The Local 1014 Health Line - Winter 2019

ISSUE 9 Winter 2019

THE 1014 HEALTH LINE

Photo by Greg Doyle

Trustees Message How the Local 1014 Health Plan Works Understanding Opioid Addiction Explanation of Dental Benefits Member XG Live Health Online

INSIDE

Protecting Firefighters & Their Families...FOR LIFE

BOARD OF TRUSTEES MESSAGE

BOARD OF TRUSTEES MESSAGE

The Local 1014 Health Plan Board of Trustees is proud to present the Winter 2019 Edition of the Health Line.

Your Local 1014 Health Plan Board of Trustees is dedicated to providing the highest level of service to our members while remaining on the cutting edge of the healthcare. To that end, all our Trustees are members of The International Foundation of Employee Benefit Plans (IFEBP). IFEBP is the leading educational organization dedicated to providing objective, solution-oriented education, research and information for over 8,200 organizations worldwide.

The Local 1014 Health Plan Board of Trustees attended the 65th Annual IFEBP Conference. Local 1014 Health Plan Trustees attended seminars on topics including: healthcare legislation, communications and social media, diabetes management, investment strategy, behavioral health, data security, and streamlining the claims and appeals process. These learning opportunities allow our Board to continue to effectively provide innovative benefits to meet our Firefighters’ unique needs.

As we close out the year, we are reminded of the great strides we have made this year towards providing the most comprehensive healthcare for our members and their families. From increased dental benefits and occupational therapy benefits to new fertility benefits and hearing care, The Local 1014 Health Plan successfully implemented over 14 new or enhanced benefits in 2019. With 2020 approaching we are looking to expand our coverage even more to meet your needs and fulfill our mission of protecting Firefighters and their families for life through excellence, quality, collaboration, and stewardship.

The Local 1014 Health Plan Board of Trustees would like to wish you and your loved ones a happy and HEALTHY Holiday Season and a joyous New Year. It is an honor to serve our fellow members of the Los Angeles County Fire Department and their families.

The Local 1014 Health Plan Board of Trustees would like to wish you and your loved ones a happy and HEALTHY Holiday Season and a joyous New Year.�

HOW THE HEALTH PLAN WORKS

How The Local 1014 Health Plan Works Whether you just enrolled in The Local 1014 Health Plan or if you’re already covered by our Plan, below are some important insurance terms for your reference. A more comprehensive explanation of the details and coverage below can be found in the 2019 Summary Plan Description at www.local1014medical.org.

Annual Deductible Each calendar year, you must meet the annual deductible before The Local 1014 Health Plan will begin to pay most covered expenses.

There are two types of deductibles:

1. Individual deductible: $200 per person (the deductible applies separately to each covered person)

2. Family deductible: $600 per family. When the combined individual deductible of three or more

family members equals the family deductible amount, the family deductible is met. If you cover only

yourself and one dependent, the individual deductible applies to each of you. Expenses incurred in one

calendar year cannot be used to meet the deductible for the following calendar year.

Note: Prescription drug, dental, and vision expenses do not apply to the annual deductible.

Coinsurance Once you meet the deductible, you share cost with The Local 1014 Health Plan (this is called coinsurance). When you go to an in-network provider, The Local 1014 Health Plan will pay 90% of most allowable expenses and you will pay the balance. When you go to an out-of-network provider, The Local 1014 Health Plan will pay 70% of reasonable and customary charges and you pay the balance.

Copayments For certain covered expenses, you pay a predetermined fee called a copayment or “copay.” For emergency room visits, a separate copayment of $50 applies to each visit when the covered person is not admitted directly from the emergency room to the hospital for continued necessary acute care. The emergency room copay does not apply in the case of an accident, when directed to the emergency room by a physician, when the covered person is transported by ambulance or if there is a reason to believe that the covered person has an emergency medical condition.

Out-of-pocket limit To protect you from mounting medical bills resulting from serious illness of injury, The Local 1014 Health Plan limits the amount of coinsurance you must pay each year after you meet the annual deductible.

o If you use in-network providers, your annual out-of-pocket limit is 10% of allowable expenses,

up to $1,000 for individual or family coverage.

o If you use out-of-network providers, your annual out-of-pocket limit is 30% of allowable

expenses, up to $1,500 for individual or family coverage, plus any amounts above reasonable

and customary charges.

