myhealthmylife
TM
2015 Issue 1
What’s Inside
Treat Yourself to
Good Health!
Preterm Labor –
Are You at Risk?
Stay Healthy for
Your Family
2
8
14
Treat Yourself
to Good Health
As an added benefit for being a Passport member, you can earn free gift cards for making healthy
choices. We hope you’ll take advantage of our 2015 rewards, because helping you stay healthy is
what we’re all about!
Who's
Eligible
All
Members
Members
with
Diabetes
Females
(ages 21 to 65)
What You
Can Earn
$20 gift card
$50 gift card
What You Need How This
to Do in 2015
Benefits Me
Visit a dentist
for a check-up.
Receive seven (7)
diabetes screens: flu
shot, microalbumin,
blood pressure, foot
check, weight with
BMI, HbA1c and a
dilated eye exam.
$20 gift card
Get a Pap test.
Children and
Teens
(ages 8 to 17)
2
$10 gift card
Visit us online at www.passporthealthplan.com
These screens
help you control
your diabetes.
A Pap test
checks for
cervical cancer
and can find
any problems
early.
Get a mammogram.
A mammogram
checks for breast
cancer and
can find any
problems early.
Visit your doctor for
a well-child visit and
get any shots you are
due to receive.
Well-child visits
help make sure
your child or teen
is growing up
healthy.
$20 gift card
Females
(ages 50 to 75)
Dental checkups help keep
your teeth and
gums healthy.
Who's
Eligible
Pregnant
Members and
New Moms
What You
Can Earn
What You Need
to Do in 2015
• Earn a $50 gift card
for attending six (6)
prenatal visits.
Up to $110
in gift cards
• Earn a $50 gift card
for attending a
postpartum check-up
within 3 to 8 weeks
after delivery.
• If you had a
C-section, earn a $10
gift card for having
an incision check.
Members with
High Blood
Pressure (ages
18 to 85)
Members
with Chronic
Obstructive
Pulmonary
Disease
(COPD)
$20 gift card
Visit your doctor and
have a blood pressure
reading of less than
140/90.
$20 gift card
If you have any
questions about how to
earn rewards or if you
need a rewards form,
please call us at
1-877-903-0082.
Get a spirometry test.
How This
Benefits Me
• Prenatal visits can
help you have a
healthy pregnancy
and baby.
• At a postpartum
and incision checkup, your OB doctor
can see how you’re
doing and make
sure you’re healing
well.
Having a blood
pressure reading
of less than 140/90
can help lower your
chances of heart
attack and stroke.
A spirometry test
tells your doctor how
well your lungs are
working and helps you
control your COPD.
To receive your gift card, have your doctor fill
out a rewards form. You or your doctor can fax or
mail the completed form to us:
Fax to: (502) 585-7997
Mail to: Passport Health Plan
Attn: Member Rewards
5100 Commerce Crossings Drive
Louisville, KY 40229
Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566
3
Set Healthy Goals
as a Family
You and your
family can grow healthy
together. The key is to
set clear health goals and
to have a plan. Each goal
you reach as a family can
improve your everyday
life and overall
health!
Here’s How to Get Started:
1
Sit down as a family and talk about your
health goals. Talk about “why” you want
your family to be healthy. Let everyone
talk and be sure to listen!
2
Each family member can choose a goal.
Pick food, body and mind goals. Some
examples may include:
3 Food Goals —eat breakfast, drink
more water, replace sugary snacks
with fruit
3 Body Goals — take a walk as a
family, try a new sport or activity,
get 8 hours of sleep each night
3 Mind Goals — read with your child,
do a puzzle, listen to music and
memorize the words
3
Set a family date each week to talk about
your goals. How are you doing? What
changes have you made?
4
Reward everyone for a job well done.
Once a goal has been reached, plan
something fun like family movie night.
Whatever you do — start with small, easy goals.
You’ll have a better chance of sticking with your
plan and making family goals a true success!
