{ FALL 2022 | FOR MEMBERS OF TRUE HEALTH NEW MEXICO } You do a lot of good things to ensure you stay healthy. You exercise regularly, make smart choices at the grocery store and try to reduce stress. But are you also staying on top of your vaccines and health screenings? If not, now is the time to get caught up. Vaccines (immunizations, shots) aren’t just for kids. They help protect people of all ages against preventable diseases and illnesses that can make you very sick and cost you a lot of money. Being vaccinated also protects the people around you. That includes those with chronic conditions, older adults and people who are receiving medical treatment that makes them more vulnerable to illness. In addition to your yearly flu shot, you and your family members may need other vaccines, depending on your age. You can find a comprehensive list of vaccines at truehealthnewmexico.com/ preventive-health-screenings. On this webpage, you’ll also learn what preventive health screenings, such as mammography and colonoscopy, you need, and how often you should get them. Best of all, vaccines and preventive health screenings are a covered benefit on your True Health New Mexico plan. If you have any questions about what vaccines or screenings you and your family need, talk to your doctor. Don’t forget! You can earn gift cards for completing these types of healthy activities through our Better You wellness program. Learn more on page 3. Source: Centers for Disease Control and Prevention Take your best shot at staying well Search for a provider or pharmacy in our network that provides flu shots at truehealthnewmexico.com. FLU SEASON ALERT Influenza can be MISERABLE & DEADLY. Nearly EVERYONE 6 months or older should get a yearly flu vaccine. Vaccinate! Don’t wait. Don’t hesitate. It takes 2 WEEKS for the flu vaccine to be fully effective. Important notice for all members By now, you should have received in the mail a notice from us about our plan discontinuation in 2023. The notice tells you what steps you should take to make sure you’re covered after your True Health New Mexico coverage ends. To find a copy of that notice and other notices about our discontinuation, please visit truehealthnewmexico.com/member-communications. VACCINES AND PREVENTIVE HEALTH SCREENINGS Simple steps to good health
On truehealthnewmexico.com, you can view and download all essential health plan information and documents. Our website has a lot of information, so use this chart to help you locate what you need. truehealthnewmexico.com/member -pharmacy-formulary • Our formulary (drug list) along with restrictions and preferences. • Information on drug coverage and any copayments you’re responsible for. • An explanation of limits and quotas. • Our pharmacy procedures, such as prior authorization, and how to use them. • How to receive coverage for non-formulary drugs. What a pharmacy exception is and how providers can provide information to support one. • Our processes for generic substitution, therapeutic interchange and step therapy. truehealthnewmexico.com/find-a-doctor • Information about network providers and their professional qualifications, including specialty, medical school attended, residency completed and board certification status. • Search for a doctor by zip code, city, gender and language spoken. • Search for a hospital or other medical facility. truehealthnewmexico.com/seeking -healthcare-services • How to choose and access a primary care provider (PCP). How to obtain primary care services. • How to obtain specialty care and behavioral health services and hospital services. • How to obtain care after normal office hours. • How to obtain emergency care, including our policy on when to go to the ER or call 911. truehealthnewmexico.com/out-of-state-coverage • How to obtain care and coverage when you are outside of our service area. truehealthnewmexico.com/get-language-assistance • How to obtain language assistance to talk with us. • The availability of TDD/TTY services. truehealthnewmexico.com/appeals-and-grievances • How to appeal a decision that adversely affects your coverage, benefits or relationship with us. • A description of the independent external appeals process for our utilization management decisions. truehealthnewmexico.com/member-rights -and-responsibilities • Our member rights and responsibilities statement. truehealthnewmexico.com/member-forms • How to submit a claim for covered services, if needed. truehealthnewmexico.com/contact-us • How to contact staff if you have questions about how we manage care and services. truehealthnewmexico.com/care-management • Information about our Case Management Program and Disease Management Program, and how you or your caregiver may self-refer to them. truehealthnewmexico.com/quality-improvement -program-members • Information about our Quality Improvement Program, including goals, processes and outcomes as related to care and service. truehealthnewmexico.com/health-wellness • Information about our no-cost health and wellness programs, such as True You. • Tools and other resources to help you improve your health. truehealthnewmexico.com/individual-family -plan-documents truehealthnewmexico.com/small-group-forms truehealthnewmexico.com/large-group-forms (Look in the Evidence of Coverage and the Summary of Benefits and Coverage for your plan.) • Information about benefits and services included in, and excluded from, coverage. Copayments and other out-of-pocket costs. Restrictions on benefits that apply to services obtained outside our system or service area. • How to voice a complaint. • Our policy prohibiting financial incentives for utilization management decision-makers. • How we evaluate new technology for inclusion as a covered benefit. truehealthnewmexico.com YOUR HEALTH PLAN INFORMATION AT YOUR FINGERTIPS { R E S O U R C E S }
