Summer 2002

~ cover up this summer for a healthier you ~~ cover up this summer for a healthier you ~

Specialinsert booklet:

Understanding

Your HealthCare Costs

Take Careof the

SKINYou’reIn

Take Careof the

SKINYou’reIn

F.A.Q. F.A.Q.ons frequently asked questions frequently asked questions frequently asked questions

Q: For state and public school employees, what is the age limit for dependent coverage?A: Dependent coverage is provided for the following:

1. A child less than age 19 and living in the home.2. A child less than age 27 (who is financially dependent on the employee) and is enrolled and regularly attending

on-campus classes as a full-time student at an accredited college, university or vocational training school.3. A child of any age who is medically certified as total disabled due to mental or physical

incapacity and chiefly dependent on the employee for financial support.

Q: Will I be notified when you have reviewed my claim?A: Yes. An Explanation of Benefits (EOB) will be mailed to you. This notice will give you the nameof the provider of service, explain the type of service, and indicate the date(s) of service as well as the reported, allowedand non-covered charges. An explanation of non-allowed amounts also is provided. The amount paid by Arkansas BlueCross and Blue Shield and the total patient’s share will be indicated on the bottom of the notice. This is the only copyyou will receive, so it should be retained for your records.

Q: If I think an error has been made on my claim, how do I ask for a review?A: After you receive the EOB (and need clarification of the action taken), write or call Customer Service. The telephonenumber and address are located on the front of the EOB. When writing, provide your identification number and refer tothe claim number indicated on the upper portion of the EOB. When calling, having the EOB in hand will save time.

Q: What is the qualifying event for COBRA coverage?A: The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires employers with 20 or more employ-ees to continue to offer coverage in their group health plans to certain former employees, retirees, spouses and depen-dent children, if they have one of the following qualifying events:

1. Termination of an enrolled employee’s employment (other than for gross misconduct) for any reason (layoff,resignation, retirement, etc.).

2. Reduction of work hours.3. Death of the covered employee.4. Divorce or legal separation from the covered employee.5. Dependent child ceasing to meet eligibility requirements.6. Retiree or retiree’s spouse or child loses coverage within one year before or after the

commencement of proceedings under Title 11.7. When dependent loses coverage due to covered employee becoming entitled to Medicare.

... from Federal Employees

Q: Is a root canal or a crown covered by dental benefits?A: Standard Option offers basic preventive dental coverage. Eligible services are paid on a fee schedule. Major dentalwork, such as orthodontics, root canals or crowns, is not covered. For more information, refer to your Benefit Planbrochure.

Q: What is the Blue Health Connection?A: Blue Health Connection is a 24-hour nurse telephone service that is available 365 days per year by calling the toll-freetelephone number 1-888-258-3432 or accessing the Internet Web site www.fepblue.org. The service, called the BlueHealth Connection, features health advice or health information and counseling by registered nurses. Also available is anAudio Health Library with hundreds of topics, ranging from first aid to infectious diseases to general health issues.

3

is published four times a year byArkansas Blue Cross and Blue Shieldfor the company’s members, healthcare professionals and otherpersons interested in health careand wellness.

Vice President of Advertising and Communications:Patrick O’Sullivan

Editor: Kelly Whitehorn — BNYou-Ed@arkbluecross.com

Designer: Gio Bruno

Contributors: Tammi Bradley, Janice Drennan, Damona Fisherand Kathy Luzietti

Customer Service Numbers

Little Rock Toll-freeCategory Number (501) Number

State/Public School Employees 378-2437 1-800-482-8416

e-mail: publicschoolemployees@arkbluecross.com stateemployees@arkbluecross.com

Medi-Pak (Medicare supplement) 378-3062 1-800-338-2312

Medicare (for beneficiaries only): Part A (hospital benefits) 378-3151 1-877-356-2368 Part B (physician benefits) 378-2320 1-800-482-5525

UniqueCare, UniqueCare Blue, Blue Select®, BlueCare PPO & PPO Plus (individual products) 378-2010 1-800-238-8379

Group Services 378-2070 1-800-421-1112

BlueCard® 378-2127 1-800-880-0918

Federal Employee Program (FEP) 378-2531 1-800-482-6655

Health Advantage 221-3733 1-800-843-1329

USAble Administrators 378-3600 1-800-522-9878

For information about obtaining coverage, call:Little Rock Toll-free

Category Number (501) Number

Medi-Pak (Medicare supplement) 378-2937 1-800-392-2583

Blue Select®, BlueCare PPO & PPO Plus (individual products) 378-2937 1-800-392-2583

Regional Office locations:Central Little RockNortheast JonesboroNorthwest FayettevilleSouth Central Hot SpringsSoutheast Pine BluffSouthwest TexarkanaWest Central Fort Smith

Customers who live in these regions may contact the regionaloffices or call the appropriate toll-free telephone numbers above.

Web sites: www.ArkansasBlueCross.com,www.HealthAdvantage-hmo.com,www.USAbleAdminArkansas.com,

www.BlueAndYouFoundationArkansas.orgwww.BlueAnnEwe-ark.com

INSIDETHIS ISSUE

~Summer 2002~

The skinny on skin ....................................... 4Age and your skin ........................................ 5Sun damage: cool tips, hot topic ................. 6Sun-smart tips ............................................. 7Face to face with acne ................................ 7Skin cancer prevention and treatment......... 8Understanding Your Health Care Costs ... insert

Beware of poison ivy ................................... 9Who’s at risk for rosacea? ........................... 9The irritation of AD .................................... 10The bottom line on diaper rash .................. 10Understanding psoriasis ............................ 11The whys and what-to-dos of cradle cap ... 11The pharmacist is in .................................. 12Blue & You Foundation established ........... 12New Open Access POS plan introduced...... 13National Medicare Part A contract ............ 14Blue & Your Community ............................. 15Coverage policies now on-line................... 15Blue On-line ............................................... 16

The SKINNY on skin4

— Source: American Academy of Dermatologyand Skin-Information.com.

What do you really know about your skin?You know you want it to have a healthy glow,and you know you don’t enjoy sunburns,

blemishes and rashes on it. You alsoknow there are a million and oneproducts on the market to help yourecover from skin ailments … or justmoisturize. However, understandingyour skin will help you realize what ittakes to keep it healthy for a lifetime.