Source: www.nourishinteractive.com
4
Visit us online at www.passporthealthplan.com
Protect Your Child from
Secondhand and Thirdhand Smoke
Children need to stay far away from any type of smoke.
If your child has any health problems, smoking could
make them worse! It’s important to know the dangers of
secondhand and thirdhand smoke.
Secondhand smoke can cause:
Secondhand smoke is being around someone who is
smoking cigarettes, pipes or cigars. You breathe in the
smoke that is exhaled by the person who is smoking.
• Ear infections
• Asthma
• Pneumonia
• Bronchitis
• Sudden Infant Death
Syndrome (SIDS)
• Lung problems
Thirdhand smoke is when
the gas and particles from
smoke stick to surfaces
like hair, skin, clothes,
toys, furniture, drapes,
carpets and walls. The
gas and particles form a
deposit on these surfaces.
Ways to Protect Your Child!
3 Keep your child’s living space smoke-free.
3 Do not let anyone smoke in your house or car, even when your child is
not there. This can make things worse for your child when he
or she returns.
3 If someone has smoked in your child’s living space, open the
windows. Using a fan or air freshener will not get rid of
lingering smoke.
3 Being prepared can help you avoid trips to the emergency
room. Know what to do and make sure your child visits
a primary care provider (PCP) regularly and follows the
PCP’s orders.
3 If you’re worried about your child’s health, you may call
your child’s PCP 24 hours a day, 7 days a week.
Source: Center for Disease Control and Prevention, Mayo Clinic
Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566
5
your RIGHTS RESponsibilities
AND
We want you to know that you have certain rights and responsibilities as a Passport member.
You have the right to:
You have the responsibility to:
1. Be treated with respect and dignity.
1. Learn about your rights.
2. Privacy and nondiscrimination, as required by law.
2. Follow the policies and procedures of the
Department for Medicaid Services and Passport.
3. Choose a primary care provider (PCP) and
request to change your PCP.
4. Join your providers in making decisions about
your health care. You can refuse treatment.
5. Ask questions and receive complete information
about your condition and treatment options.
This may include specialty care.
6. Voice grievances (within 30 days) or file an
appeal about Passport decisions that affect
you. If you don’t agree with Passport’s appeal
decision, you may file a State Hearing with the
Department for Medicaid Services.
7. Receive timely access to care without any
communication or physical barriers.
8. Make an advance directive, like a living will.
9. Obtain a free copy of your medical records, as
permitted by law.
10. Receive timely referrals and access to medically
needed specialty care.
3. Learn about health services and treatment options.
4. Follow the steps of the Appeal Process.
5. Take part in personal health care decisions and
practice a healthy lifestyle.
6. Keep your appointments with providers and
cancel them when you cannot be there.
7. Provide, to the best of your ability, information
that Passport and your providers need to give you
the best care possible.
8. Learn about your health problems and follow the
orders and care plans that you and your providers
have agreed upon.
9. Tell us if you suspect fraud or misuse of Passport
ID cards or benefits by a member or provider.
To report fraud or misuse, please call Passport’s
Compliance Hotline at 1-855-512-8500 or the
Office of the Inspector General (OIG) at
1-800-372-2970.
11. Be free from any form of restraint or seclusion
used as a means of coercion, discipline,
convenience, or retaliation.
12. Receive information about Passport, your
benefits, our services, our providers, and your
rights and responsibilities.
13. Make suggestions about your rights and
responsibilities.
14. Discuss treatment options, regardless of cost or
benefit coverage.
6
Visit us online at www.passporthealthplan.com
We hope you
are happy with your
Passport benefits. If
you’re not, we want you to
tell us right away. If you
disagree with a decision
we’ve made, you or your
approved representative
may file an appeal.
Filing an Appeal
How to File an Appeal
• You may file an appeal by phone or in writing. If someone
files for you, you must give him or her written consent.
