Health&Y O U R O X F O R D G U I D E T O L I V I N G W E L L

WellnessF A L L 2 0 0 2

MS-02-886

the healthy heart

Signs of asthma Your Oxford Ambassadors in Washington Privacy of your financial information

Did you know?A number of recent medical studies indicate that laughter is

good for you. The simple act of laughing stimulates the immune

system, increases your tolerance for pain by releasing endorphins —

the body’s natural painkillers — and decreases your stress hormones,

to lower blood pressure and relax your whole body. As if that wasn’t

enough, hearty laughter improves lung capacity and oxygen levels,

which is good for almost every other aspect of your health.

Now, let’s all find something to laugh about! O

Of all the dietary nutrients, water is the most important.

This is especially true on hot, humid days, when an active person

can lose as much as 11/2 pints of water in just 15 minutes without

even knowing it, according to the Medical College of Wisconsin.

Make it a habit to drink at least eight glasses of fluids a day —

coffee and alcoholic beverages are actually counterproductive —

and take extra water before, during, and after any vigorous

activity. If you experience muscle cramping, dark urine, dizziness,

headache, or rapid heartbeat, immediately stop what you’re

doing, head for the shade and drink water. O

Ever notice how as people age it gets harder to guess their

chronological years? That’s because many factors influence

biological aging. Now the National Institute

on Aging has identified the top 10: muscle mass, strength,

reflex speed, joint mobility, breathing capacity, endurance,

balance, skin elasticity, sleep quality, and fat-to-lean ratio.

All 10 are linked to physical activity, so if you want to look

and feel younger, get moving! O

Health&Y O U R O X F O R D G U I D E T O L I V I N G W E L L

WellnessF A L L 2 0 0 2

C O N T E N T S

Chief Executive Officer Norman C. Payson, MDPresident and COO Charles G. BergChief Medical Officer and EVP Alan M. Muney, MD, MHAVice President, Marketing Chuck GreenDirector, Member Marketing Rebecca MadsenManager, Member Marketing Meg DedmanEditor Stephanie GebingMedical Editor Alan M. Muney, MD, MHA

Health & Wellness is published exclusively for Oxford Medicare AdvantageSM Members by:Onward Publishing, Inc.10 Lewis Road, Northport, NY 11768Tel 1-631-757-3030 Fax 1-631-754-0522

Publisher Jeffrey BaraschCreative Director Melissa BaraschEditorial Director Wendy MurphyArt Director Bruce McGowinDesigner Lisanne SchnellProject Management Tamyra ZieranBusiness Manager Liz Lynch

Oxford Health Plans, Inc., and Onward Publishing,Inc., are not responsible for typographical errors.

The information in this newsletter is intended to be used as a general guide and should not replace the advice of your physician. Always consult your physician for individualized care.

© 2002 Onward Publishing, Inc. All rights reserved.

Health& Wellness is designed just for you — to give you the latest information on a wide range ofhealth topics, as well as updates on your plan benefits. We encourage you to e-mail your comments to us atpublications@oxfordhealth.com, or write to: Oxford Health Plans, c/o Stephanie Gebing, 48 Monroe Turnpike,Trumbull, CT 06611.

W E L L N E S S

Recognizing the signs of asthma

P R E V E N T I O N

Staying ahead of flu season

S P E C I A L T O P I C

Your Oxford Ambassadors in Washington

C O V E R S T O R Y

How healthy is your heart?

W O M E N ’ S H E A L T H

Mammogram myths & truths

N E W S Y O U C A N U S E

Membership updates

L I V I N G W E L L

Talking to your doctor

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W E L L N E S S4

Whether you thought you’d outgrown your asthma decades ago, or you’re experiencing it forthe first time, getting asthma correctly diagnosed isthe first step to breathing easier. Because asthma’ssymptoms are similar to those of bronchitis andemphysema, and because older patients may haveother health conditions such as heart disease thatfurther confuse the diagnosis, even a skilled doctormay have difficulty recognizing asthma at first. Thegood news is that late onset of asthma ismanageable with the correct treatment.

Asthma is the result of irritation andinflammation of the air passages, and it is provoked by various environmental“triggers.” The primary agents of this irritation are allergens, which are tiny airborne particles that typically circulatein the warmer months. Depending on anindividual’s particular sensitivities, somemonths can be more miserable than others. In the summer, various plant pollens are on the move. In early fall,mold spores released by rotting wood and fallenleaves are prevalent. Severe weather changes such asthunderstorms and high levels of ozone associatedwith air pollution are other common triggers. Andin colder months when people usually spend moretime indoors, asthma can be a reaction to pet dan-der and dust mites in the home. Winter months arealso a prime season for respiratory infections, whichare major asthma triggers among those over 65.

If you find that you are having chronic problemswith breathing, report your symptoms to your primary care physician (PCP) and start keeping adiary of the frequency and circumstances of your

symptoms. The “whens” and the “hows” you recordeach week may provide your doctor with valuableclues about what is causing your difficulty and howto best manage it. And be sure to tell your PCPabout any medications you are taking under thecare of other doctors. For example, the beta-blockerdrops that your eye doctor may prescribe for con-trolling glaucoma may provoke an asthma responseand need to be changed to another medication.

