NCHealthPlans.com Health News

Waiting Periods for Pre-Existing Conditions

Amanda — Mon, 10 Oct 2011 19:57:27 +0000

Subscribers and dependents must satisfy a 12-month waiting period for pre-existing conditions under this health benefit plan . Any waiting period for pre-existing conditions begins on the effective date of this health benefit plan. During a waiting period for pre-existing conditions, neither you nor your dependents will receive benefits for conditions for which medical advice, diagnosis, care or treatment was recommended or received within the 12 months immediately preceding the effective date of this health benefit plan. However, provided there was no significant break in coverage, a waiting period for pre-existing conditions will not apply to any condition first identified, treated and covered under prior creditable coverage. Medical records may be ordered to make this determination. Genetic information [variable] is never treated as a pre-existing condition.

For purposes of determining the specifics around any waiting period for pre-existing conditions, a significant break in coverage is 63 or more consecutive days before your application receipt date, during which you have no proof of creditable coverage. The waiting period for pre-existing conditions will be reduced by the number of days you or your dependents had prior creditable coverage, so long as there was no significant break in coverage.

The information in this article is from the 2011 Product Guidelines for Blue Advantage and Blue Options HSA plans from Blue Cross Blue Shield of NC.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

Maternity Coverage with BCBSNC

Amanda — Fri, 07 Oct 2011 19:52:17 +0000

The Maternity endorsement for Blue Cross Blue Shield Individual Plans may be purchased at the original issuance of the policy at a policy renewal (if the policy has been in effect for at least six months), or within 30 days of marriage or when adding a spouse as a dependent. If the application to add the maternity endorsement is submitted and approved during the renewal open enrollment period (October through November 30), it will become effective on January 1st and premium adjustments for any changes in coverage will apply, effective January 1.The maternity endorsement is only available for adult females, either subscriber or spouse, on non-Youth—only policies. Please see Product Movement Guidelines for additional information on when the maternity endorsement can be purchased for existing members. A request to add the maternity endorsement is subject to medical underwriting. Maternity coverage will be denied if a pregnancy exists for the subscriber/spouse.

The information in this article is from the 2011 Product Guidelines for Blue Advantage and Blue Options HSA plans from Blue Cross Blue Shield of NC.

Who Is Eligible for BCBSNC Individual Health Insurance?

Amanda — Mon, 03 Oct 2011 19:45:34 +0000

To be eligible for Blue Cross Blue Shield of North Carolina Health Insurance coverage, you must be a North Carolina resident under 65 years of age, not be covered by another health insurance policy, not be enrolled in Medicare, and qualify medically. Applicants must be able to provide one of the following as proof of residency: voter registration in NC, NC driver’s license, or current NC tax return. In addition, applicants are required to submit a Social Security Number.

Multiple Coverage

You may be covered under only one health program offered by BCBSNC, except with special permission. In that case, the total benefits paid will not be more than the allowed amount.

Dependents

For dependents to be covered under this health benefit plan, you must be covered and your dependent must be one of the following:

· Your spouse, under a legally valid, existing marriage between persons of the opposite sex

· Your or your spouse’s unmarried dependent children, to their 26th birthday, including newborn children from date of birth, stepchildren, adoptive children from the date of placement for adoption and foster children from the date of placement in the foster home.

· An unmarried dependent child who is either mentally retarded or physically handicapped and incapable of self-support may continue to be covered under the health benefit plan regardless of age if the condition exists and coverage is in effect when the child reaches the age of 26.

The handicap must be medically certified by the child’s doctor and may be verified annually by BCBSNC.

Parents residing in NC can enroll child(ren) residing outside NC as long as the parent is enrolling, as well. Parents residing outside NC with child(ren) in NC can enroll their child(ren) only; parents are not eligible to enroll.

The information in this article is from the 2011 Product Guidelines for Blue Advantage and Blue Options HSA plans from Blue Cross Blue Shield of NC.

Bullying

Amanda — Fri, 30 Sep 2011 14:31:06 +0000

Bullying is when one child picks on another child repeatedly. Bullying can be physical, verbal, or social. It can happen at school, on the playground, on the school bus, in the neighborhood, or over the Internet.

When Your Child Is Bullied

Help your child learn how to respond by teaching your child how to:
      1. Look the bully in the eye.
      2. Stand tall and stay calm in a difficult situation.
      3. Walk away.