• Send your written request, comments, records or any other
information about your appeal to:
Passport Health Plan
Appeals Coordinator
5100 Commerce Crossings Drive
Louisville, KY 40229
• If you need help filing your appeal, please call
1-800-578-0603, press 0, then press 7307. TDD/TTY users
may call 1-800-691-5566.
• You may file an “expedited” or faster appeal if your health is
in danger. We’ll give you a decision within 3 working days.
• Once we review your request, we’ll send you a decision
letter. If you don’t agree with our decision, you may ask for
a State Fair Hearing. Your request for a State Fair Hearing
must be in writing and postmarked within 45 days from the
date of the decision letter.
• Send your written request for a State Fair Hearing to:
Kentucky Department for Medicaid Services
Division of Program Quality & Outcomes
275 East Main Street, 6C-C
Frankfort, KY 40621
To learn more about appeals or how to keep getting
services that have been denied, please call us at
1-800-578-0603. You may also see the appeals section in your
Member Handbook – “Your Guide to Passport Health Plan.”
Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566
7
Preterm Labor – Are You at Risk?
A normal pregnancy should last about 40 weeks. If you go into
labor early or before 37 weeks, it’s called preterm labor.
Preterm labor can cause your baby to be too small or have
lifelong health problems.
Learn the signs of preterm labor. You could lower
your chances of starting labor too early!
Signs of Preterm Labor
When your belly tightens into a ball
(contractions)
Cramping that feels like a period
Pressure between your legs or in your
thighs (pelvic pressure)
Low, dull backache
Vaginal bleeding
Stomach pain with or without diarrhea
Leaking or gushing fluid from the
vagina
Vaginal discharge that changes in color,
odor or amount
If you have any of these signs,
call your OB doctor right away.
We’re Here for You!
Our Mommy Steps team is here to support you
during your pregnancy. If you need some help, give
us call us at 1-877-903-0082. If you need help after
hours or on the weekends, please call our 24-hour
Care for You Nurse Advice Line at 1-800-606-9880.
Source: March of Dimes
8
Visit us online at www.passporthealthplan.com
Pregnant Members —
Treat Yourself!
Attend your doctor’s visits and we’ll reward
you with up to $110 in gift cards. For more
details, see page 3 or just give us a call at
1-877-903-0082.
The Risks of Being Induced
If you’re having
a healthy pregnancy, it’s
best to let your baby pick his
or her birthday. Your baby will
be born when he or she is ready.
Inducing labor is asking your
body to do something it’s not
ready to do. Take a look at
the many risks of
being induced:
The Risks of Inducing Labor
• Higher chance of needing a C-section
• Bleeding too much after delivery
• Infection
• Having a longer labor
• Having a preterm baby (born too early)
It’s totally normal to go past your due date.
You’re not overdue until 41 weeks. At 41 weeks, your doctor will decide
if you need to be induced.
Let Nature Take Over!
There are many benefits to letting labor come naturally and carrying your baby
the full 40 weeks of pregnancy. Here are a few of them:
35 weeks
40 weeks
At 35 weeks, your baby’s brain is only two-thirds (2/3) the
size that it will be when you’re at 40 weeks. Take a look at
the difference in size!
Your baby is less likely to have problems seeing, hearing
and breathing.
Your baby will have a lower chance of having jaundice,
low blood sugar and an infection.
Source: Association for Women's Health, Obstetric and Neonatal Nurses, March of Dimes: 39 Week Campaign
Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566
9
Pharmacy Benefits
We want to help you get the most out of your pharmacy benefits. Here, you'll
find the answers to some of the most common questions.
Some medicines must be approved by Passport
before you can get them. Your doctor will send
Passport a PA request when it’s needed. We’ll look
at the request and make sure the medicine meets
medical guidelines.
Some prescriptions have limits on them
such as:
• Quantity Limits: Some medicines
have limits on the amount we’ll cover.
• Step Therapy: Sometimes you need
to try a certain medicine first before
we’ll cover another medicine.
