Teachers Health Trust Health Traxx: Volume 17 | Issue 1 | Winter 2018

Health

A Publication for Teachers Health Trust Participants

raxx Winter 2018│Volume 17, Issue 1

For Teachers by Teachers

UNDERSTANDING THE PCMH HOW YOUR PCP MANAGES YOUR CARE

SOUP'S ON!

VOLUME 17, ISSUE 1

HEALTHY & QUICK CROCKPOT RECIPES

KNOW YOUR NUMBERS HOW TO MEASURE AND LOWER YOUR BLOOD PRESSURE

GET THE RIGHT CARE ALL YEAR-ROUND There’s no deadline to enroll in your Grand Rounds health benefit — we’re here year-round to match your specific needs to the right specialist.

Find an expert grandrounds.com/thtrust | 1-800-975-3054

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WINTER 2018 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

contents WINTER 2018 VOLUME 17, ISSUE 1

21

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in this issue 4 5

RX SAVINGS SOLUTIONS How to save money on your prescriptions

FREQUENTLY ASKED QUESTIONS

Your questions answered

6

WHO SHOULD I CALL?

7

MEET THE TEAM

When to call a Healthcare Advocate or Member Services Learn more about the people who serve you

8 ASK THE PROVIDER

Tips and tricks to help you master the art of meal prep

10 UNDERSTANDING THE PCMH

How it works and the benefits for your overall health

12 SOUP'S ON!

Healthy and quick crockpot recipes for the chilly months

15 KNOW YOUR NUMBERS Decoding blood pressure readings

16 QUICK MOVES

Add these moves to your workout routine and feel the burn

17 HEALTH PROGRAMS

Enroll today for optimal health

18 MORE THAN JUST CRAMPS Signs and symptoms of endometriosis

22 WELLDYNE RX

Advanced specialty pharmacy services

23 HAVE A HEART

Eight exercises for a healthy heart

25 PCMH DEADLINES

The last day each quarter you can change your PCP in 2018

WINTER 2018 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

3

FAQ

Saving on your prescriptions keeps getting easier.

The power of Rx Savings Solutions includes: • View all your medications in one place • Review your personalized prescription savings • Access on your computer or mobile device

• Connect with pharmacy advocates to answer prescription pricing questions

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 5 a.m. – 6 p.m. PST at 1-800-268-4476 or info@rxsavingssolutions.com.

rxsavingssolutions.com

Register today at reg.rxss.co

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: Will my referral be able to be renewed before it expires?

A: Yes. The par8o system starts sending reminders to your primary care

physician (PCP) when the referral in the system gets close to the 365 day mark.

This should allow your PCP the opportunity to analyze and ensure the referral is still needed, and stop the disruption for you if it is still needed.

Q: How do I ensure I am accurately billed for my free annual visit with my assigned PCP? A: It is important that you make sure to tell the scheduling staff what type of visit you are scheduling. Inform the doctor that you are there for your annual wellness exam. The provider will not know to bill for a wellness exam unless he/she is told the reason for the visit.

Q: Why do I get a bill from my doctor sometimes even when I see my assigned PCP and pay my copayment?

A: Good question. When you see your assigned PCP and pay the

$10 copayment, that covers the routine exam. If your doctor does additional services such as a throat culture, X-rays, blood draw, etc., those are not routine and are subject to 20 percent coinsurance. The Trust will pay 80 percent of those specific billed charges, and you will be responsible for the remaining 20 percent. Always ask the doctor if tests and procedures are medically necessary, and always ask if your insurance covers what they are proposing. Be an advocate for yourself in your healthcare journey. Don't worry about being a pain, as asking questions is an important way to avoid an unexpected bill.

Q: Will my health programs change in 2018?

A: We continuously evaluate our health programs for ways to make

your life better. We want to ensure that you get the care you need while keeping your costs as low as possible. Please call the Healthcare Advocates at (855) 404-9355 if you have any questions or suggestions on how we can better serve you.

