MEMBER FOCUS. WellCare Helps with Cost of GED Testing. Utilization Management: Reviews to Ensure the Right Care. What Does GED Mean?

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1 GEORGIA 2013 ISSUE I MEMBER FOCUS WellCare Helps with Cost of GED Testing Education is a key to well being. That s why WellCare of Georgia wants to help members with the cost of GED testing. Passing the GED test can open job opportunities for members. Members who are eligible for WellCare s GED Benefit Program include those who: Are at least 16 years old Are not currently enrolled in a regular high school or Have not graduated from an accredited high school or Have not already received a high school equivalency certificate or diploma WellCare pays the total one time fee of $160 for members to take the GED tests. How to take advantage of this benefit: Members can call the Customer Service number on their WellCare member ID cards or go to georgia.wellcare.com to register. Upon confirmation of the member s information, WellCare will send the member a letter advising whether he or she qualifies and if so, how to schedule and complete the testing. What Does GED Mean? It stands for General Educational Development Passing the GED testing is equivalent to earning a Georgia high school diploma The testing involves five sub tests Utilization Management: Reviews to Ensure the Right Care WellCare of Georgia has a process for reviewing the care members get. It s called the Utilization Management (UM) Program, and it bases decisions on the following: Appropriateness of care service Existence of coverage The plan doesn t reward anyone for denying coverage. There are no rewards to encourage fewer services. Questions? Our Customer Service team can help. Just call TTY users may call You ll also find details about the UM program in your Member Handbook. Also know that you may call to get the handbook and other materials in a different format. This includes other languages, large print and audio tapes. There s no charge for this.

2 How Parents Can Help Kids Manage Weight The number of children who are overweight or obese is on the rise. This has health experts concerned. Why? Obesity can lead to all kinds of issues: Heart disease Diabetes Self esteem issues and social discrimination Also, kids who are obese are more likely to be obese as adults. What Can Parents Do? Help your child balance calories from food and drinks with physical activity. Here are some suggestions: Give your child plenty of fruits and vegetables Encourage your child to drink plenty of water Limit sugary drinks like sodas Serve sensibly sized portions Limit sugar and fats Limit fast food to once a week Choose lean meats, fish and beans for protein Switch to low fat or non fat milk and dairy products Help Your Child Stay Active Kids should get at least 60 minutes of moderate exercise daily Examples include walking, playing sports and dancing Allow no more than two hours a day watching TV or playing video games And as a parent, you can set a good example. Healthy eating and exercise are good for the whole family! Source: Centers for Disease Control and Prevention, Tips for Parents Ideas to Help Children Maintain a Healthy Weight, retrieved from children/index.html 2 Member Newsletter

3 The Goal of Managed Care? Delivering Quality Care That s Cost Effective Members sometimes ask, What s the value in managed care? It s a good question, and we d like to share some answers. With managed care, a health plan like WellCare contracts with doctors, drugstores and other providers. These providers give our members the services they need. In most cases, it s less expensive to use providers in the plan s network. Advantages of the managed care system include: Access a choice of quality providers in your area Integrated care a primary care provider (PCP) who coordinates your care, ensures you get preventive services and referrals to specialists Quality Managed care organizations receive scores for their performance and member satisfaction Cost savings An emphasis on preventive care puts the focus on finding health issues before they become big and more expensive to treat Controlling health care costs is a big challenge. Managed care seeks to control costs while giving members the care they need. Member Newsletter 3

4 CAHPS : Health Care Quality from Your Point of View What is CAHPS? It stands for Consumer Assessment of Health Care Providers and Systems. It s a program that asks members like you what you think about the quality of care you get. You may get a CAHPS survey by mail or over the phone. If you do, please take a few minutes to complete it. Your opinion matters! The answers you give can help us improve the services we give you. It also helps health care providers know how they are doing. The survey asks about your personal experiences with providers and your health plan. Topics in the survey may include: How well you can access the care you need How well your providers communicate with you Your experiences with our customer service The health care information you receive CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Source: To learn more about the CAHPS program and its products and services, visit Keep Your Member ID Card Handy Your member ID card is very important. Think of it as your key to getting health care services. That s why you ll want to keep it with you at all times. Give it to your doctor whenever you get care. It also has useful details about your health plan like the name and phone number of your primary care provider. Please keep your card up to date by calling Customer Service if you move or have other changes. This number is on your member ID card! 4 Member Newsletter