• Too Early to Refill: If you’re given
a 1-month supply of a medicine,
we’ll cover a refill when 30 days has
passed but not any sooner.
10
Visit us online at www.passporthealthplan.com
Our PDL is a list of all the medicines we cover and any limits
that apply. We also cover some over-the-counter (OTC)
medicines when your doctor gives you a prescription.
If your medicine is not on our PDL, there are three (3) things
you can do:
1
2
3
Work with your pharmacy or doctor to find a preferred
medicine.
Call Member Services at 1-800-578-0603 and ask for a
list of similar medicines that are on the PDL.
Ask your doctor to request approval for the medicine.
We make changes to our PDL from time to time. To find the
most up-to-date list, please visit www.passporthealthplan.com
and click on Pharmacy:
• To view our PDL, click on Printable Formulary.
Find out how you can
stay on top of your
health using your
cell phone!
minute.
911, family and friends.
SafeLink phone,
will not count towards your 250 minutes.
• To view our Over-the-Counter drug list, click on
Over-the-Counter Drug List.
If you don’t use a computer and would like some help,
just call Member Services at 1-800-578-0603.
We're pleased to
offer SafeLink phones to all members.
2 WAYS to enroll and get your FREE phone:
1
2
Visit www.safelink.com to apply online.
• 250 minutes
per month
Call SafeLink at 1-877-631-2550 to apply
over the phone.
• Unlimited
texting
Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566
11
As a Passport member, you have
many great benefits plus some extra
rewards! Take a quick look at three
(3) very important benefits covered
for you and your family.
My Benefits Corner
1
12
Visit us online at www.passporthealthplan.com
Dental –
What’s Covered
My Cost
1 cleaning per year
for adults (21 years
and older)
$0
2 cleanings per year
for children and teens
(under age 21)
$0
Other services for
children and teens,
as needed
$0
1 plaque removal for
pregnant women
$0
Treat Yourself
to a Few Extras
Visit a dentist for a check-up
and we’ll reward you with a
$20 gift card. We can also
find resources to help
pay for dental work.
Visits to the doctor and
any shots needed at that
time (children and teens
birth to 21 years)
My Cost
$0
Children and teens (birth to 21 years old) need
regular checkups. During a checkup, the doctor
can look for problems and make sure your child
or teen is growing up healthy. Children and teens
need checkups at these ages:
• 1 month
• 15 months
• 2 months
• 18 months
• 4 months
• 24 months
• 6 months
• 30 months
• 9 months
• Once a year during
ages 3 to 21
• 12 months
3
Treat Yourself
to a Few Extras
Have your child or teen
visit a doctor and we’ll
reward them with
a $10 gift card.
My Benefits Corner
2
Checkups –
What’s Covered
For more details
about how to earn
rewards, see page 2
or give us a call at
1-877-903-0082.
NEW! Stay Healthy at Home
We have a new benefit for members
with congestive heart failure (CHF) or
chronic obstructive pulmonary disease (COPD). Our Stay
Healthy at Home program can place a small machine in
your home to track your vital signs and symptoms. It sends
us the results and alerts us to your health status. Together,
we can help you live better with CHF or COPD.
To take advantage of this benefit, call 1-877-903-0082.
Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566
13
Stay Healthy
for Your Family!
Ladies, we know you put your family first. You do this even
if it means you have to ignore your own needs. You mean
well and you have a huge heart. But, please remember to
keep yourself healthy for the good of everyone.
The point is thiswhen a woman is healthy,
so is her family!
You can start being healthy by taking some important tests.
Finding a problem early is the key because it’s easier to
treat. Here are three (3) tests that are key for women:
14
Tests for Women
When to Get Tested
Pap Test –
checks for cervical
cancer.
• Start getting tested at age 21.
• Girls and young women
ages 9 to 26 can get an HPV
vaccine (Gardasil®) to help
prevent cervical cancer.
