Vol.

32 •

No.

2 •

Apr

il 20

18 F O R Y O U RPublished by the

New York

State Nurses

Association

Benefits Fund

Inside: Page 2: Listen to this - Menopause, perimenopause, and hot flashes Learning online with UnitedHealthcarePage 3: Call the Fund for all your benefit questions Stroke awareness continued... An important reminder regarding billing and claimsPage 4: The new shingles vaccine Home healthcare

National Stroke Awareness (NSA) Month, created to reduce the in-

cidence of strokes in the United States, is observed annually during the month of May.

National Stroke Awareness Month be-gan in May 1989 after President George H. W. Bush signed the Presidential Proclamation. NSA Month aims to in-crease public awareness about the warn-ing signs and symptoms of a stroke, stroke prevention, and the impact of stroke on survivors, families and care-givers. The United States government,

along with the National Stroke Associa-tion, the American Heart Association, and other non-profits, work together to educate Americans about the preven-tion of stroke and provide key resources to stroke survivors and their caretakers.

F.A.S.T.Act Fast

The National Stroke Association encourages people to act FAST (F-Face drooping, A-Arm weakness, S-Speech difficulty, T-Time to call 911) if they suspect that they or a loved one are experiencing a stroke.

One of the most successful drugs used to treat a stroke is tissue plasminogen activator (tPA). Because tPA, a clot-busting drug, can only be administered to stroke patients within the first three hours of the onset of a stroke, recogniz-ing the symptoms of a stroke is very important. If you’re having a stroke, or even suspect you might be having a stroke, it’s important to get immedi-ate medical attention — call 9-1-1 right away. The sooner you get treatment, the better. Immediate treatment may help minimize the long-term effects of stroke and improve recovery outcomes.

The Fund welcomes our newest participants from Champlain Valley Physicians Hospital. CVPH is part of a six-hospital network serving

patients and their families in northern New York and Vermont.

troke awareness and acting F.A.S.T.SThe importance of

We are pleased to announce that beginning June 1, 2018, prescrip-

tion drug coverage for Benefits Fund participants will be provided through Express Scripts, Inc. (ESI), replacing OptumRx as our pharmacy service provider. In reviewing their options for pharmacy service providers, the Trustees of the Fund considered many factors, with a focus on a provider committed to offering the highest level of service to our participants. We look forward to an improved experience for our participants with ESI. We expect this to be a seamless transition for Fund participants, as there

are no changes to the existing pharmacy programs.

In the coming months you’ll want to keep a close eye on your mailbox. Fund participants will receive new prescrip-tion ID cards from Express Scripts, Inc., which should be mailed in mid-May, as well as a welcome packet of information with details about filling prescriptions.

Open refills and prior authorizations will be transferred from OptumRx to ESI for you. Maintenance medications in 90 day refills can still be picked up at Wal-

greens, Duane Reade, and now Rite Aid. (According to New York State law, com-pound medications and controlled sub-stances will require a new prescription.)

Non-maintenance prescriptions (with available refills) currently filled at your local retail pharmacy can be refilled with-out a new script at the same pharmacy. All you’ll need to do is present your new ESI ID card after June 1. We look forward to this new partnership with ESI and continue to strive to offer Fund par-ticipants excellent benefits and attentive service. - FYB

Prescription drug service provider changes to Express Scripts, Inc.

B

Continued on page 3...

enefit

The Fund offices will be closed on Labor Day, Monday,

September 5th. You may still leave a message for us at

(877) RN BENEFITS or email at (benefit@rnbenefits.org)

Listen to this!

Menopause, perimenopause, and hot flashes, oh my!!

NYSNA Benefits Fund participants: Call the Benefits Fund for all

your benefit questions

If you’ve been a NYSNA Benefits Fund participant for just a few weeks or several decades, chances are you occasionally find yourself needing information about a single benefit, such as prescriptions, or a variety of benefits from multiple service providers. As a NYSNA Benefits Fund participant, there’s no need to make more than one call.

According to recent statistics on hearing loss, approxi-

mately 20 percent of Americans – that’s more than 40 million of us – report they’ve experienced gradual or sudden loss of hear-ing. For Americans over the age of 65, one out of three report a hearing loss. But, there’s also the startling fact that more than 30 million individuals in the U.S under the age of 65 suffer from hearing loss, reports the Better Hearing Institute.

