Oklahoma State and Education Employees Group Insurance Board
A Newsletter Provided by He lthChoice Holiday Issue 2007
Changes for Plan Year 2008 Two ID Cards
Changes to the HealthChoice Tobacco Cessation Program, see the
plans effective January 1, 2008, are article on page 2. With the start of the new plan
as follows: Specialty Medications year on January 1, HealthChoice
Health Plan Changes Certain specialty medications members will begin using two
Preexisting condition limitation (high cost medications which are (2) ID cards. New for 2008,
If your HealthChoice coverage typically injected) will be covered HealthChoice will have one (1)
begins January 1, 2008, or after, you only if they are ordered from Medco’s ID card for medical and/or dental
will not be subject to the preexisting specialty care, mail order pharmacy, benefits and one (1) ID card for
condition limitation. Accredo Health. (See page 2) pharmacy benefits.
If your HealthChoice coverage Dental Plan Changes HealthChoice members
began between July 1 and December Calendar Year Maximum should keep their current ID
1, 2007, and the preexisting condition The calendar year maximum card which will be used only for
limitation is applicable, then all for preventive, basic, and major pharmacy benefits after January
charges incurred prior to January 1, restorative services has been 1. Sometime before January 15,
2008, are subject to preexisting, but increased to $2,000. This is a $500 members will be receiving a new
charges incurred on or after January benefit increase. health/dental benefits ID card
1, 2008, are not. Life Plan Changes from Fiserv Health Harrington.
Pharmacy Benefits Surviving children may continue Until your new ID card arrives,
Tobacco Cessation dependent life coverage after the death you can continue to use your old
Prior authorization for tobacco of a primary member, even if there card to access medical/dental
cessation products will no longer be is no surviving spouse. Previously, services.
required. Two (2) courses of treatment if there was no surviving spouse, the If you do not receive your new
will be covered per year. For more surviving children were not allowed health/dental benefits ID card by
information on the HealthChoice to retain this life coverage. January 15, please contact Fiserv
Health Harrington at 1-405-499-
Deductibles Begin Again January 1 4920 or 1-800-782-5218. TDD
January 1, 2008, starts the non-Network hospital. users should call 1-405-499-4841
new plan year when HealthChoice The HealthChoice Basic Plan or 1-800-941-2160.
deductibles begin again. annual deductible will remain $500 In the event you need a
The annual deductible for the per individual and $1,000 per family. replacement pharmacy ID card,
HealthChoice High Option and USA Additional deductibles do not apply please contact Medco at 1-800-
plans is still $500 per individual and to the Basic Plan. 903-8113 or TDD at 1-800-825-
$1,500 per family in 2008. There is The annual deductible for the 1230. Be aware that after January
also an additional $100 deductible HealthChoice Dental plan is $25 for 1, new pharmacy ID cards will
for each emergency room visit basic and major services and $50 for show only the member’s name and
regardless of the facility’s Network orthodontia. For services at a non- will not list any dependent names.
status. This is waived only if the Network provider, the $25 deductible Your dependents’ coverage will
patient is admitted or if death occurs also applies to preventive services be verified electronically at the
prior to admission. There is a $300 and the orthodontia deductible is pharmacy when prescriptions are
deductible for each confinement in a $150. purchased.
The HealthChoice Tobacco Cessation Program – Health Promotion
New Benefit Takes Effect January 1
In an effort to encourage more (nicotine) are also strongly encouraged to take
of our members to give up tobacco • Bupropion SR 150mg advantage of the FREE Professional
products, HealthChoice has expanded (generic for Zyban®) Quit Coaches® available through
its coverage of medications that can • Buproban 150mg (generic for the Oklahoma Tobacco Helpline at
help in kicking the habit. Zyban®) 1-800-QUIT-NOW (784-8669).
