find doctors, hospitals covered by your plan.

•

Compare costs Calculator.

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View past and current claims, and Explanations of Benefits.

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Clear Your Path with Our Mobile App Connect to your coverage on the go and find your way through many obstacles with our brand-new Your Health Alliance mobile app. Download the app from the App Store or Google Play to see all it can do for you.

You A.Be

You have a sore throat and don’t know whether to go to the doctor.

A.Call the Anytime Nurse Line.

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PHARMACY

You have strep throat and found out it can be treated with an antibiotic. Take as your doctor prescribes and rest easy knowing you're getting the right treatment.

Fully Insured Essentials

Customer Service Is Here to Help Call 1-877-750-3517, TTY 711, Monday through Friday, 8 a.m. to 5 p.m. PT.

We can help you with questions about claims, coverage, appeals, pharmacy issues, preauthorization, utilization management and information about the doctors, clinics and hospitals we work with. After normal business hours, leave a message, and your call will be returned the next business day. Please note that all non-urgent review requests received after normal business hours will be recorded as being received the next business day.

Please call Customer Service if any of your personal information has changed, including: • Name • Address • Phone number

Keep Your Plan Materials Handy

To make the most of your benefits, read the plan materials you received when you first joined the plan. These materials are a convenient source for quick information about your coverage.

If you need additional copies of your plan materials, please contact Customer Service or log in at YourHealthAlliance.org.

Find Answers Online*

Find convenient answers to your questions online anytime at HealthAlliance.org. It has information about your coverage and our processes, such as: • Member rights and responsibilities • Our most recent HEDIS® and CAHPS® scores • Rally® **, our health management tool • Medical and pharmaceutical management policies and procedures, including how we review new technology

• Number of dependents • Primary care physician, if applicable • Other insurance *If you don’t have Internet access, you can request printed copies of the materials on the Health Alliance Northwest website by calling Customer Service.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

• How to file a complaint or appeal, including your right to involve an external review organization • Which benefits and services are included and excluded from your coverage in and out of the service area • How to get emergency care, primary care, specialty care and behavioral health services during and after normal business hours in and out of service area • How to get information about in-network physicians and hospitals, including searching for providers Register and log in at YourHealthAlliance.org today to: • View eligibility • Check the status of a claim • Learn how to submit a claim • Order a new ID card • View the Drug Formulary, evaluate drug interactions and determine financial responsibility for prescriptions • View your deductible and find your copayments or coinsurance • Read the Health Alliance Northwest notices of privacy practices • View your plan materials Visit HealthAlliance.org, or sign up for a username and password by going to YourHealthAlliance.org and registering as a member. **If you don’t have internet access, health surveys, self management tools and rewards are also available by mail or phone. To participate, call the number on the back of your ID card.

We Speak Your Language

If you are more comfortable speaking a language other than English, try our telephone translation service, Language Line.

We provide access to interpreters who speak 200 different languages. Simply call the Customer Service number listed on the back of your ID card and tell them which language you speak. If you need documents translated into a different language, you may request them by calling 1-877-750-3517.

Si usted necesita un interprete para traducir esta información, por favor llamar al teléfono gratis 1-877-750-3517 y pregunte por la “Language Line.” Si usted necesita documentos tradujeron a un idioma diferente, usted puede solicitar que llamando 1-877-750-3517.

Better Service, Better Care

Health Alliance Northwest Quality and Medical Management Departments continually strive to provide programs and tools to help members and providers promote healthy lifestyles. Our goals are to identify special needs of the populations we serve, establish clinical care and service standards for those populations based on industry standards, and measure performance outcomes while adhering to regulatory and plan requirements. After improvement opportunities are identified, we respond with appropriate interventions to improve care and service and then measure their effectiveness. Through regular monitoring and an annual evaluation, we continue to meet the goals we have set. To view our complete program, go to HealthAlliance.org/Why.

Some examples of our initiatives include: Clinical Guidelines Health Alliance Northwest encourages contracted doctors to consult nationally recognized standards, called clinical guidelines, when providing care to members. These evidence-based treatment suggestions have been developed to help doctors choose appropriate healthcare treatment for specific medical conditions. Doctors can review the guidelines on the Health Alliance Northwest website or contact the Quality Management Department at 1-800-851-3379, extension 8112, option 2, for a copy.

HEDIS® and CAHPS® Health Alliance Northwest participates in the annual Healthcare Effectiveness and Data Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) data collection programs through NCQA. HEDIS is the measurement tool used by the nation’s health plans to evaluate their performance in terms of clinical quality and customer service. HEDIS scores also allow those who are purchasing health insurance to compare the healthcare quality of different health plans. CAHPS® is a nationally recognized survey tool that measures members’ satisfaction with their health plans. To view the most recent HEDIS and CAHPS® scores for Health Alliance Northwest, go to HealthAlliance.org/Why.

Health and Wellness

To help you achieve and maintain your best possible health, Health Alliance Northwest offers disease management programs for members with asthma, diabetes and high blood pressure. For more information or to enroll, call 1-800-851-3379, extension 8112, and select option 2.

