Blue & You - Autumn 2013

AUTUMN
2013
A publication for the policyholders of the Arkansas Blue Cross and Blue Shield family of companies
Health Care Law
updates
for everyone
PAGES 4-10
7 things to know about
the health care law and
our Medicare plans
page
10
page
16
page
12
Meet our UAMS Primary
Care Scholarship recipients
New and
upcoming generics
page
21

3
4
6
7
8
9
10
11
12
14
16
18
Out of the Blue
Health care law checklists:
Steps you need to take
Let us help you! The best
ways to contact us
Large employers get delay on key
parts of health care law
Do you qualify for free health insurance?
Which health plan is right for you?
7 things to know about the health care
law and our Medicare plans
Medicare annual election period
October 15 through December 7
SilverSneakers keeps Conway
man surrounded by friends
Blue News
of
UAMS students receive Arkansas
Blue Cross and Blue Shield
Primary Care Scholarship
Blue & You Foundation awards
55 mini-grants to improve health
in Arkansas
Learn how
these medical
students aiming
to practice in
rural Arkansas
received help
from Arkansas
Blue Cross and
Blue Shield.
PAGE 16
AUTUMN
2013
20
21
22
23
24
26
27
28
Come home to a medical home!
New and upcoming generics
Folic acid: Not just for women
Let us help you lose weight!
Blue & You Fitness Challenge winners!
Notice of privacy practices – Arkansas
Blue Cross and Blue Shield and Health
Advantage
Summary of Benefits and Coverage Notice
Women’s Health and Cancer Rights Act
Customer Service telephone numbers
Health care law timeline
Blue & You is published four times a year by Arkansas Blue Cross and
Blue Shield for the company’s members, health care professionals
and other persons interested in health care and wellness.
Health information from sources outside of Arkansas Blue Cross and Blue
Shield do not necessarily represent the official position of the company.
EDITOR: Jennifer Sullivan – bnyou-ed@arkbluecross.com • DESIGNER: Ryan Kravitz • PHOTOGRAPHER: Chip Bayer
CONTRIBUTORS: Will Ballard, Chip Bayer, Matthew Creasman, Damona Fisher, Kristy Fleming, Lauren Green,
Trey Hankins, Heather Iacobacci-Miller, Jessica Kelley, Genny Kirchner, Kathy Luzietti, Wendy McCullar, Ben McVay,
Mark Morehead, Alex Roberts, Lee Smith, Kelly Whitehorn and Stephen Wilson
VICE PRESIDENT, COMMUNICATIONS and PRODUCT DEVELOPMENT: Karen Raley
2 BLUE & YOU AUTUMN 2013
on the
cover
72-year-old Charles Stacks works out at the Conway Regional
Health and Fitness Center thanks to SilverSneakers

OUT
BLUE
Helping everyone win under the health care law
When the health care law passed in
March 2010, Arkansas Blue Cross and
Blue Shield staff members were already
working to determine the impact various
provisions of the new law would have on
our customers. Based on our commitment
to members and our history of 65 years of
service to Arkansans, we are responsible
to make certain that our members —
and all Arkansans — continue to have
understandable health insurance options.
Early in the process, we notified our
members that there would be winners
and losers when the new law was fully
implemented in 2014. We asked that they
continue with their health insurance policies
in place; these are called “grandfathered”
policies under the new law. The law specifies
that if a grandfathered policy is significantly
modified or the coverage is dropped, the
policyholder cannot get it back.
Our small employer customers and those
who buy coverage for themselves and
their families took our advice. More than
three-fourths of them maintained their
grandfathered policy as the regulations that
define the new law were being developed.
Now that 2014 is at hand and the new Health
Insurance Marketplaces are a reality, we have
the advantage of hindsight to measure the
success of our “grandfathering” initiative.
For more than two-thirds of our individual
and small employer customers, maintaining
grandfathered status was a good financial
decision. Under the new rules, these
customers might have seen rate increases as
high as 200 percent, but by maintaining their
policy through the transition, they now have
far greater flexibility.
a message from our President and CEO,
MARK WHITE
At Arkansas Blue Cross,
our goal is to make certain
that everyone with a
Blue Cross card wins
in the new Health
Insurance Marketplace.
Unfortunately, we have a number of
customers who did not have the option of
grandfathered coverage. Already, our staff
is reaching out to these individuals and
small group employers to assist them in
evaluating cost-saving alternatives. If you
have not been contacted by your agent or
an Arkansas Blue Cross representative,
expect to hear from us soon.
At Arkansas Blue Cross, our goal is to make
certain that everyone with a Blue Cross card
wins in the new Health Insurance Marketplace.
These will likely be uncertain times for people
who want to buy health coverage, and like
any new process or system, the new Health
Insurance Marketplace may be very inefficient
in the early years. Through this new era and
the future, Arkansas Blue Cross recommits
to our “fearless” and best efforts to provide
the information, knowledge, experience and
financial stability you require in fulfilling your
health insurance needs.
AUTUMN 2013 BLUE & YOU
3

Health CARE LAW
Checklists:
Steps YOU need to take
With all the talk about health insurance and the changes coming up,
you might be wondering what steps you need to take to be ready in
2014. Here is a quick checklist for each type of coverage we offer:
IF YOU HAVE A
MEDICARE PLAN
IF YOUr EMPLOYER
purchased YOUR
HEALTH PLAN
before April 2010
IF YOU PURCHASED
AN INDIVIDUAL
OR FAMILY PLAN
before April 2010
4 BLUE & YOU AUTUMN 2013
1.
2.
1.
2.
3.
4.
1.
2.
3.
4.
5.
Don’t worry! If you have a Medi-Pak ® Supplement plan, no matter when you
purchased your coverage – before or after the law was signed – you’ll still
have the same benefits and security you have now. Read more on page 10.
If you want to shop for different coverage, read about the Medicare
Annual Election Period, which runs from October 15 through
December 7, on page 11.
We’ve got this! You may have a grandfathered plan if no major
changes have been made to your health plan. Grandfathered plans
are exempt from many of the regulations under the health care law.
If you don’t know if your health plan is grandfathered, you can
contact your human resources administrator.
Your employer will be the one to decide if you keep your current
health plan. They will be working closely with representatives of
Arkansas Blue Cross and Blue Shield to determine if it is better to
keep your current plan or switch to a new plan.
If you are an employer, an agent or an Arkansas Blue Cross
representative will be calling to help you weigh your options.
Relax! You have a grandfathered plan. Grandfathered plans are
exempt from many of the regulations under the health care law.
If you like what you have, you can keep it.
If you aren’t sure of the date you purchased your plan, call the
customer service number on your ID card.
Call your agent or give us a call at 1-800-310-3778. We will tell you
if a less expensive plan is available under the new rules, if you will
benefit from a new plan off the Health Insurance Marketplace, or if
you should keep your current plan.
If you want to find out if you might benefit from a newer plan, go to
our website, arkansasbluecross.com. You can use the “Do I Qualify for
a Tax Credit” online tool to get an estimate on any tax credit you might
receive. Regardless of your estimate, however, call your agent or call us.
Don’t give up your grandfathered plan without talking to an Arkansas
Blue Cross representative or your agent. After you lose this plan, you
cannot get it back.

