Blue & You - Autumn 2010

• Introducing: Patient-centered medical homes, Page 4
Autumn 10
• Health insurance reform updates, Page 8
• Good for you starts with …, Page 26
SilverSneakers ® Fitness
Program participant
Maudie Rogers exercises
with her friends at the
Northeast Arkansas
Baptist Clinic Wellness
Center. See story on
Page 14.
A publication for the policyholders of the
Arkansas Blue Cross and Blue Shield
family of companies

11 New DentalBlue ® plans available
14 SilverSneakers ® dynamo
21 New My Blueprint designed with
members in mind
John Selig,
director of
the Arkansas
Department of
Human Services,
addresses the
crowd at the
2010 Blue & You
Fitness Challenge
closing
ceremonies.
on Page 28
INSIDE
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Out of the Blue
Introducing: Patient-centered medical homes
Affordable health insurance plans for individuals
and families
How health insurance reform may affect you
New DentalBlue ® insurance plans available for
all ages
Can you keep the health insurance plan you have?
SilverSneakers ® dynamo inspires others
Fall into fitness
Take it easy with the sugar
Lose weight The Healthy Weigh!
Sodium overload
Self-monitoring blood pressure helps patients
keep it low
Great options again for Medicare beneficiaries
Tips to controlling bladder leakage
Are you secure in your personal relationships?
New My Blueprint designed with members in mind
Lifelong Health with Dr. David
Blood protein linked to Alzheimer’s disease
From the Pharmacist — Medication safety and
your children
The Doctor’s Corner
Good for you starts with …
2010 Blue & You Fitness Challenge results
2010 Best Practices Award winner
Notice of Privacy Practices
Notice to Medi-Pak Advantage (PFFS) members
Customer Service telephone numbers
Good for you
Autumn 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
Our reserves are there to protect you …
our member
Throughout our lives, each of us will face — or perhaps
have faced — times when a little financial planning
goes a long way. Those unexpected events happen to
everyone and when faced with those moments, it helps
to be prepared.
Whether you are an individual or a corporation, it’s
smart to plan for those “rainy days.” Arkansas Blue
Cross and Blue Shield takes the responsibility of providing
your health insurance coverage seriously and saving
for those times when you and others in our health plans
need financial backing in times of illness. We have to
make sure we save for those expenses. In our world,
these funds are called “reserves” and they are necessary
to protect our members.
In this time of policy changes and economic uncertainty,
it’s never been more important than now that we
provide economic stability and peace of mind to you,
our member. Think of reserves as protection. They keep
our company financially sound and allow us to keep our
promises to you by being able to pay for both the anticipated
and unanticipated expenses of medical care.
Arkansas Blue Cross is a mutual insurance company.
Our company has no stock or shareholders and is
managed for the benefit of our members. The reserves
that we maintain are separate from the funds used to
operate the company and have been built throughout
several decades. Reserves are a fundamental component
of pooling risk, which is a basic principle of insurance.
Appropriate reserves are important for financial
stability and allow us to provide the health coverage our
members have relied on for more than 60 years. They
also assure doctors, hospitals and other health care
professionals that they’ll be paid for their services even
in a crisis situation.
We have a unique need to maintain reserves because
we do not have access to the capital markets and cannot
raise funds on an as-needed basis for such things
as new requirements by the government or improved
information systems and technological advances that
allow us to serve you more efficiently.
The National Association of Insurance Commissioners
(NAIC) sets a minimum requirement for reserves
for insurance companies to protect our members from
unanticipated disasters. These are minimum requirements,
not recommended standards. Reserve levels
significantly higher than regulatory minimums are necessary
to make sure that if we experience an extended
period of increased health care costs such as with a
Reserves, continued on Page 6
3
Blue & You Autumn 2010