The skin is the largest organ ofthe body, both by weight and surfacearea. In adults, the weight of yourskin accounts for about 16 percent ofyour total body weight. Its mainpurpose is to act as a shield fromexternal stress. Your skin is con-

stantly in contact with bacteria, viruses andother harmful agents from the environment suchas sun, wind, heat, dryness, cold weather,pollution and cigarette smoke. It helps regulateyour body’s temperature through sweat glands,and because skin interacts with other organs, itcan alert you to other health problems.

The skin is composed of several layers. Thelowest layer is called the dermis and it is com-posed of connective tissue, blood vessels, nerveendings, hair follicles, and sweat and oil glands.The top layer is called the epidermis. Thethickness of the epidermis varies with your age,your gender and the location on your body of theskin. For example, the epidermis on your fore-arm is about five cell layers thick while theepidermis on the bottom of your foot might be30 cell layers thick. The epidermis is renewedevery 15 to 30 days; but in some disease states, itmay be renewed in about 7 to 10 days.

There are several cell types in the epidermis.The outer layer is made of flattened epithelialcells, and they are called keratinized layers

because of the build up of keratin in thosecells. Keratin is a strong protein that isspecific to the hair, skin and nails. Thislayer of skin, for the most part, is com-posed of cells that are almost pure protein.

The most abundant type of cell in theepidermis is the keratinocyte. Dandruff and

The SKINNY on skinhair are dead keratinocytes. Other skin celltypes are:• Fibroblasts which produce the collagens

and elastins that make skin very durablefrom within.

• Melanocytes, which produce the pigmentmelanin.

• Langerhans cells, also called macrophages,protect the body from injury or illness; theyare immune cells.

• Merkel’s cells, which are more numerousin the palms of hands and soles of feet,are probably sensory mechanical receptorsthat respond to stimulus, such as pressureor touch.The skin has two types of glands: sebaceous

and sweat. The sebaceous glands producesebum, an oil substance that also contains waxesand lipids. They are more concentrated in thescalp, face and forehead. Sweat glands secretemostly water, salt, urea, ammonia, and uric acid.Urea, ammonia and uric acid are toxic wasteproducts of proteinmetabolism. Theglands secrete sweatfor three mainpurposes: to moistenskin, excrete wasteand regulate bodytemperature.

The skin is alarge and complexorgan, and takingcare of your skinrequires diligenceand regular care.Remember to use gentle non-drying cleansersand apply moisturizers, use sunscreen with SPF15 or higher when outside and avoid exposure tosun and artificial tanning; wear protective gloveswhen washing dishes, working with harshchemicals or gardening; and check your skinregularly for discoloration, moles or new lumps.With your help, your skin will look healthy fora lifetime.

5We can’t avoid it. We are all gettingolder every day. The wrinkles and broken bloodvessels are natural signs of aging. Although wecan’t stop the aging process, we can look andfeel better by taking care of our skin.

Intrinsic aging results largely from unknowninternal body and genetic factors with a person’schronological age. Extrinsic aging results mostly fromenvironmental factors, with the most significant beingsun exposure. Photodamage describes the structuraldamage to skin caused by long-term sun exposure.

Aging skin appears to be rough, leathery, wrinkledand unevenly pigmented. In time, facial skin becomesprogressively lax, usually sagging along the jaw line andunder the eyes. A network of dilated blood vessels maybe visible on the cheeks and nose, making the face redand ruddy. Various blemishes, precancerous and cancer-ous lesions become more prevalent. The skin alsobecomes more fragile and may bruise easily and takelonger to heal. Age spots or “liver spots” as they areoften called, have nothing to do with the liver. Rather,these flat, brown spots are caused by years of sunexposure. Many older people also notice an increasednumber of bruises, especially on their arms and legs.That is because the skin becomes thinner with age andsun damage. Loss of fat and connective tissue weakensthe support around blood vessels, making them moresusceptible to injury. The skin undergoes many changesduring the course of the aging process.

We can’t stop the aging process, so what’s the bestway to take care of our skin as we age?

1. Avoid the sun. The sun damages your skin; no doubtabout it. Avoiding sun exposure is the best way tokeep your skin looking young and healthy.

2. Use sunscreen when you are outside even for briefperiods of time. Reapply the lotion as needed. Also,wear protective clothing to keep your skin away fromdirect sunlight.

3. We can’t say it enough. You are what you eat, so eatfoods that are good for you. The super-size nachosmay be tasty, but eat them sparingly. Junk food is justthat — junk. Drink milk, eat fruits and vegetables andeat fiber-filled foods. The antioxidants from fruitsand vegetables help prevent cancer from developingby fighting off free radicals, the by-products of thebody’s everyday processes that damage DNA, cellsand tissues.

4. A humidifier canadd moisture to theair. Bathing lessoften and usingmild soaps tocleanse your skinand mild lotions tosoften skin canrelieve dry skin.However, theAmerican Academyof Dermatologywarns people thatover-the-countercreams and lotionsmay soothe dry skinbut do little ornothing to reversewrinkles.

5. Drink lots of water.It is so good foryour skin!

6. Do not smoke. It isunhealthy for youin so many ways and causes you to lookolder sooner.

7. Exercise. It makes you look and feel better.8. Laugh a little. Laugh lines

are beautiful!

— Sources: American Academyof Dermatology, WebMD andthe National Instituteon Aging.

It’s anage thing It’s anage thing

Sun damage: COOL TIPS, HOT TOPIC

6You’ve heard the message over and over: Avoid the

sun. Sun exposure causes skin cancer. Tanning is not“cool.” Yet young people flock to the beach. And tanningbooths are popping up even in small towns.

What’s the real danger? Whether you tan or burn, theresult is the same. You are damaging your skin. It’s prettyobvious that a sunburn indicates skin damage, especiallyif it causes blistering and peeling. Physicians warn that

tanning, when the bodyproduces the pigment melanin,also is a response to injury.Whether emitted from the sunor a tanning lamp, ultraviolet(UV) rays kill and injure cells.

No UV ray is a safe UVray — although there are twokinds, UVA and UVB. UVB

radiation was once thought to be the only damagingkind, but scientists now believe that both types damagethe skin and can lead to skin cancer. Tanning booths,which emit primarily UVA rays, are not safer than thesun. In fact, UVA rays actually penetrate deeper into theskin and are linked to the most serious type of skincancer, melanoma.

