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Health

A Publication for Teachers Health Trust Participants

raxx Fall 2017│Volume 16, Issue 4

For Teachers by Teachers

OPEN ENROLLMENT

HOW TO MAKE CHANGES TO YOUR HEALTH PLAN FOR 2018

TRIMMED UP HOLIDAYS

ENJOY THE SEASON WITHOUT DERAILING YOUR HEALTHY HABITS

VOLUME 16, ISSUE 4

MERRY, MERRY, MISERABLE

ARM YOURSELF AND STAY HEALTHY THIS COLD AND FLU SEASON

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FALL 2017 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG


contents FALL 2017 VOLUME 16, ISSUE 4

14

8

10

in this issue 4

RX SAVINGS SOLUTIONS

5

FREQUENTLY ASKED QUESTIONS

6 8

How to save money on your prescriptions

Your questions answered

WHO SHOULD I CALL?

When to call a Healthcare Advocate or Member Services

TRIMMED UP HOLIDAYS

How to enjoy holiday favorites while staying on track

10 HIKES TO TAKE RIGHT NOW

Five spectacular hikes right in our backyard

14 THE 411 ON

MAMMOGRAMS

How to prepare for your exam and what to expect

17 SUGAR SABOTAGE

Are sweets keeping you from your goals?

18 YOUR HEART AND

DIABETES MEDICATION

Exciting new drug findings for those on diabetes medication

19 IN-NETWORK SPOTLIGHT Everything to know about HCA hospitals

20 WELLDYNE

Why claims get rejected

21 OPEN ENROLLMENT 2017

What you need to know to make changes to your health plan

22 MERRY, MERRY, MISERABLE

A handy guide on how to protect yourself this cold and flu season

23 VIRTUAL VISITS

How to schedule a virtual visit with MDLive

24 BACK TO SCHOOL 2017 Thank you for joining us

FALL 2017 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

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FAQ

Saving on your prescriptions just got easier.

The power of Rx Savings Solutions is now available in an app! Download the Rx Savings Solutions app today to view prescription pricing and easily access your personalized prescription savings. Search for Rx Savings Solutions on Google Play™ or the App Store®.

Questions? Contact member services.

Rx Savings Solutions member services team is staffed with Certified Pharmacy Technicians available to assist with prescription questions. They can be reached Monday – Friday from 7:00 AM – 8:00 PM CST at 1-800-268-4476 or info@rxsavingssolutions.com.

rxsavingssolutions.com

Rx Savings Solutions has partnered with your Teachers Health Trust to save all eligible participants money on prescriptions. We utilize your claims history to find opportunities to save money on medications you and your family are taking. Google Play and the Google Play logo are trademarks of Google Inc. Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc., registered in the U.S. and other countries.


FA Q

YOUR QUESTIONS ANSWERED Q: What is a referral? A: A referral is issued by (in most cases) your Primary Care Provider in order

facilitate ease of access to medical care from a specialist. It is a recommendation to seek further care from a provider more tailored to the care you need.

Q: Do I have to have a referral? A: No. You may forgo obtaining a referral to see a specialist as outlined within the Plan Document. However, please note that you will incur greater out-of-pocket costs when doing so without a referral in place.

Q: If my provider puts a referral in for me, does that mean I have an appointment already? A: No. Placing a referral into the system does not mean that you have an appointment. You still need to contact the provider’s office that you intend to visit in order to schedule an appointment.

Q: Do I need a referral to see a behavioral health specialist? A: No. You can contact the therapist of your choice to schedule directly. Be sure to call Human Behavior Institute Network to ensure that the provider you wish to see is an in-network therapist. You can also visit hbinetwork.com to search the provider network directory to verify. If you need to seek care beyond traditional therapy, your therapist will issue a referral.

Q: If someone in my family has a true emergency and cannot obtain a referral prior to getting care, will we be penalized? A: In the event of a true emergency, no referrals are required for

medical care. For the purpose of coverage, a true emergency is defined as seeing a provider in connection with an unforeseen injury or illness requiring surgical or medical attention within 24 hours after the onset, and from which, in the absence of such care, the participant could reasonably be expected to suffer serious physical impairment or death.

More questions?

We’re here to help!

Member Services can answer your questions about benefits, claims, billing and more. Contact the team by email at serviceteam@teachershealthtrust.org, or by phone at (702) 794-0272. FALL 2017 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

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WE’RE HERE TO HELP When you have questions involving in-network providers, scheduling appointments, claims status, adding or removing dependents and more, do you know who to call? At Teachers Health Trust, we have two teams dedicated to getting all of your questions answered quickly and clearlythe Healthcare Advocates and the Service Team. Both teams share a common goal of helping you navigate your healthcare and live your healthiest life.