4
Introducing:
Patientcentered
medical
homes
a new approach
to health care
Home is a place of comfort
and warmth; a place of caring and
rest. We all know that when we go
“home” there will be people who
care about our health, our happiness
and our well-being.
Wouldn’t it be great if
there was a doctor’s office
that felt a little like home?
Where getting the care you need
wasn’t such a hassle? And where
someone was…
• Working to keep you healthy;
not just taking care of you
when you are sick?
• Checking to be sure you get the
preventive care you need?
• Helping you manage your
chronic health problems?
• Arranging for any specialty care
you need and keeping all of
your doctors informed of the
care you receive?
• Caring for you and about you,
just like at home?
This new, innovative approach to
health care is great and it is coming
to a town near you. They are called
patient-centered medical homes,
and they are another reason that Arkansas
Blue Cross and Blue Shield
is good for you.
Arkansas Blue Cross will soon
be piloting eight patient-centered
medical homes located throughout
Arkansas. The medical homes
will be piloted for two years and, if
Blue & You Autumn 2010

Roberta
Monson,
M.D.
successful, other locations may be
added. The clinics selected to be
medical homes already are established,
but according to Roberta
Monson, M.D., associate medical
director for Arkansas Blue Cross,
they will be transformed
to provide
a new approach to
health care.
Quick access
when you are sick
“One of the biggest
issues in the
health care system
is that when people
are well, they
often don’t take the
preventive measures to keep them
well, but when they are sick, they
have a hard time getting in to see
the doctor,” said Dr. Monson.
In a medical home, the goal
is to get sick patients in the
clinic within 48 hours. How
is that possible? By using a
team approach — including
advanced practice nurses,
dietitians, pharmacists and
other health professionals —
the needs of many patients
will be met, sometimes with
a telephone call or even
through an e-mail. This allows
the primary care physician
(PCP) to focus on patients
with more critical issues.
Frequent reminders when
you are well
Wouldn’t it be
great if there
was a doctor’s
office where
someone was
working to keep
you healthy;
not just taking
care of you when
you are sick?
Another way medical homes are
different is that they will be “reaching
out rather than reacting,” Dr.
Monson said. Medical homes will
call patients to come in for required
visits, shots, tests
or checkups. This
“requested access”
allows medical
homes to make
sure patients are
up to date with
flu shots, vaccines
or screenings for
diseases. And, the
medical home will
communicate these
reminders with the
patients in many ways … whatever
is convenient to the patient.
You are part of the team
Just like in a football game, it is
important for everyone in a medical
home “team” to have the same information.
To make sure the “team”
is working together, a care coordinator
may be added to the staff to coordinate
care between the patient,
PCP, any specialists the patient
A care alert example
A care alert notifies the
care coordinator that
Bob’s hemoglobin A1C
has not been checked
in six months. The care
coordinator e-mails Bob
to let him know he needs
to come in to the medical
home for his test. Bob
e-mails back that he will
do the testing during
his regular visit with the
diabetes counselor and
other team members.
Together they have
brought Bob’s blood
sugar levels down to near
normal levels.
might see, the pharmacy and the
hospital if necessary. The care coordinator
understands all the goals
for the patient, follow any changes
in care if the patient is hospitalized
and will follow up if rehabilitation or
home health care is needed.
The care coordinator also will help
5
Blue & You Autumn 2010

