Blue & You - Autumn 2012

Bringing doctors to rural Arkansas; Clinics chosen for federal initiative; Health Care Reform update; Teen drivers are safer now; Meet the first Arkansas Blue Cross and Blue Shield Primary Care Scholarship recipients

Bringing doctors to rural Arkansas;
Clinics chosen for federal initiative;
Health Care Reform update;
Teen drivers are safer now;
Meet the first Arkansas Blue Cross and Blue Shield Primary Care Scholarship recipients


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Bringing doctors<br />

to rural Arkansas<br />

Meet the first Arkansas <strong>Blue</strong> Cross<br />

and <strong>Blue</strong> Shield Primary Care<br />

Scholarship recipients ... page 4<br />

Clinics chosen for<br />

federal initiative<br />

page 6<br />

Health Care<br />

Reform update<br />

page 8<br />

Teen drivers<br />

are safer now<br />

page 20

The doctor is in:<br />

How Arkansas <strong>Blue</strong> Cross<br />

is bringing primary<br />

care physicians to<br />

rural communities<br />

rkansas’ rural communities are great places<br />

to settle down, but the lack of primary health<br />

care is quickly reaching crisis proportions. Through<br />

Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield, however,<br />

medical students in the University of Arkansas for<br />

Medical Sciences (UAMS) College of Medicine who are<br />

training to become primary care physicians (PCPs)<br />

are getting the help they need to set up practice and<br />

provide small communities with quality health care.<br />

Thanks to a $1 million grant from Arkansas <strong>Blue</strong><br />

Cross, UAMS seniors Christina “Lauren” Monteith<br />

and Josue Daniel Gutierrez are the first recipients<br />

of the Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield Primary<br />

Care Scholarship. Both students will receive $20,000<br />

from interest accrued from the grant toward the<br />

cost of medical school so they can afford to set up<br />

practice in the rural communities they love.<br />

“Lauren and Josue exemplify the qualities we were<br />

looking for in providing dedicated physicians to<br />

serve rural Arkansans,” said Mark White, president<br />

and chief executive officer of Arkansas <strong>Blue</strong> Cross.<br />

“We are excited for them, and we are particularly<br />

excited for the Arkansas communities that will<br />

benefit from their dedication to medicine.”<br />

Tom South, assistant dean for medical student<br />

finance and administration in the UAMS College of<br />

Medicine, said, “With the average educational<br />

Josue Gutierrez looks up medical information<br />

from resources in the UAMS library.<br />

indebtedness of our medical school graduates<br />

approaching $140,000, the Arkansas <strong>Blue</strong> Cross<br />

and <strong>Blue</strong> Shield Primary Care Scholarships will have<br />

a significant impact on reducing the debt burden<br />

of students who wish to pursue primary care and<br />

practice in medically underserved areas in Arkansas.”<br />

“Growing up in south Arkansas, I know all too<br />

well what it is like to live in a medically underserved<br />

area,” said Lauren. “As a child, my parents had to<br />

travel more than two hours to take me to specialty<br />

doctors’ appointments, which was very hard for<br />

them financially.”<br />

Lauren grew up in a small community 10 minutes<br />

south of El Dorado and has seen first hand the<br />

decline in jobs and population. This includes a great<br />

loss in primary care physicians. Her husband also<br />

grew up in the same area.<br />

“My husband spent part of his childhood in Huttig,<br />

one hour southeast of El Dorado, and learned that<br />

even small emergencies can be life threatening<br />

when you can’t get to medical care quickly. With the<br />

upcoming changes to health care, I believe primary<br />

care will become even more vital as the first step and<br />

possibly sole provider in rural areas.”<br />

4 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>

Being a primary care physician in a rural area can be challenging, but<br />

for both Lauren and Josue, that is part of the excitement of the job.<br />

“I love the idea of treating a wide variety of medical problems, as<br />

well as taking care of patients of all ages,” Lauren said. “I feel strongly<br />

that family medicine is one of the most rewarding fields of medicine.”<br />

Josue originally came to Arkansas to attend the University of the<br />

Ozarks in Clarksville and fell in love with the Northwest Arkansas<br />

region. “During my<br />

time in Clarksville, I<br />

was able to foster many<br />

relationships with<br />

individuals from the<br />

medical community<br />

and am eager to return<br />

and practice there. I am<br />

also soon to be married<br />

and my fiancée and I<br />

plan to start a family<br />

in Clarksville after<br />

completing my residency,<br />

as this is the perfect<br />

place to raise a family.”<br />

Josue added, “It<br />

has been my dream<br />

to become a family<br />

practitioner since I was<br />

7 years old. There are<br />

so many benefits to<br />

practicing in a small<br />

community. The lack of<br />

specialties in rural areas<br />

provides the family<br />

practitioners a unique<br />

environment in which<br />

to perform procedures<br />

that many of their<br />

urban counterparts are<br />

not able to. The small<br />

town environment,<br />

with its tight-knit<br />

community, provides<br />

a perfect setting in<br />

which to foster rapport<br />

with patients that will<br />

ultimately translate into<br />

better health care.”<br />

Focusing on<br />

Primary Care<br />

A big reason for the shortage of<br />

primary care physicians is the high<br />

cost of medical school. The<br />

Association of American Medical Colleges estimates that the average<br />

medical student ends up $162,000 in debt by graduation. To tackle<br />

that debt, many medical students turn their attention toward careers<br />

as specialists, where they are more likely to make more money.<br />

Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield Primary Care Scholarship recipients<br />

are chosen from those planning to pursue post-graduate training in family<br />

medicine, general internal medicine or general pediatrics. The students,<br />

who may be in their junior or senior year, also must intend to practice<br />

primary care in Arkansas, preferably in the more rural parts of the state.<br />

The scholarship, given in honor of the Board of Directors of Arkansas <strong>Blue</strong><br />

Cross, will be awarded each year, beginning with the <strong>2012</strong>-2013 academic year.<br />

Other reasons for the primary care crisis are:<br />

Lauren Monteith researches<br />

information in preparation for her<br />

career as a primary care physician.<br />

• A shortage of primary care physicians, including family practice,<br />

pediatric and general internal medicine doctors.<br />

• An aging population and an illness burden higher than the national<br />

average, which creates high patient volume for the physicians who<br />

are available.<br />

• The potential projected influx of thousands of Arkansans to the<br />

Medicaid program in 2014 under health insurance reform.<br />

According to the Johns Hopkins Primary Care Policy Center, adults in<br />

the United States who had a primary care physician had 33 percent lower<br />

costs of care and were 19 percent less likely to die prematurely from<br />

their conditions than those who had received care from a specialist, after<br />

adjusting for demographic and health characteristics. The center found that<br />

the availability of primary care physicians is consistently associated with<br />

improved health outcomes for conditions like cancer, heart disease, stroke,<br />

infant mortality, low birth weight, as well as increased life expectancy and<br />

self-managed care.<br />

Sources: UAMS Center for Rural Health, Johns Hopkins Primary Care Policy<br />

Center, Association of American Medical Colleges, Arkansas Department of<br />

Health and Arkansas Center for Health Improvement<br />

<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />


Arkansas medical practices<br />

chosen to participate<br />

in<br />

national initiative<br />

T<br />

his spring, Arkansas was named one of<br />

seven markets to be part of the national<br />

Comprehensive Primary Care (CPC)<br />

Initiative, a pilot program through the<br />

Centers for Medicare & Medicaid Services<br />

(CMS) Innovation Center that fosters<br />

collaboration among public and private<br />

health plans to strengthen primary care.<br />

Health Advantage (an affiliate of Arkansas<br />

<strong>Blue</strong> Cross and <strong>Blue</strong> Shield), QualChoice and<br />

