BENEFIT INSIDE. For Your. TRICARE Supplemental Plan Helps Military Retirees By Tommy D. Teague OGB Chief Executive Officer SUMMER 2006

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1 SUMMER 2006 For Your BENEFIT STATE OF LOUISIANA OFFICE OF GROUP BENEFITS PPO EPO MCO HMO TRICARE Supplemental Plan Helps Military Retirees By Tommy D. Teague OGB Chief Executive Officer I am pleased to report that OGB s Annual Enrollment 2006 was very successful. We held almost 400 meetings and met with more than 17,000 plan members across the state. Thanks to the efforts of your OGB staff and your agency representatives, we are ready for the new plan year commencing July 1, Tell OGB how we re doing... complete the survey on page 6 We are already planning for next year and beyond. We want to continue to offer you and your family a choice of health care plans. We are very excited about one particular program, designed for military retirees, called TRICARE. TRICARE is available at no cost to eligible military retirees. OGB will be offering a low cost TRICARE Supplemental Policy and paying most of the premium cost on behalf of our employees and retirees eligible for such coverage. TRICARE is the health insurance program provided to the armed forces by the United States Department of Defense. OGB is fortunate to have many military retirees who have initiated a second career in state government or education. To be eligible for TRICARE, members must be retired from any branch of the armed services with at least 20 years of service and entitled to retired, retainer or equivalent pay. Coverage also extends to spouses under age 65 and unmarried dependent children under age 21 (or under age 23 if a full-time student). You will soon be hearing much more about the TRICARE program. If you are eligible to participate, you can significantly decrease your health premiums by choosing TRICARE and the TRICARE Supplemental Policy. With TRICARE, coupled with the supplemental policy offered by OGB, eligible military retirees can get benefits better than those offered by OGB with lower out-of-pocket expenses. The program also has no pre-existing condition provisions and is guaranteed issue. INSIDE 2... LaCHIP Income Limits Increased 3... Medicare Eligibility 4... OGB Partners Go the Extra Mile 6... OGB Communications Survey 7... Colorectal Cancer Screenings

2 LACHIP LA Children s Health Insurance Program (LaCHIP) Income Limits Increased Thousands previously denied coverage now eligible More Louisiana children are now eligible for the Louisiana Children s Health Insurance Program (LaCHIP) due to the annual increase in the Federal Poverty Level that took effect in April. The increase allows working families to earn more and still qualify for LaCHIP, which provides no-cost health coverage for uninsured children under age 19. Since the program started in 1998, more than 26,000 families have been denied coverage because their incomes were too high. In the past year alone, more than 2,000 families have been denied coverage because of their incomes. The annual changes to the Federal Poverty Income Guidelines may now allow many of these families to qualify for LaCHIP benefits for their children. The increase comes on the heels of a survey by the state Department of Health and Hospitals, which showed that LaCHIP had helped decrease the percentage of uninsured children to 7.6 percent as of July 2005, before Hurricanes Katrina and Rita. When LaCHIP began in 1998, Louisiana s rate of uninsured children was almost 25 percent. From the beginning of her health care reform effort, Gov. Blanco has challenged us to find and enroll every eligible child, and this goal has become even more critical as our state recovers from last year's hurricanes, said DHH Secretary Dr. Fred Cerise. Many parents lost their jobs and subsequently their health care coverage after Katrina and Rita, and we want them to know their children may be eligible for help through LaCHIP or traditional Medicaid. As people work to rebuild their lives, it is important for them to know that there are health coverage options available through the state. More complete LaCHIP income guidelines and application and renewal forms are available online at or by calling LaCHIP ( ), a toll-free number. Income guidelines also will change for LaMOMS (for pregnant women), the Medicare Savings Program (for people with Medicare) and the Medicaid Purchase Plan (for workers with disabilities). Details about these Medicaid programs can be obtained at or by calling toll-free. PAGE 2

3 MEDICARE ELIGIBILITY Be Aware of Your Medicare Status As you or your spouse approach age 65, it is very important that you contact your local Social Security office to determine whether or not you are eligible for Medicare. You can receive a reduction in your OGB health care premium if you are enrolled in both Medicare Part A, which is free, AND Part B, which has a monthly fee. It is OGB s policy to pay benefits to you as if you are enrolled in Medicare A and B. If you are not eligible for Medicare coverage, you must send OGB a copy of a letter from the Social Security Administration stating that you are not eligible. You can contact the Social Security Administration in several ways: You can visit the Social Security website at You can call Social Security toll-free at Monday through Friday between 7 a.m. and 7 p.m. Have your Social Security number handy. The lines are busiest early in the week and early in the month. You can call or visit your local Social Security office. Remember, in order to receive your OGB premium reduction, you must be enrolled in both Medicare A and B. PAGE 3

