DAYS OF SUMMER SAFETY - usfhpnw.org · Have yearly skin exams if you’re at high risk. Learn more...

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SUMMER 2018

A MEMBERSHIP SERVICE FROM THE US FAMILY HEALTH PLAN

MAKE MOVING LESS STRESSFUL PAGE 3 | NEW DOCTOR? PLANNING THE FIRST VISIT PAGE 5

101 DAYS OF SUMMER SAFETY

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Melanoma is the deadliest skin cancer. Find it early by following these tips: �Get to know the moles, spots, and freckles

on your body. Call your doctor right away if you notice any changes or new spots.

�Have yearly skin exams if you’re at high risk.

Learn more about melanoma from the American Cancer Society. Visit www.cancer.org/cancer/melanoma-skin-cancer.html.

CATCH SIGNS OF MELANOMA EARLY

101 Days of Summer: Enjoy Them Safely!Summer is a time to hit the road, hit the beach, and even see the world. Follow these tips for a safe, enjoyable vacation season.

SWIM SAFELY �Look for lifeguards. The odds

of drowning at a beach without lifeguards are almost five times higher than at a guarded beach. Ask about strong currents, hidden rocks, and other obstructions.

�Never swim alone. Always swim with a buddy, or at least have someone watch you from shore who can signal for help if needed.

2 | US FAMILY WWW.USFHPNW.ORG

�Don’t fight a rip current by trying to swim straight to shore. Swim parallel to the beach until you’re out of the current, then head in. If you can’t swim out of the current, float, wave an arm, and yell for help.

�Guard against hypothermia. You may be surprised to know that hypothermia can happen in temperatures as mild as 50 to 75 degrees, and can quickly overwhelm even strong swimmers. Wear a lifejacket while boating and a wetsuit while paddleboarding or surfing. If you swim, enter slowly to get used to the cold water. If you start to shiver, get out immediately.

OTHER SAVVY SAFETY TIPS �Prevent heat-related illnesses.

Children up to 4 years of age are at greatest risk, but adults can also get heat sickness if they work or play too hard in the heat. Never leave infants, children, or pets in a parked car, even if the windows are cracked open.

�Cover up and apply SPF. Protect against UV rays with hats, lightweight long pants, and long-sleeved shirts. Use sunscreen. Reapply throughout the day, especially after swimming or strenuous activity.

�Leaves of three, let them be! Teach your kids to identify plants like poison ivy, poison oak, and poison sumac.

�Drink responsibly. Alcohol and drugs are major factors in accidents. Substance use can impair judgment, causing people to take unhealthy risks. A party atmosphere can contribute to this. Know your limit and respect it. And be sure to appoint a designated driver.

FOR MORE SUMMER SAFETY TIPS, visit www.cdc.gov/family/minutes/tips/ summersavvy/index.htm.

WWW.USFHPNW.ORG HEALTHY LIFESTYLE SUMMER 2018 | 3

Moving can be stressful. On the plus side, there’s the opportunity for a fresh start in a new place. On the downside, there’s the strain of moving and the loss of friends.

Summer is the time many in the armed forces face Permanent Changes of Station. Though the move may be nonnegotiable, your attitude is within your control.

HELP YOURSELFHelp your family adjust by keeping a positive outlook yourself. Keep on top of the many details involved in moving. To do so: �Get organized. Make a list of what

to do before your move and after you reach your new home.

�Lighten up. Have a garage sale.Donate what’s left to charity. The less you have, the less you have to pack.

�Devise a packing system. Color-code boxes to help you quickly identify where things go.

�Keep important papers and valuables with you. Include birth and marriage certificates, school records, insurance policies, special jewelry, laptops, and heirlooms.

Get back to your routine as soon as possible. Doing so will give everyone a sense of continuity.

SUPPORT YOUR CHILDRENYour children are bound to fret about leaving old friends, making new ones, and fitting in at a new school. These suggestions can help ease the transition: �Communicate. Fill your kids in

on what you know about your new community, their new schools, and the neighborhood.

�Help them say good-bye. Throw a going-away party. Help your children make a list of people they want to keep in touch with.

Consider giving them access to social networking sites. Depending on their ages, Facebook and Twitter accounts can make staying in touch with old friends simple.

