2010 - Summer

A publication for the policyholders of the

Arkansas Blue Cross and Blue Shield

family of companies

Summer 10

HEALTHINSURANCEREFORMANSWERS

6 Good news for graduates! 12 Need more information before visiting

a specialist? We can help! 19 Redesigned PHS wins top scores in national review

Out of the Blue

Health Insurance Reform & You

Good news for graduates! Arkansas Blue Cross

extends health insurance coverage

Your health insurance, your health care, your future

Need more information before visiting a

specialist? We can help!

Lose weight The Healthy Weigh!

Chronic job stress and your waistline

How much exercise do women really need?

Lifelong Health with Dr. David

Warning issued for “baby slings”

Can breastfeeding save lives?

Redesigned PHS wins top scores in national review

Food for thought: certain foods may keep

aging brains healthy

From the Pharmacist — What’s in a drug name and

why did mine change?

The Doctor’s Corner

Financial Information Privacy Notice

Good for your community

Customer Service telephone numbers

Good for you

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Summer 10

is published four times a year by Arkansas Blue Cross and Blue Shield for the company’s members, health care professionals and other persons interested in health care and wellness.

on Page 8

INSIDECal Kellogg, Ph.D., explains what you need to know about health insurance reform.

Editor: Kelly Whitehorn — [email protected] Editor: Jennifer GordonDesigner: Gio Bruno Photographer: Chip BayerContributors: Chip Bayer, Matthew Creasman, Damona Fisher, Kristy Fleming, Trey Hankins, Heather Iacobacci-Miller, Ryan Kravitz, Kathy Luzietti and Mark MoreheadVice President, Communications and Product Development: Karen Raley

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Blue & You Summer 2010

Out of the

BlueA message from our CEO and President,Mark White

The enactment of new health insurance reform leg-

islation has left many of our valued customers confused

and unsure of how the new law will affect them. We

are hearing questions concerning the changes that can

be expected as various provisions of the new law take

effect from employers, individuals and families, as well

as agents who market our products. And the confusion

is certainly understandable as the law is far-reaching

and complex. At Arkansas Blue Cross and Blue Shield,

we are working every day to provide accurate answers

to the questions you pose. We also are working with

various government agencies to clearly understand and

effectively implement the regulations that will result

from the reform legislation passed by Congress.

One of the most frequent questions we answer for

our members relates to cost. Our members are con-

cerned that, as a result of new regulations, their premi-

um costs will rise. And that is a valid concern. There are

many provisions in the law that will increase the cost

of health insurance premiums for many people. After

all, health insurance premiums are a reflection of health

care costs. Unfortunately, the new law does little to ad-

dress the rising cost of medical services but adds new

rules that will increase administrative requirements and

new fees that will have to be funded.

As we move into the implementation phase of the

new health insurance reform bill, we will be focused on

making coverage affordable for consumers. Arkansas

Blue Cross remains committed to working with employ-

ers, providers of care (such as doctors and hospitals)

and state and federal government agencies to reduce

the cost and wasteful use of medical services, which

leads to higher medical premium costs. We will contin-

ue to participate in initiatives that keep people healthy

and help them manage chronic disease. And, we will

work to develop new payment models so that health

care providers are rewarded for providing effective,

high-quality care rather than more care. Also, we will

take a fresh look at how we operate and seek greater

administrative efficiency.

In a period of rapid and radical change in health care,

one thing remains constant. Arkansas Blue Cross is

committed to providing our members with peace of

mind, as we have done for more than 60 years. That

commitment is even more important in today’s uncer-

tain health care environment. So if you have questions

about how health insurance reform will affect your

health care, we hope you will check our Web sites for

our analysis. Or call us. We’re happy to hear from you.

In this rapidly changing health care environment, we

haven’t forgotten who we work for every day. You.

4


The Patient Protection and Affordable Care Act

(PPACA), which was signed into law on March 23,

2010, ultimately will touch almost every American. The

provisions of the law will be phased in throughout the

next 10 years, with the most significant changes taking

place in 2014. At this early stage, it is very difficult to

predict what changes are in store for each of us. That is

because there are numerous federal and state entities

that must issue regulations, which will explain to insur-

ance companies and others involved how the law will

be implemented.

The PPACA will make dramatic changes in the insur-

ance marketplace. The new law will require all health

insurance policies to contain new benefits. It will re-

quire that health insurers rate health plans in new ways.

Many health industry suppliers will be called upon to

pay new taxes to cover the uninsured, thereby increas-

ing their costs. The new reform legislation did not

contain substantial provisions to control medical costs,

which are the primary drivers of premium costs. These

facts taken together mean that for most Americans, the

cost of health insurance will rise. By 2014, many Ameri-

cans will be eligible for government subsidies, which

will help offset those increases. In the meantime, those

with private insurance should expect there to be some

increase in cost as reform provisions are implemented.

That being said, Arkansas Blue Cross and Blue Shield

and its family of companies are committed

to doing all we can to hold costs down and

help our customers understand how they

will be affected. With the understanding

that the final rules are not in place, de-

scribed in this article are the changes we

believe will be required by the new law

during the next 18 months, based on

the kind of policy you have and when

you enrolled in it. Until we better understand the re-

quirements, which will come with the issuance of regu-

lations, we are not able to accurately price the changes.

If you have health insurance through

your employer and were enrolled before

March 23, 2010 (at least one enrolled person):

Insurance policies that were in place on the day

the law was passed are considered “grandfathered”

plans. The new requirements for these plans are more

limited than for those sold after the law was enacted.

Changes that members enrolled in grandfathered em-

ployer group plans can expect during the next six to 18

months may include:

• New rules around pre-ex-

isting health conditions

for children, which may

mean that children

who are


5


insured under their parent’s health plan do not have

to meet any pre-existing condition waiting periods

even if the parents are required to do so as a result

of some condition of their enrollment (late enroll-

ment, no prior creditable coverage, etc.).

• Dependents can continue coverage under a parent’s

plan until their 26th birthday. Dependents are eligible

regardless of student or marital status. Dependents

also are eligible regardless of whether they are

claimed as a dependent on their parent’s tax return.