4 HURRICANE RESPONSE OGB Health Care Partners Serve Displaced Plan Members Last fall, OGB s health care partners went the extra mile to assist plan members affected by hurricanes Katrina and Rita and the subsequent sustained flooding. As the 2006 hurricane season begins, it is appropriate that we remember their extraordinary response with grateful appreciation. In August and September 2005, back-to-back hurricanes and unanticipated floodwaters forced thousands of OGB plan members to relocate. Many lost family members, friends, their homes and even their livelihoods along with vital prescription medications, and medical records. Most plan members affected by the storms no longer had access to their health care providers, whose offices and records were also destroyed. During the days and weeks that followed, OGB reached out to help our displaced plan members and their families locate and access the health care and prescription medications they needed wherever they were from providers there. This OGB outreach effort was fully supported by our health care partners: APS Healthcare, which administers OGB s disease management program; Catalyst Rx, administrator of the pharmacy benefit plan for PPO, EPO and MCO members; FARA, which administers the MCO plan; Humana and Vantage, which administer the HMO plans; Patient Infosystems, the utilization management company for OGB s PPO plan; UnitedHealthCare, administrator of the EPO plan; and United Behavioral Health, which administers the mental health and substance abuse plan for EPO, PPO and MCO members. With thousands of plan members scattered across the country, educating them on how to access benefits and find doctors and hospitals was a monumental effort for which there was no road map. It was difficult or impossible to use mail, phone or the media to reach plan members in affected areas. Finding workable avenues of communication was vital for both OGB plan members and medical providers, as well as employees of OGB and our health care partners who were also affected by the storms. Within 48 hours after Katrina made landfall, Humana established a dedicated web page. The site offered up-to-the-minute information for plan members, health care providers, business owners and brokers and was updated as the state Department of Insurance issued coverage guidelines. Mail service was unreliable in many areas, so Humana encouraged health care providers to sign up for electronic fund transfers via the website, which also provided a mechanism for both providers and employers to submit address changes. Armed with a recently-completed disaster recovery plan, FARA adapted to the realities of the situation by quickly developing alternative strategies and securing a national provider network that enabled MCO members to obtain in-network coverage across the country. The company had planned to set up temporary offices in Baton Rouge, but the city was full of evacuees and housing for FARA employees was not available. Instead, the company s customer service team moved to FARA s Lafayette site and the remaining operations PAGE 4

5 OGB PARTNERS relocated to the Houston office. Because FARA s procedure manual carefully described exactly how to perform every job in the company, employees were able to work in unfamiliar roles. Claim operations were transferred with less than two days of down time and mail was forwarded to the Houston location. When a claims backlog accumulated due to mail delays, 24-hour fax lines were set up for providers and plan members to submit claims. Patient Infosystems worked to locate patients hospitalized prior to the hurricanes and sent home health agencies into shelters and homes to be sure they continued to receive the care they needed. Pre-certification requirements were waived for affected PPO plan members. Those who called in were advised to seek treatment at the nearest medical facility and offered the option of switching to a different OGB plan. Patient Infosystems staff also collected clothing for evacuees and volunteered at a local shelter. Catalyst Rx suspended normal limitations on prescription drug refills, suspended the out-of-network pharmacy penalty for plan members who relocated to areas with no participating pharmacies and arranged for diabetic patients to receive supplies from a local pharmacy if mail service was unavailable. APS Healthcare focused on helping plan members obtain mental and physical health care services. APS health coaches assisted members in making plans to evacuate to special needs shelters and other facilities where medical support was provided. APS also compiled information on local, state and national resources to aid evacuees in obtaining food and shelter, finding sources of medical supplies and accessing crisis and trauma counseling services. These resources were continuously updated and posted on the APS website for use by health coaches who assisted plan members. APS also provided critical incident stress debriefings to Red Cross medical and health care personnel who treated storm victims in Washington, D.C., Houston and Milwaukee. UnitedHealth Group, which includes United Behavioral Health and UnitedHealthcare, established a toll-free hotline for affected Gulf Coast residents, regardless of their health insurance provider, to help them cope with health, emotional, financial, coverage and legal concerns. The company supported deployment of three mobile health units (staffed with medical personnel and stocked with supplies and pharmaceuticals) and sent counselors to help coordinate care and provide mental health counseling. UnitedHealth Group also offered emergency health insurance funds to assist customers in disaster areas and adopted Katrina-specific policies for payment of out-of-network services and notification. United Behavioral Health disseminated information about support services available to plan members who experienced significant emotional stress due to the storms. These services included critical incident stress debriefings, online resources and a 24-hour crisis hotline. UnitedHealth Group also dedicated $10 million to U.S. disaster relief efforts through the United Health Foundation. PAGE 5

