Blue & You - Summer 2010

Summer 10
A publication for the policyholders of the
Arkansas Blue Cross and Blue Shield
family of companies
HEALTH
INSURANCE
REFORM
ANSWERS

6 Good news for graduates!
12 Need more information before visiting
a specialist? We can help!
19 Redesigned PHS wins top scores
in national review
Cal Kellogg, Ph.D., explains
what you need to know about
health insurance reform.
on Page 8
INSIDE
3 Out of the Blue
4 Health Insurance Reform & You
6 Good news for graduates! Arkansas Blue Cross
extends health insurance coverage
8 Your health insurance, your health care, your future
12 Need more information before visiting a
specialist? We can help!
Lose weight The Healthy Weigh!
13 Chronic job stress and your waistline
How much exercise do women really need?
16 Lifelong Health with Dr. David
18 Warning issued for “baby slings”
Can breastfeeding save lives?
19 Redesigned PHS wins top scores in national review
Food for thought: certain foods may keep
aging brains healthy
20 From the Pharmacist — What’s in a drug name and
why did mine change?
21 The Doctor’s Corner
22 Financial Information Privacy Notice
23 Good for your community
Customer Service telephone numbers
24 Good for you
Summer 10
is published four times a year by
Arkansas Blue Cross and Blue Shield for
the company’s members, health care
professionals and other persons
interested in health care and wellness.
Editor: Kelly Whitehorn — BNYou-Ed@arkbluecross.com
Assistant Editor: Jennifer Gordon
Designer: Gio Bruno Photographer: Chip Bayer
Contributors: Chip Bayer, Matthew Creasman, Damona Fisher, Kristy Fleming,
Trey Hankins, Heather Iacobacci-Miller, Ryan Kravitz, Kathy Luzietti and Mark
Morehead
Vice President, Communications and Product Development: Karen Raley

Out of the
Blue
A message from our
CEO and President,
Mark White
The enactment of new health insurance reform legislation
has left many of our valued customers confused
and unsure of how the new law will affect them. We
are hearing questions concerning the changes that can
be expected as various provisions of the new law take
effect from employers, individuals and families, as well
as agents who market our products. And the confusion
is certainly understandable as the law is far-reaching
and complex. At Arkansas Blue Cross and Blue Shield,
we are working every day to provide accurate answers
to the questions you pose. We also are working with
various government agencies to clearly understand and
effectively implement the regulations that will result
from the reform legislation passed by Congress.
One of the most frequent questions we answer for
our members relates to cost. Our members are concerned
that, as a result of new regulations, their premium
costs will rise. And that is a valid concern. There are
many provisions in the law that will increase the cost
of health insurance premiums for many people. After
all, health insurance premiums are a reflection of health
care costs. Unfortunately, the new law does little to address
the rising cost of medical services but adds new
rules that will increase administrative requirements and
new fees that will have to be funded.
As we move into the implementation phase of the
new health insurance reform bill, we will be focused on
making coverage affordable for consumers. Arkansas
Blue Cross remains committed to working with employers,
providers of care (such as doctors and hospitals)
and state and federal government agencies to reduce
the cost and wasteful use of medical services, which
leads to higher medical premium costs. We will continue
to participate in initiatives that keep people healthy
and help them manage chronic disease. And, we will
work to develop new payment models so that health
care providers are rewarded for providing effective,
high-quality care rather than more care. Also, we will
take a fresh look at how we operate and seek greater
administrative efficiency.
In a period of rapid and radical change in health care,
one thing remains constant. Arkansas Blue Cross is
committed to providing our members with peace of
mind, as we have done for more than 60 years. That
commitment is even more important in today’s uncertain
health care environment. So if you have questions
about how health insurance reform will affect your
health care, we hope you will check our Web sites for
our analysis. Or call us. We’re happy to hear from you.
In this rapidly changing health care environment, we
haven’t forgotten who we work for every day. You.
3
Blue & You Summer 2010

4
T
(PPACA), which was signed into law on March 23,
2010, ultimately will touch almost every American. The
provisions of the law will be phased in throughout the
next 10 years, with the most significant changes taking
place in 2014. At this early stage, it is very difficult to
predict what changes are in store for each of us. That is
because there are numerous federal and state entities
that must issue regulations, which will explain to insurance
companies and others involved how the law will
be implemented.
The PPACA will make dramatic changes in the insurance
marketplace. The new law will require all health
insurance policies to contain new benefits. It will require
that health insurers rate health plans in new ways.
Many health industry suppliers will be called upon to
pay new taxes to cover the uninsured, thereby increasing
their costs. The new reform legislation did not
contain substantial provisions to control medical costs,
which are the primary drivers of premium costs. These
facts taken together mean that for most Americans, the
cost of health insurance will rise. By 2014, many Americans
will be eligible for government subsidies, which
will help offset those increases. In the meantime, those
with private insurance should expect there to be some
increase in cost as reform provisions are implemented.
That being said, Arkansas Blue Cross and Blue Shield
and its family of companies are committed
to doing all we can to hold costs down and
help our customers understand how they
will be affected. With the understanding
that the final rules are not in place, described
in this article are the changes we
believe will be required by the new law
during the next 18 months, based on
the kind of policy you have and when
Health Insurance
he Patient Protection and Affordable Care Act you enrolled in it. Until we better understand the requirements,
which will come with the issuance of regulations,
we are not able to accurately price the changes.
If you have health insurance through
your employer and were enrolled before
March 23, 2010 (at least one enrolled person):
Insurance policies that were in place on the day
the law was passed are considered “grandfathered”
plans. The new requirements for these plans are more
limited than for those sold after the law was enacted.
Changes that members enrolled in grandfathered employer
group plans can expect during the next six to 18
months may include:
• New rules around pre-existing
health conditions
for children, which may
mean that children
who are
Blue & You Summer 2010

