Sanford Health Plan Member Messenger Newsletter Winter 2018

MEMBER

MESSENGER Winter 2018

In each issue: Provider Updates Benefit Information Finding a Specialist

Formulary

Changes to the Pharmacy Benefit Manager

Benefits Update

Possible changes to your benefits

Cost Estimator Calculating cost

Colorectal Cancer Screening

HPV

What to know

BEHAVIORAL HEALTH Finding help and treatment

Trouble Sleeping

Finding balance and catching some Zzzs

Tips to Reduce Stress

in the New Year

sanfordhealthplan.com

Formulary Changes to the Pharmacy Benefit Manager As of January 1, 2019, OptumRx will be Sanford Health Plan’s Pharmacy Benefit Manager.

To prepare for this transition, we recommend you should: • L et your doctor know your pharmacy benefit is moving to OptumRx. • C heck to see if you have refills remaining on your prescriptions.

• E nsure you have at least a one-month supply of medication on hand during the transition if you are using home delivery.

• W atch for information by mail if you need to transfer your prescriptions for any specialty medication.

Once your coverage begins, there are a few things on your to-do list.

• L og in to your Member Portal at sanfordhealthplan.com/memberlogin and select “Prescription Information” under the Quick Links menu.

• R eview your Covered Medication List (Formulary) before filling your first prescription to check for lower cost options or if pre-approval from the Plan is necessary.

• C onfirm your pharmacy is still in-network. There were minimal changes to the pharmacy network, but we recommend you check this information with each new plan year. Log in to your Member Portal and select “ Find a Provider or Pharmacy” from the Quick Links menu.

• W hen filling your first prescription, be sure to have your new Member ID card as the pharmacy information will be different. Sanford Health Plan will mail a new card before January 1.

Questions about OptumRx?

Visit their website at optumrx.com or call (866) 833-3463.

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Benefits Update

Possible changes to your benefits As the new year approaches, we want you to be aware of some changes that may affect your benefits.

Pregnancy coverage • Only tests defined as routine per the American College of Obstetrics and Gynecologists will be paid at 100 percent.

• All non-routine tests will be processed per your benefit plan.

Immunizations • Vaccines will now have limits. If a combination vaccine is received, the single option will only be covered if under the quantity limit for the year.

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Allergy •A llergy testing and treatment will be applied to your deductible and coinsurance.

Nutrition •O nly Registered Dietitians can bill for medical nutrition therapy (MNT).

Cardiac Rehabilitation • The limit increased to 36 per year in alignment with the National Institutes of Health’s recommendations.

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Wig coverage •U p to $200 in coverage will be available if hair loss is due to a medical reason. Deductible and/or coinsurance may apply.

Call Sanford Health Plan if you have questions about these benefit changes.

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Cost Estimator Calculating cost

If you’d like additional information on the expected cost of your care, there are several resources available to you.

• C ost estimate site fairhealthconsumer.org – Provides estimates based on national claims data for a specific service.

• S anford Financial Clearance Center – If you plan to receive care at a Sanford Health facility, you can receive an estimate on anticipated charges with your insurance benefits applied in one to two business days. Visit sanfordhealth.org or call (800) 709-4274 to learn more or request an estimate by phone.

To request an estimate, you’ll need the following information: • Description of the treatment/service • Expected date of service • City and state where service will be provided • Provider name if known • Insurance information

If you need help understanding how your benefits may be applied for a specific service, please contact Customer Service by calling the number on the back of your ID card.

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Colorectal Cancer SCREENING

HPV

It’s important to know the risk factors for colorectal cancer, which include:

HPV, also known as the human papillomavirus, is a virus that can cause certain cancers and diseases in both males and females.

Unfortunately, because HPV often has no signs or symptoms, many people who have the virus don’t even know it.

• Smoking • F amily history of inflammatory bowel disease, colorectal polyps or cancer, or Lynch Syndrome • Age • Weight There are a number of different screening options, but the best way to find the one for you is by talking to your doctor. You'll find some questions below to help you get the conversation started.

• When should I begin to get screened?

• Which test is right for me?

• How do I prepare for the screening?

• When will I get my results?

• How often should I get screened?

What to know about HPV

But there is a vaccination available to help prevent the six different cancers associated with HPV. Vaccination recommendations • F irst dose between 11 and 12 years, but can start as early as 9 • S econd dose 6 to 12 months after first dose • T eens and young adults who start the series at ages 15 through 26 need three doses of HPV vaccine • T hree doses are recommended for people with certain immune conditions?

Or recommended for those who may be immuno-compromised between the ages of 9 and 26.

You may want to discuss the following questions with your provider about the HPV vaccine.

• I s the vaccine safe?

• W hat are the symptoms of HPV? • H ow do you get HPV?

Contact your doctor today to schedule an appointment. Don’t have a doctor? Contact us and we’ll help you find one.

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Behavioral Health Help for mental wellness Did you know that nearly one in five U.S. adults live with a mental illness? That’s 44.7 million people.

Mental illnesses include many different conditions that vary in degree of severity from mild to moderate to severe.

The primary care setting provides half of all mental health care.