�Do everything you can to help your children adjust to new schools. Find out and share what the schools look like and if they offer any special sports or programs of interest.

Managing Emotions During a Family Move

FOR MORE INFORMATION, visit the American Academy of Pediatrics at www.healthychildren.org and search for “moving.”

HAVE A NICE TRIP!

BEFORE YOU LEAVE �Pack a first aid kit with a supply of any

medications family members take. �Don’t forget an emergency kit with

jumper cables, a flashlight, flares, and equipment for changing a tire.

�Stock up on healthy snacks, drinks, and water to supplement meal stops.

�Have your car serviced before leaving.

ON THE ROAD �Take breaks at least every two hours. �Steer clear of aggressive drivers. �Avoid driving late at night. Experts

say the hours between midnight and 6 a.m. are especially dangerous.

COPING WITH CAR SICKNESS �Eat a light snack before the trip. �Sit in the front seat or fix your eyes

on distant objects outside the car. �Don’t read in the car. �Ask your doctor about motion

sickness medication.

KIDS AND AIR TRAVEL �Be sure your child is up-to-date on

all vaccines before traveling. �An FAA-approved car seat will ensure

your small child’s safety on the plane. �The sensation of ear-popping on

takeoff and landing can be especially painful for a child. Offer your child acetaminophen or ibuprofen before boarding. A drink of water or juice before the flight can help. So can chewing a fruit snack.


OPEN ENROLLMENT COMING THIS FALL The National Defense Authorization Act of 2017 introduced many changes to the TRI-CARE program. The legislation consolidated the TRICARE Extra and Standard programs into a PPO-like entity named TRICARE Select. TRICARE Prime is unchanged. TRICARE Prime resembles an HMO. US Family Health Plan is a TRICARE Prime option.

This fall, for the first time, TRICARE will go to an open enrollment season for TRICARE beneficiaries under the age of 65. The new enrollment rules permit a change between TRICARE Select (PPO) and TRICARE Prime (HMO) only during the open season. The only exception would be if a military family had a qualifying life event. Go to www.tricare.mil/LifeEvents/QLE to learn more about the rules of qualifying life events.

If you are satisfied with US Family Health Plan and your provider, no action is required. We value you as a member and are grateful you have chosen us to be your health care partner.

What Are Annual Beneficiary Surveys?

Annual beneficiary surveys are questionnaires that are sent on a yearly basis to random members of the health plan.

In these surveys, you'll find questions designed to address different areas, such as:1. Areas of opportunity on changes, updates, and

your perspective of the overall customer service experience. We want to be sure your experience with US Family Health Plan remains above and beyond your expectations.

2. The potential of discovering any or all of the three items below:a) Fraud—any intentional deception or

misrepresentation that an individual or entity perpetrates that could result in unauthorized benefit of payment

b) Abuse—any practice by providers, physicians, or suppliers that is inconsistent with accepted medical or business practice

c) Waste—any overutilization of service or other practice that, directly or indirectly, results in unnecessary costs to the health care system

We value your feedback and understand you may be inundated on a daily basis with many requests for your time.

We appreciate the time you spend offering honest and beneficial information that will help us improve our service and ensure you are satisfied with the services you receive from health care entities and providers.

Your feedback is another way for US Family Health Plan to demonstrate our primary goal is to care for you and ensure that our network of providers serve you with integrity, compassion, stewardship, and respect.

MAKE THE MOST OF NEW DOCTOR VISITS

When you meet a new doctor, take the time to get acquainted. This will help you and your doctor work together over time.

BEFORE YOUR VISIT: Compile a medical history. List all health conditions, surgeries, and hospitalizations. Add a family history. This can help your doctor assess your baseline health and know what to look for.

List any current problems. When did the problems start? What have you done for them? Do you see any specialists?

Write down all medicines you take. Include over-the-counter drugs, vitamins, and supplements. Give the list to your doctor. Better yet, take the medicine bottles with you.

AT YOUR VISIT:Be honest. The doctor needs to know what’s really going on.Be candid about risky behaviors (smoking, illicit drug use, too much alcohol, unprotected sex). Discuss mental health issues, too.