Reform & You
insured under their parent’s health plan do not have
to meet any pre-existing condition waiting periods
even if the parents are required to do so as a result
of some condition of their enrollment (late enrollment,
no prior creditable coverage, etc.).
• Dependents can continue coverage under a parent’s
plan until their 26 th birthday. Dependents are eligible
regardless of student or marital status. Dependents
also are eligible regardless of whether they are
claimed as a dependent on their parent’s tax return.
Policies in place before March 23, 2010, are allowed
to exclude coverage to dependents if they have access
to their own coverage from
another employer-sponsored
health plan. This exception
expires on Jan. 1, 2014.
(More information on dependent coverage is in the
article on Page 6.)
• Lifetime dollar limits will be removed on “essential
benefits.” The rules and guidelines outlining what
benefits are considered essential have not been
defined by the government as of this printing.
• On most Arkansas Blue Cross plans, the lifetime
maximum benefit is currently $5,000,000. This lifetime
benefit would become unlimited.
• The dollar limits for some benefits in place today
may be adjusted by the law. The benefits to which
this regulation applies have not been determined.
If you had an individual or family medical
policy in place March 23, 2010 (in which you
were enrolled):
Insurance policies that were in place on the day the
law was passed are considered “grandfathered” plans.
The new requirements for these plans are more limited
than for those sold after the law was enacted. Changes
that members enrolled in grandfathered plans can expect
during the next six to 18 months
may include:
• Dependents can continue coverage under a parent’s
plan until their 26 th birthday. Dependents are eligible
regardless of student or marital status. Dependents
also are eligible regardless of whether they are
claimed as a dependent on their parent’s tax
return. (More information on dependent coverage
is in the article on Page 6.)
• Lifetime dollar limits will be removed on
“essential benefits.” The rules and guidelines
outlining what benefits are considered
essential have not been defined
by the government as of this printing.
• On most Arkansas Blue Cross
Reform, continued on Page 14
5
Blue & You Summer 2010

Good news for graduates!
Arkansas Blue Cross extends health insurance coverage
Health and Human Services to pre-
• Standard pre-existing condition
vent a disruption of services to our
waiting periods will apply.
members.
The following is information on
how this affects you and your adult
child depending on your health
insurance plan:
If you have a fully insured
health care plan through an
employer (small business or
large corporation)
• Dependents who currently are
If you have an individual or
enrolled on their parent’s cover-
family medical insurance
age (regardless of insurance
policy
carrier) as of May 2010, will be
• Dependents who currently are
allowed to remain on that cover-
enrolled on their parent’s cov-
age as long as they are under
erage as of May 2010, will be
age 26. These dependents are
6
To help our members who
have dependents who are graduating
from high school or college this
spring or may be “aging off” their
parent’s medical policy, Arkansas
Blue Cross and Blue Shield has
extended health insurance coverage
for most young adults up to age 26
who currently are covered by their
parent’s individual or fully insured
group plan.
Although this provision of the
health insurance reform law (the
Patient Protection and Affordable
Care Act) becomes effective on the
renewal date of a member’s policy
beginning Sept. 23, 2010, or after,
Arkansas Blue Cross, along with 38
other independent Blue Plans, has
extended dependent care coverage
early (it began June 1) at the
request of the U.S. Secretary of
allowed to remain on that coverage
as long as they are under
age 26. Dependents are eligible
regardless of student or marital
status. Dependents also are
eligible regardless of whether or
not they are claimed as a dependent
on their parent’s tax return.
• There will be no rate impact on
this change until renewal on
plans already in place as of
May 15 or before. However, a
premium must be paid to cover
the cost of the dependent.
• Those dependents who are
under age 26, and who lost
eligibility for dependent coverage
earlier, can apply to be added
back to the plan at the effective
date of the regulation, which is
Oct. 1, 2010.
• These dependents will be subject
to medical underwriting.
eligible regardless of student
or marital status. Dependents
also are eligible regardless of
whether or not they are claimed
as a dependent on their parent’s
tax return.
• Dependents who are under the
age of 26, who were not covered
under their parent’s plan as of
May 2010, and who lost eligibility
for dependent coverage earlier,
can be added back to the group
plan at the effective date of the
regulation, which is the first
renewal date beginning Oct. 1,
2010, or after.
• A special 30-day open enrollment
period for dependents who had
previously aged off their coverage
will be held for each group
health plan beginning on their
renewal date. You will receive
Blue & You Summer 2010

notification before the open
enrollment period. Dependents
on COBRA due to “aging off”
their parents’ coverage, who are
still younger than 26, also will be
allowed to rejoin the group during
open enrollment. They would
again be eligible for COBRA
when they reach the age of 26.
• Policies in place before March
23, 2010, are allowed to exclude
coverage to dependents if they
have access to their own coverage
from another employer-sponsored
health plan. This exception
expires on Jan. 1, 2014.
• There is no premium rate impact
until the group’s renewal. However,
a family premium (employee/child)
will continue to be
charged.
• If the current plan covers dependents
to age 27, the change
does not impact their plan (fully
insured large group plans only).
• Although this change will be
made automatically, employer
groups may choose to “opt out.”
If you are an employee of a
self-insured group
• Your employer will make the
decision. Employers are being
notified of this industry trend
toward early implementation.
• Without early implementation,
the increase in dependent to
age 26 coverage will take effect
at renewal.
• A special 30-day open enrollment
period for dependents who had
previously aged off their coverage
will be held for each group
health plan beginning on their
renewal date. You will receive notification
before the open enrollment
period.
If you have an Arkansas
Blue Cross dental plan
through your employer
• Dependent rules are the same
as for the fully insured group
health plans.
• There is no premium rate impact
until the group’s renewal. However,
a family premium (employee/child)
will be charged.
• Although this change will be
made automatically, employer
groups may choose to “opt out.”
Dental plans for
individuals and families
(if you purchased your own
dental plan)
• Dependents who are age 19 and
aging off their parent’s plan can
apply for an individual dental
policy.
If you are a state or public
school employee in Arkansas
• The change to cover dependents
up to age 26 was implemented
on April 1, 2010, and a 90-day
open enrollment period was given
to employees to add previously
dropped dependents.
• The provisions for adding dependents
prior to plan renewal are
as follows:
° Child must be unmarried.
° Parent’s home is the
primary residence of the
dependent.
° Parent provides bulk of the
financial support.
• After plan renewal, all dependents
up to age 26 can be added
regardless of their residence or
marital status.
If you are a federal
employee (FEP)
• This change does not impact FEP
members until Jan. 1, 2011.
7
Blue & You Summer 2010