Contact a

Contact the

HEALTHCARE ADVOCATE

SERVICE TEAM

if you need to...

if you need to...

Find an in-network provider

Ask in-depth benefit questions

Confirm your primary care provider

Get answers about eligibility questions

Schedule appointments for complex care medical conditions

Get help with referral management and coordination

Get information about prescription refills

Find or file a Provider Change Request form

Receive information regarding prescription costs or co-pays

Request, obtain or send medical records

Add or remove dependents from a policy

Discuss or enroll in Here’s to Health programs (diabetes,

Get policy payment or reimbursement information

heart health, high risk pregnancy and asthma/COPD)

Ask about claims or an explanation of benefit details

Ask questions regarding Telemedicine or Teletherapy

Ask billing questions

Contact Healthcare Advocates P: (855) 404-9355 | E: advocates@wellhealthqc.com

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FALL 2017 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

Contact the Service Team P: (702) 794-0272 | E: serviceteam@teachershealthtrust.org


Caring for you while caring about you. Coordinated care throughout the Las Vegas Valley for you and your family.

Make an appointment today

(702) 255-3547

Obstetrics & Gynecology|Pelvic Health|High-Risk Pregnancy Cardiology|Endocrinology|Anesthesia|Primary Care wellhealthmedicalgroup.com|

wellhealthmedicalgroup|

@whmedicalgroup

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Trimmed Holidays UP

W

ith the holidays approaching, it can be very easy to derail from your healthy habits and give in to larger portions, rich foods and a less active lifestyle.

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FALL 2017 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG


F E AT U R E S

A shift in mindset and with these few tips and tricks, you can still enjoy your holiday favorites and stay on track with your health goals.

HOLIDAY TRADITIONS

Create a tradition that does not involve food. Start a holiday challenge with coworkers, friends or family members, or join family and friends for a local holidaythemed run or walk.

MANAGE STRESSORS

Remember to stay active, as physical activity can help relieve stress. Also make sure not to bite off more than you can chew when volunteering to take on added duties through the holiday season.

COOKING ALTERNATIVES

Use vegetable or olive oil instead of butter. Opt for whole-grain breads and rolls instead of white. Try to bake, grill or steam vegetables and meats instead of frying or cooking in heavy sauces. For dips, try using plain Greek yogurt instead of things like sour cream and cream cheese.

try it!

guilt-free egg nog

DON’T GO HUNGRY

When heading to holiday gatherings bring a lighter version of your favorite dish, and remember to not skip meals earlier in the day. Going in hungry usually leads to overeating.

GO EASY ON APPETIZERS

Use a small appetizer plate to help control calories. Fill half your plate with items from the veggie tray. Keep portions of cheese, meats and creamy dips small as they are rather calorie dense. If possible, choose dips such as hummus or low-fat ranch dressing.

DON’T DRINK YOUR CALORIES

Specialty holiday beverages such as egg nog are loaded with calories. Try the lighter egg nog recipe! If choosing to drink, look for lighter options such as a light beer, wine or vodka with soda water, and limit yourself to one serving with your meal or during appetizers.

CREATE YOUR PLATE

When eating holiday meals, continue to practice healthy eating patterns. Fill half of your plate with non-starchy vegetables like green beans, carrots or salad. With the other half, use one quarter for starchy items like sweet potatoes, corn or a roll. Then use the last quarter of your plate for lean proteins like turkey, ham or chicken.

by Alissa Dougherty, MS, RD, LDN

SAVOR SWEETS

It’s okay to have dessert, but remember to keep portions small and enjoy each bite. You may want to share a dessert with a friend of family member.

BAKING SWAPS

When baking items, instead of butter try using equal parts of no sugar added applesauce. Substitute low-fat milk in recipes that may call for whole or heavy cream. Instead of sugar try a sugar substitute; for instance, a recipe that calls for one cup of sugar can be swapped for one teaspoon of liquid stevia. Whole wheat flour can be substituted one-for-one for all-purpose flour. Two egg whites can typically replace the need for a whole egg.