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.

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

F E AT U R E S

Meet The Team On the phones, in the office and here to serve you! This issue we caught up with Willyna Henderson, Member Services Representative, and Sonia Ancira, Healthcare Advocate, for a little behind-the-scenes insight.

What’s your job and what do you do on a daily basis?

I’m a Member Service Representative. Daily my job consists of assisting participants via email, phone, or in a walk-in setting.

This includes answering any questions they may have relating to their benefits and or claims. We also work closely with other departments to resolve any challenges for participants.

What’s your favorite part of the job?

I like being able to educate and assist participants so that they are able to maximize the full benefit of their insurance.

How long have you been working here?

I began with Tristar Insurance Group in June of 2016.

What’s one thing you wish everyone knew about what you do?

Here in Member Services, we truly are a team working diligently to give accurate information and a personal touch to each participant.

Willyna Henderson

What’s your favorite thing to do when you aren’t working?

My family and I are very active in our church and outreach ministries, visiting nursing homes, feeding the homeless and canvassing local parks and neighborhoods.

What’s your job and what do you do on a daily basis?

I’m a Healthcare Advocate. I spend most days answering questions participants have about their PCP and helping them change their doctor if they want to.

Sonia Ancira

What’s your favorite part of the job?

I love helping people find the right provider.

How long have you been working here?

I have been a Healthcare Advocate for almost two years.

What’s one thing you wish everyone knew about what you do?

Our entire team feels a sense of gratitude whenever we can help a participant get the help they need.

What’s your favorite thing to do when you aren’t working?

When I'm not helping participants, I enjoy playing with my doggies.

WINTER 2018 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

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ASK THE

PROVIDER

How to succeed at meal prep

So it’s that time again to ring in the New Year with a new version of a healthier you, but this time let’s try and keep it simple. That’s right, no cutting out whole food groups, fasting for days, juicing all day or cursing carbohydrates.

Registered dietitian, Alissa Dougherty, shows you how to make sustainable changes that are consistent with your lifestyle.

The biggest challenge that clients tend to express is time and how to make the right choices. When it comes to a time crunch, we are more likely to make poor choices in regards to meal and snack options. Putting in a little bit of work ahead of time can help save you from making unhealthy choices and relieve the mental burden of sticking to your health plan.

Of course it is one thing to talk about meal planning, but to actually apply it can be a pretty overwhelming task for someone who may be new to the idea of planning ahead. In order to make things a little easier, here are some tips and tricks to start off meal planning.

WHIP UP A QUICK BREAKFAST Overnight oats not only don’t have to be cooked, but are portable too. Combine oats with milk, almond milk or Greek yogurt and let it sit in your fridge overnight. In the morning, add items like almonds, nut butters, berries and/or cinnamon for added nutrients and flavor. Want a hot breakfast, but don’t have the time? Spray a microwave safe bowl with cooking spray and add eggs, egg white, or Egg Beaters. Add chopped frozen veggies of choice and cook for 2-3 minutes for a quick egg dish or place on top of an English muffin with reduced fat cheese or Canadian bacon for a quick breakfast sandwich.

INCORPORATE VEGGIES OF ALL VARIETIES Keep a variety of vegetables on hand for meals and snacks. Use raw carrots, peppers and cucumber with hummus for a quick on-the-go snack. Don’t have the time to wash, cut and prep vegetables? Opt for steaming frozen vegetables in the microwave.

Want to add a little more flavor or texture to your frozen veggies?

Season and add olive oil to cauliflower, asparagus, zucchini or Brussels sprouts and roast them until crispy for a side dish, add them to your salad or pasta bowl, spruce up soups or sauces, or add frozen spinach for a nutrient boost in a smoothie.