Your health insurance, your health
8
Cal Kellogg, Ph.D., senior vice president and chief strategy
officer for Arkansas Blue Cross and Blue Shield,
closely followed health insurance reform as the debate
was waged in Congress and has become an expert on
the resulting Patient Protection and Affordable Care Act
(PPACA). Blue & You recently sat down with Dr. Kellogg
to discuss the overall effect the new law will have, not
only on the lives of our members, but also on the lives
of all Americans.
What were the goals of health care reform?
Looking back, the initial goal of “health care” reform
legislation was to solve three problems, according
to Dr. Kellogg.
1. Get as many people as possible covered by
health insurance.
2. Address the overall cost of care.
3. Make sure Americans receive high-quality health
care services.
Kellogg said the new law addresses goal No. 1. However,
“that means we have to work on the other two
issues,” he said. “That can be done legislatively, or we
will have to do that as an industry.”
What do our members need to know about
health insurance reform?
According to Kellogg, members need to keep three
important points in mind:
1. Personal Responsibility
As a consumer of health care services, it is important
to take personal responsibility for your own health.
This will benefit you and your family both financially and
personally. “The current reform package doesn’t address
the underlying causes of the increases in medical
costs,” Kellogg said. “People can manage their own
health to prevent illnesses by doing simple things like
eating healthy, exercising and reducing stress — we
just need to be proactive. Rather than saying, ‘let it
happen and then we’ll fix it,’ we should say, ‘let’s do
what we can to prevent illness,’ because the prevented
illness is the one that is the least expensive.”
2. Changes to Your Coverage
There will be changes related to your health insurance
coverage because of PPACA. We will keep you
informed through Blue & You and our Web sites. “While
reform will ensure that more Americans have health
insurance,” Kellogg said, “the coverage will cost more,
simply because of how the changes in the marketplace
are structured by the new law.” He explained that under
reform, individual and family insurance plans will have
rules similar to the current small group insurance plans.
“If you look at the current marketplace, premiums
for small employer groups are about three times higher
Cal Kellogg, Ph.D.
Blue & You Summer 2010

care, your future
What you need to know about
health insurance reform
“While reform will
ensure that more
Americans have
health insurance,”
Kellogg said, “the
coverage will cost
more, simply because
of how the changes
in the marketplace
are structured by the
new law.”
than for individual health insurance policies written for
individuals and their families without an employer sponsor,”
Kellogg explained. “This is because small group
health insurance plans are “guaranteed issue,” which
means that employees and their dependents can have
coverage regardless of any health conditions they may
have. In addition, premiums are based in part on the
health conditions of all the employees on the group
plan. So if there are a number of very sick people within
a group, the group premiums will be higher.”
Kellogg said the rates in Arkansas’ current individual
marketplace are some of the lowest in the United
States because of the manner in which the laws in
Arkansas allow health plans to calculate premiums.
Currently, each state has its own set of laws and regulations
that take into
account the unique
circumstances that
may exist in its marketplace.
“If you are
relatively healthy, you
get a much lower
rate,” he said. “If you
are unhealthy, you
may have to pay a
surcharge, or you may
not be offered individual
coverage in the
private marketplace.
You would still have access to the high-risk pool, where
the premium rates are closer to the premium rates for
small employer groups.” But beginning in 2014, individual
insurance policies in Arkansas will be required
to be “guaranteed issue” as well. For that reason, the
rates are expected to be closer to what we see in small
employer group health plans today.
In addition, PPACA changes the process and the
factors that insurance companies currently use to set
premium rates. Currently, older individuals generally pay
higher premiums than younger people because they
are likely to need more medical services. But in 2014,
insurance companies will be limited in the difference
in premium charged between an older person and a
younger person. This works out well for you if you are
older and not so well if you are younger.
Also, in 2014, PPACA requires that each state establish
health insurance exchanges or marketplaces where
citizens can go to shop for insurance. At that time, Kellogg
said, a person who buys individual insurance and
whose household income is under 400 percent of the
federal poverty level will receive government subsidies
to help pay for their insurance coverage. Subsidies will
be available to people from 133 percent of the federal
9
Blue & You Summer 2010

poverty level up to 400 percent of
to $250, but an older person
the federal poverty level on a sliding
paying $750 might move
scale. People who earn more than
down to $650 a month,” Kel-
400 percent of the poverty level will
logg said. “The impact is go-
not receive a subsidy. “If you are on
ing to vary a lot for people in
the lower end of the scale, you may
the individual policy market.”
not end up paying very much more
Kellogg said the new law
for your policy,” he said, “but if you
doesn’t have as much of
are on the higher end of the scale,
a direct impact on people
you may pay a significant amount.”
ages 65 and older. He noted
10
It is difficult to explain how the
new health insurance reform law
will affect people financially, Kellogg
said, because it depends on their
situation. “Say I’m a 55-year-old
with diabetes. In the current environment,
if I get individual coverage
it may be very expensive because
of my health condition, or I might
not be offered coverage at all in
the private marketplace. But under
the new law, I will be able to get
coverage regardless of my health
condition and it might be a little
less expensive than it would otherwise
have been. This is because
of the new limits in the difference
in premiums that the insurance
company will be able to charge
between an older, unhealthy person
and a younger, healthy individual.
Now, if I’m a single 22-year-old man,
I might see my rates double or triple
because of those same limits, plus
the law’s inclusion of maternity and
other medical services as essential
benefits.
“A young person’s membership
premium might move from $90 up
that they did receive some
immediate relief for prescription
drug coverage and that the
“donut hole” in prescription drug
coverage would close by 2020.
3. The Cost Issue
Health insurance reform does not
fix all the problems in the health
care system. There are still many
important issues to be addressed.
While the new health insurance
reform law deals with access to
insurance, Kellogg said it doesn’t
address the problem of increasing
medical costs. And there is still a
question of whether our medical
system will have the capacity to
serve everyone.
“We are estimating that 500,000
previously uninsured Arkansans will
be able to get coverage,” he said.
“There may be problems with being
able to see doctors as quickly, or
scheduling appointments as easily.
In rural areas, it may be even more
of an issue, because there are fewer
physicians. It also may be a little
bit tighter with the addition of new
Medicaid patients who have not had
insurance and have not been seeing
primary care physicians as frequently
as they should.” There will
be a rise in premiums for young and
healthy people who already have
insurance. Because of this, some
of these individuals may choose not
to pay the higher premiums and go
without coverage.
Some proponents of the new law
have said there will be a windfall
for the insurance companies with
all the new people in the system,
but Kellogg said it doesn’t necessarily
work out that way. “Yes, there
will be new people in the system,
but they may not be as healthy,
and that is going to drive costs,” he
explained. “Our experience is that
folks who have not had insurance,
and then get coverage, tend to use
their coverage quite a bit, which
creates higher volume. You take all
those things together and we could
run into some supply problems.”
Advice to Members
Kellogg suggested members not
make any significant changes in their
Blue & You Summer 2010

