2018 Membership Guide \ geha.com. Live healthier.

Transcription

1 2018 Membership Guide \ geha.com Live healthier.

2 From our President GEHA is here to serve you. For 80 years, GEHA has provided quality, affordable health and dental plans designed exclusively for federal employees. It is our mission to serve you with only the utmost trust, honor and integrity every step of the way we stand by those who stand for us. As a GEHA member, you have a partner invested in your health and well-being. That s why we want to make sure you know about every benefit we offer, from comprehensive prenatal care all the way to help for elderly relatives in an emergency. Whether you re looking for ways to lead a healthier lifestyle or facing a serious diagnosis, let GEHA be your partner and support system. Our programs are designed to educate and inform you every step of the way, because everyone should be able to make health care decisions with confidence. So let us help. It s what we do. Thank you for selecting GEHA for your health care coverage. We know you have many choices, and appreciate the trust you ve put in GEHA with your decision. This Membership Guide is a great reference tool to keep and use throughout the year. It contains valuable coverage information about your plan, supplemental benefits *, exclusive member benefits, web addresses and phone numbers. Please visit geha.com/getstarted to create your GEHA web account, enroll in delivery of your explanation of benefits (EOB), sign up to receive plan materials electronically and subscribe to GEHA s Health e-report. If you have questions about your health plan, visit our website, geha.com, or call Customer Service at In good health, GEHA s Mission GEHA provides products and services that help members protect their families and access quality, affordable health care. Julie Browne, President & CEO *GEHA supplemental benefits are neither offered nor guaranteed under contract with the FEHB or FEDVIP programs, but are made available to all enrollees and family members who become members of GEHA. 2 geha.com 2018

3 Table of Contents 04 Health Advice Line and Telemedicine 05 Specialized Care 06 Your Care Now 08 Maternity Care 09 Save on Prescriptions 10 Healthy Behaviors 11 Embrace Safety 12 Lifestyle and Fitness 14 Vision Care 16 Hearing Benefits 18 Teeth Whitening Connect with GEHA on social media Like Us Follow Us Pin Us Watch Us Join our community facebook.com/gehahealth Find announcements and member information twitter.com/gehahealth Discover healthy living tips pinterest.com/gehahealth Find information about GEHA benefits and health advice youtube.com/gehahealth 2018 geha.com 3

4 HEALTH ADVICE LINE AND TELEMEDICINE Get answers without leaving home. In addition to primary care, GEHA members can receive care and advice via phone, via video or in person. Health Advice Line Call to speak with a registered nurse any time, 24/7. Please have your member ID number available when you call. If you re calling the GEHA Health Advice Line from outside the United States, call collect The Health Advice Line nurses can help evaluate symptoms and determine an appropriate method of treatment, which may include home-based remedies, referral to an urgent care facility or walk-in clinic, or referral to our telemedicine service to speak with a physician. Telemedicine GEHA health plan members can speak with a physician about their symptoms by using our telemedicine service, anywhere they have access to a phone, computer, tablet or smartphone (where allowed by state law), 24/7/365. GEHA Standard and High Option health plan members and members with Medicare referred from the Health Advice Line have a $0 copay for utilizing this service. Members with HDHP pay a $42 copay. Use telemedicine if you have: Acne Insect bites Allergies Nausea Cold/Flu Pink eye Constipation Rash Cough Respiratory problems Diarrhea Sore throat Ear problems Urinary/UTI Fever Vomiting Headache More Call to speak with a telemedicine physician at MDLIVE. 4 geha.com 2018

5 SPECIALIZED CARE Care for the most challenging conditions. Rare Disease Management Depending on your diagnosis, as a GEHA member, you may be eligible for our Rare Disease program. For more information, call GEHA AccordantCare toll-free at Monday-Friday from 8 a.m. to 9 p.m. Eastern time. Cancer Care Management A cancer diagnosis can leave you and your family feeling frightened and overwhelmed. GEHA s Cancer Care Management program can help you better understand your diagnosis and treatment options, including possible side effects and follow-up testing. Our program can also help you coordinate medical treatments once a plan of action has been established. Call the GEHA Cancer Care Management program at Monday-Friday from 8 a.m. to 9 p.m. Eastern time geha.com 5

