DIRECTOR'S REPORT–Thomas H. Young, Director

Happy New Year!

On behalf of all of us here at the NALC Health Benefit Plan, I want to wish you and your families a happy, prosperous, HEALTHY and peaceful 2003.

Open Season is over and the numbers are now coming into the Plan. It is still too soon to tell exactly the outcome of this Open Season, but we are currently showing a modest gain in membership, including the active postal category.

Our new members, as well as those who have remained with us, need to be continually educated as to how they can receive the highest level of benefits when the need arises.

That is where you come in, by delivering this information to your Branch members. The key elements of this education should be the proper use of the prescription drug program, the use of our extensive PPO network and the use of our various toll-free telephone numbers.

Year after year the membership seems to be confused as to the difference between "temporary" prescriptions and "maintenance" medications. Converting to the mail order system where maintenance medications are involved is a very important component of the Plan’s prescription drug program and a means of receiving the most from this very worthwhile benefit.

With regard to the PPO network, our members must understand that use of the PPO directory should be relegated to last on the list when seeking a provider. This is because the information contained in the directory is only up-to-date at the time of printing. New doctors and facilities are constantly being added and deleted. It is best to call the 800 number or use First Health’s website to find the most current list of providers.

Important too is the toll-free number for United Behavioral Health when a mental health/substance abuse provider is needed. The member must understand that, to obtain the most from this benefit, pre-authorization is required.

When you raised your right hand at your Branch installation ceremony, you committed yourself to take on a very tough job in the NALC. You will wear many hats — a counselor, teacher, comforter, and, at times, a bearer of news no one wants to hear. You share in illness and recovery, life and death, all in the name of representing the NALC and our Health Benefit Plan.

FOR THAT, I EXTEND A HEARTY THANK YOU!!!

THE HIPAA PRIVACY RULE

What You Have the Right to Know

As the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule compliance date of April 14, 2003 draws near, it is important to understand the purposes of the Privacy Rule. The Privacy Rule was written to protect the rights of individuals by limiting the access to their individually identifiable health information and how that information is used.

As a health insurer, the NALC Health Benefit Plan has always taken care to protect our member’s protected health information (PHI). However, under the Privacy Rule, we have adopted a Notice of Privacy Practices (Notice). This is located on Pages 7 through 10 of the 2003 brochure. The Notice is written in plain language, making it easy to read and understand.

Our Notice of Privacy Practices explains how we are allowed to use and/or disclose your protected health information. Unless there is an emergency situation or you are incapacitated,we must have your authorization to use or disclose your PHI for purposes other than to carry out treatment, payment or health care operations (TPO), and other uses permitted in our Notice. It is important that you complete and return the HIPAA Privacy Rule Personal Representative Authorization form if you anticipate a need to have someone assist you with your health insurance claims or questions.

If an enrollee in your branch wants you, as a Health Benefit Representative, to contact the Plan on his or her behalf to ask questions on specific claims, check claim status, or access health information, then the enrollee must complete a Personal Representative Authorization form naming you, the HBR, as a personal representative. You can request these forms from our Customer Service Representatives so you can have them available for your branch members. Even if the enrollee is with you when you make the call, under the HIPAA Privacy Rule, we cannot disclose individually identifiable health information to you unless we have this form on file.

We can and will continue to release limited claim status information only to an enrollee’s spouse enrolled on the policy. We will only disclose whether a claim has been paid and, if so, on what date and the amount paid.
We cannot disclose any further information such as the diagnosis or the reason for treatment, without an authorization. So you can see why it is also important for a husband and wife to name each other as their personal representatives.

Members with adult children (a person generally is considered an adult at age 18) on their policy should also be reminded that under the Privacy Rule, the Plan can only disclose to the natural parents of the adult child, claim status as well. In order for the natural parents to access more detailed PHI, such as diagnosis and treatment of the adult child, the child must complete a Personal Representative Authorization form naming the parents as their personal representative. Any member having an adult child away from home at college needs to understand the importance of having the adult child name a personal representative.

The Customer Service Department at the Plan is always available to assist our members complete these forms and answer any questions relating to the Privacy Rule during normal business hours, Monday through Friday, 8:00 a.m. through 3:30 p.m. eastern standard time.

HEALTH IN THE NEWS

Fight these health wreckers of winter

Skipping your workouts

• If you started skipping exercise in November, it’s even more important to start exercising again now so you can get back into shape.