Making the Most of It
will take to comply, including the im-
Going forward, Kellogg
plications for them and positives and
said, Arkansas Blue Cross
negatives for some of the choices
will focus on ways to effec-
they may make,” he said. “So, hope-
tively pay for benefits and to
fully, that will help our members
provide information to help
if they have employer coverage.
customers find the most
Employers are going to be struggling
effective treatments and the
to understand this; this isn’t their
places with the best out-
business, this is our business, so
comes. “And we want to pay
we’d better be the experts on it and
coverage until there is more information
about the regulations. “The law
has been passed, but the regulations
that define the law really don’t
exist yet. And, until they exist, we
don’t really know exactly how things
will work.”
For example, Kellogg said, the law
discusses “essential benefits,” which
are medical services that every
health insurance plan in the country
will be required to cover, but the regulations
don’t exist to explain which
benefits are considered “essential.”
We have to understand the details
in the regulations before you start
making changes.
Kellogg said that for the
next six to 18 months the law is in
the implementation stage, which
will include some minor changes
and explanation of the law through
regulations. “You are not going to
see major changes until 2014,
when these significant structural
changes will happen to the
insurance market.”
providers — not for the number
of services they provide
— but for the outcomes that they
generate for their patients,” he said.
“We can help people identify where
there is waste in the system and
get rid of it. And, if we do all these
things in a relatively short time, then
we can lessen the cost impact that
reform will otherwise have on our
members.”
Implementation
Kellogg said that Arkansas Blue
Cross is working to understand the
regulations as quickly as they are
announced and will implement them
in a timely, organized fashion with
minimal disruption. “Hopefully, for
our members, transitions will be as
painless as possible and they hardly
will notice that they’ve happened,”
he said, “unless it’s a situation
where they have the opportunity
to extend coverage for their child
or whatever the situation might be
and then we will have a process for
doing that.”
“We also are going to try to keep
help them.”
What is the Silver Lining?
Kellogg said that under reform
many previously uninsured people
will now have access to coverage.
“And, beginning in 2014, if you have
a lower income, there will be significant
government subsidies and
it won’t cost you as much for insurance.
For those groups it is positive.”
But that silver lining isn’t for
everyone. “For the rest of the folks,
the subsidies have to come from
taxes, so the increased tax burden
will be out there,” Kellogg said. “And
for people who are at or above 400
percent of the federal poverty level,
they won’t get any subsidy and
there will be added costs.”
But Kellogg said the efforts to
change health care have only just
begun. “The other positive is now
that the issue of access has been
addressed, we can focus on other
major issues, like cost and quality,”
he said. “I guess that is the biggest
positive.”
11
employer groups informed of what it
Blue & You Summer 2010

12
Need more information
before visiting a specialist?
We can help!
If you are planning a visit to the doctor and need a little more information
on what medical care may be appropriate for you, Physician
Connection can help. Physician Connection allows you (as a member)
to find quality information for a specific health condition or physician
specialty.
Quality information is available Physician Connection is available
exclusively for members to
for health conditions such as pregnancy,
diabetes, heart, eye and help you make informed health
respiratory conditions. The quality decisions. It’s available in the
information also is available for secure My Blueprint sections of
the following specialties: allergy/ our Web sites — arkansasbluecross.com,
healthadvantage-
immunology, cardiology, endocrinology,
family practice, internal hmo.com and blueadvantagearkansas.com.
Visit the home
medicine, neurology, obstetrics/
gynecology, ophthalmology, otolaryngology,
pediatric medicine,
page to register or log in.
pulmonary diseases and urology.
What is quality information?
Medical experts have established guidelines that most informed
practitioners believe physicians should follow in many — but not all —
situations. Quality measures show how often physicians in our network
(as a group) provide frequently recommended treatments to their
patients.
Within Physician Connection on our Web sites, under the section
called “Quality measures for my physician’s specialty,” you can select a
physician specialty, read the recommended treatment options (quality
measure) for specific conditions, and review a graph that shows how
often physicians in that specialty followed the recommended treatment
(quality measure) for their patients.
In a similar section on our Web sites called “Quality measures for my
health condition,” you can select a health condition (such as diabetes)
and review the graph that shows (by specialty) how often physicians
who treat diabetes followed the recommended treatment (quality measure)
for their patients.
Lose
weight
The Healthy
Weigh!
The Healthy Weigh! Education
Program is free for members of
Arkansas Blue Cross and Blue Shield,
Health Advantage (except state and
public school employees*), Blue Cross
and Blue Shield Service Benefit Plan
(Federal Employee Program), Medi-Pak
Advantage (PFFS) and eligible members
of BlueAdvantage Administrators
of Arkansas.
To enroll, complete the attached
enrollment form and return it in the
self-addressed, postage-paid envelope
included in this magazine. The program
starts when you enroll.
After enrollment, you will begin to
receive information through the mail,
which you can read in the privacy of
your own home and at your own pace.
The program is completely voluntary,
and you may leave the program at any
time. If you have further questions
about the program, call the Health
Education Program’s toll-free number
at 1-800-686-2609.
* Our state and public school members can
access the “Nourish” program through
Life Synch.
Simply complete, sign and return the
attached enrollment form in the selfaddressed,
postage-paid envelope.
Blue & You Summer 2010

