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New Member Materials 2018 New Member Materials Tips and Forms Evidence of Coverage Welcome to SelectHealth Advantage. We’re Glad You’re Here! Thank you for choosing SelectHealth Advantage® fitness center of your choice, a weight (HMO), your Medicare Advantage plan. Now that loss class or program, or any other you’ve made one important decision, we can help you wellness activity you choose. Visit with many others. Count on us to answer your selecthealthadvantage.org and click questions and to help you understand your coverage. on “Already a Member?” then “Wellness As a new member of SelectHealth Advantage, you and Benefit,” or see Chapter 4 of your Evidence your health are very important to us. We want you to be as of Coverage for more details. This is a healthy as possible and to have access to the most benefit that helps you invest in yourself and appropriate and effective care available when you are not. your health. Please consider these five ways we can work together: > Create a My Health account—visit > See your Primary Care Provider (PCP) at least selecthealthadvantage.org and click on once every year for an Annual Wellness Visit “Already a Member?” and Routine Physical. Use the convenient online tools to help you Making sure your PCP is aware of all of better manage your health. Also, opting-in your medical conditions—even those that to receive electronic statements and other are well-managed and under control—helps available plan communications reduces ensure that we can provide you with the care printing and postage costs and lets us pass and coverage benefits needed to manage the savings back to you. your conditions. > Follow your PCP’s recommendations for Our Member Services team is here to answer care and treatment, including taking your your questions and resolve your concerns. Call prescription medication as prescribed. us toll-free at 855-442-9900 during the It’s harder to get better or stay healthy following dates and times: if you choose not to follow your PCP’s October 1 to February 14: Weekdays recommendations for care. In addition, failing 7:00 a.m. to 8:00 p.m., Saturday and Sunday to take your medications as prescribed 8:00 a.m. to 8:00 p.m. and not refilling your prescriptions when February 15 to September 30: Weekdays recommended may lead to much more 7:00a.m. to 8:00 p.m., Saturday 9:00 a.m. expensive care. to 2:00 p.m., closed Sunday. > Complete all recommended preventive TTY users should call 711. Outside of these hours health screenings (e.g., colonoscopy, cancer of operation, please leave a message. Your call screenings, and heart health screenings). will be returned within one business day These screenings not only help to detect disease early when it is easier to treat, but also help us ensure that you receive quality care. Plus, most This information is not a complete description preventive health screenings are covered at no of benefits. Contact the plan for more additional cost to you. (Refer to Chapter 4 in information. Limitations, copayments, and your Evidence of Coverage for details.) restrictions may apply. Benefits may change on January 1 of each year. SelectHealth is an > Use your Wellness Reimbursement Benefit HMO plan sponsor with a Medicare contract. (i.e., gym membership or weight loss program). Enrollment in SelectHealth Advantage depends on contract renewal. SelectHealth will reimburse you up to $240 a year for membership or class fees to a gym or H1994_4670_FINAL Approved © 2016 SelectHealth. All rights reserved. 4670 9/16 SelectHealth Advantage® (HMO) 2018 New Member Materials Table of Contents Tips and Forms Healthy Living AdvantageSM Wellness Incentive and Checklist Wellness Reimbursement Benefit and Form Hearing Aid Benefit Prescription Reimbursement Form Intermountain Home Delivery Pharmacy Services Intermountain Home Delivery Pharmacy Enrollment Form Fraud, Waste and Abuse Information Advance Directives Information Authorization to Release Information Form Evidence of Coverage 2018 TIPS & FORMS SelectHealth Healthy Living® 2018 Start a healthier lifestyle today. EARN A $50 GIFT CARD 2018 HEALTHY LIVING WELLNESS ACTIVITIES Healthy lifestyles have proven to pay off. POINTS We know that regular preventive care along Annual Wellness Visit with exercise and proper nutrition can help 40 points Required for $50 gift card eligibility prevent or delay disease and disabilities. Colonoscopy 20 points But we all need a little motivation from time to time to live healthy. That’s why Mammogram 20 points our Healthy Living program rewards you Flu Shot 20 points for keeping up with wellness activities like Eye Exam 10 points annual wellness visits and flu shots. Enroll in My Health 10 points Read on to