PUT THOSE EMPTY CONTAINERS TO GOOD USE Use empty mason jars to prepare salads for an on-the-go entrée or side dish. To prevent soggy lettuce, pour your dressing into the bottom of the jar then layer in vegetables like peppers, carrots, celery and cucumber.

Add grains like quinoa and brown rice. Increase your fiber even more with beans and berries. Make sure to save room in the jar for your leafy green, and, when you’re ready to enjoy, shake it up! Another great use for mason jars and portable snacks are yogurt and cottage cheese parfaits. Layer Greek yogurt or cottage cheese with frozen berries or fruit of choice, almonds or pistachios, and add a hint of cinnamon for a protein-packed portable snack.

THEME MEALS Make meal planning fun with themed meals. For instance, for “Meatless Mondays” have a grain bowl with brown rice, quinoa, or pasta and add black beans, load up on veggies, and seasoning of choice. Save some black beans for a side dish or garnish for “Taco Tuesday." Get family, friends or coworkers involved. Plan a themed meal for work where coworkers each bring something to contribute to the meal. Get the whole family involved in picking the theme for the week or incorporating different types of veggies.

GROCERY STORE TRIPS Schedule time during the week to plan your grocery store trip.

Taking the extra 10-20 minutes before going to the store will save you from roaming the aisles and spending more money than you intended on items you don’t need. I recommend keeping a calendar of meal ideas that you plan on using during the week to assist in making your grocery list. Remember that if you make chicken for a meal on Monday, you can use that leftover chicken for a lunch on Wednesday. Keep recipes of meals you enjoy to help plan your weeks, and know what items you will need from the store.

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F E AT U R E S

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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Understanding the

Patient-centered medical home

T

he PCMH (patient-centered medical home) model is designed to provide you with the best possible healthcare experience and to ensure you are receiving exemplary care. Your primary care provider (PCP) is at the helm of your healthcare ship, the quarterback (QB), if you will.

Picking an in-network PCP is step one on your healthcare journey. This is important not only to your plan of care, and how comfortable you feel, but it is also important from a monetary standpoint. If you see your assigned PCP, the first string QB, you will experience a much lower out-of-pocket cost. If you see a PCP that is in the network, but not assigned to you, let’s call them the second string QB, you will be responsible for a higher out-of-pocket cost. It is set up this way so that your PCP can be knowledgeable and familiar with your healthcare needs. The more this doctor gets to know you, the better they can treat all of your potential healthcare issues that may arise. They will know your past medical issues, which allows them to make more informed decisions on the care you may or may not need.

If your PCP identifies that you need care that would be better treated by a specialist, they will create a referral - much like a QB throws a pass to a receiver. A referral is basically a request to the specialist to see you for an identified issue. This referral ensures that the specialist communicates back to your PCP, who will stay involved in every step of your healthcare journey. This also allows your PCP to make future decisions about your healthcare more accurately. The referral from your assigned PCP also affects your out-of-pocket costs because the visit to the specialist with a referral will be significantly cheaper than if you access a specialist without a referral. For the exact breakdown of costs to see a specialist with or without a referral, please see the plan document located on the Teachers Health Trust website under the Participants tab.

While your assigned PCP is the QB in the PCMH model, specialty providers also have a very significant role. Like football, in order to work efficiently, a team needs to support the QB, and this model is no different. Identified providers in a multitude of specialties have been selected be on our PCMH team.

Being on this team brings a lot of benefits to both the provider and you as a participant. Think of us as the coach. We get to choose who plays in the game, and we only want the best players to be on our roster.

When specialty providers choose to be on our team, we can hold them accountable for certain things, like the quality of care that they provide to you and the access they give to you as a participant. This helps us make sure you are getting the entirety of care that you need — not just the quick sick visits that we have all experienced before.

We have also included Healthcare Advocates into this model. This team is here to help you navigate your healthcare. If you have questions about what a certain term that your doctor said to you means, or need to know how to go about accessing your healthcare, or even scheduling and picking your PCP, this department is here for you. They are here to hold your hand throughout the entire healthcare ecosystem.