Beginning January 1, 2008, Over-the-counter products (such The Professional Quit Coaches®
HealthChoice will cover two (2) full as nicotine patches and gum) are not work with Helpline callers to develop
90-day courses of any FDA-approved covered. a quit plan tailored to individual
tobacco cessation product per year. In addition to the expanded needs. Up to four (4) follow-up
This benefit is available to active coverage for tobacco cessation calls with a quit coach are also
and retired HealthChoice members, products, HealthChoice will no provided free of charge. The
as well as their enrolled dependents longer require prior authorization Helpline hours of operation
who are at least 18 years old. The to access these products. Previously, are 7 a.m. to 11 p.m., seven
covered medications are listed in members were limited to a benefit (7) days a week, and staff will
the HealthChoice formularies and of one (1) course per lifetime and return any messages left after
include: prior authorization was required. hours. Services are also available
• Chantix™ (varenicline) All HealthChoice members in Spanish by calling 1-800-793-
• Nicotrol® Inhaler (nicotine) who choose to quit tobacco and take 1552.
• Nicotrol® Nasal Spray advantage of this new health benefit Studies have concluded that
a combination of medication and
Specialty Pharmacy Program counseling is by far the most effective
way to successfully quit tobacco.
Effective January 1, HealthChoice will be making some important
changes to the way members purchase certain specialty medications.
Specialty medications are generally high-cost medications that are typically OSEEGIB
injected. Welcomes Norman
Certain specialty medications will be covered only if you order them W. Cooper
through Medco’s specialty pharmacy, Accredo Health. When you switch
these prescriptions to Accredo, you’ll be able to get the same benefit you
were receiving at your other pharmacy. It’s easy to switch to Accredo who The Oklahoma State and
also provides: Education Employees Group
• Free supplies, such as needles and syringes Insurance Board welcomes
• Free shipping Mr. Norman W. Cooper to the
• Refill reminder calls Advisory Council. Mr. Cooper
• Trained pharmacists available 24 hours a day, 7 days a week is the new Executive Director of
• Personal counseling by a team of registered nurses and pharmacists the Oklahoma Retired Educators
Switching to Accredo gives you affordable access to your specialty Association and as an Advisory
medications while holding down the rising costs of these products. Be aware Council member, represents
that if you don’t order your specialty medication through Accredo, you will retired educators. In addition to
be responsible for the full cost of your medication. serving in the U.S. Army, Mr.
If you are currently taking a medication that is available through Accredo, Cooper has taught high school
both you and your physician will be receiving a letter that will provide history and was an adjunct
more details about our specialty medication pharmacy. Your letter will also professor of history at Rose
include contact information and step-by-step instructions on how to get your State College. Welcome Mr.
prescriptions switched to Accredo. Cooper!
Note: Medicare Supplement with Part D members see page 3.
Attention Medicare Supplement With Part D Members 2008 HealthChoice
If you are a HealthChoice Medicare Supplement with Part D member, Formulary Changes
please be aware that the new pharmacy change requiring members to Effective January 1, 2008,
order their specialty medications through Accredo does not apply to due to new generic alternative
you. In fact, ordering specialty medications through Accredo is not an medications and new quantity
option for you. You will continue to get your medications at the same limitations, there are numerous
retail/mail order pharmacy you are now using. changes to the HealthChoice
Medicare Formulary. Some
Protect Your Personal Allowable Quantities drugs have also been added
Information! of Medication and some removed. If you
are Medicare primary, please
HealthChoice members should Per Copay
review the recently mailed 2008
be aware that neither HealthChoice, HealthChoice Medicare Abridged
nor any of our partners such as Fiserv Formulary.
Health Harrington, Medco Health, or Pharmacy benefits
may cover up To obtain a copy of the
GHS Property & Casualty, will ever Comprehensive HealthChoice
contact you to ask for your personal to a 34-day
supply or 100 Medicare Formulary or to find
financial information. out how your medication(s) are
If any personal information is units, whichever
i s g r e a t e r , n o t to covered, contact Medco at 1-
needed for our files, a request will 800-758-3605, TTY 1-800-716-
be made in writing. exceed the FDA approved
‘usual’ dosing for a 100-day 3231, or go to the HealthChoice
Never give your personal website at www.sib.ok.gov or
information to anyone who contacts supply. Specific therapeutic
categories, medications and/ www.healthchoiceok.com
you by telephone. If you become
suspicious of a caller, end the call or dosage forms may have
more restrictive quantity Accepts vs Contracted
immediately, and contact the business
or organization the caller claimed to and/or duration of therapy
limitations. Pharmacy HealthChoice members
represent. should be aware that just
Protecting your personal financial benefits are also subject to
and limited by the physician’s because a provider “accepts”
information could be one of the HealthChoice, does not mean that
smartest things you do! orders.