You need to be aware of the two kinds of UVradiation because some sunscreens do not protect againstUVA rays. Be sure that your sunscreen protects againstboth types and has an SPF (sunprotection factor) of at least 15. TheU.S. Food and Drug Administration(FDA) suggests a sunscreen of no higherthan 30 SPF because anything abovethat level offers little additional benefitand might expose people to harmful

levels of chemicals.You should not use sunscreen at

all on babies younger than sixmonths because of thechemicals it contains.Protect them with shading,hats and clothing.

Damage from the sunextends beyond increasing

Sun damage: COOL TIPS, HOT TOPIC

the risk of skin cancer. Premature aging of the skin;leathery, wrinkled skin; age spots; actinic keratoses; andskin discoloration also may result from too much sunexposure. Actinic keratoses are reddish, rough skingrowths that occur on parts of the body exposed to thesun. These can be precancerous.

Sun exposure can even damage your immune systemand make you more susceptible to illnesses. Somediseases, such as lupus and herpes simplex (cold sores),worsen with sun exposure. Some people are even allergicto the sun’s rays and develop bumps, hives, blisters orred blotches after exposure.

Another danger relatedto sun exposure is increasedsensitivity caused by somemedications, such asantibiotics, antihistamines,birth control pills andnonsteroidal anti-inflammatory drugs(NSAIDs) such asibuprofen. These medicationscontain photoreactive agents, which cause chemicalchanges that increase a person’s sensitivity to light.Photoreactive agents also are present in somedeodorants, antibacterial soaps and artificial sweeteners.Getting a tattoo can even increase sun sensitivity because

of the cadmium sulfide injected into the skinduring the process.

No age is immune to sun damage. Peopletypically get 80 percent of their lifetimeexposure to the sun by the age of 18. One infive Americans develops skin cancer at sometime in their life. If you have fair skin; blue,green or gray eyes; red, blond or light brown

hair, you are at greater risk for sun damage — but peoplewith dark eyes, hair and skin also are at risk. People whohave a family history of melanoma should takeprecautions any time they are outside.

— Sources: U.S. Food and Drug Administration, U.S.Environmental Protection Agency, National Center forChronic Disease Prevention and Health Promotion,National Institute on Aging.

. . . . 7At one time or another almost everyone over the age of 12 has

had to face acne. As the most common skin disease, acne affects morethan 17 million Americans, predominantly adolescents and youngadults. Technically, acne is a disorder resulting from the action ofhormones on the skin’s oil glands (sebaceous glands), which leads toplugged pores and outbreaks of lesions commonly called pimples orzits. In reality, it’s just plain annoying and often times embarrassing,especially for teens.

So what causes acne? The exact cause is unknown, but doctorsbelieve it results from several related factors. One important factor isan increase in hormones called androgens (male sex hormones).Hormonal changes related to pregnancy or starting or stopping birthcontrol pills also can cause acne. For some people, it’s simply intheir genes. Researchers believe that the tendency to develop acnecan be inherited from parents.

Despite its popularity, the belief that chocolate and greasyfoods cause acne is not true. In fact, foods seem to have littleeffect on the development and course of acne in most people.Another common myth is that dirty skin causes acne; however,blackheads and other acne lesions are not caused by dirt. Finally,stress does not cause acne.

Acne flare-ups result from changing hormone levels in adolescentgirls and adult women two to seven days before their menstrualperiod starts or friction caused by items that rub the skin, such asbike helmets, backpacks or tight collars. Even environmental irritants,such as pollution and high humidity, can trigger or lead to acne.

There are some simple steps you can take to lessen the occurrenceof acne outbreaks. To begin with, be gentle to your skin. Curb the urgeto rub, squeeze, pinch or pick blemishes, or you risk developing scarsand dark blemishes. Avoid scrubbing your skin and using strongdetergent soaps and rough scrub pads to cleanse the skin. The truth isthis will not improve acne; in fact, it can make the problem worse.Most doctors advise people with acne to gently wash their skin with amild cleanser. Astringents are not recommended unless the skin isvery oily, and then they should be used only on oily spots. And if youuse cosmetics, switch to oil-free products.

To treat mild acne outbreaks, doctors usually recommend an over-the-counter topical of which benzoyl peroxide, resorcinol, salicylicacid and sulfur are the most common, or a prescription topical medi-cation, which is applied directly to the acne lesions or tothe entire area of affected skin. Patients withmoderate to severe inflammatory acne shouldconsult a dermatologist (a doctor who specializesin skin problems) for treatment options.

— Source: National Institute of Arthritis andMusculoskeletal and Skin Diseases.

Face to face

with Acne

Sun-Smart Tips1. Plan outdoor activities before 10 a.m.

and after 4 p.m. during daylight savingstime (9 a.m. and 3 p.m. standard time).

2. Apply sunscreen 20 minutes before yougo outdoors. Apply liberally and reapplyoften. Don’t overlook any exposed skin,including places people often forget,such as ears, neck and tops of feet.

3. Make sure your sunscreen has an SPFfactor of at least 15 and protects againstboth UVA and UVB radiation.

4. Wear protective clothing, including sunglasses, hats made of tightly wovenfabric, long-sleeved shirts, long pantsand dark colors whenever you can.

5. Check the UV forecast. The NationalWeather Service forecasts the UV indexfor 58 U.S. cities daily. On a scale of 0 to10+, the higher the number, the greaterthe risk of exposure to dangerous UVradiation. A UV index of only 3 to 4means that fair-skinned people will burnin less than 20 minutes.

6. Avoid a false sense of security. Cloudsdo not provide much protection sincethey block only as much as 20 percent ofUV rays. Being in water offers noprotection from UV rays, and wet clothesprotect less than dry clothes. Sand, snowand concrete increase UV exposure sincethey reflect the sun’s rays.

7. Sun exposure is cumulative, so you needprotection even during short outings,such as walking the dog, doing yardwork, jogging and window shopping.

8. Avoid tanning beds, lamps and tanningpills. The large amount of color additivein tanning pills could be dangerous toyour health. Bronzing products are notharmful but can result in an unevencolor and offer no protection fromUV rays.

Face to face

with Acne. . . .

8Skin cancer is the most common type of cancer in

the United States. About a million people in Americalearn they have skin cancer each year. In fact, it isestimated that 40 to 50 percent of Americans who live toage 65 will have skin cancer at least once.