P rimary care physicians involved in the CPC Initiative will focus<br />

on five fundamental elements of comprehensive care:<br />

Managing care for patients with high<br />

health care needs – By engaging high-risk<br />

patients, primary care providers can create a<br />

plan of care that uniquely fits each patient’s<br />

individual circumstances and values.<br />

Ensuring access to care – CPC Initiative<br />

primary care practices must be accessible to<br />

patients 24/7 and be able to utilize patient<br />

data tools to give real-time, personal health<br />

care information to patients.<br />

Arkansas Medicaid teamed together<br />

to apply for the initiative.<br />

Medical practices within Arkansas<br />

were given the opportunity to apply to<br />

participate in the CPC Initiative and 116<br />

completed the application process. CMS<br />

chose 65 of those practices to participate<br />

in the first part of the initiative — other<br />

practices could be added later.<br />

Delivering preventive care – Primary<br />

care practices involved with CPC<br />

Initiative will be able to proactively<br />

assess their patients to determine their<br />

needs and provide appropriate and<br />

timely preventive care.<br />

Engaging patients and caregivers<br />

– Primary care practices will have<br />

the ability to engage patients and<br />

their families in active participation<br />

in their care.<br />

6 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>

Medical practices chosen to participate in the CPC Initiative include:<br />

Baptist Health Family Clinic<br />

Arkadelphia<br />

Bradley Bibb M.D., PLLC<br />

Ash Flat<br />

Covert Clinic, P.A.<br />

Ashdown<br />

Batesville Family Practice Clinic<br />

Batesville<br />

Verona T Brown, M.D.<br />

Batesville<br />

Beebe Family Clinic<br />

Beebe<br />

Mercy Clinic Primary Care Lancashire Bella Vista<br />

Benton Family Clinic<br />

Benton<br />

Saline Med Peds<br />

Benton<br />

Baptist Health Family Clinic Bryant Bryant<br />

Bryant Family Practice<br />

Bryant<br />

Bryant Medical Clinic<br />

Bryant<br />

Baptist Health Family Clinic<br />

Cabot<br />

Internal Medicine Diagnostics Inc. Cherokee Village<br />

Ozark Internal Medicine and Pediatrics Clinton<br />

B. Brooks Lawrence, M.D., P.A. Conway<br />

Conway Family Medical Care, P.A. Conway<br />

Freeman Family Medicine<br />

Conway<br />

Barry V. Thompson, M.D.<br />

Crossett<br />

Family Clinic of Ashley County<br />

Crossett<br />

Lofton Family Clinic<br />

De Queen<br />

Randy D. Walker, M.D., PLLC<br />

De Queen<br />

SAMA Healthcare Services<br />

El Dorado<br />

Washington Regional Clinic for Senior Health Fayetteville<br />

Shipley and Sills Family Doctors<br />

Fort Smith<br />

Glenwood Family Medicine<br />

Glenwood<br />

Coordinating care across<br />

the medical neighborhood –<br />

Under this initiative, primary<br />

care doctors and nurses will<br />

work together, and with a<br />

patient’s other health care<br />

providers and the patient, to<br />

make decisions as a team.<br />

Greenbrier Family Clinic<br />

Greenbrier<br />

Garner Family Medical Clinic<br />

Hardy<br />

Harrison Family Practice Clinic<br />

Harrison<br />

The Leslie Clinic, P.A.<br />

Harrison<br />

Cowherd Family Medical Center<br />

Heber Springs<br />

Cypert Ridge Family Practice Clinic Helena<br />

Fountain Lake Family Medicine<br />

Hot Springs<br />

Hamilton West Family Medicine<br />

Hot Springs<br />

UAMS AHEC Northeast<br />

Jonesboro<br />

West Washington County Clinic, P.A. Lincoln<br />

<strong>Autumn</strong> Road Family Practice<br />

Little Rock<br />

Baptist Health Family Clinic Baptist Health Drive Little Rock<br />

Baptist Health Family Clinic Hillcrest Little Rock<br />

Baptist Health Family Clinic West Little Rock<br />

Barg-Gray Clinic<br />

Little Rock<br />

Little Rock Family Clinic - West<br />

Little Rock<br />

Little Rock Family Practice - Central Little Rock<br />

St. Vincent Family Clinic - Chenal Little Rock<br />

St. Vincent Family Clinic - Rodney Parham Little Rock<br />

St. Vincent Medical Clinic Midtowne Little Rock<br />

St. Vincent Medical Group Longevity Center Little Rock<br />

John E Alexander Jr. M.D., P.A.<br />

Magnolia<br />

Baptist Health Family Clinic<br />

Malvern<br />

Tilley Diagnostic Clinic<br />

Malvern<br />

Baptist Health Family Clinic<br />

Maumelle<br />

North Central Arkansas Medical Associates Mountain Home<br />

Dr. Andy’s Family Practice PLLC<br />

Mountain View<br />

Baptist Health Family Clinic Lakewood North Little Rock<br />

Burchfield Family Medicine<br />

Paragould<br />

Baptist Health Family Clinic<br />

Perryville<br />

Mercy Clinic Internal Medicine<br />

Rogers<br />

Sherwood Family Medical Center<br />

Sherwood<br />

Siloam Springs Medical Center<br />

Siloam Springs<br />

UAMS Family Medical Center<br />

Springdale<br />

UAMS AHEC Southwest<br />

Texarkana<br />

Foscue Medical Clinic<br />

Warren<br />

Michelle Weaver M.D.<br />

Warren<br />

Senior Health Clinic<br />

West Memphis<br />

<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />


In June, the U.S. Supreme Court ruled that the<br />

Patient Protection and Affordable Care Act (PPACA)<br />

is constitutional. Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong><br />

Shield had been working to prepare for health care<br />

reform even before the law was signed, so we are<br />

well prepared to move forward in implementing the<br />

reforms within the law.<br />

We know you may have questions regarding how<br />

the ruling affects your health plan. Various Web<br />

sites and e-mails circulating lately have contained<br />

misinformation about reform. We’ve been a trusted<br />

source of health care information for more than<br />

60 years, and we want you to be well informed<br />

about health care reform so you can make the<br />

right decisions for yourself and your family.<br />

Because we want to be available to you, we have<br />

created a new e-mail address just for your questions<br />

on health care reform. If you have questions, feel free<br />

to contact us at HCRinfo@arkbluecross.com. We will<br />

be gathering questions and responding to them on a<br />

regular basis and including the questions and answers<br />

in future issues of <strong>Blue</strong> & <strong>You</strong> magazine.<br />

While some things still are unknown, I can tell you<br />

that Arkansas <strong>Blue</strong> Cross will continue to provide the<br />

products and services our members value and that<br />

we are expanding our involvement in health care in<br />

innovative ways to increase quality and contain costs.<br />

We have a lot of work to do between now and late<br />

2013 to get ready for the health insurance exchanges<br />

and the new insurance market.<br />

The insurance exchange will be a new, online location<br />

for people to purchase insurance products. If your<br />

income is below a certain amount, you may receive<br />

significant subsidies to help cover your insurance<br />

premium, but most people still will have to pay<br />

for coverage.<br />

If you choose not to have insurance, the penalty per<br />

person is $95 for the first year, or 1 percent of your<br />

adjusted gross income, whichever is greater, with the<br />

penalty capped at four family members. The maximum<br />

penalty in 2016 is $695 or 2.4 percent.<br />

Cal Kellogg,<br />

Senior Vice President<br />

and<br />

Chief Strategy Officer<br />

Arkansas <strong>Blue</strong> Cross’ work toward the exchanges will<br />

focus on how our systems will interact with the federal<br />

system. We are working with the state and other<br />

stakeholders to determine the best ways to facilitate<br />

what will be a state/federal exchange partnership.<br />

The Arkansas Insurance Department has taken<br />

on the responsibility to design the exchange and<br />

is deciding which companies can sell on it and how<br />

consumers can be assisted. Arkansas <strong>Blue</strong> Cross,<br />

however, has membership on the steering and plan<br />

management committees involved in planning<br />

for the exchange. We have been able to make<br />

recommendations on topics like essential health<br />

benefits, but ultimately it will be the Insurance<br />

Department that determines how the exchange is run.<br />

Many employer-based insurance plans (group<br />

plans) under reform will be looking at whether they<br />

should change plans, or if it is in their best interest<br />

to drop their plan and pay the penalty. We do know<br />

that for many it will cost more to pay the fine than to<br />

keep their plan, but there still is a lot of uncertainty<br />

about pending regulations and the likely potential<br />

for continuing political debate and change. The main<br />

message we want to share is that no one has to make<br />

those decisions right now.<br />

The next year will provide the detailed regulations<br />

and guidelines we will need to provide valuable and<br />

meaningful advice for our members ahead of the<br />

January 2014 implementation. As soon as we have<br />

information on these changes we will be sharing it<br />

with you. In the meantime, feel free to ask us your<br />

questions at HCRinfo@arkbluecross.com. We love<br />

to hear from you.<br />

8 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>

For the past eight years,<br />

I’ve had the honor of caring<br />

for hundreds of patients at<br />

Hospice Home Care who are at<br />

the end of their life. I’ve heard<br />

stories that almost made<br />

me choke with laughter and<br />

others which made my soul<br />

ache with despair. I’ve heard<br />

the most sacred confessions<br />

and witnessed love that could<br />

almost be touched.<br />

What has never been<br />

requested include the<br />

following: more chemotherapy,<br />

more radiation, more<br />

MRIs, more biopsies, more<br />

surgeries, more blasts of<br />

electricity through the chest,<br />

more life support, more time<br />

away from home and separated<br />

from family and friends, or<br />

more time in an institution.<br />

This serves as a wake-up<br />

call on how all members of<br />

the health care team can<br />

help patients achieve what<br />

is important for them at the<br />

end of life: quality! It’s about<br />

quality of life and ensuring<br />

patients achieve their goals<br />

with the life they have left.<br />

This is where the growing<br />

trend of hospice is saving<br />

patients from artificial<br />

prolongation of the dying<br />

process. There are studies<br />

which show that hospice not<br />

only improves quality of life<br />

for dying patients, but helps<br />

patients live longer. Isn’t<br />

longer, happier life the entire<br />

goal of health care?<br />

Hospice care is a team<br />

approach for supporting the<br />

patient and family during<br />

the end of life in a variety<br />

of settings, including home,<br />

assisted living facilities,<br />

nursing homes, and hospice<br />

facilities. Sometimes events<br />

happen quickly, like a severe<br />

stroke or heart attack, and<br />

hospice care is invaluable<br />

during these times. Hospice<br />

is even more effective when<br />

patients have two to three<br />

months of hospice care.<br />

This takes a realistic<br />

approach to life expectancies<br />

and selected treatments by<br />

the medical team. Proper<br />

channels of communication<br />

should be respected, so if<br />

one team member is not<br />

comfortable or skilled at<br />

discussing end-of-life care,<br />

utilizing other team members<br />

who are comfortable with<br />

these situations can be<br />

helpful. It is most important<br />

that the team always<br />

remember the guiding<br />

principle of medical ethics:<br />

the Principle of Autonomy.<br />

Patients have the right to<br />

hear all information of<br />

their care in an unbiased<br />

manner. Fortunately, hospice<br />

care considerations may<br />

be started by anyone in the<br />

team, including patients, their<br />

families or friends, doctors,<br />

nurses, social workers,<br />

chaplains or case managers.<br />

My life is going to end one<br />

day. When it is time, please,<br />

love me enough not to prolong<br />

the agony of dying. Follow<br />

these guidelines for me to<br />

honor my life:<br />

• Make any pain nonexistent.<br />

If anyone thinks<br />

I am in pain, give me<br />

whatever it takes to keep<br />

me comfortable, even if<br />

I have to be asleep.<br />

Don’t let me hurt!<br />

• Make any other symptoms<br />

non existent. Don’t let<br />

me suffer!<br />

• Treat me with dignity,<br />

respect, and<br />

unconditional love.<br />

• Keep me clean.<br />

• Support my friends and<br />

family while I am dying<br />

and after I am gone.<br />

Reviewing these five goals<br />

can help health care providers<br />

recognize the beauty of<br />

hospice and how it is enriching<br />

and rewarding for patients.<br />

Morgan Sauer, M.D., with the<br />

Longevity Center at St. Vincent<br />

Infirmary Medical Center,<br />

is board certified in<br />

family and preventive<br />

medicine, geriatric<br />

medicine, and<br />

hospice and<br />

palliative care.<br />

He also is the<br />

medical director<br />

for Chenal Heights<br />

Memory Center and<br />

Hospice Home Care<br />

Inpatient Center and<br />

serves on the<br />

Governor’s<br />

Task Force for<br />

Alzheimer’s<br />

disease.<br />

<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />


Clinical<br />

Partnership<br />

Award<br />

Arkansas <strong>Blue</strong><br />

Cross and <strong>Blue</strong> Shield<br />

employees (pictured,<br />

from left: Roberta<br />

Monson, M.D.,<br />

associate medical<br />

director, Connie<br />

Meeks M.D., corporate<br />

medical director,<br />

Internal Affairs,<br />

Alicia Berkemeyer,<br />

director of Enterprise<br />

Networks Special<br />

Projects, Vic Snyder,<br />

M.D., corporate medical<br />

director, External<br />

Affairs) were recently honored as the recipients of the Clinical Partnership Award given by<br />

the Community Health Centers of Arkansas, Inc. (CHCA). The award is given to a group<br />

or individual who has remained a steadfast supporter of CHCA and community health<br />

centers (CHCs), and has focused on the goal of providing quality care to all Arkansans.<br />