IF YOUr health plan
was purchased
AFTER MARCH 2010
AND IS THROUGH A
LARGE EMPLOYER
1.
2.
It’s all good! If your employer has more than 100 employees,
most of the changes to your health plan have already occurred.
The big news for you and your employer is that you may
qualify for free health insurance under the Arkansas Medicaid
expansion. There is no penalty to your employer if you
qualify. Find out more on page 8.
IF YOUr HEALTH PLAN
WAS PURCHASED
AFTER MARCH 2010
AND IS THROUGH A
SMALL EMPLOYER
1.
2.
Find out more! Our team at Arkansas Blue Cross is working
closely with your employer to determine the best option for
you and your co-workers.
You may qualify for free health insurance under the Arkansas
Medicaid expansion. There is no penalty to your employer if
you qualify. Find out more on page 8.
IF YOU PURCHASED
AN INDIVIDUAL
OR FAMILY PLAN
AFTER MARCH 2010
1.
2.
3.
4.
5.
6.
Keep reading! You have several options.
If you like what you have, you can keep that plan until
December 30, 2014. That gives you a whole year to work
with your agent or an Arkansas Blue Cross representative to
determine the best new health plan for you.
If you want to explore your options, you have until March
2014 to purchase a new health insurance policy for coverage
in 2014.
Call your agent or call us at 1-800-310-3778, or go to our
website, arkansasbluecross.com, to find out more about the
health plans available. You can use the “Do I Qualify for a Tax
Credit” online tool to find out if you could receive financial
help on your health insurance premium.
Read the article “Let us help you” on page 6.
Trust us! You have coverage through Arkansas Blue Cross, a
company Arkansans have trusted for 65 years for affordable,
reliable health insurance. We are dedicated to providing the
best possible coverage and service to you.
AUTUMN 2013 BLUE & YOU
5

Let US HELP YOU!
If you purchased health care coverage
for you and your family on your own,
whether it was purchased before or
after the health care law was signed,
we want to talk to you!
Having a health plan review is the
best way to get a clear understanding
of how the health care law affects
you. Maybe you stay with what you
have. Maybe you can get a tax credit
through the Marketplace. Finding out
is fast and easy!
Get your health plan review before
you make any big decisions about
your health insurance. Call us. Call
your agent. Come by. We can help.
Whether you want to call, visit or go online — Arkansas Blue Cross and Blue Shield
wants to be sure you have the most affordable health plan options available to you.
Call us!
Call our toll-free telephone number —
1-800-310-3778 — to talk to one of
our Arkansas Blue Cross and Blue
Shield representatives. We can walk
you through the entire process, from
identifying the most affordable health
plan to enrollment. If you have an
agent, they can help you too.
Come by!
If you prefer to speak to someone face
to face, you can visit your agent
or one of our many offices throughout
the state (see addresses and numbers
on page 27). We can provide you
with information on the health plans
available to you and help you enroll.
It’s easy, and you can ask all the
questions you want.
6 BLUE & YOU AUTUMN 2013
Go online!
Selecting the right health plan with
Arkansas Blue Cross is as easy
as going online to our website,
arkansasbluecross.com. You can even
stay in your pajamas! On our main
page, just select “Individual and
Family Plans” or “Do I Qualify for
a Tax Credit.”
Our online experience will show you
the many health plans available from
Arkansas Blue Cross based on your
income and family size. You can view
the details of each health plan, sort
them based on cost, choose to view
only certain kinds of plans, and even
compare up to three plans at once. If
you have questions at any time, you
can select a link to email or call an
agent. It’s fast and easy!
So what are you waiting for? With
Arkansas Blue Cross, selecting the
right health insurance has never
been easier.

Large employers get delay
on key parts of health care law
In July, the U.S. Department of Treasury
postponed enforcement of two key parts
of the Affordable Care Act: the employershared
responsibility payments (the “play
or pay” provisions), and the requirement to
report minimum essential health insurance
coverage until January 2015.
The “play or pay” provisions require
employers to offer “affordable” health
insurance to both their employees
and dependents or pay a penalty. If
a full-time employee qualifies for
and buys subsidized coverage
on the Health Insurance
Marketplace, the employer
would owe a penalty for
each subsidized employee.
The reporting provisions of the health
care law require large employers (those
with 50 or more full-time equivalent
employees) to report whether they offer
minimum essential coverage to their
employees, the length of the waiting
period, the monthly premium, the
employer’s share of total allowed costs
and the number of full-time employees.
Arkansas Blue Cross will continue
to provide our customers with
reliable information regarding
implementation of the
health care law as it
becomes available.
AUTUMN 2013 BLUE & YOU 7

Do YOU qualify for
FREE
health insurance
What’s covered?
How it works:
?
With Arkansas Blue Cross
coverage through the Healthcare
Independence Option (Arkansas
Medicaid program), you’ll get
the best care from the best
doctors, and free checkups
and cancer screenings.
Your household and income
determine whether you
get free or very low-cost
health insurance.
Changes under the new health care law will
allow thousands of low-income Arkansans
to qualify for free or low-cost private health
insurance — even if they have health conditions
— through the Arkansas Medicaid expansion.
Maybe you purchased your health plan on your
own. Maybe you have it through an employer.
If you qualify for Medicaid, you are likely to
receive an Arkansas Blue Cross and Blue Shield
health insurance card that gives you the same
access to doctors and hospitals at no cost to
you — or your employer.
Here’s what’s covered:
• Doctor visits
• Prescription drugs
• Hospital stays
• Surgeries
• Free checkups
You will qualify for free or lowcost
health insurance if you
are at or below the following
weekly or yearly incomes:
• Maternity and
newborn care
• Free screenings
for certain cancers
• Free birth control
• X-rays and lab work
NOTE: If you earn
minimum wage and
work 50 weeks per year,
40 hours per week you
earn $14,500.
$1,957
*Free or low-cost health
insurance depends on the
health plan you choose.
Enroll now!
You can purchase insurance right
now that goes into effect as early
as January 1, 2014.
Learn more by calling us at
1-855-625-0451 (8 a.m. to 5 p.m.
Monday-Friday) or call your agent.
8 BLUE & YOU AUTUMN 2013

Which health plan is right for YOU?
For a small percentage of our members, a more affordable health plan
is available through the Health Insurance Marketplace. If this is your
situation, Arkansas Blue Cross and Blue Shield has the answers you
need to identify the most affordable health plan for you.
Metallic Plans
Plans on the Health Insurance
Marketplace are divided into
different levels based on their
financial value — Bronze,
Silver, Gold and Platinum
— and are often referred to
as Metallic Plans. The levels
indicate the financial value
of the plan. For instance, all
Bronze plans are estimated to
cover 60 percent of the medical
costs for an average American.
100%
0%
Because the financial value of each level of
health plan must fit within the parameters
set by the federal government, there are
fewer plan options available than in the past,
however, each Bronze plan may offer different
deductibles, coinsurance or even variations
on benefit coverage, so you will benefit by
talking with an agent or Arkansas Blue Cross
representative to discuss your options
before making a selection.
On average, the lower the financial value
of a health plan, the less you will pay in
monthly premiums, but the more you will
pay at the doctor’s office. Arkansas Blue Cross
offers Bronze, Silver and Gold plans on the
Marketplace.
Metallic Coverage LEVELS
60% * 70% * 80% * 90% *
BRONZE SILVER GOLD PLATINUM
*NOTE: Percentage shows how much of your total health care costs this plan pays.
Affordable Options
Health insurance companies also can sell some
individual health plans off the Marketplace
that may be more affordable options than the
Metallic Plans, especially if you are young and
healthy. Arkansas Blue Cross offers Essential
Blue Freedom as one of these options.
Essential Blue Freedom offers $30
copayments for doctor’s office visits,
$15 generic prescription drugs, a $1,000
deductible and $2,000 out-of-pocket
maximum. Because it is not approved for the
Marketplace, you will have a review of your
medical history and you may have to pay the
penalty for not purchasing a Metallic Plan.
Don’t try to go it alone! Call us at
1-800-310-3778. We will walk you through
the process and give you the confidence
you need to make a great decision for you
and your family.
AUTUMN 2013 BLUE & YOU
79