Take someone with you. A friend or family member can remind you what you planned to talk about, and help you remember what the doctor said.

Ask questions. Find out what you can do to feel better, such as diet changes. If what the doctor says is not clear, ask. When it comes to your health, there are no silly questions.

US Family Health Plan at PacMed membership includes more than 18,000 members. The Plan has grown over 45 percent in the past six years. The USFHP network now has more than 700 primary care providers in 96 locations in nine counties in Western Washington. Ninety-two percent of our members have access to a primary care clinic within a 10-minute drive.

Our civilian health network includes top medical groups: Pacific Medical Centers (PacMed™), MultiCare Health System, Providence Medical Group, Whidbey Health, Pediatric Associates of Whidbey Island, Island Hospital Family Care Clinics, Family Care Network, Franciscan Medical Group (including The Doctors Clinic and Harrison Health Partners), Yelm Family Medicine, Lakewood Pediatric Associates, South Sound Pediatric Associates, and Peninsula Community Health Services.

US Family Health Plan members are free to choose a primary care provider (PCP) from any medical group in the network. If you would like to change providers, use our online directory to find a PCP near you: www.usfhpnw.org/find-a-doctor.

Before you change, call the clinic to be sure the provider is open to taking new patients. Call Member Services to let us know you would like to change your provider.


Our Family Is Growing

DO YOU HAVE OTHER HEALTH INSURANCE?

US Family Health Plan (USFHP) is required by the Department of Defense

to obtain information about other health insurance you or your dependents may have. USFHP will conduct an annual

survey requesting this information. When you receive this survey in the mail,

complete the questionnaire and return it in the enclosed postage-paid envelope.

If you or your family member(s) do not

have other health insurance, please respond to question one, sign and date

the questionnaire, and return it. You may also fax it to 206-326-2458.

Please call Member Services if you require assistance.


Member Rights and Responsibilities

WE ARE DEDICATED TO PROTECTING THE RIGHTS OF OUR MEMBERS. THE FOLLOWING INFORMATION IS DESIGNED TO INFORM YOU

OF YOUR RIGHTS AND RESPONSIBILITIES AS A MEMBER OF THE US FAMILY HEALTH PLAN.

IMPORTANT PLAN INFORMATION—KEEP FOR YOUR RECORDS

MEMBERS’ RIGHTSAs a US Family Health Plan member, you have the right to: �Receive information about covered benefits

and cost sharing �Receive information about the US Family Health

Plan, and our services, licensure, certification, and accreditation status

�Receive information about our practitioners, providers, and health care facilities, including information about the composition of our network

�Have a choice of health care providers that is sufficient to ensure access to appropriate high-quality health care

�Receive information on member satisfaction �Be informed of the processes for accessing

specialists and emergency services �Receive considerate and respectful care, with

recognition of your personal dignity at all times �Have access to all the health care and treatment

services we provide, including care management information, consistent with available resources and generally acceptable standards

�Have access to emergency health care services when and where the need arises

�Refuse treatments to the extent permitted by law and government regulations and the right to be informed of the consequences of such refusal of treatment

�Question the adequacy of care being provided �Have privacy and confidentiality concerning your

medical care and records to the extent permitted by law. You have the right, and will be afforded the opportunity, to approve or refuse the release of such information, except when release is required by law or the Department of Defense

�Know the identity and professional status of the health care provider primarily responsible for providing and managing your care, as well as other health care personnel involved in your treatment

�Participate in decisions involving your health care. Members who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other representatives

�Understand an explanation of the diagnosis, treatment, and prognosis of your illness

�Be informed of possible complications, risks, benefits, and alternative treatments associated with consent or refusal for treatment in order to make knowledgeable decisions about your course of care

�Be advised if the US Family Health Plan proposes to engage in or perform experimental research in order to make knowledgeable decisions about your care. You have the right to refuse to participate in experimental research

�Receive care and treatment in a safe environment and to be informed of the facility’s rules and regulations that relate to patient and visitor conduct

�Be informed of the US Family Health Plan member grievance and appeal system, designated for the initiation, review, and resolution of member complaints and appeals. You have the right to file complaints and appeals with US Family Health Plan, as outlined in the Grievances and Appeals Processes section of the Member Handbook