Teach your child how to say in a firm voice.
      1. “I don’t like what you are doing.”
      2. “Please do NOT talk to me like that.”
      3. “Why would you say that?”
– Teach your child when and how to ask for help.
– Encourage your child to make friends with other children.
– Support activities that interest your child.
– Alert school officials to the problems and work with them on solutions.
– Make sure an adult who knows about the bullying can watch out for your child’s safety and well-being when you cannot be there.

When Your Child Is the Bully

– Be sure your child knows that bullying is never OK.
– Set firm and consistent limits on your child’s aggressive behavior.
– Be a positive role mode. Show children they can get what they want without teasing, threatening or hurting someone.
– Use effective, non-physical discipline, such as loss of privileges.
– Develop practical solutions with the school principal, teachers, counselors, and parents of the children your child has bullied.

When Your Child Is a Bystander

– Tell your child not to cheer on or even quietly watch bullying.
– Encourage your child to tell a trusted adult about the bullying.
– Help your child support other children who may be bullied. Encourage your child to include these children in activities.
– Encourage your child to join with others in telling bullies to stop

The information in this article : Back to School Tips is from the American Academy of Pediatrics Web site ( http://www.aap.org ).

How to Purchase BCBSNC Insurance for Your Child Only

Amanda — Wed, 28 Sep 2011 16:41:05 +0000

You can purchase a Blue Advantage, Blue Advantage Saver or Blue Options HSA policy to cover your child or adopted/foster child without being covered by the policy yourself. Your child will receive full plan benefits, including immunization, well-child and well-baby care coverage. When you apply, be sure to enter your child’s information (name, gender and birth date) as the primary applicant. If you plan to cover multiple children, each child must have his or her own policy, so you’ll need to apply for each policy separately. Multiple children may be covered on the same policy, as long as the parent is also covered by that same policy. You can cover children up to age 26 on your policy, as long as they are your legal dependents. However, children under age 18 are not eligible to have their own health savings account. Children under age 18 are subject to certain tax guidelines. Consult a tax professional for more information.

The information above is provided by BCBSNC, 2011 Plan Information Guide.

MyPlate replaces Food Pyramid

Amanda — Mon, 26 Sep 2011 15:57:51 +0000

The colorful quarters of the plate – green for vegetables, red for fruits, orange for grains, and purple for protein – are aimed at nudging Americans away from meals dominated by meat and starch and towards meals made up mostly of plant-based foods.

MyPlate promotes fruits and vegetables, which cover half the circle, with grains and proteins such as meet, fish and poultry a quarter each. Dairy (e.g. a glass of milk or food, such as cheese or yogurt) rests to the side. Desserts are – well – in the desert, nowhere to be found.

Blue Cross Blue Shield of NC offers discounts in premium to individuals in excellent health. Practice fitness and good nutrition at an early age and reduce the risk of health problems, regardless of age.

Three goals

According to the the new MyPlate home page, the USDA wants Americans to:

1. Balance Calories, Enjoy food, but eat less and avoid oversized portions.

2. Increase portions of some foods. Make half the plate fruits and vegetables and make at least half of the grains whole grains. Switch to fat-free or low-fat (1%) milk.

3. Decrease consumption of some foods. Compare sodium in foods like soup, bread, and frozen meals – and choose the foods with lower numbers. Drink water instead of sugary drinks.

“Brilliant in its simplicity”

Unlike MyPyramid, MyPlate offers people immediately useful information without sending them to consult their computers. It visually represents portion sizes and sends the message that a balanced meal should be at least half vegetables and fruits.

“It’s brilliant in its simplicity,” said Robb MacKie, head of the American Bakers Association, which represents bread makers. “It’s something the average American can look at and get a visual feel for how they can fill up a plate at a real meal.”

The new symbol, unveiled on June 2, 2011, with First Lady Michele Obama in attendance, is “grabbing the consumer’s attention that we are after this time, not making it so complicated that perhaps it is a turnoff, said Robert Post of the USDA’s Center for Nutrition Policy and Promotion. “There is something really inviting about this familiar setting for meal time.”

USDA will be promoting MyPlate through social media (e.g. Twitter), with its website eventually featuring interactive tools that help people manage their weight and track exercise.

Well-received

So far, according to the Washington Post, MyPlate has been well received, especially in comparison with MyPyramid.

MyPlate is also based on better science than MyPyramid, or the granddaddy of food icons, the Food Guide Pyramid.

But, says, P.J. Skerrett, editor of the Harvard Heart Letter in a post on the Harvard Health Blog, MyPlate ignores important issues like the healthiest choices for grains, protein, and fat.