7
things to know about the health care law and our Medicare plans
Some of our members with Medicare health plans (Medi-Pak ® Supplement,
Medi-Pak ® Advantage and Medi-Pak ® Rx) have concerns about the health care law.
Here are 7 things we want you to know:
1.
If you have a Medi-Pak Supplement plan, no matter when you purchased
your coverage – before or after the law was signed – you’ll still have the same
benefits and security you have now.
2.
3.
4.
5.
6.
7.
We don’t refer to Medicare plans as “grandfathered” or “non-grandfathered”
because that part of the law doesn’t apply to those plans.
If you want to change to your Medicare plan, you don’t have to
shop on the Health Insurance Marketplace, or replace your Medicare
coverage for Marketplace coverage. You can stay with Medicare and
shop for coverage the same way you always have.
All Medicare plans, no matter when they are purchased, are not eligible
for tax credits.
Your Medicare plan covers certain preventive services, like mammograms
and colonoscopies with no out-of-pocket costs to you. You also can get
a free yearly “Wellness” visit.
If you’re in the donut hole, you’ll get even better coverage when buying
Part D-covered prescription drugs. In 2014, under the standard gap coverage,
you will pay 72 percent for generic drugs and 47.5 percent for brand name drugs.
The law supports new initiatives to provide your doctor with additional
resources to make sure that your treatments are consistent.
10 BLUE & YOU AUTUMN 2013

Medicare
Annual Election Period
October 15
t h r o u g h
December 7
Medicare’s Annual Election Period (AEP) begins October 15 and runs through December 7.
During AEP, Medicare beneficiaries can purchase a Medicare Advantage plan and/or a Medicare
Part D prescription drug plan. You also may switch from your existing plans. If you join a plan
during AEP, or make changes to an existing plan, your new benefits will be effective January 1, 2014.
Affordable products and peace of mind
Arkansas Blue Cross and Blue Shield’s Medicare products offer members low monthly premiums.
And, in 2014 you can expect the same great selection of Medicare products you’ve come to
expect from us over the years.
• $0 premiums for Medi-Pak ® Advantage MA-PD Private Fee-for-Service (PFFS) (includes
drug coverage) in 27 counties and affordable premiums in all Arkansas counties. Medi-Pak
Advantage members have access to our extensive network of more than 7,000 doctors and
hospitals across the state. In addition, Medi-Pak Advantage MA-PD members receive a free
membership in the popular SilverSneakers ® Fitness Program.
• $0 premiums for Medi-Pak ® Advantage MA (PFFS) (does not include drug coverage) in 50
counties. These plans offer all the health benefits of our Medi-Pak Advantage MA-PD plans,
but do not include drug coverage. Members have the same access to our network of doctors
and hospitals, and a free SilverSneakers membership.
• Two Medi-Pak ® Rx Prescription Drug Plans (PDP) – Basic and Premier – with competitively
priced monthly premiums. More than 95 percent of Arkansas pharmacies are in our network.
• Four Medi-Pak ® supplement plans including Plan F, our most comprehensive supplement
plan, and Plan N, one of our lowest-priced supplement plans.
Attention Medicare Advantage plan members
If you have a Medicare Advantage or Medicare Part D plan, before October, you will receive an
Annual Notice of Change (ANOC), which will explain any changes to your current plan that will
become effective in January. If you are satisfied with your current plan, you are not required to
change anything. Every year, the Centers for Medicare and Medicaid Services (CMS) requires
companies to inform members of these changes prior to AEP so they may shop their coverage.
If you would like to learn more about our Medicare plans...
Call your local Medi-Pak ® Choice licensed agent or 1-800-392-2583 to learn more. You also can
visit our website, arkansasbluecross.com/Medicare. We’d love to hear from you. If you have a
friend or family member who will be looking for a Medicare Advantage or Part D plan this AEP,
we hope you’ll recommend Medi-Pak Advantage and Medi-Pak Rx.
AUTUMN 2013 BLUE & YOU
11

FAMILY
IS Where you
find it
SilverSneakers
keeps Conway
man surrounded
by friends
Three years ago, Charles Stacks, a 72-yearold
Medi-Pak ® member, had to have a hand
surgery that led to his retirement. At the same
time, he was fighting a 12-year battle with
throat cancer. As he dealt with, and continues
to deal with these challenges, Charles
remained true to the personal motto he’s been
wearing on his bicep since 1959, “Love is life.”
Once in the Navy and a truck driver for 40
years, the Greenbrier native spent his whole
life moving. After his hand surgery, a doctor
suggested Charles try SilverSneakers ® , the
nation’s leading exercise program designed
exclusively for older adults. Charles,
who lives just five minutes away from
the Conway Regional Health and Fitness
Center with his 92-year-old mother, jumped
at the chance to try the innovative blend
of physical activity, healthy lifestyle and
socially oriented programming.
“I started going to the classes as part of my
therapy, but I really like the social aspect,”
said Charles. “I enjoy living.”
Indeed, Charles is known for being a giver
and a bit of a joker. During class, he’s often
the instructor’s unofficial assistant, helping
latecomers get set up by grabbing a chair,
exercise balls, bands and other items for
them. After helping a latecomer during a
recent session, Charles “accidentally” moved
the box that was in the center of the circle
with his foot. This shift in placement would
give his team an advantage for a game later
on! He also likes to find the flattest balls he
can for the instructor so she has to work extra
hard with her manual exercises.
This year, Charles learned that, despite seven
throat surgeries and 15 years of treatment,
the cancer had moved to his lungs. While his
illness has definitely affected his strength, he
12 BLUE & YOU AUTUMN 2013

If I can
walk,
I will
be there.
– Charles
Stacks
still goes to classes five days a week.
He attributes his perseverance to the strong
mental and physical health he’s developed
through the SilverSneakers program,
as well as the many “girlfriends” (as he
likes to playfully call his female classmates)
that he has at the center.
With one daughter in Maumelle and another in
Michigan, Charles has found a family among
his classmates and the staff, often calling to
check in on any who miss a class. According
to the program director, Tiffeny Crow, Charles
always is the first to arrive and welcome
other class members, and he’s the last to
linger and visit with friends and staff. “For a
man who had few roots, Charles has made
a second home here with us,” Tiffeny said.
“His experience with the program, his life, his
warm personality… it’s all inspirational. We’re
so grateful that he found us!”
SilverSneakers is available to Arkansas Blue
Cross and Blue Shield Medi-Pak ® , Medi-Pak ®
Advantage (PFFS) and Medi-Pak ® Advantage PPO
members at no additional cost to the member.
Participants can visit wellness centers, YMCAs
and Curves ® locations all over the country.
For more information on SilverSneakers, call
1-888-423-4632, or visit silversneakers.com.
SilverSneakers ® is a registered mark of
Healthways, Inc. The SilverSneakers ®
Fitness Program is provided by
Healthways, Inc., an independent
company that operates separately from
Arkansas Blue Cross and Blue Shield.
AUTUMN 2013 BLUE & YOU 13

NEWS
Creshelle R. Nash, M.D., M.P.H., has joined
Arkansas Blue Cross and Blue Shield as the
medical director for Medi-Pak Advantage
Dr. Nash was a consultant to the Arkansas
Minority Health Commission and previously
was their medical director. She also
has been an assistant professor for the
Inaugural Faculty at the Clinton School of
Public Service and assistant professor in
both the College of Public Health and the
Department of Internal Medicine at the
University of Arkansas for Medical Sciences.
She is a member of the American Public
Health Association, the National Medical
Association, the Arkansas Public Health
Association, a past executive board member
for the Arkansas Medical, Dental and
Pharmaceutical Association, a member of
the South Central Public Health Leadership
Institute Alumni Association and the
Arkansas Medical Society.
She has been
honored by
the Pearls
Foundation and
Chi Eta Omega Chapter of Alpha Kappa
Alpha Sorority, Inc., as a Brown Girls Rock
VIP honoree for Service and Contributions
in Health, the Royal Knight Society, Inc.,
Outstanding Public Service Award, and
Sister Friend’s United, Inc., Women of
Excellence Award, business leader honoree.
Creshelle R. Nash, M.D., M.P.H.
She has served in the community through
the Arkansas Department of Health’s
Minority Health Advisory Council and its
breast cancer control program; the Arkansas
Commitment internship and leadership
programs; and the Philander Smith College
National Youth Sports Program.
Night at the Museum!
Arkansas Blue Cross and
Blue Shield members
enjoyed free admission to
the Museum of Discovery
in Little Rock during the
Arkansas Blue Cross -
sponsored “A Night at
the Museum/Pajama
Party” on June 1.
Arkansas Blue Cross
employees Carl Carter,
Micki Smith and Will
Ballard visit with Katie
and Megan Bayer at
the museum.
14 BLUE & YOU AUTUMN 2013