he/she is a contracted Network
Provider. When a provider says
Women’s Health Cancer Rights Act of 1998 Notice
he/she “accepts” HealthChoice,
Under the Oklahoma Breast ♦Reconstruction of the breast this may simply mean he/she will
Cancer Patient Protection Act, on which the mastectomy was file your claim for you. Before
group health plans that provide performed; making an appointment, ask if the
medical and surgical benefits ♦Surgery and reconstruction provider is “contracted” with
for a mastectomy must on the other breast to produce a the HealthChoice Network.
provide benefits for certain symmetrical appearance; When using a non-Network
reconstructive surgeries. ♦Prostheses and treatment Provider, you can be balance
In the case of a participant or of physical complications at all billed for amounts above the
beneficiary who is receiving benefits stages of the mastectomy, including HealthChoice Allowed Charge.
in connection with a mastectomy and lymphedemas. Remember, to get the most
who elects breast reconstruction, This coverage is subject to benefit at the lowest out-of-
Oklahoma law requires coverage in a plan’s annual deductibles and pocket cost, make sure to use
a manner determined in consultation coinsurance provisions. These HealthChoice Network Providers
with the attending physician and the provisions are generally described whenever possible.
patient for: in the plan’s benefit handbook.
‘Tis The Season for Overeatin’
It will soon be time for holiday Thanksgiving. It will be easier to start slowly and savor all the different
feasts. If you’re not careful, one of exercising before Thanksgiving than flavors.
these meals can be more calories after you’ve overeaten. Whether Applying these tips may be
than you need for an entire you’ve started exercising or helpful in preventing that “I need
day. not, try taking a walk after to be carried home feeling” as well
Here are some tips dinner. as any feelings of guilt caused by
for approaching these get- Enjoy the meal. Eat overeating.
togethers in a sensible
manner: Two Days of Calories in One Meal
Do not skip breakfast and lunch
to save up calories for the big dinner. Traditional Holiday Meal Calories
By skipping these meals, your Roasted Turkey - 6 Ounces Dark and White Meat 450
appetite will increase. You’ll be Untrimmed
starving by dinner time and setting
1 Cup of Homemade Stuffing 400
yourself up to overeat. Choosing
to eat lighter is better than skipping 1 Cup of Giblet Gravy 300
meals altogether. 1 Cup of Mashed Potatoes 350
Drink lots of water. Drinking Stuffed Celery - 1 stick 100
water will help you cut back on other 1 Cup of Candied Sweet Potatoes 400
beverages, such as wine or beer, and 1/2 Cup of Cranberry Sauce 200
will help curb your appetite. 2 Rolls with Butter 300
Watch the portion size. Be 1 Cup of English Peas with Butter 150
selective by choosing only the foods
1 Slice of Pumpkin Pie with Topping 450
that you really want and keep the
portions small. 1 Slice of Pecan Pie 650
Start exercising before Grand Total 3750
Medications Now Available in Generic Form
New generic medications are now or will soon be available for the brand-name medications listed below. If
you are taking any of these brand-name medications, please note that choosing a generic medication will cost
you less. Should you decide to continue using the brand-name medication, you will be responsible for the cost
difference between the brand-name and generic medication, in addition to the appropriate copay.
Treatment Launch Date
Coreg carvedilol Heart/Hypertension 10/2007
Ambien zolpidem tartrate Insomnia 4/23/2007
Lamisil 250mg Tablets terbinafine HCL Nail Fungus 07/02/2007
Lotrel Amlodipine besylate/ Hypertension
Verelan PM 100mg, 200mg, Verapamil HCL Angina
Accuneb 0.21% Neb. Albuterol sulfate Adult / Pediatric Asthma
Penlac Ciclopirox Nail Fungus 09/19/2007
Controlling Cholesterol During the Holidays New Precertification
Taking medication sounds like
many days of the week as possible
an easy way to control cholesterol, is optimal.