2 cups nonfat milk 2 large strips orange and/or lemon zest 1 vanilla bean 2 large eggs plus 1 egg yolk 1/3 cup sugar 1 tsp cornstarch White rum or bourbon (optional) Freshly grated nutmeg, for garnish Directions Combine 1 1/2 cups milk and the citrus zest in a medium saucepan. Split the vanilla bean lengthwise and scrape out the seeds; add the seeds and pod to the saucepan and bring to a simmer over medium heat. Meanwhile, whisk the eggs, egg yolk, sugar and cornstarch in a medium bowl until light yellow. Gradually pour the hot milk mixture into the egg mixture, whisking constantly, then pour back into the pan. Place over medium heat and stir constantly with a wooden spoon in a figure-eight motion until the eggnog begins to thicken, about 8 minutes. Remove from the heat and immediately stir in the remaining 1/2 cup milk to stop the cooking. Transfer the eggnog to a large bowl and place over a larger bowl of ice to cool, then chill until ready to serve. Remove the zest and vanilla pod. Spike the eggnog with liquor, if desired, and garnish with nutmeg. Source: foodnetwork.com

FALL 2017 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

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5

hikes to take right now

Now that the cooler weather is here to stay, relax and recharge with these fun hikes right in our backyard.

A Stanford University study found that spending time outdoors not only helps keep people physically fit, it also could lower your risk for depression. According to the study, going for a 90-minute walk in a natural area showed decreased activity in a region of the brain associated with a key factor in depression. As with all physical activity, please consult with your physician before trying any of these hikes, never hike beyond your limit and take plenty of water and snacks with you.

1

raintree

Hike Stats: Start of trail: North Loop Trailhead Mileage: 5.4 miles roundtrip Elevation gain: 1,584 feet Max elevation: 10,023 feet Pet-friendly: yes, leashed

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FALL 2017 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

Raintree Trail, Mount Charleston

Located in the Mount Charleston Wilderness, Raintree is fairly strenuous hike on the North Loop Trail. While the hike is only 2.7 miles one-way, it has an elevation gain of about 1,500 feet. The hike's name comes from the old bristlecone pine located at the turnaround point thought to be the largest and oldest tree (around 3,000 years old) in the Spring Mountains.

Photo by John Ridge


F E AT U R E S

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calico tanks Moving further south in the Vegas Valley, we find a host of trails for every fitness level in the Red Rock Canyon National Conservation Area. One of the most popular hikes is Calico Tanks, a medium difficulty 2.4-mile roundtrip hike up a canyon and over sandstone slickrock to the "tank." This hike does require some scrambling over boulders and light trail-finding skills. Since Red Rock is a state park, there is an entrance fee into the park. Hike Stats: Start of trail: Sandstone Quarry Trailhead Mileage: 3 miles roundtrip Elevation gain: 872 feet Max elevation: 8,585 feet Pet-friendly: yes, leashed, but not recommended Cathedral Rock Trail, Mount Charleston

Photo by Charles Oisten Calico Tanks, Red Rock Canyon

2

cathedral rock Also located in the Mount Charleston Wilderness, Catheral Rock is a popular hike overlooking Kyle Canyon. As with the Raintree hike, this hike is only 1.5 miles one-way, but is fairly strenuous due to elevation change. From the summit of the hike you can see the start of the trailhead and lodge and many peaks of the forest system. Hike Stats: Start of trail: Cathedral Rock Trailhead Mileage: 3 miles roundtrip Elevation gain: 872 feet Max elevation: 8,585 feet Pet-friendly: yes, leashed

Photo by Mark Harper FALL 2017 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

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F E AT U R E S

4

goldstrike Just south of Las Vegas in Boulder is Goldstrike Canyon. This hike runs along a rocky canyon to a series of natural hot springs, perfect for a quick soak after a 2-mile journey. Most of the trek is fairly easy; however, there is some scrambling over boulders, which may make visiting the springs difficult for pets and smaller children. Due to high temperatures, this trail is closed during the summer months, making it the perfect walk during the cooler months of fall. Hike Stats: Start of trail: Goldstrike Trailhead off Lakeshore Drive exit on Highway 93 Mileage: 4.5 miles roundtrip Elevation loss: 883 feet Max elevation: 1,580 feet Pet-friendly: yes, leashed, but not recommended

Photo byTravel Nevada Goldstrike Canyon

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valley of fire

Hike Stats: Start of trail: Parking Lot #3 inside the park Mileage: 1.2 miles roundtrip Elevation gain: negligible Max elevation: 3,009 feet Pet-friendly: yes, leashed Source: birdandhike.com

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FALL 2017 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

Valley of Fire

Much like Red Rock, Valley of Fire is famous for its red sandstone crags, often appearing striped. The crags are fossilized sand dunes from the age of the dinosaurs, formed some 150 million years ago. Once covered in trees, as evidenced by the petrified wood at several sites, the current terrain is dry and dominated by desert bushes. One of our favorite hikes here is the Fire Wave. A relatively easy hike perfect for pets and children, the highlight is the striped sandstone saddle known as Fire Wave. Also like Red Rock, Valley of Fire is a state park and all hikers are required to pay an entrance fee.