PRIOR AUTHORIZATIONS Certain procedures and special services require prior authorizations to evaluate the medical necessity of the service. TRISTAR is an independent third party administrator for the Teachers Health Trust and handles all prior authorization requests. Any provider may request a prior authorization for an indicated procedure or special service on the Teachers Health Trust website by selecting Forms under the Provider tab.

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The turnaround time is generally 48 hours unless additional documentation is required. Once the prior authorization is obtained, the provider should schedule the procedure or special service without difficulty. On rare occasion, you and/or your provider may disagree with the authorization decision that you receive. Should this occur, the provider may appeal the decision to TRISTAR in writing. Often times the issue is only that additional information is required to support the initial request.

F E AT U R E S

Health care i today n ’s soc iety c be a v an ery da unting and o verwh elmin g exper i e n c e witho ut the prope r guida nce.

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SOUP'S ON!

HEALTHY & QUICK RECIPES

Servings: 8 cups Prep Time: 15 minutes Cook Time: 4-8 hours Vegetarian-friendly

Black Bean Soup Ingredients •

3 cups dried black beans soaked

•

1 TB extra virgin olive oil

•

1 medium yellow onion, chopped

•

1 red bell pepper, chopped

•

4 garlic cloves minced

•

1 TB salt (reduce if your broth includes salt)

•

8 cups chicken or vegetable broth

•

1/2 cup chopped fresh cilantro

•

1 lime juiced (optional)

Recipe & photo: livesimply.me

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Directions 1. In a large skillet, over medium-high heat, heat the olive oil. Add the chopped onion and red pepper. Sauté the vegetables for 4-5 minutes, just until the onions are translucent. Add the minced garlic and stir for 1 minute, until the garlic is fragrant.

2. Pour the black beans into a crockpot, followed by the pepper and onion mixture. Add the salt and broth. Stir the soup ingredients to combine. Cook the soup in the crockpot for 8 hours on low or 4 hours on high.

3. Once the soup is done (the beans are soft), stir in the cilantro and lime juice.

4. Serve warm with fresh cilantro, sour cream, rice, tomatoes, cheese, avocado, salsa or any of your favorite add-ins.

F E AT U R E S

Servings: 5 cups Prep Time: 15 minutes Cook Time: 7 hours

Classic Chicken noodle Soup Ingredients • • • • • • • • • • • • • • • • •

1 1/2 lbs boneless skinless chicken breasts 5 medium carrots, peeled and chopped 1 medium yellow onion, finely chopped 4 stalks celery, chopped 3-5 cloves garlic, minced 3 TB extra virgin olive oil 6 cups low-sodium chicken broth 1 cup water 3/4 tsp dried thyme 1/2 tsp dried rosemary, crushed 1/2 tsp dried sage (optional) 1/4 tsp celery seed, finely crushed 2 bay leaves Salt and freshly ground black pepper to taste 2 cups uncooked wide egg noodles 1/4 cup chopped fresh parsley 1 TB fresh lemon juice

Directions 1. Add chicken breasts, diced carrots, onion, celery and garlic to your crockpot.

2. Add in olive oil, chicken broth, water, thyme, rosemary, celery seed, bay leaves and season with salt and pepper to taste.

3. Cover and cook on low heat 6-7 hours.

4. Remove cooked chicken and allow to rest 10 minutes, then dice into bite size pieces.

5. Meanwhile, add egg noodles and parsley to the crockpot.

6. Increase temperature to high, cover and cook 10 more minutes (or until noodles are tender).

7. Stir in lemon juice and toss in cooked, diced chicken.

Serve warm with saltine crackers or top with Parmesan cheese if desired.

Recipe: cookingclassy.com WINTER 2018 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

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F E AT U R E S

KNOW YOUR

NUMBERS Do you know what these numbers mean?

