| PEBB December 2006 Newsletter |
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| PEBB's Push for Change |
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One Year Along
In 2006, PEBB began an ambitious, long-term effort – one that other large healthcare purchasers are watching closely.
The Board set the initial course by selecting plans that are able and willing to change – to turn their focus to the Board’s Vision of a healthcare system that provides proven value through better quality care, not just services. It charged the plans with offering:
- Systems of care for PEBB members that are based on national quality standards
- New resources to help members stay well and manage their health.
Each of the plans assigned their top medical and administrative leaders to work with the Board. This Council of Innovators regularly meets with PEBB leadership to identify ways they can implement elements of the Vision to improve their delivery systems.
Because each plan has a different structure, each must design its own strategic changes. However, all agree that PEBB is a catalyst for positive change in how their systems work – for members and providers. To quote one innovator, “Don’t mess with your Vision. We’re in this for the long term.”
More to Come
The Board and PEBB members have experienced one year of change. The Board has told the plans that they’re pleased with the initial efforts. Over the coming months this newsletter will report on other changes undertaken by the plans. You’ll learn more about:
- How a Medical Home keeps the system focused on the patient
- New personal health and wellness tools the plans have put in place for PEBB members
- How the move to proven prescription drug options is saving dollars for individuals and all PEBB members
- Decision support to help members and their providers choose treatments based on what the patient prefers
- How plan providers use information technology to improve and coordinate
member care.
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| Rx Exceptions Continue in 2007 |
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If you received a co-pay exception for a non-preferred brand drug in 2006, that exception should continue through 2007.
If your provider prescribes a new medication for you in 2007, remember to ask:
- Is this the most effective drug for my condition?
- Is it on my plan’s formulary?
- Are alternative drugs available that are equally effective?
- Are alternative drugs available that are effective, and less costly?
- Is there a generic available for the brand-name version?
Using equally effective but less expensive medications saves money for you and for all PEBB members.
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| FSA Grace Period & Run Out |
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A PEBB flexible spending account (FSA) for healthcare or dependent care is more flexible than ever. Before, you could use dollars left over from the previous year’s account only for expenses incurred in that plan year. In addition, with the IRS "use it or lose it" rule, you forfeited any dollars remaining in the account at the end of the "run-out period."
Last year, the Board implemented the new IRS grace-period rule. The change allows members to incur eligible expenses in the current plan year and be reimbursed from any money left over in the previous plan year account. It gives them more time to use the last year’s balance.
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FSA TERMS TO KNOW
Plan year: January 1- December 31 of a given year.
Grace Period: January 1 – March 15 following close of the previous plan year. You may submit eligible expenses incurred during this period and be reimbursed from any balance remaining in the previous plan-year account.
Run-out Period: January 1- March 31 following close the of previous plan year. You may submit eligible expenses incurred in the previous plan year and be reimbursed from any balance remaining in the previous plan-year account.
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Here are three examples of how PEBB members can make use of the FSA grace period.
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Derrick Loses Dollars
Derrick has a healthcare FSA in 2006. He doesn’t enroll for 2007.
At the end of 2006, he has $50 left in his account. In January, he receives a $20 bill from his doctor for office care he received in December 2006. He pays the bill and submits an FSA claim for the $20 amount. BHS pays the claim from his 2006 ending balance, which is now reduced to $30.
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In February, Derrick buys over-the-counter allergy medications for a total of $15.75 and submits a claim for that amount. He made the purchase during the grace period, so BHS processes his claim using his 2006 account balance, which is reduced to $14.25.
Derrick has no other 2006 expenses to claim and incus no other eligible expenses during the grace period. On March 31, he loses the $14.25 balance remaining in his 2006 account.
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Couple Cuts Daycare Costs
Jim and Mary have a dependent care FSA in 2006 and enroll in another for 2007.
Mary was on leave for a month in 2006 and cared for their children during that period. That reduced their annual daycare expenses by $300, so they have that amount remaining in their 2006 account.
When they enrolled in their 2007 account, they realized that the grace period meant they could use the 2006 balance to pay for the January 2007 daycare bill. So they enrolled to deposit $300 less in their annual 2007 account.
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In February, they submit a $300 claim for January’s daycare costs. BHS processes the claim from their 2006 account balance, which zeros out the account. They’ll use their 2007 account to be reimbursed for the rest of the year’s daycare costs.
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Susan Saves All the Way
Susan has a healthcare FSA in 2006 and enrolls in one for 2007.
At the end of 2006, she has $125 left in her account. In January 2007, she gets a new pair of glasses that cost $285 — $125 more than her vision plan allowance of $165. So, she submits a claim for the balance of the cost — $125. BHS processes the claim using the $125 remaining in her 2006 account. Her 2006 account balance now is $0.
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A week later, Susan discovers a December 2006 pharmacy receipt for $35 she forgot to claim. To be reimbursed, she must submit a reallocation claim form to BHS.
On the form, she requests a redistribution of the 2006 account funds used for the new glasses — $90 from the 2006 account and $35 from the 2007 account. Susan must now submit a regular claim form for the $35 pharmacy receipt from the 2006 account; this will zero out the 2006 account.
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For More Information
If you have questions about your FSA, contact BenefitHelp Solutions (BHS), which administers the FSA program for PEBB. Call (800) 556-2230. Or go to their e-mail page and select PEBB FSA Specialist from the drop-down menu.
