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If you want more information about the drug coverage policies under this plan, or if you have a question or a concern about your pharmacy benefit, please call Customer Service. If you want to know more about your rights under the law, or if you think anything you received from this plan may not conform to the terms of your contract, you may contact the Washington State Office of Insurance Commissioner at 1-800-562-6900. If you have a concern about the pharmacists or pharmacies serving you, please call the State Department of Health at 360-236-4825. Does this plan exclude certain drugs my health care provider may prescribe, or encourage substitution for some drugs? As part of this review, some prescriptions may require additional medical information from the prescribing provider, or substitution of equivalent medication. If changes are made to the drug list prior to the quarterly update, you will receive a letter advising you of the change that may affect your cost share. What should I do if I want a change from limitations, exclusions, substitutions or cost increases for drugs specified in this plan? Provisions regarding substitution of some drugs are described above in question 1. Please see Complaints and Appeals, or call our Customer Service department at the telephone numbers listed on the back cover for information on how to initiate an appeal. The amount you pay for covered drugs dispensed by a retail pharmacy, mail-order pharmacy or specialty pharmacy is described in the Summary of Your Costs. Do I have to use certain pharmacies to pay the least out of my own pocket under this plan? You only receive benefits when you have your prescriptions filled by participating pharmacies. Benefits for refills will be provided only when the member has used 75% of a supply of a single medication. This benefit is limited to covered prescription drugs and specified supplies and devices dispensed by a licensed participating pharmacy. Other services, such as diabetic education or medical equipment, are covered by the medical benefits of this plan, and are described elsewhere in this booklet. Preventive Care Preventive care is a specific set of evidence-based services expected to prevent future illness. These services are based on guidelines established by government agencies and professional medical societies. After a limit has been exceeded, these services are not covered in full and may require you to pay more out-of-pocket costs Some of the services your doctor does during a routine exam may not meet preventive guidelines. These services are then covered the same as any other similar medical service and are not covered in full. For example: During your preventive exam, your doctor may find an issue or problem that requires further testing or screening for a proper diagnosis to be made. Also, if you have a chronic disease, your doctor may check your condition with tests. These types of screenings and tests help to diagnose or monitor your illness and would not be covered under your preventive benefits. You can also get a complete list of the preventive care services with the limits on our website at premera. This list may be changed as required by state and federal preventive guidelines change. The list will include website addresses where you can see current federal preventive guidelines. When federal or state preventive requirements change, this plan will administer preventive care consistent with those changes, as of their effective date, even if they are not specifically referenced in this document. See Diagnostic Lab, X-ray and Imaging for mammograms needed because of a medical condition. Includes the purchase of a non-hospital grade breast pump or rental of a hospital grade breast pump. For electric breast pumps and supplies purchased at a retail location you will need to pay out of pocket and submit a claim for reimbursement.
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Employers want health assessments that provide meaningful context, a good return on investment, and a clear path for employees to take, to work toward improved health. Unlike other health assessments, with questionnaires that take upwards of 45 minutes and produce dozens of pages of results that often go unread, My Life Check Enhance can provide simple, understandable results and actionable engagement in just a few minutes. Personalized action plan and Health Actions based on individual responses to the assessment and incorporated health screening lab values, with the latest scientific information from the American Heart Association bundled and sequenced into actions anyone can take to work toward ideal heart health:? Healthy, the American Heart engaged employees are more productive, with lower absenteeism and Association creates a lower healthcare costs. Workplace Health Achievement Index (a service provided by the employees are American Heart Association at no charge) comfortable sharing. Workplace Programs, Policies, And Environmental Supports To Prevent Cardiovascular Disease. Employee Health Survey 2016: An American Heart Association study conducted by Nielsen Fonarow, G. Workplace Wellness Recognition for Optimizing Workplace Health: A Presidential Advisory from the American Heart Association. Ten modifiable health risk factors are linked to more than one-fifth of employer-employee health care spending. Ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States. The role of worksite health screening: a policy statement from the American Heart Association. The association of ideal cardiovascular health with incident type 2 diabetes mellitus: the Multi-Ethnic Study of Atherosclerosis. People that start at a high level of exercise have 17% lower hospital costs than those unengaged a 0. People that start at a high level of exercise have 55% lower mortality than those a 11 0. Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program. It is overseen by a five-member board appointed by the governor and the Legislature. On the cover: the works of art depicted on the cover of this document are part of a series of murals commissioned by Covered California to attract attention to enrollment locations, promote the role of health and wellness locally and demonstrate that Covered California is woven into the fabric of communities across the state. This booklet is a brief summary of information about individual health insurance plans for Covered California. The rate information in this book is preliminary because it is still subject to public regulatory review. This booklet does not include offerings for Covered California for Small Business. Heading into 2019, Covered California will continue to use all of the tools available in the Affordable Care Act to maintain a stable and competitive marketplace that puts consumers in control. From actively selecting the health insurance companies that will participate in the marketplace, to designing the patient-centered benefits that will be offered to consumers and negotiating the rates, Covered California works to make sure that consumers drive the market by shopping for what provides them the best value. Covered California is a stable model in this new era of health care that has served 3. Together, these achievements have helped California reduce its uninsured rate from 17 percent at the end of 2013 to a record low of 6. As a result, the uninsured rate is dropping faster in California compared to the nation and stands at the lowest level on record. While the uninsured rate in California remained on a steady decline, the national uninsured rate increased, showing its first uptick since the passage of the Affordable Care Act, moving from 9. In addition to a historically low uninsured rate, two recent reports show that California continues to attract a healthy mix of consumers to its individual insurance market, which is a key element to a strong and stable exchange. A healthier consumer pool means lower premiums for everyone in the individual market. This decrease is important because off-exchange enrollees tend to be healthier than average, and these are individuals who do not have the federal tax credit to make coverage more affordable. Figure 1: Total Individual Market Enrollment, in millions Source: Centers for Medicare and Medicaid Services.