Equally important, it is silent about avoiding sugary baked goods, breakfast cereals, and drinks, as well as salty processed foods and snacks, which make up a big chunk of the average American’s daily caloric intake.

One small but interesting fact lost in the hullabaloo over the launch of MyPlate, says Harvard Health: it’s almost exactly the same as the New American Plate, developed in 1999 by the American Institute for Cancer Research.

The information in this article is from the USDA and Lindsay Burton from momsteam.com

Prime Therapeutics Questions and Answers for BCBSNC Employer Groups

Amanda — Fri, 23 Sep 2011 17:30:20 +0000

Last week, investment bank Morgan Stanley issued a “Healthcare Services & Distribution” report that makes reference to a potential change in Blue Cross and Blue Shield of North Carolina’s (BCBSNC) Pharmacy Benefits Management relationship. Because this mention could generate questions from our customers, we want to share some information with you about this. As part of our effort to reduce costs for our company and our customers, BCBSNC is in negotiations to change our pharmacy benefits management vendor. Assuming that final negotiations are concluded successfully and we receive regulatory approval, Prime Therapeutics would administer pharmacy benefits for our commercial customers whose pharmacy benefits we handle.

We hope this change will take place beginning April 1, 2012. This change would result in lower pharmacy costs for BCBSNC and our group customers, and would provide more flexibility regarding services and programs.

Please refer to the questions and answers below for more information. Questions and Answers for BCBSNC Employers and Members

Who is Prime Therapeutics?

Prime Therapeutics (Prime) is a thought leader in the pharmacy benefit management (PBM) industry. Its mission is to provide the highest quality care and service for members while focusing on delivering the lowest cost of care and empowering clients to make informed decisions in health care management. Prime is owned by 9 entities, representing 12 BCBS plans, and is the fourth largest PBM in the industry.

What is Prime’s ownership structure?

Prime is a privately-held company owned jointly by 12 Blue Cross and Blue Shield (BCBS)health plans:

???? Blue Cross and Blue Shield of Alabama

???? Blue Cross and Blue Shield of Florida

???? Blue Cross and Blue Shield of Illinois

???? Blue Cross and Blue Shield of Kansas

???? Blue Cross and Blue Shield of Minnesota

???? Blue Cross and Blue Shield of Montana

???? Blue Cross and Blue Shield of Nebraska

???? Blue Cross and Blue Shield of New Mexico

???? Blue Cross and Blue Shield of North Dakota

???? Blue Cross and Blue Shield of Oklahoma

???? Blue Cross and Blue Shield of Texas

???? Blue Cross and Blue Shield of Wyoming

Through its private ownership structure, Prime is able to focus on BCBS stakeholder value, not stockholder value. Prime offers a proven, strategic partnership that supports its clients’ overall health care goals. BCBSNC would be part-owner of the company.

Why is BCBSNC looking to make this change?

BCBSNC decided to explore changing pharmacy benefits managers (PBMs) for a number of reasons. Most importantly, we want to secure the most competitive pricing possible, which means we would be better able to control pharmacy claims expense.

Prime offers the economies of scale of a national provider with the flexibility, customization and quality service of an in-house solution. As a leading PBM owned by Blue Cross and Blue Shield plans, Prime is uniquely able to meet our high standards, while at the same time leveraging best practices. As a result, Prime consistently delivers the best pharmacy trend of the major PBM competitors, and outperforms them in customer satisfaction.

How much will I save?

One important reason that BCBSNC decided to contract with Prime Therapeutics was to secure better pharmacy discount pricing. Prime works with clients to identify factors driving their pharmacy trend and then implements various approaches to lower pharmacy costs. These include:

• Low net-cost approach. Prime uses a low net-cost approach that is applied to formulary development, benefit design, manufacturer contracts, and network reimbursement. Using this approach, Prime has helped health plan clients successfully decrease overall per member per month costs.

• Maximum allowable cost (MAC) program (generic drug pricing). Prime believes its MAC program to be the most clinically comprehensive and competitive in the industry

• Driving employees to lower-cost drugs. Driving utilization to lower-cost products is a key to managing costs. Prime has several programs to move utilization to lowercost brand and generic products. Actual member or group level savings will depend on a number of factors including specific utilization patterns.

Does this have any impact on me now?

No. The target date for moving to Prime is April 1, 2012, pending completion of final negotiations and regulatory approval. Therefore, there are no changes for members at this time.

Why are you targeting a 4/1 implementation date?