��Use our internal complaint and appeal processes to address concerns that may arise

�� Receive considerate, respectful care from all members of the health care system without



discrimination based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment

�Report recommendations or questions you have to a Member Services Representative. Doing so will help us better serve all members

MEMBERS’ RESPONSIBILITIESAs a US Family Health Plan member, you are responsible for: �Becoming knowledgeable about your health

plan coverage and health plan options, including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions

�Providing your physician complete information, to the best of your knowledge, regarding your past medical history and other matters relating to your health

�Becoming involved in specific health care decisions �Complying with the medical and nursing treatment

plan, including the follow-up care, agreed upon by

you and your health care provider(s). This includes keeping appointments and notifying providers, in a timely manner, when an appointment cannot be kept. You also have the responsibility of letting your provider know whether or not you understand the treatment plan and what is expected of you

�Maximizing healthy habits, such as exercising, not smoking, and maintaining a healthy diet

�Making a good-faith effort to meet financial obligations, including paying applicable copayments at the time the services are received

�Following the claims process and using the disputed claims process when you have a disagreement concerning your claims

�Being considerate of the rights of other patients, and of US Family Health Plan personnel and network providers

�Being respectful of the property of other persons and facilities

�Following provider facility rules and regulations affecting patient conduct, including no-smoking rules, parking regulations, etc.

�Reporting wrongdoing and suspected fraud to appropriate resources or legal authorities

Member Rights and Responsibilities

WE ARE DEDICATED TO PROTECTING THE RIGHTS OF OUR MEMBERS. THE FOLLOWING INFORMATION IS DESIGNED TO INFORM YOU

OF YOUR RIGHTS AND RESPONSIBILITIES AS A MEMBER OF THE US FAMILY HEALTH PLAN.



How Does 3-D Mammography Legislation Affect You?Recently the Washington State Senate passed legislation requiring all private insurance companies to cover digital breast tomosynthesis, also called three-dimensional mammography. This imaging technique attempts to improve the visibility of cancers and identify malignant and non-malignant features.

This mandate does not apply to TRICARE programs, including US Family Health Plan. The Department of Defense may establish this coverage requirement at some point in the future, although we have received no indication this will be happening soon.

USFHP Members seeking this service are required to sign a Waiver of Non-Covered Services form. USFHP network providers

must inform beneficiaries in advance that 3-D mammograms are not covered by TRICARE or USFHP.

PacMed’s contract with the DoD will not permit it to reimburse network providers for non-covered services. Additionally, network providers can only bill beneficiaries for those services if the beneficiary signs a waiver. The signed waiver confirms that the beneficiary has agreed in advance to pay for non-covered services. Providers must keep copies of all signed beneficiary waivers.

If you need have questions or need assistance, please contact USFHP Member Services at 1-800-585-5883.

UNDERSTANDING YOUR USFHP MEMBERSHIP CARD


Summertime is packed with parties, family gatherings, road trips, and more. Amid the fun, don't forget to take your medications. These steps can help:� ��Use a weekly pillbox. ��Take your medicine at the same

time each day. ��Set a reminder alarm or ask your

pharmacist about timer caps. These special caps on pill bottles remind you when it’s time to take a dose.

��If possible, order a 90-day supply of your medicine so you always have it on hand.

��Traveling? Pack enough medicine to last the entire trip. Keep it in a carry-on bag in case your checked baggage gets lost.

If a prescription or over-the-counter drug expires, what should you do? An expired medication may not be dangerous, but it may be less effective.

Over time, medication loses its potency, especially tablets and capsules. Exposure to air, light, and moisture increases the process. That’s why it’s so important to store drugs in a cool, dry, dark place. For example, avoid keeping medicines in bathrooms or by a window.

Bottom line? Experts say that some drugs can be effective for up to five years after the expiration date if stored properly. But there’s no way to tell. Play it safe. Discard medicine when it reaches its expiration date.

Mind Your Meds on VacationPHARMACY CORNER

We have heard feedback from many members on the recent changes to copayment amounts. These changes were shared with you in a letter as well as in a previous newsletter. We know that these changes can be confusing, so we hope to address some of your questions and concerns.

