2018 ISSUE 2 WHAT S INSIDE Enjoy Your Summer & Be Safe! Back-to-School Reminder Planning Your Next Pregnancy 10 12 18 Kentucky HEALTH is Here! Learn more on Page 8
Medicaid Premiums Are Coming Here s What You Need to Know. Are you enrolled in Medicaid s new Kentucky HEALTH program? If so, you need to know about the cost sharing changes coming your way starting July 1 st. As a Kentucky HEALTH member, you may have to pay a small monthly insurance premium to help with the cost of your health care. It s important to pay on time. If you don t pay on time, you ll lose your benefits or receive a Non-Payment Penalty and have to pay co-pays. ACT NOW. DON T RISK LOSING YOUR BENEFITS! Why should I pay my premiums? When you pay your premium on time, you ll not only get to keep your benefits, but you will ALSO: Get a My Rewards* account to use for vision, dental, and fitness! (*All Kentucky Health Members can use My Rewards for enhanced benefits such as fitness. Medicaid expansion adults can use My Rewards for vision and dental services.) Get to use medical services and fill your prescriptions without paying a co-pay! Co-pays can add up quickly. Paying a once-a-month premium can cost you less money and it lets you predict your budget. How much are the new premiums? Your premium will range from $1 to $15 a month per family, depending on your income. Your Payment Options Mail your Payment with the stub at the top of your bill. Pay by Phone with a credit/debit card or electronic check. Pay Online with a credit/debit card or electronic check. Pay with a Direct Deposit from your pay check. 2 Visit us online at www.passporthealthplan.com
Are there any exemptions? You could be exempt from paying a premium if you have a good cause. If you have a one of these good causes, please call Passport at 1-877-903-0082: Good Cause Exemptions An immediate family member, who lives in your home, dies or becomes institutionalized. You are a victim of a natural disaster such as a flood, storm, earthquake, or serious fire. You submitted an address change on time, but did not receive an invoice. You were hospitalized and unable to make a payment. You were a victim of domestic violence and unable to make a payment. You were evicted from your home or became homeless. You were incarcerated and unable to make a payment. You have a medical condition that is severe enough to be an American Disability Act (ADA) disability. You are a caregiver of someone with an ADA disability. Get Your Bills by Email If you d like to receive your premium bills by email, please log into our Payment Portal at https://passportmbr.mysecurebill.com/default. Call Us We re in This Together If you have any questions at all, just give us a call at 1-800-578-0603. Remember, we re in this TOGETHER and we re here to help you with your health care! Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 3
Crying Babies There is one thing that s for sure all babies cry. Crying is how your baby communicates with you. Crying helps your baby deal with stress, block out loud noises, and deal with overstimulation (too many things going on at one time). Sometimes, no matter what you do to calm your baby, he or she will still keep crying. As a parent, this can be very frustrating and can be a test of your patience. Just remember, your baby s safety is important and there are things you can do! What to Do When You re Unable to Calm Your Baby Take a moment to regroup. Take a deep breath and count to 10. Place your baby in a safe place such as a baby bed or play pen. Walk away for 10 minutes. Take a minute to yourself. Do something that calms you down such as deep breathing or listening to music. After 10 to 15 minutes, check on your baby to be sure he or she is safe. If you don t feel calm, do not pick up your baby. Leave your baby in a safe place until you feel calm. If you need to, call someone who can support you a friend, family member, or someone you trust. Once you ve calmed down, pick up your baby and try to soothe him or her again. If your baby keeps crying, call your baby s doctor. Source: American Academy of Pediatrics 4 Visit us online at www.passporthealthplan.com
It s normal to feel frustrated at times, but it is also very important to be calm when caring for your baby. It s NEVER safe to shake, throw, hit, or jerk your baby. Shaking a baby can lead to blindness, brain damage, and possibly death. Remember your baby s safety is the most important thing! The more relaxed you are, the better able you will be to calm your baby. Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 5