Tips to lower your blood pressure DIETARY MODIFICATIONS • • • •

115/70

The top number, 115, indicates the pressure your blood is exerting against the walls of your arteries each time your heart beats.

The bottom number, 70, indicates the pressure your blood is exerting against the walls of your arteries between beats (when the heart is resting).

TIPS FOR TAKING YOUR BLOOD PRESSURE To ensure a more accurate reading when taking your blood pressure: •

Avoid smoking and drinking caffeinated beverages 30 minutes before your blood pressure reading

•

Avoid exercising 30 minutes before your blood pressure reading

•

Sit still during your reading

•

Sit with both feet on the floor

•

Measure at the same time every day

•

When repeating, wait at least 3-5 minutes between readings

It's always a great idea to regularly check your blood pressure and document it for your healthcare provider. This is extremely important if you are overweight, have diabetes or are over the age of 50.

Lower salt intake Lower saturated fat intake Increase water intake Increase fiber intake

INCORPORATE MODERATE EXERCISE INTO YOUR DAILY ROUTINE

Always check with your healthcare professional before starting a new exercise routine.

zz z

REST AND RESTORE YOUR BODY • •

Get 7-8 hours of sleep every night Rest mid-day; as little as 15 minutes of quiet time has been proven to positively impact your health

TAKE YOUR MEDICATIONS AS PRESCRIBED

Schedule an appointment with your healthcare professional before changing how much, when or how you take your medication.

Understanding what your blood pressure means is vital in understanding how to maintain it. Gaining control is easy once you adjust your diet, activity level, sleep schedule and prescribed medications, if applicable.

If a healthcare professional has diagnosed you with high blood pressure, you may hear terms like HBP (high blood pressure) or hypertension. Both terms mean your blood pressure reading has been elevated repeatedly. Knowing your numbers and what those numbers mean are important to your health today and your health years from now.

If you have a personal history of high blood pressure, you should take your blood pressure daily (around the same time each day), documenting it for your healthcare provider.

If your blood pressure is ever greater than or equal to 180/110, wait five minutes and repeat the reading. If your blood pressure is greater than 180/110 again, you should seek emergency medical attention immediately.

WINTER 2018 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

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Try It!

Quick Moves Shake up your routine with these moves and feel the burn!

Place your entire right foot onto the bench or chair. Press through your right heel as you step onto the bench, bringing your left foot to meet your right so you are standing on the bench, then step down to return to the starting position.

Place your feet shoulderwidth apart or slightly wider. Sit back and down like you’re sitting into an imaginary chair. Lower down so your thighs are parallel to the floor with your knees over your ankles. Keep your body tight and push through your heels to bring yourself back to the starting position.

Position your hands shoulder-width apart, then slide your butt off the front of the bench with your legs extended out in front of you.

Slowly bend your elbows to lower your body toward the floor until your elbows are at about a 90-degree angle.

Press down into the bench to straighten your elbows to return to the starting position.

Assume a modified pushup position with your elbows bent 90 degrees and both forearms resting on the floor.

Position your elbows directly underneath your shoulders and look straight toward the floor.

Your body should form a perfectly straight line from the crown of your head to your heels. Hold as long as you can.

Simultaneously raise your arms above your head and jump up just enough to spread your feet out wide. Without pausing, quickly reverse the movement and repeat.

Stand with your back pressing against a wall.

Slide downward into a squat position by moving your feet forward until your knees make a 90-degree angle and your hamstrings are parallel to the floor. Hold this move as long as you can.

In a plank position, set your hands at a distance that is slightly wider than shoulder-width apart; feet can be together or further apart, whatever is most comfortable. Steadily lower yourself until your elbows are at a 90-degree angle or smaller, then push back up to starting position, keeping your body straight.

Raise your head and shoulders off of the floor.

Hold for three deep breaths, then return to starting position. Never clasp your hands behind your head.