6
keep track of all the medications a members. This is a change that is
patient may take to ensure there are about them and for them,” said
no interactions. By making sure all Dr. Monson.
medical personnel who work with
a patient have their entire medical State-of-the-art technology
background, the care coordinator The medical homes will be using
can assure that fewer mistakes new technology that includes electronic
medical records and a data-
are made.
“This is an exciting time for our base that provides nationally recognized
treatment options for specific
conditions. This way the medical
staff has the information they need
to determine the best course of action
for each patient. The technology
also provides alerts regarding
gaps in care for vaccinations or
screenings that might otherwise
go unnoticed.
Coming soon to a town near you!
Arkansas Blue Cross is in the process of selecting the clinics to
be transformed into medical homes and will share the locations in
the next issue of Blue & You.
Quality care means better value
The goal of the medical home
is to treat patients with quality
care that keeps them from getting
chronic illnesses. For our members,
that means lower medical costs in
the long run through fewer emergency
room visits, lower drug costs
and better health overall. For participating
physicians, that means more
support through the team approach
and the knowledge that they are
making a real difference in the lives
of their patients.
Welcome home!
Arkansas Blue Cross recognizes
that a medical “home” should be
just that ... a place of comfort and
care. When you go to your medical
home, you should know that your
medical needs, whether you have
a chronic illness or a stomach bug,
will matter to the team who is your
medical home family.
Reserves, continued from Page 3
flu epidemic or pandemic we can
pay for the health care needs of
our members. The Arkansas state
insurance department monitors our
solvency, and we work closely with
them to ensure that we are providing
the highest quality health coverage
for our members while keeping
our rates as low as possible.
The uncertainty surrounding the
impact of health insurance reform
makes a strong reserve level more
essential for our members. The new
laws require that insurers accept
all who apply for coverage, but the
costs associated with the newly
insured are unknown. The effects of
this can be seen in the health insurance
reforms in Massachusetts,
where the newly insured used more
services than expected, leading to
higher costs and, ultimately, significant
reductions in reserve levels
for all of the major health plans in
the state.
The bottom line is that Arkansas
Blue Cross is in the business to
protect our members from financial
disaster when they need us the
most. We consider it our obligation
to ensure that our members have
peace of mind knowing they are
covered in times of need. Keeping
healthy reserves is just one more
thing we do that is good for you.
Blue & You Autumn 2010

Affordable
Whether you are just starting out on your own, have
recently married, started a family, emptied the nest,
retired early or are anywhere else along life’s highway,
Arkansas Blue Cross and Blue Shield has health insurance
plans to meet you right where you are in life.
For individuals and families under the age of 65 and
not on Medicare, we have a variety of affordable health
plans to meet your needs … big or small. We have health
plans that are good for your budget, good for your health,
good for your family and good for you.
Comprehensive Coverage
Arkansas Blue Cross offers traditional health insurance
plans with comprehensive major medical coverage and
many features of a PPO (preferred provider organization)
insurance plan. You may see doctors and specialists with
no referrals. Preventive benefits are available with no
deductible, and children’s preventive care is covered at
100 percent. These plans have prescription drug coverage
and cover services when you have to stay in the
hospital or when you receive hospital services and go
straight home. These health plans also feature a variety
of deductible options that can help you better control
your monthly premium costs.
Health Savings Account Support
health insurance plans
for individuals and families
Perhaps you like the tax advantages of a health savings
account (HSA). Arkansas Blue Cross offers an HSAcompatible
health insurance plan. It works together with
a separate HSA, purchased from a financial institution of
your choosing. All HSA contributions are tax-deductible,
which means your taxable income is reduced by the
amount contributed to the HSA each year. In addition to
seeing doctors and specialists with no referrals, preventive
benefits with no deductible and 100 percent coverage
for children’s preventive care, this plan also provides
prescription drug coverage and hospital coverage.
Short-Term Coverage
If you are between jobs, do not have employer-
sponsored insurance, or need to stretch between early
retirement and Medicare eligibility, we also have shortterm
health insurance plans that allow you to re-apply as
needed to span your gap. Our short-term health insurance
policy is designed to provide coverage for those
who want protection against catastrophic events such
as unexpected illnesses, diseases and accidents. You
choose the deductible and the number of days (a minimum
of 30 and a maximum of 182) you’ll need coverage.
The process for securing the affordable health plan
you need is as near as your independent or Farm
Bureau agent, a telephone call (toll-free 1-800-392-
2583) or a Web page (arkansasbluecross.com/
Individual&FamilyPlans).
For more than 60 years, Arkansas Blue Cross has
been providing peace of mind for Arkansans in all
seasons of life.
7
Blue & You Autumn 2010