Unfortunately, it’s a trend that’s only getting worse. Between 2000 and 2015, the number of Americans with hearing loss doubled. Internationally, the number is up 44 percent.

Early detection and treatment is important to minimizing the impact of hearing loss, especially in children and young adults. If you suspect you’ve experienced some level of hearing loss – suddenly or over time – don’t be ashamed to seek an evaluation. Advances in technology and hearing healthcare have made it possible to treat hearing loss in most individuals.

Fortunately, Davis Vision now offers the largest hearing care provider network in the coun-try. Fund participants can take advantage of substantial savings on top-tier brand devices and related professional services through the EPIC Hearing Ser-vice Plan.

The EPIC Hearing Service Plan features audiologists and ENTs with access to all name-brand hearing aid technology at prices up to 60 percent below manu-facturer suggested retail price. Participant savings range from $550 to over $1,000.

For more information about these new discounts and benefits call a benefits participant service representative at (877) RN BENEFITS [762-3633]. – FYB

• Medical (UnitedHealthcare/Oxford)• Vision (Davis Vision) • Dental (Aetna) • Prescription Drugs (ESI beginning 6/1/18)• Life Insurance/Disability/Paid

Family Leave (The Hartford)

The Benefits Fund can answer your questions and help resolve any issues with your:

Our participant service representatives are available by phone Monday through Friday 8:30 a.m. until 4:30 p.m. to assist with your questions about claims, benefits, and eligibility.

Reach us at (877) RN BENEFITS

UnitedHealthCare offers advice and recommendations when dealing

with a variety of health issues – including menopause and perimenopause. Benefits Fund participants can learn about the signs and symptoms of menopause and perimenopause and how to prevent bigger health issues at www.uhc.com/health-and-wellness/health-topics/menopause-perimenopause.

Menopause is a normal part of aging, usually beginning around age 51, when a woman goes one full year without a men-strual cycle. According to UnitedHealth-care, when most women think of meno-pause, they’re thinking of perimenopause. This transitional period begins about six years before menopause and lasts one year after the last period. During this time, a woman’s body produces less estrogen and progesterone, and menstruation becomes less frequent.

One common sign of perimenopause and menopause is hot flashes. While hot flashes are common in perimenopause, not all women experience them, and not all hot flashes are of the same intensity. Hot flashes can be as mild as a light blush or severe enough to wake you from a sound sleep and be associated with per-spiration, also known as night sweats. Most hot flashes last 30 seconds to five minutes. They usually disappear within a few years after menopause, but in some women, they can continue for decades.

If your hot flashes are severe enough, your doctor may prescribe low-dose birth control pills or an estrogen supple-ment, also known as hormone replace-ment therapy. As with all medicines, there are risks and benefits from tak-ing HRT. Results from a large study, the Women’s Health Initiative, showed that long-term use of estrogen-proges-terone combination therapy caused an increased risk of breast cancer, heart disease, blood clots, and stroke. You and your doctor may also want to explore other medication options, such as a low dose of antidepressants or drugs typi-cally used to control high blood pres-sure. If you prefer to take care of hot flashes without seeking medical advice, try dressing in light layers and avoid hot liquids and spicy foods to ease the discomfort.

It’s not uncommon for other health conditions to coincide with menopause. Those to look out for include arthri-tis, depression, fibromyalgia, and heart disease. Consulting with your general practitioner or gynecologist with your concerns about these possible conditions is important. Visits to your gynecologist (well-woman visits) and general prac-titioner (preventative care) are covered at no cost to you when provided in-net-work. Out-of-network, these visits are paid at 70 percent of the usual, custom-ary, and reasonable cost. - FYB

If you like learning online, United-Healthcare’s online seminars is the

go-to spot for you! With a wide variety of topics, this online offering allows you to decide when and where you learn about everything from healthy meals to balanc-ing your life while managing stress.

Some seminars to watch at www.uhc.com/health-and-wellness/attend-a-semi-nar include:

Family Health seminars with Kathleen Zelman, MPH, RD

Must Eat Foods for You and Your Family – By loading your shelves with delicious and nutritious foods, your kids will stop begging for junk food. Learn tips and tricks to help your family make healthier food choices and develop good eating habits that can last a lifetime.

The ABCs of Child Nutrition and Physi-cal Activity: Raising a Happy, Healthy Eater – Getting kids to enjoy and embrace a healthy diet and regular physical fitness can be a real challenge for parents. This informa-tive online seminar offers tips and tricks to

help your kids make healthier food choices and develop good eating habits.