Policies in place before March 23, 2010, are allowed

to exclude coverage to dependents if they have ac-

cess to their own coverage from

another employer-sponsored

health plan. This exception

expires on Jan. 1, 2014.

(More information on dependent coverage is in the

article on Page 6.)

• Lifetime dollar limits will be removed on “essential

benefits.” The rules and guidelines outlining what

benefits are considered essential have not been

defined by the government as of this printing.

• On most Arkansas Blue Cross plans, the lifetime

maximum benefit is currently $5,000,000. This life-

time benefit would become unlimited.

• The dollar limits for some benefits in place today

may be adjusted by the law. The benefits to which

this regulation applies have not been determined.

If you had an individual or family medical

policy in place March 23, 2010 (in which you

were enrolled):

Insurance policies that were in place on the day the

law was passed are considered “grandfathered” plans.

The new requirements for these plans are more limited

than for those sold after the law was enacted. Changes

that members enrolled in grandfathered plans can ex-

pect during the next six to 18 months

may include:





claimed as a dependent on their parent’s tax

return. (More information on dependent cov-

erage is in the article on Page 6.)

• Lifetime dollar limits will be removed on

“essential benefits.” The rules and guide-

lines outlining what benefits are consid-

ered essential have not been defined

by the government as of this printing.

• On most Arkansas Blue Cross


Reform, continued on Page 14

6


Good news for graduates!Arkansas Blue Cross extends health insurance coverage

Health and Human Services to pre-

vent a disruption of services to our

members.

The following is information on

how this affects you and your adult

child depending on your health

insurance plan:

If you have an individual or

family medical insurance

policy

• Dependents who currently are

enrolled on their parent’s cov-

erage as of May 2010, will be

allowed to remain on that cover-

age as long as they are under

age 26. Dependents are eligible

regardless of student or marital

status. Dependents also are

eligible regardless of whether or

not they are claimed as a depen-

dent on their parent’s tax return.

• There will be no rate impact on

this change until renewal on

plans already in place as of

May 15 or before. However, a

premium must be paid to cover

the cost of the dependent.

• Those dependents who are

under age 26, and who lost

eligibility for dependent coverage

earlier, can apply to be added

back to the plan at the effective

date of the regulation, which is

Oct. 1, 2010.

• These dependents will be sub-

ject to medical underwriting.

• Standard pre-existing condition

waiting periods will apply.

If you have a fully insured

health care plan through an

employer (small business or

large corporation)

• Dependents who currently are

enrolled on their parent’s cover-

age (regardless of insurance

carrier) as of May 2010, will be

allowed to remain on that cover-

age as long as they are under

age 26. These dependents are

eligible regardless of student

or marital status. Dependents

also are eligible regardless of

whether or not they are claimed

as a dependent on their parent’s

tax return.

• Dependents who are under the

age of 26, who were not covered

under their parent’s plan as of

May 2010, and who lost eligibility

for dependent coverage earlier,

can be added back to the group

plan at the effective date of the

regulation, which is the first

renewal date beginning Oct. 1,

2010, or after.

• A special 30-day open enrollment

period for dependents who had

previously aged off their cover-

age will be held for each group

health plan beginning on their

renewal date. You will receive

To help our members who

have dependents who are graduat-

ing from high school or college this

spring or may be “aging off” their

parent’s medical policy, Arkansas

Blue Cross and Blue Shield has

extended health insurance coverage

for most young adults up to age 26

who currently are covered by their

parent’s individual or fully insured

group plan.

Although this provision of the

health insurance reform law (the

Patient Protection and Affordable

Care Act) becomes effective on the

renewal date of a member’s policy

beginning Sept. 23, 2010, or after,

Arkansas Blue Cross, along with 38

other independent Blue Plans, has

extended dependent care cover-

age early (it began June 1) at the

request of the U.S. Secretary of


7


notification before the open

enrollment period. Dependents

on COBRA due to “aging off”

their parents’ coverage, who are

still younger than 26, also will be

allowed to rejoin the group dur-

ing open enrollment. They would

again be eligible for COBRA

when they reach the age of 26.

• Policies in place before March

23, 2010, are allowed to exclude

coverage to dependents if they

have access to their own cover-

age from another employer-spon-

sored health plan. This exception

expires on Jan. 1, 2014.

• There is no premium rate impact

until the group’s renewal. How-

ever, a family premium (em-

ployee/child) will continue to be

charged.

• If the current plan covers de-

pendents to age 27, the change

does not impact their plan (fully

insured large group plans only).

• Although this change will be

made automatically, employer

groups may choose to “opt out.”

If you are an employee of a

self-insured group

• Your employer will make the

decision. Employers are being

notified of this industry trend

toward early implementation.

• Without early implementation,

the increase in dependent to

age 26 coverage will take effect

at renewal.

• A special 30-day open enrollment

period for dependents who had

previously aged off their cover-

age will be held for each group

health plan beginning on their

renewal date. You will receive no-

tification before the open enroll-

ment period.

If you have an Arkansas

Blue Cross dental plan

through your employer

• Dependent rules are the same

as for the fully insured group

health plans.

• There is no premium rate impact

until the group’s renewal. How-

ever, a family premium (employ-

ee/child) will be charged.

• Although this change will be

made automatically, employer

groups may choose to “opt out.”

Dental plans for

individuals and families

(if you purchased your own

dental plan)

• Dependents who are age 19 and

aging off their parent’s plan can

apply for an individual dental

policy.

If you are a state or public

school employee in Arkansas

• The change to cover dependents

up to age 26 was implemented

on April 1, 2010, and a 90-day

open enrollment period was given

to employees to add previously

dropped dependents.

• The provisions for adding depen-

dents prior to plan renewal are

as follows:

° Child must be unmarried.

° Parent’s home is the

primary residence of the

dependent.

° Parent provides bulk of the

financial support.

• After plan renewal, all depen-

dents up to age 26 can be added

regardless of their residence or

marital status.

If you are a federal

employee (FEP)

• This change does not impact FEP

members until Jan. 1, 2011.