Antipsychotics and Foster Kids Antipsychotics are a type of medicine used to treat mental health issues such as psychosis or thought disorder. They are also prescribed for anxiety and depression in children. More and more kids, mostly kids in foster care, are being prescribed antipsychotics than ever before. The Number of Kids Being Prescribed Antipsychotics 2% of kids in 18% Kentucky of kids in Kentucky s foster care Antipsychotics are strong drugs that can have many negative side effects. Some of these side effects are: >> Weight gain >> Inflammation (swelling) of the heart >> Higher chance of getting Type II diabetes and cataracts What are we doing about it? Passport is working with the Department for Community Based Services (DCBS), University of Louisville and its behavioral health center (Bingham Clinic) to help foster kids get the best care possible. When we see a prescription for antipsychotics, we make sure a psychiatrist reviews it. The psychiatrist will make sure it s the best treatment. He or she will see if: >> There are other medicines with fewer side effects that can treat the problem. >> The diagnosis is correct. >> The kid is also receiving talk therapy or some other type of treatment. Want to learn more? If you have any questions, call 1-877-903-0082 and ask to speak with someone from our Foster Care Team. You may also request a copy of our new booklet called Helping Children with Behavioral Health Needs. Source: American Academy of Child Adolescent Psychiatry 6 Visit us online at www.passporthealthplan.com
Is it time to switch doctors? If you are getting close to becoming an adult, you want to think about the type of doctor you are seeing. As an adult, you should see a doctor who specializes in caring for adults. If you will soon become an adult and are seeing a pediatrician, talk with him or her about when you should switch doctors. You can switch to an internal medicine, family medicine, or general medicine doctor. Here are some tips for finding a new doctor: Your pediatrician can help you decide which doctor is best for you. You can search our Provider Directory for an in-network doctor at www.findapassportdoctor.com. You can also use this website to see if any doctor is signed up with Passport. If you would like help finding a doctor or if you have any questions, call us at 1-800-578-0603. TDD/TTY users may call 1-800-691-5566. If you re already seeing an internal, family, or general medicine doctor, you don t need to do anything! Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 7
Kentucky HEALTH is Here You may have heard that Kentucky has changed the way Medicaid works for many people. The state s new program is called Kentucky HEALTH. Kentucky HEALTH offers health insurance for certain low-income adults and their families. Many of Kentucky s Medicaid members, including Passport members, will be covered under Kentucky HEALTH. You will know if you are a part of Kentucky HEALTH if you receive a new ID card that looks like this: SMITH, JANE M. 0012345678 987654321 01/10/08 J. SMITH, MD 5025559090 004336 ADV RX6432 If you re covered under Kentucky HEALTH, you may have to meet new requirements to keep your benefits. This could include paying a small premium, paying co-pays, or earning some benefits by doing health-, job-, education-, or community-related activities. The Key Parts of Kentucky HEALTH Cost Sharing Premiums Co-pays Deductible Account My Rewards Account PATH (Partnering to Advance Training and Health) Many members will have to share a small part of the cost of their health care. You may need to pay a monthly premium or co-pay as a way of investing in your health: Premiums will range from $1 to $15 a month per family, depending on income. Co-pays will range from $0 to $8 for most services and $50 for hospital visits. You will pay either premiums or co-pays not both A small amount some members pay once-a-month to help with the cost of their health care. A small amount some members pay to receive a service or medicine. An account that helps you track your health care spending and shows you the cost of your health care. Your account shows what you would pay under a commercial health insurance plan with a deductible. Kentucky HEALTH adults will get a $1,000 deductible each year. You will never have to pay out-of-pocket to meet a deductible. You should not get any bills for services applied to your deductible. A special account some members can use to get extra benefits. You can earn funds in your account by doing health-, job-, education-, or community-related activities. PATH is the community engagement part of Kentucky HEALTH that helps you get more involved in your community and gain the skills you need for future success. It connects you to opportunities like education, job training, substance use disorder treatment, employment, and volunteer work. 8 Visit us online at www.passporthealthplan.com