FALL 2022 TRUE TO YOUR HEALTH is published as a health and wellness service for the members of TRUE HEALTH NEW MEXICO. Information comes from a wide range of medical experts. If you have any concerns or questions about specific content that may affect your health, please contact your primary care provider. Models may be used in photos and illustrations. 2022 © Coffey Communications, Inc. All rights reserved. THNM-ID0630-0922 Find us online: truehealthnewmexico.com Contact us: Customer Service: 844-508-4677 truehealthnewmexico.com/contact-us We might contact you to ensure you’re receiving the care you need Your health and wellness are very important to us, and we do regular outreach to ensure you are receiving the healthcare services you need. Some of this outreach may include: • A phone call from a pharmacist about our medication therapy management program. • A phone call and letter offering an in-home or telehealth visit to assess your overall health. • A phone call and letter offering members with diabetes an inhome diabetic eye exam. • A phone call or letter from our provider partners to remind you of recommended preventive health screenings. While this outreach doesn’t replace a doctor’s care, it can help fill some gaps. These services are available at no cost to you, and they will not affect your True Health New Mexico benefits, cost-sharing amounts or premiums. You are never obligated to take part in any of these services. If you would like to opt out, just tell the caller, and we will put you on a do-not-call list. Learn the ABCs of diabetes Having diabetes can increase your risk of heart attack and stroke. The good news: Doing your homework can help you beat heart disease and other diabetes complications. How? By learning the ABCs of diabetes. It’s an easy way to remember what to do to help keep your diabetes in check and increase your chances of living a full and active life. A is for the A1C test. How well are you controlling your diabetes? The A1C, also known as the HbA1C, is a top indicator. It’s a blood test that averages your blood sugar over the past two to three months. Get the A1C test at least twice a year. To reduce the risk of developing diabetes complications, a target A1C number for most people is under 7%. B is for blood pressure. Roughly 2 out of 3 people with diabetes have high blood pressure. Over time, unmanaged high blood pressure can lead to serious health problems, including heart disease, stroke and kidney disease. A healthy blood pressure goal is less than 130/80, unless your doctor sets a different goal for you. Work with your doctor to meet your blood pressure goal. C is for cholesterol. High LDL (“the bad”) cholesterol—a waxy substance that can build up inside blood vessels and increase your risk of heart attack and stroke—is more common in people with diabetes. To help keep your heart healthy, get your cholesterol tested once a year. Work with your diabetes care team to get your cholesterol within the optimal levels. LDL cholesterol should be below 100 mg/dL and your HDL (“the good”) cholesterol, which helps remove LDL cholesterol from your blood vessels, should be 40 mg/dL or higher. Keep up the good work! To live well with diabetes, keep track of your ABCs, make healthy food choices, be physically active for 30 minutes most days of the week and see your healthcare team for checkups as scheduled. Sources: American Diabetes Association; Centers for Disease Control and Prevention; National Heart, Lung, and Blood Institute Our True You programs continue through Dec. 31 In each issue of this newsletter, we have told you about our True You wellness programs that are available free of charge to all our members and their covered dependents. • Better You awards points every time you complete a wellness activity or challenge, take a Better You university course, or visit your provider for preventive care. You can redeem those points for gift cards to major retailers. Visit truehealthnewmexico.com/ better-you to learn more. • Mindful You provides expert mindfulness training from Michelle DuVal, MA, director of The Mindful Center in Albuquerque. Michelle’s Life on Mindfulness series will teach you how to reduce stress and anxiety, sleep better, and improve your relationships. Visit truehealthnewmexico.com/mindfulness to learn more. Mindful You’s fourth-quarter offerings include these live online workshops: • Nov. 5: Single-Tasking in a Multi-Task World • Nov. 19: Speaking from the Heart: Mindful Communications • Dec. 3: Sharing Mindfulness with Others And these self-guided programs: • Nov. 1 to 22: Mindful Eating Four-Week Program • Dec. 5 to 19: Starter Kit in Mindfulness Three-Part Program You have until Dec. 31, 2022, to take advantage of these great wellness programs. Do something nice for yourself—you deserve it! Want to continue mindfulness training in 2023? All members of True Health New Mexico’s Life on Mindfulness can choose to continue this program for a monthly fee of $10. Everyone who chooses to continue will receive the month of January at no cost. The monthly fee begins Feb. 1, 2023. By choosing to continue Life on Mindfulness with Michelle DuVal, MA, and The Mindful Center, you’ll keep access to the daily drop-in meditations, all workshops, and many more mindfulness perks and benefits. If you have questions, email support@themindfulcenter .zendesk.com. { W E L L N E S S }