Photo by Dave Toussaint


Call to schedule a Mammogram appointment @ 1-855-445-2246 if you are 40 or over. • Most insurance plans accepted • Featuring 3D DIGITAL MAMMOGRAPHY • NAPBC Accredited 3006 South Maryland Parkway Suite 250

Open Monday - Friday

7:00 a.m. – 4:00 p.m.


F E AT U R E S

the 411 on

MAMMO GRAMS You just blew out the candles on your 50th birthday cake, which means it's time to add another screening to your list - the mammogram. But what do you need to do to prepare?

prepare for your visit WHY ARE MAMMOGRAMS IMPORTANT?

Schedule the test for a time when your breasts are least likely to be tender. If you haven't gone through menopause, that's usually during the week after your menstrual period. Your breasts are most likely to be tender the week before and the week during your period.

WHAT RISKS ARE INVOLVED?

If you're going to a new facility for your mammogram, request to have any prior mammograms placed on a CD, and bring the it to your appointment so that the radiologist can compare past mammograms with your new images.

Mammography is X-ray imaging of your breasts designed to detect tumors and other abnormalities. Mammograms have the potential to help detect breast cancer earlier. However, like most medical procedures, there are risks as well as benefits.

Mammograms expose you to low-dose radiation, though for most women the benefits outweigh the risks posed by this amount of radiation. Additionally, mammograms aren't always accurate. The accuracy of the procedure depends on the technique used, age and breast density. The breasts of younger women contain more glands and ligaments than those of older women, resulting in dense breast tissue that can obscure signs of cancer.

WHEN SHOULD I START SCREENING?

When to begin mammogram screening and how often to repeat it is a personal decision based on your preferences. Talk to your doctor about the benefits, risks and limitations of mammograms and decide together what is best for you. Some women may start screening at 40 or earlier, depending on their risk factor.

Avoid using deodorants, antiperspirants, powders, lotions, creams or perfumes under your arms or on your breasts. Metallic particles in powders and deodorants could be visible on your mammogram and cause confusion. Consider an over-the-counter pain medication, such as aspirin, acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others), about an hour before your test to ease the discomfort.

Source: mayoclinic.org

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5 THINGS YOU NEED TO KNOW ABOUT

3D

mammography

There is so much information out there today regarding screening mammography that it’s difficult to know what to do. The recent introduction of 3D mammography adds one more thing to consider. Let's clear up the confusion with the facts about this new technology.

40% increase in Cancer Detection

Not all 3D is the Same

15% Decrease in false positives

Are You Dense?

3D Mammography, or Digital Breast Tomosynthesis, is a breakthrough in breast cancer detection. When combined with standard 2D mammography, studies show up to a 40 percent increase in breast cancer detection as compared to using 2D mammography alone. This is a game-changer for women, especially those who have already been diagnosed with breast cancer and will need more frequent screening and added peace of mind.

A false positive is when a study is interpreted as showing an abnormality when in reality the study was normal. Tomosynthesis is an especially effective screening technique for women with dense breast tissue and has demonstrated a reduction in false positives by approximately 15 percent.

10% Decrease in subsequent imaging

Because standard 2D mammography is not as accurate as 3D, patients are sometimes called back to conduct additional exams such as breast ultrasounds, breast MRI and breast biopsies. As a patient, when you get that call to say that you need to come back for further testing, it causes a great deal of stress and anxiety. 3D mammography has been shown to decrease these stressful subsequent exams by 10 percent.

When evaluating the different 3D technology, one brand stood out – the GE SenoClaire system. Only GE’s system delivers a screening mammogram with no more radiation than standard 2D mammography. Unlike the Hologic “Genius” system, GE’s SenoClaire 3D exam is conducted simultaneously with the 2D mammogram, so it delivers NO more radiation than your previous 2D digital mammogram, and only takes a few more minutes. In this case, less is definitely more!

Forty percent of women in the U.S. have dense breast tissue, and dense breast tissue is the Achilles heel of standard digital mammography. Dense tissue shows up as white on a mammogram, as does cancer. 3D mammography overcomes this issue in the way that it creates the images. As the scanner sweeps over the breast in an arc, it takes the images (called slices) of the breast from all different angles, making it harder for cancer to hide. This greatly enhances our radiologists’ ability to detect abnormalities and identify suspicious structures in the breast more easily.

Still not sure if 3D Mammography is for you?

Don’t hesitate to call us with your questions, or get more information at: www.sdmi-lv.com/3Dmammogram. 3D mammography is available at all seven Steinberg Diagnostic Medical Imaging locations. Physician referral required. Call (702) 732-6000 to schedule yours today.

