Response on Rates and Plan Changes

Response on Rates and Plan Changes
Statement by Bill Crain, Administrator of the Oklahoma State and Education Employees Group Insurance Board

In July, the Oklahoma State and Education Employees Group Insurance Board was presented the preliminary rate study for current and pre-Medicare HealthChoice members. Actuaries for the Board recommended a 12% overall increase in premiums for the 2010 plan year.

The Board took several factors into consideration. These included information provided by meetings with several constituency groups, the projected budget shortfall for the state and the frozen appropriations for state agencies, school districts and other entities. The Board discussed that an increase of 12% would likely require additional cost cutting measures by employers, such as job layoffs.

After much deliberation, the Board decided that they had an obligation to keep the premium increase as low as possible. There were not any additional plan reserves that could be used to offset premium increases for plan year 2010, so plan changes would be necessary. After reviewing several options (including raising the deductible from $500 to as much as $1,000), it was decided that office visit copays and copays for other services would increase from $25 to $50. For preferred medications costing $100 or less, pharmacy copays were adjusted from $25 to $30. For preferred medications costing more than $100, the copay will increase to 25% of the cost of the drug up to a maximum of $60 (currently $50). The Board also directed its pharmacy benefits manager to contract for deeper discounts on pharmacy reimbursements.

With the implementation of these plan design and reimbursement changes, the Board was able to lower the premium increase to approximately 7.6%.

While this decision was difficult, the Board believed it to be necessary given the realities of tight budgets and increasing health care costs.

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Claims Processing Update

Although the transition from the previous claims administrator to EDS has been extremely difficult, there has been significant improvement with claims payment. Now, more than 70% of electronic claims are processed within one business day. However, much improvement is still needed in regards to the customer service being provided to HealthChoice members and providers. The extremely long hold times members and providers are experiencing when attempting to call EDS does not meet the requirements stipulated in its contract with HealthChoice. EDS has hired additional customer service representatives in an effort to reduce the hold time. HealthChoice will continue to monitor EDS’s progress in this area and apply financial penalties appropriately until it is in compliance with the contract.

For assistance with any outstanding claim issues, you can send an email containing the details of your issue to EDSResolution@sib.ok.gov. For security reasons, please include the member ID number in your email instead of the member's Social Security number.

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Save Your Skin - Tips for Winter Sun Safety and Skincare

Even though the sun’s rays are less intense during the winter, don’t be fooled by the weaker rays and colder temperatures. If you work and/or play outside during the winter months, it’s still very important to protect your skin from the harmful ultraviolet rays of the sun.

Hibernation is the only sure way to avoid the sun during the winter, but if hibernation isn’t in your plans, the American Academy of Dermatology offers the following recommendations for winter sun safety:

• Use a full-spectrum sunscreen with a sun protection factor (SPF) of at least 15. Be sure the product will block both UVA and UVB rays.
• Always use sunscreen if you’re going to be in the sun for more than 20 minutes.
• Apply sunscreen 15 to 30 minutes before you go outside.
• Remember to put sunscreen on every area of skin that will be exposed to the sun. Don’t forget the tops of your ears!

Be aware that along with colder temperatures, winter can bring dry, itchy, irritated skin. Your skin may crack, peel, or become inflamed. Most wintertime dryness is caused by a combination of low humidity and indoor heating. By following the guidelines below, you can feel more comfortable in your skin this winter:

Use a humidifier to replace some of the moisture that indoor heating takes out of the air.

Drink plenty of water to help keep your skin hydrated.

Avoid excessive bathing even though nothing feels better on a cold day than a long, hot shower. Bathing with lukewarm water instead of hot will help keep your skin hydrated (water shouldn’t be hot enough to redden your skin). Try not to spend more than 5 or 10 minutes in the shower or bath. To dry off, pat yourself gently, and never rub your skin.

Use mild cleansers instead of soap, and look for cleansers that are fragrance free. If you have to use soap, use it sparingly. If washcloths and other types of body sponges irritate your skin, use your hands to lather up.

Use a moisturizer to protect your skin. Oil based moisturizers work best – the more oil the moisturizer contains, the better it will protect your skin against moisture loss. Ointments contain the most oil and will form a protective layer on your skin, but they shouldn’t be used on areas of the body that get hot and sweaty. For the best results, apply moisturizers just after a bath or shower when your skin is still damp. Avoid products that contain alcohol as they can cause dryness, and it’s also a good idea to avoid products that contain fragrances or other chemicals that might irritate your skin.

Wear gloves to protect your hands from the cold air. Be sure the gloves don’t irritate your skin.

Dress in layers when you’re going to be outside because this will prevent overheating. Getting overheated and sweating are the most common causes of the scratch/itch cycle. Always remove wet clothing and shoes as soon as possible.

See your doctor if you have itchy skin without a visible rash, if your itchy, dry skin keeps you from sleeping, or if you develop any open cuts or sores from scratching.

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Could You Have Diabetes?

According to the American Diabetes Association, 23.6 million people in the United States have diabetes. That number includes both children and adults, and represents about 7.8% of our country’s population. Unfortunately, it’s been estimated that nearly one-fourth of these people, or about 5.7 million people, are unaware they have diabetes.