It s Time to ACT! Kentucky HEALTH will have some effect on most Passport members. It s VERY important that you read your mail from the Department of Medicaid Services and Passport, and stay on top of the things you need to do to keep your benefits. If you do nothing and ignore your mail, you could lose your benefits. Now Available Your Guide to Kentucky HEALTH All of us here at Passport are here to help you through the many changes. We ve created a special booklet, Your Guide to Kentucky HEALTH, which explains the changes in more details and tells you what you can do to stay enrolled. Your Guide to Kentucky HEALTH To view a copy of our booklet, please visit www.passporthealthplan.com/together. To request a copy of our booklet or to ask us about Kentucky HEALTH, please call 1-800-578-0603. To learn more about Kentucky HEALTH, please visit www.kentuckyhealth.ky.gov. Remember, we re in this TOGETHER and you can always count on us! Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 9
Enjoy Your Summer And Be Safe! There are so many ways to be active and enjoy the summer months. You can get out there and have some fun, but be sure to remember your safety. Being safe means more fun for everyone! Summer Safety Tips These simple safety tips can help you and your family make the most of your time outdoors: Put on sunscreen with an SPF 15 or higher. You want your sunscreen to have ultraviolet A (UVA) and ultraviolet B (UVB) protection. Reapply sunscreen after swimming and lots of sweating. Put on insect repellent to protect you from mosquito and tick bites: - Adults should use repellent with DEET or Picaridin. - Children 2 months or older can use repellent that contains up to 30% DEET or Picaridin. Talk with your child s doctor prior to use. When playing outdoors, wear protective gear such as wrist guards, knee and elbow pads, helmets, and life jackets. Watch your kids closely when they are around cooking surfaces, bodies of water, stairs, and playground equipment. Stay hydrated by drinking plenty of fluids. Pay attention to heat and air quality warnings. WARNING! Anyone at any time can suffer from heat-related illnesses, but these people are at a greater risk: Infants and young children People 65 years of age or older People who are overweight People who are physically ill especially those with heart disease, high blood pressure, or those who take certain medicines for depression, insomnia, or poor circulation Source: https://www.cdc.gov/disasters/extremeheat/heattips.html, https://www.cdc.gov/family/minutes/tips/protectskin/index.htm, https://www.cdc.gov/family/minutes/tips/protectyourkids/index.htm, 10 Visit us online at www.passporthealthplan.com
We have a special program for members with Chronic Obstructive Pulmonary Disease (COPD) and Asthma. Our program is called Stay Healthy at Home and may be able to help you! You can join Stay Healthy at Home if you have COPD or asthma and can answer YES to one of these questions: Do you feel that your symptoms stop you from doing things you normally enjoy? Are you taking daily medicines to help control your COPD or Asthma symptoms? Do you use your nebulizer every day? Have you been prescribed steroids or antibiotics in the past 6 months for your COPD or Asthma? The Benefits Stay Healthy at Home has health educators who can give you support and advice on how to live a healthier life. Once you join, we ll send a health kit to your home. This kit will include equipment to help you watch your condition and a device to answer questions about how you re feeling. We ll watch your information closely. We ll help you talk with your doctor about changes in your health. Our goal is to help you and your primary care provider (PCP) with managing your condition and to keep you healthy at home! If you would like to join Stay Healthy at Home, please call us 1-877-903-0082. Our Stay Healthy at Home program does not replace medical care from your primary care provider (PCP) or emergency care. We will work with your PCP to help you manage your symptoms Source: Prevent Child Abuse Kentucky Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 11
Back-to-School Reminder The new school year is right around the corner, and NOW is the time to schedule your child s school physical. Doctor s offices get busy and the first day of school will be here before you know it. Passport covers school physicals at no cost to you so call today to make sure your child gets an appointment! Earn Rewards! You and your children can earn rewards by using some of your Passport benefits. For more details on how you can start earning rewards, please call us at 1-877-903-0082. 12 Visit us online at www.passporthealthplan.com