6 YOUR CARE NOW Sometimes you can t wait for an appointment. CVS MinuteClinic For GEHA members in many states and the District of Columbia, convenient, high-quality health care is available at MinuteClinic, the walk-in medical clinic inside select CVS Pharmacy locations. GEHA High and Standard Option health plan members pay a $10 copay for each visit, and appointments are not necessary. If you have Medicare Part A & Part B, your cost is $0. MinuteClinic is staffed by certified family nurse practitioners and physician assistants who diagnose, treat and write prescriptions for common illnesses, injuries and skin conditions. MinuteClinic also offers physical exams, routine vaccinations and screenings for disease monitoring. To locate a MinuteClinic, visit cvs.com/minuteclinic/clinic-locator. Urgent Care Urgent Care clinics do not require an appointment, and they often have convenient evening and weekend hours. GEHA High and Standard health plan members pay a $35 copay when visiting an in-network Urgent Care facility. No deductible. No coinsurance. If you have Medicare Part A & Part B, your cost is $0. Visit an Urgent Care clinic for the treatment of non-emergency health issues such as minor burns or injuries, sprains, fever or flu, skin irritations or nausea. Visit geha.com/search to find an in-network Urgent Care facility near you. 6 geha.com 2018

7 Tips to help you manage stress. Identifying coping strategies to help you manage stress is essential to keeping your health in balance. Be quiet. When tensions get high, try closing your eyes and practicing deep breathing to achieve calm in the chaos. Write it out. Keeping a daily journal can be an effective way to help you identify your stressors. Get moving. Feeling tense at work? Stand and stretch to wake up your muscles and relax. Sleep. It s a good rule of thumb to shoot for 8 hours a night. Sleep can give your ability to handle stress a major boost. Get fresh air. Time in nature can calm your mind, reduce stress, and lower your cholesterol and blood pressure. Be social. Spending time with people you care about and enjoy can help you refocus your mental energy. Get a second opinion when it matters most. When it comes to making medical decisions, such as whether surgery is right for you, you want to be sure. GEHA partners with Best Doctors, an innovative second-opinion service and your go-to benefit for peace of mind. Best Doctors brings together the world s best medical minds to get you the right diagnosis and treatment so you can make medical decisions with confidence. With your permission, Best Doctors collects your medical records and matches you with an appropriate medical expert. That expert either confirms your diagnosis and treatment plan, or recommends a change. There is no need to visit a second doctor or leave home. You ll receive a confidential and easy-to-understand report with the expert s findings that you can share with your treating physician, if you choose. If you want a little more help making a surgical decision, you also have free access to one-on-one coaching, as well as interactive online educational modules featuring in-depth, easyto-follow information about your specific condition. If you have a qualifying condition and would like to take advantage of the free and confidential Best Doctors service, contact a GEHA Care Management Nurse at , or Best Doctors by phone at or directly online at bestdoctors.com/geha-members. Qualifying conditions for Best Doctors services: Cancer Breast cancer Prostate cancer Surgery Bariatric surgery Hip surgery Knee surgery 2018 geha.com 7

8 MATERNITY CARE Benefits to support breastfeeding moms GEHA s breast-pump contracted provider is HOMELINK. You can order a breast pump by calling HOMELINK at GEHA pays the full cost of one double-channel electric breast pump with double suction capability, with a physician s prescription, every two years. You must obtain the breast pump and supplies from HOMELINK. A new prescription is required when requesting a new/replacement pump. Additional pumps may be obtained from HOMELINK at the member s expense. You can order a breast pump by calling HOMELINK at Your growing family. Expecting parents can turn to GEHA s maternity program for answers to all your questions about how to best care for baby. Our maternity resource packet is packed with information about pregnancy, prenatal care and your maternity benefits. Get more Order your maternity resource packet, enroll in Maternity Health Rewards and find a due date calculator at geha.com/maternity. 8 geha.com 2018

9 SAVE ON PRESCRIPTIONS Don t pay more for prescriptions than you have to. GEHA s nationwide network of pharmacies makes it easy to estimate costs and get your prescriptions filled. Visit info.caremark.com/geha to enter your prescription drug name and get an estimate of what you should pay out of pocket for your medication. Retail pharmacies: Get your prescriptions at more than 70,000 nationwide in-network locations. That includes any CVS Pharmacy (including locations inside Target stores) and chains such as Rite Aid, Walmart and Walgreens, as well as independent pharmacies. G et t he app and pay less Scan your prescriptions, compare prices and check your refills with the CVS Caremark app on Google Play and the App Store. Home delivery: With CVS Caremark s Mail Service Pharmacy, you can save money and have maintenance medications delivered to your door. Many drugs qualify for 90-day refills. ExtraCare Health Card: The CVS Caremark ExtraCare Health Card can save you even more, with a 20 percent discount on CVS-brand health items, such as cold remedies, pain medications, first-aid supplies, vitamins, skin care, baby care and more. You can use your ExtraCare card at any CVS Pharmacy location or online at cvs.com geha.com 9