LEARN YOUR ABCs Tips to keep your diabetes in check 3 YOUR PLAN INFORMATION Find documents and more with just a few clicks 2 truehealthnewmexico.com 2440 Louisiana Blvd. NE, Suite 601 Albuquerque, NM 87110 Standard U.S. Postage PAID Walla Walla, WA Permit No. 44 If you have a chronic health condition, such as asthma, coronary artery disease or diabetes, it’s important that you visit your primary care provider (PCP) regularly. Your PCP manages your overall healthcare. He or she may refer you to a specialist, if needed. Your PCP also may refer you to other healthcare professionals who are not doctors, such as a diabetes educator. You will need regular screenings and tests to determine how well you are managing your chronic condition over the long term. Your doctor can work with you to create an action plan. This plan will help you understand what you’re doing well and what changes to make to improve your health. It’s important to feel comfortable asking your PCP questions about your chronic condition. If you would like to find a new PCP, or if you don’t have a PCP yet, you can search for a new one at truehealthnewmexico.com/find-a-doctor. As you know, our parent company, Bright Health, is exiting its individual and family plan business at the end of 2022 and is discontinuing its employer group business in 2023. You can find more information at truehealthnewmexico.com—click on the red “Important Notice” button. If you are an individual/family plan member, your coverage will end on Dec. 31, 2022. You will need to select another health insurance plan during open enrollment this fall. If you are a group plan member, your coverage will end when your employer’s contract with us expires. Talk to your benefit administrator or human resources manager if you have questions about when your group coverage will end. We will close our doors sometime in 2023. Until that day comes, we will continue to be here for you. Our programs and services—such as our care management programs—will be available to you as long as you have True Health New Mexico coverage. You can still call Customer Service at 844-508-4677 or email info@truehealthnewmexico.com. You may be able to find what you’re looking for on our website, including updates about our closure. Visit truehealthnewmexico.com/members. Thank you—and your employers—for choosing True Health New Mexico coverage. We are deeply grateful to have had the opportunity to support you in your health and well-being while you have been a member in one of our plans. Wishing you the best in health, The Employees of True Health New Mexico Message from TRUE employees: It has been our pleasure Chronic conditions need a doctor’s care
Thank you for giving True Health New Mexico the opportunity to serve you. In the normal course of doing business, True Health creates records about you and the treatment and services you receive from medical providers. The information we collect is called Protected Health Information (PHI). True Health is committed to maintaining and protecting your privacy. We are required by federal and state law to protect the privacy of your PHI and to provide you with this Notice about how we safeguard and use it. You may ask for a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically. We will promptly provide you with a paper copy. When we use or disclose your PHI, we are bound by the terms of this Notice. This Notice applies to all oral, electronic or paper records we create, obtain and/or maintain that contain your PHI. This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. How we protect your oral, written and electronic information We understand the importance of protecting your PHI. We restrict access to your PHI to authorized workforce members who need that information for your treatment, for payment purposes and/or for healthcare operations. We will not disclose your PHI without your authorization unless it is necessary to provide your health benefits, administer your benefit Plan, support Plan programs or services, or as required or permitted by law. If we need to disclose your PHI, we will follow the policies described in this Notice to protect your privacy. True Health protects your PHI by following processes and procedures for accessing, labeling and storing confidential records. Access to our facilities is limited only to authorized personnel. Internal access to your PHI is restricted to Plan employees who need the information to conduct Plan business. We train our workforce members on policies and procedures designed to protect you and your privacy. Each department at True Health New Mexico is