The good news? Skin cancer is now almost 100percent curable if found early and treated promptly, andit is preventable if you treat the skin you’re in with carefrom very early in life.

Most Common Skin CancerThe two most common types of

skin cancer are basal cell carcinomaand squamous cell carcinoma.(Carcinoma is cancer that begins inthe cells that cover or line an organ.)Ninety percent of all skin cancers inthe United States are basal cellcarcinomas. It is a slow-growingcancer that seldom spreads to otherparts of the body. Squamous cellcarcinoma also rarely spreads, but itdoes so more often than basal cellcarcinoma. Basal and squamous cell carcinoma aresometimes called nonmelanoma skin cancer. Leftuntreated, these cancers can cause substantial illness,considerable damage and disfigurement.

Most Serious Skin CancerMelanoma is another type of skin cancer that occurs

in the skin and begins in the melanocytes. Melanoma isthe most serious cancer of the skin. In America, thenumber of new cases of melanoma has more thandoubled in the past 20 years. Melanoma occurs whenmelanocytes (pigment cells) become malignant. Mostpigment cells are in the skin. Sometimes, though rarely,melanoma can occur in the eye, the meninges, thedigestive tract, lymph nodes or other areas wheremelanocytes are found.

Melanoma can occur on any skin surface. In men, itis often found in the trunk (the area from the shoulders

to the hips) or the head and neck. Inwomen, melanoma often developson the lower legs. Melanoma israre in black people and otherswith dark skin. When it occurs indark-skinned people, it may be

found under the fingernails ortoenails, or on the palms or soles.

— Sources: National Cancer Institute and the Centers forDisease Control and Prevention.

Melanoma spreads. These cancer cells can spread tothe lymph nodes (or glands), and then it may mean thatcancer cells have spread to other parts of the body suchas the liver, lungs or brain. When this happens, thecancer cells in the new tumors are still melanoma cells,and the disease is called metastatic melanoma. Malignantmelanoma diagnosed at a late stage is more likely tospread and cause death.

Signs and Symptoms of MelanomaThe first sign of melanoma is usually a “change” in

the size, shape, color or feel of an existing mole. TheNational Cancer Institute (NCI) recommends that whenlooking for melanoma, you remember “ABCD.”

Asymmetry — One side does not match the other.Border — The edges are often ragged, notched,blurred or irregular in outline; the pigment mayspread into the surrounding skin.Color — The color is uneven; shades of black, brownand tan may be present. Areas of white gray, red,pink or blue also may be present.Diameter — There is a change in size, usually anincrease. Melanomas are usually larger than theeraser of a pencil (5mm or 1/4 inch).

Curing This CancerMelanoma can be cured if it is diagnosed and treated

when the tumor is thin and has not deeply invaded theskin. However, if a melanoma is not removed at its earlystages, cancer cells may grow downward from the skinsurface and invade healthy tissue. When a melanomabecomes thick and deep, the disease is difficult to controland often spreads to other parts of the body and isdifficult to control. The standard treatment for melanomais surgery; in some cases, doctors may also usechemotherapy, biological therapy or radiation therapy, orsome combination of methods.

Causes/Risk Factors/PreventionThe causes of melanoma are not fully

known at this time. Some of the risk factorsassociated with this disease are: family and/or personal history of melanoma, abnormalmoles, weakened immune system, more than50 ordinary moles, ultraviolet radiationexposure, severe blistering sunburns, andfair skin.

Don’t let cancerget under your skinDon’t let cancerget under your skin

Leaves of three, let it be. Berries white, run in fright.That folk rhyme is something you might want to

share with your children, so they can beware of poisonivy. Poison ivy is a plant despised by man but is moreabundant today than in the past.

Poison ivy (and its cousins poison oak and poisonsumac) can be found anywhere and everywhere. Itthrives in the woods, on roadsides, in your neighborhoodand even empty lots. Where people go, it seems tofollow. Depending on how many times a person hasbeen exposed to poison ivy, a person’s reaction to theplant may be as soon as a few hours or as late as twoweeks after exposure.

Poison ivy causes a severe skin reaction in humanswhen its leaves come in contact with skin. The result is ared, bumpy rash on areas of the body where the skin isthin (arms, shins, face, etc.). It spreads easily and maycause swelling. The rash usually progresses to itchyblisters that ooze, harden and then crack. Four to fivedays after it begins, the blisters usually break openreleasing a watery liquid. Healing usually takes one totwo weeks.

To care for a poison ivy rash at home:1. Wash the area with warm water. The sooner you wash — Sources: Woodall Publications, Inc.,

www.yourhealth.com and WebMD.

the area, the less likelyyou are to developa rash.

2. Apply cotton clothssoaked in cool wateror colloidal ointment to the area.

3. Try soaking in a slightly warm bath with Aveeno orbaking soda to aid with healing.

4. Apply calamine lotion or a paste of baking soda andwater on the rash.

5. Take an antihistamine.If the rash becomes painful or does not seem to be

healing, or the following symptoms appear, consult aphysician.1. Blisters ooze for more than two weeks.2. A fever develops.3. The lymph nodes under your arms, in your groin area

or in your neck become sore and swollen.4. You have insomnia, nervousness, upset stomach or

weight gain.5. The rash covers more than 20 percent of your body or

develops in sensitive areas such as eyes or mouth.

Rosacea, sometimes called acne rosacea, isa chronic skin disease (that also affects theeyes) characterized by redness, bumps,pimples and, in advanced cases, thickened

skin on the nose. Rosacea is most likely to occur on theface, but the neck and upper chest are alsosometimes involved. In more than 50 percent ofpeople, there is a mild degree of eye involvement.

Those most likely to develop rosacea are fair-skinned adults, especially women, between theages of 30 and 50, although it may affect men orwomen of any age and even children. For someunknown reason, women get rosacea more often thanmen, and some cases of this disorder have been associatedwith menopause. Rosacea usually develops over a longperiod of time. It may first seem like a tendency to blusheasily, a ruddy complexion, or an extreme sensitivity tocosmetics. An occasional embarrassment or a tense

Are you at risk for rosacea?

— Sources: National Institute ofArthritis and Musculoskeletal andSkin Diseases and the AmericanAcademy of Dermatology.

moment also may trigger flushing. There are other factorsknown to aggravate rosacea including heat, strenuousexercise, sunlight, wind, cold, hot drinks, spicy foods,emotional stress, and coughing.