10 HEALTHY BEHAVIORS Health Rewards makes it easy to live healthier. GEHA s Health Rewards program gives two adult members per household (age 18 or older) the opportunity to earn up to $250 for participating in activities that promote healthy behaviors. This money can be used for qualified medical expenses and health-related items at the online FSA store. 1. Go to healthbalance.geha.com. First-time users should click the REGISTER NEW ACCOUNT button to create your username and password. 2. After you ve successfully logged in, start the Health Rewards program by completing the Health Assessment. When you re done, you will earn a $75 GEHA HealthBalance prepaid MasterCard. 4. Once you ve earned 75 points for taking the biometric screening, or earned at least 100 Health Rewards points in the portal, you will receive an within six weeks with a link to fsastore.com/gehahealthbalance. You can use the credit for any items sold on the site. 3. Earn up to 175 points by completing a free biometric screening and other wellness activities throughout the year. Details are online for how to schedule your biometric screening, participate in wellness workshops and earn points through your healthy behaviors. 10 geha.com 2018

11 Embrace safety with Life Alert Emergency Response. Get round-the-clock peace of mind for you and any family members, even if they re not GEHA members. Life Alert s leading medical alert system is available at special promotional pricing that includes up to $199 in waived activation fees and 10 percent off monthly rates. Life Alert is a medical alert system specifically designed to protect seniors and all family members in a home health emergency. G et s t ar ted w it h Life Alert To receive your GEHA discount (free activation plus a 10 percent discount on your monthly billing), call and request a free Life Alert brochure. Life Alert services can help seniors remain independent and possibly avoid a retirement home by sending help fast in the event of a medical emergency, fall or home invasion. The simple act of pushing a button when help is needed allows independent seniors to live alone, without being alone. Life Alert s medical alert system provides emergency help 24/7, even if you can t reach a phone, as well as peace of mind to family members geha.com 11

12 LIFESTYLE AND FITNESS Work out the way it works for you. Connection Fitness With GEHA s Connection Fitness program, all GEHA health plan members can choose from more than 9,000 Active&Fit Direct participating fitness centers nationwide for just $25 a month (plus a $25 enrollment fee and applicable taxes). The program offers a free guest pass to try out a fitness center before enrolling (where available), online fitness tracking from a wide variety of wearable fitness devices, apps and exercise equipment, and more. To learn more, visit geha.com/fitness. Diet: Just one factor in the weight equation Nutrition: Your body needs the right balance to maintain a healthy weight. Exercise: Your body relies on lean muscle mass to regulate your metabolism, which is why cardio workouts alone don t achieve much weight loss for dieters. Make sure your workouts include strength training. Stress: The hormones released when you experience anxiety can also provoke your body into storing fat around your midsection. Sleep: Deep sleep is the time your body uses to repair itself. When you don t get enough, your body releases more hunger hormones like ghrelin. Skimping on sleep also limits leptin, making it harder for you to fight cravings. Checkups: If you re finding it hard to slim down or experiencing weight fluctuations, tell your doctor. Your problem could be easy to diagnose, or a sign of something more serious. 12 geha.com 2018

13 Find more member advantages online. Depending on your circumstances, you may qualify for one of GEHA s online wellness programs such as Virtual Lifestyle Management or Better Choices, Better Health. Virtual Lifestyle Management weight loss program Virtual Lifestyle Management (VLM) provides online strategies for weight loss at no cost to qualified members. VLM s program focuses on helping you overcome your personal obstacles to losing weight. GEHA offers this online program to our health members who need to lose 30 or more pounds, or any member who has been diagnosed with a condition that is either caused or made worse by being overweight. VLM was developed by doctors and weight-loss experts. The program consists of 16 weekly online sessions followed by eight monthly sessions. If you qualify, you ll learn how to practice proper nutrition, as well as develop ways to gradually increase your activity level. To learn more, and for a link to the enrollment form, visit geha.com/vlm. Better Choices, Better Health Better Choices, Better Health is a self-management program developed at Stanford University. This six-week online workshop offers techniques to deal with problems associated with a wide range of chronic conditions, such as diabetes, hypertension, high cholesterol, chronic pain and heart disease. This flexible, interactive workshop uses and message boards to explore appropriate use of medications; communicating effectively with family, friends and health professionals; healthful eating; making informed treatment decisions; and disease-related problem-solving. Visit healthbalanceconnect.com geha.com 13