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Such information may be particularly helpful in the home environment where household members often have primary responsibility for adherence to recommended infection control practices. Healthcare personnel must be available and prepared to explain this material and answer questions as needed. Hand hygiene Hand hygiene has been cited frequently as the single most important practice to 559, 712, 713 reduce the transmission of infectious agents in healthcare settings and is an essential element of Standard Precautions. The term hand hygiene includes both handwashing with either plain or antiseptic-containing soap and water, and use of alcohol-based products (gels, rinses, foams) that do not require the use of water. In the absence of visible soiling of hands, approved alcoholbased products for hand disinfection are preferred over antimicrobial or plain soap and water because of their superior microbiocidal activity, reduced drying of 559 the skin, and convenience. The scientific rationale, indications, methods, and products for hand hygiene are summarized in other publications 559, 717. The effectiveness of hand hygiene can be reduced by the type and length of 559, 718, 719 fingernails. Individuals wearing artifical nails have been shown to harbor more pathogenic organisms, especially gram negative bacilli and yeasts, 720, 721 on the nails and in the subungual area than those with native nails. The need to restrict the wearing of artificial fingernails by all healthcare personnel who provide direct patient care or by healthcare personnel who have contact with other high risk groups. The following sections highlight the primary uses and methods for selecting this equipment. Gloves Gloves are used to prevent contamination of healthcare personnel hands when 1) anticipating direct contact with blood or body fluids, mucous membranes, nonintact skin and other potentially infectious material; 2) having direct contact with patients who are colonized or infected with pathogens 559, 727, 728 transmitted by the contact route. Gloves can protect both patients and healthcare 73 personnel from exposure to infectious material that may be carried on hands. The extent to which gloves will protect healthcare personnel from transmission of bloodborne pathogens. Although gloves may reduce the volume of blood on the external surface of a sharp by 46729 86%, the residual blood in the lumen of a hollowbore needle would not be affected; therefore, the effect on transmission risk is unknown. The selection of glove type for non-surgical use is based on a number of factors, including the task that is to be performed, anticipated contact with chemicals and chemotherapeutic agents, latex sensitivity, sizing, and facility policies for creating 17, 732-734 a latex-free environment. For contact with blood and body fluids during non-surgical patient care, a single pair of gloves generally provides adequate 734 barrier protection. However, there is considerable variability among gloves; both the quality of the manufacturing process and type of material influence their 735 barrier effectiveness. While there is little difference in the barrier properties of 736 unused intact gloves, studies have shown repeatedly that vinyl gloves have higher failure rates than latex or nitrile gloves when tested under simulated and 731, 735-738 actual clinical conditions. For this reason either latex or nitrile gloves are preferable for clinical procedures that require manual dexterity and/or will involve more than brief patient contact. Heavier, reusable utility gloves are indicated for non-patient care 11, 14, activities, such as handling or cleaning contaminated equipment or surfaces 739. During patient care, transmission of infectious organisms can be reduced by adhering to the principles of working from clean to dirty, and confining or limiting contamination to surfaces that are directly needed for patient care. It may be necessary to change gloves during the care of a single patient to prevent 50 559, 740 cross-contamination of body sites. It also may be necessary to change gloves if the patient interaction also involves touching portable computer keyboards or other mobile equipment that is transported from room to room. Discarding gloves between patients is necessary to prevent transmission of infectious material. Gloves must not be washed for subsequent reuse because microorganisms cannot be removed reliably from glove surfaces and continued glove integrity cannot be ensured. Gloves that fit snugly around the wrist are preferred for use with an isolation gown because they will cover the gown cuff and provide a more reliable continuous barrier for the arms, wrists, and hands. Hand hygiene following glove removal further ensures that the hands will not carry potentially infectious material that might have penetrated through unrecognized tears or that could 559, 728, 741 contaminate the hands during glove removal. The need for and type of isolation gown selected is based on the nature of the patient interaction, including the anticipated degree of contact with infectious material and potential for blood and body fluid penetration of the barrier. When applying Standard Precautions, an isolation gown is worn only if contact with blood or body fluid is anticipated. The routine donning of isolation gowns upon entry into an intensive care unit or other high-risk area does not prevent or influence potential colonization or 365, 747-750 infection of patients in those areas.
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