Chronic job stress and your waistline
Are you stressed out at work? Worried about job
security? Feeling like you have little control? Chronic
stress may be adding to employees’ waistlines, according
to a recent study conducted by the University of
Rochester Medical Center.
Researchers found that workers who suffered from
chronic job stress had a higher Body Mass Index (BMI)
than less stressed workers. According to the study,
workers dealing with chronic stress tended to look “forward
to going home and ‘vegging out’ in front of the
TV.” And, when layoffs were occurring, the unhealthiest
snacks were the first to go from vending machines. Employees
noted that they did not take time to exercise or
eat better in order to remain at their desks.
One conclusion that the study made is that employers
should “focus on strengthening wellness programs
to provide good nutrition, ways to deal with job demands
and more opportunities for physical activities
that are built into the regular workday without penalty.”
Sources: University of Rochester Medical Center,
msnbc.com
13
How much exercise do
women really need?
We’ve all heard the standard 30 minutes a day, most
days of the week recommendation. But recent research
shows that may not be enough for women as they age.
According to a study in the Journal of the American
Medical Association, middle-aged women may actually
need closer to 60 minutes a day of moderate-intensity
exercise. Don’t be discouraged so quickly. The study
uses Metabolic Equivalent (MET) hours. To put it into
perspective, 1 MET would be equivalent to lying in bed
for an hour while running at 6 mph would equal approximately
10 METs.
So, in order to meet the 60-minute recommendation
to prevent weight gain,
middle-aged women would
need to aim for a minimum of
21 METs per week. To hit those
MET requirements in less time,
up the intensity of your workouts,
which will allow you to
meet the MET requirements
in less than an hour a day.
Source: Health.com
Blue & You Summer 2010

Reform, continued from Page 5
14
plans, the lifetime maximum benefit is currently
$5,000,000. This lifetime benefit would become
unlimited.
If you were enrolled in a health plan
through your employer effective April 1,
2010, or after:
For more recently effective health plans, a number of
changes apply during the next six to 18 months. These
changes may include:
• New rules around pre-existing health conditions for
children, which may mean that children who are insured
under their parent’s health plan do not have to
meet any pre-existing condition waiting periods even
if the parents are required to do so as a result of
some condition of their enrollment (late enrollment,
no prior creditable coverage, etc.).
• Dependents can continue coverage under a parent’s
plan until their 26 th birthday. Dependents are eligible
regardless of student or marital status. Dependents
also are eligible regardless of whether they are
claimed as a dependent on their parent’s tax return.
(More information on dependent coverage is in the
article on Page 6.)
• Lifetime dollar limits will be removed on “essential
benefits.” The rules and guidelines outlining what
benefits are considered essential have not been
defined by the government as of this printing.
• On most Arkansas Blue Cross plans, the lifetime
maximum benefit is currently $5,000,000. This lifetime
benefit would become unlimited.
• The dollar limits for some benefits in place today
may be adjusted by law. The benefits to which this
regulation applies have not been determined.
• Emergency services must be covered at the innetwork
coinsurance or copayment level even if you
receive the services at an out-of-network facility.
(This benefit is already offered by Arkansas Blue
Cross and Health Advantage.)
• Access to any in-network primary care physician or
pediatrician who is accepting new patients. (Already
available.)
• Direct access for women to obstetricians/gynecologists
without a referral.
• Preventive services identified by the U.S. Preventive
Services Task Force will be covered with no member
cost-sharing (copayments, deductibles or coinsurance.)
The specific services that will be covered have
not yet been identified.
If you were enrolled in a family or
individual medical policy on April 1, 2010,
or after:
For more recently effective health plans, a number
of changes apply over the next six to 18 months. These
changes may include:
• New rules around pre-existing health conditions for
children which may mean that children who are in-
For more information on health insurance reform,
go to our Web sites or call Customer Service
(telephone numbers found on Page 23).
Blue & You Summer 2010

sured under their parent’s health plan do not have to
meet any pre-existing condition waiting periods even
if the parents are required to do so.
• Dependents can continue coverage under a parent’s
plan until their 26 th birthday. Dependents are eligible
regardless of student or marital status. Dependents
also are eligible regardless of whether they are
claimed as a dependent on their parent’s tax return.
(More information on dependent coverage is in the
article on Page 6.)
• Lifetime dollar limits will be removed on “essential
benefits.” The rules and guidelines outlining what
benefits are considered essential have not been
defined by the government as of this printing.
• On most Arkansas Blue Cross plans, the lifetime
maximum benefit is currently $5,000,000. This lifetime
benefit would become unlimited.
• The dollar limits for some benefits in place today
may be adjusted by law. The benefits to which this
regulation applies have not been determined.
• Emergency services must be covered at the innetwork
coinsurance or copayment level even if you
receive the
services at
an out-ofnetwork
facility. (Arkansas Blue Cross already offers
this benefit.)
• Access to any in-network primary care physician or
pediatrician who is accepting new patients. (Already
available.)
• Preventive services identified by the U.S. Preventive
Services Task Force will be covered with no member
cost-sharing (copayments, deductibles or coinsurance).
The specific services that will be covered have
not yet been identified.
• Direct access for women to obstetricians/gynecologists
without a referral will be included in all policies.
In addition to the new requirements described above,
PPACA includes additional regulations that may impact
members. These provisions include:
• New appeals processes will be established.
• The federal Department of Health and Human Services
will create a Web site to facilitate consumer
and small group health plan shopping.
• State ombudsman programs will be established.
• Over-the-counter drugs not prescribed by a physician
can no longer be reimbursed from a flexible spending
account or HRA.
These are the changes you can expect in the next
six to 18 months. As regulations are clarified, Arkansas
Blue Cross will notify you of those provisions that
impact your policy. Most importantly, we will keep you
informed of the impact these changes may have on
your rates.
The most substantial changes will be implemented
in 2014. Those provisions will change where and how
you buy insurance, how it is priced and how you pay for
it. As regulations are issued, Arkansas Blue Cross will
provide you with as much information as possible to
help explain health insurance reform and its impact on
the health care industry. Please visit our Web sites or
contact us with any questions you may have.
15
Blue & You Summer 2010

Lifelong Health
with Dr. David
16
David A. Lipschitz, M.D., Ph.D.
For women, heart attack
prevention and education
are key
In recent years, American women have become increasingly
aware that heart disease is not just a “man’s
issue.” Before menopause, a woman’s risk of heart
attacks is lower than a man’s. But post-menopause, the
risk slowly increases, and within a decade both sexes
have similar statistics. We now know that in the last
two decades of life, a woman’s risk of heart attack and
death from heart disease is significantly greater than
a man’s.
In many women, coronary artery disease is different
from that found in men. Women tend to deposit
cholesterol and fats uniformly throughout their arteries,
whereas men tend to have more localized disease. This
may make women less prone to a massive heart attack,
but more likely to have different symptoms, including
potentially fatal abnormal heart rhythms. Prior to menopause,
estrogens protect the heart from the ravages
of a sedentary and stressful lifestyle, unhealthy diets,
elevated cholesterol levels and smoking. However, after
menopause, the protection disappears and hormone replacement
therapy seems to make the problem worse
rather than better.
As women grow older, heart attacks become more
common, but the symptoms are quite different from
our stereotypic expectations. Most Americans imagine
a heart attack to be preceded by a sudden crushing,
centralized chest pain that feels as if the chest is in a
vice. This is rarely the case. For many women, chest
pain is not the initial symptom. Instead, symptoms
can be extremely varied, including a sudden shortness
of breath, palpitations,
nausea and vomiting,
or feeling
clammy and
ill. If chest
pain does
occur, it
frequently
is atypical,
meaning it
For many women,
chest pain is not the initial
symptom. Instead, symptoms
can be extremely varied,
including a sudden shortness
of breath, palpitations, nausea
and vomiting, or feeling
clammy and ill.
Blue & You Summer 2010