FALL 2017 | HEALTH TRAXX

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Sponsored by Steinberg Diagnostic Medical Imaging TEACHERSHEALTHTRUST.ORG


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FALL 2017 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG


F E AT U R E S

Sugar Sabotage Are sweets keeping you from reaching your goals?

Believe it or not, sugar, morphine and drugs like heroine all stimulate the same receptors in your brain that release pleasure hormones and endorphins that signal your body to calm and relax. Does this mean we can actually be addicted to sugar like many other dangerous substances? Absolutely! Since our brains are hardwired to like sugar, we need to take control so we can stay healthy. Sugar is linked to many diseases like heart disease, diabetes and irreversible kidney damage. While indulging in the occasional sweet treat is okay, the bigger problem is when we eat sugar-loaded foods every day. Sugar is added to most processed foods, so chances are if it's convenient, it's probably not giving you the nutrients your body needs.

Would you ever sit down and just eat 22 teaspoon of sugar?

"

"

Hopefully not, but that’s what many Americans do according to the American Heart Association. So how do we stop eating sneaky sugars? The biggest and most important step to take is to read the labels before you buy or consume anything. Sugar content is listed on every nutritional label in the form of grams. For example, a six ounce container of Greek yogurt typically has 15-19 grams of sugar, which is the equivalent of about four teaspoons of sugar, or an additional 75 calories! Every day strive to limit your total sugar intake to 24 grams if you're a woman, or 36 grams if you're a man.

9

WAYS TO CURB

SUGAR CRAVINGS

1. Get enough sleep every single night. 2. Cut sodas and juices. 3. Reach for nature's candy - fruit! Add a couple of slices of mango or pineapple to meals for a sweet treat packed with nutrients. 4. If you have to indulge, have a small portion (100 calories or less). Be careful though, as sometimes it's hard to stop at one serving. 5. Keep your pantry stocked with healthy food, then when cravings hit you have to go out of your way to satisfy them. The harder it is to get a treat, the less likely you are to overindulge. 6. Buy fresh fruit often, or try incorporating dried fruit into salads for a satisfying crunch. 7. Sip on some hot tea. 8. Take a multivitamin. Sometimes sugar cravings are your body's signal of a vitamin deficiency. 9. Chew on sugar-free gum.

Sources: heart.org, diabetes.org and nih.gov FALL 2017 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

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Your Heart & Diabetes Medication by Paul Tomasic, MD, MS, FACP, FACE

Once a decision is made that medication is needed to help control blood sugar in type 2 diabetes, the most common medications used have been the sulfonylureas (glyburide, glipizide, and glimepiride, for example) and metformin, or thiazolidinediones (pioglitazone, for example) and DPP-4 inhibitors (sitagliptin, saxagliptin, alogliptin, and linagliptin), or insulin, though insulin has traditionally been reserved for those patients who have been unable to control blood sugar with other non-insulin agents first. Two drug classes deserve special mention and are the focus of this article: glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists) and sodium-glucose co-transporter 2 inhibitors (SGLT-2 inhibitors). GLP-1 receptor agonists are medications that are injected, either on a twice daily, once daily or once weekly basis, that help prolong the action of the body’s own insulin, may serve as an appetite suppressant and also slow gastric (stomach) emptying. SGLT-2 inhibitors are oral medications taken once a day by mouth. SGLT-2 inhibitors work by blocking excess sugar from being reabsorbed back into the body by the kidneys and by sending excess sugar out of the body through the kidneys and into the urine. Both of these drug classes help to control blood sugar, but through very different mechanisms.

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In recent years, the federal government has required studies of new diabetic medications to show that these new medications do not cause harm, especially with regard to cardiovascular risk such as heart attack, blood vessel disease and stroke. Because of these studies, called cardiovascular outcome trials, new data is emerging that show medications used to control blood sugar can have beneficial effects unrelated to their blood sugar lowering effects. A study of empagliflozin, a SGLT-2 inhibitor, published in the New England Journal of Medicine in November 2015, found after 3.1 years there was a 14 percent reduction in heart attacks, strokes and cardiovascular death in those patients on empagliflozin. This is most likely due to a reduction of blood pressure, blood vessel volume and blood vessel stiffness.

"

Liraglutide is a GLP-1 receptor agonist that is injected once daily. In a study published in the New England Journal in July 2016, liraglutide also showed cardiovascular benefit.

After 3.8 years, the study found a 13 percent reduction in major adverse cardiovascular events.