8


Cal Kellogg, Ph.D., senior vice president and chief strat-

egy officer for Arkansas Blue Cross and Blue Shield,

closely followed health insurance reform as the debate

was waged in Congress and has become an expert on

the resulting Patient Protection and Affordable Care Act

(PPACA). Blue & You recently sat down with Dr. Kellogg

to discuss the overall effect the new law will have, not

only on the lives of our members, but also on the lives

of all Americans.

What were the goals of health care reform?

Looking back, the initial goal of “health care” reform

legislation was to solve three problems, according

to Dr. Kellogg.

1. Get as many people as possible covered by

health insurance.

2. Address the overall cost of care.

3. Make sure Americans receive high-quality health

care services.

Kellogg said the new law addresses goal No. 1. How-

ever, “that means we have to work on the other two

issues,” he said. “That can be done legislatively, or we

will have to do that as an industry.”

What do our members need to know about

health insurance reform?

According to Kellogg, members need to keep three

important points in mind:

1. Personal Responsibility

As a consumer of health care services, it is impor-

tant to take personal responsibility for your own health.

This will benefit you and your family both financially and

personally. “The current reform package doesn’t ad-

dress the underlying causes of the increases in medical

costs,” Kellogg said. “People can manage their own

health to prevent illnesses by doing simple things like

eating healthy, exercising and reducing stress — we

just need to be proactive. Rather than saying, ‘let it

happen and then we’ll fix it,’ we should say, ‘let’s do

what we can to prevent illness,’ because the prevented

illness is the one that is the least expensive.”

2. Changes to Your Coverage

There will be changes related to your health insur-

ance coverage because of PPACA. We will keep you

informed through Blue & You and our Web sites. “While

reform will ensure that more Americans have health

insurance,” Kellogg said, “the coverage will cost more,

simply because of how the changes in the marketplace

are structured by the new law.” He explained that under

reform, individual and family insurance plans will have

rules similar to the current small group insurance plans.

“If you look at the current marketplace, premiums

for small employer groups are about three times higher

Your health insurance, your health care, your future

8

Cal Kellogg, Ph.D.

9


than for individual health insurance policies written for

individuals and their families without an employer spon-

sor,” Kellogg explained. “This is because small group

health insurance plans are “guaranteed issue,” which

means that employees and their dependents can have

coverage regardless of any health conditions they may

have. In addition, premiums are based in part on the

health conditions of all the employees on the group

plan. So if there are a number of very sick people within

a group, the group premiums will be higher.”

Kellogg said the rates in Arkansas’ current individual

marketplace are some of the lowest in the United

States because of the manner in which the laws in

Arkansas allow health plans to calculate premiums.

Currently, each state has its own set of laws and regula-

tions that take into

account the unique

circumstances that

may exist in its mar-

ketplace. “If you are

relatively healthy, you

get a much lower

rate,” he said. “If you

are unhealthy, you

may have to pay a

surcharge, or you may

not be offered indi-

vidual coverage in the

private marketplace.

You would still have access to the high-risk pool, where

the premium rates are closer to the premium rates for

small employer groups.” But beginning in 2014, indi-

vidual insurance policies in Arkansas will be required

to be “guaranteed issue” as well. For that reason, the

rates are expected to be closer to what we see in small

employer group health plans today.

In addition, PPACA changes the process and the

factors that insurance companies currently use to set

premium rates. Currently, older individuals generally pay

higher premiums than younger people because they

are likely to need more medical services. But in 2014,

insurance companies will be limited in the difference

in premium charged between an older person and a

younger person. This works out well for you if you are

older and not so well if you are younger.

Also, in 2014, PPACA requires that each state estab-

lish health insurance exchanges or marketplaces where

citizens can go to shop for insurance. At that time, Kel-

logg said, a person who buys individual insurance and

whose household income is under 400 percent of the

federal poverty level will receive government subsidies

to help pay for their insurance coverage. Subsidies will

be available to people from 133 percent of the federal

Your health insurance, your health care, your futureWhat you need to know about

health insurance reform

9

“While reform will

ensure that more

Americans have

health insurance,”

Kellogg said, “the

coverage will cost

more, simply because

of how the changes

in the marketplace

are structured by the

new law.”

10


poverty level up to 400 percent of

the federal poverty level on a sliding

scale. People who earn more than

400 percent of the poverty level will

not receive a subsidy. “If you are on

the lower end of the scale, you may

not end up paying very much more

for your policy,” he said, “but if you

are on the higher end of the scale,

you may pay a significant amount.”

It is difficult to explain how the

new health insurance reform law

will affect people financially, Kellogg

said, because it depends on their

situation. “Say I’m a 55-year-old

with diabetes. In the current envi-

ronment, if I get individual coverage

it may be very expensive because

of my health condition, or I might

not be offered coverage at all in

the private marketplace. But under

the new law, I will be able to get

coverage regardless of my health

condition and it might be a little

less expensive than it would oth-

erwise have been. This is because

of the new limits in the difference

in premiums that the insurance

company will be able to charge

between an older, unhealthy person

and a younger, healthy individual.

Now, if I’m a single 22-year-old man,

I might see my rates double or triple

because of those same limits, plus

the law’s inclusion of maternity and

other medical services as essential

benefits.

“A young person’s membership

premium might move from $90 up

to $250, but an older person

paying $750 might move

down to $650 a month,” Kel-

logg said. “The impact is go-

ing to vary a lot for people in

the individual policy market.”

Kellogg said the new law

doesn’t have as much of

a direct impact on people

ages 65 and older. He noted

that they did receive some

immediate relief for prescrip-

tion drug coverage and that the

“donut hole” in prescription drug

coverage would close by 2020.

3. The Cost Issue

Health insurance reform does not

fix all the problems in the health

care system. There are still many

important issues to be addressed.

While the new health insurance

reform law deals with access to

insurance, Kellogg said it doesn’t

address the problem of increasing

medical costs. And there is still a

question of whether our medical

system will have the capacity to

serve everyone.

“We are estimating that 500,000

previously uninsured Arkansans will

be able to get coverage,” he said.

“There may be problems with being

able to see doctors as quickly, or

scheduling appointments as easily.

In rural areas, it may be even more

of an issue, because there are few-

er physicians. It also may be a little

bit tighter with the addition of new

Medicaid patients who have not had

insurance and have not been seeing

primary care physicians as fre-

quently as they should.” There will

be a rise in premiums for young and

healthy people who already have

insurance. Because of this, some

of these individuals may choose not

to pay the higher premiums and go

without coverage.