Arkansas <strong>Blue</strong> Cross received the award for its dedication to the development of patientcentered<br />

medical homes throughout the state. Arkansas <strong>Blue</strong> Cross exhibited leadership<br />

in merging existing programs/projects to align with the goals and strategic plan of CHCA<br />

and the CHCs, acting as a partner, advocate, liaison and mentor.<br />

Case management receives<br />

URAC accreditation<br />

Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield, Health Advantage<br />

and <strong>Blue</strong>Advantage Administrators of Arkansas, recently<br />

received reaccreditation for case management from<br />

URAC, a Washington, D.C.-based health care accrediting<br />

organization that establishes quality standards for the<br />

health care industry.<br />

In its notification of reaccreditation, the URAC<br />

Accreditation Committee said, “Arkansas <strong>Blue</strong><br />

Cross and <strong>Blue</strong> Shield, Health Advantage, and<br />

<strong>Blue</strong>Advantage Administrators of Arkansas have been granted FULL accreditation,”<br />

and all three organizations are “commended for their commitment to promoting quality<br />

health services.”<br />

URAC’s case management accreditation standards require companies to establish<br />

a process to assess, plan and implement case management interventions.<br />

10 12 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>

Red, White and Arkansas<strong>Blue</strong> summer family fun<br />

Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield kept kids and their families watchin’, rockin’, and<br />

packin’ this summer with lots of family-oriented activities at Arkansas<strong>Blue</strong>, Arkansas<br />

<strong>Blue</strong> Cross’ health insurance store, located in the Shackleford Crossings shopping center.<br />

In June, we sponsored a special showing of the<br />

new Disney/Pixar movie “Brave” on the movie’s<br />

premiere weekend. More than 100 families<br />

picked up tickets at Arkansas<strong>Blue</strong> and 330<br />

attended the movie.<br />

“We had lots of young moms come in to<br />

Arkansas<strong>Blue</strong> to pick up tickets to the movie,” said<br />

Sara Harris, Arkansas<strong>Blue</strong> team leader. “Many were<br />

pleasantly surprised when they walked in to the<br />

location. They said they were not aware we were<br />

here, asked about what the store was for and if we<br />

sold insurance here. It was a great opportunity to<br />

tell them about the kinds of policies we sell and<br />

that we are available to visit face-to-face to discuss<br />

any questions they have about insurance.”<br />

<strong>Blue</strong>Ann Ewe greets two eager fans at<br />

the special Arkansas <strong>Blue</strong> Cross and<br />

<strong>Blue</strong> Shield screening of Disney/Pixar’s<br />

“Brave” held at The Rave.<br />

In July, we rocked the parking lot with a <strong>Blue</strong><br />

Beach Party at Arkansas<strong>Blue</strong>. Adults and kids<br />

got moving and played games with Radio Disney outside the Arkansas<strong>Blue</strong> store, received<br />

complimentary sunscreen, then cooled down with tasty shaved ice and made their own leis<br />

inside the store. Two tickets to the sold-out Justin Bieber concert in Little Rock in January<br />

were given away, compliments of Radio Disney.<br />

In August, the Pack’n it in – Lunchbox Prep event had kids getting ready for a happy,<br />

healthy school year. Faith Anaya from Kids Cook! demonstrated two easy, economical<br />

and healthy food preparations perfect for packing a healthy lunchbox. She also discussed<br />

the importance of healthy eating and encouraged kids to try new foods. Parents were<br />

invited to participate in a nutrition label exercise designed to teach them about what<br />

kinds foods they are offering their children.<br />

“We were thrilled to spend the summer with our members and guests, focusing<br />

on nutrition, health and family fun,” said Sara. “We look forward to even<br />

more exciting events this fall and during the holidays.”<br />

Happy Birthday Arkansas<strong>Blue</strong>!<br />

Arkansas<strong>Blue</strong>, Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield’s<br />

health insurance store in Little Rock, celebrated its first<br />

birthday on October 1! Since opening, Arkansans’ have<br />

dropped in to speak face-to-face with our staff and learn<br />

more about health insurance. If you have questions about<br />

health insurance, stop by Arkansas<strong>Blue</strong> in the Shackleford<br />

Crossings Shopping Center. We’d love to visit with you.<br />

<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />

11 13

12 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />

Foundation Awards 35 Mini-grants to Health Programs<br />

The <strong>Blue</strong> & <strong>You</strong> Foundation for a Healthier Arkansas has awarded<br />

$1,000 grants to 35 health improvement programs in Arkansas<br />

Mini-grant recipients in <strong>2012</strong> include:<br />

• Arkansas Department of Emergency<br />

Management, North Little Rock,<br />

work-site wellness and obesity.<br />

• Arkansas Hospice, North Little Rock,<br />

Alzheimer’s, hospice and end-of-life planning.<br />

• Arkansas Voices for the Children Left<br />

Behind, Little Rock, healthy lifestyles<br />

and mental health.<br />

• Arthritis Foundation Southeast Region,<br />

Little Rock, arthritis and chronic disease<br />

self-management.<br />

• Camp Aldersgate, Little Rock, senior wellness.<br />

• CARTI Foundation, Little Rock, patient<br />

transportation.<br />

• Christian Health Ministry of White<br />

County, Searcy, charity clinic operation<br />

and electronic medical records.<br />

• City of Cammack Village, swimming pool<br />

wheelchair access.<br />

• Delta Community Based Services,<br />

Little Rock, girls’ empowerment conference.<br />

• Delta Presents Outreach Foundation,<br />

Little Rock, aspiring college students project,<br />

addressing substance abuse.<br />

• Donald W. Reynolds Cancer Support<br />

House, Fort Smith, skin cancer education.<br />

• Eagle Mountain Magnet Elementary,<br />

Batesville, nutrition and obesity (nutrition<br />

and exercise).<br />

• East Arkansas Area Agency on Aging,<br />

Jonesboro, exercise/physical activity and<br />

healthy lifestyles.<br />

• Elizabeth Richardson Center, Springdale,<br />

disabilities and autism.<br />

• Forrester-Davis Development Center,<br />

Clarksville, disabilities and heart health.<br />

• Friends of the Timberwolves, Newark,<br />

nutrition, exercise and healthy lifestyles.<br />

• Hearth, Jonesboro, nutrition, food costs<br />

and parenting.<br />

• Hip Hop Tumblers, Harrison, nutrition<br />

and exercise.<br />

• Historic Harrison Business Association,<br />

Harrison, physical activity and substance<br />

abuse.<br />

• Hometown Health Coalition Network,<br />

Warren, healthy lifestyles and exercise/<br />

physical activity.<br />

• Hope Cancer Resources, Springdale,<br />

healthy lifestyles and cancer.<br />

• LifeHouse Ministries, Paragould,<br />

STDs and HIV/AIDS.<br />

• Marion County Hometown Health, Inc.,<br />

Yellville, prenatal/pediatrics and safety.<br />

• Mid-Delta Health Systems, Clarendon,<br />

tobacco-related health conditions.<br />

• Newton County Resource Council,<br />

Jasper, nutrition, exercise and parenting.<br />

• Northwest Arkansas Community College,<br />

Bentonville, CPR/first aid/AED and medical<br />

professional education.<br />

• Old High Middle School, Bentonville,<br />

chair-free classrooms.<br />

• Ozark Guidance, Springdale, mental<br />

health, wellness education and prevention.<br />

• Ozarka College, Melbourne, Australian<br />

Walkabout Fitness Challenge.<br />

• Paragould School District, Paragould,<br />

nutrition, exercise and mental health.<br />

• Pediatrics Plus Connections, Conway,<br />

nutrition, exercise and disabilities.<br />

• S.W. Chance, Maumelle, obesity, nutrition,<br />

exercise and disabilities.<br />

• University of Central Arkansas, Conway,<br />

preschoolers and the USDA MyPlate project.<br />

• Washington Regional Medical Foundation,<br />

Fayetteville, cancer support.<br />

• Wildwood Park for the Arts, Little Rock,<br />

healthy lifestyles and nutrition.<br />

Nonprofit and charitable organizations, schools and government institutions in<br />

Arkansas are eligible to apply for two different programs: a $1,000 mini-grant program<br />

and a regular grant program of $5,000 to $150,000. New applications will be accepted<br />

beginning in March 2013. Grant guidelines and the online applications can be found at<br />

blueandyoufoundationarkansas.org.<br />

The <strong>Blue</strong> & <strong>You</strong> Foundation was established in 2001 by Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong><br />

Shield to help support community organizations that are implementing programs to<br />

improve the health of Arkansans.