So, too, the ACE inhibitor you take tolower your blood pressure can producea cough that can be confused with thecough associated with asthma.Furthermore, various non-steroidal anti-inflammatory drugs (NSAIDs),including aspirin used for the pain of arthritis, have the potential to causesevere bronchial spasms.

Although asthma cannot be cured, it canbe managed through a good partnershipwith your doctor, who can show you howto avoid prime triggers. Your PCP can

also educate you about medications that can reduceyour sensitivities to allergens and treat acute attacks.You’ll be urged to protect yourself from respiratoryinfections, too — a flu vaccine each fall, as well asimmunization against pneumococcal infections arecritical strategies. (see page 5) O

Recognizing the signs of asthmaIt’s often thought of as a childhood condition, but many older adults

are also troubled by asthma — a treatable lung disease characterized

by wheezing, shortness of breath, coughing, and tightness in the chest.

OOX F O R D I N F O

Our Better Breathing® program helps Memberslearn about asthma triggers, how to avoid themand the importance of taking appropriate medication(s). For more information about theprogram, please call 1-888-201-4254, Mondaythough Friday, 8 AM to 4:30 PM.

5P R E V E N T I O N

While a cough or cold can be unpleasant, influenza, or the flu, is just plain misery. And for some people — over 65 or with long-term or chronic health problems — the flu can be life threatening. That’s because the virus that causes it is far tougher than any cold virus.

At the very least, the flu causes severe body aches,cough, profound fatigue, intense headache, andoften, a sore throat. In comparison to the worstcold, the flu comes on faster and goes deeper intothe body’s systems. It can sometimes overwhelmthe very immune system that is supposed to helpyou recover. Instead of gradually improving afterthe onset of flu, you may experience second stagebronchitis, pneumonia, or even inflammation ofthe heart and brain.

Fortunately, there’s a simple way to minimize the risk of getting the flu, and that’s through anannual flu vaccine. Yearly immunizations are needed because the particular strain of virus isalways changing. Immunizations offered this fallwere tailor-made in the laboratory over the pre-ceding months to stifle this year’s bug. However,no vaccine can be 100% effective. So despite get-ting your annual vaccine, it’s possible to encounterone of the less prevalent strains of the flu. As forrumors that you can catch the flu as a result of getting vaccinated, well, they’re just not true. Fluvaccines are made from dead viruses, thereforethey are not likely to cause symptoms beyond thebrief sore arm or mild headache, though there are some exceptions. (see sidebar at right)

Each fall, we mail a flu vaccine reminder to all ofour Members over the age of 50 to remind themof the importance of receiving this vaccination.Once you receive your reminder, call your primarycare physician (PCP) to find out if and when you

can get your vaccine. Also ask if you’re up-to-dateon your protection for bacterial pneumonia.Pneumococcal disease usually gets its start after aserious upper respiratory infection — a cold, sorethroat, or flu. Like the flu, it can be very serious inolder people, and its incidence can be sharplyreduced with an immunization. Although its pro-tection can last a lifetime, if you’re in a high-risk category, your PCP may recommend abooster dose every five to 10 years. O

Staying aheadof f lu season

S H O U L D Y O U G E T T H E F L U V A C C I N E ?

OOX F O R D I N F O

There is no charge for flu and pneumococcal vaccines administered by your primary care physician if that is the only service provided during the visit. If additional services are receivedduring your visit, a copayment may apply.

Who should:• Most of us — not only to reduce our risk

of illness, but to lower the chance we’ll spread the flu to someone unprotected

• Children between six and 23 months old

• Any individuals who might be considered at high risk:

• Persons aged 50 years and older

• Residents of long-term care facilities with otherresidents who have chronic health problems

• Persons with serious long-term heart, kidney,lung, or metabolic diseases, asthma, or anemia

• Persons with a weakened immune system due to disease, long-term treatment with drugs such as steroids, or cancer treatment with X-rays or drugs

Who shouldn’t:• Anyone allergic to eggs

• Anyone who has had a severe reaction to a previous flu vaccine

• Anyone with a history of Guillain-Barre Syndrome

• Anyone who has a fever or is severely ill

Information used in this article was derived from the Centers for Disease Control (CDC).

S P E C I A L T O P I C6

In urban areas of the country, medical costs havebeen rising annually at three times the rate ofMedicare’s reimbursements. Unlike traditional fee-for-service plans, Medicare+Choice plans offer Medicare beneficiares helpful, extra benefits, like prescription drug coverage. YourOMA Ambassadors feel that Congressional actionis the best way to help Medicare beneficiares maintain choice in accessing healthcare and inenhancing delivery in their health system.

For three incredibly busy days, the 10 women and six men in Oxford’s Ambassadorial delegationalong with Medicare beneficiares representing 23 other AAHP member plans from around thecountry took their fight directly to key legislators —and the President — in hopes that their urgentmessage would be heard — and acted upon.

The OMA Ambassadors, all from New York, alsomet in smaller groups with representatives in theirSenatorial and Congressional districts, and withrepresentatives of Senate Majority Leader, TomDaschle’s office and of Senate Finance CommitteeChairman, Max Baucus.

