Author: matrixsuperadmin

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Awareness Food

Are Summer BBQ Alternatives Really Healthy?

“Plant-based” burgers, or veggie burgers, have been on the market for a while—do you want to know what are they really made of? Are they good for you?

While traditional veggie burgers have been around for years (typically made of whole beans, rice, corn, etc. and shaped into a disc), alternatives from companies like Impossible Foods™ and Beyond Meat™ offer something different: a look, taste and texture that might pass for the real thing. But one thing is for sure—neither option should be considered a health food.

Here’s a comparison of the nutrition information from each company compared to a real beef patty.*

Nutritional Info Real Beef (80% lean) ImpossibleFoods (TM) BeyondMeat (TM)
Calories 287 220 270
Fat 23 g 13 g 20 g
Sat. Fat 9 g 10 g 5 g
Protein 19 g 20 g 20 g
Carb 0 g 5 g 5 g
Sodium 75 mg 430 mg 380 mg
Fiber 0 g 0 g 3 g
Sugar 0 g <1 g 0 g

*Based on 4oz. patties.

Neither company is marketing these burgers for their health benefits. If you’re watching your sodium intake, pay particular attention to those eye-popping numbers above. To make these burgers taste like the real thing, salt and saturated fats are added—often in excess. Depending on your dietary restrictions, eating real meat may be healthier than one of these alternatives.

However, if you already follow a vegetarian or vegan diet, these options can provide a tasty alterative, even when dining out. Well-known chain restaurants like Burger King, McDonald’s and KFC are offering meatless options to their customers.

Categories
OSP

The Results are In: Option Selection Period Materials

Last fall, we included a survey in the materials our members received for the Option Selection Period. The survey asked members to rate the materials on a scale from 1 to 10. The results are in and were similar to past years’:

  • 89% rated the materials as 8 or higher on a scale of 1 (not satisfied) to 10 (very satisfied).
  • 86% felt they received the right amount of information—not too much or too little.
  • About 89% rated the personalized statement’s understandability as 8 or higher on a scale of 1 (not understandable) to 10 (very understandable).

While over 87% of members felt they had the right number of coverage options, a little more than 60% are interested in a vision benefit, a hearing benefit, or both.

Thank you to the more than 5,300 members who responded. We work hard to meet your needs and provide useful and relevant materials. We hope you continue to find the materials informative and helpful.

SilverSneakers Swanson Award

SilverSneakers® has opened nominations for the 16th annual Richard L. Swanson Inspiration Award. The award will be presented to one member whose commitment to health and staying active encourages others to live with vitality and purpose.

If you are an active member of SilverSneakers with an inspiring story, or know a member who should be nominated, SilverSneakers would like to hear it! Now through August 7, you can submit nominations for the SilverSneakers Swanson Award online at silversneakers.com/swansonaward.

Inspiration can come in many forms. Has SilverSneakers inspired you or someone you know to:

  • Set and reach a fitness goal?
  • Transform the way they look and feel?
  • Foster an active lifestyle?
  • Encourage others to join or keep participating in SilverSneakers?

If so, complete a nomination form today and you could become one of the faces of SilverSneakers! The top 10 finalists will be selected and their stories shared on the SilverSneakers website where a vote will determine the national award recipient. Online voting will begin on August 24 and the winner will be announced on September 14.

Categories
Awareness Prevention Safety Skin Care Sunscreen UV

Sun Protection Makeover

Summer is here! While it feels great to get outdoors, it’s important to consider your sun protection routine before stepping outside. It may be time for a makeover.

According to the American Cancer Society, a common cause for skin cancers is too much exposure to ultraviolet (UV) rays. For most people, the majority of UV-ray exposure comes from the sun. Most people don’t think about this in their usual routine—like running errands or walking around the block. This regular exposure can add up, which makes daily use of sunscreen one of the best defenses against UV rays.

There are many types of sunscreen with different levels of protection. Before buying your next bottle, consider the following:

  • Are you making quick trips or spending the day poolside? The sun protection factor (SPF) is the level of protection from UVB rays, which are the main cause of sunburn. The SPF number measures two things—how long you’re protected and the percentage of UVB rays that are filtered out. For example, an SPF 30 means 30 minutes in the sun with sunscreen is the same as 1 minute in the sun without it. Generally, the higher the SPF, the better, but only to a point. An SPF 15 filters out 93% of UVB rays; SPF 30 filters out 97%; SPF 50 filters out 98%. Certain medications may also make it easier to burn. Check with your doctor if you have questions about how your medications react to the sun.
  • Will you be swimming or exercising? Sunscreens labeled “water resistant” have to protect skin for 40 or 80 minutes of swimming or sweating.
  • Is it expired? Generally, sunscreen will last two to three years, but if the sunscreen has been exposed to heat for a long period of time, it might be less effective. Throw out sunscreen past its expiration date.
  • Is it easy to apply? Sunscreen should be applied before makeup or insect repellant. Some brands require application 20−30 minutes before going out in the sun. Others, like sprays and wipes, may make it a little trickier to get an even application across all areas of the skin. To stay protected, reapply every two hours and more often if you’re swimming or sweating.