Some proponents of the new law

have said there will be a windfall

for the insurance companies with

all the new people in the system,

but Kellogg said it doesn’t neces-

sarily work out that way. “Yes, there

will be new people in the system,

but they may not be as healthy,

and that is going to drive costs,” he

explained. “Our experience is that

folks who have not had insurance,

and then get coverage, tend to use

their coverage quite a bit, which

creates higher volume. You take all

those things together and we could

run into some supply problems.”

Advice to Members

Kellogg suggested members not

make any significant changes in their

10

11


coverage until there is more informa-

tion about the regulations. “The law

has been passed, but the regula-

tions that define the law really don’t

exist yet. And, until they exist, we

don’t really know exactly how things

will work.”

For example, Kellogg said, the law

discusses “essential benefits,” which

are medical services that every

health insurance plan in the country

will be required to cover, but the reg-

ulations don’t exist to explain which

benefits are considered “essential.”

We have to understand the details

in the regulations before you start

making changes.

Kellogg said that for the

next six to 18 months the law is in

the implementation stage, which

will include some minor changes

and explanation of the law through

regulations. “You are not going to

see major changes until 2014,

when these significant structural

changes will happen to the

insurance market.”

Making the Most of It

Going forward, Kellogg

said, Arkansas Blue Cross

will focus on ways to effec-

tively pay for benefits and to

provide information to help

customers find the most

effective treatments and the

places with the best out-

comes. “And we want to pay

providers — not for the num-

ber of services they provide

— but for the outcomes that they

generate for their patients,” he said.

“We can help people identify where

there is waste in the system and

get rid of it. And, if we do all these

things in a relatively short time, then

we can lessen the cost impact that

reform will otherwise have on our

members.”

Implementation

Kellogg said that Arkansas Blue

Cross is working to understand the

regulations as quickly as they are

announced and will implement them

in a timely, organized fashion with

minimal disruption. “Hopefully, for

our members, transitions will be as

painless as possible and they hardly

will notice that they’ve happened,”

he said, “unless it’s a situation

where they have the opportunity

to extend coverage for their child

or whatever the situation might be

and then we will have a process for

doing that.”

“We also are going to try to keep

employer groups informed of what it

will take to comply, including the im-

plications for them and positives and

negatives for some of the choices

they may make,” he said. “So, hope-

fully, that will help our members

if they have employer coverage.

Employers are going to be struggling

to understand this; this isn’t their

business, this is our business, so

we’d better be the experts on it and

help them.”

What is the Silver Lining?

Kellogg said that under reform

many previously uninsured people

will now have access to coverage.

“And, beginning in 2014, if you have

a lower income, there will be sig-

nificant government subsidies and

it won’t cost you as much for insur-

ance. For those groups it is positive.”

But that silver lining isn’t for

everyone. “For the rest of the folks,

the subsidies have to come from

taxes, so the increased tax burden

will be out there,” Kellogg said. “And

for people who are at or above 400

percent of the federal poverty level,

they won’t get any subsidy and

there will be added costs.”

But Kellogg said the efforts to

change health care have only just

begun. “The other positive is now

that the issue of access has been

addressed, we can focus on other

major issues, like cost and quality,”

he said. “I guess that is the biggest

positive.”

11

12


The Healthy Weigh! Education

Program is free for members of

Arkansas Blue Cross and Blue Shield,

Health Advantage (except state and

public school employees*), Blue Cross

and Blue Shield Service Benefit Plan

(Federal Employee Program), Medi-Pak

Advantage (PFFS) and eligible mem-

bers of BlueAdvantage Administrators

of Arkansas.

To enroll, complete the attached

enrollment form and return it in the

self-addressed, postage-paid envelope

included in this magazine. The pro-

gram starts when you enroll.

After enrollment, you will begin to

receive information through the mail,

which you can read in the privacy of

your own home and at your own pace.

The program is completely voluntary,

and you may leave the program at any

time. If you have further questions

about the program, call the Health

Education Program’s toll-free number

at 1-800-686-2609.

* Our state and public school members can access the “Nourish” program through Life Synch.

Simply complete, sign and return the attached enrollment form in the self-addressed, postage-paid envelope.

Lose weight

The Healthy Weigh!

If you are planning a visit to the doctor and need a little more infor-

mation on what medical care may be appropriate for you, Physician

Connection can help. Physician Connection allows you (as a member)

to find quality information for a specific health condition or physician

specialty.

Quality information is available

for health conditions such as preg-

nancy, diabetes, heart, eye and

respiratory conditions. The quality

information also is available for

the following specialties: allergy/

immunology, cardiology, endocri-

nology, family practice, internal

medicine, neurology, obstetrics/

gynecology, ophthalmology, oto-

laryngology, pediatric medicine,

pulmonary diseases and urology.

What is quality information?

Medical experts have established guidelines that most informed

practitioners believe physicians should follow in many — but not all —

situations. Quality measures show how often physicians in our net-

work (as a group) provide frequently recommended treatments to their

patients.

Within Physician Connection on our Web sites, under the section

called “Quality measures for my physician’s specialty,” you can select a

physician specialty, read the recommended treatment options (quality

measure) for specific conditions, and review a graph that shows how

often physicians in that specialty followed the recommended treatment

(quality measure) for their patients.

In a similar section on our Web sites called “Quality measures for my

health condition,” you can select a health condition (such as diabetes)

and review the graph that shows (by specialty) how often physicians

who treat diabetes followed the recommended treatment (quality mea-

sure) for their patients.

Need more information before visiting a specialist?

We can help!

12


Physician Connection is avail-

able exclusively for members to

help you make informed health

decisions. It’s available in the

secure My Blueprint sections of

our Web sites — arkansasblue-

cross.com, healthadvantage-

hmo.com and blueadvantagear-

kansas.com. Visit the home

page to register or log in.

13


How much exercise do women really need?

Are you stressed out at work? Worried about job

security? Feeling like you have little control? Chronic

stress may be adding to employees’ waistlines, accord-

ing to a recent study conducted by the University of

Rochester Medical Center.