Thursday was a particularlyaction-filled day. At noon,the group lunched withCongressman Steve Israel(D-NY), co-sponsor of thepending “Medicare+ChoiceEquity and Access Act,”which, if passed later thisfall, will go a long way inaddressing some of the greatest inequities in OMA Ambassadors

Arina and Alfred Holmes

Your Oxford Ambassadors

On Wednesday, May 15, 2002, 16 Oxford Medicare Advantage

(OMA) Ambassadors along with several Oxford Health Plans staffers

boarded an early morning train for Washington, D.C. They were

bound for the fourth annual “March on Washington,” sponsored by

the American Association of Health Plans (AAHP). Their common

goal was to advocate for reform of the Medicare program — specifical-

ly, to win government support for the Medicare+Choice (M+C) pro-

gram, which is available to millions of seniors in our tri-state area.

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in Washington

funding for the M+C program. In the evening,they dined with Mark McClellan, a key advisorto the President, on Medicare issues. But it wasn’t all work and no play by any means.Oxford’s delegates also found time for sight-seeing and socializing with old friends and new, and were treated so hospitably whereverthey went that by one Member’s description,no one “could imagine anywhere better except maybe Heaven.”

The highlight of the trip for everyone, however, was a reception held at the WhiteHouse on Friday. The combined delegationfrom the many health plans that offer M+Cwere received in the historic East Room of theWhite House. Before President Bush addressedthis group, he took time out to speak with several individuals personally. Among the select few were long-time OMA AmbassadorsArina and Alfred Holmes. Arina, who is cele-brating her 78th birthday this year, recalls theoccasion with amused delight. “My eyes were

big as eggs when the President called on me.And then when he shook my hand, I couldhardly bear to wash it again!” But Arina andAlfred, for all their modesty, are quite ready to advocate convincingly for the benefits of the M+C program. Alfred, who at 90 is livingcomfortably with both diabetes and a thyroidcondition, told the President how much he appreciates what it means to have compre-hensive healthcare. And Arina, who has hadher share of short-term medical incidents in recent years, speaks with her persuasiveschool teacher voice when talking about howimportant Oxford’s preventive screening services have been to keeping her “top-of-the-line healthy,” as she likes to describe herself.

All in all, the OMA Ambassadors spent a very satisfying and memorable three days “on the road” speaking out on behalf of the millions of Medicare beneficiares who currently enjoy, or are eligible for, healthcarecoverage through the M+C program. O

Back in 1955 when vacationing President Dwight D. Eisenhower suffered

severe chest pains during the night, Mamie Eisenhower called his doctor back

East in a state of alarm. The doctor’s advice was to cuddle up close in bed to

keep the President warm and hope for the best until he could be taken to a

hospital in the morning. Remarkably, Eisenhower made a good recovery from

his heart attack, but in those years most people in similar situations did not.

C O M P L E M E N T A R Y & A L T E R N A T I V E M E D I C I N E8

How healthy is

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Few of the now standard drugs like clot busters wereavailable to help through the first dangerous hours.And advances such as angioplasties, artificial valves,bypass surgeries, cardiac care units, defibrillators, pacemakers, or sophisticated diagnostic technologieswhich enable doctors to identify the damage and make repairs, didn’t exist.

Today, the cardiac landscape has changed dramatically,as seen by Vice President Dick Cheney, who in the past24 years has survived four heart attacks, a quadruplecoronary bypass, and several lesser heart procedures. Yet, the fact that he has had so many cardiovascularincidents at a relatively young age highlights an important fact: like so many Americans, Cheney was late in paying attention to heart health. It took a seriousattack to prompt him to make some lifestyle changes.

First, he gave up his three-pack-a-day cigarette habit.Then he worked on his cholesterol counts through dietand medications. He also shed 40 extra pounds. And hemade a conscious decision to exercise regularly and topractice relaxation techniques. Although he cannotundo damage already done, the VP’s lifestyle conversionis one we all should embrace.

According to the Centers for Disease Control (CDC),more than 61 million Americans are currently burdenedwith cardiovascular disease (CVD), a term encompassing congestive heart failure, coronary artery disease, angina,arteriosclerosis, atherosclerosis, arrhythmia, myocardialinfarction, hypertension, and stroke. And CVD doesn’tjust affect older men; it’s a major health problem forolder women, too.

your heart?

RR E S O U R C E S

Web sites of special note are the American Heart Associationwww.americanheart.org and theNational Institutes of Health/NationalHeart, Lung, and Blood Institutewww.nhlbi.org

The National Coalition for Womenwith Heart Disease sponsors a relatively new site www.womenheart.org

OO X F O R D I N F O

Oxford’s Heart SmartSM programoffers educational materials and support for Members with cardio-vascular disease and congestiveheart failure. Educational effortsfocus on risk factors and lifestylemodifications to improve health outcomes. For more informationabout these programs, please call 1-888-585-0630, Monday throughFriday, 8 AM to 4:30 PM.

C O M P L E M E N T A R Y & A L T E R N A T I V E M E D I C I N E10

Taking controlIronically, this health crisis continues to grow in severity even as modern medicine is becoming betterequipped to prevent CVD and death. According tothe Centers for Disease Control, most of us who are or will be afflicted could prevent it by adopting a few sensible and healthy behaviors:

• be moderately physically activemost of the week

• maintain a diet low in fat (no more than 30% of calories fromfats) and eat at least 5 servings a day of fruits and vegetables

• limit salt and alcohol intake, each of which increases blood pressure

• stop (or never start) smoking (see sidebar on page 11)

• keep your weight in line with doctor’s recommendations

• learn techniques to reduce emotional and physical stress

• get annual wellness checkups with your PCP and share responsibility in making whatever changes are needed

• get regular screenings for blood pressure (BP) and cholesterol (HDL and LDL), and work to keep readings in line with current recommendations

• follow prescribed drug regimens

B l o o d P r e s s u r e

A normal healthy BP hovers around120/80, the higher number reflectingpeak pressure when the heart contracts (systolic), and the lowernumber measuring pressure when the heart relaxes (diastolic).The actual cause of high blood pressure is unknown in 95% of cases. However,many factors can elevate BP such as:obesity, high alcohol use, high saltintake, aging and perhaps sedentarylifestyle, stress, low potassium intake,and low calcium intake.