Simplify Your Life seminars with Audrey Thomas, MPH, RD

Be More Productive – Productivity is a hot button these days because most people admit to feelings of insanity when balancing home, work, and life. This webinar provides 10 strategies that most people aren’t currently implementing designed to increase personal productivity – both at home and at work – so that you can enjoy life in the sane lane.

Aha! Simple Secrets of Organized People – If you’re feeling overwhelmed in your surroundings, then this session is for you. Learn a five-step process that many organized people follow to get and stay organized. This process can be applied at home, work, and even with your kids!

Other online seminar topics include:• Emotional health• Heart health• Health conditions• Healthy habits

…and more at www.uhc.com/health-and-wellness/attend-a-seminar. - FYB

Learning online with UnitedHealthcare

You should never pay more than your office visit copay-

ment when you see an in-network primary care provider for an office visit. Sometimes though, billing mistakes occur. If you receive a bill from your doctor, even after paying your copay, don’t pay the bill until you’ve cleared things up with your doctor’s office.

In general, if you receive services from an in-network provider, Ox-ford will pay the physician or facil-ity directly. If an in-network provid-er bills you for any covered service other than your initial copayment, please contact the Benefits Fund at (877) RN BENEFITS [762-3633] as soon as possible. (See claim sub-mission deadlines below)

In-Network Providers:First, make sure your healthcare

provider is in the Oxford or Unit-edHealthcare provider network by checking online at www.oxford-health.com. (If you’re out of the Oxford service area of NYC, Long Island, Connecticut, New Jersey, and Dutchess, Orange, Westchester, Rockland, and Ulster Counties, you need to use the UnitedHealthcare Choice Plus network of providers.) Our participant service represen-tatives also can verify that your provider is in-network. Call (877) RN BENEFITS [762-3633]. If the provider you saw is in-network, call their office and verify that the staff knows you’re an Oxford/United Healthcare participant through the NYSNA Benefits Fund. Make sure they check your file and make any necessary updates to your insurance information. In the event they will not submit a claim for you, you can submit your own within 90 days of the date of service.

Out-of-Network Providers:In the event your provider is

out-of-network, send the bill and a completed claim form to:

Oxford Health Plans Attn: Claims Department

PO Box 29130 Hot Springs, AR 71903

Out-of-network claim forms are available online at the Fund’s Web site, www.rnbenefits.org, and must be submitted within 120 days of the date of service.

For any questions or concerns regarding a claim, please call a participant service representative at 877 RN BENEFTS. - FYB

An important reminder regarding

medical billing and claims

Recognizing a stroke’s causes and symptoms in men and women — and their differences

There are a variety of causes of a stroke for men and women, including high blood pressure, diabetes, high cholesterol, and circulation problems. Many stroke symp-toms, for both men and women, include sudden numbness or weakness of the face, arm or leg, especially on one side of the body. Other symptoms are sudden confu-sion, trouble speaking or understanding, trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance or coordination, and severe headache with no known cause.

Each year strokes kill twice as many wom-en as breast cancer. Unique stroke symp-toms for women include hiccups, seizures, shortness of breath, fainting, agitation, and sudden behavior changes. These unique symptoms create a problem in diagnosing stroke symptoms and treatment, unfortu-nately, is often delayed.

In order to avoid a delayed diagnosis in women, keep in mind that the following factors may increase the risk of stroke:

• Taking birth control pills• Using hormone therapy

• Being pregnant• Suffering migraine headaches with

aura.

Get help FASTThrough the Benefits Fund and United-

Healthcare/Oxford, access to immediate medical attention can come at little to no cost for you. Participants and their cov-ered dependents may seek emergency care at urgent care centers. Benefit Coverage Plan A participants pay a copay of $25 per visit, while Benefit Coverage Plan B partic-ipants pay a $30 copay. Emergency care re-ceived at a hospital emergency room – no matter where it’s located – requires a $75 copay per visit for those in Plan A and a $100 copay for those in Plan B. This copay is waived if you’re admitted to the hospi-tal. In cases where emergency ambulance services are needed, transport is covered when medically necessary. Inter-facility ambulance transfers also will be covered when they’re precertified.

For more information on the causes, signs, and symptoms of a stroke and for resources and information on National Stroke Awareness Month, please visit www.stroke.org. - FYB

Stroke awareness continued...