SAFETY FIRST!

Trying new workouts always makes gym time more exciting; however, you should consult your physician or other healthcare professional before starting this or any other fitness program to determine if it is right for your needs. You can cause serious injury doing these moves incorrectly, so if you're not sure you're doing them right, ask a professional.

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SPRING 2017 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

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F E AT U R E S

More than

JUST CRAMPS

Endometriosis affects an estimated 176 million women worldwide, many remain undiagnosed and are therefore not treated.

Learn the signs and symptoms and when it's time to seek treatment.

When to See the Doctor

WHAT ARE THE SYMPTOMS?

The severity of pain isn't necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have intense pain, while others with advanced endometriosis may have little pain or even no pain at all. Discuss with your provider if you have any of these symptoms. Endometriosis can be a challenging condition to manage. An early diagnosis, a multidisciplinary medical team and an understanding of your diagnosis may result in better management of your symptoms.

The primary symptom of endometriosis is pelvic pain, often associated with menstruation. While many women experience cramping during their menstrual period, women with endometriosis typically describe the pain as more intense and report that it increases over time. Pelvic pain is not the only sign. Below are additional symptoms that are associated with endometriosis.

Painful periods (dysmenorrhea) Pelvic pain and cramping may begin before your period and extend several days into your period. You may also have lower back and abdominal pain.

Pain with intercourse Pain during or after sex is common with endometriosis.

Excessive bleeding You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).

Infertility Endometriosis is first diagnosed in some women who are seeking treatment for infertility.

Other symptoms Pain with bowel movements or urination. You're most likely to experience these symptoms during your period. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

Sources: mayoclinic.org; endometriosis.org

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WHAT ARE THE RISK FACTORS?

Several factors place you at greater risk of developing endometriosis, such as: • • • • • • • • • •

Never giving birth Starting your period at an early age Going through menopause at an older age Short menstrual cycles — for instance, less than 27 days Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces Low body mass index Alcohol consumption One or more relatives (mother, aunt or sister) with endometriosis Any medical condition that prevents the normal passage of menstrual flow out of the body Uterine abnormalities

Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis end temporarily with pregnancy and end permanently with menopause, unless you're taking estrogen.

F E AT U R E S

IN-NETWORK REMINDER ABOUT Before you chose your doctor, you probably researched his/her experience, background, specialties, office hours, types of insurance accepted and everything else you could. So why wouldn’t you do the same when choosing something as important as a testing lab? With Quest Diagnostics, you can be tested in many doctors’ offices and at approximately 2,000 testing centers nationwide. You can even make an appointment. We offer more than 3,000 tests.

We’ve introduced more than 100 tests to help detect numerous diseases, including the first commercially available H1N1 influenza virus test. Our laboratories aim to meet the Six Sigma standard. We’re also leading the charge to raise the overall quality of healthcare delivery in the United States.

THE PLAN BENEFIT - LABORATORY IN-NETWORK OUT-OF-NETWORK

WITH OR WITHOUT REFERRAL 40 percent co-insurance after deductible, $0 co-payment at Quest Diagnostics plus any charges over eligible medical expenses*

LOCATIONS NORTHWEST

NORTH

PARADISE

•

•

•

•

7061 Grand Montecito Pkwy Las Vegas, NV 89149 7891 W Tropical Pkwy #110 Las Vegas, NV 89149

EAST • •

305 N Nellis Blvd #150 Las Vegas, NV 89110 3100 W Charleston Blvd #110 Las Vegas, NV 89102

SUMMERLIN • •

761 S Rainbow Blvd #100 Las Vegas, NV 89145 9499 W Charleston Blvd #110 Las Vegas, NV 89117

•

• •

6945 N Aliante Pkwy #104 North Las Vegas, NV 89084 3150 N Tenaya Way #250 Las Vegas, NV 89128 7460 W Lake Mead Blvd STE 3 Las Vegas, NV 89128 1815 E Lake Mead Blvd #103 North Las Vegas, NV 89030