Effective April 1, 2008
but it is usually not the first or “HDL or ‘good’ cholesterol can
best option recommended by be raised 10 percent or more with The following diagnostic
physicians. Exercise and a healthy this type of moderate to vigorous imaging services will require
diet are preferred alternatives – or exercise,” Michel said. precertification beginning April
companions – to medications for Despite aggressive attention 1, 2008:
controlling cholesterol. to diet and exercise, some • Sinus CT / MRI
According to Leslie Michel, people are genetically at risk • Head / Brain CT / MRI
M.D., OU Physicians internal for high cholesterol. For these • Chest CT including
medicine specialist, reducing people, medications may offer spiral CT (RAD)
your weight through exercise the help needed to bring cholesterol • Spine CT / MRI
and smart eating can significantly levels into an acceptable range. • Shoulder MRI
reduce your total cholesterol. Consult a physician to determine • Pet Scans
“It is very important to keep if medications have an appropriate For the first three
cholesterol levels in control,” place in your total plan for a healthy months of the change,
Michel said. “Elevations in LDL lifestyle. April 1 through June
and triglycerides (bad cholesterol) Source: OU Physicians 30, 2008, HealthChoice will
can result in increased risk of heart waive the 10% penalty that is
attacks, peripheral vascular disease, ClaimLink Users’ applied when services are not
and strokes.” Online Survey precertified; however beginning
Unfortunately, the holiday season July 1, 2008, the 10% penalty
can be a difficult time to eat right. We need you to give us your will be applied when the above
“Many people overeat during opinion of ClaimLink. ClaimLink is procedures are not precertified.
the holidays, which can result in intended to be an easy-to-use online The penalty will be charged to
elevations of cholesterol levels,” tool available on the HealthChoice all outpatient hospital facilities,
Michel said. “Trying to stick to a website at www.sib.ok.gov or www. freestanding radiologists, and
good exercise regimen during the healthchoiceok.com. It is designed radiologists who perform the
holidays can help. You should also to give members access to the most professional component of the
opt for food choices with lean cuts frequently requested claim and benefit service.
of poultry and fish, vegetables, information 24 hours a day, seven Be aware that the
and fruit, when possible. Drinking days a week. Your opinion about its above services will
lots of water is also a great way to usefulness is very important to us. still be subject to
stay hydrated and feel full with no Please take a minute to complete a medical necessity
calories consumed.” short online survey about your review before reimbursement
Michel explained that saturated experience with ClaimLink by can be made. During the medical
fats – especially prevalent in meats, logging in with your user name and necessity review, HealthChoice
butter, and cheese – trigger the body’s password and clicking ClaimLink may require additional information
production of excess cholesterol, so Survey towards the bottom of the from your provider.
it is strongly recommended to keep page. To request precertification,
them at less than seven percent (7%) Not a ClaimLink user? c o n t a c t Fiserv HealthCare
of your diet. Registration is easy and allows you Management at 1-800-848-8121
Michel recommends jogging, to check the status of medical and or TDD at 1-214-647-4507.
cycling, walking, or participating dental claims, check deductible Remember to present your
in some other form of moderate status, view and print Explanation of HealthChoice medical ID card to
exercise for 20 to 30 minutes at least Benefits (EOB) forms, and confirm your provider prior to obtaining
three (3) times a week. Exercising as eligibility anytime, day or night. services.
Decorate Your Holidays Safely!