Not eating right

• Drink water often. (Indoor heat is dehydrating.) Drink a glass of water after each mixed drink at a party.
• Start meals with chicken soup. It has disease-fighting chemicals, and you eat less of the main course.
• Choose nuts at gatherings and parties and eat them slowly. Skip the baked goods, candies and chips.

Getting sick

• Wash your hands often, especially if you touch your eyes, nose, or mouth, and after touching sick people.
• Increase your immunity by eating squash, carrots, or pumpkin, which the USDA says will increase your immune-cell count by a third.
• Do moderate exercise. Doctors say those who do seem to have fewer colds.
• Get enough sleep. Maintain your routine. Don’t eat heavy food or drink alcohol for a few hours before bed.

Virus, not bacteria, responsible for sore throats

When adults complain about sore throat, doctors prescribe antibiotics, so says a recent study published in the Journal of the American Medical Association.

The study found that during a 10-year period doctors prescribed antibiotics for a sore throat in 73-percent of the cases. Patients usually request antibiotics.

But here are the facts:

• A virus, not bacteria, most likely caused your sore throat. Antibiotics are ineffective against viruses, so they probably didn’t cause your recovery.
• Taking antibiotics for viruses contributes to the development of antibiotic-resistant bacteria, a problem with potentially dire consequences to public health and your own health.
• Antibiotics are useful against strep throat, but the condition, which is easily identifiable, is responsible for only 5 to 17 percent of sore throats.

THE PHARMACY CORNER

New Year — A few changes to note:

1		We have changed the copayment for mail order prescription drugs and supplies. If you order a 60-day supply, you pay only $7.00 for generic and $20.00 for brand name drugs; for a 90-day supply, you will pay $10.00 for generic and $30.00 for brand. In 2002 you paid $8.00 for generic and $17 for brand for a 60-day supply and $12.00 for generic and $25.00 for brand for a 90-day supply.
2		If you have Medicare, your mail order copayment for a 60-day supply of your medication is $5.00 for generic and $17 for brand. For a 90-day supply, you will pay $7.50 for generic and $25.00 for brand. Previously you paid $5.00 for generic and $13.00 for brand for a 60-day supply, and $7.50 for generic and $19.50 for brand for a 90-day supply.
Some drugs require authorization such as growth hormones or drugs for sexual dysfunction. If you find that you need prior authorization, please call the Plan directly during our normal business hours at (703) 729-4677 or toll-free at 1-(888) 636-6252.

New Drug Use Approved:

Xalatan’s Use for Glaucoma Widened

The FDA has approved Xalatan (generic: latanoprost ophthalmic solution) as a first treatment for elevated eye pressure associated with glaucoma and ocular hypertension. The drug is a prescription eye drop used once a day.

Xalatan has been available since 1996 and was initially approved as a secondary treatment only after treatment with other medications had failed.

How it works:		Xalatan lowers eye pressure by increasing the rate at which fluid drains out of the eye.
Side effects:		Possible side effects include blurred vision, burning and stinging, redness, itching, irritation, and color change.
Basis of approval:		Xalatan’s manufacturer submitted five-year safety data to the FDA to support its use as a first drug to lower elevated eye pressure. The drug already is used as a first treatment in 80 countries, according to the manufacturer.
FYI:		Caremark will ship 3 bottles as a 90-day supply–however, do not open all the bottles at one time because this drug has a 6-week shelf life once opened.
Manufacturer:		Pharmacia

FYI

Branch Reimbursement Forms

Enclosed with this issue of the HBR Report is the new Branch Reimbursement Certificate. Please read the instructions carefully.

In order to receive reimbursement, you must order a branch print-out from the Plan. Send a copy of the print-out, along with the completed certificate (signed by your Branch President or Secretary), to the Plan no later than April 30, 2003. Please make sure that all blanks are filled in. Remember, your reimbursement will be the lesser of $.75 per member enrolled in the NALC Health Benefit Plan, or the amount of expenses incurred during calendar year 2002.

United Behavioral Health

New to this issue of the HBR Report is a monthly insert from United Behavioral Health. These informative articles are sure to provide you with a wealth of information regarding mental health.

HBR Reference Manual

There are still copies available of the HBR’s 2003 Reference Manual. If you have not received a copy, have a new HBR, or need an additional one, please contact my office.