Arkansas Blue Cross and Blue Shield and
Health Advantage receive Health Plan Accreditation
Arkansas Blue Cross and Blue Shield and
Health Advantage recently were granted health
plan accreditation from URAC, a health care
accrediting organization that establishes quality
standards for the health care industry.
URAC’s Health Plan Accreditation standards
require a comprehensive review of an
organization’s operations, including:
network management; quality improvement;
credentialing; member protection and utilization
management. Companies must pass reviews of
all of these sections to receive accreditation.
“We are very pleased
to be recognized in the
industry for providing
outstanding services,”
said Mike Brown,
Arkansas Blue Cross
executive vice president and chief operating
officer. “Our mission to bring quality health
plan services to our members always has
guided our business practices, and each
division in the company demonstrated this
by helping Arkansas Blue Cross achieve
health plan accreditation.”
A second ArkansasBlue
store opens in Pine Bluff
Residents of Pine Bluff and
southeast Arkansas are able to
speak face to face with health
insurance experts who can
advise them about affordable
health plans and more at
the new ArkansasBlue office
located at 509 Mallard Loop
Drive in Pine Bluff (across from
Walmart on Highway 63).
Health insurance experts at
ArkansasBlue will provide
Arkansas Blue Cross and
Blue Shield members and
insurance shoppers with
information about Arkansas
Blue Cross insurance plans,
advice on which plan best
covers them and fits their
budget, as well as assistance
with questions or concerns
they may have about
purchasing or choosing health
insurance. ArkansasBlue also
will provide visitors with
information on dental and
other insurance plans.
Mike Brown, executive
vice president and
chief operating officer;
Mark White, president
and chief executive
officer; and Dwayne
Pierce, regional
executive; join Pine
Bluff Mayor Debe
Hollingsworth (center),
and members of the
Pine Bluff Chamber of
Commerce in cutting
the ribbon to officially
open the ArkansasBlue
health insurance store
in Pine Bluff.
And, with the full
implementation of the Patient
Protection and Affordable
Care Act (PPACA) approaching
in 2014, visitors who have
purchased individual or family
health insurance plans will
be able to come for a health
insurance review to see
how new regulations will
impact their health insurance
coverage and cost.
AUTUMN 2013 BLUE & YOU
15

Health
care
in
the
heartland
University of Arkansas for Medical Sciences
(UAMS) College of Medicine classmates
Justin Allen and Megan Busch were both
greeted with good news this summer —
$20,000 worth of good news to be exact.
Justin and Megan were named the 2013
Arkansas Blue Cross and Blue Shield
Primary Care Scholarship recipients, each
awarded a $20,000 scholarship for their
commitment to providing health care in
rural Arkansas.
The ScholarS
“Becoming a doctor has been the plan since
I was in eighth grade,” Justin said. “Growing
up in a rural community definitely helps you
appreciate the relationships you form with
people in that setting.”
Justin grew up in Mt. Vernon, a sleepy town
in central Arkansas that totaled 148 people
at the last census count. Growing up in Mt.
Vernon shaped Justin’s decision to become
a primary care physician and to focus on
Arkansas’ rural population.
For Justin, the Arkansas Blue Cross and
Blue Shield Primary Care Scholarship will
help him accomplish his goal.
“This scholarship means the world to me,”
he said.
Megan’s career ambitions weren’t always as
clear. Born and raised in Little Rock, it wasn’t
until she completed undergrad and moved
to the small town of Warren that Megan
realized her desire to work amongst the
state’s rural population.
In Warren, Megan had a job working for one
of the town’s primary care physicians
and learned firsthand the incredible
importance of a small-town doctor.
16 BLUE & YOU AUTUMN 2013
Megan Busch (left) and
Justin Allen were named
recipients of the 2013 Arkansas
Blue Cross and Blue Shield
Primary Care Scholarship.
“You’re the first person they go to with any
type of problem. You’re the person following
everything. From head to toe, from baby to
grandma, you experience continuity of care
that other specialists just don’t get to see,”
she said. “The doctor I worked with was a
hero to the whole town. I saw how much
that one person contributed to the town.”
Two years later, when she returned from
Warren to UAMS in Little Rock, Megan
knew her career’s trajectory.
“I came back to Little Rock and totally
changed my views about what I wanted
to do in the field of medicine,” Megan said.
Like Justin, she wanted to provide primary
care to rural Arkansans.

saturday, october 20
Join Arkansas Blue Cross’ BlueCares
Team for the Komen for a Cure
walk. Our team will be handing out
goodies to walkers. We look forward
to supporting finding a cure for breast
cancer with Central Arkansans.
saturday, november 10
Get ready for a happy, healthy
holiday season with P. Allen Smith!
Join us at the ArkansasBlue
insurance store, from 9 a.m.
to 1 p.m. for healthy food
growing and cooking
demonstrations, and activities
with SilverSneakers ® * instructors.
*SilverSneakers ® is a registered mark of
Healthways, Inc. The SIlverSneakers ® Fitness
Program is provided by Healthways, Inc.,
Healthways is an independent company
that operates separately from Arkansas
Blue Cross and Blue Shield.
MPI 1129 9/12
saturday, december 1
City Mouse, Country Mouse, Christmas
House! Arkansas Blue Cross is hosting
a special showing of City Mouse,
Country Mouse, Christmas House at
the Arkansas Arts Center. Round up
the family and enjoy a FREE night
of the arts. Tickets can be picked
up at ArkansasBlue, located in the
Shackleford Crossing shopping center,
while supplies last. Check our Web
site for details.
spring 2013
Although spring is months away, now
is the time to plan for the Blue & You
Fitness Challenge. Start forming your
team or group and plan to register
for the 2013 Challenge.
The Blue & You Fitness Challenge
is an exercise contest (March 1 –
May 31) that encourages participants
to work toward the public health
recommendation of adult physical
activity 30 minutes each day, most
days of the week.
For more information, call toll
free 1-800-686-2609, or visit
blueandyoufitnesschallenge-ark.com.
Clinics chosen for
federal initiative
page 6
Health Care
Reform update
page 8
Meet the first Arkansas Blue Cross
and Blue Shield Primary Care
Scholarship recipients ... page 4
Teen drivers
are safer now
page 20
T H E
SCHOLARSHIP
SPECS
NAME:
Arkansas Blue Cross
and Blue Shield Primary
Care Scholarship
RECIPIENTS: 2 each year
AMOUNT: $20,000
Next year, both Justin and
Megan will begin their
residency and take one
step closer to becoming a
primary care physician in rural
Arkansas. And the $20,000
scholarship will go a long way
toward helping them get there.
The ScholarSHIP
For future primary care
physicians, medical school is
a painstaking and rigorous
challenge that has to be
overcome. So is financing it.
That’s why scholarship
opportunities like the
Arkansas Blue Cross and
Blue Shield Primary Care
Scholarship are important.
Tom G. South, assistant
dean of medical student
admissions at UAMS, said
the newly founded Arkansas
Blue Cross scholarship is
among the very largest
available to UAMS students.
“We see an increasing number
of students graduating with
a lot of debt,” Tom said. “The
scholarship allows students to
divert the money that would’ve
gone to paying back those
student loans to their practice
and patients.”
Justin and Megan use a bag-valve mask on a mannequin at the UAMS
patient simulation center.
According to Tom, the
average debt for a UAMS
College of Medicine student
was $139,044 in 2012.
FOLLOW UP
ON LAST YEAR’S
WINNERS
Last year, the
good for you
events
inaugural
activities
and
Arkansas
Blue Cross
scholarship
winners were
Christina “Lauren”
Monteith and
Josue Gutierrez.
Lauren is currently a
family medicine resident
in El Dorado.
Bringing doctors
to rural Arkansas
Josue is in the family
medicine resident program
in Lincoln, Neb. (Although
Josue was matched
out of state, he remains
committed to returning to
Arkansas upon completion.)
Each year, students who are
studying to be primary care
physicians compete for the
scholarship, which comes from
interest earned on a $1 million
grant given by Arkansas Blue
Cross to UAMS.
“One of the primary
considerations of our
students is trying to get
them to go to rural
underserved communities,”
Tom said. “We have a
tremendous need for
physicians to stay in Arkansas
and to locate their practices
in the rural parts of the state.”
Tom said the large debt
burden taken on by medical
school students each year
is problematic. When faced
with mounting student loans,
medical school students are
often attracted to careers as
higher-wage specialists.
The partnership between
UAMS and Arkansas Blue
Cross will continue to
encourage students to choose
primary care and help improve
the health of the state’s rural
population.
AUTUMN 2013 BLUE & YOU
17