New at the <strong>Blue</strong><br />

New people and new positions<br />

Bryan Dorathy<br />

Bryan Dorathy has joined Arkansas <strong>Blue</strong> Cross<br />

and <strong>Blue</strong> Shield as an agency market manager for<br />

our offices in Little Rock and Pine Bluff. Bryan is<br />

responsible for Arkansas <strong>Blue</strong> Cross’ relationships<br />

with agents and partners as well as producing<br />

contracts for groups from two to 100. Bryan has<br />

more than 15 years of experience in the insurance<br />

industry.<br />

Sam Vorderstrasse<br />

Sam Vorderstrasse recently was promoted to vice<br />

president of Actuarial Services. He is responsible<br />

for providing decision support and direction<br />

related to the pricing and development of products,<br />

actuarial management, rating programs and<br />

determining/estimating outstanding liabilities.<br />

He is a Fellow of the Society of Actuaries and a<br />

member of the American Academy of Actuaries.<br />

Dr. John Brineman<br />

Dr. John Brineman has accepted the position of<br />

regional medical director for our Little Rock office<br />

and associate medical director for Health Advantage.<br />

He is a graduate of the College of William and Mary<br />

in Williamsburg, Virginia, and received his doctorate<br />

in medicine from Eastern Virginia Medical School.<br />

He completed a residency in Anatomic and Clinical<br />

Pathology at Walter Reed Army Medical Center and<br />

is a diplomat of the American Board of Pathology<br />

in Combined Anatomic and Clinical Pathology. He<br />

had a distinguished career in the active Army and<br />

the U.S. Army Reserve, rising to the rank of Colonel,<br />

serving two tours in Iraq.<br />

“In its first 10 years of grantmaking, the <strong>Blue</strong> & <strong>You</strong> Foundation has awarded<br />

a total of $14 million to 293 health improvement projects in Arkansas,” said<br />

Patrick O’Sullivan, executive director. “ These include programs to address<br />

obesity, diabetes, healthy lifestyles, medical and dental care for the uninsured,<br />

and dozens of other health issues that are affecting our state’s population.”<br />

The <strong>Blue</strong> & <strong>You</strong> Foundation is an independent licensee of the <strong>Blue</strong> Cross and<br />

<strong>Blue</strong> Shield Association and serves the state of Arkansas.<br />

<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong> 13

Sleep and mindlessly munching<br />

Have you ever found yourself hitting the afternoon<br />

slump then reaching for a bag of chips? What about<br />

sitting on the couch watching your favorite show,<br />

yawning and feeling the urge to snack on something<br />

less than healthy? <strong>You</strong> might need to get more sleep<br />

to prevent mindless munching.<br />

According to researchers, there may be a link between<br />

“sleep-related hunger and food cravings.” And not just<br />

any food cravings, but fatty, high-calorie foods.<br />

Marie-Pierre St. Onge, Ph.D., suggests that when you’re<br />

tired, you gravitate towards high-calorie foods because<br />

your body is looking for energy. Additionally, sleep<br />

deprivation seems to increase activity in the areas of the<br />

brain that seek pleasure, which can include enjoyment<br />

from junk foods.<br />

And if that’s not enough, research also suggests that being<br />

sleep deprived impairs decision-making. Therefore, you’re<br />

less likely to think through the repercussions of reaching for<br />

the junk foods. <strong>You</strong>’re literally mindlessly munching.<br />

Source: Health.com<br />

Diesel fumes officially declared<br />

to cause cancer<br />

The World Health Organization (WHO) recently<br />

elevated diesel to the “known carcinogen” level,<br />

officially declaring that diesel fumes cause lung<br />

cancer. Experts also concluded that the fumes were<br />

more carcinogenic than secondhand cigarette smoke.<br />

Diesel is a type of fuel derived from crude oil, and<br />

exposure to diesel exhaust is widespread in today’s<br />

world. Health concerns about diesel exhaust relate<br />

not only to cancer, but also to other health problems<br />

such as respiratory and heart diseases.<br />

Diesel exhaust now shares the WHO’s Group 1<br />

carcinogen status with smoking, asbestos, ultraviolet<br />

radiation, alcohol and other elements that pose<br />

cancer risks.<br />

14 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />


*Arkansas State and Public School<br />

Employees can enroll in a weightloss<br />

program administered by the<br />

Employee Assistance Program’s<br />

vendor. Call 1-877-247-4621 to enroll.<br />

**Medi-Pak Medicare supplement<br />

insurance policyholders are not eligible<br />

for The Healthy Weigh! program.<br />

Lose weight<br />

The Healthy Weigh! Education<br />

Program is free for members of<br />

Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield,<br />

Health Advantage (except ARBenefits<br />

members*), <strong>Blue</strong> Cross and <strong>Blue</strong> Shield<br />

Service Benefit Plan (Federal Employee<br />

Program), Medi-Pak® Advantage<br />

(PFFS), Medi-Pak Advantage PPO, and<br />

eligible members of <strong>Blue</strong>Advantage<br />

Administrators of Arkansas.**<br />

To enroll, complete the attached<br />

enrollment form and return it in the<br />

self-addressed, postage-paid envelope<br />

included in this magazine. The<br />

program starts when you enroll.<br />

After enrollment, you will begin to<br />

receive information through the mail,<br />

which you can read in the privacy of<br />

your own home and at your own pace.<br />

The program is completely voluntary,<br />

and you may leave the program at any<br />

time. If you have further questions<br />

about the program, call the Health<br />

Education Program’s toll-free number<br />

at 1-800-686-2609.<br />

Simply complete, sign and return<br />

the attached enrollment form in the<br />

self-addressed, postage-paid envelope<br />

to join The Healthy Weigh!