Mammogram –
checks for breast
cancer.
• Start getting tested at age 50.
If you have a family history,
ask your doctor if you need
to start earlier.
Chlamydia Test –
checks for a sexually
transmitted disease
that is passed from
person to person
during sex.
Get tested if:
• You’re under age 25 and
having sex.
• You have a new or more than
one sex partner.
• You’re pregnant.
Visit us online at www.passporthealthplan.com
Treat
Yourself
to a Few Extras
Get a mammogram and/or
Pap test and we’ll reward you
with a $20 gift card for
each test!
For more details
about how to earn rewards,
see page 2 or give us a call
at 1-877-903-0082. You can
also call us if you need help
setting up one of these tests
or getting a ride to
the appointment.
Source: The Clinical Guide to Preventive Services, US Preventive Task Force/Agency for Healthcare Research Quality
Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566
15
Help stop Fraud and Abuse
When fraud and abuse happens,
it hurts you, your doctors and
everybody in the health care system.
What is fraud?
When someone does something on purpose to get benefits they do
not have the right to receive.
Examples of fraud by a doctor, dentist, chiropractor or
other provider:
• A doctor bills you for a service you did not receive.
• A doctor bills you more than once for the same service.
Examples of fraud by a person or member:
• Someone lies about their income to receive Medicaid benefits.
• Someone uses a member ID card that doesn’t belong to them.
What is abuse?
Abuse can happen:
1
When someone does something that goes
against acceptable practices and causes
unnecessary costs to Passport.
2
When a provider causes Passport to pay
for something that was not needed or not
done the right way.
You Can Help!
• If you suspect fraud or abuse, report it! You may call Passport’s Compliance Hotline at
1-855-512-8500 and leave a message. When you call, you don’t have to give your name if you
don’t want to. Leave as much detail as possible so we can look into the matter. If you want to
speak with someone, please call 1-800-578-0603 and ask for the Program Integrity Investigator.
• If you receive a statement, look at it closely and make sure you received the services listed.
• Never let anyone use your Passport or Medicaid ID card.
16
Visit us online at www.passporthealthplan.com
Choosing the Right Care
for a Non-Emergency
Choosing the right care for a non-emergency can save you a lot of time
and trouble. Some examples of non-emergencies may include sore
throats, stomach aches, colds, minor cuts and bruises, and muscles aches.
The next time you have a non-emergency,
here’s what you can do:
Call your Primary Care Provider
(PCP) any time of the day or night.
Your PCP has your health history
and knows you the best! If the
office is closed, be sure to leave a
message. The doctor on-call will
call you back soon.
If you cannot reach your PCP,
you may call our 24-Hour Care
for You Nurse Advice Line at
1-800-606-9880. Nurses
are here to give you medical
advice and help you decide
what to do.
We Can Help You!
If you have any questions or need help setting up
an appointment, please call our Care Connectors
team at 1-877-903-0082. TDD/TTY users may
call 1-800-691-5566.
Your Opinions Matter to Us
Soon, you may receive a Member Satisfaction
Survey in the mail. This survey asks about the care
and service you are getting. If you receive a survey,
please fill it out and tell us how you feel. We want
to know what’s working for you and how
you think we can do better.
We’d like to thank you for
choosing Passport and for
being a valued member!
We look forward to hearing
from you.
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-21
Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566
CONT
INUE
TO
NEXT
PAGE


17
You Can Control Your Asthma
If you or your child has asthma, you’re not alone and you can control it!
People of all ages have asthma and are living healthy lives. Follow the tips
listed here and you’ll be on your way to controlling your asthma:
1
Make an Asthma
Action Plan
Talk with your doctor about making an
Asthma Action Plan. Your plan will tell you:
• What medicines to take
• When to take them
• How much to take
• When to get help
Share your plan with anyone who might be around when you have an asthma
attack — family, friends, teachers, coaches or day care workers.