"

Type 2 diabetes mellitus is a disease where there is either resistance to insulin action or deficiency of insulin production relative to the body’s needs, or both, that leads to high blood sugar levels. Uncontrolled diabetes mellitus can lead to complications including eye disease, kidney disease, nerve problems and cardiovascular (heart and blood vessel) disease. A diagnosis of type 2 diabetes mellitus is a life-changing event that requires proper nutrition, physical activity and usually diabetic medications in order to get blood sugar under control. In the U.S., about 30 million people have diabetes, so many people are now facing the all too familiar situation of caring for themselves or family members with this condition. Although lifestyle change involving nutrition and physical activity is the foundation of any type 2 diabetic treatment plan, this article will focus on the latest trends in development of medications to control and treat this disease.

This was for patients who were previously high risk for cardiovascular disease and took liraglutide during the study. This may be due to the direct action of liraglutide on the heart muscle, blood vessels and the nervous system.

Whether or not all diabetes medications within these two classes will have the same cardiovascular benefits as empaglifozin and liraglutide is an active area of research, and many more of these cardiovascular outcome trials are expected to be reported in the near future. These new studies may soon lead to changes in the way providers choose medications to treat patients with diabetes as well as changes in the order in which they use them. If you have type 2 diabetes mellitus, or if you help to care for a loved one with type 2 diabetes, be on watch for these changes while working with your healthcare providers.


F E AT U R E S

IN-NETWORK SPOTLIGHT ABOUT HCA stands for the best practices of medicine, using our reach, scale and stability to transform healthcare and help communities thrive. One of the nation’s leading providers of healthcare services, HCA is made up of locally managed facilities that include 174 hospitals and 119 freestanding surgery centers located in 20 U.S. states and in the United Kingdom. We are committed to delivering healthcare as it should be: patient-centered and for the good of all people, no matter their circumstance. To achieve this, we must be active; we must be kind. We must work with integrity, share our skills and never stop learning. Exceptional healthcare is built on a foundation of inclusion, compassion and respect – for our patients and for each other. We will foster a culture of inclusion across all areas no matter a person’s race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity or veteran status.

THE BENEFIT - OUTPATIENT HOSPITAL SERVICES Emergency Room - Hospital Charges, Emergency Services (True Emergency)

$250 (deductible does not apply)

Emergency Room - Hospital Charges, Non-Emergency Services

$400 (deductible does not apply)

Facility Charges - Outpatient, Ambulatory $400 per day; 800 max per stay Surgical Center, Observation (deductible does not apply) Facility Charges Copay does not apply to all other outpatient services Dialysis

20 percent coinsurance (deductible does not apply)

$20 (deductible does not apply)

Diabetic Education $0 copay (deductible does not apply) Your Selected PCP $10 copay for hospital consult; 20 percent (No referral required) coinsurance for all other services (deductible does not apply) Radiologist/Pathologist $0 copay (deductible does not apply) All Other Physician Charges Not Listed Above* (Including, but not limited to: Emergency Room Physician, Surgeon, Assistant Surgeon, Anesthesiologist, Hospitalist, Specialist Physician and PCP other than your selected)

20 percent coinsurance after $600 deductible

LOCATIONS MountainView Hospital │ Southern Hills Hospital & Medical Center │ Sunrise Hospital & Medical Center

FALL 2017 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

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Why Are My Claims Being Rejected?

There are many reasons why a prescription claim might not process, but some of the more common are listed below. Be sure to check your plan information to see whether any additional specifications may affect your prescriptions.

Step therapy

Refill-too-soon

Step therapy means that you must start with a similar, lower cost drug (Step One drug) before using a higher cost, brand medication. If the Step One drug doesn’t help, you can try another drug that may cost more (Step Two drug). This ensures you get medications that are safe and cost effective.

If you recently filled your prescription, you will not be able to request a refill until you have used most of it. The pharmacy bases the next refill date on the date you filled your current supply. This ensures that your medicine is being used appropriately and is not wasted.

Quantity level limits

What can I do? n

If your doctor thinks a Step Two drug will be more effective than a Step One medication, s/he can send a prior authorization form by fax to 888-473-7875, or call 866-240-2204 to speak to a Prior Authorization Specialist.

Prior authorization Prior authorization means that you must receive approval before you can receive certain drugs. This depends on your plan and the drug. Prior authorization ensures that your medications are safe and helpful for your condition. What can I do? n

Quantity level limit means that certain drugs are covered for only a limited amount. Limits are based on the manufacturer’s recommendations, FDA guidelines and WellDyneRx’ clinical review. What can I do? n

If your prescription is for more than the allowed amount, only the allowed amount will be covered by your plan, unless your doctor sends a quantity limit override request form to WellDyneRx. You or your doctor can call Member Services to request the form.

n

You can pay for the higher amount instead of using your plan benefits.