Keep in mind that sunscreen is just a filter—it does not block all UV rays. Don’t forget about other forms of sun protection, like hats, UV-blocking sunglasses, umbrellas, and long sleeves.

Categories
Uncategorized

Online Information Sessions

Due to the COVID-19 health crisis, our in-person group meetings have transitioned to online meetings. 

Review the schedule of upcoming live webinars. Then, register for one or more of the sessions. After you make your selection, you'll receive a confirmation email with the date and time.

If you can't make a live webinar, or there are none currently scheduled, watch a recorded webinar. If you have any questions, call the HOP Administration Unit at 1-800-773-7725.

Categories
Health Options Program Prescription Drugs

Health Care 101: What You Need to Know

When your doctor prescribes a new medication, how do you know if it is covered? You need to check the formulary, which is the list of medications—both generic and brand name—covered by a prescription drug plan. In most cases, if a medication is not on the formulary, it is not covered by the plan.

Review the points below about how prescription drug coverage under the Health Options Program works, so you know what to expect the next time you fill a prescription.

What you Need to Know Why it is Important
The formulary lists all the covered medications. If a medication is on the formulary, it is covered. Use the Find a Drug Tool, download the Comprehensive Formulary for your Option, or call OptumRx to see if your medication is covered.
The Medicare Rx Options available under the Health Options Program use two different formularies.

The Enhanced and Basic Medicare Rx Options use the Prescription Drug Formulary for the Enhanced and Basic Medicare Rx Options. There are certain medications that are covered only under the Enhanced Medicare Rx Option.

The Value Medicare Rx Option uses the Gold5 Prescription Drug Formulary for the Value Medicare Rx Option.
A doctor’s prescription does not guarantee coverage. If a medication is not on the formulary, it is not covered. If your medication is not on the formulary, ask your doctor if another could work for you.
The formulary can change.

Formularies change to keep up with new therapies, medical practices, Food and Drug Administration (FDA) guidance, and Medicare requirements.

The Comprehensive Formularies for the Medicare Rx Options are updated monthly.
We may contact you if there are changes. If there is a change to the formulary that affects one of your medications, you may receive a letter in the mail from OptumRx or the HOP Administration Unit.
Medications fall into one of five coverage tiers.

The coverage tier identifies how the medication is covered. Generally, the higher the tier, the more it costs.

Sometimes, tiers are specific to one type of drug (e.g., all generic prescriptions are put on Tier 1). Other times, tiers are structured based on drug cost (e.g., lower-cost drugs are put on Tier 1).

It is up to the Plan to decide how to structure their formulary to provide members with cost-efficient options. The Centers for Medicare and Medicaid Services (CMS) reviews formulary decisions and may require changes, to ensure the formulary is created in the best interest of Plan participants.
There may be limits.

The formulary uses the abbreviations to note any limitations or restrictions:

  • Prior Authorization (PA). Approval from the Plan is needed before you fill this prescription. If you don’t get approval, it may not be covered.
  • Quantity Limit (QL). The Plan limits the amount of this drug that will be covered.
  • Step Therapy (ST). You must first try another drug to treat your medical condition before we will cover this one for that condition.
  • Non-Extended Day Supply (NDS). The drug is not available for an extended day supply.

As a reminder, if you are enrolled in a Medicare Advantage plan, the drug formulary, frequency of updates, and any limitations or restrictions will be different. Check with your plan for the most updated formulary.

Categories
Benefits Health Health Options Program Medical

Support When You Need it Most

Whether you are facing a serious health issue, hospital admission, or want to quit smoking, the Health Options Program has you covered. Our plan options provide financial protection from the high cost of health care, and other programs—such as the Elder Care and Health Care Management Programs—help with everything else.

The best part is you do not need to be a benefit expert. The advocates and case managers are trained on the Health Options Program benefit plans. Let them support you while you focus on your well-being. Each program is designed to focus on a specific type and level of care, as shown below.

Type of Info Elder Care Program (general wellness resources) Health Care Management (medically necessary services)
Program description A service that connects members with resources for their overall well-being. A program that supports members (or their authorized representative) through a serious health condition and related treatment.
How it works

Members can call the Elder Care Program at 1-866-794-0685 to speak to a social and human services advocate.

In certain cases, such as a hospital admission, an advocate may reach out directly to the member.

Advocates also work with Health Care Management case managers.

In most cases, a representative will reach out to members based on their claims experience.

However, members can call the Health Care Management Program at 1-800-480-6658.