Although rosacea cannot be cured, it can be treatedand controlled. Treatment options include topical antibiot-ics and oral antibiotics (for more severe cases). In somepatients, electrosurgery and laser surgery may be optionsto improve skin appearance. If you have been diagnosedwith rosacea, sunscreens are recommended to protect theskin from ultraviolet light.

For more information aboutrosacea, consult your physician.

9 IT’S EVERYWHERE YOU WANT TO BE

POISON IVY — PROLIFIC, PERSISTENT AND SOMETIMES PAINFUL

10Atopic dermatitis (AD), often referred to as “ec-

zema, is a chronic (long-lasting) disease that affects theskin. It is the most common of the many types of ec-zema, a general term for certain kinds of dermatitis,among which are contact eczema, allergic contacteczema, seborrheic eczema and nummular dermatitis.

All types of eczema causeitching and redness.

With AD, the skinbecomes extremely itchy andinflamed, causing redness,swelling, cracking, weeping,

crusting, and scaling. It is not contagious.The itchy feeling is an important factor in AD

because scratching and rubbing in response to itchingworsen the skin inflammation characteristic of thisdisease. Those with AD seem to be extra sensitive toitching and feel the need to scratch longer. They developwhat is referred to as “the itch-scratch cycle.”

Some treatments reduce specific symptoms of thedisease. Antibiotics are used to treat skin infections, andantihistamines, which may cause drowsiness, reducenighttime scratching. Phototherapy (treatment with light)

Diaper rash is the most common skin ailment forinfants and, more than likely, most babies and youngchildren will experience it. While a diaper rash may makethe skin look red and blotchy, normally it is not serious.

The most common causes of diaper rash are: infre-quent changing of wet or dirty diapers, irritation fromrubbing caused by a diaper, a skin reaction to perfumesin the disposable diaper or detergents and fabric soften-ers used to clean cloth diapers.

To care for a diaper rash on your baby: changediapers frequently; when changing the

diapers, use plain water or mildsoapy water to clean baby’s

bottom (use a cotton cloth orcotton balls for cleaning andavoid disposable babywipes); avoid bulky diapersthat can create a “hot-house” effect next to baby’sskin; try to give your baby

some “diaper-free” time each

— Source: National Institute of Arthritis and Musculoskel-etal and Skin Diseases.

— Source: WebMD and the Disney Encyclopedia ofChildren’s Health.

that uses ultraviolet A or B lightwaves or both together, can be aneffective treatment for mild tomoderate dermatitis in older children (more than12 years old) and adults.

AD usually affects infants and young children, but itcan continue into adulthood or first show up later in life.Most often, there are periods of time when the disease isworse, followed by periods when the skin improves orclears up entirely. Although sometimes the problemfades, people with AD tend to have dry skin, occupa-tional skin disease (hand dermatitis), skin infections andeye problems, as well as a disruption of family and socialrelationships.

While the symptoms of AD can be irritating anduncomfortable, the disease can be successfully managed.Many people with AD can, and do, lead healthy, normallives. As researchers discover more about AD and whatcauses it, they continue to work toward effective treat-ments, and perhaps, ultimately, a cure.

day; to aid with healing (and with yourpediatrician’s permission), try an over-the-counter diaper rash cream orointment with zinc oxide; avoid usingtalcum powder or cornstarch; use amild detergent when washing clothdiapers; make sure the diaper fits thebaby correctly and is not too tight; when your baby isready for food, try one at a time so you can identify andwithdraw any food that causes an allergic reaction; and ifyour baby seems especially prone to diaper rash, use abarrier cream with each diaper to keep moisture awayfrom skin.

Consult your pediatrician if the diaper rash containsblisters, crusty areas or bright red spots that togetherform a solid red area with a scalloped border or if thediaper rash shows no improvement after two days ofhome treatment.

�������That itchy, scratchy

feelingThat itchy, scratchy

feeling

Diaper rash: how to care for it and when to be concernedDiaper rash: how to care for it and when to be concerned

Understanding

psoriasis 11Psoriasis is a chronic

skin disease, which is charac-terized by scaling and inflammation. The scaling occurswhen cells in the outer layer of the skin reproduce fasterthan normal and pile up on the skin’s surface. Whilepsoriasis occurs in all age groups and almost equally inmen and women, it is more prevalent among adults.Patients with the disease may suffer discomfort, includ-ing pain and itching, restricted motion in their joints andemotional anguish.

Diagnosis of the disease may be difficult becausepsoriasis can look like other skin diseases. There areseveral forms of psoriasis, the most common of which isplaque psoriasis (psoriasis vulgaris). In this form ofpsoriasis, lesions have a reddened base covered bysilvery scales. Other types of psoriasis include guttatepsoriasis, characterized by small, drop-like lesions thatappear on the trunk, limbs and scalp; pustular psoriasis,where blisters of noninfectious pus appear on the skin(this may affect small and/or large areas of the body).Patients with inverse psoriasis may develop large, dry,smooth, vividly red plaques in the folds of the skin nearthe genitals, under the breasts or in the armpits. Inerythrodermic psoriasis, itching or pain often accompa-nies extensive reddening and scaling of the skin. It may

Cradle cap is a form of seborrheic dermatitis thatforms crusty, yellowish scales on a baby’s scalp thuslooking somewhat like a “cap.” Don’t bealarmed if your baby has cradle cap becausealmost 50 percent of newborns are affected.

Although it may be somewhat unsightly,it is harmless. It causes no discomfort oritching and usually disappears with properscalp hygiene.

Cradle cap is probably linked to the oil-producing sebaceous glands, which are locatedprimarily on the scalp. If the hair is infrequently sham-pooed, secretions accumulate on the scalp and causecradle cap.

Removal of the crusts and regular, thorough cleans-ing of the scalp will eliminate cradle cap in virtuallyevery case. To remove the scales, massage mineral oil orolive oil into the baby’s scalp and allow it to soften thescales. Use a soft wash cloth to gently remove the crust.

Understanding

psoriasis

— Source: National Institute of Arthritis and Musculoskel-etal and Skin Diseases.

— Source: The DisneyEncyclopedia of Children’sHealth.

be precipitated by severe sunburn, use of oral steroids(such as cortisone) or a drug-related rash.