5 Weight Loss Myths There s a lot of information about ways to lose weight. The trouble is, not all of it is true. We ve checked out these three popular weight loss ideas and found out they re really false. You may have heard these Myth 1: Starches are fattening. They should be avoided when trying to lose weight. Foods that are high in starch provide the carbohydrates that our bodies use for energy. And many are relatively low in fat and calories. This includes familiar foods like bread, rice, pasta, beans, fruits, potatoes and yams. So it s not the type of food that s the problem. It s eating too much of it or adding fatty toppings like butter, cheese or sour cream. Myth 2: Low fat or fat free means no calories. This one is false too. Why? Because some low fat or fat free foods contain things like sugar, flour or starch thickeners. These are added to improve flavor and texture after fat is removed. But these ingredients add calories. Check the nutrition labels to make sure you know how many calories are in the food you eat. Also be sure to look at the serving sizes. You might be surprised to see one serving is much smaller than what you normally eat. Myth 3: Eating after 8 p.m. causes weight gain. When you eat doesn t affect weight. Instead, weight is affected by: What you eat How much you eat How much physical activity you do during the day No matter when you eat, your body stores extra calories as fat. So if you want to have a snack before bedtime, go ahead. But first think about your calorie intake for the day. Source: Weight control Information Network ( Member Newsletter 5

6 When Should Dental Care Start? Many parents have a tough time judging how much dental care their kids need. They know they want to prevent cavities, but they don t always know the best way to do so. Easy Dental Guidelines Run a damp washcloth over your baby s gums following feedings Schedule your child s first dental visit when their first tooth comes in, but no later than their first birthday Take your child for a dental checkup between ages 1 and 2, and then every six months until age 18 Brushing with just water and a soft toothbrush is recommended for children under age 2 Use a pea sized amount of toothpaste with fluoride for children 2 and over Begin using floss once your child has two teeth that touch Source: MedlinePlus 6 Member Newsletter

7 Pregnant? Take Care of Yourself (and Your Baby)! Moms to be need special care. After all, they want to be healthy for themselves and their unborn child. Prenatal care is the health care you get while you re pregnant. See your health care provider as soon as you think you are pregnant. Most experts suggest you see your health care provider: Once each month for the first 6 months Every two weeks in the 7th and 8th months Every week in the 9th month But be sure to follow your health care provider s advice. He or she may need to see you more frequently. What will happen at prenatal visits? Your health care provider will check to see how you and your baby are doing. Each visit may be different. But at each visit, your provider will do the following: Take your weight and blood pressure See how the baby is growing Dental Care during Pregnancy Listen to the baby s heart rate Be sure to take care of your teeth and Ask if you feel the baby moving gums while you re pregnant. These are Ask if you are eating well and signs that you should talk to your dentist taking your vitamins as soon as possible: Ask if you are walking, stretching Tenderness and bending Bleeding Talk to you about not smoking Swollen gums drinking alcohol or using drugs Ask you about your safety Seeing your provider early and often can help you have a healthier baby, low birth weight can affect your child s ability to grow and develop. Don t miss any of your prenatal visits. They are all important! Early Elective or Full Term Delivery? There may be a good health reason for early delivery. But natural delivery at the end of the full term (39 weeks) is most often the healthy choice. You can make the choice that s best for you and your baby s health! Source: U.S. Department of Health and Human Services, Prenatal Care Fact Sheet, retrieved from publications/fact sheet/prenatal care.cfm Member Newsletter 7

8 211 Perimeter Center Parkway Suite 800 Atlanta, GA Para solicitar este documento en español, llame al Servicio al Cliente al (TTY/TDD ). GA021482_CAD_NEW_ENG State Approved WellCare 2013 GA_02_ In this Issue Welcome to this edition. Think of it as a little hello from us, full of information and articles that ll help you and your family get the most from your plan. We ve even included information on how WellCare can help you receive your GED, plus much more. So please explore what s inside and enjoy. Click or Call for the Latest Drug Coverage Updates Want to find the latest about the drugs we cover? Be sure to stop by our website. You ll find our Preferred Drug List (or PDL for short). You can learn about recent additions and removals. You ll also find changes to any drug requirements or coverage limits. Just go to georgia.wellcare.com. Then click on Pharmacy. You can also call us for updates. Reach us at Numbers to Know We re just a phone call (or click) away! Call Customer Service: TTY/TDD Monday Friday, 7 a.m. to 7 p.m. Eastern Or visit georgia.wellcare.com Nurse Advice Line:

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