2
Know Your
Medicines
There are two (2) main types of asthma medicines:
• Asthma controller medicines — the ones you take every
day to control your asthma. You must take controller medicines
every day for them to work.
• Rescue medicines — the ones you take to get relief from asthma
symptoms. Rescue medicines work fast to stop any coughing,
wheezing, trouble breathing or asthma attacks.
3
Use a Peak
Flow Meter
• A peak flow meter is a small device that
measures how fast you can blow air out of your
lungs. Your peak flow meter will give you a
reading or number. This number tells you how
well your asthma is doing.
• Know your “Personal Best” Peak Flow Number.
Your personal best number is the highest reading you
have within a 2 to 3 week time period.
• Your Asthma Action Plan will list a peak flow number for
each zone (green, yellow, red). Use your personal best number
to see which zone you’re in and what to do in that zone.
18
Visit us online at www.passporthealthplan.com
Get the Most from Your Medicine
Taking medicine for high blood pressure and high cholesterol can play a big role in helping
you feel better. Here are some easy tips to help you get the most from your medicine.
Know “Why” Taking Medicine Helps
• Taking medicine for high blood pressure and high cholesterol can lower
your numbers and help you avoid major problems.
• High blood pressure can lead to heart attack, stroke, kidney
disease and other problems.
• High cholesterol can lead to chest pain, heart attack and stroke.
Take Your Medicine As Directed,
Even if You Feel Fine
• When you have high blood pressure, you don’t
usually feel sick.
• Your medicine works best when taken exactly
as your doctor orders.
You May Need More Than One Medicine
• It may take more than one medicine to
control your blood pressure and cholesterol.
• Your doctor may give you a special diet,
ask you to exercise and watch your weight.
Call your doctor if you have any of
these side effects:
• Brown or dark-colored urine,
pale stool
• A dry cough
• Hives
• Yellow skin or if the whites of
your eyes become yellow
• Trouble breathing
• Swelling of your face, lips,
tongue or throat
• You become pregnant or if you
plan to get pregnant
• Stomach pain, nausea or
vomiting
• Fever
• Muscle problems like
weakness, tenderness or pain
• Feel more tired than usual
Treat
Yourself!
Control your blood
pressure and you can
earn a $20 gift card. For
more details, see page
3 or just give us a call at
1-877-903-0082.
Source: http://circ.ahajournals.org/content/early/2011/11/01/CIR.0b013e318235eb4d.full.pdf
Member Services 1-800-578-0603, TDD/TTY 1-800-691-5566
19
Marketing and Community Engagement Department
5100 Commerce Crossings Drive
Louisville, KY 40229
Helping Kentuckians
Live Healthier Lives™
Any information included in this newsletter is not intended to replace medical care or advice from your doctor. Any
references to other companies or internet sites are not an endorsement or guarantee of the services, information or products
provided. Passport does not take responsibility for anything that may result from the use, misuse, interpretation or
application of the information in this newsletter.
Passport does not guarantee the availability or quality of care. We are not responsible for any act or omission of any provider.
All providers contracted with Passport are independent contractors and not employees or agents of Passport.
CHECK OUT OUR NEW WEBSITE
WWW.PASSPORTHEALTHPLAN.COM
If you haven’t visited us online in a while –
now is the time! Our brand-new website
makes it easy for you to find the
information you need. One of the
coolest features is that you can
view our website in eight (8)
different languages:
• Spanish • Vietnamese
• Arabic
• Russian
• Somali
• Nepali
• Swahili
• English
P.S. — One more thing…
If you haven’t already done so, follow us on
Facebook, Twitter, Instagram and Pinterest!
Following our social media pages is a great
way to find health tips and information.
You might even score a $10 gift card for
visiting our Facebook page on Tuesdays at
noon Eastern Time! If you’re the first member
to answer the trivia question correctly, you win!
Be sure to read over the Trivia Tuesday rules
listed below the question.
MARK-40832 3/31/2015