How health insurance
8
In the past few months, we’ve
learned more about how health
insurance reform, or the Patient
Protection and Affordable Care Act
(PPACA), will affect you, our member.
As promised, we are sharing
this information so you can make informed
decisions about your health
insurance coverage.
The provisions discussed in this
article are for fully insured individual
and group health plans for people
under age 65. They do not pertain
to self-insured health plans. Please
contact your human resources administrator
if you are unsure if you
have a self-insured or fully insured
health plan.
Please review the following information
and remember that it may
be different depending on whether
you have an individual or family
medical insurance policy or if you
have fully insured coverage through
an employer.
Good news for parents of adult
children under age 26
Most young adults up to the
age of 26 now can have dependent
coverage under their parents’
health plans.
If you have an individual or family
policy —
• Young adults who were enrolled
on their parents’ policies as of
Blue & You Autumn 2010
May 2010 were previously informed
that they may remain
on those policies until the
age of 26. This allowed young
adults graduating from college
or high school in May to
remain on their parents’ plans
even if they were no longer
students.
• For those who were not
covered by their parents’ plans at
that time but are still 25 years of
age or younger, there is an annual
open enrollment period in
October 2010, during which
young adults can apply (or reapply)
on their parents’ plans.
° Dependents ages 18 and
younger will be offered
coverage regardless of their
health condition, however,
they are subject to medical
underwriting and parents
may pay a higher premium.
° Please be aware that dependents
age 19 to 26 will have
to pass medical underwriting
in order to qualify
for coverage. This means
coverage may not be offered
or extra premium may be
charged based on medical
conditions.
° Coverage for approved
dependents will become
effective January 2011.
If you have a fully insured plan
If you have:
• A young adult living at home?
• A child with a pre-existing
health condition?
• Been wondering what other
benefits have changed?
This information is for you.
through an employer (small business
or large corporation) ––
• Many young adults who were
enrolled on their parents’ policies
as of May 2010 were previously
informed that they may remain
on those policies until the age
of 26. This allowed young adults
graduating from college or high
school in May to remain on their
parents’ plans even if they were
no longer students.
• For those who were not covered
by their parents’ plans at that
time (or did not receive
notification from the
employer sponsor
to remain enrolled)
but are still 25
years of age
or younger,
an open enrollment
period will
be held 30 days
before each
employer
group health
plan’s renewal
date to allow
parents to add

eform may affect you
dependents. Your human resourc-
More information on the
age simply by applying and paying
es department or the employee
pre-existing health
the premium in either case. In the
who deals with your company’s
condition requirements and
case of a health insurance applicant,
health plan can provide you with
guaranteed issue
the coverage may be offered at a
the renewal date for your company
plan.
° In some situations, adult
dependents who are eligible
for coverage under their
own employer’s health plan
What is a pre-existing health
condition?
A pre-existing condition is any
health condition that existed before
you applied for health insurance coverage
or enrolled in a health plan.
higher rate or not offered at all if the
applicant already has costly health
conditions. This is not unlike people
with poor driving records having
to pay more or being denied auto
coverage. Health plans operating in
may not be able to enroll for
coverage as a dependent.
° If you work for an employer
with fewer than 50 employees
(considered a small employer
group under the new
federal law), your dependent
must answer the medical
questions on the application.
What is “guaranteed issue”?
It means that a health insurance
company will accept anyone who
applies for coverage (and pays the
premium).
A little history …
Health plans in many states
traditionally have required that
people who buy individual or family
coverage on their own (not through
an employer) meet certain health
standards before offering insurance
coverage.
The process in which an insurance
company evaluates the health
condition of an applicant is called
“medical underwriting.” Health
insurance companies use medical
underwriting to help manage the
risk of the customers they insure to
keep coverage affordable, in much
the same way as auto insurance
companies look at an applicant’s
driving record before deciding
whether to offer auto insurance. An
applicant is not guaranteed cover-
states that allow this practice use it
because they know that accepting
too many of those who already have
health problems will make health
insurance more expensive for everyone.
(Remember that insurance
is about sharing risk across a lot of
people.) In addition, in states where
coverage is guaranteed regardless
of any health conditions an applicant
may have, people often have waited
until they are sick or needed medical
care to buy insurance. Can you
imagine how expensive car insurance
would be if you could buy a
policy when your car was already
wrecked? And when insurance
costs a lot, people either can’t afford
to buy it or won’t buy it.
One of the provisions of the
new health insurance reform law
requires health plans to guarantee
health insurance coverage to those
who are 18 and younger in spite
of any health conditions they may
have (guaranteed issue) as long as
9
Blue & You Autumn 2010