Blue & You Foundation awards 55 mini-grants
to improve health in Arkansas
1
From food pantries to summer
camps to community gardens
— there are many ways
Arkansans can live healthier
lives with a little bit of funding
to make it happen. That’s why
the Blue & You Foundation
for a Healthier Arkansas
began awarding $1,000 minigrants
to health-improvement
programs throughout the
state that needed a financial
boost. The Foundation recently
awarded $1,000 mini-grants to
55 programs in Arkansas.
“This year’s recipients will
be conducting a wide variety
of healthy activities in their
communities,” said Patrick
O’Sullivan, executive director
of the Blue & You Foundation.
“From nutrition and exercise
18 BLUE & YOU AUTUMN 2013
to medical and mental health,
these programs help bring
communities together in
positive ways to improve
the health of Arkansans.”
The Blue & You Foundation
was established in 2001
by Arkansas Blue
Cross and Blue
Shield to help
support community
organizations
that are implementing
programs to improve
the health of Arkansans.
In its first 12 years of
grant making, the Blue
& You Foundation has
awarded more than
$16 million to 381
health-improvement
projects in Arkansas.
The mini-grant recipients for 2013 are:
2
9 MINI-
GRANTS
5
7 MINI-
GRANTS
1
15 MINI-
GRANTS
3
10 MINI-
GRANTS
6
4 MINI-
GRANTS
Central Arkansas
Bryant: Bryant Parks and Recreation — Bishop Parks Community Garden
Cabot: Cabot Crisis Pregnancy Center — Empowered! Sexual Risk Avoidance
Hot Springs: Lupus Foundation of America, Inc., Arkansas Chapter —Public Awareness of Lupus in Arkansas Project
North Little Rock: Academy of Creative Arts at Shorter College — Fresh Start Whole Food Nutrition Program
Amboy Community Food Pantry — School’s Out: Extra Cereal for the Kids
In Your Hands Ministries, Inc. — Nutritional Outreach for Kids
We Care Adult Day Care Center, Inc. — Mental Stimulation and Sensory Awareness
Therapeutic Program
Little Rock: Arkansas Association of Health System Pharmacists — Health and Wellness Education
Arkansas Insurance Department — AHELP: Motivate, Move, Maximize
Arkansas Workers’ Compensation Commission — AHELP Initiative
Compassion Works for All — Family Re-Unification Broadcasts
Forest Park Elementary PTA — Centennial Athletic Pavilion and Track
Jack Stephens Youth Golf Academy, Inc. — Summer Outreach Program
Leukemia & Lymphoma Society — Light the Night Walk
Village Commons — Healthy Foods Community Dinner
4
10 MINI-
GRANTS

2
3
4
5
6
Northwest Arkansas
Fayetteville: Public Education Foundation — Roadrunner Day
Peace at Home Family Shelter — Building Bridges domestic violence intervention
Hartford: Hartford School District — Community Health Fair
Mena: Quality of Life Outreach, Inc. — Outreach Resource Guide
Morrilton: Conway County Literacy Council — Safety Baby Showers
Ozark: Ozark School District — Play Equipment
Perryville: Perryville School District — The PHS School and Community Garden
Russellville: Arkansas Tech University — Safe Spring Break Health and Wellness Fair
Van Buren: North Park Baptist Church — AEDs for NPKidz
North Central Arkansas
Bald Knob: H. L. Lubker Elementary — Cardio Rebounder Trampolines
Batesville: City of Batesville — Eat Well, Play Hard, Make It Balance
Independence County Hometown Wellness Coalition —Physical Activity Fun
Southside Elementary School — Step Up to Good Health
University of Arkansas Community College — Get ACTIVE
Heber Springs: (The) CALL in Cleburne County — CPR and Pediatric First Aid Materials
Mountain View: Stone County Hometown Health Planning Coalition, Inc. — Family Care Fair
Pleasant Plains: Midland High School — Step Up to Good Health
Searcy: White County Medical Center — A Day of Caring
White County Single Parent Scholarship Fund, Inc. — Scholarship Fund
Northeast Arkansas
Augusta: ARcare — ARcare Healthy Weight Initiative
DeWitt: Grand Prairie Charitable Christian Medical Clinic — Patient Medications and Clinic Maintenance
Jonesboro: Westside Consolidated School District #5 — Stabilizing Learners’ Lives
Marianna: Lee County Cooperative Clinic — Regional Health Education Fair
Memphis: Boy Scouts of America, Chickasaw Council — Summer Camp Scholarships
(serving
Northeast Arkansas)
Jes Lere-Hama Corp., Memphis — Drug Abuse Awareness and Healthy Lifestyle Choices
Newport: Jackson County Learning Center — Healthy Lifestyles
Oil Trough School District — Step Up to Good Health
Paragould: Center for Fathers & Families — Healthy Lifestyles
Mission Outreach of NEA, Inc. — Charitable Medical Clinic
Southwest Arkansas
Arkadelphia: Clark County Strategic Plan — Clark County Adolescent Summer Fitness Challenge
Camden: Christian Health Center — Service Expansion Program
Hope: Our Lady of Good Hope Catholic Church — Food Pantry
Kirby: Kirby School District — Sugar Sugar Everywhere
Magnolia: Bethlehem Missionary Baptist Church — Community-Wide Vacation Bible School
Calhoun Heights Community Outreach, Inc. — Summer Enrichment Program
Texarkana: Texarkana Arkansas Police Department — P.R.I.D.E. Academy
SouthEAst Arkansas
Monticello: Southeast Arkansas Education Service Cooperative Foundation —
Effectively Conducting Physical Fitness Assessments on School Age Children
Pine Bluff: Southeast Arkansas Medical Education Foundation, Inc., Pine Bluff — Health Literacy Awareness
New Morning Star Children & Families Development Services Center, Inc.— Healthy Choices
Star City: Lend A Hand of Lincoln County — Emergency Food Assistance Program
Nonprofit and charitable organizations, schools and government institutions in Arkansas are eligible
to apply for two different programs: a $1,000 mini-grant program (available again in early 2014), and
a regular grants program of $5,000 to $150,000 with an application deadline of July 15, 2014.
Grant guidelines and the online applications can be found at blueandyoufoundationarkansas.org.
The Blue & You Foundation is an independent licensee of the Blue Cross and Blue Shield Association and serves the state of Arkansas.
AUTUMN 2013 BLUE & YOU
19