Ask your doctor to fax a prior authorization request to WellDyneRx at 888-473-7875. Your doctor can also call 866-240-2204 to talk to a Prior Authorization Specialist.

www.WellDyneRx.com

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FALL 2017 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

8.2016 ©WellDyneRx


TEACHERS HEALTH TRUST OPEN ENROLLMENT FAST FACTS WHAT IS OPEN ENROLLMENT?

FAQs

Open enrollment is the annual period to review and make any changes necessary to your coverage level, update life insurance beneficiary or to select/change your primary care physician (PCP).

Q. What if I do not have any changes that I need to make on my benefits? A. If you do not have any changes to be made, you will automatically continue with your current benefit structure moving into 2018. It is always recommended that you log into the open enrollment portal to ensure your chosen primary care provider is listed, your contact information is up to date and your dependent information is accurate.

During this time, you can also add or drop coverage for eligible dependents and enroll in the Section 125 Premium Only Plan (only if you are not currently enrolled). Open enrollment is not mandatory to continue on your current plan, however, it is recommended that you login and review your coverage.

HOW DO I ACCESS THE OPEN ENROLLMENT PORTAL? 1. To access the online enrollment site, go to afenroll.com/ TeachersHealthTrustEnroll. 2. At the login screen, you will enter the site using the following information: • •

Type in your nine digit Teachers Health Trust Member ID. Your PIN is the last four digits of your SSN and the last two digits of your birth year. For example, for SSN XXX-XX-6789 and birth year 1974, you would type in 678974.

3. Click the ‘Log on’ button. You may also complete open enrollment by scheduling an in-person, by-phone or virtual conference appointment with an American Fidelity Assurance Company representative by visiting: americanfidelity.com/ TeachersHealthTrustOpenEnrollment For information on portal troubleshooting, contact American Fidelity at 888-6591531, 6 a.m. to 7 p.m. PST.

2017 - 2018 Key Dates

• October 18, 2017

Open Enrollment Begins

• November 22, 2017 Last Day for Open Enrollment

• December 15, 2017 Last Day to Submit Documentation

• January 1, 2018

Open Enrollment Coverage Begins

Q. If I need to add a dependent, how do I submit verification to the Trust? A. Once you’ve added a new dependent to your health plan, you will have until December 15, 2017 to submit the required eligibility documents. Any documents received between December 16 and December 31, 2017 are subject to a $100 administration fee. Please note that no supporting documentation for open enrollment will be accepted after December 31, 2017. When submitting the required documentation, include your full name and Teachers Health Trust ID for identification purposes. The required documentation is identified below. • Spouse - A copy of your certified marriage certificate. • Domestic Partner - A copy of your Certificate of Registered Domestic Partnership through the State of Nevada. • Child - A copy of the certified birth certificate, which includes one or both parents’ names, issued by either the state or county of birth. If the birth certificate is from a foreign country, a translation must accompany the birth certificate; the Trust will not pay for the translation. Birth certificates issued by a hospital are NOT acceptable. Q. When will changes become effective? A. If you make a change to your plan, it will become effective on January 1, 2018.

Contact Main Office 2950 E. Rochelle Ave. Las Vegas, NV 89121 Phone (702) 794-0272 (800) 432-5859 Healthcare Advocates (855) 404-9355 Service Team (702) 794-0272


Merry, merry, Miserable With weather cooling down and fall approaching, cold and flu season is also coming our way. Protect yourself, your families, your coworkers and your students this season with this handy guide.

F

lu, or influenza is a virus. The common cold is also a viral disease, thus antibiotics don’t work on either. There are many types of influenza viruses out there, and each season new strains develop. Because colds and the flu share many symptoms, it can be difficult to tell the difference between them based on symptoms alone. Special tests can be done within the first few days of illness to tell if a person has the flu or not. Your healthcare provider can determine the best treatment based on the test results and exam.

cough, sneeze or talk. These viruses also may spread when people touch something with flu virus on it and then touch their mouth, eyes or nose. Many other viruses spread like this too.

People infected with the flu may be able to infect others beginning one day before symptoms develop and up to five to seven days after becoming sick. That means you may be able to spread the flu to someone else before you know you are sick as well as while TAKE A SHOT FLU SHOT MYTHS you are sick. Young children, those who are The CDC A flu shot cannot cause flu illness. Flu severely ill and those who have severely recommends a yearly vaccines given with a needle are weakened immune systems may be able to flu vaccine as the first currently made in two ways: infect others for longer and most important than the usual five to step in protecting 1. Flu vaccine viruses that have been seven days. against the flu. ‘inactivated’ and are therefore not infectious. Influenza causes more hospitalizations among young 2. With no flu vaccine viruses at all children than ANY other vaccine(which is the case for recombinant influenza vaccine). preventable disease.