Researchers found that workers who suffered from

chronic job stress had a higher Body Mass Index (BMI)

than less stressed workers. According to the study,

workers dealing with chronic stress tended to look “for-

ward to going home and ‘vegging out’ in front of the

TV.” And, when layoffs were occurring, the unhealthiest

We’ve all heard the standard 30 minutes a day, most

days of the week recommendation. But recent research

shows that may not be enough for women as they age.

According to a study in the Journal of the American

Medical Association, middle-aged women may actually

need closer to 60 minutes a day of moderate-intensity

exercise. Don’t be discouraged so quickly. The study

uses Metabolic Equivalent (MET) hours. To put it into

perspective, 1 MET would be equivalent to lying in bed

for an hour while running at 6 mph would equal approxi-

mately 10 METs.

So, in order to meet the 60-minute recommendation

to prevent weight gain,

middle-aged women would

need to aim for a minimum of

21 METs per week. To hit those

MET requirements in less time,

up the intensity of your work-

outs, which will allow you to

meet the MET requirements

in less than an hour a day.

Source: Health.com

snacks were the first to go from vending machines. Em-

ployees noted that they did not take time to exercise or

eat better in order to remain at their desks.

One conclusion that the study made is that employ-

ers should “focus on strengthening wellness programs

to provide good nutrition, ways to deal with job de-

mands and more opportunities for physical activities

that are built into the regular workday without penalty.”

Sources: University of Rochester Medical Center,

msnbc.com

Chronic job stress and your waistline

14


plans, the lifetime maximum benefit is currently

$5,000,000. This lifetime benefit would become

unlimited.

If you were enrolled in a health plan

through your employer effective April 1,

2010, or after:

For more recently effective health plans, a number of

changes apply during the next six to 18 months. These

changes may include:

• New rules around pre-existing health conditions for

children, which may mean that children who are in-

sured under their parent’s health plan do not have to

meet any pre-existing condition waiting periods even

if the parents are required to do so as a result of

some condition of their enrollment (late enrollment,

no prior creditable coverage, etc.).







article on Page 6.)









may be adjusted by law. The benefits to which this

regulation applies have not been determined.

• Emergency services must be covered at the in-

network coinsurance or copayment level even if you

receive the services at an out-of-network facility.

(This benefit is already offered by Arkansas Blue

Cross and Health Advantage.)

• Access to any in-network primary care physician or

pediatrician who is accepting new patients. (Already

available.)

• Direct access for women to obstetricians/gynecolo-

gists without a referral.

• Preventive services identified by the U.S. Preventive

Services Task Force will be covered with no member

cost-sharing (copayments, deductibles or coinsur-

ance.) The specific services that will be covered have

not yet been identified.

If you were enrolled in a family or

individual medical policy on April 1, 2010,

or after:

For more recently effective health plans, a number

of changes apply over the next six to 18 months. These

changes may include:

• New rules around pre-existing health conditions for

children which may mean that children who are in-

Reform, continued from Page 5

For more information on health insurance reform,

go to our Web sites or call Customer Service

(telephone numbers found on Page 23).

15


sured under their parent’s health plan do not have to

meet any pre-existing condition waiting periods even

if the parents are required to do so.







article on Page 6.)









may be adjusted by law. The benefits to which this

regulation applies have not been determined.

• Emergency services must be covered at the in-

network coinsurance or copayment level even if you

receive the

services at

an out-of-

network facility. (Arkansas Blue Cross already offers

this benefit.)

• Access to any in-network primary care physician or

pediatrician who is accepting new patients. (Already

available.)

• Preventive services identified by the U.S. Preventive

Services Task Force will be covered with no member

cost-sharing (copayments, deductibles or coinsur-

ance). The specific services that will be covered have

not yet been identified.

• Direct access for women to obstetricians/gynecolo-

gists without a referral will be included in all policies.

In addition to the new requirements described above,

PPACA includes additional regulations that may impact

members. These provisions include:

• New appeals processes will be established.

• The federal Department of Health and Human Ser-

vices will create a Web site to facilitate consumer

and small group health plan shopping.

• State ombudsman programs will be established.

• Over-the-counter drugs not prescribed by a physician

can no longer be reimbursed from a flexible spend-

ing account or HRA.

These are the changes you can expect in the next

six to 18 months. As regulations are clarified, Arkan-

sas Blue Cross will notify you of those provisions that

impact your policy. Most importantly, we will keep you

informed of the impact these changes may have on

your rates.

The most substantial changes will be implemented

in 2014. Those provisions will change where and how

you buy insurance, how it is priced and how you pay for

it. As regulations are issued, Arkansas Blue Cross will

provide you with as much information as possible to

help explain health insurance reform and its impact on

the health care industry. Please visit our Web sites or

contact us with any questions you may have.

16


For women, heart attack prevention and education are key

In recent years, American women have become in-

creasingly aware that heart disease is not just a “man’s

issue.” Before menopause, a woman’s risk of heart

attacks is lower than a man’s. But post-menopause, the

risk slowly increases, and within a decade both sexes

have similar statistics. We now know that in the last

two decades of life, a woman’s risk of heart attack and

death from heart disease is significantly greater than

a man’s.

In many women, coronary artery disease is differ-

ent from that found in men. Women tend to deposit

cholesterol and fats uniformly throughout their arteries,

whereas men tend to have more localized disease. This

may make women less prone to a massive heart attack,

but more likely to have different symptoms, including

potentially fatal abnormal heart rhythms. Prior to meno-

pause, estrogens protect the heart from the ravages

of a sedentary and stressful lifestyle, unhealthy diets,

elevated cholesterol levels and smoking. However, after

menopause, the protection disappears and hormone re-

placement therapy seems to make the problem worse

rather than better.

As women grow older, heart attacks become more

common, but the symptoms are quite different from

our stereotypic expectations. Most Americans imagine

a heart attack to be preceded by a sudden crushing,

centralized chest pain that feels as if the chest is in a

vice. This is rarely the case. For many women, chest

pain is not the initial symptom. Instead, symptoms

can be extremely varied, including a sudden shortness

of breath, palpitations,

nausea and vomit-

ing, or feeling

clammy and

ill. If chest

pain does

occur, it

frequently

is atypical,

meaning it

Lifelong Healthwith Dr. David

David A. Lipschitz, M.D., Ph.D.