For Your Benefit is published six times each year as a service to participants

in the New

York State Nurses A

ssociation Benefits Fund. The information

in this newsletter is not intended to be com

plete plan information, and is

not a substitute for the Summ

ary Plan Description. Please address questions

regarding this newsletter to the C

omm

unications Departm

ent.

Ronald F. Lamy, C

PA, C

EBS, Chief Executive Officer

Christopher J. Rosetti, CPA, CFE, CFF, Chief O

perating Officer

Linda M. W

helton, Benefits Departm

ent Manager

Tricia E. Cupp, Senior Comm

unications Specialist

Meighan C

. Rask, Comm

unications Specialist, FYB Editor

Sharron Carlson, C

EBS, Comm

unications Representative

NYSN

A Benefits Fund

PO Box 12430

Albany, N

Y 12212-2430(518) 869-9501 • (877) RN

BENEFITS [762-3633] • (800) 342-4324

ww

w.rnbenefits.org

If you’ll be changing your address, please notify us so you w

on’t miss the next issue of For Your Benefit.

Non-Profit O

rg.US Postage

PAIDPerm

it No. 79

Albany, NY

N Y S N

ABenefits Fund

New

York State Nurses A

ssociation

PO Box 12430

Albany, N

Y 12212-2430

CH

AN

GE SERV

ICE REQ

UESTED

The Fund offi

ces will be closed

on Friday, March 30 and again

on Monday, M

ay 28 . You may

leave a message for us at (877)

RN BEN

EFITS or e-mail us at

benefit@rnbenefits.org

Unfortunately, there are times when you or a

loved one may find yourself in need of medical care or assistance within your home. With precertification from Oxford, the Benefits Fund covers care provided in your home by a home health ser-vice or licenced state agency. The care must be provided by

look at your Benefits Fund Summary Plan Description: Home Healthcare

physician-supervised health professionals according to your physician’s written treat-ment plan and must be in lieu of hospitalization or confine-ment in a skilled nursing facility. Home care includes:1. Part-time or intermittent

nursing care by or under the supervision of a regis-tered professional nurse,

2. Part-time or intermittent services of a home health aide,

3. Physical, occupational, or speech therapy provided by the home health ser-vice or agency, and

4. Medical supplies and medications prescribed by a network physician, and laboratory services by or on behalf of the Home Health Agency to the

extent these items would have been covered dur-ing a hospitalization or confinement in a skilled nursing facility.

While home healthcare is unlimited for in-network pro-viders it is limited to 140 visits for out-of-network. Each visit of up to two hours by a regis-tered nurse or therapist is one visit. In addition, each visit up to four hours by a home health aide is considered one visit. “Home” includes any place the patient makes his/her home. This may include his/her dwelling, an apart-ment, a relative’s home, home for the aged or, a custodial care facility.

Services of an independent nurse hired directly by the family or patient are excluded.

Your skilled home health care services are covered, under Benefit Coverage Plans A and B at no cost to you, when in-network. Out-of-network coverage is paid at 70 percent of the usual, customary, and reasonable charges.

Please note: Any rehabilitation services received under this benefit will not reduce the amount of services available under the outpatient rehabilitation therapy. Medical supplies and medications that are used in conjunction with a home healthcare visit are covered as part of that visit. Some examples are, but not limited to, surgical dressing, cath-eters, syringes, and irrigation devices. - FYB

A

Eligible N

YSNA

Benefits Fund participants have coverage

for the shingles vaccine to protect against the varicella zoster virus, the virus that causes both chicken pox and shingles. Beginning April 1, 2018, there is a new

vaccination, Shingrix, w

hich provides earlier prevention and a m

ore positive response and defense to shingles.

Prior to the release of Shingrix, to be eligible for shingles vaccine coverage, participants had to be at least age 60. Th

is is no longer the case. Th

e U.S. Centers for D

isease C

ontrol recomm

end receiving the Shingrix vaccination starting at age 50, w

hich is 10 years earlier than the previous Zostavax recom

-m

endation. Under the guidance of

your doctor, participants can opt for Shingrix over Zostavax and get Shingrix even if you’ve already got-ten the Zostavax vaccination.

The Shingrix vaccination consists

of two shots that should be given

two to six m

onths apart. Consult

your physician to make a schedul-

ing plan for your vaccinations.

Contact the Benefits Fund at

(877) RN BEN

EFITS if you have any questions regarding this benefit. - FY

B

New

shingles vaccination available

as early as age 50