Avoid the pain, get vaccinated<br />

Almost one in three people in the United<br />

States will develop shingles during their<br />

lifetime. This painful illness is a possibility<br />

for anyone who suffered with chickenpox<br />

and is more likely to occur if you are stressed<br />

or older.<br />

The good news is you can protect yourself<br />

against shingles. Talk with your doctor about<br />

the shingles vaccine. Arkansas <strong>Blue</strong> Cross<br />

and <strong>Blue</strong> Shield covers the shingles<br />

vaccines for members age 60 or older<br />

as a one-time vaccination based on<br />

Advisory Committee for Immunization<br />

Practices (ACIP) recommendations.<br />

Shingles, also known as herpes zoster,<br />

is caused by the varicella zoster virus<br />

(VZV). This is the same virus that causes<br />

chickenpox. The painful, blistering skin rash<br />

from shingles can last two to four weeks.<br />

If you have had chickenpox in the past,<br />

then VZV is inside you. It never leaves your<br />

body and stays in a dormant state. For<br />

reasons that are not fully known, the virus<br />

can reactivate years later and cause shingles.<br />

Some people may develop severe nerve<br />

pain that can last for months or even years<br />

after the rash goes away. This is called postherpetic<br />

neuralgia (PHN). Older adults are<br />

more likely to get PHN. Shingles can lead<br />

to other serious complications, including<br />

eye problems.<br />

Pain from shingles has been described<br />

as excruciating, aching, burning, stabbing,<br />

and shock-like. It has been compared to<br />

the pain of childbirth or kidney stones.<br />

The pain from shingles can cause depression,<br />

anxiety, difficulty concentrating, loss of<br />

appetite and weight loss. Shingles can<br />

interfere with activities of daily living<br />

like dressing, bathing, eating, cooking,<br />

shopping and travel.<br />

The only way to reduce your risk of<br />

developing shingles and PHN is to get<br />

vaccinated. Some people should wait to<br />

get vaccinated, or they should not get<br />

vaccinated at all if they have a weakened<br />

immune system. Shingles vaccine is available<br />

in pharmacies and doctors’ offices. Talk with<br />

your doctor if you have questions about the<br />

shingles vaccine.<br />

<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />


October is Open Enrollment Period for individual family policies<br />

Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong><br />

Shield’s Open Enrollment Period<br />

(OEP) for individual and family<br />

health plans began October 1 and<br />

runs through Oct. 31, <strong>2012</strong>.<br />

During this OEP, members may<br />

apply for changes to their policy<br />

and individuals age 18 or younger<br />

may apply for a child-only policy.<br />

Making changes to<br />

individual and<br />

family policies<br />

Members may request changes to<br />

their policy, such as:<br />

• Adding or deleting dependents.<br />

• Increasing or decreasing<br />

the deductible.<br />

• Adding or deleting maternity.<br />

• Requesting the removal of<br />

surcharges or exclusions.<br />

Change forms related to<br />

OEP must be received (not<br />

just postmarked) by Arkansas<br />

<strong>Blue</strong> Cross no later than Oct. 31,<br />

<strong>2012</strong>. Changes to existing<br />

policies will be effective Jan. 1<br />

or 15, 2013, depending on the<br />

policy billing cycle.<br />

An underwriting change form<br />

is required if you are:<br />

• Adding a dependent<br />

to your policy<br />

- Dependents age 18<br />

or younger cannot be<br />

declined coverage but will be<br />

medically underwritten and<br />

may be surcharged based on<br />

medical conditions. Children<br />

eligible for Medicaid or<br />

ARKids First are not eligible<br />

for coverage under an<br />

individual policy.<br />

- Dependents age 19 or<br />

older will be medically<br />

underwritten and may<br />

be surcharged or denied<br />

coverage based on medical<br />

conditions.<br />

• Increasing your<br />

policy benefits by:<br />

- Lowering the deductible.<br />

- Raising the coinsurance<br />

percentage.<br />

- Lowering the calendar-year<br />

coinsurance maximum.<br />

- Adding the maternity rider.<br />

• Requesting that an<br />

exclusion be removed<br />

• Requesting that a surcharge<br />

be reduced or removed.<br />

A non-underwriting change<br />

form is required if you are:<br />

• Deleting a dependent<br />

from your policy.<br />

• Decreasing your policy<br />

benefits by:<br />

- Raising the deductible.<br />

- Lowering the coinsurance<br />

percentage.<br />

- Raising the calendar-year<br />

coinsurance maximum.<br />

- Deleting the<br />

maternity rider.<br />

Both underwriting change<br />

forms and non-underwriting<br />

change forms are available online<br />

at arkansasbluecross.com or<br />

you can call Customer Service at<br />

1-800-238-8379.<br />

Applying for a<br />

child-only policy<br />

During the OEP, individuals age<br />

18 or younger may apply for a<br />

child-only policy. Applications for<br />

child-only policies must be received<br />

(not just postmarked) by Arkansas<br />

<strong>Blue</strong> Cross no later than Oct. 31,<br />

<strong>2012</strong>. If approved and accepted,<br />

all new child-only policies will be<br />

effective Jan. 1, 2013.<br />

<strong>You</strong> may apply for a child-only<br />

individual policy:<br />

• Online at<br />

arkansasbluecross.com<br />

• By calling us at<br />

1-800-392-2583; or<br />

• By contacting your<br />

independent or<br />

Farm Bureau agent.<br />

Outside the OEP, individuals<br />

age 18 or younger can be<br />

considered for coverage only<br />

as a dependent on a parent or<br />

guardian’s policy or as a result<br />

of a “qualifying life event.”<br />

Qualifying life events<br />

Requesting a change<br />

to an existing policy<br />

Changes may be made to<br />

existing policies at any time<br />

throughout the year as a result<br />

of a “qualifying life event” —<br />

such as a marriage, divorce,<br />

death, birth of a child, or loss of<br />

other health insurance coverage.<br />

There are specific notification<br />

periods and documentation<br />

requirements associated with<br />

qualifying life event changes.<br />

To get information, go to<br />

arkansasbluecross.com/<br />

members/making_policy_<br />

changes.aspx or call Customer<br />

Service at 1-800-238-8379.<br />

Applying for a new<br />

child-only policy<br />

In addition, there are two<br />

qualifying life events that allow<br />

individuals age 18 or younger<br />

to apply for a child-only policy<br />

outside of the OEP.<br />

Those are:<br />

• The loss of employersponsored<br />

health<br />

insurance coverage; or<br />

• An involuntary loss<br />

of any other health<br />

insurance coverage.<br />

In either case, the application<br />

must be submitted within 30<br />

days of the loss of coverage<br />

and documentation is required<br />

to verify the loss of coverage.<br />

Children eligible for Medicaid<br />

or ARKids First are not eligible<br />

for coverage under an individual<br />

policy.<br />

Should you have any questions,<br />

call Customer Service at<br />

1-800-238-8379.<br />

16 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>

Medicare Annual Election Period<br />

October 15 through December 7<br />

Medicare’s Annual Election<br />

Period (AEP) will begin October<br />

15, and will run through<br />

December 7. During AEP,<br />

Medicare beneficiaries can<br />

purchase a Medicare Advantage<br />

plan and/or a Medicare Part D<br />

prescription drug plan. <strong>You</strong> also<br />

may switch from your existing<br />

plans. If you join a plan during<br />

AEP, or make changes to an<br />

existing plan, your new benefits<br />

will be effective Jan. 1, 2013.<br />

Affordable products<br />

and peace of mind<br />

Generations of Arkansans have<br />

trusted Arkansas <strong>Blue</strong> Cross and<br />

<strong>Blue</strong> Shield for peace of mind.<br />

Our Medicare products offer<br />

members low monthly premiums.<br />

And, in 2013 you can expect the<br />

same great selection of Medicare<br />

products you’ve come to expect<br />

from us through the years.<br />

• $0 premiums for Medi-Pak®<br />

Advantage MA-PD Private<br />

Fee-for-Service (PFFS)<br />

(includes drug coverage) in<br />

27 counties and affordable<br />

premiums in all Arkansas<br />

counties. Medi-Pak Advantage<br />

(PFFS) members have access<br />

to our extensive network of<br />

more than 7,000 doctors and<br />

hospitals across the state.<br />

In addition, Medi-Pak<br />

Advantage MA-PD members<br />

receive a membership in<br />

the popular SilverSneakers®<br />

Fitness Program* at no<br />

additional cost.<br />

• $0 premiums for Medi-Pak<br />

Advantage MA (PFFS) (does<br />

not include drug coverage) in<br />

50 counties. These plans offer<br />

all the health benefits of our<br />

Medi-Pak Advantage MA-PD<br />

plans, but do not include drug<br />

coverage. Members have the<br />

same access to our network of<br />

doctors and hospitals, and a<br />

SilverSneakers membership.<br />

• Two Medi-Pak® Rx<br />

Prescription Drug Plans<br />

(PDP) – Basic and Premier<br />

– with competitively priced<br />

monthly premiums. More<br />

than 95 percent of Arkansas<br />

pharmacies are in our<br />

network.<br />

• Four Medi-Pak® supplement<br />

plans including Plan F,<br />

our most comprehensive<br />

supplement plan, and Plan<br />

N, one of our lowest-priced<br />

supplement plans.<br />

Attention Medicare<br />

Advantage plan members<br />

If you have a Medicare<br />

Advantage or Medicare Part D<br />

plan, during October you will<br />

receive an Annual Notice of<br />

Change (ANOC) which will explain<br />

any changes to your current plan<br />

that will become effective in<br />

January. If you are satisfied<br />

with your current plan, you<br />

are not required to change<br />

anything. Every year, the Centers<br />

for Medicare and Medicaid<br />

Services (CMS) require companies<br />

to inform members of these<br />

changes prior to AEP so they may<br />

shop their coverage.<br />

If you would like to<br />

learn more about our<br />

Medicare plans …<br />

Call your local Medi-Pak®<br />

Choice licensed agent or<br />

1-800-392-2583 to learn<br />

more. <strong>You</strong> also can visit our Web<br />

site, arkansasbluecross.com/<br />

Medicare. We’d love to hear from<br />

you. If you have a friend or family<br />

member who doesn’t have one of<br />

our Part D prescription drug plans<br />

or Medicare Advantage plans, we<br />

hope you’ll recommend Medi-Pak<br />

Rx and Medi-Pak Advantage.<br />

*See disclosure on page 28<br />

2013 Open Enrollment for Arkansas State and Public School members<br />

October 1 through October 31<br />

The Arkansas State and Public and<br />

School Employee and Retiree Open<br />

Enrollment Period began October 1<br />

and run through October 31. Please<br />

refer to the Employee Benefits<br />

(EBD) newsletter, The Buzz, for plan<br />

information or go the EBD Web site,<br />

ARBenefits.org.<br />

This year will be a passive<br />

enrollment – meaning that if you<br />

do not wish to change plans you<br />

automatically will be enrolled<br />

in the plan you selected for the<br />

<strong>2012</strong> plan year. However, if you<br />

want to change plans, add or drop<br />

dependents or update demographic<br />

information, you must complete an<br />

election form.<br />

<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />


with Dr. David<br />

David A. Lipschitz,<br />

M.D., Ph.D.<br />

<strong>You</strong> can reduce the risk of a serious fall<br />

Falls become more prevalent with age<br />

After age 65 about 30 percent of people fall at<br />

least once annually. And, if a hip fracture occurs, 25<br />

percent will die in a year and 50 percent will become<br />

dependent, frequently requiring nursing home care.<br />

Fortunately, much can be done to reduce the risk of<br />

a fall, the need for lengthy hospital stays or the loss<br />

of independence.<br />

Causes of falls<br />

Increased fall risk with age frequently is due to<br />

declines in balance, mobility and gait, and a high<br />

risk of fainting caused by blood pressure drops<br />

when attempting to stand up. Visual difficulties,<br />

dizziness, inappropriate shoe choices and side effects<br />

of drugs often contribute to falls. Tripping due to<br />

environmental hazards in the home or elsewhere<br />

remains the major cause of falls at any age.<br />

An evaluation by a physician is<br />

essential<br />

If you or a loved one is at risk of falling, an<br />

evaluation by a physician is essential. Medical<br />

conditions that contribute to falls must be identified<br />

and treated and problems with gait and balance<br />

evaluated. There are standardized tests that can<br />

be done that identify major problems with the way<br />

someone walks. First, can the patient get up from<br />

the chair without assistance? Does he have to use his<br />

hands to stand, or does someone have to help him?<br />

Can he walk without using an assistive device such<br />

as a cane or a walker? Can he walk in a straight line?<br />

How long does it take him to walk<br />

10 meters, turn around and sit back down.<br />

If it is longer than 20 seconds, a serious<br />

problem exists.<br />

A careful assessment of all medications<br />

must be done. Many medications can<br />

increase the risk of falling by causing<br />

drowsiness, confusion, worsening weakness<br />

and balance difficulties and significant<br />

dizziness. This particularly occurs if a person<br />