The tentative 4/1/2012 implementation date was chosen to ensure that appropriate quality and service associated with planned annual renewals is maintained. Implementing off-cycle also ensures minimal disruption to membership during transition.

Will there be any cost to the group for this transition?

No. There are no costs to BCBSNC members or groups associated with the change from Medco to Prime Therapeutics.

Are my benefits changing?

Prime Therapeutics will be able to administer your pharmacy benefits without making significant benefit changes. Any changes to your pharmacy benefit will be positive additions driving to lowest net costs for you and your membership. The change from Medco to Prime Therapeutics will be nearly transparent to BCBSNC members.

How will my deductibles, accumulators, out of packet maximums transfer?

BCBSNC will work with Prime to ensure that all records are transferred to the Prime claims system appropriately. When the change from Medco to Prime Therapeutics becomes effective, the change will not affect deductibles, accumulators or out of pocket maximums.

Will I need to change pharmacies?

While Blue Cross and Blue Shield of North Carolina reviews its retail pharmacy network options regularly to ensure the best pricing for its clients and members, there are no plans to change the pharmacy network at this time. The process for filling your prescription at a retail pharmacy would not change. Bring your prescription and member identification (ID) card to a pharmacy in your pharmacy network. The pharmacist will send your prescription electronically to Prime to confirm your benefit plan and ensure the correct prescription price.

What prescription mail service option is offered by Prime? How will mail order prescriptions transfer?

PrimeMail® is Prime’s prescription mail service. PrimeMail makes transferring prescriptions, ordering new prescriptions and ordering refills safe, fast and easy. In addition to easy ordering, PrimeMail members have access to member service agents 24-hours a day, seven days a week. PrimeMail customers can also use the member website to order refills, track their prescription history and find drug information. With PrimeMail, prescription medications are confirmed for accuracy and quality by registered pharmacists and delivered to your door in safe, plain-labeled packaging. When the transition occurs, if you have a prescription with Medco mail service, and there are open refills, that information will automatically be transferred to Prime and your refills will be delivered to you without interruption. You won’t have to wait for your important medications.

Will Prior Authorization (PA) files transfer?

Yes. During the integration, Prime will work with Medco to transfer historical PA files as part of the overall transition of member records. Members will not have to reestablish PA status.

Will this affect BCBSNC’s specialty pharmacy program?

No. There will be no change to the specialty pharmacy network launched on July 1st.

The information in this article was taken from a Press Release from Blue Cross Blue Shield of North Carolina on August 1, 2011.

Coaching Your Own Child: Attitude, Objectivity and Preparation Are Keys

Amanda — Wed, 21 Sep 2011 15:40:02 +0000

Whether it is soccer, baseball, basketball, or the chess team, you have a golden opportunity to make a difference. Being your child’s coach, assistant coach, referee, or Team Parent lets you contribute to the quality experience your child will enjoy. But like many opportunities, it can be a double-edged sword.

Blue Cross Blue Shield of NC offers discounts in premium to individuals in excellent health. Practice fitness with team sports and good nutrition at an early age and reduce the risk of health problems, regardless of age.

Sport teams in particular put parents in the hot seat. We all recognize we spend most of our time watching our child play (the rest of the team is there, but heck, our kid is the best). Humbly, we know we are biased, but when the adrenalin flows and our natural instincts as parents get turbo charged, we can say and do embarrassing things, things we never knew we could do, or even imagine doing. One dad who was an assistant coach even went onto the field and tackled a 12-year-old kid who made a late tackle on his son!

Forewarned is forearmed: Know you are vulnerable and you become less vulnerable. It is called an attitude inoculation. As John Wooden says, being prepared is preparing to succeed. Failing to prepare is preparing to fail.

Coaching Your Own Child: Three Keys

Now that you know that your biases are itching to come out, get ready to implement a simple 3-step strategy:

Recognize your own bias. Just like every other parent, you see your child’s actions with a rosy glow of pride. While useful, these rose-colored lenses lead you (and every other parent) to think your child is the most talented or has the most potential.

Train yourself to watch and make decisions objectively. Observe every child’s playing behavior on your team. Give quality, equal advice based on observable actions. Make fair decisions based on team goals, not your goals as your child’s parent. Some parents as coaches favor their own child while others are too hard on their child. Finding the balance is the hardest task you will have! Balance. Not too much attention, not too little attention; just the right amount. Your child will thank you.

Prepare your child by describing your job as a coach. Explain to your child that you will do your very best to treat all the players equally, giving praise, guidance, and play time fairly to all. That is your job if the team is to have a quality team coach!