Other great resources are available to you on our Health and Wellness page: • Quit For Life® smoking cessation program • More information about Rally, our health management tool that helps motivate you with online missions, support and rewards • Immunization program for adults and children • Our blog, which features articles on health, wellness and insurance subjects • More information about our disease management program • Exclusive discounts at various gyms, health clubs and weight loss centers • Nutrition information and recommended preventive services To learn more, visit HealthAlliance.org/Health-and-Wellness.

Pharmacy Benefits and Management Procedures

The Health Alliance Northwest Drug Formulary lists the preferred and most frequently used brand-name drugs. It also contains information on other pharmacy management procedures and processes, such as generic substitution, step therapy, preauthorization, managed dose limits and other limits or quotas.

To view the Drug Formulary online, log in at YourHealthAlliance.org.

Go to the Plan & Benefits tab, and choose the Your Drug Benefits button under the “Prescription Drugs Benefits” section. You may request a paper copy of the Drug Formulary or any other pharmacy materials on the website by calling the Health Alliance Northwest Pharmacy Department at 1-800-851-3379, option 4.

Physicians may request a Medical Exception for a medication on behalf of a member or request more information by calling the Health Alliance Northwest Pharmacy Department at 1-800-851-3379, option 4. Specific information required from the provider is detailed in our online Drug Formulary. The Medical Exception decision may be appealed by contacting Health Alliance Northwest Pharmacy at 1-800-851-3379, option 4.

Vaccine Options

You can get a vaccine at any in-network pharmacy that carries the vaccine you need. The pharmacy could require a prescription for certain patients and for some vaccines. Call your pharmacy to ask if you need a prescription and to check that the pharmacy has the vaccine you need.

To find in-network pharmacies, call Customer Service at the number on the back of your ID card or choose the Find a Pharmacy button on HealthAlliance.org/Pharmacy. If you get a vaccine in a doctor’s office instead of the pharmacy, you might have an office visit copay.

Members Have the Right to an External Review

Appeals are divided into two categories: administrative decisions and denials of coverage based on medical necessity. If coverage for a procedure or health service has been appealed and continues to be denied based on medical necessity, you have the right to an independent third-party review. An independent (or external) review is a review of the Health Alliance Northwest decision conducted by an organization that specializes in dispute resolution.

The external reviewer has no direct financial interest in connection with the case, and the member will not be charged for external review. In most cases, an external review can be conducted; however, all lines of appeal must have first been exhausted. For more information about this option, please read your policy or call the Member Relations Department at 1-800-500-3373.

Health Alliance Northwest Ensures Reasonable Access to Services

Health Alliance Northwest is committed to providing members with efficient, cost-effective and quality healthcare coverage.

Health Alliance Northwest employees never encourage decisions that result in underutilization of care. We do not give financial inducements or set quotas for issuing denials of coverage or care; nor do we keep statistics identifying individual providers and their denial rates. Coverage decisions made by our medical

directors, nurse coordinators, pharmacy coordinators and pharmacists are based only on appropriateness of care and service and the existence of coverage. There are no incentives, financial or otherwise, to encourage barriers to care and services.

Switching from Pediatric to Adult Care

If you’re ready to switch from pediatric (child) to adult health care or have a child who is ready, there are lots of options.

Pediatricians typically see children from birth to age 18, but you can stay with your pediatrician if the relationship works. You can choose a primary care physician (PCP) who works in family practice, general practice or internal medicine. To change your PCP or get a list of in-network doctors, call Customer Service at 1-877-750-3517 or log in at YourHealthAlliance.org.

A Choice for Women

Females enrolled in a managed care plan can select a Woman’s Principal Health Care Provider (WPHCP) in addition to a primary physician. WPHCPs are licensed to practice medicine in all its branches and specialize in obstetrics, gynecology or family practice. You may visit a WPHCP without a referral from your primary physician. For more information on selecting a WPHCP, call our Customer Service Department at 1-877-750-3517.

Breast Reconstruction Surgery Is Covered

If you’ve had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomyrelated benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: • All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses; and • Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under your plan. Therefore, plan deductibles, copays and coinsurance may apply. If you would like more information on WHCRA benefits, see your plan materials or contact Customer Service.

We Respect Your Privacy

Protecting the privacy of your medical information is a responsibility we take very seriously. Health Alliance Northwest follows the Health Insurance Portability and Accountability Act (HIPAA) and other applicable state and federal regulations to ensure that your information is kept confidential. This means we will only use and disclose your information in ways that are permitted by law. If you would like a complete copy of our website Privacy Policy or our Notice of Privacy Practices, please contact the Customer Service Department. This information is also available on any of our websites at the bottom of the page.

