563M_QC Member_Sp12.indd

spring 2012
QualChoice
of Arkansas
Receives
2012 Business
of the Year
Award
I am proud to announce that
QualChoice of Arkansas has been
named 2012 Arkansas Business of
the Year (Category III) by Arkansas
Business Publishing Group.
Over 800 business leaders and
associates attended the annual
awards event honoring Arkansas
businesses, business executives,
nonprofit organizations and nonprofit
executives. Other nominees in our
category were Baldwin & Shell
Construction Company, Landers
Toyota, Ozark Natural Foods and
Ritter Communications, Inc.
QualChoice congratulates these
outstanding organizations as finalists
for this year’s award.
This recognition would not have
been possible without our team of
employees and their hard work and
dedication to making a difference
every day. I also believe that an
honor such as this is a testimony to
our members and their support and
commitment to our company—as
well as to all our valued business
partners who have put their
confidence and trust in QualChoice.
We excitedly look forward to a
rewarding and successful 2012!
Michael E. Stock
President and CEO
Important Information
About Your Health Plan
As a QualChoice member you
periodically receive important legal
documents from us regarding your
health plan coverage. These documents
provide a detailed explanation of the
health and/or prescription drug benefits
and services available to you.
The documents have information on:
Benefits and services included and
excluded from your coverage
Details about co-payments and other
charges for which you are responsible
 How to voice a complaint
How to appeal a decision that has
adversely affected your coverage or
benefits
How to obtain care after normal office
hours, including emergency care
Glossary of important terms
Your member rights and
responsibilities
Depending on your particular plan, you
may receive an Evidence of Coverage
(EOC), a Certificate of Coverage (COC),
or a Summary Plan Description (SPD).
Please remember to keep these important legal documents in a safe place so
you can easily retrieve them.
It’s All Online
To download or view your plan
document, go to www.qualchoice.com.
After member log-in, click
Benefits Booklet.
Looking for a Doctor or a Hospital?
The recommendation of your trusted family doctor or a friend is probably the best
way to find a doctor or hospital you will feel comfortable with. If you are doing
research on your own, look for:
S
pecial expertise. See if the doctor is board-certified, which means they are
trained, and have passed an exam in their specialty
E
xperience. The more procedures a doctor and a hospital/facility have performed,
the better outcomes patients tend to have, studies show.
P
atient satisfaction. Find out how well hospitals or doctors scored on patient
satisfaction surveys.
Find a Doctor or Hospital
Go to www.qualchoice.com, click Provider Search. Our real time Provider Directory
is easy to use. You can search for a healthcare provider or hospital by entering
specific information. For a doctor or specialist, enter your address, the range of
miles from that address you are willing to travel, and then click PCP or Specialist.
The Doctor Is In
By Stephen Sorsby, M.D.,
QualChoice Medical Director
Pharmacy
Corner
Weight Loss
Resolutions
I applaud all those who are taking
steps toward better health by losing
weight. You can add years to your
life and life to your years by getting
down to, and maintaining, a healthier
weight. You can also harm yourself,
and rebound to a higher weight, if
you are not careful in how you lose.
In the popular TV show “Biggest
Loser” a large part of the weight loss
comes from the intensive exercise
program the participants undertake.
They are not pounding the pavement
and pumping iron on a starvation diet
regimen. Their trainers would not let
them, and they would not be able to
keep going if they were cutting their
calories to an extreme degree.
Remember before beginning any
weight-loss plan—it’s a start on a
healthier lifestyle for the long-term,
rather than a quick fix.
To get started on a healthy weightloss plan be sure to contact one of
our QCARE health coaches for
personalized support and information.
For CHI employees please call
CareWise for your Personal Health
Management Plan at 1-877-878-5445.
IMPORTANT NOTICE
Enhanced Formulary Update
Barry Fielder, PharmD., Vice President, Pharmacy
Effective April 1, 2012, the following benefit change will be implemented for
new and renewing groups who use the Enhanced Formulary.
The benefit change will apply to brand-name drugs when a generic equivalent
is available. Generic drugs are chemically and clinically equivalent to their brandname counterparts, as approved by the U.S. Food and Drug Administration
(FDA). The use of generic products can save both you and your health plan
money while providing the same quality care as the use of the more expensive
brand-name product.
For members with a traditional co-payment benefit design:
When the member chooses a covered brand-name product when a generic
equivalent is available, the member will be charged the Tier 3 co-payment plus
the difference in cost between the brand product and the generic equivalent.