S t r o k e

Known as a “brain attack,” stroke is thesudden disturbance of blood flow in thebrain, usually due to a clot in a cerebralartery. Some sudden-onset signs:

• weakness or numbness on one side of the body

• loss of vision or blurred sight in one or both eyes

• confusion, speech impairment, or difficulty understanding speech

• sudden, severe headache with no known cause

• dizziness, loss of balance or coordination

H ea r t A t t ac k

Getting quick treatment is critical.Here are overt signs to look for:

• moderate to severe chest discomfort, a squeezing sensation,heavy pressure on the chest,fullness, heaviness, or pain

• pain in one or both arms, the back, neck, jaw, or stomach

• shortness of breath

• breaking out in a cold sweat, nauseaand/or lightheadedness (Womenseem to experience a heart attack’smilder signs first, which may explaintheir higher mortality rates.)

• cardiac arrest, loss of consciousness

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• take advantage of the wellness programs availableto help you realize your healthy lifestyle goals

Meeting trouble head onBut even the best efforts can’t eradicate all cases of heart disease and stroke. Unfortunately, somepeople are more vulnerable to CVD as the result of heredity, or type 2 diabetes, or another disorderthat strains the heart. So it’s important to tell yourPCP about all personal risk factors. It also helps toknow what measures to take if you or a loved one has a cardiac emergency.

The problem is that heart attack and stroke don’talways develop in the way we expect — in momentsof high drama or with heart-clutching suddenness.More often an attack will start slowly and withoutclear provocation. Quick response is critical to a positive outcome, because the triggering event inmost attacks is a blocked artery. Unless effectiveaction is taken within the first hour, a cascade of life-threatening changes may be set in motion. Thesafest bet is to call 911 or the emergency medicalservice (EMS) system in your area for emergencyhelp when symptoms of heart attack or stroke persist for more than five minutes. (see sidebars on page 10) You might also consider learning cardiopulmonary resuscitation (CPR) if you haven’t already. Most adults can master CPR in a few sessions, learning to save lives by keeping oxygen-rich blood flowing to the brain until help arrives on the scene. It may not qualify as a new “lifestylebehavior,” butbecoming certified ishealthy for youand everyonearound you. O

2 0 % o f a l l C V D d e a t h s a r e s m o k i n g - r e l a t e da c c o r d i n g t o t h e C D C

It’s always a good idea to quit smoking, butespecially if you’reat risk of heart disease.The toughpart is that most people who try to stop smokingusually start upagain.Almost 80% fail the first time. Nowthe American Cancer Society offers realhelp:“Twenty-one Days to Stop Smoking.”This audio tape provides proven tools to help you or someone you know identify and conquer obstacles that standin the way of quitting for good. OxfordMembers can order it by calling QualityBooks & Audio at 1-800-556-9444,and asking for item #100.To get the discounted price of $8.95, including shipping, handling, and taxes, identify yourself as an Oxford Member.*

For free information from specialists over the phone, complimentary self-helpbooklets, and a list of smoking cessationprograms near you, call the toll freeSmokers Quitline in your state:

New York Quitline1-888-609-6292

New Jersey Quitline1-866-NJSTOPS (1-866-657-8677)

Connecticut Quitline 1-866-END-HABIT (1-866-363-4224)

*This discount is offered in addition to and separate from your benefit coveragethrough Oxford Health Plans. Available discount percentages may change from time to time without notice. Discount is applicable to the items referenced.Oxford cannot assume any responsibility for the failure of vendors referenced tomake available discounts negotiated withOxford; however, any failure to receive discounts should be reported to CustomerService by calling the number on yourMember ID card.

W O M E N ’ S H E A L T H12

Let’s be honest. The whole experience of havinga mammogram can be a little unnerving to saythe least. But an annual mammogram is one ofthe important things you can do to protect yourself. According to the National Center forHealth Statistics, all but one or two in every thousand women who get tested each year go home with a clean bill of health. By getting tested annually, it’s also likely that breast cancer can be discovered at an early stage, whenthere are more treatment optionsavailable, and the odds of beatingthe disease are greater. For thesereasons, mammograms remain acritically important element of preventive health for women who are 65 and older.

The mammography controversyThe statistics on breast cancer and older womenmake it clear why regular screenings are particularlyimportant now. Research from the AmericanCancer Society and National Cancer Institute showthat cancers of all types occur predominantly in thelater years of life, and in the case of breast cancer,the risk of a malignant tumor rises sharply as weage. Whereas the likelihood of developing breastcancer is a mere one in nearly 20,000 among youngwomen, the odds in women at 65 are a fairly sub-stantial one in 17 individuals. And these risks con-tinue to rise to one in 11 among women at age 75and one in eight among women 85 and older.