DISCRIMINATION IS AGAINST THE LAW Health Alliance Northwest complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Health Alliance Northwest does not exclude people or treat them differently because of race, color, national origin, age, disability or sex. Health Alliance Northwest: • Provides free aids and services to people with disabilities to communicate effectively with us, such as: o Qualified sign language interpreters o Written information in other formats (large print audio, accessible electronic formats, other formats) • Provides free language services to people whose primary language is not English, such as: o Qualified interpreters o Information written in other languages If you need these services, contact customer service.

If you believe that Health Alliance Northwest has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Health Alliance Northwest, Member Services, 316 Fifth Street, Wenatchee, WA 98801, telephone: 1-877-750-3350 TTY: 711, fax: 217-337-3425, MemberServices@healthalliance.org. You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, Member Services is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, TTY: 1-800-537-7697.

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

ATENCIÓN: Si habla Español, servicios de asistencia lingüística, de forma gratuita, están disponibles para usted.

Llame 1-877-750-3350 (TTY: 711). 注意：如果你講中文，語言協助服務，免費的，都可以給你。呼叫1-877-750-3350（TTY: 711）。 UWAGA: Jeśli mówić Polskie, usługi pomocy języka, bezpłatnie, są dostępne dla Ciebie. Zadzwoń 1-877-750-3350 (TTY: 711).

Chú ý: Nếu bạn nói Tiếng Việt, các dịch vụ hỗ trợ ngôn ngữ, miễn phí, có sẵn cho bạn. Gọi 1-877-750-3350 (TTY: 711). 주의 : 당신이한국어, 무료 언어 지원 서비스를 말하는 경우 사용할 수 있습니다. 1-877-750-3350 전화 (TTY: 711). ВНИМАНИЕ: Если вы говорите русский, вставки услуги языковой помощи, бесплатно, доступны для вас. Вызов 1-877-750-3350 (TTY: 711).

Pansin: Kung magsalita ka Tagalog, mga serbisyo ng tulong sa wika, nang walang bayad, ay magagamit sa iyo.

Tumawag 1-877-750-3350 (TTY: 711). ‫ ﺍﺳﺘﺪﻋﺎء‬. ‫ ﺗﺘﻮﻓﺮ ﻟﻚ‬، ‫ ﻣﺠﺎﻧﺎ‬، ‫ ﺧﺪﻣﺎﺕ ﺍﻟﻤﺴﺎﻋﺪﺓ ﺍﻟﻠﻐﻮﻳﺔ‬، ‫ ﺇﺫﺍ ﻛﻨﺖ ﺗﺘﺤﺪﺙ ﺍﻟﻠﻐﺔ ﺍﻟﻌﺮﺑﻴﺔ‬:‫ﺗﻨﺒﻴﻪ‬1-877-750-3350 (TTY: 711).

Wenn Sie Deutsch sprechen, Sprachassistenzdienste sind kostenlos, zur Verfügung. Anruf 1-877-750-3350 (TTY: 711).

ATTENTION: Si vous parlez français, les services d'assistance linguistique, gratuitement, sont à votre disposition.

Appelez 1-877-750-3350 (TTY: 711). ધ્યા: તમે વયત તો �ુજરયતી, ભયષય સહય્ સેવયઓ, મફત, તમયરય મયટ� ઉપલબ્ છે . કૉલ 1-877-750-3350 (TTY: 711). 注意：あなたは、日本語 、無料で言語支援サービスを、話す場合は、あなたに利用可能です。 1-877-750-3350コール（TTY: 711）。 LET OP: Als je spreekt pennsylvania nederlandse, taalkundige bijstand diensten, gratis voor u beschikbaar zijn. Bel 1-877-750-3350 (TTY: 711). УВАГА: Якщо ви говорите український, вставки послуги мовної допомоги , безкоштовно, доступні для вас. Виклик 1-877-750-3350 (TTY: 711).

ATTENZIONE: Se si parla italiano, servizi di assistenza linguistica, a titolo gratuito, sono a vostra disposizione.

Chiamare 1-877-750-3350 (TTY: 711). cmp-nondiscnotice15NW-0617

316 Fifth Street Wenatchee, WA 98801

Healthy Apple “Donut” Slices with Coconut Cream Cheese Frosting Ingredients

Preparation

2 apples

1. In a mixing bowl, whisk together the cream cheese, yogurt, vanilla, coconut oil and food coloring (if using) until smooth and creamy, about 1 minute. Refrigerate while preparing apples or until you’re ready to use it.

4 ounces whipped cream cheese 4 ounces honey Greek yogurt (or plain) 1 tablespoon coconut oil (can omit if desired) 1/2 teaspoon vanilla extract

2. Slice apples and remove each core from center using a knife or pastry tip.

2 drops food coloring (optional)

3. Spread frosting on top of each apple slice.

Sprinkles

4. Dust with preferred sprinkles.

Nutrition 154 calories; 9 g fat; 6 g saturated fat; 17 mg cholesterol; 13 g sugar; 113 mg sodium; 18 g carbohydrate; 2.5 g dietary fiber; 3 g protein; 86 mg potassium.

Servings: 4 (Recipe modified from TheQuikChik.com.) com-NWFIFYB-0118