Typical vaccination times start in October and go through April, but the ideal time for vaccination is by the end of October each year. Flu vaccines can be obtained through your primary care provider or local pharmacy.

HOW IS THE FLU VIRUS SPREAD

Flu viruses are thought to spread mainly from person to person through droplets made when people with flu

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FALL 2017 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

BE ON THE WATCH FOR FLU SYMPTOMS

Once the flu hits, you may notice a fever or feeling feverish/chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches or fatigue (tiredness). Some people may have vomiting and diarrhea, though this is more common in children than adults. It is important to note that you may not always have a fever with the flu, so it's important to note all of your symptoms. Again, the single best way to protect against seasonal flu for children and adults is to get a seasonal influenza vaccine.

by Evangelia Papageorge, MD

The most common side effects from the influenza shot are soreness, redness, tenderness or swelling where the shot was given. Low-grade fever, headache and muscle aches also may occur.


F E AT U R E S WHO'S AT RISK?

The flu vaccination is recommended for all ages six months and older. The most vulnerable people to the flu are children; adults over the age of 65; people with chronic illnesses such as diabetes, heart disease, asthma, emphysema and COPD; people with weakened immune systems; and pregnant women.

KEEPING IT CLEAN

Cleaning removes germs, dirt and impurities from surfaces or objects. It does not necessarily kill germs, but by removing them, it lowers their numbers and the risk of spreading infection.

PROTECT YOURSELF

1. Avoid close contact with sick people. 2. If you're sick, limit contact with others. 3. Stay home for at least 24 hours after your fever is gone. 4. Cover your nose and mouth with a tissue when you cough or sneeze. 5. Wash your hands often with soap and water. 6. Avoid touching your eyes, nose and mouth. 7. Clean and disinfect surfaces and objects that may be contaminated.

Disinfecting kills germs on surfaces or objects. It does not necessarily clean dirty surfaces or remove germs, but by killing germs on a surface after cleaning, it can further lower the risk of spreading infection. Clean and disinfect surfaces and objects that are touched often, and follow your school’s standard procedures for routine cleaning and disinfecting. Typically, this means daily sanitizing surfaces and objects that are touched often, such as desks, countertops, doorknobs, computer keyboards, hands-on learning items, faucet handles, phones and toys. Immediately clean surfaces and objects that are visibly soiled. If surfaces or objects are soiled with body fluids or blood, use gloves and other standard precautions to avoid coming into contact with the fluid. Remove the spill, and then clean and disinfect the surface.

When you need to make sub plans, plan to schedule a virtual visit with MDLIVE Being around kids all the time means it’s only a matter of time before you may need to take some sick days. And when you’re absent, your students kind of check out, too. (You know what we mean). So you need to get better – fast.

A virtual visit with MDLIVE is fast, easy and hassle-free ƒ ƒ ƒ ƒ ƒ

24/7/365 access to caring, board-certified doctors See a doctor in the comfort of your own home Average wait for an appointment: 15 minutes or less No waiting in room full of other sick patients Skip the higher ER or urgent care clinic copays

Register and schedule your virtual appointment today.

WellHealthOnline.com

3.3%

36%

16%

11

Reduction in fourth grade students’ mathematics achievement for each 10 days of teacher absence.

U.S. teachers who were absent more than 18 days during the 2012-2013 school year.

U.S. teachers who were absent more than 10 days during the 2009-2010 school year.

Average number of days a teacher is absent each school year in the U.S.

(866) 327-4873 or dowload the MDLIVE app

Source: “Roll call: The importance of teacher attendance,” National Council on Teacher Quality, June 2014. Copyright © 2017 MDLIVE Inc. All Rights Reserved. MDLIVE may not be available in certain states and is subject to state regulations. MDLIVE does not replace the primary care physician, is not an insurance product and may not be able to substitute for traditional in person care in every case or for every condition. MDLIVE does not prescribe DEA controlled substances and may not prescribe non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE does not guarantee patients will receive a prescription. Healthcare professionals using the platform have the right to deny care if based on professional judgment a case is inappropriate for telehealth or for misuse of services. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission. For complete terms of use visit https://www.mdlive.com/terms-of-use/. V.090817 MCR-738


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FALL 2017 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

Teachers Health Trust Health Traxx: Volume 16 | Issue 4 | Fall 2017  

A quarterly publication by the Teachers Health Trust.

Teachers Health Trust Health Traxx: Volume 16 | Issue 4 | Fall 2017  

A quarterly publication by the Teachers Health Trust.

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