For many women,

chest pain is not the initial

symptom. Instead, symptoms

can be extremely varied,

including a sudden shortness

of breath, palpitations, nausea

and vomiting, or feeling

clammy and ill.

17


doesn’t fit the classic description of pain associated

with a heart attack. It may be in the back or abdomen

and is often attributed to a muscle strain or indigestion.

Frequently there is no pain at all or merely a feeling of

pressure or tightness across the chest or throat.

Heart attacks with atypical symptoms or no chest

pain are frequently misdiagnosed, or diagnosed after it

is too late. A recent report published in a major medical

journal showed that pain-free heart attacks, particularly

common in older women, are three times more likely to

be fatal than those with typical symptoms.

There are some very important lessons to be learned

from this information. Women must remember that

they are not immune to heart disease. From a young

age, all women must pay attention to a heart-healthy

lifestyle of diet, exercise and stress management. If

medical concerns are present, such as high blood pres-

sure and elevated cholesterol, they should be treated

and managed.

In addition to prevention, women need to be more

informed and aware of the initial symptoms of heart

attacks. Do not ignore a sudden shortness of breath,

sweating, nausea, vomiting or unexplained palpitations.

Never ignore an unusual pain such as a heaviness or

tightness in the chest, pain in the back, arm or abdo-

men, particularly if you have never had anything like this

before. The sudden onset of any of these symptoms

is best handled by taking an aspirin and calling 911; it

could save your life. When it comes to issues of the

heart, it is far better to be safe than sorry!

Editor’s Note: David A. Lipschitz, M.D., Ph.D., is na-

tionally recognized as a leader in the field of geriatrics.

Arkansas Blue Cross and Blue Shield is honored to have

him as a contributor to Blue & You magazine.

18


Nearly 900 babies could be saved

each year, along with billions of dol-

lars, if 90 percent of U.S. women

fed their babies only breast milk

for the first six months of life, ac-

cording to a cost analysis published

in the April issue of the journal

Pediatrics.

The analysis studied the preva-

lence of 10 common childhood

illnesses, costs of treatment, includ-

ing hospitalization, and the level of

disease protection other studies

have linked with breastfeeding.

Breastfeeding is thought to protect

against stomach viruses, ear infec-

tions, asthma, juvenile diabetes,

sudden infant death syndrome and

even childhood leukemia.

The $13 billion in estimated

losses includes an economist’s cal-

culation partly based on lost poten-

tial lifetime wages — $10.56 million

per death.

The methods were similar to

a widely cited 2001 government

report that said $3.6 billion could

be saved each year if 50 percent of

mothers breastfed their babies for

six months. Medical costs have

climbed since then, and breast-

feeding rates have increased only

slightly.

About 43 percent of U.S. mothers

do at least some breastfeeding for

six months, but only 12 percent fol-

low government guidelines recom-

mending that babies receive only

breast milk for six months.

Source: Pediatrics, Associated Press

Can breastfeeding save lives?

The U.S. Consumer Product Safety

Commission (CPSC) has issued a

warning concerning the use of infant

carriers known as “baby slings.”

A baby sling is a soft fabric carrier

with a padded shoulder strap con-

necting to a hammock-style cradle

that is worn by an adult. The warning

was issued after three infants suf-

focated in baby slings in 2009.

Babies younger than four months

old have very weak neck muscles

and can’t control their heads. An

infant can suffocate in as little as two

minutes if the strap from a baby sling

covers his/her nose and mouth.

Also, baby slings can force an

infant’s chin downward to his or her

chest, making breathing difficult and

possibly causing a slower suffoca-

tion. Children with breathing prob-

lems and a low birth weight are at a

higher risk.

The CPSC has not issued a recall

on baby slings, but advises parents

to take special care when using the

device. Specifically, parents should:

• Placethechild’schinup

with his/her face clearly

visible.

• Checkonthechild

often.

Warning issued for “baby slings”• Donotallowtheslingtocover

the child’s face.

• Donotcarrythechildtoolowin

the sling.

• Donotcarrythechildhunched,

with his/her chin touching

the chest.

• Donotcarrythechildwithhis/her

face pressed tightly against the

wearer of the sling.

19


Arkansas Blue Cross and Blue

Shield’s new Personal Health State-

ment — a redesign of the traditional

Explanation of Benefits (EOBs) —

earned a first-place finish, as well as

a designation of “Excellent,” during a

recent national review of insurance

companies’ EOBs.

The EOB, which is generated each

time a member’s doctor or hospi-

tal files a claim, is the primary way

Arkansas Blue Cross communicates

with its members. The goal was to

simplify and personalize the benefit

statement so members will under-

stand exactly what is happening with

their claims and their benefits.

The new Personal Health State-

ment is designed to help members

understand a complex industry in

everyday language.

It helps members:

• Understandclaimsandhowthey

were handled.

• Monitorout-of-pocketcosts

(deductibles, copayments,

coinsurance)

• Seebenefitsandhowtheywork.

• Haveabetterunderstandingof

discounts on services.

• Knowhowtocontacttheirhealth

insurance plan.

• Haveaquickunderstandingof

how much they owe and

to whom.

DALBAR, a leading third-party

evaluator in the financial services

industry, conducted this first-ever

national evaluation of the EOB. The

evaluation gave 68 percent of EOBs

failing grades. Arkansas Blue Cross,

however, was deemed innovative

for recognizing the importance

of this member communication

and transforming its EOBs into

Personal Health Statements that

are understandable and useful

consumer tools.

The DALBAR report evaluates

EOBs according to clarity, content

and design. Three DALBAR designa-

tions are used: Excellent: 80-100

points, Very Good: 70-79 points and

Good: 60-69 points.

Eating a Mediterranean diet may

help keep your brain healthy as

you age, findings from an ongoing

study show.