Doctors generally treat psoriasis according to theseverity of the disease, size of the affected areas, the typeof psoriasis and the patient’s responsiveness to initialtreatments. This is sometimes known as the “1-2-3”approach. In step 1, medicines areapplied to the skin (topical treat-ment). Step 2 focuses on light treat-ments (phototherapy). Step 3 involvestaking medicines internally, usuallyby mouth (systemic treatment).

Also, a treatment that works verywell for one person may have littleeffect for another. Thus, doctors commonly use a trial-and-error approach to find a treatment that works, andthey may switch treatments occasionally.

Researchers continue to search for genes that con-tribute to the inherited and other causes of psoriasis.They also are working to broaden our understanding ofwhat happens in the body to trigger this disease. Inaddition, research is focused on developing new andbetter treatments.

Be sure to follow this procedure by washing thebaby’s hair and scalp with a mild shampoo. Oil left on

the baby’s scalp can aggravate cradle cap.Once the condition has cleared up, frequentshampooing and daily brushing will keep itfrom reappearing.

Be sure to consult your child’s pediatricianif the cradle cap does not respond to hometreatment, the rash spreads toother parts of your baby’sbody, or the rash

becomes itchy or inflamed andshows signs of infection.

Why do some babies wear the cradle cap?Why do some babies wear the cradle cap?

The Pharmacist is inDo you have any questions?

The Pharmacist is inDo you have any questions?

problem is an impor-tant gift in mostcases. However, we mustbe careful not to abuse this gift. Medications are aphysician’s primary tool in the non-invasive attempt tocontrol or correct a medical problem presented by apatient. Although many people have a profound respectfor pharmaceutical drugs and take them as directed bytheir physician, some have become complacent abouttaking medications and have little concern for thepotential adverse events that can happen. The advertis-ing of physician-prescribed drugs tends to accommodatethis lack of respect for powerful drugs and promotesincreased utilization.

Minor side effects are a part of normal medicationtherapy. The fact is — there will be side effects of somekind, whether noticeable or unnoticeable by the patient,associated with every drug. Patients must evaluatewhether these are endurable or not. Also, remember thatthere may be situations where a drug mishap may occur,for whatever reason, and may require immediatemedical assistance.

The side effects of medicationsBoth pharmacists and physicians receive numerous

questions about the side effects of potential medicationtherapies prescribed or about medications patients aretaking. This is proper and intelligent thinking on the partof the patient. There always will be side effects associ-ated with the taking of prescribed or over-the-countermedications. Most side effects are not very noticeableand may be overlooked, considering the advantages ofthe therapy. However, the benefits do not diminish thepotential seriousness of the side effects of medications.Please contact your physician if side effects such asvomiting, diarrhea, blurred vision, extreme drowsiness,and others severely hamper your daily activities or createa potential safety concern.

Taking excessive amounts of a prescribed or over-the-counter medication, or taking too many differentmedications from various physicians may produceadverse side effects, which may be exaggerated beyondnormal levels and may create a potentially dangeroussituation.

Taking chemicals into our bodies to correct a medical

New Foundation to award up to $1 million to promote better healthArkansas Blue Cross and Blue Shield has provided

$5 million to establish a charitable foundation to promotebetter health in Arkansas. The foundation is accepting itsfirst grant applications through Sept. 16.

The Blue & You Foundation for a HealthierArkansas anticipates awarding up to $1 millionin grants in 2002 to non-profit or governmentalorganizations and programs that positivelyaffect the health of Arkansans. Particular emphasis willbe given to projects affecting health care delivery, healthcare policy and health care economics.

“We have a health care crisis in Arkansas that mustbe addressed,” said Robert L. Shoptaw, chief executiveofficer of Arkansas Blue Cross and chairman of thefoundation’s board of directors.

“The poor health status of our citizens ranks 46th inthe nation and contributes to rising medical costs. Byproviding funding and working together with otherorganizations, we hope to establish or expand a numberof diverse health care projects that will benefit allArkansans over the long term,” Shoptaw said.

The Blue & You Foundation for a Healthier Arkansaswill accept proposals for its first grants through Sept. 16,with awards being announced before Dec. 31. Foundation

grants will be made to non-profit or govern-mental organizations only and not to individu-als. In addition to these grants, Arkansas BlueCross expects to continue its support ofArkansas charitable organizations through

direct corporate contributions.A board of directors will govern the foundation and

make the final selection of grant awards. The currentboard of directors includes: Sybil J. Hampton, president,Winthrop Rockefeller Foundation, Little Rock; Hayes C.McClerkin, Of Counsel, Dunn, Nutter and Morgan,Texarkana; George K. Mitchell, M.D., Little Rock;and Robert L. Shoptaw. The foundation is a 501(c)(3)organization.

For information on how to apply for a grant, write toBlue & You Foundation, 601 S. Gaines Street, Little Rock,AR 72201 — or visit the foundation Web site atwww.BlueAndYouFoundationArkansas.org.

OAPOS

13When choosing a health insurance plan, people

should look for two things —the right insurance coveragefor their needs and the right level of customer service.

Right CoverageIn response to customer requests for direct access to

network providers and a lower-priced health plan, HealthAdvantage is now offering a new product — Open AccessPoint-of-Service (OAPOS).

OAPOS is an innovative plan that combines thecharacteristics of traditional health maintenance organi-zation (HMO) coverage with the extra provider options ofa point-of-service (POS) plan. OAPOS provides preven-tive and routine services with co-payments required forvisits to primary care physicians (PCPs). Members of theOAPOS plan also may visit their in-network specialtyphysicians without a PCP referral; however, this is wherethe lower-priced health plan becomes apparentwith benefit choices of deductibles, co-paymentsand co-insurance for specialty and hospital services.

Open Access means that members have choiceswhen visiting health care providers and in using theirHealth Advantage benefits. Open Access gives membersthe ability to visit any in-network provider without goingthrough the PCP for a referral and receive the highestlevel of benefits available under the in-network benefitprogram. Members also have the option of using out-of-network providers and receiving the out-of-networkbenefit coverage.

The OAPOS plan offers:• In-network deductible — Options include no deduct-

ible, $250 in-network deductible, $500 in-networkdeductible, or $1,000 in-network deductible. The in-network deductible is applied to specialty carephysician services, hospital services, maternityservices as well as rehabilitation, home health andskilled nursing facility services. This deductible for in-network services is applied after the member pays theapplicable co-payment for the services.