is taking medications to lower blood pressure.<br />

Whenever possible, keep medications to a<br />

minimum and avoid sleeping pills, tranquilizers<br />

and alcohol. Medications to treat hypertension<br />

(high blood pressure) also can lead to dangerous<br />

drops in blood pressure. If your loved one takes<br />

blood pressure medication, remind them to stand<br />

up slowly and always have something to hold on to<br />

in case he feels faint.<br />

Exercise is the key to preventing falls<br />

No matter your health, aging is associated with<br />

a relentless loss of muscle mass, an increased<br />

proportion of weight as fat and progressive weakness<br />

that slows gait speed, affects balance and increases<br />

the risk of falls. The more we do to maintain strength<br />

the better. Physical therapy can help reduce falls.<br />

Treatment includes balance exercises and working<br />

with weights that builds muscle, bones and most<br />

importantly strength. The older the patient,<br />

the longer the time it will take to see tangible<br />

improvements, but they will occur and the results are<br />

well worth the effort. When physical therapy ends, it<br />

18 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>

is important to keep moving and consider<br />

joining a health club to continue exercise<br />

and maintain and improve strength<br />

and balance.<br />

Use assistive devices if needed<br />

Do not be embarrassed to use a cane,<br />

walker or a wheelchair, but walk as much as<br />

possible. The more time spent being immobile<br />

or sitting in a wheelchair, the greater the loss of<br />

muscle and the increased chance of a fall. Electric<br />

wheelchairs are great, but should only be used if<br />

needed and if walking is impossible.<br />

Assess your house for fall risk<br />

Most serious falls occur in the bathroom.<br />

Carefully review the bathroom to make sure<br />

slippery surfaces can be avoided, that water does<br />

not leak from the shower or tub and, if possible,<br />

install hand rails from the bed all the way into the<br />

bathroom. Often a raised toilet seat with armrests<br />

can prove helpful. A sturdy plastic seat should be<br />

placed in the tub or shower and use a hand-held<br />

shower head to bathe. If a wheelchair is needed<br />

or gait and balance are significantly impaired,<br />

a uniquely designed bathtub or shower may be<br />

needed. During the night, a bedside commode may<br />

be a good option rather than walking in the dark to<br />

a very hazardous area.<br />

Fall-proof the home by clearing walking areas<br />

of boxes and electrical phone cords. Remove low<br />

coffee tables and move magazines and plants out<br />

of the way. Loose rugs should be removed or<br />

taped to the floor, uneven wooden floorboards or<br />

carpeting must be repaired and skid proof materials<br />

should be used for cleaning. Many falls are caused<br />

by standing on a chair or attempting to remove<br />

something from an out-of-reach cupboard. For this<br />

reason, clothing, cleaning materials, dishes, utensils<br />

and food must be accessible and stored within easy<br />

reach. Adequate lighting decreases fall risk. Assure<br />

that each room has ambient light from outside<br />

during the day, is well lit at night and night lights<br />

are used liberally. Always switch on a light before<br />

climbing the stairs and install glow-in-the-dark or<br />

illuminated light switches.<br />

Consider moving<br />

If a fall risk is too great, consider whether living<br />

alone in a large house with stairs is appropriate.<br />

It may be time to move to a one-level home or to<br />

an assisted-living facility where help is available<br />

and people surround you. And, as you grow older,<br />

no matter your health, live as close as possible to<br />

immediate family.<br />

Accidents due to falls are a major cause of physical<br />

disability, the need for nursing home care and a<br />

poor quality of life. The earlier precautions are<br />

taken to reduce a fall risk, the better.<br />

David A. Lipschitz, M.D., Ph.D., is nationally<br />

recognized as a leader in the field of geriatrics.<br />

Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield is<br />

honored to have him as a contributor to<br />

<strong>Blue</strong> & <strong>You</strong> magazine.<br />

<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />



The Natural State<br />



DL<br />

CLASS:<br />

D<br />

0000<br />

DLN:<br />

987654321<br />

DOB:<br />

05-30-1997<br />

Expires:<br />

05-30-2013<br />

Issued:<br />

9-27-<strong>2012</strong><br />

Sex:<br />

F<br />

It is a terrifying moment for any parent —<br />

your teen hops in the car with a brand new<br />

driver’s license, leaving you to worry until the<br />

car pulls back into the driveway.<br />

Under 18 until 05-30-2015<br />

Under 21 until 05-30-2018<br />

Height: Eyes:<br />

5-02 HZ<br />

Endors: Restr:<br />

A T<br />

While parents always will have that<br />

nervous feeling about their teen drivers, a<br />

recent report from the Arkansas Center for<br />

Health Improvement (ACHI), a nonpartisan,<br />

independent, health policy center, shows that<br />

a 2009 Arkansas law (Act 394) is helping to<br />

save lives by allowing teens to gain driving<br />

experience through the use of restrictions<br />

based on age and their driving record.<br />

“It’s very encouraging to see these positive<br />

trends in our teen driver statistics,” said Mary<br />

Aitken, M.D., director of the Injury Prevention<br />

Center at Arkansas Children’s Hospital (ACH)<br />

and a member of the University of Arkansas for<br />

Medical Sciences pediatrics faculty. “There is<br />

still a lot of work to be done to make sure the<br />

roads in Arkansas are safer, however. The Injury<br />

Prevention Center at ACH will continue<br />

to advocate for<br />

strong policies like Graduated<br />

Driver License (GDL) and provide education<br />

for teen drivers and their parents about how<br />

they can reduce risk on the roads — everything<br />

from adhering to the GDL provisions and<br />

putting away the cell phone, to buckling<br />

up on each trip.”<br />

The GDL provides for teen driver’s licenses<br />

in three levels: learner’s license, intermediate<br />

license and unrestricted/regular license. A<br />

learner’s license permits teens that are 14-15<br />

years old to drive only while accompanied by<br />

an adult 21 years of age or older. To receive an<br />

intermediate license, a teen driver must have no<br />

20 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>

serious traffic violations or accidents on record<br />

during the previous six months. Teens with an<br />

intermediate license are allowed to drive without<br />

an adult, but they are restricted from having<br />

more than one unrelated passenger under the<br />

age of 21. Drivers with this license also may not<br />

drive unsupervised between 11 p.m. and 4 a.m.,<br />

unless they are traveling to or from a school or<br />

church-related activity, work or in emergency<br />

situations. At 18, teens are eligible to apply for<br />

a regular, unrestricted, driver’s license if they<br />

have a clean driving record (i.e., there must be<br />

no major traffic violations on the applicant’s<br />

record in the previous 12 months).<br />

ACHI studied the impact of the law using<br />

information from the Arkansas State Police<br />

Motor Vehicle Crash Data. What they found was<br />

that there was a significant reduction in crashes<br />

and crash-related fatalities among teens during<br />

that timeframe. This is especially true for<br />

the youngest drivers who obtained their<br />

intermediate license to drive for the first time<br />

An Arkansas mom hands over the<br />

car keys to her teen daughter, now driving<br />

with a Graduated Driver’s License.<br />

without an adult. Similar reductions in crashes<br />

or fatalities were not found for the adult<br />

population during this same timeframe.<br />

Between 2008 and 2010, fatalities involving<br />

teen drivers were reduced by 59 percent, from<br />

about 25 fatal crashes per 10,000 drivers<br />

in 2008 to 10 in 2010. This translates to an<br />

estimated 32 actual lives that were saved.<br />

The most drastic change was among<br />

16-year-old drivers. The number of crashes<br />

among this age group was reduced by 22<br />

percent (from 1,467 per 10,000 drivers in<br />

2008 to 1,145 in 2010).<br />

ACHI also found that between 2008 and<br />

2010, fatalities involving teen drivers from<br />

11 p.m. and 4 a.m. dropped by 76 percent,<br />

from 21 fatalities in 2008 to five fatalities in<br />

2010. Teens between the ages of 16 and 18<br />

experienced a 19 percent reduction in single<br />

vehicle crashes, and a 52 percent reduction<br />

in single vehicle fatal crashes.<br />

Mary Aitken, M.D., speaks at a celebration<br />

of the Graduated Driver’s License at<br />

Arkansas Children’s Hospital.<br />

The limit on passengers in a vehicle driven<br />

by a teen also helped save lives. ACHI found<br />

a 20 percent decrease in teen driver crashes<br />

with multiple passengers from 2008 to 2010.<br />

The most significant decrease was recognized<br />

in cars carrying five or more passengers.<br />

Sources: Arkansas Center for Health Improvement,<br />

Arkansas Children’s Hospital<br />

<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />


Notice: The notice below regarding Medical Loss Ratio Information is required by the federal government.<br />

Some readers may have received a medical loss ratio rebate because their employer’s health plan was eligible<br />

for a rebate. This notice is for members who did not receive a rebate because their segment of the market had<br />

a medical loss ratio higher than the minimum required by the Affordable Care Act.<br />

Medical Loss Ratio Information<br />

The Affordable Care Act requires health insurers in the individual and small group markets to<br />

spend at least 80 percent of the premiums they receive on health care services and activities<br />

to improve health care quality (in the large group market, this amount is 85 percent). This<br />

is referred to as the Medical Loss Ratio (MLR) rule or the 80/20 rule. If a health insurer<br />

does not spend at least 80 percent of the premiums it receives on health care services and<br />

activities to improve health care quality, the insurer must rebate the difference.<br />

A health insurer’s Medical Loss Ratio is determined separately for each State’s individual,<br />

small group and large group markets in which the health insurer offers health insurance.<br />

In some States, health insurers must meet a higher or lower Medical Loss Ratio.<br />

No later than August 1, <strong>2012</strong>, health insurers must send any rebates due for 2011<br />

and information to employers and individuals regarding any rebates due for 2011.<br />

<strong>You</strong> are receiving this notice because your health insurer had a Medical Loss Ratio for<br />

2011 that met or exceeded the required Medical Loss Ratio. For more information on<br />

Medical Loss Ratio and your health insurer’s Medical Loss Ratio, visit www.HealthCare.gov.<br />

Congratulations to the<br />

winners of the <strong>2012</strong><br />

<strong>Blue</strong> & <strong>You</strong> Fitness Challenge!<br />

They are:<br />

A program of Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield,<br />

Arkansas Department of Human Services<br />

and the Arkansas Department of Health<br />

Group Category 1 (2-5 participants)<br />

Jefferson County — Pine Bluff, AR<br />

Group Category 2 (6-9 participants)<br />

Arkansas Education Association — Little Rock, AR<br />

Group Category 3 (10-11 participants)<br />

Boys and Girls Club — Alma, AR<br />

Group Category 4 (12 participants)<br />

The RoArk Group — Rogers, AR<br />

Group Category 5 (13 participants)<br />

National Park Service — St. Paul, MN<br />

Group Category 6 (14 participants) - TIE<br />

Eagle Heights Elementary — Harrison, AR<br />

UAMS AHEC Northeast — Jonesboro, AR<br />

Group Category 7 (15-16 participants)<br />

SFLIC — Hot Springs, AR<br />

Group Category 8 (17-18 participants)<br />

Arkansas State Plant Board — Little Rock, AR<br />

Group Category 9 (19-20 participants)<br />

Alliance Rubber Company — Hot Springs, AR<br />

Group Category 10 (21-24 participants)<br />

Harrisburg Middle School — Harrisburg, AR<br />

Group Category 11 (25-28 participants)<br />

Ben E. Keith Foods — North Little Rock, AR<br />

Group Category 12 (29-36 participants)<br />

Northrop Grumman CEO — St. Charles, MO<br />

22 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />

Group Category 13 (37-43 participants) - TIE<br />

Keruso — Berryville, AR<br />

Lamar Elementary School, Lamar AR<br />

Group Category 14 (44-60 participants)<br />

Lamar High School — Lamar, AR<br />

Group Category 15 (61-80 participants)<br />

Nucor Yamato Steel — Blytheville, AR<br />

Group Category 16 (81-95 participants)<br />

Administrative Office of the Courts — Little Rock, AR<br />

Group Category 17 (96-138 participants)<br />

Red River Credit Union — Texarkana, AR<br />

Group Category 18 (139-234 participants)<br />

Transportation Security Agency — Little Rock, AR<br />

Group Category 19 (235+ participants)<br />

Simmons First National Bank — Pine Bluff, AR<br />

Student Winners:<br />

Grand-prize winner:<br />

• Wade Lambright of Harrisburg Middle School in Harrisburg<br />

won a Walmart gift card toward the purchase of a bike.<br />

Runners-up prize winners<br />

(fitness-related gift bags and gift cards):<br />

• Dalton Parnell of Lamar High School in Lamar,<br />

• Alexis Whitten of Watson Chapel Junior High FBLA in Pine Bluff,<br />

and<br />

• Jonah Hyman of HAAS Hall Academy in Fayetteville.