The “Two Hat” Trick

One coach told me a trick he used when coaching his daughter, Kimberly, on a varsity high school volleyball team. He explained that as he was driving her home from the game he would say, “O.K., I am going to take off my Coach Hat now and talk to you wearing my Dad Hat. You played great. I loved the way you….” and he would go on to tell her about specific things she did – this amazing pass or getting to a speeding jump served ball in the last minute. He said he often had fun with it and would refer to himself in the third person, telling her that her “coach was really nuts to take (her) out after (she) missed a serve, but heck, he was the coach… it was his decision.”

The amazing coach who gave me that advice was Jesse Quiroz of Harvard-Westlake High School in North Hollywood, California. No wonder Coach Quiroz took his team to the California state championships twice and won both times (2001, 2002)!

So, Mom or Dad, congratulations again for taking the opportunity to support your child’s team in whatever role you can.

If you are a little intimidated about your own athletic training, be consoled. The top NCAA Division-1 athletic coaches say the #1 thing they look for in a young athlete who is a real winner is one who Loves to Play. So start your job as Coach, Assistant Coach, Referee, and/or Team Parent with the goal of helping all kids learn to Love to Play!

This article is from Moms Team by Shari Kuchenbecker, Ph.D. on August 16, 2011.

Horseback Riding Is Great Exercise for your Children

Cathy — Mon, 19 Sep 2011 18:37:23 +0000

Many children are enamored with horses and long for riding lessons. Horseback riding can be a great pleasure providing terrific exercise for young riders (as well as the horses!). Often, children who learn to ride continue horseback riding into adulthood, helping to keep them fit and healthy. Exposure to good fitness at an early age helps your children become fitness conscious through adulthood.

Recommendations for Safe, Fun Riding

While experts will stress that a child’s size, strength, ability to focus and take direction, and desire to learn horseback riding are the best indicators that they are ready to begin formal lessons, the typical age range for beginners is between 5-7 years old. Parents should make sure that their child wears proper attire, including long pants, sturdy shoes or boots, and most importantly, a well fitted safety helmet. Children must be advised as to the importance of following all of the rules and asking questions if they have concerns or do not understand what is expected of them. Horse riding instructors who work with children are typically very patient and understanding, hoping to give children positive experiences in hopes that they will develop a lifelong appreciation of the sport.

Competitive Horseback Riding

Many stables that offer lessons hold occasional competitions, open to all riders, even beginners. Riders are normally categorised by age and ability, with inexperienced riders participating in walks and trots. More advanced riders may be offered the opportunity to showcase their skills in jumping and putting their horse through specified paces. If children choose to compete, parents and instructors should be sure that the emphasis remains on fun and sportsmanship, rather than only winning. Everyone likes to win, but kids should understand that the benefits of horseback riding go far beyond accumulating an assortment of ribbons and trophies. Horseback riding is great exercise, offers opportunities for fresh air fun, teaches responsibility and caring toward animals, and is enjoyed by people of all ages, making it an ideal family activity.

Maternity Coverage for Individual BCBSNC Policies

Amanda — Fri, 16 Sep 2011 19:44:11 +0000

BCBSNC offers an optional maternity rider to females (policy holder or spouse) ages 18 and over who are NOT pregnant when they apply for coverage unless their most recent creditable coverage was underwritten by BCBSNC and included maternity coverage. If you elect not to purchase the maternity rider when you first apply, you can add at the following times so long as you are not pregnant at the time:

1. During the annual renewal period (November for a January 1 effective date) as long as the policy has been in effect for at least 6 months

2. Within 30 days following marriage (requires copy of marriage certificate)

3. Upon adding your spouse as a dependent for reasons other than marriage (requires supporting documentation)

Here are some additional things to consider:

• The maternity rider covers maternity services under the core health plan’s deductible and coinsurance.

There are usually no office visit co-payments and no separate deductible for maternity coverage.

• Complications from pregnancy1 are covered under Blue Advantage or Blue Options HSA even if you do not have the maternity rider. These health plans provide you the protection in the event of certain complications with your pregnancy.

• You can add your newborn to your existing policy within 30 days of the date of birth (without medical underwriting) regardless of whether or not you have the maternity rider. Coverage will be effective as of the baby’s date of birth so long as your policy was active on the day of birth.

• Many people see the maternity option simply as a means to help “pre-pay” and choose to purchase it only if they are planning on getting pregnant in the near future.

The information in this article is from bcbsnc.com, maternity rider benefits.