For members with a high-deductible benefit design:
When the member chooses a covered brand-name product when a generic
equivalent is available, the member will be responsible for the difference in cost
between the brand product and the generic equivalent. This amount will not
apply to any deductible or out-of-pocket maximum.
Questions? Contact Customer Service at 501-228-7111 or 800-235-7111.
To find the formulary your plan covers, go to www.qualchoice.com,
after member login, click Drug Pharmacy.
2
S p rin g 2012
Working Together to Save Costs
QualChoice works hard to help keep healthcare costs affordable.
One way we can help you save is by reminding you to check your
policy before receiving services, to make sure they’re covered.
If you receive services that are not covered, you will have
to pay for the charges. Some services may be considered
investigational, experimental, or cosmetic and are not covered
under your policy. If your doctor orders a test that you have never
heard of, ask him or her for the procedure code, then confirm that
it is a covered service by any of these methods:
R
efer to your official plan documents for a list of your
covered services.
C
heck for the latest medical policy updates online at
www.qualchoice.com—select Medical Policies.
E
mail your questions to a Customer Service representative,
privately and securely, 24/7, through our QuicQuestions
message center or call us between 8 a.m. and 5 p.m. at
the number on your ID card.
C
heck your covered benefits online at www.qualchoice.com
after member log-in by selecting View Deductibles and
Accumulators.
Insurance Fraud
Hurts Everyone
QualChoice monitors fraud, waste, and
abuse to protect our members and
providers. All members should be alert for:
B
illing for services not rendered
B
illing both Medicaid and the member
or another insurance carrier for the same
services
B
illing for services that are not medically
necessary
B
illing for a more expensive item than
what was actually provided (upcoding)
B
illing related services separately to
charge a higher amount than if they
were combined and billed as one service
(unbundling)
F
alsifying records
P
atient neglect or abuse
Your Privacy Is Important
We are committed to protecting your privacy. You can read our Privacy
Policy, Internet Privacy Policy, and Financial Information Privacy Policy on
our website, www.qualchoice.com. Click Privacy Policy at the bottom of
the home page. You can also call Customer Service at the number listed
on your ID card to request a copy.
If you suspect fraud, waste, or abuse,
please email us at [email protected].
3
A Better You
© 2012. All rights reserved.
No material may be reproduced in
whole or in part from this publication without the express permission
of the publisher. Any reference in
this material to other organizations
or companies, including their
Internet sites, is not an endorsement
or warranty of the services, information, or products provided by those
organizations or companies.
All models are used for illustrative
purposes only.
PRSRT STD
U.S. Postage
PAID
Permit #372
Long Prairie, MN
The QualChoice Building
12615 Chenal Pkwy., Suite 300
Little Rock, AR 72211
563M
For Our
Individual/Family
Plan Members –
IQChoice
As a valued IQChoice member, you
may not have a benefit administrator
to consult, but you do have many
resources at www.qualchoice.com,
where you can:
Locate a primary care provider,
specialist, allied health
practitioner, or urgent care center
(click Providers Search)
Learn more about our health
management programs available
to you
Access our QuicRewards program
that offers savings at many
Arkansas health-related companies
Research specific health topics
In addition, our secure member
portal is available to all IQChoice
members. Here you’ll be able to
check the status of a claim, keep
track of your transactions, order or
download a temporary ID card, send
a secure email to Customer Service
and much more.
Looking for individual/family
health coverage? Call 866-645-1790
or visit www.myiqchoice.com to get
a free quote.
QuicRewards Programs
Can Help You Lose Weight
QuicRewards is an exclusive QualChoice program that
provides members with great savings from a number of
leading Arkansas health-related companies. These
programs are offered to our members as a complement
to their health plan and at discounts not generally
available to the public. For questions about QuicRewards,
please call 501-228-7111, ext. 7008, or
800-235-7111 (outside Central Arkansas).
Special Savings from Jenny Craig
As a special incentive, Jenny Craig offers QualChoice
members and their adult household dependents:
A FREE 30-Day Trial Program
25 percent off a Premium Program
Special Savings from Weight Watchers
QualChoice members receive $6 off the joining fee
when they present their QualChoice ID card at sign-up.
Coming to a Computer Near You
We want to put timely information about your health plan at
your fingertips. So starting soon, we will be delivering your
important documents electronically—adding convenience for
you, and reducing our environmental impact on the earth.
More details about our paperless initiative will be posted at
www.qualchoice.com as they become available.