6 OGB Communications Survey Please take a few minutes to give us your opinion. Your feedback will help us continue to improve services to you, our plan members. Please mail the completed survey by July 17, 2006! Please circle Yes or No or the appropriate number: 5 (Most/Extremely Useful) 4 (Very Useful) 3 (Useful) 2 (Somewhat Useful) 1 (Not Useful) 1. Did you attend an annual enrollment meeting in 2006? Yes No 2. Did you attend an annual enrollment meeting in 2005? Yes No 3. If you attended a meeting, how useful was the information presented in choosing your health plan? 4. Do you read the OGB For Your Benefit newsletters? Yes No 5. How useful are the newsletters to you? 6. How easy to read are the newsletters? 7. Do you visit the OGB website? Yes No 8. How often do you visit the website? (circle one) daily weekly monthly occasionally 9. How useful is the website to you? 10. Have you viewed the Health Care Saving Secrets video on the OGB website? Yes No 11. Have you accessed personal claim information on the OGB website? Yes No 12. How useful are the following publications? Helpful Information Book Plan Comparison and Rate Sheet For Our Retirees PPO Provider Directory Flexible Benefits Plan Summary Guide Flexible Spending Account Guide 13.Did you evacuate during the hurricanes? Yes No (If you did NOT evacuate, please skip questions 14, 15 and 16 and go to 17.) 14. Did you see OGB s newspaper ads after the hurricanes about plan member benefits? Yes No 15. How useful were the newspaper ads to you? For each question, please circle the appropriate number: 5 (Superior) 4 (Very Effective) 3 (Effective) 2 (Not Adequate) 1 (Poor) 16. How would you rank OGB s communication efforts after the hurricanes? 17. Did you attend OGB meetings about the Medicare Part D prescription drug program? Yes No 18. How useful was the information? 19. Have you called our OGB Help Line? Yes No 20. How useful was the OGB Help Line to you? Is there anything we can do to improve our communication with you? Name (optional) (Circle one) Retired or Active Former or Current State Agency THANK YOU FOR COMPLETING THIS SURVEY. YOUR OPINION IS IMPORTANT TO US. Mail your completed survey form to: OGB Communications Section P. O. Box Baton Rouge, LA PAGE 6

7 COLORECTAL CANCER SCREENINGS OGB Plans Cover Colorectal Cancer Screenings As baby boomers age, they become more aware of the dangers of colon cancer, which can often be detected early with appropriate diagnostic tests. OGB is pleased to announce that all health care plans will pay for routine colorectal cancer screenings, effective July 1, This new benefit is designed to reduce colorectal cancer deaths, in accordance with recommendations of the American College of Gastroenterology and the American Cancer Society. Routine colorectal screenings include: Fecal occult blood test (a stool test for blood) Flexible sigmoidoscopy Colonoscopy Although you should check your plan document for the specific details of this benefit, the following will apply: For normal risk persons, screening tests begin at age 50, and the preferred approach is a colonoscopy every 10 years. An alternative strategy is an annual stool test for blood and a flexible sigmoidoscopy every three to five years. For those with higher risk of colon cancer, due to personal or family history, more frequent testing is needed. PAGE 7

8 Office of Group Benefits State of Louisiana P. O. Box Baton Rouge, LA Pre-Sorted Standard US Postage Paid Baton Rouge, LA Permit # 266 This document was published at a total cost of $22, for 140,000 copies.this document was printed by the State Printing Office, under authority of the Division of Administration, to inform state employees about their benefits.this information was printed in accordance with the standards for printing by state agencies established pursuant to R.S. 43:31. Vision OGB envisions itself as a leader in improving and preserving quality of life. Mission OGB will offer an employee benefits system that meets or exceeds industry standards and/or benchmarks. OGB Area Customer Service Offices Alexandria 900 Murray St. Room F-100 Alexandria, LA Baton Rouge 5825 Florida Blvd. Baton Rouge, LA Lafayette 825 Kaliste Saloom Rd. Building II, Suite 101 Lafayette, LA Lake Charles 710 W. Prien Lake Rd. Suite 109 Lake Charles, LA New Orleans 3421 N. Causeway Blvd. Suite 400 Metairie, LA Monroe 1400 N. 19th St. Monroe, LA Shreveport 1525 Fairfield Ave. Room 669 Shreveport, LA TDD (hearing impaired)