learn how to start earning today! Physical Activity 10 points HERE’S HOW IT WORKS: Your Choice 10 points 1. Choose wellness activities to earn at EARN 70 POINTS TO REDEEM YOUR REWARD! least 70 rewards points. Visa Gift Card $ 50.00 2. Record and track the completion of your wellness activities using the Checklist in this handout or track your activities online using If you have questions about the Healthy Living program the Activities and Rewards Balance page. or need help recording activities and redeeming your Healthy Living points, visit selecthealthadvantage.org 3. Redeem 70 points for a $50 Visa gift or call Member Services at 855-442-9900 (toll-free). card by the December 30, 2018 deadline. HOW TO ACCESS THE HEALTHY LIVING ONLINE PORTAL Visit selecthealthadvantage.org and click Already A Member. Click Go to register for a My Health account. If you already have an account, simply log in. If you do not have a My Health account, follow the simple registration process. Registration for My Health counts as a Healthy Living activity! Click on the SelectHealth button at the top of the page to access the Healthy Living Dashboard. You can track Activities, view your Reward Points balance, and redeem points for your $50 gift card. 2018 Healthy Living Wellness Activities Checklist If you do not want to use My Health to track your wellness activities use this checklist. Once you have earned at least 70 points, return this completed checklist by December 30, 2018 to the address following this form to redeem your gift card. Additional gift card options are available if you track and redeem your points using My Health. LOCATION AND POSSIBLE MY ACTIVITY DATE COMPLETED POINTS POINTS This is a required activity to be eligible for the $50 gift card. Preventive care is an important factor in maintaining good Annual health. The Annual Wellness Visit is a Wellness Medicare-covered service that is designed Visit to help you and your primary caregiver identify the preventive care you need and manage any chronic conditions you may have. Date / / I have received an Annual Wellness Visit 40 from my primary care provider during 2018. It’s recommended that all plan members Flu receive a flu shot every year to prevent the Shot flu or passing it on to others. I have received a flu shot during 2018. Date / / 20 If you are between the ages of 50 and 75, it’s recommended you receive a cut here. colonoscopy at least every 10 years (every Colonoscopy 2 years for high-risk members). Colonoscopy screens for colon cancer and can identify and remove precancerous colon polyps. Date / / 20 I have received a colonoscopy during 2018. For female plan members between the ages of 52 and 74, it’s recommended that Mammogram you receive a mammogram every one to two years. Date / / 20 I have received a mammogram during 2018. Eye health is important for everyone. Regular eye exams can be especially Eye important for people who have been Exam diagnosed with diabetes, glaucoma, or cataracts. Date / / 10 I have received an eye exam during 2018. My Health is not just for tracking healthy living activities. You can also look up past Enroll in medical claims, print your member ID card, My Health and review important plan information. I have enrolled in My Health. Date / / 10 2018 Healthy Living Wellness Activities Continued POSSIBLE MY ACTIVITY DATE COMPLETED POINTS POINTS Staying active is one of the best ways we can maintain good physical, mental, and emotional health. If you are active, you Physical may be able to lessen the effects of many Activity chronic conditions and you just feel better. I have participated in at least 30 minutes of physical activity per day for the past three weeks. Date / / 10 There are a number of ways you can stay healthy and active. Tell us what you did to participate in Healthy Living. Your What I did: Choice Date / / 10 Total Points: Once you have earned at least 70 points, please mail the completed form to P.O. Box 30196 Salt Lake City, UT 84130-0196 or fax it to 801-442-6580 to receive a $50 Visa gift card. Name Ph# ( ) Member ID# (found on your SelectHealth Advantage ID card) Mailing address City, State, Zip I certify that I have received an Annual Wellness Visit and earned at least 70 points and would like to redeem these points for a $50 Visa gift card. Your gift card PIN will be the last four digits of your Member ID number. Signature Date / / If you have questions about the Healthy Living program, please call Member Services at 855-442-9900 (toll-free) during the following dates and times: • October 1 to February 14: Weekdays from 7:00 a.m. to 8:00 p.m., Saturday and Sunday from 8:00 a.m. to 8:00 p.m. • February 15 to September 30: Weekdays from 7:00 a.m.
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