14 VISION CARE Give your eyes the care they deserve. Connection Vision powered by EyeMed Vision coverage is part of your GEHA membership. With Connection Vision, you and covered family members get annual eye exams for only a $5 copay when you visit an EyeMed provider. For eye exams at out-of-network providers, EyeMed reimburses you up to $45 per covered member. Benefits include: Access to thousands of network providers, including LensCrafters, Pearle Vision, Sears Optical, Target Optical, JCPenney Optical and private practitioners. A 40 percent discount off retail prices on frames at qualified EyeMed providers. No limit on the number of discounted glasses or contacts purchased each year for those on our High Option and Standard Option plans. Savings on surgical procedures, including LASIK, at participating locations. OTHER DISCOUNTS INCLUDE WHAT YOU PAY IN NETWORK* Eye exam (with dilation as necessary) $5 copay Eyeglass lenses (pair): Standard plastic single vision Up to $50 Standard plastic bifocal Up to $70 Standard plastic trifocal Up to $105 Standard progressive lens Up to $135 Premium progressive lens 80% of the retail price Eyeglass lens options: UV treatment $15 Tint (solid and gradient) $15 Standard plastic scratch coating $15 Standard polycarbonate $40 Standard anti-reflective coating $45 Photochromatic / transitions plastic 80% of the retail price See your benefits clearly Find out more about your vision plan at geha.com/vision. Premium anti-reflective Other add-ons Contact lenses: Conventional Disposable Additional pairs: Eyeglasses (complete pair) Contacts (conventional lenses) 80% of the retail price 80% of the retail price 85% of the retail price 100% of the retail price (no discount on disposable) Up to 60% of the retail price 85% of the retail price * High Option and Standard Option when you visit an EyeMed provider. Out-of-network not covered. These benefits are neither offered nor guaranteed under contract with the FEHB or FEDVIP programs, but are made available to all enrollees and family members who become members of GEHA. 14 geha.com 2018

15 Eye exams: A window into your overall health Did you know that eye exams are used as a first line of detection for serious illnesses? Here are some of the symptoms a comprehensive assessment can reveal: Diabetes: Retinal hemorrhages and other vascular changes are one of the first signs of untreated diabetes. High cholesterol: Warning signs can include fat deposits on eyelids, white discoloration on the cornea and occlusions on retinal blood vessels. Hypertension: Subtle changes in the retina can tip off your doctors to possible high blood pressure. If left untreated, high blood pressure can lead to vision loss. Neurological diseases: While most eye tics and twitches are benign, they can also be a sign of multiple sclerosis or Parkinson s. Brain tumors: Slow pupil response, a loss of peripheral vision and changes in the optic nerve can all be symptoms of a tumor in the brain putting pressure on the eye from behind. Source: National Institutes of Health 2018 geha.com 15

16 HEARING BENEFITS Listen up: Your hearing is covered, too. Connection Hearing powered by TruHearing As a GEHA member, you have exclusive access to low prices on hearing aids through our Connection Hearing program powered by TruHearing and not just for yourself. Because this benefit can be shared, both you and your extended family can choose from more than 100 reduced-price, new models from top companies such as Starkey, Phonak, ReSound, Oticon and Widex. Learn more at geha.com/hearing. BENEFIT SAVINGS EXAMPLES (PER PAIR) STANDARD OPTION AND HIGH OPTION SAMPLE PRODUCT AVERAGE RETAIL PRICE TRUHEARING PRICE BENEFIT YOU PAY ReSound LiNX 3D 5 $3,840 $2,500 $2,500 $0 TruHearing Flyte 770 $3,700 $1,990 $2,500 $0 Widex Beyond 200 $4,010 $2,500 $2,500 $0 Starkey Muse iq i1600 $4,430 $2,550 $2,500 $50 Phonak Audeo B50 $3,860 $2,590 $2,500 $90 Oticon Opn 3 $5,700 $3,050 $2,500 $550 These benefits are neither offered nor guaranteed under contract with the FEHB or FEDVIP programs, but are made available to all enrollees and family members who become members of GEHA. Rates and products are subject to change. 16 geha.com 2018