Arkansas <strong>Blue</strong> Cross joins<br />

new state payment initiative<br />

Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong><br />

Shield and QualChoice have<br />

joined with Arkansas Medicaid<br />

to create the Arkansas Health<br />

Care Payment Improvement<br />

Initiative (AHCPII), which will<br />

transform the state’s payment<br />

system for doctors, hospitals and<br />

other medical facilities and put<br />

Arkansas on the leading edge of<br />

national efforts to improve health<br />

care quality and cost efficiency.<br />

Under our current payment<br />

system medical providers are<br />

paid for each activity, regardless<br />

of value. The system is called<br />

“fee for service.” For every<br />

medical service provided, the<br />

doctor or hospital receives<br />

a pre-determined fee. There<br />

are many drawbacks to this<br />

system. For example, doctors<br />

are not motivated to coordinate<br />

patient care. <strong>You</strong> may go to your<br />

primary care doctor (PCP) and<br />

have an imaging study. <strong>You</strong>r<br />

PCP may refer you to a specialist<br />

who repeats the imaging study<br />

because he is unaware that it<br />

was previously conducted.<br />

With the AHCPII model,<br />

health care providers are paid<br />

based on an agreed upon set<br />

of standards for the episode of<br />

care. Based on the cost of the<br />

provider’s care compared to<br />

pre-determined cost targets,<br />

they either will share in savings<br />

created, break even, or owe<br />

back money share in excess cost<br />

with to payers. By providing<br />

necessary evidence-based, high<br />

quality, and cost-effective care<br />

and better coordinating care<br />

across a patient’s providers care<br />

team, they can actually increase<br />

their net profit payment from<br />

the plan while saving money<br />

overall. This initiative was<br />

developed with input from<br />

physician associations, hospital<br />

executives, clinicians, patients,<br />

advocacy groups and the Center<br />

for Medicare & Medicaid<br />

Services (CMS). AHCPII is not a<br />

requirement of the federal health<br />

care reform legislation, but<br />

rather a state-based initiative.<br />

During the first phase of the<br />

new payment initiative, which<br />

began July 1, six episodes<br />

of care will be monitored.<br />

Participation in the initiative<br />

within the six episodes will<br />

vary. Arkansas <strong>Blue</strong> Cross will<br />

participate in the new payment<br />

initiative within the episodes<br />

with an asterisk (*):<br />

• Hip and knee replacements*<br />

• Congestive heart failure*<br />

• Pregnancy*<br />

• Developmental disabilities<br />

• Upper respiratory<br />

infections<br />

• Attention-deficit/<br />

hyper-activity disorder<br />

During the first three to<br />

six months of the initiative,<br />

doctors and hospitals will have<br />

access to reports designed to<br />

help them understand their<br />

current practice patterns<br />

and the financial and quality<br />

outcomes they generate.<br />

Information for those reports<br />

will be pulled from existing<br />

claims data and from a limited<br />

set of data that providers will<br />

enter into a provider portal for<br />

some of the episodes.<br />

Arkansas <strong>Blue</strong> Cross will<br />

work with doctors and hospitals<br />

to identify ways to improve<br />

the new payment method.<br />

After the introductory period,<br />

reimbursement changes will be<br />

implemented by the insurance<br />

companies and Arkansas<br />

Medicaid. The intent is to<br />

develop a common method<br />

for reimbursement but not to<br />

implement a common level<br />

of reimbursement.<br />

We are all paying the price<br />

of an uncoordinated delivery<br />

system. It is essential that<br />

Arkansas <strong>Blue</strong> Cross take the<br />

lead in building a new model<br />

that will serve our members and<br />

provide the kind of high-quality,<br />

affordable care you deserve.<br />

Source: healthcare.gov/news/factsheets/2011/09/primary-care09282011a.html<br />

<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />


P. Allen Smith is an awardwinning<br />

designer, gardening and<br />

lifestyle expert. Arkansas <strong>Blue</strong><br />

Cross and <strong>Blue</strong> Shield is honored<br />

to have him as a contributor to<br />

<strong>Blue</strong> & <strong>You</strong> magazine.<br />

Even though I am still harvesting tomatoes<br />

and squash, it is time to start thinking about<br />

planting my cool season favorites.<br />

I grow certain cool season vegetables<br />

from seeds, like arugula, spinach, and various<br />

types of lettuce that germinate easily and mature<br />

quickly. Others like broccoli, cabbage, kale and<br />

collards are better started from transplants.<br />

If you are starting from seeds it is important<br />

to account for the number of days it will take for<br />

a plant to mature versus the first below-freezing<br />

temperatures of the season.<br />

The average date of the first killing frost in your<br />

area is the most important thing to know when it<br />

comes to fall vegetable gardening. To determine<br />

when to start planting, find out the number of<br />

by<br />

P. Allen<br />

Smith<br />

days to maturity for the vegetable. Count back the<br />

number of days from the first average frost date<br />

and add a week or so to allow for a few extra days to<br />

harvest the mature produce.<br />

Another thing to keep in mind when planting fall<br />

vegetables is that the seedlings require plenty of<br />

moisture. Keep them well watered until fall rains begin.<br />

Many of the leafy vegetables such as spinach and kale<br />

are heavy feeders, so be generous with fertilizer.<br />

Plants for <strong>You</strong>r Fall Vegetable Garden<br />

Broccoli - Mulch to help keep<br />

the ground cool and moist. Feed<br />

the plants three weeks after<br />

transplanting. I blanche any extras,<br />

then freeze for eating in the winter.<br />

Broccoli is high in vitamin C, high in<br />

folate, a good source of dietary fiber<br />

and a good source of potassium.<br />

Brussels Sprouts – Set the<br />

plants out in mid-summer. It will<br />

take about three months before<br />

the sprouts appear. Harvest when<br />

they are firm and green. Great<br />

roasted in the oven with sea salt<br />

and olive oil. Brussels sprouts<br />

are high in vitamin C and a good<br />

source of folate.<br />

Cabbage – Heavy feeders that<br />

require fertile soil rich in organic<br />

matter and consistent moisture. I<br />

have several cole slaw recipes that<br />

make my mouth water as I think<br />

about fresh cabbage. Cabbage comes<br />

in a number of varieties, but all are<br />

rich in vitamins C and E. They also<br />

contain vitamins A, B1, B2, B6, K<br />

and folic acid as well as the minerals<br />

calcium, sulfur, iron, magnesium,<br />

phosphorous and potassium.<br />

Cauliflower – Fluctuations<br />

in temperature, moisture and<br />

nutrients can cause the plant<br />

to “button,” or produce small,<br />

undersized heads. Blanch the<br />

heads by tying the outer leaves<br />

together over the heads when they<br />

are about 2 to 3 inches across.<br />

Great when florets are roasted with<br />

olive oil and garlic in the oven!<br />

Cauliflower is high in vitamin C<br />

and a good source of folate.<br />

Kohlrabi - Shade young plants<br />

from summer sun. Delicious in<br />

stir-fry. Kohlrabi is an excellent<br />

source of vitamin C and a good<br />

source of fiber.<br />

Lettuce – Sow seeds in late<br />

summer. Provide the seedlings with<br />

consistent moisture and shade from<br />

the afternoon sun. Clip outer leaves<br />

first for salads on the leaf and looseleaf<br />

varieties. They will produce for<br />

as long as temperatures remain<br />

cool! Lettuce is high in vitamin A<br />

and a good source of folate.<br />

Mustard Greens – Keep the soil<br />

consistently moist to encourage<br />

rapid growth and tender greens.<br />

I love them sautéed with chard,<br />

olive oil and garlic! Mustard greens<br />

are an excellent source of vitamin<br />

A, C and K, folate and manganese.<br />

24 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>

Radish – Quick to mature, sow<br />

seeds 4 weeks before the first<br />

frost. Sow evenly so you don’t<br />

have to thin them. No feeding<br />

necessary, but soil should be fertile<br />

and well drained. Radishes are<br />

delicious sautéed in a honey glaze.<br />

Radishes are high in vitamin C.<br />

Rutabaga – Wait to sow seeds<br />

until night time temperatures are<br />

consistently around 50 to 60 F. Keep<br />

the soil moist to prevent roots<br />

from forking. Simply toss with sea<br />

salt, pepper, olive oil and apple<br />

cider vinegar then roast. Amazing!<br />

Rutabaga is an excellent source of<br />

vitamin C.<br />

Spinach – An established<br />

spinach crop will last well<br />

into winter and can survive<br />

temperatures down into the 20s.<br />

Spinach prefers very fertile soil<br />

to encourage rapid growth and<br />

tender leaves. Add strawberries<br />

and a vinaigrette and there’s<br />

dinner! Spinach is an excellent<br />

source of fiber, vitamins A and C;<br />

high in iron, high in folate and a<br />

good source of magnesium.<br />

Good to Know<br />

Root vegetables are the “storage<br />

bin” for a plant’s nutrients and are<br />

health-promoting powerhouses.<br />

They are an excellent source of<br />

complex carbohydrates, fiber,<br />

potassium and antioxidants.<br />

Potatoes are among the highest<br />

in potassium of any fruit or<br />

vegetable commonly eaten in<br />

this country, while orange root<br />

vegetables like carrots and sweet<br />

potatoes are an excellent source<br />

of beta-carotene.<br />

Annual Notice<br />

2013 Summary of Benefits and<br />

Coverage – available November 15<br />

for individual/family policy holders<br />

As required by the Patient Protection and Affordable<br />

Care Act (PPACA), the Summary of Benefits and<br />

Coverage (SBC) (OMB Control Numbers 1545-2229,<br />

1210-0147 and 0938-1146) provides information<br />

regarding coverage specifications and limitations that<br />

apply to the health insurance plan you have selected.<br />

Before the end of each year, Arkansas <strong>Blue</strong> Cross<br />

and <strong>Blue</strong> Shield provides members who are under<br />