A “Mediterranean diet” encour-

ages the following:

• Vegetables

• Fruits

Food for thought:Certain foods may keep aging brains healthy

• Morefish,lessmeat

• Oliveoil

• Moderatewine

• Wholegrains

• Nutsandseeds

The study included 4,000 adults

aged 65 and older who were given

series of tests to examine their

mental abilities every three years

during a 15-year period. Those who

scored highest in following a Medi-

terranean diet were least likely to

suffer cognitive decline, the study

authors found.

Source: National Institutes of Health

Redesigned PHS wins top scores in national review


19

20


by Trey Gardner, Pharm D.,Arkansas Blue Cross and Blue Shield

What’s in a drug name and why did mine change?

From the Pharmacist

Every drug usually has three

names: the chemical name, the

generic name and the brand name.

Each name is subject to different

rules and regulations.

The chemical name specifies the

chemical structure of the drug. It

does not have to be preapproved by

any organization. Chemical names

are primarily used by researchers

but not in medical practice.

The generic name usually is cre-

ated when a new drug is ready for

marketing. It is selected by the U.S.

Adopted Names (USAN) Council,

whose expertise is recognized by

the U.S. Food and Drug Administra-

tion (FDA), according to principles

developed to ensure safety, con-

sistency and logic. These names

typically are used by health care

professionals.

Generic names are made using

an established stem, or group of

letters, that represents a specific

drug class. For example, the USAN

stems include suffixes like -mab for

monoclonal antibodies, such as inf-

liximab. Names that include stems,

chemistry roots or other coded

information are easier to remember

and give clues to the drug’s use.

These names, however, may sound

or look alike and can contribute to

medication errors.

The brand name is created as

soon as a generic name has been

established. To minimize confusion

between drug names that look or

sound alike, the FDA rejects about

one-third of an average of 400 possi-

ble brand names submitted based on

similarities with other drug names.

Still, confusion from similar-

sounding drug names does occur.

To monitor the situation, the FDA

has a medication errors committee

that occasionally recommends a

name change.

The most recent name change

happened this year. Kapidex®

(dexlansoprazole), a proton pump

inhibitor that hit the market in Febru-

ary 2009, became confused with

the similar-sounding drug name

Casodex®. The FDA committee

recommended a name change for

Kapidex® and effective April 2010, it

became Dexilant®.

The last time the FDA changed

a drug name after it was approved

was in 2005, when the Alzheimer’s

medication Reminyl® was confused

with the diabetes drug Amaryl® and

one person died. The Alzheimer’s

medicine now is called Razadyne.

The need to change a drug’s

name does not happen often and

usually occurs within the first year

a drug is marketed. The complex

procedure of giving each drug a

chemical, generic and brand name

does not always eliminate confu-

sion. However, the pharmaceutical

companies, the USAN Council and

the FDA all share one basic goal —

to create a name for each drug that

easily distinguishes it from other

drug names, ensuring patient safety.

Source: fda.gov

21


by Ray Bredfeldt, M.D.,Regional Medical DirectorNorthwest Region, Fayetteville

TheDoctor’s Corner

Drugs used to treat high

blood pressure also may

keep dementia away

ACE-inhibitors are commonly

used to treat high blood pressure,

but evidence now indicates that

these same medications also may

prevent the worsening of dementia.

Researchers recently discovered

that people who take “centrally ac-

tive” ACE-inhibitors (examples are

captopril and lisinopril) had memory

function that declined 65 percent

less when compared to those not

taking these same medications. Of

course, more research needs to be

completed, but for someone with

dementia who already is taking high

blood pressure medications, switch-

ing to one of these medications

might be something to consider.

No smoking!

Two new studies have deter-

mined that smoking bans in public

places significantly reduces the rate

of heart attacks. The studies found

that the overall rate of heart attacks

in cities that have banned smoking

in public places has decreased by as

much as 36 percent during a three-

year study. Exposure to smoke (or

smoking) can cause blood vessels

of the heart to constrict, which can

cause a heart attack. One of the

studies, published recently in the

Journal of the American College of

Cardiology, estimated that a nation-

wide smoking ban in public places

could prevent more than 150,000

heart attacks each year.

No link between cell phones

and brain cancer

Someone may have sent you an

e-mail or some sort of “document”

that suggests that radio waves from

cell phones cause an increase in

brain cancer. Scientists have found

no evidence that radio waves can

damage a cell’s DNA, which would

be necessary for cancer to oc-

cur from cell phones. Now, a new

study gives further assurances of

the apparent safety of cell phones

related to radio waves and brain

cancer. Researchers have found no

increase in the rate of brain cancer

in four different countries during the

10 years after a significant increase

in cell phone use occurred in those

countries.

Take folic acid prior to

pregnancy

For many years, doctors have rec-

ommended that women take folic

acid (vitamin B9) during pregnancy

to help prevent birth defects. Now,

evidence suggests that taking folic

acid prior to getting pregnant has

definite advantages. Women think-

ing about getting pregnant should

probably start taking folic acid up to

one year prior to becoming preg-

nant. A recent study discovered that

women who take folic acid before

getting pregnant reduce their risk of

having a premature baby by 50 to

70 percent. The recommended pre-

conception dose of folic acid is 400

micrograms per day.

22


At Arkansas Blue Cross and Blue

Shield and its affiliates (including

HMO Partners, Inc. d/b/a Health

Advantage), we understand how

important it is to keep your private

information just that — private.

Because of the nature of our

business, we must collect some

personal information from our

members, but we also are committed

to maintaining, securing and

protecting that information.

Customer Information

Arkansas Blue Cross and its

affiliates only compile information

necessary for us to provide the

services that you, our member,

request from us and to administer

your business. We collect non-public

personal financial information (defined

as any information that can be tied

back to a specific person and is

gathered by any source that is

not publicly available) about our

members from:

• Applications for insurance cov-

erage. The application includes

information such as name, ad-

dress, personal identifiers such

as Social Security number, and

medical information that you

authorize us to collect.

• Payment history and related

financial transactions from the

purchase and use of our

products.

• Information related to the fact

that you have been or currently

are a member.

Sharing of Information


affiliates do not disclose, and do not

wish to reserve the right to disclose,

non-public personal information about

you to one another or to other parties

except as permitted or required by

law. Examples of instances in which

Arkansas Blue Cross and its affiliates

will provide information to one

another or other third parties are:

• To service or process products

that you have requested.