Come homE to a
MEDICAL homE!
Do these sound familiar?
A loved one comes
home from a doctor
visit and is confused
about which
medications to
take—or even what
the doctor said.
You saw a
specialist or had
a test, but your
family doctor
didn’t get a
report back.
You had to go to
the emergency
department because
your primary doctor
had no appointments
available for a week.
by Randal Hundley, M.D.,
Arkansas Blue Cross and Blue Shield
Your diabetes is not well
controlled, but your doctor
doesn’t have the resources
to help you manage your
condition except during
actual office visits, rather
than working with you
throughout the year.
The Patient Centered Medical Home (PCMH) is a model for improving primary care and fixing some
other shortcomings of our medical system. A PCMH is not a place — it is a concept. A PCMH is a
medical practice that has embraced a new way of caring for patients, with a focus on the “triple aim” of
improving health, improving patient experience and lowering cost. While there is no single definition
of a PCMH, there are several key ingredients to transforming a medical practice into a medical home.
These include:
A team approach to care –
A medical home is led by a
physician, often collaborating
with an advanced practice nurse
or physician assistant. Unlike a
traditional practice, where the staff
is focused on helping the providers,
in a medical home everyone
(including the receptionist,
medical assistant, nurse and
medical technician) works and
communicates as a team to identify
and address the patients’ needs.
Shared decision-making –
Rather than always telling patients
what they need, a medical home
will, whenever possible, present
patients with options and
information for making a decision.
The patient’s deepest wishes
and concerns will be taken into
account, and the ultimate decision
is made by the patient.
Care coordination – In a traditional practice, the
patient gets great care from the doctor at the time of a
visit or when they call the office for help. In a medical
home, the staff reaches out to patients between visits,
making sure specialist appointments are made and
kept, and looking for missed treatment opportunities
through the use of electronic medical records and other
software. For example, a care coordinator in the practice
might find that a patient qualifies for a pneumonia
vaccine but has not gotten it. The receptionist then may
contact the patient to come in and get this vaccination
— possibly preventing a serious illness. In addition,
there is great attention to getting medications and
follow up right when a patient goes home from a
hospitalization. We know that miscommunication often
occurs during transitions from hospital to home.
Continuous improvement – A medical home
strives to improve the quality of care and lower the
cost of care through tracking and analyzing data,
and by providing better access to care through
extended hours, urgent care availability, and 24/7
phone access. Patients are actively invited to give
feedback to the practice on how it can improve.
20 BLUE & YOU AUTUMN 2013

At Arkansas Blue
Cross and Blue
Shield, we believe
that the PCMH
is a big part of
improving our
health care delivery
system. Starting in
2010, we gave extra
support and reimbursement
to several practices around the
state to help transform them
into PCMHs. These clinics met
rigorous criteria to ultimately
become recognized by a
national accreditation body as
true patient centered medical
homes. We now are working to
increase the number of PCMHs
in Arkansas.
We look forward to a time when
every patient will have a place
to call home — medical home,
that is!
NEW and upcoming generics
The following medications may be available soon (or now!) in generic form. Ask your
pharmacist if there is a generic available for your prescription. Generic medications are
the same as their brand-name counterparts. You can learn more about generics on the
U.S. Food and Drug Administration’s website, fda.gov.
Brand name GeneRIC use Generic Release
Patanase Olopatadine Nasal allergy 2013
Advicor Niacin and Lovastatin High cholesterol 2013
Bromday Bromfenac eye swelling and pain 2013
Lidoderm Lidocaine pain patch 2013
Aciphex Rabeprazole acid reflux 2013
Cymbalta duloxetine antidepressant and pain 2013
Locoid lipocream Hydrocortisone Itching Late 2013
Vanos Fluocinonide psoriasis Late 2013
Vivelle-Dot estradiol Menopause Late 2013
Loestrin 24 Fe Ethinyl Estradiol Birth control early 2014
and Norethindrone
Renvela tabs sevelamer Chronic kidney disease Early 2014
Actonel Risedronate Osteoporosis 2014
Detrol La tolterodine Overactive bladder 2014
Kapvay Clonidine High blood pressure 2014
Lunesta eszopiclone sleep agent 2014
Nexium esomeprazole acid reflux 2014
Viracept Nelfinavir antiviral 2014
Avelox Moxifloxacin antibiotic 2014
Micardis telmisartan High blood pressure 2014
Micardis HCT tabs Telmisartan and High blood pressure 2014
hydrochlorothiazide
Renagel sevelamer Chronic kidney disease Late 2014
Intuniv Guanfacine High blood pressure Late 2014
Tazorac gel tazarotene psoriasis Late 2014
AUTUMN 2013 BLUE & YOU
21

Folic Acid: Not Just for Women
Folic acid is mostly known as being very
important for women during pregnancy, but
did you know that folic acid, or folate, provides
major health benefits for everyone?
Folate is a water-soluble B vitamin found
naturally in food and folic acid. Folate enables
our bodies to make DNA and other genetic
material. Studies have shown that folate can
keep the brain young and decrease the risk of
several forms of cancer. Taken in combination
with other B vitamins, it can prevent stroke and
anemia. A deficiency can lead to an increased risk
of depression, dementia and heart disease.
Folate is found in many foods, including:
• Green leafy vegetables like spinach,
broccoli and asparagus
• Bananas, strawberries, oranges and tomatoes
• Peanuts, fish, eggs and organ meats like
kidney and liver
• Enriched flour foods like bread, bagels and pasta
The amount of folate you should consume
varies depending on your age and ranges from 65
micrograms for infants to 600 micrograms
for pregnant women.
LIFE
STAGE
Birth to 6 months
7-12 months
1-3 years
4-8 years
9-13 years
14 years and up
Pregnant women
Breastfeeding women
22 BLUE & YOU AUTUMN 2013
RECOMMENDED
MICROGRAMS
65
80
150
200
300
400
600
500
Let us HELP
YOU
lose weight!
Are you trying to lose weight, but feel
like you are losing the battle? If so,
you aren’t alone. Let Arkansas Blue
Cross and Blue Shield help you win
at losing! For free!
The Healthy Weigh education
program is available to most of our
members.* To join, complete and
return the enrollment form included
in this magazine. We’ve even
provided a self-addressed, postagepaid
envelope! It’s that easy!
Members will receive free information
each month by mail, including:
• Guides on weight loss, fitness
and maintaining a healthy weight
• Information on fun activities
• Recipes and menus
• Tips on buying groceries and
eating out
• Information on walking
• Healthy eating tips for
grandchildren
• Strength-training information
• A portion-size placemat
Want to know more? Call the Health
Education Program’s toll-free number:
1-800-686-2609.
*The Healthy Weigh! health education program is
available to most members of Arkansas Blue Cross,
Health Advantage and BlueAdvantage Administrators
of Arkansas. Members with Medi-Pak ® supplement and
Medi-Pak Rx health plans and Arkansas state and public
school employees are not eligible. Some BlueAdvantage
members may not be eligible. Check your benefits for
more information or call Customer Service to find out.