According to the tree. In homes with small children, Never leave burning candles
U.S. Consumer Product take special care to avoid decorations unattended and keep them away
Safety Commission, that are sharp or breakable, keep from furniture, drapes, Christmas
the estimated number of trimmings with small removable parts trees, and other decorations. Always
people who go to hospital out of their reach, and avoid use non-flammable holders and
emergency rooms for falls, trimmings that resemble keep them away from children
cuts, shocks, and burns related candy or food that may tempt and pets.
to holiday decorating is about 12,500 a child to eat them. Keep “fire salts,” which
each year. Whether you are produce colored flames when
To keep from being a statistic, stringing lights indoors or thrown on wood fires, away
follow the safety tips below when out, use only lights that have been from children. They contain heavy
decorating this year. tested for safety by a nationally- metals that, if eaten, can cause
Artificial trees labeled “Fire recognized testing laboratory, such intense gastrointestinal irritation and
Resistant” are more resistant to as UL or ETL/ITSNA. Newer lights vomiting.
burning, but it doesn’t mean the tree have thicker wiring and are required Wrapping paper can ignite
won’t catch fire. Always place them to have safety fuses to prevent them suddenly and burn intensely,
away from fireplaces and radiators. from overheating. Make sure any resulting in a flash fire, so do not
Never use electric lights on a extension cords you use are rated put it in your fireplace. Always have
metallic tree. The tree can become for what you are doing with them. a screen around your fireplace to
charged with electricity from Outdoor lights should be certified for prevent sparks from igniting nearby
faulty lights, and a person outdoor use and should be plugged flammable materials.
touching a branch could be into only ground-fault circuit Even with the best intentions,
electrocuted. interrupter (GFCI) protected accidents will happen. If you injure
Live trees should be receptacles. yourself and need to go to the
fresh. They should be green Check each set of lights, emergency room, remember, if you
with the needles hard to pull from the new or old, for broken or are a High Option or USA plan
branches and not brittle. The needles cracked sockets, frayed or bare wires, member, you have an additional $100
should not fall off when the tree is or loose connections. Throw out emergency room deductible. This is
tapped on the ground. Heated rooms damaged sets. waived if you are admitted or if
dry out live trees quickly, so be sure Remember to turn off all death occurs prior to admission.
to keep the tree well watered. Once holiday lights when you go to This doesn’t apply to the
your tree dries out, dispose of it. bed or leave the house. The Basic Plan.
Use only non-combustible or lights could short out and Source: U.S. Consumer
flame-resistant decorations on your start a fire. Product Safety Commission
Maternity Benefit Information
This benefit includes one (1) skilled nurse home Includes the Mommy and Me Program
health visit if the delivery is at home or in a The member must complete a change form
birthing center; prior authorization through within 30 days following the birth to enroll the
the HealthChoice Health Care Management baby.
Division is required or a 10% penalty will be A separate calendar year deductible applies
applied. to the newborn.
Includes hospital and delivery with prenatal For more detailed maternity benefit
and postnatal care information, call Fiserv Health Harrington at 1-
Includes lab work associated with prenatal visits 405-499-4920 or 1-800-782-5218.
Update to Fitness Letter From a Walking Club Member
We would like to thank our having done something for my
We are excited to add another Walking Club member, Mr. Jeffrey health, but I also feel good about
12 facilities to the list of Short of Weatherford, Oklahoma, having done something for the
fitness centers who provide for the following letter and for environment. I have saved well
a special discount letting us share it with you. over 50 gallons of gasoline by
to HealthChoice I have accomplished my goal; I walking to work and while running
members. have walked 1,000 miles. It took a errands. I have prevented emitting
If your favorite center little over one (1) year. Walking has over 1,000 lbs. of carbon dioxide
is not listed, and you would like become a big part of my life since I to the atmosphere. I walk with
HealthChoice to contact them about began. confidence and enthusiasm, knowing
offering a discount, please call the When I started, I was walking at that I am feeling better and making a
H.E.L.P. line at 1-405-717-8991 or the gym for pure exercise. I found difference on some small scale.