• Co-payments — These vary depending on service.Physician co-payment options are $25 or $35. Theinpatient admission co-payment is $200 or $500, andthe outpatient facility co-payment is $100. Benefitdetermination requires that co-payments are alwayssubtracted first, followed by the deductible andco-insurance.

• Preventive services — PCP services are not subjectto deductible.

• Emergency services — The $100 co-payment and co-insurance are not subject to deductible.

• Co-insurance — The in-network options are 20percent and 30 percent.

• Out-of-network — Out-of-network services are appliedafter deductibles. The deductible options are $1,000or $2,000. There is no out-of-pocket limit for out-of-network services.

• Pharmacy – Options include co-payments of $10/$20/$30, $10/$30/$50 and 20 percent co-insurance withco-payments of $10/$30/$50.

Right ServiceQuality service may be the single most important

factor for employers (and employees) when choosing ahealth insurance plan. To assess a company’s quality ofservice, employers should check references from othersimilarly sized businesses. Insurance companies areunlikely to release references from anyone but satisfiedcustomers, so the best way to get information is toconduct personal research. Call the customer servicedepartments of the insurance companies you are consid-ering. To make accurate comparisons, try to call eachcompany at the same time of the day. It may take extratime, but you should be able to tell whether calls forservice get routed through the circuit of automatedmenus with long waits and if the insurance company hasstaff skilled in handling your call.

Another way to obtain information concerningservice is to ask the office manager at your ownphysician’s office for his or her opinion. He or she hasthe unique experience of working with many insurers ona day-to-day basis. That experience can give you anaccurate picture of each health insurance company.

Most health insurance companies now have Websites. Be sure to visit these, if possible. Many timesemployers will find value-added services from the healthinsurance company that may enhance the employees’benefits and overall health. These may include suchthings as frequently asked questions, wellness programs,disease management programs, and on-line providerdirectories.

Finally, check with the Insurance Department to findout about the stability of the company, and check withthe Arkansas Department of Health to obtain the resultsof its periodic HMO reviews.

Please call Health Advantage at (501) 221-3733 or1-800-843-1329 for more information.

Health Advantage introducesa new OPEN ACCESS POS plan

14Arkansas Blue Cross and Blue Shield has been

awarded the Medicare Part A maintenance contract forthe Fiscal Intermediary Standard System (FISS) by theCenters for Medicare and Medicaid Services (CMS),previously the Health Care Financing Administration.

As a result of the contract, Arkansas Blue Crossbecomes the sole national maintenancecontractor (“maintainer”) of the computersoftware system used to process morethan 160 million Medicare Part A claimsnationwide.

Arkansas Blue Cross was selected toprovide computer software services to supportFISS, including maintenance, developmentenhancements and special projects. ArkansasBlue Cross will be responsible for maintainingand improving the FISS software and with distributingthe software to seven regional data centers, whichprocess Medicare claims. FISS is the primary componentof Medicare’s claim processing function under MedicarePart A.

Ed Person, manager of Medicare Systems at ArkansasBlue Cross, has been named FISS project director.

The contract was effective Feb. 13, 2002, at whichtime an anticipated six-month transition period beganwith the current maintainer, First Coast Service Optionsin Florida, to ensure a smooth transition from onemaintainer to another.

“This is a noteworthy accomplishment for an Arkan-sas company and a significant vote of confidence fromCMS,” said Robert L. Shoptaw, president and CEO ofArkansas Blue Cross. “Since July 1, 1966, when westarted as a Medicare claims processing program, Arkan-sas Blue Cross has given priority attention to the admin-istration of the Medicare program and the opportunity toprovide services to the senior citizens of our state. Theexcellent reputation we have built in Arkansas also hasallowed us to gain Medicare roles in other states.”

Charlie Clem, Arkansas Blue Cross vice president forPublic Programs, said, “We are pleased to be given thisopportunity to serve an even greater role in the nationalMedicare program as maintainer of the FISS. We willcontinue to do whatever we can to provide the best

Arkansas Blue Cross and Blue Shield SelectedMaintenance Contractor for National Medicare Part A System

possible service. We believe this reinforces ourstanding with CMS as an efficient and effectiveMedicare contractor.”

In the 1980s, CMS began a push toward nationalstandardization in processing Medicare claims by movingtoward standard software systems in claims processing

and shared processing across one hardwareplatform. The goal was to reduce variation inhardware and software used for Medicare pro-cessing, to achieve savings in system develop-ment and maintenance as well as a reduction inprocessing costs. In 1996, CMS decided to moveall Medicare Part A contractors to one system,FISS. Currently, there are six contractors re-maining to be transitioned to FISS from theArkansas Part A Standard System (APASS),

which has been used successfully for many years toprocess Medicare Part A claims.

When Arkansas Blue Cross began administeringMedicare in 1966, there were approximately 45 employ-ees who processed claims manually. Today, ArkansasBlue Cross has more than 750 employees in five stateswho work with Medicare.

Arkansas Blue Cross currently administers MedicarePart A and Part B programs in Arkansas and also admin-isters Part B claims in Louisiana, Oklahoma, New Mexicoand eastern Missouri.

As of Dec. 31, 2001, Arkansas Blue Cross serves2,524,613 Medicare beneficiaries in five states. Thenumber of Medicare claims processed annually byArkansas Blue Cross for these five states is more than 42million (Part A and Part B) and the Medicare benefitdollars paid out annually is more than $3.8 billion.

Arkansas Blue Cross also serves as the data centerfor contractors who process Medicare Part A claims forAlabama, Alaska, Maine, Maryland, Massachusetts,Mississippi, New Hampshire, North Carolina, RhodeIsland and Washington.

“We have moved from a small contractor to a majorplayer,” said Clem. “This is due to our increased contrac-tor jurisdictions, systems role, and desire and ability ofour employees to be innovative and strive for excellence.Our success is due to our dedicated employees.”

Part

A

MEDICARE

15Arkansas Blue Cross and Blue Shield strives to be a

good corporate citizen. Our employees raise money andspend many hours helping those causes near and dear tothe hearts of Arkansans.