Diabetes is a metabolic disorder that is caused by the body’s inability to produce or use insulin properly. Insulin is a hormone that is required by the body to convert sugars, starches, and other foods into energy. Insulin is produced by the pancreas, and generally when people eat, the pancreas produces just the right amount of insulin; however, for people affected by diabetes, little or no insulin is produced by the pancreas or the body’s cells are not responding properly to the insulin that the pancreas is producing. The major types of diabetes are:

• Type 1 diabetes is often called juvenile diabetes or insulin-dependent diabetes and is usually diagnosed in children, teenagers, or young adults.
• Type 2 diabetes is known as adult-onset or non-insulin-dependent diabetes. This is the most common form of diabetes, and it can be diagnosed at any age.
• Gestational diabetes only affects pregnant women. Although this condition usually goes away after the baby is born, a woman who has had gestational diabetes is likely to develop type 2 diabetes later in life.
• Pre-diabetes is a condition that that occurs when a person’s blood sugar levels are higher than normal but not high enough for a diagnosis of type 2 diabetes.

Many people are unaware that they have diabetes because a number of the symptoms seem so harmless. Some of the signs and symptoms of diabetes include:

• Frequent urination
• Excessive thirst
• Extreme hunger
• Unusual weight loss
• Increased fatigue
• Irritability
• Blurry vision

There are certain factors that can increase your risk of developing diabetes. To find out your risk, take a look at the following list and note each item that applies to you:

• I am 45 year of age or older.
• I have a parent, brother, or sister with diabetes.
• My family background is African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander.
• I had gestational diabetes while I was pregnant, and/or I gave birth to a baby weighing 9 pounds or more.
• I have been told that my blood glucose levels are higher than normal.
• My blood pressure is 140/90 or higher, or I have been told that I have high blood pressure.
• My cholesterol (lipid) levels are not normal. My HDL cholesterol (“good” cholesterol) is less than 35 or my triglyceride level is higher than 250.
• I am fairly inactive. I am physically active less than three times a week.
• I have been told that I have polycystic ovary syndrome.
• The skin around my neck or in my armpits appears dirty. The skin appears dark, thick and velvety. This is called acanthosis nigricans.
• I have been told that I have blood vessel problems affecting my heart, brain, or legs.

If you checked any of the items listed above, be sure to talk with your doctor about your risk for diabetes and whether or not you should be tested.

Diabetes is a serious disease that can lead to other health problems such as heart disease, stroke, kidney failure, blindness, and amputations, but with early detection and treatment, the chances of developing the complications of diabetes can be decreased.

Pre-diabetes does not necessarily lead to the development of type 2 diabetes. By making changes in your diet and increasing your level of physical activity, it is possible for your blood sugar levels to return to normal range.

People with pre-diabetes and diabetes can and do live happy, healthy lives.

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The Dangers of Inhalants

According to The 2008 National Survey on Drug Use and Health, approximately 22.3 million Americans ages 12 or older have reported using inhalants at least once during their lifetimes. Inhalants are readily available, free or very cheap to purchase, and represent an easy way to get high. Inhalants are second only to marijuana when it comes to illicit drug use among Americans.

Common inhalants include:

• Medical gases like nitrous oxide or ether, and whipped cream dispensers that contain nitrous oxide*
• Aerosol sprays like air fresheners, hairsprays, deodorants, vegetable oil cooking sprays, spray paints, and static cling sprays
• Nail polishes
• Shoe polishes
• Glues
• Felt-tip markers or type correction fluids such as “White-Out”
• Fuel products like gasoline, propane tanks, butane lighters, and lighter fluids
• Paint thinners and removers
• Degreasers
• Refrigerants
• Compressed air keyboard cleaners**

In order to ingest the fumes from the gases, inhalant users will:

• Sniff or snort fumes from aerosol spray containers directly into their noses or mouths
• “Huff” fumes from inhalant-soaked rags stuffed into their mouths
• Sniff fumes from substances sprayed into paper or plastic bags
• Inhale fumes from balloons filled with gases such as nitrous oxide

Inhalant users often:

• Paint their fingernails with “White-Out” or a similar product
• Sit with felt-tip pens or markers held to their noses
• Have unusual odors on their clothing or breath
• Have sores or burns around their mouths
• Experience glazed eyes, slurring of speech, dizziness, and disorientation

Inhalants have a direct effect on the central nervous system and give a mind-altering, intoxicating effect that has symptoms similar to that of drinking alcohol. The high only lasts for a brief period of time. This is why some users continue to inhale over and over again to keep the high going. Habitual inhalant users can develop brain damage, muscle weakness, headaches, the loss of their sense of smell or hearing, nosebleeds, and depression.

There is always a chance of death with the use of inhalants. Death can occur from:

• Asphyxiation – when toxic fumes take the place of oxygen in the lungs and breathing stops
• Choking – it is common for users to choke on their own vomit
• Suffocation – many users will put a plastic bag over their heads containing inhalants
• Accidental death – caused by the lack of alertness or awareness
• Suicide – inhalant users are more prone to take their own lives

There is also a type of death from inhalants called “sudden sniffing death”. In this situation, it could be the first, the tenth, or the hundredth time an inhalant of any type has been used, but it can cause the heart to beat so rapidly and irregularly that it stops.

Keep yourself educated and aware of the warning signs of inhalant use. Early detection and treatment could save someone’s life!

*Known on the street as “whippets”
**Known on the street as “dusting”

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