1-800-318-BEOK (2365). For a the gym routine did not fit my daily Hopefully, Mr. Short’s success
complete list of fitness centers, visit schedule well, and I really liked will be an inspiration to others.
the HealthChoice website at www. being outdoors. I liked watching
sib.ok.gov or www healthchoiceok. the seasons turn and being around Join the HealthChoice
com the town during the different times Walking Club
New Participating Fitness of the year, so I decided to give Membership in the HealthChoice
Centers up the car for many of my regular Walking Club is open to all
Tennessee activities and walk. Many around HealthChoice members and
Spectrum Health Operations – our community now know me as the dependents. All Walking Club
Cleveland guy who walks. members receive a logbook to record
1-423-478-2664 I feel 100% better than I did one dates and distances walked. Club
OklahOma (1) year ago. I find that I don’t huff members send their logbook pages to
Ladies Workout Express –Ardmore and puff to get up stairs, and yes, I HealthChoice at the end of each 100
1-580-224-9205 started taking the stairs instead of miles walked (up to 1,000 miles) to
Curves of Bartlesville the elevator. I played softball again receive a free incentive gift.
1-918-331-2128 this past summer, an activity I gave It’s easy to enroll, just go online
Curves of Broken Arrow up 16 years ago. I used to struggle to www.healthchoiceok.com or www.
1-918-259-9933 to walk three (3) miles and was sib.ok.gov or call 1-800-318-BEOK
Curves of Chickasha exhausted. I now can walk over (2365) for more information.
1-405-222-4114 ten (10) miles easily. I helped with
recreation activities at my daughter’s Receive Your Newsletter
Curves of Edmond
1-405-478-4700 church camp. I was able to run and Via Email
Curves of Henryetta play with the kids and have fun while To receive this
1-918-652-0200 doing it. newsletter via email, HealthVoic
Anytime Fitness – Mustang During this past year, I have email your name,
1-405-256-6177 walked in snow, sleet, torrential address, email address,
Athletic Loft – Norman rain, oppressive 112° heat, and and your member ID number to:
1-405-360-5638 frigid -4° wind chill, and I feel great email@example.com
Anytime Fitness – Oklahoma City about knowing I can walk anywhere Online subscribers will receive
1-405-601-4177 anytime I want. This walking club all future newsletters via email.
Anytime Fitness – Sapulpa was just the challenge I needed to As an added bonus for online
1-918-512-6700 find out what I could accomplish. subscribers, OU Physicians will
Great Plains Family YMCA – Each day inspires me to walk and answer three (3) medical questions
Weatherford be active. submitted by our members in each
1-580-772-0202 Not only do I feel great about electronic issue.
He lthVoice Presorted
U. S. Postage
A Newsletter Provided by He lthChoice Okla. City, OK
3545 NW 58th Street, Suite 110 Permit #1067
Oklahoma City, OK 73112
Phone Number 1-405-717-8780
Toll Free 1-800-752-9475
Hearing Impaired 1-405-949-2281
This publication, printed by the Oklahoma State and Education Employees Group Insurance Board as authorized by 74 O.S., Section 1301 et seq. 132,000 copies have been printed at a cost of $0.162 each. Copies have been
deposited with Publications Clearinghouse of the Oklahoma Department of Libraries.
Flu Shot Time! Members to Receive
According to the Centers for months and older, who need
Disease Control and Prevention, the HealthChoice High Option,
regular medical care
single best way to prevent the flu is Basic, and USA Plan members and
Children under 18 who are on
to get vaccinated and the best time HealthChoice Medicare Supplement
to get vaccinated is during October Plan members will be receiving a
Women who will be pregnant
and November. new member handbook after the first
during flu season
People who are at high risk for of the year.
All children 6 to 23 months of
complications of the flu should always Members who have enrolled in
get the vaccine. This includes: the new S-Account Plan will receive
Children less than six (6) months
Anyone 65 years of age or older the High Option and Basic Plan
of age, people who are allergic to
Anyone living in a nursing home handbook with information specific
hens’ eggs, and people who have had
or other long-term care facility to the S-Account Plan included.
a severe reaction to a flu vaccine in
that houses those with long-term Members who have the
the past should not get the flu shot
illnesses HealthChoice Dental Plan will be
before talking to their doctor.
Adults and children six (6) receiving a new dental handbook
Since the flu vaccine is covered
months and older, who have as well.
under the HealthChoice health plans
chronic heart or lung conditions, Handbooks for all HealthChoice
and Medicare, you should take
including asthma plans are available on our website
advantage of this benefit to avoid
Adults and children six (6) a t w w w. s i b . o k . g o v o r w w w.
getting the flu!