responsible for monitoring the policies and procedures and ensuring that they are being followed. Our Compliance department arranges for new hire and annual training on this important topic. Notice of confidentiality of domestic abuse information The Domestic Abuse Insurance Protection Act (DAIPA) is a state confidentiality law. It protects a member’s confidential information if he or she is or has been involved in domestic abuse. This act regulates insurers’ and insurance support organizations’ use of confidential abuse information. In processing your application for insurance or a claim for insurance benefits, we may receive confidential domestic abuse information from sources other than you. If this happens, we are prohibited from using it or any other confidential abuse information, or your status as a victim of domestic abuse, as a basis for: • Denying or refusing to insure, renewing or reissuing, canceling or otherwise terminating (ending) your healthcare coverage. • Restricting or excluding coverage. • Charging a higher premium for health coverage. You have the right to access and correct all confidential domestic abuse information we may have about you. You have the right to inform us of your wish to be designated as a protected person. As a protected person, confidential information, such as your address and phone number, will remain confidential. We will disclose and transfer it only in accordance with state and federal laws. If you wish to be designated as a protected person, please contact True Health at 844-508-4677. How we use and disclose your confidential information We may disclose your PHI without your written authorization if necessary while providing your health benefits. We may disclose your PHI for the following purposes: • Treatment. We may disclose your PHI to your healthcare provider for Plan coordination; to help obtain services and treatment you may need; or to coordinate your healthcare and related services. • Payment. We may use and disclose your PHI to make coverage determinations; to obtain payment of premiums for your coverage; and to determine and fulfill our responsibility to provide your benefits. However, we are prohibited from using or disclosing genetic information to make any coverage determinations, such as eligibility or rate setting. We may also disclose your PHI to another health plan or a healthcare provider for its payment activities. • Healthcare operations. We may use and disclose your PHI for our healthcare operations, such as providing customer service; to support and/or improve the programs or services we offer you; or to assist you in managing your health. We may also disclose your PHI to another health plan or a provider who has a relationship with you so that it can conduct quality assessment and improvement activities. • Appointment reminders and treatment alternatives. We may use and disclose your PHI for appointment reminders or send you information about treatment alternatives or other health-related benefits and services. You will have an opportunity to opt out of future communications. • Disclosure to Plan vendors and accreditation organizations. We may disclose your PHI to companies with whom we contract if they need the information to perform the services they provide to us. We may also disclose your PHI to accreditation organizations such as the National Committee for Quality Assurance (NCQA) when the NCQA auditors collect Health Employer Data and Information Set (HEDIS®) data for quality measurement purposes. When we enter into these types of arrangements, we obtain a written agreement to protect your PHI. • Public health activities. We may use and disclose your PHI for public health activities authorized by law, such as preventing or controlling disease, reporting child or adult abuse or neglect to government authorities, or to close friends or family members who are involved in or help pay for your care. We may also advise your family Privacy Commitment { FALL 2022 P R I V A C Y P O L I C Y }
members or close friends about your condition or location (such as that you are in the hospital). • Health oversight activities. We may disclose your PHI to a government agency that is legally responsible for oversight of the healthcare system or for ensuring compliance with the rules of government benefit programs, such as Medicare or Medicaid, or other regulatory programs that need health information to determine compliance. • For research. We may disclose your PHI for research purposes, subject to strict legal restrictions. • To comply with the law. We may use and disclose your PHI as required by law. • Judicial and administrative proceedings. We may disclose your PHI in response to a court or administrative order and, under certain circumstances, a subpoena, warrant, discovery request or other lawful process. • Law enforcement officials. We may disclose your PHI to the police or other law enforcement officials, as required by law in compliance with a court order, warrant, or other process or request authorized by law to report a crime or as otherwise permitted by law. • Health or safety. We may disclose your PHI to prevent or lessen a serious and imminent threat to your health or safety or the health and safety of the general public or other