Editor’s Note: David A. Lipschitz, M.D., Ph.D., is nationally
recognized as a leader in the field of geriatrics.
Arkansas Blue Cross and Blue Shield is honored to have
him as a contributor to Blue & You magazine.
doesn’t fit the classic description of pain associated
with a heart attack. It may be in the back or abdomen
and is often attributed to a muscle strain or indigestion.
Frequently there is no pain at all or merely a feeling of
pressure or tightness across the chest or throat.
Heart attacks with atypical symptoms or no chest
pain are frequently misdiagnosed, or diagnosed after it
is too late. A recent report published in a major medical
journal showed that pain-free heart attacks, particularly
common in older women, are three times more likely to
be fatal than those with typical symptoms.
There are some very important lessons to be learned
from this information. Women must remember that
they are not immune to heart disease. From a young
age, all women must pay attention to a heart-healthy
lifestyle of diet, exercise and stress management. If
medical concerns are present, such as high blood pressure
and elevated cholesterol, they should be treated
and managed.
In addition to prevention, women need to be more
informed and aware of the initial symptoms of heart
attacks. Do not ignore a sudden shortness of breath,
sweating, nausea, vomiting or unexplained palpitations.
Never ignore an unusual pain such as a heaviness or
tightness in the chest, pain in the back, arm or abdomen,
particularly if you have never had anything like this
before. The sudden onset of any of these symptoms
is best handled by taking an aspirin and calling 911; it
could save your life. When it comes to issues of the
heart, it is far better to be safe than sorry!
17
Blue & You Summer 2010

Warning issued for “baby slings”
18
The U.S. Consumer Product Safety
Commission (CPSC) has issued a
warning concerning the use of infant
carriers known as “baby slings.”
A baby sling is a soft fabric carrier
with a padded shoulder strap connecting
to a hammock-style cradle
that is worn by an adult. The warning
was issued after three infants suffocated
in baby slings in 2009.
Babies younger than four months
old have very weak neck muscles
and can’t control their heads. An
infant can suffocate in as little as two
minutes if the strap from a baby sling
covers his/her nose and mouth.
Also, baby slings can force an
infant’s chin downward to his or her
chest, making breathing difficult and
possibly causing a slower suffocation.
Children with breathing problems
and a low birth weight are at a
higher risk.
The CPSC has not issued a recall
on baby slings, but advises parents
to take special care when using the
device. Specifically, parents should:
• Place the child’s chin up
with his/her face clearly
visible.
• Check on the child
often.
• Do not allow the sling to cover
the child’s face.
• Do not carry the child too low in
the sling.
• Do not carry the child hunched,
with his/her chin touching
the chest.
• Do not carry the child with his/her
face pressed tightly against the
wearer of the sling.
Can
breastfeeding
save lives?
Nearly 900 babies could be saved
each year, along with billions of dollars,
if 90 percent of U.S. women
fed their babies only breast milk
for the first six months of life, according
to a cost analysis published
in the April issue of the journal
Pediatrics.
The analysis studied the prevalence
of 10 common childhood
illnesses, costs of treatment, including
hospitalization, and the level of
disease protection other studies
have linked with breastfeeding.
Breastfeeding is thought to protect
against stomach viruses, ear infections,
asthma, juvenile diabetes,
sudden infant death syndrome and
even childhood leukemia.
The $13 billion in estimated
losses includes an economist’s calculation
partly based on lost potential
lifetime wages — $10.56 million
per death.
The methods were similar to
a widely cited 2001 government
report that said $3.6 billion could
be saved each year if 50 percent of
mothers breastfed their babies for
six months. Medical costs have
climbed since then, and breastfeeding
rates have increased only
slightly.
About 43 percent of U.S. mothers
do at least some breastfeeding for
six months, but only 12 percent follow
government guidelines recommending
that babies receive only
breast milk for six months.
Source: Pediatrics, Associated Press
Blue & You Summer 2010

Redesigned PHS wins top scores
in national review
Arkansas Blue Cross and Blue
Shield’s new Personal Health Statement
— a redesign of the traditional
Explanation of Benefits (EOBs) —
earned a first-place finish, as well as
a designation of “Excellent,” during a
recent national review of insurance
companies’ EOBs.
The EOB, which is generated each
time a member’s doctor or hospital
files a claim, is the primary way
Arkansas Blue Cross communicates
with its members. The goal was to
simplify and personalize the benefit
statement so members will understand
exactly what is happening with
their claims and their benefits.
The new Personal Health Statement
is designed to help members
understand a complex industry in
everyday language.
It helps members:
• Understand claims and how they
were handled.
• Monitor out-of-pocket costs
(deductibles, copayments,
coinsurance)
• See benefits and how they work.
• Have a better understanding of
discounts on services.
• Know how to contact their health
insurance plan.
• Have a quick understanding of
how much they owe and
to whom.
DALBAR, a leading third-party
evaluator in the financial services
industry, conducted this first-ever
national evaluation of the EOB. The
evaluation gave 68 percent of EOBs
failing grades. Arkansas Blue Cross,
however, was deemed innovative
for recognizing the importance
of this member communication
and transforming its EOBs into
Personal Health Statements that
are understandable and useful
consumer tools.
The DALBAR report evaluates
EOBs according to clarity, content
and design. Three DALBAR designations
are used: Excellent: 80-100
points, Very Good: 70-79 points and
Good: 60-69 points.
19
Food for thought:
Certain foods may keep aging brains healthy
Eating a Mediterranean diet may
help keep your brain healthy as
you age, findings from an ongoing
study show.
A “Mediterranean diet” encourages
the following:
• Vegetables
• Fruits
• More fish, less meat
• Olive oil
• Moderate wine
• Whole grains
• Nuts and seeds
The study included 4,000 adults
aged 65 and older who were given
series of tests to examine their
mental abilities every three years
during a 15-year period. Those who
scored highest in following a Mediterranean
diet were least likely to
suffer cognitive decline, the study
authors found.
Source: National Institutes of Health
Blue & You Summer 2010

