True Health New Mexico | true to your health | Spring 2018

2440 Louisiana Blvd. NE, Suite 601 Albuquerque, NM 87110 Standard U.S. Postage PAID Walla Walla, WA Permit No. 44 HERE FOR YOU Why you need a PCP 3 PHARMACY BENEFIT What’s changed in 2018 2 We believe in the importance of receiving regular preventive care: checkups, vaccinations (immunizations) and tests that screen for signs of disease. If you are wondering what preventive care you or your family members need at different stages of life, we have a guide on our website, truehealthnewmexico.com/preventive-screenings.aspx , for you to download and keep. If you have any questions about these preventive health guidelines, talk to your primary care provider. H ave you signed up to use our member portal? It offers you secure access to all the essential parts of your health plan, like your ID card, your summary of benefits and coverage and other health plan documents, our provider directory, the status of your claims, and more. You also can link quickly to health and wellness resources on truehealthnewmexico.com . Visit truehealthnewmexico.com/my-account-login.aspx to get started. Take the True Health New Mexico member portal with you wher- ever you go with our new mobile app for Android devices. You’ll find links to download the app when you log in to the portal. The iOS ver- sion of the app (for Apple devices) has been delayed. But even if you do not have the mobile app, the portal is optimized for mobile devices, so you can log in from your smartphone or tablet’s web browser and see everything that app users can see. THE MORE THINGS CHANGE … W elcome to the first issue of the True to Your Health newsletter. True Health New Mexico became your health plan on Jan. 1, 2018, when New Mexico Health Connections (NMHC) evolved into two com- panies. NMHC will keep offering individual health plans, while True Health New Mexico offers plans for employer groups. This new structure gives New Mexi- cans more choices for health insurance, whether they are individuals or part of a group. Although we have changed our structure, we have not changed our commitment to caring for our members and improving the health of our community. You can still count on the same excellence in care management and service. You can count on us to help you and your family stay as healthy as possible. Our zero-dollar copays for many generic medications is one way we do that. Another way is our use of advanced analytics. This helps our medical management team identify members who are at risk for a chronic disease so that we can help them before a serious problem develops. We also reach out to healthcare providers regularly to help ensure that our members are getting the right care, at the right time and in the right place. At True Health New Mexico, we take our mission of healthcare very seriously. Health is personal, but the healthcare system can feel overwhelming. We’re here to help you navigate the system to receive the best care—and to find your own state of true health. Martin Hickey, MD, CEO of True Health New Mexico Looking for your ID card? Find it in the member portal. Martin’s Message PREVENTIVE HEALTH CARE: WHAT IT IS AND WHAT YOUR PLAN COVERS THNM-ID0252-0218 What ispreventivecare? TheU.S.PreventiveServicesTaskForce (USPSTF) definespreventivecare servicesas “services suchas screening tests,counseling services,andpreventive medicines, [that]are testsor treatments thatyour doctororothersprovide toprevent illnessesbefore theycauseyou symptomsorproblems.” Whydoyouneedpreventivecare? Webelieve thatpreventivecare isvital toyour overallhealthandwellness.Oneof thebestways youcanbecomeand stayhealthier is tofindapri- marycareprovider (PCP)andbecomeestablished withhimorher.YourPCPwillcoordinateallof yourhealthcare services, includingpreventivecare. Whatdoesyourplancover? • Most preventivecare servicesarenot subject tocost-sharingwhenyouare seenbyaprovid- er in theTrueHealthNewMexiconetwork. • Age-andgender-specificpreventivecareand periodichealthexamsarecoveredbyyour TrueHealthNewMexicoplan.Thismeans that somepreventive servicesarecoveredwithout cost-sharingonly ifyouarewithin theappro- priateage range for those servicesasdeter- minedby theUSPSTFAandB recommenda- tions.Formore information,visit uspreventiveservicestaskforce.org . • On the followingpages isa listofpreventivecare servicescoveredbyTrueHealthNewMexico. Whatdoesyourplannotcover?What isnot consideredpreventivecare? • Ifyou receivenon-preventive (diagnostic) servicesduringapreventivecarevisit,youwill have topayyouroffice-visitcost-shareamount (copayment,coinsurance,deductible) for those services.Forexample,yourPCPmaydiagnose amedical issueduringawellnessexamand orderadditional tests.These testsarenownot consideredpreventive,andyouwillhave topay adifferentcost-shareamount. • Somepreventive services – forexample, travel immunizations –aregenerallynotcovered. Othernon-covered servicesor suppliesmay include those thatarenotconsideredmedical- lynecessaryorareconsideredexperimentalor investigational (unproven). Formore information • For informationaboutprescriptiondrugs that arecoveredunderyourpreventive services benefit,visit thePharmacypageofourwebsite, truehealthnewmexico.com/Formulary.aspx . • To learnmoreaboutwhat iscoveredbyyour TrueHealthNewMexicoplan,please refer to yourEvidenceofCoverage.Youcanfind itat truehealthnewmexico.com/small-group-plan- documents.aspx or truehealthnewmexico. com/large-group-plan-documents.aspx . • Questions? Call theCustomerServicenumber on thebackofyour insurance IDcard. be true to your health. truehealthnewmexico.com { B E P R O A C T I V E } Numbers you need to know CUSTOMER SERVICE: 855-769-6642, Monday through Friday, 8 a.m. to 5 p.m. •   Benefits. •   ID cards. •   Billing questions. •   Claims questions, status and reconsiderations. •   Member login help. •   General information. CARE CONNECT NURSE ADVICE LINE: 844-308-2552 TRUE HEALTH NEW MEXICO PHARMACY SERVICES: 866-341-8561 CVS SPECIALTY, OUR SPECIALTY PHARMACY: 800-237-2767 Good preventive care keeps you healthier, longer Our member portal puts your health plan at your fingertips