person. • Government functions. Under certain circumstances, we may disclose your PHI to various departments of the government such as the U.S. military or the U.S. Department of State. • Workers’ Compensation. We may disclose your PHI when necessary to comply with Workers’ Compensation laws. State law may further limit the permissible ways we use or disclose your PHI. If an applicable state law imposes stricter restrictions, we will comply with that state law. Uses and disclosures with your written authorization We will not use or disclose your PHI for any purpose other than the purposes described in this Notice without your written authorization. The written authorization to use or disclose health information shall remain valid, which in no event shall be for more than twenty-four (24) months. You can revoke the authorization at any time. Your individual privacy rights When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities. • Right to request additional restrictions. You may request restrictions on our use and disclosure of your PHI for the treatment, payment and healthcare operations purposes explained in this Notice. This may be done by means of an oral, written or electronic request from you. While we will consider all requests for restrictions carefully, we are not required to agree to a requested restriction. If we do agree to the restrictions, we will abide by them. • Right to receive confidential communications. You may ask to receive communications of your PHI from us by alternative means of communication or at alternative locations, if you believe that communication through normal business practices could endanger you. While we will consider reasonable requests carefully, we are not required to agree to all requests. Your request must specify how or where you wish to be contacted. • Right to inspect and copy your PHI. You may ask to inspect or to obtain a copy of your PHI that is included in certain records we maintain. Under limited circumstances, we may deny you access to a portion of your records. If you request copies, we may charge you copying and mailing costs consistent with applicable law. If your information is stored electronically and you request an electronic copy, we will provide it to you in a readable electronic form and format. • Right to amend your records. You have the right to ask us to amend your PHI that is contained in our records. If we determine that the record is inaccurate, and the law permits us to amend it, we will correct it. If your doctor or another person created the information that you want to change, you should ask that person to amend the information. • Right to receive an accounting of disclosures. Upon your oral, written or electronic request, you may obtain an accounting of disclosures we have made of your PHI, except for disclosures made for treatment, payment or healthcare operations; disclosures made earlier than six years before the date of your request; and certain other disclosures that are exempted by law. If you request an accounting more than once during any 12-month period, we may charge you a reasonable fee for each accounting statement after the first one. • Right to receive a paper copy of this Notice. You may contact Customer Care at the number on your Plan ID card to obtain a paper copy of this Notice. If you wish to make any of the requests listed above under “Your Individual Privacy Rights,” you must notify the Plan in writing (unless otherwise noted). For more information or if you have complaints If you have any questions about your privacy rights, believe that True Health has violated your privacy rights or disagree with a decision that we made about access to your PHI, or if you want more information about your privacy rights or do not understand your privacy rights, you may contact our Director of Consumer Operations and Compliance at the following address or telephone number. If we discover a breach involving your unsecured PHI, we will notify you of the breach by letter or other method permitted by law. Director of Consumer Operations and Compliance You may contact our Director of Consumer Operations and Compliance at: True Health New Mexico • P.O. Box 37200 • Albuquerque, NM 87176 • 844-508-4677 If you believe True Health may have violated your privacy rights, you may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services (HHS). Your complaint can be sent by email, fax, or mail to the HHS’ Office for Civil Rights (OCR). You can file a written complaint to: U.S. Department of Health and Human Services • Office of Civil Rights • 200 Independence Ave., SW • Washington, DC 20201 • or by calling 800-368-1019. For more information, go to the OCR website: www.hhs.gov/ocr/privacy/hipaa/complaints. We will not take any action against you if you exercise your right to file a complaint with us or the Secretary. We may change the terms of this Notice at any time, and we may, at our discretion, make the new terms effective for all of your PHI in our possession, including any PHI we created or received before we issued the new Notice. The new Notice will be available upon request, on our website, and we will mail a copy to you. { P R I V A C Y C O M M I T M E N T C O N T I N U E D }
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