age 65 and have individual/family health insurance<br />

policies* with an SBC.<br />

This official communication includes information<br />

about the coverage provided by your health insurance<br />

plan in a summary format for the upcoming year.<br />

Beginning Nov. 15, <strong>2012</strong>, you may access this<br />

information:<br />

• Online in the “Benefits” section of the Arkansas<br />

<strong>Blue</strong> Cross secure member self-service center,<br />

My <strong>Blue</strong>print, at arkansasbluecross.com<br />

• By calling Arkansas <strong>Blue</strong> Cross Customer Service at<br />

1-800-238-8379 to receive a printed version<br />

After that date, you also may log on to<br />

arkansasbluecross.com/sbc and enter your member<br />

number (found on your Member ID card) into the SBC<br />

locator tool to review the document online and print it.<br />

If you make changes to your Arkansas <strong>Blue</strong> Cross<br />

health plan benefits that differ from your current<br />

coverage, a new SBC will be created for you within seven<br />

work days of our receipt of your change request. It will be<br />

available to you in the same manner described above.<br />

*These are members who do not have health insurance<br />

through an employer, a Medicare health plan, or<br />

Short-Term <strong>Blue</strong> product.<br />

Arkansas <strong>Blue</strong> Cross, Health Advantage and<br />

<strong>Blue</strong>Advantage Administrators of Arkansas members<br />

who receive health coverage through an employer<br />

group will get their SBC from their employer group<br />

plan administrator at the appropriate time.<br />

<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />


Women’s Preventive<br />

Services<br />

In order to comply with the new health care<br />

reform law (PPACA or the Patient Protection<br />

and Affordable Care Act), Women’s Preventive<br />

Services will be added to many health plans.<br />

On August 1, <strong>2012</strong>, the change will be made to<br />

certain employer-sponsored health insurance<br />

plans. The change will take place on January 1,<br />

2013, for certain individual health plans.<br />

What are PPACA preventive services?<br />

PPACA preventive services, unlike our<br />

traditional preventive services, are covered<br />

under the employer’s plan at 100 percent with<br />

no member responsibility (e.g., no copayment,<br />

coinsurance or deductible when delivered by<br />

a network provider). Effective August 1, these<br />

benefits include Women’s Preventive Services.<br />

What are Women’s Preventive Services?<br />

The additional Women’s Preventive Services<br />

that will be covered without copayments,<br />

coinsurance or deductibles on applicable<br />

group policies are as follows:<br />

• Well-woman visits: An annual well-woman<br />

preventive care visit for adult women<br />

to obtain the recommended preventive<br />

services, along with additional visits if the<br />

woman and her doctor determine they are<br />

necessary.<br />

• Gestational diabetes screening: For women<br />

24 to 28 weeks pregnant, and those at high<br />

risk of developing gestational diabetes.<br />

• HPV DNA Testing: Women who are 30 years<br />

of age or older will have access to high-risk<br />

human papillomavirus (HPV) DNA testing<br />

every three years, regardless of pap<br />

smear results.<br />

• STI counseling, and HIV screening<br />

and counseling: Sexually active women will<br />

have access to annual counseling on HIV<br />

and sexually transmitted infections (STIs).<br />

• Contraceptives and contraception counseling:<br />

Coverage of prescription contraceptives on the<br />

drug list (brand-name contraceptives may have<br />

a copayment if a generic is available without a<br />

copayment); patient education and counseling;<br />

and Plan B (known as the morning-after pill)<br />

when prescribed for members under age 18.<br />

Any drugs used to cause abortion (e.g., RU<br />

486) are not covered. Over-the-counter birth<br />

control methods, even if prescribed by a<br />

doctor, are not covered.<br />

• Breastfeeding support, supplies and<br />

counseling: Pregnant and postpartum<br />

women will have coverage for lactation<br />

counseling from applicable health care<br />

providers. Manual breast pumps are<br />

covered; electric breast pumps and supplies<br />

are not covered. NOTE: Pregnancy services<br />

including prenatal, delivery and postnatal<br />

care are subject to member copayments,<br />

deductibles and coinsurance.<br />

• Domestic violence screening: Screening<br />

and counseling for interpersonal and domestic<br />

violence will be covered for all women.<br />

26 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>

Women’s Health<br />

and Cancer Rights Act<br />

The Women’s Health and Cancer<br />

Rights Act of 1998 introduced changes<br />

in insurance coverage for a mastectomy.<br />

In accordance with the law, all group<br />

and individual health plans that provide<br />

medical and surgical benefits for a<br />

mastectomy will cover reconstructive<br />

breast surgery, including:<br />

• Reconstructive surgery on the<br />

breast on which the mastectomy<br />

was performed.<br />

• Reconstructive surgery on<br />

the unaffected breast needed<br />

to “produce a symmetrical<br />

appearance.”<br />

• Prostheses and treatment of<br />

complications of any stage of a<br />

mastectomy, including lymphedema<br />

(postsurgical fluid buildup).<br />

The provisions of the Women’s Health<br />

and Cancer Rights Act of 1998 apply to all<br />

group health insurance coverage effective<br />

on the first day of the plan year (which<br />

in most cases is the anniversary date of<br />

the group contract) after Oct. 21, 1998.<br />

The law went into effect on all individual<br />

insurance policies issued, renewed or in<br />

effect on or after Oct. 21, 1998.<br />

These provisions apply to all policies<br />

issued by Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong><br />

Shield and Health Advantage and are<br />

subject to the applicable copayments,<br />

coinsurance, benefit limitations,<br />

exclusions and benefit maximums.<br />

If you have questions about your<br />

insurance coverage, contact your group<br />

benefits administrator or a customer<br />

service representative at an Arkansas<br />

<strong>Blue</strong> Cross office near you. We’d love<br />

to hear from you!<br />

We Love to Hear From <strong>You</strong>!<br />

May we help? For customer service, please call:<br />

Little Rock<br />

Number (501)<br />

Toll-free<br />

Number<br />

Medi-Pak ® members 378-3062 1-800-338-2312<br />

Medi-Pak Advantage members 1-877-233-7022<br />

Medi-Pak Rx members 1-866-390-3369<br />

Arkansas <strong>Blue</strong> Cross members 378-2010 1-800-238-8379<br />

Pharmacy questions 1-800-863-5561<br />

Specialty Rx pharmacy questions 1-866-295-2779<br />

Health Advantage members 378-2363 1-800-843-1329<br />

Pharmacy questions 1-800-863-5567<br />

<strong>Blue</strong>Advantage members 378-3600 1-888-872-2531<br />

Pharmacy questions 1-888-293-3748<br />

Federal Employee members 378-2531 1-800-482-6655<br />

Looking for health or dental insurance? We can help!<br />

For individuals, families 378-2937 1-800-392-2583<br />

For employer groups* 378-3070 1-800-421-1112<br />

*Arkansas <strong>Blue</strong> Cross, Health Advantage and <strong>Blue</strong>Advantage Administrators of Arkansas<br />

Prefer to speak with someone close to home?<br />

Call or visit one of our offices near you:<br />

Arkansas<strong>Blue</strong> — Little Rock<br />

2612 S. Shackleford Rd. — Suite J 501-378-2222<br />

Fayetteville<br />

516 East Millsap Rd. — Suite 103 1-800-817-7726<br />

Fort Smith<br />

3501 Old Greenwood Rd. — Suite 5 1-866-254-9117<br />

Hot Springs<br />

100 Greenwood Ave. — Suite C 1-800-588-5733<br />

Jonesboro<br />

707 East Matthews Ave. 1-800-299-4124<br />

Little Rock<br />

601 Gaines Street 1-800-421-1112<br />

Pine Bluff<br />

1800 West 73rd St. 1-800-236-0369<br />

Texarkana<br />

1710 Arkansas Boulevard 1-800-470-9621<br />

Visit our Web sites for more information:<br />

arkansasbluecross.com • healthadvantage-hmo.com<br />

blueadvantagearkansas.com • blueandyoufoundationarkansas.org<br />

<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />


good for you<br />

events and<br />

activities<br />

saturday, october 20<br />

Join Arkansas <strong>Blue</strong> Cross’ <strong>Blue</strong>Cares<br />

Team for the Komen for a Cure<br />

walk. Our team will be handing out<br />

goodies to walkers. We look forward<br />

to supporting finding a cure for breast<br />

cancer with Central Arkansans.<br />

saturday, november 10<br />

Get ready for a happy, healthy<br />

holiday season with P. Allen Smith!<br />

Join us at the Arkansas<strong>Blue</strong><br />

insurance store, from 9 a.m.<br />

to 1 p.m. for healthy food<br />

growing and cooking<br />

demonstrations, and activities<br />

with SilverSneakers ® * instructors.<br />

*SilverSneakers ® is a registered mark of<br />

Healthways, Inc. The SIlverSneakers ® Fitness<br />

Program is provided by Healthways, Inc.,<br />

Healthways is an independent company<br />

that operates separately from Arkansas<br />

<strong>Blue</strong> Cross and <strong>Blue</strong> Shield.<br />

MPI 1129 9/12<br />

saturday, december 1<br />

City Mouse, Country Mouse, Christmas<br />

House! Arkansas <strong>Blue</strong> Cross is hosting<br />

a special showing of City Mouse,<br />

Country Mouse, Christmas House at<br />

the Arkansas Arts Center. Round up<br />

the family and enjoy a FREE night<br />

of the arts. Tickets can be picked<br />

up at Arkansas<strong>Blue</strong>, located in the<br />

Shackleford Crossing shopping center,<br />

while supplies last. Check our Web<br />

site for details.<br />

spring 2013<br />

Although spring is months away, now<br />

is the time to plan for the <strong>Blue</strong> & <strong>You</strong><br />

Fitness Challenge. Start forming your<br />

team or group and plan to register<br />

for the 2013 Challenge.<br />

The <strong>Blue</strong> & <strong>You</strong> Fitness Challenge<br />

is an exercise contest (March 1 –<br />

May 31) that encourages participants<br />

to work toward the public health<br />

recommendation of adult physical<br />

activity 30 minutes each day, most<br />

days of the week.<br />

For more information, call toll<br />

free 1-800-686-2609, or visit<br />


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