Note: The $1,000 in-network out-of-pocket limit is combined with, or counts towards, the $1,500 out-of-network limit.

Once you have reached the annual out-of-pocket limit after meeting your deductible, The Local 1014 Health Plan will pay 100% of allowable expenses, up to the specific Plan limits, for the remainder of that calendar year. Annual deductibles, prescription drug or other copayments, non-covered expenses and amounts that exceed reasonable and customary charges do not count toward your out-of-pocket limit.

OPIOID ADDICTION Continued

Understanding Opioid Addiction The mission of The Local 1014 Health Plan is to care for the whole person and address a broad range of issues in order to improve the overall health and quality of life for our members and their families. With that in mind, we are always trying to not only provide excellent healthcare for our members but also health education for them and their families.

As many of you have seen on the job, the United States has been battling with an opioid crisis over the past several years.

While our first responders face challenges treating members of the public affected by this crisis, some of our first responders are also fighting their own battle with opioid addition in private. Whether it is a symptom of post-traumatic stress from a lifetime of bad calls or the result of an injury, opioid use and addiction is a serious issue and one that needs to be addressed immediately in order to prevent long-term health effects.

Anyone who takes opioids is at risk of developing addiction. Your personal history and the length of time you use opioids play a role, but it’s impossible to predict who is vulnerable to eventual dependence on and abuse of these drugs.

Unlike other drugs opioids can be prescription medication and are often prescribed for common injuries and illnesses but until recently their prescription frequency was not monitored. In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to opioid pain relievers and healthcare providers began to prescribe them at greater rates. The increased prescription of opioid medications led to widespread misuse of both prescription and non-prescription opioids before it became clear that these medications could indeed be highly addictive.* “Opioids are highly addictive, in large part because they activate powerful reward centers in your brain,” an article from the Mayo Clinic states. “Opioids trigger the release of endorphins, your brain’s feel-good neurotransmitters. Endorphins muffle your perception of pain and boost feelings of pleasure, creating a temporary but powerful sense of well-being.

When an opioid dose wears off, you may find yourself wanting those good feelings back, as soon as possible. This is the first milestone on the path toward potential addiction.”**

THE OPIOID EPIDEMIC BY THE NUMBERS

130+

People died every day from opioid-related drug overdoses3

People misused prescription opioids in 20181

(estimated)

47,600

2.0 million

81,000

808,000

2 million

15,349

People died from overdosing on opioids2

According to the National Survey on Drug Use and Health, it is estimated that over 10 million people misused prescription opioids last year. Additionally, over 130 people per day died from opioid-related overdoses totally over 47,000 deaths last year alone. The National Survey on Drug Use and Health also revealed that up to 29% of first responders nationwide engage in some form of substance abuse and as many as 10% may be currently abusing prescription drugs.

If you are not sure if you or a loved one is suffering from opioid addiction, please take the self-assessment. If you checked yes to any or all of these questions, you may be at risk of developing an addition. Seek help immediately. Do not wait. The most important step to avoiding opioid addiction is recognizing that no one is immune.

10.3 m

People used heroin for the first time1

People misused prescription opioids for the first time1

32,656

People had an opioid use disorder in 20181

People used heroin in 20181

Deaths attributed to overdosing on heroin (in 12-month period ending February 2019)2

Deaths attributed to overdosing on synthetic opioids other than methadone (in 12-month period ending February 2019)2

SOURCES 1. 2019 National Survey on Drug Use and Health. Mortality in the United States, 2018 2. NCHS Data Brief No. 329, November 2018 3. NCHS, National Vital Statistics System. Estimates for 2018 and 2019 are based on provisional data.

Updated October 2019. For more information, visit: http://www.hhs.gov/opioids/

Sources: *U.S. Department of Health and Human Services: Help Resources and Information on the National Opioid Crisis; https://www.hhs.gov **Mayo Clinic Online Article “How Opioid Addiction Occurs”; https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372 ***Opiate Addiction Self-Assessment Screening Quiz: https://www.rehabs.com/assessments/opiate-addiction-quiz/

OPIOID ADDICTION

Opioid Use Self-Assessment Test YES

NO Do you spend a lot of time acquiring, using, or recovering from the effects of using opiates?

Do you often use opiates for a longer time than you originally intended?