• To provide information as per-

mitted and required by law to

accrediting agencies.

• To provide information to com-

ply with federal, state or local

laws in an administrative or

judicial process.

How We Protect Your Information


affiliates use various security

mechanisms to protect your personal

data including electronic and physical

measures as well as company

policies that limit employee access

to non-public personal financial

information. Improper access and

use of confidential information by an

employee can result in disciplinary

action up to and including termination

of employment.

Disclosure of Privacy Notice


affiliates recognize and respect the

privacy concerns of potential, current

and former customers. Arkansas Blue

Cross and its affiliates are committed

to safeguarding this information. As

required by state regulation, we must

notify our members about how we

handle non-public financial information

of our members. If you would like

to review the Financial Information

Privacy Notices for all Arkansas Blue

Cross members, you can visit our Web

site at arkansasbluecross.com or call

the appropriate Arkansas Blue Cross

affiliate company to receive the Privacy

Notice. Our customer service areas

are open from 8 a.m. to 4:30 p.m.,

Central time, Monday through Friday.

To receive a copy of the Privacy

Notice, members should call:

Arkansas Blue Cross —

1-800-238-8379.

Health Advantage — 1-800-843-1329.

Self-funded group members should

call Customer Service using the toll-

free telephone number on their

ID card.

Arkansas Blue Cross and Blue Shield Financial Information Privacy Notice

22


23


We love to hear from you!May we help? For customer service, please call:

Little Rock Toll-free Number (501) Number

Medi-Pak members 378-3062 1-800-338-2312

Medi-Pak Advantage members 1-877-233-7022

Medi-Pak Rx members 1-866-390-3369

Arkansas Blue Cross members 378-2010 1-800-238-8379

Pharmacy questions 1-800-863-5561

Specialty Rx Pharmacy questions 1-866-295-2779

Health Advantage members 378-2363 1-800-843-1329


BlueAdvantage members 378-3600 1-888-872-2531


State and Public School members 378-2364 1-800-482-8416

Federal Employee members 378-2531 1-800-482-6655

Looking for health or dental insurance? We can help!

For individuals, families and those age 65 or older 378-2937 1-800-392-2583

For employer groups 378-3070 1-800-421-1112 (Arkansas Blue Cross Group Services, which includes Health Advantage and BlueAdvantage Administrators of Arkansas)

Prefer to speak with someone close to home? Call or visit one of our regional offices:

Pine Bluff/Southeast Region 1-800-236-0369 1800 West 73rd St.Jonesboro/Northeast Region 1-800-299-4124 707 East Matthews Ave.Hot Springs/South Central Region 1-800-588-5733 100 Greenwood Ave., Suite CTexarkana/Southwest Region 1-800-470-9621 1710 Arkansas BoulevardFayetteville/Northwest Region 1-800-817-7726 516 East Milsap Rd., Suite 103Fort Smith/West Central Region 1-866-254-9117 3501 Old Greenwood Rd., Suite 5Little Rock/Central Region 1-800-421-1112 320 West Capitol Ave., Suite 900

You can contact customer service through our Web sites: arkansasbluecross.com

healthadvantage-hmo.comblueadvantagearkansas.com

Related Web sites:blueandyoufoundationarkansas.org

blueannewe-ark.com

Heart-healthy walkingArkansas Blue Cross and Blue Shield employees

raised more than $8,000 for the American Heart Associ-

ation 2010 Central Arkansas Heart Walk, which was held

April 17 at the North Shore River Walk in downtown

North Little Rock. Mike Brown, executive vice president

and chief operating officer, served as the overall Central

Arkansas Heart Walk chairman and launched thousands

of participants for the 5K, including more than 300

Arkansas Blue Cross employees.

BlueAnn leads Anti-Drug Walk in Arkadelphia

For the 12th year, BlueAnn Ewe helped lead the an-

nual “Just Say No” drug prevention walk hosted by Per-

ritt Primary School in Arkadelphia. On April 9, BlueAnn

helped lead the fight against drugs with hundreds of

elementary students, high school and college mentors,

parents, teachers and administration staff, and commu-

nity supporters during the 23rd year of the event. Com-

munity and state leaders greeted the walkers, pledging

their support in the fight against drugs. Clark County

Sheriff’s Office

staff, Arka-

delphia Police

Department

officers and

members

of the Arka-

delphia Fire

Department

Rescue Unit

participated

as well.

24


At Arkansas Blue Cross and Blue Shield, we are always looking for new ways to be "Good for You." Here are some of our latest accomplishments.

Know Your ExposureTo protect our members from overexposure to ioniz-

ing radiation used in medical imaging, Arkansas Blue

Cross and Blue Shield and its family of companies

are including a calculation of a member’s equivalent

dose of radiation from medical procedures in the

new Personal Health Statements. The information,

supplied by National Imaging Associates (NIA), is

based on claims data from health care providers.*

It is important to talk with your doctor about your

medical imaging choices. This additional information

can help you make informed health care decisions.

Your doctor can explain the need for a medical imag-

ing procedure based on the benefits and potential

risks involved.

* Claims data is provided to NIA from Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administra-tors of Arkansas at regular intervals. If a claim has not been filed or was not paid, if the patient has had a lapse in coverage or if the employer group has opted not to participate, there may be information on exposure to ionized radiation that is not factored into this calculation.

New Tools for Small GroupsEffective June 1, Arkansas Blue Cross and Blue

Shield and Health Advantage will introduce two new

services for small group (2-50) customers.

eBill Manager is an electronic billing service that

can replace the traditional paper invoice. Only em-

ployer groups that have signed up for Blueprint for

Employers will be able to access this new service.

eBill Manager will be available to all new groups

sold on or after June 1, and to all renewal groups

on their anniversary date beginning June 1. Elec-

tronic applications for new employees (e-apps) will

be available for all small groups who are registered

for Blueprint for Employers effective June 1, 2010,

regardless of their anniversary date.

NIA provides prior authorization services for outpatient diag-nostic imaging services for Arkansas Blue Cross, Health Advan-tage and BlueAdvantage. NIA is an independent company that operates separately from these companies.

Documents

2010 - Summer