What’s in a drug name
and why did mine change?
20
Every drug usually has three stems include suffixes like -mab for
names: the chemical name, the monoclonal antibodies, such as infliximab.
Names that include stems,
generic name and the brand name.
Each name is subject to different chemistry roots or other coded
rules and regulations.
information are easier to remember
The chemical name specifies the and give clues to the drug’s use.
chemical structure of the drug. It These names, however, may sound
does not have to be preapproved by or look alike and can contribute to
any organization. Chemical names medication errors.
are primarily used by researchers The brand name is created as
but not in medical practice.
soon as a generic name has been
The generic name usually is created
when a new drug is ready for between drug names that look or
established. To minimize confusion
marketing. It is selected by the U.S. sound alike, the FDA rejects about
Adopted Names (USAN) Council, one-third of an average of 400 possible
brand names submitted based on
whose expertise is recognized by
the U.S. Food and Drug Administration
(FDA), according to principles Still, confusion from similar-
similarities with other drug names.
developed to ensure safety, consistency
and logic. These names To monitor the situation, the FDA
sounding drug names does occur.
typically are used by health care has a medication errors committee
professionals.
that occasionally recommends a
Generic names are made using name change.
an established stem, or group of The most recent name change
letters, that represents a specific happened this year. Kapidex ®
drug class. For example, the USAN (dexlansoprazole), a proton pump
From the
inhibitor that hit the market in February
2009, became confused with
the similar-sounding drug name
Casodex ® . The FDA committee
recommended a name change for
Kapidex ® and effective April 2010, it
became Dexilant ® .
The last time the FDA changed
a drug name after it was approved
was in 2005, when the Alzheimer’s
medication Reminyl ® was confused
with the diabetes drug Amaryl ® and
one person died. The Alzheimer’s
medicine now is called Razadyne.
The need to change a drug’s
name does not happen often and
usually occurs within the first year
a drug is marketed. The complex
procedure of giving each drug a
chemical, generic and brand name
does not always eliminate confusion.
However, the pharmaceutical
companies, the USAN Council and
the FDA all share one basic goal —
to create a name for each drug that
easily distinguishes it from other
drug names, ensuring patient safety.
Pharmacist
Source: fda.gov
by Trey Gardner, Pharm D.,
Arkansas Blue Cross and Blue Shield
Blue & You Summer 2010

The
Doctor’s
Corner
No smoking!
Two new studies have determined
that smoking bans in public
by Ray Bredfeldt, M.D.,
Regional Medical Director
Northwest Region, Fayetteville
Drugs used to treat high
blood pressure also may
keep dementia away
ACE-inhibitors are commonly
used to treat high blood pressure,
but evidence now indicates that
these same medications also may
prevent the worsening of dementia.
Researchers recently discovered
that people who take “centrally active”
ACE-inhibitors (examples are
captopril and lisinopril) had memory
function that declined 65 percent
less when compared to those not
taking these same medications. Of
course, more research needs to be
completed, but for someone with
dementia who already is taking high
blood pressure medications, switching
to one of these medications
might be something to consider.
places significantly reduces the rate
of heart attacks. The studies found
that the overall rate of heart attacks
in cities that have banned smoking
in public places has decreased by as
much as 36 percent during a threeyear
study. Exposure to smoke (or
smoking) can cause blood vessels
of the heart to constrict, which can
cause a heart attack. One of the
studies, published recently in the
Journal of the American College of
Cardiology, estimated that a nationwide
smoking ban in public places
could prevent more than 150,000
heart attacks each year.
No link between cell phones
and brain cancer
Someone may have sent you an
e-mail or some sort of “document”
that suggests that radio waves from
cell phones cause an increase in
brain cancer. Scientists have found
no evidence that radio waves can
damage a cell’s DNA, which would
be necessary for cancer to occur
from cell phones. Now, a new
study gives further assurances of
the apparent safety of cell phones
related to radio waves and brain
cancer. Researchers have found no
increase in the rate of brain cancer
in four different countries during the
10 years after a significant increase
in cell phone use occurred in those
countries.
Take folic acid prior to
pregnancy
For many years, doctors have recommended
that women take folic
acid (vitamin B9) during pregnancy
to help prevent birth defects. Now,
evidence suggests that taking folic
acid prior to getting pregnant has
definite advantages. Women thinking
about getting pregnant should
probably start taking folic acid up to
one year prior to becoming pregnant.
A recent study discovered that
women who take folic acid before
getting pregnant reduce their risk of
having a premature baby by 50 to
70 percent. The recommended preconception
dose of folic acid is 400
micrograms per day.
21
Blue & You Summer 2010