Despite the rising risks, the simple fact is that themajority of women who get mammograms receive

good news afterwards and with that, a big dose ofpeace of mind for another year. And even thosewomen in whom a malignant breast tumor is ultimately detected have a high probability of being cured if the cancer is caught at an early stage, before it has had time to invade surroundingtissue. This is why yearly visits are so important.

For any woman who has yet to haveher first mammogram, the proceduretakes only a few minutes and is usuallyperformed at a center associated with a hospital — which your doctor mayrecommend and that specializes in this form of imaging technology. Ifyour doctor does not know of a mammography screening center in your area, check your Roster ofParticipating Physicians and Providers,

or call the Customer Service number on yourMember ID card so that we can help you find one. Your only preparation on the day of yourappointment is to avoid wearing any deodorants,talc, lotion, or perfume (because these substancesmay interfere with the clarity of the imaging).Once the technician takes the pictures and spends a few minutes developing the film you will be free to go. A radiologist who specializes inreading mammograms will review the films andsend a report to your doctor in a few days. Beforeyou know it, you’ll be done for another year. Theup side is that you’ve provided your doctor withinvaluable, up-to-date information that can beused to assess the health of your breasts. Why notcall your doctor today to make an appointment?O

&Mammogram

mythstruths

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RR E S O U R C E S OOX F O R D I N F O

At Oxford, we believe in thevalue of preventive care and want to make the process simplefor you — that’s why you don’tneed a referral to get an annualmammogram, and you are notresponsible for any copayment.

National Alliance of Breast Cancer Organizations (NABCO)9 East 37th Street, 10th FloorNew York, NY 100161-888-80-NABCO (1-888-806-2226)www.nabco.org

NABCO consists of more than 300 breast cancer organizations and offers The Breast Cancer Resource List, which is a comprehensivecatalogue of books, videos, tapes, support groups, and nationwidebreast cancer organizations arranged by topic.

Myths and TruthsThe American Cancer Society has noted with concern that while many women are conscientious about having annual screening mammograms, certain fears and misconceptions continue to deter many olderwomen. This important preventive screening is part of your annual benefit and offered at no charge throughyour Oxford Medicare Advantage plan. We’ve provided the truth behind some of the myths:

Myth TruthSelf-examination is enough. Monthly self-examination of your breasts is just one part of an

early detection program, together with annual clinical breast exams by trained professionals and regular annual mammograms.

Having a mammogram once and getting an “all clear” is sufficient to provide protection for life.

Finding a lump is a certain sign ofbreast cancer.

Mammography can spread breast cancer or induce it in a healthy person.

If and when a malignancy is detected,major surgery is the only option.

Every mammogram is important, beginning with the first, whichprovides the “baseline” information with which all subsequentscreenings can be compared to detect subtle changes.

Over 80% of lumps are benign (non-cancerous), but if any lumppersists it should be examined by an expert, either with a follow-upsonogram, needle aspiration, or possibly a biopsy, which can determine definitively if a lump is malignant (cancerous).

Neither the low levels of radiation required today nor compressionof the breast during the screening procedure have a measurableeffect on the incidence of tumors.

The surgical options for a woman with breast cancer have changeddramatically in recent years with radical mastectomies being just oneof the possibilities. Other primary treatments that require little or nodisfigurement may also be appropriate in some instances. And post-surgical treatments today are very much tailored to the particularnature of the tumors found, with chemotherapy, hormone therapy,and radiation combined in various highly effective ways. Whendetected and treated early, the outlook is highly favorable.

N E W S Y O U C A N U S E14

Membership updatesPrivacy notice concerning financial information

At Oxford, protecting the privacy of the personal information we have about our

customers and Members is of paramount importance, and we take this responsibility

very seriously. This information must be maintained in a manner that protects

the privacy rights of those individuals. The following notice describes our policy

regarding the confidentiality and disclosure of customer and Member personal

financial information that Oxford collects in the course of conducting its business.

Our policy applies to both current and former customers and Members.

The information Oxford collectsWe collect non-public, personal financial informa-tion about Members from the following sources:

• Information we receive from you on applicationsor other forms (e.g., name, address, Social Securitynumber, and date of birth);

• Information about your transactions with us, ouraffiliates (companies controlled or owned byOxford), or others; and

• Information we receive from consumer reportingagencies concerning large group customers.

The information Oxford disclosesWe do not disclose any non-public, personal financial information about our current and former customers and Members to anyone except as permitted by law. For example, we may discloseinformation to affiliates and other third parties toservice or process an insurance transaction; or provide information to insurance regulators or law enforcement authorities upon request.

This notice is being provided on behalf of the following Oxfordaffiliates: Oxford Health Plans, Inc., Oxford Health Plans (CT), Inc.,Oxford Health Plans (NJ), Inc., Oxford Health Plans (NY), Inc.,Oxford Health Insurance, Inc., Investors Guaranty Life InsuranceCompany, and MedSpan Health Options, Inc.

Oxford security practices We emphasize the impor-tance of confidentialitythrough employee training,the implementation of procedures designed toprotect the security of ourrecords, and our privacypolicy. We restrict access to personal financial infor-mation of our customersand Members to thoseemployees who need to know that information to perform their job responsibilities. We maintainphysical, electronic, and procedural safeguards thatcomply with federal and state regulations to guardyour non-public, personal financial information.