Do you often use opiates in greater doses than you originally intended?

Because of your opiate use, have you failed to meet obligations and responsibilities at home, work, or school?

Have you suffered relationship issues or social problems because of your opiate use and kept using opiates anyway?

Have you been forced to reduce or abandon your social or recreational activities due to your continued use of opiates?

Have you taken opiates when it was physically dangerous to do so, such as while operating a motor vehicle or machinery, or in other unsafe situations?

Have you often wanted to cut back on your use of opiates?

Have you tried unsuccessfully to reduce your use of opiates?

Do you experience powerful cravings and strong urges to use opiates?

Have you continued using opiates even when you knew this was worsening your physical or mental health issues?

When discontinuing prolonged use of opiates, have you experienced muscle aches, insomnia, a runny nose, nausea, vomiting, fever, diarrhea, yawning, sweating, or an uneasy mood? (Please answer “No” if you are only taking opiates as directed under medical supervision.)

Have you continued or resumed taking opiates to avoid or relieve these symptoms? (Please answer “No” if you are only taking opiates as directed under medical supervision.)

After taking the same dose of opiates for a period of time, have they had a reduced effect on you? (Please answer “No” if you are only taking opiates as directed under medical supervision.)

Have you found yourself needing to take larger doses of opiates for the effect you wanted? (Please answer “No” if you are only taking opiates as directed under medical supervision.)

DENTAL BENEFITS

The Local 1014 Health Plan Dental Benefit Explained Over the past several years, The Local 1014 Health Plan has expanded the dental benefit significantly for our members. All dental expenses must be performed by or under the direction of a dentist and be medically necessary.

Excess Dental Coverage One of the most unique features of The Local 1014 Health Plan is the Excess Dental Coverage benefit.

The Local 1014 Health Plan will reimburse 100% of your out-of-pocket expenses under your underlying dental plan, up to a maximum of $1,500 per covered person per calendar year. This benefit is available regardless of the underlying dental plan in which you are enrolled.

Orthodontia The Plan will pay 100% of covered expenses for orthodontia treatment, up to a maximum benefit of $3,000 per person per lifetime. Any licensed orthodontist can be used. You or your orthodontist must submit a treatment plan and periodic claims to received payment. Once lifetime maximum is reached you can use your excess dental coverage to pay for orthodontia.

Dental Implant Coverage The Plan will pay 100% of the charges up to a maximum benefit of $2,500 per lifetime. Once lifetime maximum is reached you can use your excess dental coverage to pay for implants.

What is a Dental Implant?

A dental implant is a metal post that replaces the root portion of a missing tooth. An artificial tooth (crown) is placed on an extension of the post (abutment) on the dental implant, giving you the look of a real tooth.

Dental implants are often selected over dental bridges.

Dental Accident Coverage If you have a non-occupational accidental injury to the teeth, the Plan will pay 100% of dental expenses related to your accident, up to a maximum benefit of $10,000 per accident. Expenses must be incurred within 180 days of the accident.

For more information on our dental benefit view the Summary Plan Description (page 47) at www.local1014medical.org.

MEMBER XG

TAKE ADVANTAGE OF OUR FEATURE TODAY! Local 1014 Health Plan members can find the answer to questions about your medical benefits anytime, using any internet-connected computer, tablet – even your smartphone!

Your secure login gives you 24/7 access to your personal medical benefits details and status, as well as important plan documents and updates. Sign on any time, any day, from anywhere you can access the internet, and quickly get the information you need. There is no charge for this service!

SIGNING UP IS EASY

and can be done TODAY at www.local1014medical.org, click Member XG! All you need is: Name Address Date of Birth Social Security Number

NOTE:

When registering all fields must match EXACTLY in order to create an account. One email address per user. For security, you will be asked to verify your identity each time you login from a new device.

As part of our efforts to improve accessibility to services and make healthcare more convenient for you, The Local 1014 Health Plan offer access to Live Health Online. Visit with a doctor 24/7 and get prescriptions if needed—ALL ONLINE! The Local 1014 co-pay for this service is only $15 per session.

CONTACT INFORMATION: The Local 1014 Health Plan 3460 Fletcher Avenue El Monte, CA 91731 800-660-1014 medicalplan@local1014.org local1014medical.org

Photo by Juan Guerra