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2006 FSA End-of-plan-year Schedule
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Event
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Date
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2006 Plan-year Run-out Period
(can submit claims for eligible expenses incurred during 2006 to be paid from 2006 balance)
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Jan. 1-March 31, 2007 |
2006 Plan-year Grace Period
(can incur eligible expenses during current year to be reimbursed from Plan Year 2006 balance)
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Jan. 1-March 15, 2007 |
2006 Plan-year Claims Deadline
(all 2006 Plan Year and Grace Period claims must be submitted for payment from 2006 Plan Year funds)
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March 31, 2007
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| Lowering Cholesterol |
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IT'S IMPORTANT TO EVERYONE
What is cholesterol, and why does it matter?
Cholesterol is a fat-like substance in your blood. Over time, it builds up on the walls of your arteries. This can narrow the arteries, slowing down blood flow to the heart. This can cause chest pain. If part of the blood supply is completely blocked, you can have a heart attack.
Who should pay attention to cholesterol?
High cholesterol is a major risk factor for heart disease. And heart disease is the number one killer of women and men in the U.S.
The National Heart, Lung and Blood Institute (NHLBI) says, "Cholesterol lowering is important for everyone – younger, middle age and older adults; women and men; and people with or without heart disease."
How do I know my cholesterol levels?
Many PEBB members who attended worksite health screening clinics this summer and fall had a blood test called a "lipoprotein profile." This fasting test measures:
- Total cholesterol
- Low-density lipoprotein (LDL) cholesterol
- High-density lipoprotein (HDL) cholesterol
- Triglycerides – another type of fat in your blood.
The NHLBI says "everyone age 20 and older should have their cholesterol measured at least once every five years." If you’re due for a cholesterol check, go to the PEBB Web site to view a schedule of worksite health screenings or contact your medical provider.
What can I do about my cholesterol levels?
- Diet. Reduce the amount of saturated fat and cholesterol in the foods you eat.
- Weight. Losing weight can lower your "bad" and total cholesterol levels, along with triglycerides, and increase your "good" cholesterol levels.
- Physical Activity. Try to be physically active for 30 minutes or more on most days. It helps lower bad cholesterol and raise good cholesterol levels.
- Treatment. If your doctor prescribes medication to lower your cholesterol levels, be sure to take it as recommended.
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Type of Cholesterol
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Fasting Values
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Values if Not Fasting
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Total: Total HDL and LDL in bloodstream
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Desirable
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200 or lower
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Normal
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200 or lower
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Borderline
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200-239
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High
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240 or higher
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LDL “Bad”: Clogs vessels; may cause heart attack or stroke (lower is better)
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Ideal
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100 or lower
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Not valid if not fasting
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HDL “Good”: Helps remove bad cholesterol (higher is better)
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Low
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40 or lower
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Low
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40 or lower
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High
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60 or higher
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High
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60 or higher
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Triglyceride: Fat in blood and fat tissue (lower is better)
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Ideal
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150 or lower
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Not valid if not fasting
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Normal
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200 or lower
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High
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200-499
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Very High
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500 or higher
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Online Resources
Visit the NHLBI Cholesterol Education Month Web site. The site offers an entire kit of materials to help you learn more about cholesterol and how to keep it in check for a lifetime of health.
The American Heart Association’s Cholesterol Web section also offers support for keeping your cholesterol numbers where they should be.
Resources from Your Medical Plan
- Kaiser Permanente has a complete self-study packet. Call (503) 286-6816, option 1.
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| Check Your Pay Stub in January |
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If you’re paid through the Oregon State Payroll System (most agency employees are), remember to check your first pay stub of the year. That January stub will show all enrollments and deductions for your 2007 benefits. If you have questions, contact your payroll office as soon as possible for assistance.
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| Prepare for a Peaceful Season |
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The holidays are a short time away along with the stress that sometimes goes with them. The following tips can help you prepare for a more peaceful and enjoyable season:
- Re-assess traditions. Think about your family’s lifestyle – schedules, living arrangements, major life changes in the past year, etc. The "have-to-do’s" and memories of "perfect" times may no longer be really possible. Make a list. Write down what you and your family would most like to do for yourselves and for someone else. Then do it.
- Start a family calendar. Decide what activities you and your family will enjoy most. Then schedule them so everyone can see what‘s coming up. Be sure to leave time for relaxing and spontaneity.
- Organize your shopping. Set a budget and stick to it. Start shopping now. Take advantage of catalogs and the internet. (If you do order online, read the seller’s privacy policy thoroughly to make sure the site is secure.) Put some thought into your gift list. The most memorable gifts are not always the most extravagant.
- Take care of yourself. Make allowances for feeling sad if the season carries memories of loss or sad times. Indulge yourself with a toy, a really good book or something else for your "inner child."
Source: Cascade Centers EAP. Get more EAP assistance.
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| Check Out Wellness Library |
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All employees have access to the State Employee Wellness Collection at the State Library. Check out the wide range of books, videos and tapes on wellness topics available through the library’s online catalog. Select "Online Catalog," and use the keyword "Wellness."
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| Looking for a Flu Shot? |
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The last PEBB flu shot clinic is December 8. Kaiser members can get a flu shot in any Kaiser nurse-treatment room throughout the season. Others can call their county health department to ask about clinics in December. Or, call your provider. With an in-network provider, you won’t pay for the shot, but you may have a payment for the office visit.
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