No referral required for diabetic retinal examAt Oxford, we believe in the power of prevention.That’s why we’ve eliminated the referral require-ment for Oxford Members with diabetes to obtainan annual eye examination.

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Effective May 13, 2002, Oxford Members who arediagnosed with diabetes no longer need a referralfrom their primary care physician to receive anannual eye examination from a participating ophthalmologist or optometrist.

Dental fee schedule changeAfter evaluating our dental benefits and the feesassociated with these services, we have updated ourEnhanced Dental Fee Schedule to complement thechanges in the dental managed care market. We areconfident that the new dental fee schedule reflectsthe costs associated with delivering quality dentalcare while providing you with access to an extensivenetwork of primary care and specialty care dentists.

This new schedule continues to offer you discountedfees relative to average dentist charges for servicesrendered; other advantages of the Enhanced DentalPlan include:

• No charges for certain preventive and diagnostic services

• No deductibles

• No annual maximums

• No claim forms

• Discounted coverage for several new procedures

The new fees are effective October 1, 2002, andapply to all services received on or after this date.You can expect to receive the complete EnhancedDental Fee Schedule in your Annual Notification of Change packet, which is being mailed in October.

If you have questions or would like additional information, please call Oxford’s Dental CustomerService Department at 1-888-336-6563, Mondaythrough Friday, 8:30 AM to 5:00 PM.

Merck-Medco name changeMerck-Medco Managed Care, L.L.C., changed itsname to Medco Health Solutions, Inc., effective July 1, 2002. Your prescription benefits coverage willnot change as a result of the name change and youdo not have to do anything differently to obtain yourprescriptions. In fact, you can continue to use yourcurrent Oxford Member ID card when filling yourprescriptions at a retail pharmacy.

If you use the Medco Health Home DeliveryPharmacy Service™ (formally Merck-Medco Home Delivery Pharmacy Service™) to fill your prescriptions, you can continue to use the sameorder forms and envelopes as you have in the past.You can also continue to order prescriptions and get important health and prescription benefit information by calling our Pharmacy CustomerService at 1-800-905-0201, 24 hours a day.

Important new prescription drug benefit informationThe Food and Drug Administration (FDA)approved Kineret™ (anakinra) on November 14,2001, a new drug for the treatment of the signs and symptoms of moderate to severe rheumatoidarthritis in patients 18 years of age and older whohave failed treatment with one or more disease-modifying anti-rheumatic drugs (DMARDS).

Oxford will offer coverage of Kineret to Memberswho are covered under an Oxford plan that includes a brand name drug benefit. Coverage is subject to the applicable copayment and annualprescription limit.

In order for Kineret to be covered, Oxford requiresprecertification. To obtain precertification, pleasehave your physician call Oxford’s pharmacy benefitmanager at 1-800-753-2851, Monday through Friday,8 AM to 9 PM.

N E W S Y O U C A N U S E16

2002 Drug Formulary Update

The following is an update to the Preferred Drug List (PDL) for Oxford Medicare Advantage Members who have a three-tier prescription drug benefit*. The Pharmacy and Therapeutics Committee reviewed these new medications in February and May 2002.

Therapeutic Class Preferred Brand Non-Preferred Brand Therapeutic Alternatives(Recently added to Oxford’s (Currently on Oxford’s Preferred

Preferred Drug List) Drug List)

Acne Therapy Tazorac Cream tretinoin, Accutane, Desquam X, Klaron, Novacet, Tazorac Cream/Gel

Anticonvulsants Neurontin carbamazepine suspension, Oral Solution Neurontin Oral Solution

Antihistamine/ Zyrtec-D Allegra-DDecongestant

Antineoplastics Gleevec Gleevec

Antipsychotics Geodon clozapine, Risperdal, Zyprexa

Antiviral Agents Rebetol RebetolValcyte Valcyte

Beta Agonist Inhalers Foradil Serevent

Glaucoma Agents Alphagan P Alphagan, Alphagan P

Headache Therapy Axert Amerge, Imitrex, Maxalt

HIV/AIDS Therapy Viread Combivir, Epivir, Kaletra, Sustiva, Videx, Viracept, Viramune, Viread, Zerit, Ziagen

Miscellaneous Canasa Canasa, RowasaGastrointestinal Agents

Miscellaneous Lumigan XalatanGlaucoma Agents Travatan

Non-Narcotic Analgesic Ultracet pentazocine/APAP, pentazocine/naloxone

*Please note that copayments vary by plan for non-preferred brand, preferred brand, and generic drugs.

Merck updates Vioxx labelingThe Food and Drug Administration (FDA) hasrequired Merck to add a precaution to its productlabeling for Vioxx warning doctors to exercise caution in using Vioxx in patients with a history ofischemic heart disease. This new precaution is basedon results from the VIGOR study, which showed thatpatients on Vioxx experienced a higher incidence ofserious cardiovascular events as compared to patientson naproxen. Examples of serious cardiovascularevents included sudden death, myocardial

infarction, unstable angina, and ischemic stroke.Vioxx is also associated with an increased incidencein peripheral edema, mean systolic blood pressureand thromboembolic cardiovascular adverse events.

Vioxx should not be used as a substitute for aspirinfor cardiovascular prophylaxis due to its lack ofplatelet effects. Antiplatelets should not be discon-tinued in patients taking Vioxx and antiplatelet ther-apy should be considered in patients who are candi-dates for cardiovascular prophylaxis.

