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Important Information About Saving Money on Health Care

To all Members and Their Families:

You are all probably aware that medical rates are rising at an alarming rate. What you may not know is that together we can work to keep costs down.

You may ask, “Why should I do this?” Maybe your boss pays your premiums. However, even if your boss pays 100% of your premium, when 30% + annual rate increases are the norm, there will be a lot less money left on the table for raises and other benefits.

It is in ALL of our interests to work to keep our medical usage and costs down as a group.

At some point, the increases in medical costs will shift to the workers in the form of reduced wages or partial payments for the coverage. Most people in the country are already paying a portion of their medical premiums and with huge increases, this trend will increase.

So, even if it has not impacted your paycheck yet, it is just a matter of time before medical costs will impact every single one of you.

Since participants in Oxford/UnitedHealthcare through the UWF/USWU are rated as a large group, if we work together, we can keep our costs down.

You may not realize that a few very simple changes in the way we all utilize medical care can have a big impact on costs.

As educated consumers interested in protecting your own interests, we are asking you to start taking these simple steps. Please review the following pages of informational materials that will save you money. If you are married, please share this information with your spouse as well.

Some of the key points are:

  1. Minimize the use of the Emergency Room

    • Emergency room usage represents a huge portion of health care costs
    • Many emergency room visits are not truly medically necessary and superior care can be obtained using urgent care centers
    • Numerous Urgent Care Centers are available to Oxford participants
    • Urgent Care centers provide the same or better care for most illnesses and injuries that are treated in Emergency Rooms.
    • Urgent care centers offer faster service
    • Urgent care centers charge a fraction of the cost of emergency room visits – lower co-pays and much lower costs paid by your insurance
  2. Take advantage of the mail-order prescription plan for drugs you take on a regular basis

    • There is significant costs savings as well as added convenience in using this service
    • A sample order form is attached to these materials
  3. Log on to Oxford’s website periodically and check that your claims are being processed properly

    • Page 5 of this section explains how to log into the website to review the status of your claims
    • You should watch for errors in the processing of your claims
    • When you become aware of the costs of medical care, you will be better able to make prudent decisions about your medical care usage.
  4. Take steps to live a healthier lifestyle.

    • We’ve all heard it before – maintain a healthy weight, eat well, exercise, don’t smoke, etc.
    • Oxford offers a wide variety of wellness programs and services to help you get and stay healthy.

Workers’ Compensation

Another way you can save money by keeping your medical usage costs lower is to make sure you fully take advantage of Workers’ Compensation. Be sure to file a worker’s compensation claim if you suffer a job-related injury or illness. The costs associated with workers’ compensation claims are paid by your state’s workers’ compensation agency, NOT your medical coverage negotiated with your employer.

Workers’ compensation provides medical treatment, wage replacement and permanent disability compensation to employees who suffer job-related injuries or illnesses, and death benefits to dependents of workers who have died as a result of their employment.  If you are injured on the job you should notify your employer as soon as possible.   The notice may be given to your supervisor, personnel office, or anyone in authority at your place of business.  Notice should be in writing. If you need medical treatment, a request should be made to your employer as soon as possible.

By most state laws, you must be unable to work for seven days (including weekends and holidays) before you are eligible for temporary disability benefits. Benefits are retroactive to the first day. The seven days need not be consecutive. Necessary medical care is provided no matter how short or how long the length of the disability.

If you can return to work but your injury prevents you from earning the same wages you once did, you may be entitled to a benefit that will make up the difference. You may also return to work on light or alternate duty before you are fully healed.

If the worker dies from a compensable injury, the surviving spouse and/or minor children, and lacking such, other dependents as defined by law, are entitled to weekly cash benefits. The amount may vary from state to state.

For more information or to file a workers’ compensation claim please visit the following web sites:

New York : wcb.state.ny.us
New Jersey: dol.state.nj.us
Connecticut: wcc.state.ct.us

Ways to Save on Prescription Costs

You don’t have to be uninsured to worry about the cost of prescription drugs.  Increasingly, insurance companies are boosting co-payments and placing restrictions on what medicines are covered under its insurance plans. And though Medicare Part D has helped pay for millions of prescriptions, many seniors still struggle with the cost of their medications.

Yet people find ways to rein in the cost, and some pharmacies, drug companies and Web sites are helping their efforts. Here’s what you need to know to get started on trimming your medicine bills:

Check your policy. If your health insurance covers prescription drugs, it may have lower co-pays for generic drugs. A typical co-pay is $10 or $20 for a generic prescription and $30 or more for a brand-name version.

Many insurers have arrangements with mail-order pharmacies that allow patients to get three-month supplies of many “maintenance,” or long-term, medications, either at a discount or with lower co-pays -- one or two months’ worth of co-pays, for example, instead of having to pay for all three months. Your policy also may cap how much it will pay out annually for prescriptions or pay only for drugs on its formulary, which is a preferred list of medications.

Enlist your doctor and your pharmacist. If you want to cap your drug costs, you need these professionals as allies. Your physician knows your medical history and can discuss alternative therapies with you, while your pharmacist may be more aware of the specific costs of those alternatives. Also, pharmacists tend to be more clued in about what prescription drugs are about to be available over the counter.