Stompin’ in GurdonThere was some stompin’ going on in Southwest

Arkansas recently. Juniors and seniors who were selectedat Gurdon High School to lead thecharge against tobacco in theirprimary schools visited with fifth-graders in their school district toteach students about the dangers ofsmoking and smokeless tobaccouse. BlueAnn Ewe was on hand tosupport their presentations andperform the “BlueAnn Stomp” rap/dance with the Heroes and middle-schoolers. The American LungAssociation developed the HighSchool Heroes student mentoring program; ArkansasBlue Cross and Blue Shield sponsors it statewide.

Brownies meet BlueAnnIn an effort to earn “Try-Its,” staying healthy was the

topic being reviewed recently by Brownie Troop 291 inMaumelle. And to help make the learning a whole lot offun, BlueAnn Ewe made a special appearance at thetroop’s February meeting ... on Valentine’s Day. The big,blue sheep presented her wellness lesson for the girls inan effort to teach them about health and safety with afocus on their particular issues: “Healthy Habits” and“Eat Right, Stay Healthy.” Each Brownie got a copy ofBlueAnn’s “Wild & Woolly Health Tips for Kids” coloringbook and watched her “BlueAnn Rocks” musical healthmessages at their next meeting. A “sweet” time was hadby all.

Sheep serves up soup on SundayBlueAnn was dishing out some fun for kids on Soup

Sunday, the annual fundraiser for the Advocates forWomen and Children held in February. Chefs fromrestaurants around the central Arkansas area served uptheir signature soups d’jour for thousands of peoplesupporting the organization and big appetites! BlueAnn

Ewe was on hand to entertainlittle ones in the Kids’ Areafor a portion of the eventand even kicked up herhooves on the dance floor tothe tunes of Little Joe andthe BKs. The event helpedraise money to supportbattered women and awareness of theneed to help stop domestic violence.It was a “soup-er” day.

Walking for the heartArkansas Blue Cross and Blue Shield and Health

Advantage served as corporate sponsors of the AmericanHeart Association’s Faulkner County Heart Walk onApril 6 in Conway. Our Blue team joined almost 900other walkers, along with BlueAnn Ewe, to raise moneyfor research and education. The team was the secondlargest corporate team at the event, raising $5,453 tosupport the more than $56,500 collected to fight heartdisease. BlueAnn posed with survivors ranging in agefrom 10 months to 70 years. It was a beautiful day forwalking and a great day for talking to those who havesuffered and survived heart problems.

BlueAnn poses withnew High SchoolHeroes at Gurdon.

BlueAnnboogies

with alittle chef

at SoupSundayevent.

The Arkansas Blue Cross and Blue Shield CoveragePolicy recently was added to the Arkansas Blue Crossand Health Advantage Web sites.

The purpose of the Coverage Policy is to informmembers and their physicians about what is and what isnot covered under Arkansas Blue Cross insurancecontracts and Health Advantage health plans.

Within the Coverage Policy section, users may searchby key word, policy title, policy number or procedurecode. In addition, users may access explanations of thefollowing:

• What is the Coverage Policy?• How are coverage decisions made?• What is a CPT code?

The new Coverage Policy section may be found in the“Members” and “Providers” sections of both Web sites.

Coverage Policies now on-line

www.ArkansasBlueCross.comwww.HealthAdvantage-hmo.comwww.USAbleAdminArkansas.com

www.BlueAndYouFoundationArkansas.orgwww.BlueAnnEwe-ark.com

Arkansas Blue Cross and Blue ShieldP.O. Box 2181Little Rock, AR 72203-2181

Our on-line world is growing. The Arkansas BlueCross and Blue Shield family of companies hosts sixsites on the World Wide Web:• ArkansasBlueCross.com — for members of Arkansas

Blue Cross and the providers, employers and agentswho help serve our members;

• HealthAdvantage-hmo.com — for members of HealthAdvantage group plans and the providers, employersand agents who help serve our members;

• USAbleAdminArkansas.com — for members of self-funded health plans administered by USAbleAdministrators who have “Blue-branded” productssuch as BlueCard®;

• USAbleAdmin.com — for members of self-fundedhealth plans administered by USAble Administratorswho have non-branded products;

• BlueAndYouFoundationArkansas.org — withinformation about the charitable foundation topromote better health in Arkansas;

• BlueAnnEwe-ark.com — targeted toward youngerchildren but with something fun for everyone.

Blue BusinessOn the four business sites, you will find information

about our companies, health plans and services, as wellas the “Provider Directory.” Each site has an e-mail linkso that you can send questions to Customer Service.Each site also has a “Frequently Asked Questions”section, where you might find answers to your questions.If you need to contact us by telephone or mail, you willfind that information in the “Contact Us” section.

The newest feature of our business sites is thecustomized “Provider Directories” for USAbleAdministrators members. To find an in-network doctor orhospital, a member enters the member ID number fromthe USAble Administrators ID card. This number opensthe key to the member’s customized search page.

Later this year, members will be able to register forself-service features, such as “Check Claim Status” and“Order a Replacement ID Card.”

New BusinessIf you or a family member needs information about

an individual health insurance policy or Medi-Pak, visitthe “Individuals and Families” page in the “Health Plansand Services” section of ArkansasBlueCross.com. You can

get a free, no-obligation rate quote on-line. You also mayrequest an information packet for BlueCare PPO®,BlueCare PPO Plus®, Blue Select® or Medi-Pak®. When youcomplete the on-line form, you will receive a packet inthe mail. Summaries of each of the individual plans areavailable on-line. If you would like to apply immediately,you may fill out, print and mail an on-line applicationform. For now, we need an original signature on theapplication form, although plans are under way todevelop a method of accepting an electronic signature.

Educational FunChildren of all ages will find something fun to do at

BlueAnnEwe-ark.com. BlueAnn recently added a fun andeducational game called “Who Wants To Feel Like aMillion Bucks?” Other games include “Concentration”and “BlueAnn’s Wild and Woolly Word Search,” whichoffer challenges even for adults. The “Healthy HabitsColoring Page,” “Fan Mail” and “Scrapbook” are easy foryounger children to explore.

Other features allow children to e-mail BlueAnn,watch her colorful TV spots and listen to her radiocommercials. Health related information changes eachmonth in the “Healthy Goodies” section. Parents can feelconfident that BlueAnn’s site is a safe and beneficial onefor their children to visit.

If you have suggestions for improving our sites,please e-mail us from any site. Thanks for visiting!