17

The use of Vioxx 50 mg for more than five days in the management of pain has not been studied. Chronic daily use of Vioxx 50 mg is not recommended. If you have any questions,please speak with your physician.Referenced from:Vioxx package insert.Whitehouse Station,NJ: Merck & Co., Inc.; 2002. Whelton,A., et al, Am. J.Ther. 2001,8:85-95

A Summary of Oxford’s Confidentiality Policy Oxford is committed to maintaining the confidentiality of its Members’ protected healthinformation (PHI). PHI is any information,which relates to an individual’s:

• Physical or mental condition

• Medical history

• Medical treatment

PHI also includes any information obtained byOxford from which judgments can be made abouta Member’s character, habits, avocation, finances,occupation, general reputation, credit, health, or any other personal characteristics. Such infor-mation includes a Member’s name and address.

Consent obtained during the enrollment processand by use of an Oxford ID covers use and disclosure of PHI for purposes of treatment, payment, and healthcare operations, includingquality assessment and measurement, and disease management activities. Before any PHI is disclosed for purposes of treatment, payment, or healthcare operations, agreements with therecipients of such information are entered into to protect the confidentiality of PHI.

All Members have the right to access, obtaincopies (within 30 business days of a request), and correct any PHI about them, which is inOxford’s possession.

PHI can be released to a third party upon priorreceipt of a valid written consent from the Memberin question. To be valid, a written consent must:

• Be signed by the Member

• Contain the Member’s name and Oxford ID number

• Be dated

• Specify the information to be disclosed

• Specify to whom the information can be disclosed

If a Member is unable to give consent, family orlegally appointed representatives will be author-ized to release and/or receive access to informa-tion about the Member.

Although it is Oxford’s policy not to release PHIto any third party without the Member’s writtenconsent, there are exceptions, the most commonof which are:

• To the Member directly

• To providers/physicians treating the Member

• To an applicable regulatory body

• To a law enforcement or other governmental authority

It is Oxford’s general policy not to share PHI withany employer without consent from the Member.When Oxford is obligated to share informationwith employers for auditing and other purposes,such information is either de-identified or a certification is provided by the employer/grouphealth plan acknowledging that the informationcan be used only for plan administration func-tions and not for employment-related purposes.

The sale of PHI is strictly prohibited. This information will also not be disclosed for marketing purposes, for purposes related to a worker’s compensation claim or auto insuranceclaim, or for research studies, unless the Memberto whom the information pertains has given specific written consent allowing disclosure.

We emphasize the importance of confidentialitythrough employee training, the implementation ofprocedures designed to protect the security of ourrecords, and our privacy policy. We restrict accessto PHI to those employees who need to know thatinformation to perform their job responsibilities.We maintain physical, electronic, and proceduralsafeguards that comply with federal and state regulations to guard the confidentiality of PHI.

N E W S Y O U C A N U S E18

2002 Adult Preventive Screening Guidelines

The following guidelines have been developed by the U.S. Preventive Services Task Force, in conjunctionwith the American Medical Association. These guidelines were reviewed and approved by Oxford’sRegional Quality Committees in March 2002.

Procedures Ages 18-39 Ages 40-49 Ages 50-64 Ages 65+

Health Screenings

Routine Preventive Health Assessment Every 5 years Every 2 years Annually

Blood Pressure At least every 2 years Annually

Serum Cholesterol Every 5 years

Hemoglobin 20 years or over at least once every 5 years

Urinalysis At clinician’s discretion

Tuberculin Skin Test (PPD) For all those in high-risk groups

Chlamydial Infection▲ Under 25 years regular screening and sexually active

Cancer Detection

Clinical Breast Exam▲ At clinician’s Annuallydiscretion

Mammography▲ At clinician’s Annually with clinical breast exam to age 70discretion

Pelvic Exam and Pap Smear▲ Annually at onset of sexual activity or starting at age 18;after three consecutive normal smears, every 1 to 3 years

Prostate Specific Antigen (PSA) ■ At clinician’s discretion

Digital Rectal Exam At clinician’s discretion

Fecal Occult Blood (FOB) Test At clinician’s discretion Annually

Sigmoidoscopy At clinician’s discretion Every 3-5 years in conjunction with FOBT

Immunizations

Diptheria and Tetanus Booster Every 10 years (following initial series of three doses)or once at age 50

Hepatitis B Vaccine One series, if at risk and not immunized previously, or at clinician’s discretion

Hepatitis A Vaccine One series, if at risk or at a clinician’s discretion and not immunized previously (a booster is necessary

1 year after initial vaccination)

Influenza Vaccine Annually with chronic Annuallydisease/high-risk

Pneumococcal Vaccine* Initial dose for those at high risk Initial dose (long-term health problems or for those weakened immune system)* 65+*

▲Women Only ■ Men Only*Revaccinate if less than 65 years old when initial dose was received and if received more than five years ago.