WINNERS!
You walked, you ran, you worked
out … and you met the Challenge!
A total of 126 groups took on the
Blue & You Fitness Challenge this
year, including 8,495 individuals
logging 198,616 hours of exercise!
Representatives from several of the winning organizations
were in attendance at the Blue & You Fitness Challenge
wrapup held July 16 at the Little Rock Convention Center.
The organizations represented are, (front row) left to right; Delta
AHEC, Helena; The Ten Wonders, Clinton; Lamar Elementary,
Lamar; Simmons First National Bank, Pine Bluff; CMI, Little
Rock; Arkansas State Plant Board, Little Rock; Arkansas
Children’s Hospital, Little Rock; (back row) Pace Industries,
Fayetteville; and Transportation Security Agency, Little Rock.
The winners of the 2013 Blue & You Fitness Challenge are:
Group Category 1
(Under 10 participants)
Delta AHEC – Helena
Group Category 2
(10-11 participants)
The Ten Wonders – Clinton
Group Category 3
(12-14 participants)
Arkansas State Plant Board –
Little Rock
Group Category 4
(15-16 participants)
National Park Service –
St. Paul, Minnesota
Group Category 5
(17-19 participants)
CMI – Little Rock
Group Category 6
(20-23 participants)
ACHI – Little Rock
Group Category 7
(24-29 participants)
Arkansas Best Federal
Credit Union – Fort Smith
Group Category 8
(30-39 participants)
Lamar Elementary – Lamar
Group Category 9
(40-60 participants)
Northwest Arkansas
Community College –
Bentonville
Group Category 10
(61-86 participants)
Nucor Yamato Steel –
Blytheville
Group Category 11
(87-150 participants)
Transportation
Security Agency —
Little Rock
Group Category 12
(151-275 participants)
Pace Industries —
Fayetteville
Group Category 13
(400+ participants)
Simmons First
National Bank —
Pine Bluff
For more information about the
Blue & You Fitness Challenge, log on to
BlueAndYouFitnessChallenge-ark.com.
Student Winners:
Grand-prize (won a
Walmart gift card toward
the purchase of a bike)
Saphire Zambrana
of Kimmons Junior High School
PE4life in Fort Smith
Runners-up (received fitnessrelated
gift bags and gift cards)
Tommy Ford
of Harrisburg High School
in Harrisburg
Deandre Alexander
of Watson Chapel Junior High
FBLA in Pine Bluff
AUTUMN 2013 BLUE & YOU
23

24
Notice of Privacy Practices — Arkansas Blue Cross and Blue Shield and Health Advantage
This notice describes how claims or medical information about you may be used and disclosed and how
you can get access to this information. Please review it carefully.
By law, Arkansas Blue Cross and Blue Shield
and its affiliated company, Health Advantage,
(sometimes referred to in this notice for
convenience as a group as “Arkansas Blue
Cross”) are required to protect the privacy of
your protected health information. We must
also give you this notice to tell you how we may
use and release (disclose) your protected health
information held by us.
Throughout this notice, we will use the name
“Arkansas Blue Cross” as a shorthand reference
for not only Arkansas Blue Cross and Blue Shield,
but also for its affiliated company, HMO Partners,
Inc., d/b/a Health Advantage. Please note that
although we are combining this privacy notice in
this way for convenient, short-hand reference, and
to make it more efficient to inform you about your
privacy rights, these companies remain separate
companies, each with their own operations,
management and compliance responsibilities.
Arkansas Blue Cross must use and release
your protected health information to provide
information:
• To you or someone who has the legal right to
act for you (your personal representative)
• To the Secretary of the Department of Health
and Human Services, if necessary to make
sure your privacy is protected, and
• Where required by law.
Arkansas Blue Cross has the right to use and
release your protected health information to
evaluate and process your health plan or health
insurance claims, enroll and disenroll you and
your dependents, and perform related business
operations.
For example:
• We can use and disclose your protected health
information to pay or deny your claims, to
collect your premiums, or to share your benefit
payment or status with other insurer(s).
• We can use and disclose your protected
health information for regular health care
operations. Members of our staff may use
information in your personal health record
to assess our efficiency and outcomes in
your case and others like it. This information
will then be used in an effort to continually
improve the quality and effectiveness of
benefits and services we provide.
• We may disclose protected health information
to your employer for health plan administration
purposes, including health care operations
of the health plan, if your employer arranges
for your insurance or funds the health plan
BLUE & YOU AUTUMN 2013
coverage and serves as Plan Administrator.
If your employer meets the requirements
outlined by the privacy law to ensure adequate
separation between the employer and the
health plan itself, we can disclose protected
health information to the appropriate health
plan administrative department of your
employer to assist in obtaining coverage or
processing a claim or to modify benefits, work
to control overall plan costs, and improve
service levels. This information may be provided
to the appropriate health plan administrative
department of your employer in the form of
routine reporting or special requests.
• We may disclose to others who are contracted
to provide services as business associates on
our behalf. Some services are provided in our
organization through contracts with others.
Examples include pharmacy management
programs, dental benefits, and a copy service
we use when making copies of your health
record. Our contracts require these business
associates to appropriately protect your
information in compliance with applicable
privacy and security laws.
• Our health professionals and customer
service staff, using their best judgment, may
disclose to a family member, other relative,
close personal friend or any other person you
identify, health information relevant to that
person’s involvement in your care or payment
related to your care. Examples of such releases
of your protected health information could
include your spouse calling to verify a claim
was paid, or the amount paid on a claim, or an
adult child inquiring about explanation of benefit
forms received by an elderly parent who is ill
or impaired and unable to address their own
health insurance or health plan business.
Arkansas Blue Cross may use or give out your
protected health information for the following
purposes, under limited circumstances:
• To state and other federal agencies that have
the legal right to receive Arkansas Blue Cross
data (such as to make sure we are making
proper claims payments).
• For public health activities (such as reporting
disease outbreaks).
• For government health care oversight activities
(such as fraud and abuse investigations).
• For judicial and administrative proceedings
(such as in response to a subpoena, law
enforcement agency administrative request or
other court order).
• For law enforcement purposes (such as
providing limited information to locate a

missing person or in response to any federal
or state agency administrative request that is
authorized by law).
• For research studies that meet all privacy law
requirements (such as research related to the
prevention of disease or disability).
• To avoid a serious and imminent threat to
health or safety.
• To contact you regarding new or changed
health plan benefits.
By law, Arkansas Blue Cross must have your
written permission (an authorization) to use or
release your protected health information for
any purpose other than treatment, payment or
health care operations or other limited exceptions
outlined here or in the Privacy regulation or
other applicable law. Once you have given your
permission for us to release your protected
health information you may take it back (revoke)
at any time by giving written notice to us, except
if we have already acted based on your original
permission. To the extent (if any) that we maintain
or receive psychotherapy notes about you,
most disclosures of these notes require your
authorization. Also, to the extent (if any) that we
use or disclose your information for our fundraising
practices, we will provide you with the ability to
opt out of future fundraising communications. In
addition, most (but not all) uses and disclosures
of medical information for marketing purposes,
and disclosures that constitute a sale of protected
health information, require your authorization.
Personal Health Record (PHR)
If you have a health benefit plan issued by
Arkansas Blue Cross or Health Advantage on or
after October 1, 2007, you have a Personal Health
Record (PHR). Your PHR contains a summary
of claims submitted for services you received
while you are or were covered by your health
benefit plan, as well as non-claims data you
choose to enter yourself. Your PHR will continue
to exist, even if you discontinue coverage under
your health benefit plan. You have access to
your PHR through the Arkansas Blue Cross or
Health Advantage websites. In addition, unless
you limit access, your physician and other health
care providers who provide you treatment have
access to your PHR. Certain information that
may exist in the claims records will not be made
available to your physician and other health care
providers automatically. To protect your privacy,
information about treatment for certain sensitive
medical conditions such as HIV/AIDS, sexually
transmitted diseases, mental health, drug or
alcohol abuse or family planning will be viewable
by you alone, unless you choose to make this
information available to the medical personnel who
treat you. Similarly, non-claims data, such as your
medical, family and social history, will only appear
in your PHR if you choose to enter it yourself. It
is important to note, that you have the option to
prohibit access to your PHR completely, either by
electronically selecting to prohibit access or by
sending a written request to prohibit access to the
Privacy Office at the address below.
Special Note on Genetic Information
We are prohibited by law from collecting or using
genetic information for purposes of underwriting,
setting premium, determining eligibility for benefits
or applying any pre-existing condition exclusion
under an insurance policy or health plan. Genetic
information means not only genetic tests that
you have received, but also any genetic tests of
your family members, or any manifestations of a
disease or disorder among your family members.
Except for pre-existing condition exclusions,
we may obtain and use genetic information in
making a payment or denial decision or otherwise
processing a claim for benefits under your health
plan or insurance policy, to the extent that genetic
information is relevant to the payment or denial
decision or proper processing of your claim.
Your Rights Regarding Medical Information
About You
You have the right to:
• See and get a copy of your protected health
information that is contained in a designated
record set that was used to make decisions
about you. This may include an electronic
copy in certain circumstances if you make this
request in writing.
• Have your protected health information
amended if you believe that it is wrong,
or if information is missing, and Arkansas
Blue Cross agrees. If Arkansas Blue Cross
disagrees, you may have a statement of your
disagreement added to your protected health
information.
• Receive a listing of those getting your
protected health information from Arkansas
Blue Cross. The listing will not cover your
protected health information that was given
out to you or your personal representative,
that was given out for payment or health
care operations, or that was given out for law
enforcement purposes.
• Ask Arkansas Blue Cross to communicate with
you in a different manner or at a different place
(for example, by sending your correspondence
to a Post Office box instead of your home
address) if you are in danger of personal harm
if the information is not kept confidential.
• Ask Arkansas Blue Cross to limit how your
protected health information is used and
given out to pay your claims and perform
health care operations. Please note that
Arkansas Blue Cross may not be able to
agree to your request.
• Get a separate paper copy of this notice.
(continued on page 26)
AUTUMN 2013 BLUE & YOU
25