SOUTHWEST • • •

420 W Sahara Ave #108 Las Vegas, NV 89117 4180 S Rainbow Blvd #801 Las Vegas, NV 89103 6485 S Rainbow Blvd #102 Las Vegas, NV 89118

•

2595 S Maryland Pkwy Ste 103 Las Vegas, NV 89109 4230 Burnham Ave #144 Las Vegas, NV 89119

HENDERSON • • • • • • •

6301 S Mountain Vista St Ste 100 Henderson, NV 89014 1701 N Green Valley Pkwy #7d Henderson, NV 89074 100 N Green Valley Pkwy #110 Henderson, NV 89074 2465 W Horizon Ridge Pkwy #120 Henderson, NV 89052 10001 S Eastern Ave #309 Henderson, NV 89052 2505 Anthem Village Dr J Henderson, NV 89052 210 N Boulder Hwy STE 140 Henderson, NV 89015

WINTER 2018 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

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Advanced Specialty Pharmacy Services US Specialty Care provides specialty medications for all Teachers Health Trust plan participants Specialty Medications are used to treat and manage complex disease conditions such as multiple sclerosis, hemophilia, and cancer. Depending on the condition and prescribed therapy, these medications may be taken orally, intravenously (IV), or self-injected. Specialty medications often require special handling, such as refrigeration, and they are usually more expensive than traditional drugs.

WellDyneRx is dedicated to providing you with the medication and support you need to understand your treatment and condition. We work with you, your doctors and nursing staff to create a personalized treatment plan. Our pharmacy staff provides you with complete patient support.

Working together to improve your health n

Expert care: Once you enroll with WellDyneRx you will be assigned a Patient Care Advocate. Your Patient Care Advocate provides counseling, support and education to help you: •

Understand your treatment and how to manage side effects

•

Review dosing and medications schedules, including medications used for other conditions

•

Stay on track with your treatment and receive refills on time

n

Medication delivery: We know that getting your medication on time is important. Your medications will be carefully packaged and discreetly shipped to ensure your security and confidentiality.

n

Insurance and financial assistance coordination: WellDyneRx will coordinate benefit and insurance paperwork, obtain prior authorizations, identify additional options to lower your out-ofpocket costs, and direct you to grants and/or financial assistance to help bridge benefit gaps.

Getting Started To get started, ask your doctor to send your prescription electronically to WellDyneRx or by fax to 800-530-8589. Your doctor can also call and talk with our industry-leading team of pharmacists. A Patient Care Advocate will contact you to help you enroll in our specialty pharmacy program, schedule your medication delivery, and help you manage your medical supplies.

With WellDyneRx, you’ll have the peace of mind knowing that you have access to the medications, tools and resources to manage your health. To learn more about WellDyneRx, contact us at 800-641-8475 or visit www.WellDyneRx.com.

www.WellDyneRx.com

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8.2016 ©WellDyneRx

F E AT U R E S

H E A LT H C A R E

T E R M S

glos·sa·ry

CHRONIC DISEASE MANAGEMENT PROGRAM

An integrated care approach to managing illness, which includes screenings, check-ups, monitoring and coordinating treatment, and patient education. It can improve your quality of life while reducing your health care costs if you have a chronic disease by preventing or minimizing the effects of a disease.

CLAIM

After you’ve visited the doctor, they will send a claim to your insurance company, aka the Trust, for any services you received, such as lab tests, the visit itself. The insurance company processes the claim, or pays for its portion, and then lets you know how much, if anything, you have to pay.

COINSURANCE

This is the slice of a medical service you are responsible for. Whether you pay a copayment or coinsurance depends on the type of service, and in some cases, whether you’ve met your deductible.

COPAYMENT

A copayment is like an admission ticket. It is the flat fee you pay for covered medical service like annual physician office visits.