A representative will take your information and send it to a case manager, who will contact you at a later time. All case managers are registered nurses.
Examples of when to use these programs
  • If you need help navigating Medicare resources, such as the State Health Insurance Program (SHIP).
  • If you need to find local meal delivery, transportation, utility assistance, or prescription drug delivery and discount programs.
  • If you need general wellness, specific condition care, or nutrition resources (e.g., smoking cessation tips).
  • When you need help planning for recovery or looking for alternative methods of medical care or treatment, equipment, or supplies.
  • When you need skilled nursing care at home, a skilled nursing facility, or home intravenous infusion therapy.

Services are available only when they are medically necessary and covered under the Health Options Program.

 

Categories
Prescription Drugs Safety

The Health Options Program has high standards for medication quality measures.

The prescription drug options under the Health Options Program are being recognized by the Pharmacy Quality Alliance for maintaining high standards in medication quality measures. These categories are part of the overall CMS star rating. The Program received an overall rating of 4.5 stars out of 5 for 2020. The Program also received a 4.5 star rating in 2019.

CMS awards a star rating to prescription drug plans based on performance in categories such as customer service, overall member satisfaction and patient safety. The Pharmacy Quality Alliance works with CMS on these measures and recognizes plans with an Excellence in Quality Award and the Quality Improvement Award. The Health Options Program is pleased to share this recognition.

Categories
Uncategorized

A Message from the Health Options Program

The Health Options Program is committed to ensuring your benefits continue to support you and your loved ones during the coronavirus (COVID-19) health emergency. This includes working with our health care administrators to implement plan changes based on newly-passed federal laws related to this crisis. It also means keeping you up-to-date on what these changes mean to you.

The latest piece of legislation is the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act). It clarifies how plans are required to cover COVID-19-related testing.

What the CARES Act means to you

  • Any test used to detect the virus is covered 100%. This includes tests authorized by the Federal Food Drug and Cosmetic Act; tests for which the developer has requested, or intends to request, emergency use authorization under the Drug Act; and those authorized by a state that has notified the U.S. Department of Health and Human Services (HHS) of its intention to review the tests; and tests determined appropriate by HHS
  •  Administration of the test is covered 100%
  • Provider visits—in person, telehealth, urgent care or emergency room visits—that result in an order for testing for COVID-19 are covered 100%
  • There are no prior authorization requirements for testing-related services

In addition, Medicare covers all medically necessary hospitalizations. This includes if you are diagnosed with COVID-19 and might otherwise have been discharged from the hospital after an inpatient stay, but instead you need to stay in the hospital under quarantine.

The insurance providers for the Medicare Advantage plans available under the Health Options Program may make other plan design changes. If you are enrolled in a Medicare Advantage plan, contact the insurance provider with questions about how your benefits work.

Frequently Asked Questions

  • Do I have to worry about staying in my network for COVID-19 testing? No. COVID-19 testing must be available to you at no cost whether the provider doing the testing is in-network or out-of-network.
  • What if I am charged for COVID-19 testing, including deductibles, copayments, and coinsurance? You will be reimbursed and/or your deductibles adjusted by your health plan. This applies to telemedicine services as well.
  • Will there be additional laws passed regarding COVID-19 and my health benefits? Potentially. We’re keeping a close eye on all the federal and state announcements to make sure we’re up-to-date.

We encourage you to follow all local, state and national COVID-19 regulations, and the advice and practical tips offered by medical professionals. Should you have additional questions about using your benefits during this time, contact the applicable plan administrator.

Benefit Plan Contact information
Medical benefits HOP Medical Plan, Value Medical Plan or Pre-65 Medical Plan HOP Administration Unit
1-800-773-7725
Medicare Advantage plans available under the Health Options Program Applicable contact information
Prescription drugs Enhanced, Basic or Value Medicare Rx Options OptumRx
1-888-239-1301
Dental MetLife Dental Plan 1-855-700-7997
Wellness SilverSneakers (available to members enrolled in the HOP Medical Plan, the Pre-65 Medical Plan and certain Medicare Advantage plans) HOP Administration Unit
1-800-773-7725
Categories
Materials

Pre-65 Meeting Materials

Like many organizations in the wake of the COVID-19 virus, we are evaluating situations that involve large gatherings of our members. The health and safety of our members is our top priority. This is why the Health Options Program has made the difficult decision to cancel the upcoming spring 2020 group meetings scheduled to run through the end of April.

We are providing the following alternatives until the in-person meetings are able to resume:

  • Limited individual telephone consultations. Members registered for a group meeting will be contacted to schedule an individual telephone consultation.
  • Online recording of the meetings. You can view a pre-recorded video of the Age 65 meeting presentation.

In the meantime, you can visit the About the Health Options Program page and watch the video that explains how Medicare works with the Health Options Program. The Forms/Resources page for Medicare-eligible participants provides additional information about the benefit options.

We will continue to closely monitor the circumstances specific to COVID-19 and update our members should the meetings resume.

If you have any questions or need any additional support, contact us at 1-800-773-7725.

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