L I V I N G W E L L 19

The Bayer Institute notes, however, that becoming amore active, engaged partner in health doesn’t comenaturally to many people. Nor do some time-presseddoctors with waiting rooms full of other patientsencourage the less communicative patient to speakup. Patient empowerment takes a certain amount ofpractice on everybody’s part, but it’s worth the effort.We’ve come up with some tips to help you and yourdoctor get the most out of every visit:

1. Keep a healthcare diary. Briefly note allmajor events in your health history, includingimmunizations, incidences of contagious diseases, physical injuries, and other significanthealth conditions, treatments, and surgeries. Put these on file with your primary care physician and keep a copy for yourself. If youhave a current health condition, keep fairlydetailed notes about symptoms — timing, frequency, and associated events such as injury,fever, and changes in eating patterns. Tell all of your doctors what medications you are taking, including prescriptions, over-the-counter drugs such as aspirin and cough syrups, vitamins, and herbs, and include dosages and side effects, if any. Carry a list of all current medications in your wallet.

2. Prepare for your next appointment.Write down the most important questions you want to discuss in order of importance.

Take them with you, and let your doctor know you want to discuss them during your appointment.

3. Bring a family member or friend. If you think your issues are complicated or you might not remember everything, another person can be a second set of eyes and ears, taking notes if necessary.

4. Be assertive during your visit. Ask questions, especially if you do not understandwhat’s being said. Ask your doctor about printed material that you can read later to fully understand your condition or treatment.

5. Discuss the different ways you couldhandle a new health condition. Be sure you understand the advantages and disadvantages of each option. If your procedurerequires time to recuperate, make sure yourphysician explains how you can expect to feel a few hours afterwards, as well as a few days later, so you can prepare. Also ask if there aredietary, exercise, or behavioral changes youshould make to improve your prognosis.

6. Get test results. Ask for blood and cholesterol work-ups, diagnostic imaging, EKGs, etc. — and find out what your scoresmean. If scores change from one visit to thenext, ask the doctor what he or she thinks iscausing it. O

According to the Bayer Institute, a group that studies the role of physician-

patient communication in promoting better health, the typical patient still

takes a passive approach when visiting the doctor. Studies show that

patients who are actively involved in their own care tend to be more

satisfied with their doctor and feel more positive about their condition.

They’re also more likely to follow treatment in the most effective

way and to experience better health outcomes as a result.

Talking to your doctor

P.O. Box 7081, Bridgeport, CT 06601

HWFA02/5677

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ONWARD PUBLISHING INC.

OCUSTOMER SERVICE 1-800-234-1228(8 AM - 6 PM, Mon to Fri) For Members who have questions ranging from covered benefits to claims issues. For a hearing impaired interpreter,you may contact Oxford’s TTY/TDD hotline at 1-800-201-4874. Please call 1-800-303-6719 for assistance in Chinese, 1-888-201-4746 for assistance in Korean, 1-800-449-4390 para ayuda en Español,and 1-800-234-1228 for languages other than English.

PHARMACY CUSTOMER SERVICE

1-800-905-0201 (24 hours a day, 7 days a week)Receive answers to your questions about pharmacybenefits, claims, prescriptions, and participating pharmacies in your area.

DAVIS VISION MEMBER SERVICES

1-800-999-5431 (8 AM - 8 PM, Mon to Fri; 9 AM - 4 PM, Sat) Find Davis Vision locations near you.

MEDCO HEALTH HOME DELIVERY

PHARMACY SERVICE (MAIL-ORDER

SERVICE) 1-800-905-0201 (24 hours a day,7 days a week) This mail-order pharmacy service provides a cost-effective, convenient way for Memberswith a mail-order prescription benefit to order certain maintenance medications.

QUEST LABORATORIES 1-800-225-7483(24 hours a day, 7 days a week) To find Oxford participating labs in your area.

MEDICARE TELESALES 1-800-303-6720(8 AM - 6 PM, Mon to Fri) To use when referring friends to Oxford Medicare Advantage.

NAT’L. SUPPORT ORGANIZATIONS

Advocates for the Disabled 1-800-522-4369Alzheimer’s Association 1-800-272-3900Asthma and Allergy Foundation 1-800-727-8462American Cancer Society 1-800-227-2345American Diabetes Association 1-800-342-2383American Dietetic Association 1-800-366-1655American Heart Association 1-800-242-8721American Kidney Foundation 1-800-638-8299American Lung Association 1-800-586-4872Arthritis Foundation Information 1-800-283-7800Cancer Care, Inc. 1-800-813-4673Elder Care Locator 1-800-677-1116Grief Recovery Institute 1-800-445-4808Medicare Information Line 1-800-633-4227Multiple Sclerosis Foundation 1-800-441-7055National Osteoporosis Foundation 1-800-223-9994National Parkinson’s Foundation 1-800-327-4545Social Security Information Line 1-800-772-1213

LOCAL COM M U N ITY RESOURCES

New York City Department for the Aging 1-212-442-1000Access-a-Ride (NYC paratransit system) 1-877-337-2017EPIC (NY prescription assistance) 1-800-332-3742Nassau County Department for the Aging 1-516-571-5814Able-Ride 1-516-853-3712Richmond County Department for the Aging 1-212-442-1000New York Dental Clinic (dental assistance) 1-212-998-9800New Jersey Department for the Aging 1-877-222-3737New Jersey Dental Society (dental assistance) 1-732-821-2977PAAD (NJ prescription assistance) 1-800-792-9745SHARE (NY & NJ nutritional assistance) 1-800-708-4667Connecticut Agency for the Aging 1-203-933-5431ConnPACE (prescription assistance) 1-800-423-5026West Haven Elderly Services Department 1-203-937-3507

O X F O R D C O N T A C T I N F O