These changes affect only military retirees without Medicare Part B. The copayment is the amount you pay when you see a provider in the US Family Health Plan network. On January 1, the copayment changed to $20 for primary care and $30 for

CO-PAY CHANGES: WE HEAR YOU

specialty care. The copayment used to be $12 for either kind of visit. It is important to understand how the amount was changed. The U.S. Department of Defense (DoD) sponsors US Family Health Plan. The DoD

determines all aspects of the Plan, including copayments. PacMed is the administrator of US Family Health Plan in this region, and we must carry out all DoD decisions for the Plan.

We care tremendously about your health, and we understand that this change may be difficult. We do not want any member to skip care. You can talk with your provider about ways to keep costs as low as possible. This may include making a strategy for the timing and frequency of visits.

If your provider uses an electronic health record, you may send an

electronic message to him or her, for example, by using MyChart. This is useful for minor concerns that may not need a visit, like questions about a cold or a medication.

As always, keep in mind other resources and services US Family Health Plan makes available to our members. These include Medline Plus (www.medlineplus.gov) and nurse and social work case managers. Our case managers can help coordinate your care and connect you to health and other services you need.

We believe that US Family Health Plan continues to offer excellent value to military families like yours. Our Member Services team is available to answer your questions. Please call 1-800-585-5883.

Thank you for your service. We are grateful you have chosen US Family Health Plan at PacMed as your TRICARE option.

How Does 3-D Mammography Legislation Affect You?

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US Family Health Plan1200 12th Ave. SouthSeattle, WA 98144-9901

Healthy Lifestyle is published twice a year by US Family Health Plan at 1200 12th Ave. South, Seattle, WA 98144-9901. ©2016. All rights reserved. Reproduction of Healthy Lifestyle without permission is strictly prohibited. No material in this issue may be reproduced without written permission. The publishers do not assume responsibility for unsolicited editorial material.TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved.

All articles in Healthy Lifestyle are written and edited by professionals in health care communications and reviewed for accuracy by appropriate specialists. Healthy Lifestyle does not promote any form of medical treatment, nor does it encourage the self-management of medical problems. It is meant to supplement, not replace, the advice and care of health care professionals.

A MEMBERSHIP SERVICE FROM THE US FAMILY HEALTH PLAN

Developed By StayWell

Ask Member ServicesQ: WHO CAN ANSWER QUESTIONS ABOUT ELIGIBILITY, BENEFITS, OR PROVIDERS IN THE US FAMILY HEALTH PLAN NETWORK?A: If you have questions regarding eligibility, benefits, or providers, call the Member Services Department at 1-800-585-5883. Representatives are available Monday through Friday, 8 a.m. to 4:30 p.m.

Q: CAN I USE MY VA INSURANCE AT MY US FAMILY HEALTH PLAN CLINIC? A: To qualify for routine health care at community facilities at the VA’s expense, you must first get a written referral. The medical facility must also agree to accept VA referrals. Some factors that may determine whether such care is authorized is your medical condition and the availability of VA services within your geographic area. VA copayments may be applicable.

Q: WHAT DO I DO IF I GET A BILL FROM A PROVIDER? A: Instruct your provider to send the bill to US Family Health Plan. Do this as soon as you receive the bill to keep it from going into collections. Have the provider send the bill to the address on the back of your membership card. US Family Health Plan will pay for covered and authorized services.

Q: DO I NEED AN AUTHORIZATION BEFORE GOING TO THE ER? A: If you have a medical situation that you think threatens life, limb, or sight, call 911 or go to the nearest emergency room (ER) right away.

The Plan defines an emergency as a condition that a layperson expects may place the patient in serious danger, seriously harm their body functions, or seriously harm their organs. A layperson is

not an expert but has an average knowledge of health and medicine.

Examples of an emergency include the following: Severe chest pains Difficulty breathing Loss of consciousness Poisoning

If you’re not sure whether a condition is a true emergency, call your clinic first. Notify the Plan about your ER visit within 24 hours or on the next business day.

DAYS OF SUMMER SAFETY - usfhpnw.org · Have yearly skin exams if you’re at high risk. Learn more...

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