Adults with serious mental illnesses and substance use disorders have a higher rate of chronic illness. It’s also been shown that adults with common physical health conditions, like diabetes and heart disease, are also at a higher risk of mental health issues. By bringing mental health, substance abuse and primary care experts together, patients can experience integrated care.

This means one connected team is helping you along your health care journey, addressing all of your needs whether they are physical, behavioral or both. This collaborative approach to care helps deliver positive outcomes and more cost-effective care.

BEHAVIORAL HEALTH RESOURCES Finding help and treatment Suicide Prevention Lifeline (800) 273-TALK (8255) | TTY: (800) 799-4889 suicidepreventionlifeline.org This 24-hour, toll-free, confidential suicide prevention hotline is available to anyone in suicidal crisis or emotional distress. Calls are routed to the nearest crisis center in the national network of more than 150 crisis centers.

SAMHSA's National Helpline (800) 662-HELP (4357) | TTY: (800) 487-4889 samhsa.gov/find-help/national-helpline Also known as, the Treatment Referral Routing Service, this helpline provides 24-hour free and confidential treatment referral and information about mental and/or substance use disorders, prevention, and recovery in English and Spanish.

Disaster Distress Helpline (800) 985-5990 samhsa.gov/find-help/disaster-distress-helpline Stress, anxiety and other depression-like symptoms are common reactions after any natural or human-caused disaster. Call this toll-free number to be connected to the nearest crisis center for information, support and counseling.

Veteran's Crisis Line (800) 273-TALK (8255) | TTY: (800) 799-4889 veteranscrisisline.net Connects veterans in crisis (and their families and friends) with qualified, caring Department of Veterans Affairs responders through a confidential, toll-free hotline, online chat, or text.

Behavioral Health Treatment Services Locator Find alcohol, drug or mental health treatment facilities and programs around the country at findtreatment.samhsa.gov.

Buprenorphine Physician & Treatment Program Locator Find information on locating physicians and treatment programs authorized to treat opioids, such as heroin or prescription pain relievers, at samhsa.gov/medication-assisted-treatment/physicianprogram-data/treatment-physician-locator.

Early Serious Mental Illness Treatment Locator Find treatment programs in your state that treat recent onset of serious mental illnesses such as psychosis, schizophrenia, bi-polar disorder, and other conditions at samhsa.gov/esmi-treatment-locator.

Opioid Treatment Program Directory Find treatment programs in your state that treat addiction and dependence on opioids, such as heroin or prescription pain relievers, at dpt2.samhsa.gov/treatment/.

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Trouble Sleeping

Finding balance and catching some Zzzs If you find yourself struggling to fall asleep, you’re not alone.

This common ailment can be tied to your lifestyle habits. This includes: • Inconsistent sleep schedule • Stress • Too much light exposure before bed • Too much caffeine • Exercising too late If fixing those lifestyle habits doesn’t help, you might suffer from insomnia. This is the inability to get to sleep or sleep well at night. This might be caused by stress, jet lag, a health condition, the medications you take or even the amount of coffee you drink. Insomnia can also be caused by other sleep disorders or mood disorders such as anxiety and depression.

Try not to force yourself to sleep. Tossing and turning only amps up the anxiety. Get up, leave the bedroom and do something relaxing, such as reading, drinking a cup of herbal tea or taking a bath. When you’re sleepy, go back to bed.

Keeping a sleep diary can also help you identify things that may be keeping you from sleeping, what helps you fall asleep and what may be keeping you up.

If you’ve tried a variety of self-help remedies without success, schedule an appointment with a sleep specialist or ask your family doctor for a referral to a sleep clinic, especially if: • Y our main sleep problem is daytime sleepiness and self-help hasn’t improved your symptoms.

• Y ou or your bed partner gasps, chokes or stops breathing during sleep.

• Y ou sometimes fall asleep at inappropriate times, such as while talking, walking or eating.

Provide your doctor with as much supporting information as possible, including information from your sleep diary.

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Provider Update To see the most current list of providers, visit sanfordhealthplan.com/ memberlogin

Benefit Information For additional Health Plan benefit information, visit sanfordhealthplan.com/ memberlogin or call Customer Service at (800) 752-5863.

Finding a Specialist If your doctor refers you to a specialist, but the specialist is not available as soon as you would like, you have options.

Ask the clinic if a similar specialist is available or call Sanford Health Plan Customer Service.

Tips to Reduce Stress in the New Year A new year can mean the stress of resolutions, financial stress and more. Try to keep in mind these four tips for a stress-free new year.

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CONTACT US memberservices@ sanfordhealth.org

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(800) 752-5863 TTY: (877) 652-1884 Language Line: (800) 892-0675

SVHP-2876 Rev. 12/18

Accept imperfection – Be ready to accept and go with whatever happens. Sometimes the unexpected moments turn into the best memories.

Reflect on your accomplishments from the past year – Think of the things you’ve accomplished and how much growth you’ve experienced this year. No matter how large or small that list may be, take time to reflect and see how far you’ve come.

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Choose something you will do for yourself in the coming year – Think of something you’ve been wanting to do and give yourself permission to follow through with it.

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Have a Positive Outlook – Have you ever heard that smiles are contagious? People want to be around happy people, not the opposite. Be a trend setter and smile.