Ask whether a prescription is necessary. There are plenty of over-the-counter medications that often work as well as their prescription counterparts. Some of these OTC remedies, such as Claritin for allergies or Prilosec for heartburn, were once prescription-only. Other OTC medicines have a long history of effectiveness. Consumer Reports recently noted, for example, that nonprescription drugs containing antihistamines -- such as Benadryl, Nytol, Sominex, Tylenol PM and Unisom -- can be just as helpful for occasional sleeplessness as more heavily promoted (and expensive) prescription medications such as Ambien, Lunesta, Rozerem and Sonata.

Or maybe the answer isn’t a drug at all. Some people have reported being able to save about 50% on drug costs simply by asking whether a drug is actually required. Maybe what you really need is to take better care of yourself. Ask the doctor if extra sleep, some vitamins, or a home remedy will do the trick. You’d be surprised what the answer is in some cases. If you’re overweight, don’t get enough exercise, eat a lousy diet or constantly are stressed, fixing those issues also can save you a bundle in the long run.

Some people simply have uncontrollable high blood pressure, diabetes, etc., but if your doctor warns you about being pre-diabetic take him seriously and make the lifestyle changes. It might not work -- some people are going to have these conditions no matter what they do -- but it’s better to try to avoid the problem to start with rather than ignore your health until you have to pay for meds and deal with chronic disease.

Ask about drug alternatives. If a prescription is necessary, find out first if there is a generic version that might work for you. Generics are basically former brand-name drugs whose patents have expired. The average prescription for a generic cost $29.82 in 2005, according to the National Association of Chain Drug Stores, while the average brand-name prescription cost $101.71. Web sites such as Rxaminer, founded by a cardiologist, can help you explore potential alternatives to many brand-name drugs. Obviously, you’ll want to discuss the options with your physician.

There isn’t always a generic equivalent. That’s where “pill splitting” can come in handy. Since increased dosages of a drug often don’t cost substantially more, your doctor can in some cases prescribe a larger pill that you can slice using a splitter available for $5 at most pharmacies. Someone taking a 10-milligram daily dose of the high-cholesterol medication Lipitor, for example, would pay $1,020 annually for the medication. If she took half of a 20-milligram pill, by contrast, she could lower the cost to $732, according to Rxaminer. Not all pills can or should be split, though, and this is not a do-it-yourself project. Talk to your doctor first.

Your doctor also may be able to write the prescription in a way that takes best advantage of your insurance policy’s co-pays. Buying in bulk through a mail-order plan for example, often results in savings. However, sometimes you might want to ask for less, particularly if you’re not sure how you’ll react to the drug or if it’s a painkiller that might not be necessary.

Ask for samples. If there’s no generic equivalent, your doctor may be able to supply you with enough free samples of a prescription drug to at least reduce your costs somewhat. Most physicians have a closet full of prescription-drug samples, thanks to free-handed drug vendors.

Shop around. Once you’ve got your prescription in hand, a little time spent on the Web and on the phone can save bundles of money. By the way, you should put as much or even more effort into shopping for your generic prescriptions as you do for your brand-name ones. The price you pay for a generic can vary by 80% or more, depending on where you buy it, while a brand-name drug’s cost typically varies by only 10% or so. One Houston physician who compared prices for a 90-day supply of generic Prozac found the cost ranged from a high of $117 at a chain pharmacy to a low of $12 at a warehouse club. And now you can get many generics for even less.

Take advantage of the generic-drug price war. Kmart and Wal-Mart kicked off the trend, and now it’s spread to other big chains. Wal-Mart, Sam’s Club, and Target offer hundreds of generic prescriptions for $4 a month while Kmart offers more than 200 generic prescriptions for $15 for a 90-day supply. Prices may be higher in some states; California, for example, has a law against pricing drugs below their cost, so some prescriptions on the list will be more expensive there.

Look for coupons and deals. Head to a brand-name drug’s official Web site to see whether there are coupons or other rebates available.  Doctors usually have rebate forms for insulin and other supplies. You can also register on the sites so that you are updated, occasionally getting a rebate form or check in the mail.

Log in today!

The Oxford Website is designed to make it  easy  for  you  to  keep  track  of  your  health care coverage. With just a few clicks of your mouse, you can check on a claim, let us know you are pregnant, or change your address. But www.oxfordhealth.com doesn’t just help you with administrative tasks. When you log in, you gain access to resources that can help you make important health care decisions. Learn how to get  the  care  you  need,  how  to  use our tools to help you stay healthy, and how to make the most of your health care coverage.

It’s probably a good time to do a quick “Website  walk  through” to help make sure you know  where  to  find  everything  you  need, and  to make sure  you are  taking advantage of our innovative offerings. So, log in to  www.oxfordhealth.com, and use this guide to take you where you need to go.

Log In

To log in to our Web site, type in your Username and Password, and click Log In.  If you forgot your Username or Password, click the “Forgot your username or password?” link to recover your information. If you need to register for our Web site, click the “Register Now” button.

Home

Once you log in to our site, your personalized home screen will open, which  shows  your  primary  care  physician  (PCP),  your  coverage information, our current messages, and our 24/7 Live Nurse Chat.  You’ll also notice large blue buttons along the right side of the page and seven blue tabs on the top of the page. These visual features will help you easily navigate through our Web site.

Claims & Accounts

Search and sort claims for you and your covered dependents. Use this page to view your claim summary and claims details, and to search past claims.  You can also download a copy of your Explanation of Benefits (EOB) for each claim, if applicable.  From  here  you  can  navigate  to  other  parts  of  the Web  site, including  Account  Balances,  Prescription  Claims  and  Claim Forms.

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