Keep Children and Teens Healthy with Regular Checkups All children and teens need to get regular checkups. Even if your child or teen looks and feels healthy, he or she could still have a health problem. Checkups are helpful because the doctor will look for problems and make sure your child or teen is growing up healthy. Children and teens need to get checkups at these ages: 1 month 2 months 4 months 6 months 9 months 12 months 15 months 18 months 24 months 30 months Once a year during ages 3 to 21 What's Covered Who's Covered Your Cost Regular visits to the doctor and any immunizations (shots) needed at that time Children and teens up to age 21 $0 Earn Rewards! You and your children can earn rewards by using some of your Passport benefits. For more details about how to earn rewards, give us a call at 1-877-903-0082. Source: Bright Futures/American Academy of Pediatrics Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 13
Help Stop Fraud and Abuse When fraud and abuse happens, it can hurt you, your doctors and everybody in the health care system. What is fraud? Fraud is when someone does something on purpose to get benefits or payments they don t have the right to receive. Examples of fraud by a doctor, dentist, chiropractor or other provider: A doctor bills you for a service you didn t receive. A doctor bills you or Passport more than once for the same service. Someone lies about their income to receive Medicaid benefits. Someone uses a member ID card that doesn t belong to them. What is abuse? Abuse is when someone does something that goes against acceptable practices and causes unnecessary costs. An example is when a provider causes Passport to pay for something that was not needed. 1 How can you help? 1. If you think fraud or abuse is happening, report it! When you report fraud or abuse, you are ensuring the health care system has the money to take care of people who need help. 2 You can call our Compliance Hotline at 1-855-512-8500 and leave a message. When you call, you don t have to give us your name. If you do leave your name, it helps us helps us get as much information as possible. If you want to speak with someone, please call 1-800-578-0603 and ask for a Program Integrity Investigator. 2. If you get a health statement in the mail, check to make sure you received the services listed on the statement. 3. Never let anyone else use your Passport or Medicaid ID cards. Source: https://www.cdc.gov/healthyweight/losing_ weight/getting_started.html 3 14 Visit us online at www.passporthealthplan.com
DON T BE A NO-SHOW Call to Cancel Appointments! If you re going to miss a doctor s appointment, don t be a No-Show! Please make sure you call to cancel your appointment. Being a No-Show is when you don t show up f or an appointment and you don t call the office to cancel. What s so bad about being a No-Show? When you miss an appointment and you don t call to cancel, you lose a chance to get medical care from a doctor. It may take a while to get a new appointment, and you could hurt your relationship with your doctor. How to Avoid Being a "No-Show" Write down all of your appointments in one calendar. Keep your calendar in a place where you can see it every day. You might keep your calendar on the refrigerator or near a coffee maker If your cell phone has a calendar, set a reminder for the appointment. It s best to set a reminder for the day before and the day of your appointment. If you rely on others (friends, family members, neighbors, Medicaid) to drive you to your appointment, check with them the day before to make sure they can still take you. Make sure your ride knows the time of your appointment and where you are going. What To Do When You Have to Miss An Appointment 1. As soon as you know, call your doctor s office and let them know if you cannot make your appointment. The sooner you call, the more likely the office can give your appointment time to someone who needs it. Reschedule your appointment for a day and time that works for you. 2. If your doctor schedules a lab test for you, be sure to get this done. If you cannot make it, call the lab and reschedule. Remember, your doctor ordered the lab test because he or she needs this information to treat you. Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 15