DEDUCTIBLE

This is the amount you have to pay toward medical costs before your health insurance starts picking up part of the bill. Every plan is different, but generally, your payments for things like hospital bills and lab tests count toward your deductible. For example, if you have a $3,000 deductible, that's how much you must pay outof-pocket before your insurance plan starts to pay its portion.

FORMULARY

A list of prescription drugs covered by your insurance plan. Also called a drug list.

OUT-OF-POCKET MAXIMUM

This is the max amount of money you have to pay for healthcare in a year. This includes money that goes toward your deductibles, copayments and coinsurance fees.

After you meet your maximum, your insurance pays for all costs related to your covered health benefits.

OUT-OF-NETWORK

Insurance companies define the rates they are willing to pay for services. Doctors agree to these rates go through contracting to become in-network; doctors who don't agree stay out-of-network.

You can still see out-of-network doctors, but your insurance will pay a smaller part of the fee and you'll be responsible for more.

PREMIUM

A premium is like your cable bill but for healthcare coverage. It’s the base amount you pay each month to stay on your health plan.

PRIMARY CARE PROVIDER (PCP)

If your healthcare was a ship, this would be your captain. They are responsible for managing all points of your healthcare, from referrals to specialists to routine exams.

REFERRAL

Sometimes your PCP needs help caring for you and calls on a specialist to see you for a specific reason. The referral is the permission slip to see the specialist without having to pay an out-of-network fee.

WINTER 2018 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG

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HAVE A HEART

heart health program

8 HEART

EXERCISES FOR

A HEALTHY

WEIGHTS

CYCLING

RUNNING

TENNIS

BASKETBALL

HIKING

JUMP ROPE

DANCING

Physical activity can help boost energy, improve your mood and add significant gains to our health measures, including weight, blood pressure, cholesterol and blood sugars. The U.S. Department of Health and Human Services recommends 150 minutes of moderate intensity aerobic activities per week in conjunction with muscle strengthening exercises on two or more days a week, or 75 minutes of vigorous aerobic exercise per week with muscle strengthening activities two or more days a week.

Sometimes it is hard to find large blocks of time to commit to exercising. For some individuals, it may be easier to make time for activity throughout the day, such as taking 20 minutes after lunch, or 10 minutes after every meal. You can also incorporate exercise into your daily tasks, such as walking two laps around the grocery store before shopping, parking your car farther away or adding physical activities that involve the rest of your family. Every little bit counts!

The Have a Heart program is designed to provide additional support and assistance for participants diagnosed with Hypertension (HTN) or Congestive Heart Failure (CHF).

Enroll online at teachershealthtrust.org!

NEED HELP NAVIGATING THROUGH YOUR BENEFITS? COPAYS

BENEFITS

DEPENDENTS BILLING

ELIGIBILITY

PRESCRIPTION

COST

TAKE

THE SHORTCUT Give us a call at 1.800.432.5859 or log in to your member portal at www.teachershealthtrust.org/participants/portal

TRISTARexchange© Member Portal Advantage • Real time and up-to-date deductible and out of pocket amount.

• Easy access to important and pertinent claim status.

• Detail itemized information such as remark codes and/or claim deductions. *Powered by

®

2018

PCMH Change

Deadlines

With the Performance Plus Plan, you are able to change your provider once per quarter. Below is the last day you are able to change your primary care provider (PCP) in 2018. Request a change by reaching out to the Healthcare Advocate team by phone at 855-404-9355, or download the form at teachershealthtrust.org and email it to advocates@ wellhealthqc.com once completed.

QUARTER 2

Begins April 1 Last day for PCP change is March 31

QUARTER 3

Begins July 1 Last day for PCP change is June 30

QUARTER 4

Begins October 1 Last day for PCP change is September 30

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WINTER 2018 | HEALTH TRAXX TEACHERSHEALTHTRUST.ORG