(continued from page 25)
Breach Notification
In the event of breach of your unsecured health
information, we will provide you notification of such
a breach as required by law or where we otherwise
deem such notification appropriate.
To Exercise Your Rights
If you would like to contact Arkansas Blue Cross or
Health Advantage for further information regarding
this notice or exercise any of the rights described in
this notice, you may do so by contacting Customer
Service at the following toll-free telephone
numbers:
Arkansas Blue Cross 1-800-238-8379
Health Advantage 1-800-843-1329
You also may get complete instructions and
request forms from our companies’ websites:
arkansasbluecross.com
healthadvantage-hmo.com
Changes to this Notice
We are required by law to abide by the terms of this
notice. We reserve the right to change this notice
and make the revised or changed notice effective
for claims or medical information we already have
about you as well as any future information we
receive. When we make changes, we will notify
you by sending a revised notice to the last known
address we have for you or by alternative means
allowed by law or regulation. We also will post a
copy of the current notice on Arkansas Blue Cross
and Health Advantage websites.
Complaints
If you believe your privacy rights have been
violated, you may file a complaint with Arkansas
Blue Cross or its affiliated company, Health
Advantage, or with the Secretary of the
Department of Health and Human Services. You
may file a complaint with Arkansas Blue Cross or
its affiliated company, Health Advantage, by writing
to the following address:
Privacy Office
ATTN: Privacy Officer
P.O. Box 3216
Little Rock, AR 72201
We will not penalize or in any other way retaliate
against you for filing a complaint with the secretary
or with us. You also may file a complaint with the
secretary of the U.S. Department of Health and
Human Services. Complaints filed directly with the
secretary must: (1) be in writing; (2) contain the
name of the entity against which the complaint is
lodged; (3) describe the relevant problems; and (4)
be filed within 180 days of the time you became or
should have become aware of the problem.
26 BLUE & YOU AUTUMN 2013
Last revision 5/13
Annual Notice
2014 Summary of Benefits and
Coverage – available November 15
for individual/family policyholders
As required by the Patient Protection and
Affordable Care Act (PPACA), the Summary of
Benefits and Coverage (SBC) (OMB Control
Numbers 1545-2229, 1210-0147 and 0938-1146)
provides information regarding coverage
specifications and limitations that apply to the
health insurance plan you have selected.
Before the end of each year, Arkansas Blue
Cross and Blue Shield provides members
who are under age 65 and have individual/
family health insurance policies* with an SBC.
This official communication includes
information about the coverage provided
by your health insurance plan in a
summary format for the upcoming year.
Beginning November 15, 2013, you may
access this information:
• Online in the “Benefits” section of the
Arkansas Blue Cross secure member
self-service center, My Blueprint, at
arkansasbluecross.com
• By calling Arkansas Blue Cross Customer
Service at 1-800-238-8379 to receive a
printed version
After that date, you also may log on to
arkansasbluecross.com/sbc and enter your
member number (found on your member ID
card) into the SBC locator tool to review the
document online and print it.
If you make changes to your Arkansas Blue
Cross health plan benefits that differ from your
current coverage, a new SBC will be created
for you within seven work days of our receipt
of your change request. It will be available to
you in the same manner described above.
*These are members who do not have health
insurance through an employer, a Medicare
health plan, or Short-Term Blue product.
Arkansas Blue Cross, Health Advantage and
BlueAdvantage Administrators of Arkansas
members who receive health coverage
through an employer group will get their
SBC from their employer group plan
administrator at the appropriate time.

Women’s Health and Cancer Rights Act
The Women’s Health and Cancer Rights Act
of 1998 introduced changes in insurance
coverage for mastectomy.
In accordance with the law, all group and
individual health plans that provide medical
and surgical benefits for mastectomy will
cover reconstructive breast surgery, including:
• Reconstructive surgery on the breast on which the mastectomy was performed.
• Reconstructive surgery on the unaffected breast needed to “produce a
symmetrical appearance.”
• Prostheses and treatment of complications of any stage of a mastectomy, including
lymphedema (post-surgical fluid buildup).
These provisions apply to all policies issued by Arkansas Blue Cross and Blue Shield,
Health Advantage and BlueAdvantage Administrators of Arkansas and are subject to the
applicable copayments, coinsurance, benefit limitations, exclusions and benefit maximums.
If you have questions about your insurance coverage, contact your group benefits administrator
or a customer service representitive at your local Arkansas Blue Cross office.
CUSTOMER SERVICE NUMBERS
May we help? For customer
service, please call:
LITTLE ROCK
TOLL FREE
Number (501)
Number
Medi-Pak ® members 378-3062 1-800-338-2312
Medi-Pak ® Advantage members 1-877-233-7022
Medi-Pak ® Rx members 1-866-390-3369
Arkansas Blue Cross members 378-2010 1-800-238-8379
• Pharmacy questions 1-800-863-5561
• Specialty Rx pharmacy questions 1-866-295-2779
Health Advantage members 378-2363 1-800-843-1329
• Pharmacy questions 1-800-863-5567
BlueAdvantage members 378-3600 1-888-872-2531
• Pharmacy questions 1-888-293-3748
Federal Employee members 378-2531 1-800-482-6655
Looking for health or dental insurance? We can help!
For individuals, families 378-2937 1-800-392-2583
For employer groups* 378-3070 1-800-421-1112
*Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas
Prefer to speak with someone close to home?
Call or visit one of our offices near you:
• ArkansasBlue — Little Rock
2612 S. Shackleford Rd., Suite J 1-501-378-2222
• Fayetteville
516 East Millsap Rd., Suite 103 1-800-817-7726
• Fort Smith
3501 Old Greenwood Rd., Suite 5 1-866-254-9117
• Hot Springs
100 Greenwood Ave., Suite C 1-800-588-5733
• Jonesboro
707 East Matthews Ave. 1-800-299-4124
• Little Rock
601 Gaines Street 1-800-421-1112
• ArkansasBlue — Pine Bluff
509 Mallard Loop Drive 1-800-236-0369
• Texarkana
1710 Arkansas Boulevard 1-800-470-9621
Visit our websites for more information:
arkansasbluecross.com • healthadvantage-hmo.com • blueadvantagearkansas.com • blueandyoufoundationarkansas.org
AUTUMN 2013 BLUE & YOU 27

the HEALTH CARE LAW timeline
OCT.1
2013
DEC.15
2013
JAN.1
2014
Online Marketplace opens
Final day to buy health insurance for a
January 1, 2014, effective date
New health insurance plans begin
MAR.31
2014
Last day to sign up for health insurance
Questions about the health care law?
Email us!
HCRinfo@arkbluecross.com
Call us!
1-800-310-3778
Come by!
Find a location on page 27
Go online!
arkansasbluecross.com
MPI 1738 9/13