Arkansas Blue Cross and Blue Shield
Financial Information Privacy Notice
At Arkansas Blue Cross and Blue
Shield and its affiliates (including
HMO Partners, Inc. d/b/a Health
Advantage), we understand how
important it is to keep your private
purchase and use of our
products.
• Information related to the fact
that you have been or currently
are a member.
information. Improper access and
use of confidential information by an
employee can result in disciplinary
action up to and including termination
of employment.
22
information just that — private.
Because of the nature of our
business, we must collect some
personal information from our
members, but we also are committed
to maintaining, securing and
protecting that information.
Customer Information
Arkansas Blue Cross and its
Sharing of Information
Arkansas Blue Cross and its
affiliates do not disclose, and do not
wish to reserve the right to disclose,
non-public personal information about
you to one another or to other parties
except as permitted or required by
law. Examples of instances in which
Arkansas Blue Cross and its affiliates
Disclosure of Privacy Notice
Arkansas Blue Cross and its
affiliates recognize and respect the
privacy concerns of potential, current
and former customers. Arkansas Blue
Cross and its affiliates are committed
to safeguarding this information. As
required by state regulation, we must
notify our members about how we
affiliates only compile information
will provide information to one
handle non-public financial information
necessary for us to provide the
another or other third parties are:
of our members. If you would like
services that you, our member,
request from us and to administer
your business. We collect non-public
personal financial information (defined
as any information that can be tied
back to a specific person and is
gathered by any source that is
not publicly available) about our
members from:
• Applications for insurance coverage.
The application includes
information such as name, address,
personal identifiers such
as Social Security number, and
medical information that you
authorize us to collect.
• Payment history and related
financial transactions from the
• To service or process products
that you have requested.
• To provide information as permitted
and required by law to
accrediting agencies.
• To provide information to comply
with federal, state or local
laws in an administrative or
judicial process.
How We Protect Your
Information
Arkansas Blue Cross and its
affiliates use various security
mechanisms to protect your personal
data including electronic and physical
measures as well as company
policies that limit employee access
to non-public personal financial
to review the Financial Information
Privacy Notices for all Arkansas Blue
Cross members, you can visit our Web
site at arkansasbluecross.com or call
the appropriate Arkansas Blue Cross
affiliate company to receive the Privacy
Notice. Our customer service areas
are open from 8 a.m. to 4:30 p.m.,
Central time, Monday through Friday.
To receive a copy of the Privacy
Notice, members should call:
Arkansas Blue Cross —
1-800-238-8379.
Health Advantage — 1-800-843-1329.
Self-funded group members should
call Customer Service using the tollfree
telephone number on their
ID card.
Blue & You Summer 2010

Heart-healthy walking
Arkansas Blue Cross and Blue Shield employees
raised more than $8,000 for the American Heart Association
2010 Central Arkansas Heart Walk, which was held
April 17 at the North Shore River Walk in downtown
North Little Rock. Mike Brown, executive vice president
and chief operating officer, served as the overall Central
Arkansas Heart Walk chairman and launched thousands
of participants for the 5K, including more than 300
Arkansas Blue Cross employees.
BlueAnn leads Anti-Drug
Walk in Arkadelphia
For the 12th year, BlueAnn Ewe helped lead the annual
“Just Say No” drug prevention walk hosted by Perritt
Primary School in Arkadelphia. On April 9, BlueAnn
helped lead the fight against drugs with hundreds of
elementary students, high school and college mentors,
parents, teachers and administration staff, and community
supporters during the 23rd year of the event. Community
and state leaders greeted the walkers, pledging
their support in the fight against drugs. Clark County
Sheriff’s Office
staff, Arkadelphia
Police
Department
officers and
members
of the Arkadelphia
Fire
Department
Rescue Unit
participated
as well.
We love to hear from you!
May we help? For customer service, please call:
Little Rock
Number (501)
Toll-free
Number
Medi-Pak members 378-3062 1-800-338-2312
Medi-Pak Advantage members 1-877-233-7022
Medi-Pak Rx members 1-866-390-3369
Arkansas Blue Cross members 378-2010 1-800-238-8379
Pharmacy questions 1-800-863-5561
Specialty Rx Pharmacy questions 1-866-295-2779
Health Advantage members 378-2363 1-800-843-1329
Pharmacy questions 1-800-863-5567
BlueAdvantage members 378-3600 1-888-872-2531
Pharmacy questions 1-888-293-3748
State and Public School members 378-2364 1-800-482-8416
Federal Employee members 378-2531 1-800-482-6655
Looking for health or dental insurance? We can help!
For individuals, families
and those age 65 or older 378-2937 1-800-392-2583
For employer groups 378-3070 1-800-421-1112
(Arkansas Blue Cross Group Services, which includes
Health Advantage and BlueAdvantage Administrators
of Arkansas)
Prefer to speak with someone close to home? Call or visit one
of our regional offices:
Pine Bluff/Southeast Region 1-800-236-0369
1800 West 73rd St.
Jonesboro/Northeast Region 1-800-299-4124
707 East Matthews Ave.
Hot Springs/South Central Region 1-800-588-5733
100 Greenwood Ave., Suite C
Texarkana/Southwest Region 1-800-470-9621
1710 Arkansas Boulevard
Fayetteville/Northwest Region 1-800-817-7726
516 East Milsap Rd., Suite 103
Fort Smith/West Central Region 1-866-254-9117
3501 Old Greenwood Rd., Suite 5
Little Rock/Central Region 1-800-421-1112
320 West Capitol Ave., Suite 900
You can contact customer service through our Web sites:
arkansasbluecross.com
healthadvantage-hmo.com
blueadvantagearkansas.com
Related Web sites:
blueandyoufoundationarkansas.org
blueannewe-ark.com
23
Blue & You Summer 2010

24
At Arkansas Blue Cross
and Blue Shield, we are
always looking for new
ways to be "Good for You."
Here are some of our
latest accomplishments.
Know Your Exposure
To protect our members from overexposure to ionizing
radiation used in medical imaging, Arkansas Blue
Cross and Blue Shield and its family of companies
are including a calculation of a member’s equivalent
dose of radiation from medical procedures in the
new Personal Health Statements. The information,
supplied by National Imaging Associates (NIA), is
based on claims data from health care providers.*
It is important to talk with your doctor about your
medical imaging choices. This additional information
can help you make informed health care decisions.
Your doctor can explain the need for a medical imaging
procedure based on the benefits and potential
risks involved.
* Claims data is provided to NIA from Arkansas Blue Cross and
Blue Shield, Health Advantage and BlueAdvantage Administrators
of Arkansas at regular intervals. If a claim has not been
filed or was not paid, if the patient has had a lapse in coverage
or if the employer group has opted not to participate, there
may be information on exposure to ionized radiation that is not
factored into this calculation.
New Tools for Small Groups
Effective June 1, Arkansas Blue Cross and Blue
Shield and Health Advantage will introduce two new
services for small group (2-50) customers.
eBill Manager is an electronic billing service that
can replace the traditional paper invoice. Only employer
groups that have signed up for Blueprint for
Employers will be able to access this new service.
eBill Manager will be available to all new groups
sold on or after June 1, and to all renewal groups
on their anniversary date beginning June 1. Electronic
applications for new employees (e-apps) will
be available for all small groups who are registered
for Blueprint for Employers effective June 1, 2010,
regardless of their anniversary date.
NIA provides prior authorization services for outpatient diagnostic
imaging services for Arkansas Blue Cross, Health Advantage
and BlueAdvantage. NIA is an independent company that
operates separately from these companies.
Blue & You Summer 2010