Fall 2015 FOCUS Your Health Mind your health this holiday season During the holidays, many people feel overwhelmed, stressed and tired. The amount of parties, family gatherings and shopping leave many people dreading the holidays. It is important to pay attention to your health during this time. Getting stressed doesn t have to be part of your holiday habit. Ease the stress by: taking a break getting more sleep eating well and healthy thinking positive If you think you can benefit from a meeting with a behavioral health specialist, please call Beacon Mental Health Services at 888.581.PLAN (7526). You have access to: Individual and group behavior health testing and treatment Outpatient care to check drug therapy Meet with a psychiatrist 4426 INSIDE THIS ISSUE What Every Member Needs to Know Words You May Hear Get healthy by making the best out of your health care Wash hands under running water Drug list at your finger tips Flu season is coming: Are you protected? Fall 2015
2 What Every Member Needs to Know Health Plan of San Joaquin (HPSJ) is your community managed care plan. Managed care simply means we help you get the care you need and find ways for you to stay healthy. Dr. Lin, Primary Care Provider You Can Choose a Network Doctor We have a large group (network) of doctors and specialists who can help you. You can choose the doctors you know and trust. To see if a doctor is in our network, or if you cannot find a doctor in our online provider directory at hpsj.com please call 888.936.PLAN (7526) or 209.942.6306 (TTY/TDD) for hearing impaired. You have a PCP You will have a primary care provider (PCP) who is a doctor that: gives routine care coordinates specialty care gets to know you and your medical history Your doctor s name will be listed on your member ID card. To change your doctor, please call 888.936.PLAN (7526) or 209.942.6306 (TTY/TDD) for hearing impaired or visit hpsj.com and create a myhpsj account. We Help You Live a Healthy Life We cover lots of preventive care to help you avoid major health problems. We offer health programs to help you with illness and disease. We have case and disease managers who can work with you one-on-one. They can give you health tips and help you get the care you need. We have HealthReach, a 24/7 Advice Nurse Line you can call and get medical advice anytime of the day or night 800.655.8294. 4405
Clean Hands Saves Lives It is important to keep hands clean because it is one of the ways you can stop from getting sick or giving germs to other people. There are many sicknesses that are spread by not washing your hands with soap and clean, running water. Below you can learn the best way to wash your hands. Wash hands under running water Wet your hands with clean, warm water, turn off the tap, and apply soap. Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers and under your nails. Scrub your hands for at least 20 seconds. Need a timer? Hum the Happy Birthday song from beginning to end twice. Rinse your hands well under clean, running water. Dry your hands using a clean towel or air dry them. Drug list at your fingertips You can see the HPSJ drug list and learn all about your pharmacy benefits. Find out about: Prescription drugs that are covered Generic drug options Prior authorization and step therapy rules Formulary changes You can get full policies and the list of prescription drugs that are covered by your health plan. Please call our Customer Service Department at 888.936.PLAN (7526) or 209.942.6306 (TTY/TDD) for hearing impaired or go online to www.hpsj.com/formulary. 4 4256
7751 S. Manthey Road French Camp, CA 95231 888.936.PLAN (7526) 209.942.6306 (TTY/TDD) www.hpsj.com Want to learn more about topics in this FOCUS newsletter? Our HealthReach Audio Health Library helps you get health information you need and it s easy! You can find a list of topics and codes on our website at hpsj.com/advice-nurse-line or by calling 800.655.8294 and pressing the number 2 to access the library. It s never too early to start caring for your child s teeth Did you know your child s doctor can also find cavity risks, provide dental information, and refer you to a kid-friendly dentist? Cavities are the most common chronic children s disease, but they are preventable. Here s how to start a lifetime of good dental health: Fluoride: It can make teeth stronger and protect them from acid-caused decay. Check/clean baby s teeth: Healthy teeth should be one color. As soon as your child has a tooth, start gently brushing with just a little fluoride toothpaste. Feed your baby healthy food: Choose drinks and foods that do not have a lot of sugar. Prevent tooth decay: Do not put your baby to bed with a bottle. Milk, formula, juices, and other sweet drinks have sugar. Make a dental home: Since your child s doctor will start to see them from their first days, talk to them about when and how to make a dental home with a dentist. 6 2852
3 Words You May Hear Primary Care Provider (PCP) Medical Home Referral Prior Authorization (PA) Specialist The main doctor who gets to know your health history, gives you most of your care and makes referrals when you need them. The main doctor who organizes and helps you get care. Think of your PCP as your medical home, the place that knows you the best. Something you need from your PCP to see most specialists. Referrals are a way for your PCP to help you see the right doctor the first time. Some medicines and services must be approved before you can get them. Your doctor will send a request when it is needed. We will look at the request and make sure it is covered. A doctor who works in a specific area of medicine or works with certain parts of the body. For example, an optometrist (eye doctor) would be a specialist. Get healthy by making the best out of your health care 4659 1. Choose your PCP Pick one from our large network of doctors. Pick one that speaks your language. We do offer language help if your doctor doesn t speak your language. We can get someone skilled to go with you to your appointment if you need help to speak with your doctor. 2. Set up a well visit with your PCP Visit your new PCP right away, even if you are not sick. This lets your PCP get to know you and plan how to treat you. Your PCP will give you an Initial Health Assessment to get to know more about your health history, find health issues that may require you to work with our case managers, give you community resources, and give any preventive care you may need. 3. Know who to call If you re feeling sick, call your PCP s office 24/7. If you re calling after hours, the doctor on-call will call you back. When you need medical advice or help figuring out where to get care, call your PCP or HealthReach at 800.655.8294 available for 24/7 FREE. 4. Count on Us Call Customer Service! We have been serving members for almost 20 years. With our members help, we have learned how the health system works. Our team is ready to help you find the answers you need to get you the the care you deserve. Call today at 888.936.PLAN (7526) or 209.942.6306 (TTY/TDD) for hearing impaired. As your local community health plan, we understand the issues you face.
5 Flu Season is comingare you protected? The flu is a breathing sickness caused by germs that affect the nose, throat, and lungs. The flu season usually occurs between October and May. December and February is when most people catch the flu. It is advised that everyone 6 months of age and older get a flu shot yearly to protect themselves and their families against serious disease. Talk to your doctor about getting a flu shot. CDC states that the annual flu-related deaths in the U.S. are as high as 49,000 As stated by the CDC 200,000 Americans Even if you get the flu shot, make sure you stay away from others that are sick and always wash your hands so that germs are not spread. If you or a family member is sick, stay home from work or keep your kids home from school. Get protected this flu season. Who should get the flu shot? Nearly everyone 6 months and older can and should get a flu shot. Flu shots are especially important for people at high risk of complications from the flu, including: People with chronic medical conditions Pregnant women Children younger than 5 years old Adults 65 and older If you live with or care for people at high risk, including infants younger than 6 months, you should get a flu shot. People who have had a severe allergic reaction to eggs or to the flu vaccine might need to skip vaccination. Talk to your doctor if you have concerns. are hospitalized from flu problems each year. Getting a flu shot can cut the risk of more serious flu results, like hospitalizations and DEATHS. Centers for Disease Control and Prevention (CDC) Where can I get a Flu shot? All HPSJ members are eligible for a FREE flu vaccination at their doctor s office. Don t wait for your next appointment Every HPSJ member 19 years or older can get a FREE flu vaccination at a participating HPSJ network pharmacy. Flu vaccines can take up to two weeks to become fully effective. Signs of the flu: Fever or feeling feverish/chills Cough Sore throat Runny or stuffy nose Muscle or body aches Headaches Fatigue (very tired) Throwing up and diarrhea 4441