You Have a Right to Your Health Information Our Notice of Privacy Practices (NPP) tells you about your privacy rights and how you can use them. The NPP also tells you how Passport may use and share your health information. To find a copy of our NPP, please visit www.passporthealthplan.com: Click on Members Click on Notice of Privacy Practices If you d like us to mail you a copy of our NPP, please call us at 1-800-578-0603. TDD/TTY users may call 1-800-691-5566. Want to get a copy of our Preferred Drug List (PDL)? Our PDL is a list of all the medicines we cover and any limits that apply. We also cover some over-the-counter (OTC) medicines when your doctor gives you a prescription. We make changes to our PDL from time to time. To find the most up-to-date list, please visit www.passporthealthplan.com and click on Pharmacy and then Drug Formulary from the drop down.: To view or print our PDL, use the click here link next to Printable Preferred Drug List. To view or print our Over-the-Counter drug list, use the click here link next to Over-the-Counter (OTC) Drug List. To see if a drug is covered using our online formulary, use the click here link next to Searchable Drug Formulary. If you don t use a computer and would like some help, just call Member Services at 1-800-578-0603. 16 Visit us online at www.passporthealthplan.com
Our Medical Review At Passport, we are here to help you get the right care. We have a special team called Utilization Management (UM) that looks at the care you receive. This team of nurses and medical staff want to make sure you get the care you need! As a Passport member, you should know the following about how we make decisions: 3 We check to see if a service is medically needed and covered. 3 We do not reward anyone for denying services to you. 3 We do not give anyone extra money for making decisions that stop you from getting the care you need. If you have any questions, please call us at 1-800-578-0603 between 7 a.m. and 7 p.m. Eastern Time. TDD/TTY users may call 1-800-691-5566. Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 17
Just for Women Just for Women Just for Women Planning Your Next Pregnancy If you ve already had a baby and you re thinking about getting pregnant again, there are things you can do to plan and get ready. Try to plan ahead as much as you can you and your new baby will be glad you did! 3 Ways to Plan for Your Pregnancy 1 2 3 Talk to your OB doctor before you get pregnant to see if you re healthy and ready to carry a baby. An OB is a doctor who takes care of your health care needs during and after your pregnancy. Space out your pregnancies. Wait at least 18 months between the birth of one baby and the start of your next pregnancy. You don t want to have your babies too close together or too far apart. Having Babies Too Close Together Babies born less than 18 months apart have a higher chance of: Having a low birth weight Being born preterm (early) Being small in size for his or her age Think about your age. Being over age 35 or having medical problems increases your chances of having pregnancy complications. If you re over age 35 or if you have any medical problems, see your OB doctor before you get pregnant. You can lower your risk of having complications for you and the baby. Source: Mayoclinic.org, World Health Organization: Report of a WHO Technical Consultation on Birth Spacing 18 Visit us online at www.passporthealthplan.com
Not sure if or when you want another baby? Need birth control until you get ready? You can talk to your OB doctor or primary care provider (PCP) about which birth control option is best for you. Passport can help you learn more about all of your birth control options. We cover lots of these options. To find out more, call us at 1-877-903-0082. We can talk with you about birth control and mail you a booklet called Your Body, Your Choice which tells you all of the options covered for you. Just for Women Just for Women Just for Women Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566 19
Marketing and Community Engagement Department 5100 Commerce Crossings Dr. Louisville, KY 40229 Helping Kentuckians Live Healthier Lives Any information included in this newsletter is not intended to replace medical care or advice from your doctor. Any references to other companies or internet sites are not an endorsement or guarantee of the services, information or products provided. Passport does not take responsibility for anything that may result from the use, misuse, interpretation or application of the information in this newsletter. Passport does not guarantee the availability or quality of care. We are not responsible for any act or omission of any provider. All providers contracted with Passport are independent contractors and not employees or agents of Passport. KHPP00051 APP_6/13/2018 Want to learn more about your benefits and how to use services? Check out our How-To Guide at www.passporthealthplan.com: Click on Members Click on Using Your Benefits Click on Your Benefits & How-To Guide If you do not use a computer, you may call us at 1-800-578-0603 and someone can mail you a copy. TDD/TTY users may call 1-800-691-5566.