17 Features to look for in a hearing aid Keep your lifestyle in mind when you re selecting a hearing aid, and you ll have a better idea of what you ll really need. Sometimes, keeping it simple yields the best results. Telecoils: These small wires help hearing aids pick up telephone signals and sounds in rooms that have audio induction loops installed. Telecoils can be set for manual or automatic use, but only manual telecoils pick up audio induction loops. Directional microphones: These help users converse in noisy environments by amplifying the audio signals in front of a person at a higher rate than the noise to the rear and sides. Directional microphones get positive results in loud social settings and household settings, but they re susceptible to wind noise. Feedback suppression: Also called feedback reduction, this feature uses a delay to filter out highpitched squeals as they enter hearing range. This is handy when users are close to telephones or have to adjust volume frequently. Find a hearing aid provider Learn more about your hearing aid options at truhearing.com or by phone at Wind suppression: It reduces the rumbling users experience when air flows across the microphones in their hearing aids. It comes in handy for people who spend a lot of time outside. Speech enhancement: Sometimes also called noise reduction, this involves a computer chip that analyzes background noises like running water and blocks them, allowing conversation, TV or music to come through. Number of frequency channels: More channels allow you to customize what comes through your hearing aid. Some people have more problems with high-pitched sounds, while others can t pick up low, rumbling sounds like truck engines. If you have overall consistent loss, you don t need as many channels geha.com 17

18 TEETH WHITENING Don t wait to start smiling brighter. Get your exclusive discount at smilebrilliant.com/geha. A plan you can smile about. Simple, affordable whitening is easier than ever with Smile Brilliant. Whiten your teeth with a custom-made system from the comfort of home. All GEHA members will receive 20 percent off the lowest published price on all Smile Brilliant products custom-fitted trays, teeth whitening gel and desensitizing gel. Smile Brilliant s lab-direct system replicates the results dentists have been providing for years, with both inoffice treatments and custom-fitted teeth whitening trays, at a 70 percent discount. For your convenience, your Smile Brilliant kit is mailed to your home. Make your upper and lower dental impressions a simple process that takes about 10 minutes and mail them back to the lab in the postage-prepaid envelope provided. Your handcrafted, customized trays are mailed back within eight business days. A 100 percent refund is guaranteed within the first 45 days if you are not completely satisfied. 18 geha.com 2018

19 Helpful resources at your fingertips. Smiles: More than just an expression They make you happier on the inside. Smiling releases dopamine and serotonin, the same feel-good neurotransmitters in your brain that prescription antidepressants work to stimulate. This works even when you re faking it. The act of smiling can actually turn your mood around. When you smile, it affects others. Seeing a smiling face activates the orbitofrontal cortex, the part of the brain concerned with sensory rewards. In other words, when other people see you smiling, they feel rewarded by it. Your body responds. When you smile, your blood pressure is naturally lowered. It can help you at work. Studies have shown that workers who smile more are perceived as more approachable and are more likely to be promoted. It s in your nature. Infants learn most facial expressions by mimicking the faces around them, but even blind babies are born with the ability to smile. GEHA s web-based resources let you take a more active role in your health care wherever you are at home, at work or on the go. Sign up for a member account and learn more on your computer or mobile device at geha.com/signin. Member information: Get a summary of benefits for every family member covered under your plan. Track your spending by seeing the amounts applied toward your deductible and out-of-pocket maximum. Answers about claims: Access claims from the past 18 months to see dollar amounts for out-of-pocket expenses, GEHA s negotiated amount and what we paid on your behalf. Electronic EOBs: Subscribe to receive your Explanation of Benefits by . Temporary ID cards: If you lose your card or just need an extra copy, we make it simple to go online and print a temporary card. Provider search: Find nearby doctors by entering names, locations and specialties. You also get full access to Healthgrades reports on cost and quality. Healthy living tools: Our wellness portal at healthbalance.geha.com helps you stay informed with tools that include an online health assessment and your personal health record. Source: Psychology Today 2018 geha.com 19

20 P.O. Box 4665 Independence, MO PRESORTED STANDARD U.S. POSTAGE PAID GEHA GEHA Customer Service GEHA Health Advice Line, RN, 24/7/ MDLIVE, 24/7/ GEHA member benefits Connection Dental Network Connection Fitness gym discounts Connection Hearing powered by TruHearing Connection Vision powered by EyeMed Smile Brilliant teeth whitening GEHA /gehahealth geha.com Life Alert Emergency Response Preferred Provider Network information GEHA Connection Dental Federal Prescription drugs/lab Card CVS Caremark Prescription Services CVS Caremark Specialty Customer Care CVS Caremark Specialty Prior Authorization Lab Card program For complete plan information, see GEHA Plan Brochures RI and RI at geha.com/planbrochure Government Employees Health Association, Inc. All rights reserved. GF-BKT Please recycle.