the premium is paid. This coverage
er as of Jan. 1, 2011.
The lifetime dollar limit benefit is
is available during an annual enroll-
• During open enrollment, depen-
now unlimited. On most Arkansas
ment period held in the fall each
dents age 18 or younger will be
Blue Cross plans, the lifetime maxi-
year and becomes effective on
offered coverage regardless of
mum benefit previously ranged from
January 1 of the following year.
health condition, however, they
$1 million up to $5 million.
10
If you are employed with a small
business or large corporation and
are enrolled on a group policy, it’s a
little different. Your health insurance
coverage has been and will continue
to be guaranteed issue. This means
you are covered from when you
enroll and once the waiting period
established by your employer is satisfied.
However, you may be subject
to rules surrounding pre-existing
health conditions. This means you
may have to wait for a certain period
of time (usually a year) before you
are subject to medical underwriting
and may have to pay a higher
premium. Medical underwriting
simply means the child’s
health information may be used
to evaluate the application. The
first open enrollment will be in
November 2010, and coverage
will go into effect Jan. 1, 2011.
If you have a fully insured plan
through an employer (small business
or large corporation) ––
• Your insurance plan will remove
the pre-existing condition re-
What are the rules on annual
dollar maximums?
For both individual or family policies
and fully insured plans through
an employer —
There will be changes in your current
benefits for ambulance, home
health and durable medical equipment.
These changes will be described
in detail in your Certificate
of Coverage or Evidence of Coverage
policy, which will be provided to
you when you renew your coverage.
have coverage for certain conditions
quirements for individuals age
We’re working to keep you
unless you have been continuously
18 and younger at your group’s
informed
covered by a group health plan for
health plan’s renewal date, begin-
Changes to your benefits are
the preceding 12-month period. For
ning in October.
based on our current understanding
example, if you had knee surgery
• There always has been guaran-
of PPACA. These changes have been
the month before you joined the
teed issue on group policies.
made in good faith based on the
group policy, you may have to wait
Everyone is covered at the time
interim final regulations released by
for a year before the policy will
of enrollment.
the U.S. Department of Health and
cover any more surgery or other
treatments for that knee.
How has health insurance reform
affected pre-existing health
conditions requirements? And
does Arkansas Blue Cross guarantee
coverage for those age 18
and younger?
If you have an individual or family
policy —
• Pre-existing health condition
requirements will be removed for
all individuals age 18 and young-
What are the rules on
lifetime limits?
If you have an individual or family
policy —
Lifetime dollar limit benefits have
been removed. On most Arkansas
Blue Cross plans, the lifetime maximum
benefit previously ranged from
$1 million up to $5 million.
If you have a fully insured plan
through an employer (small business
or large corporation) ––
Human Services. Many of the regulations
remain in a “comment” period;
therefore, other changes could
be coming. We will continue to
keep you up to date. As your health
insurance company, it’s
our responsibility to
help you understand
the changes in your
coverage. And,
it’s our privilege
to serve you.
Blue & You Autumn 2010

New DentalBlue ® insurance plans
Arkansas Blue Cross and Blue Shield has
affordable dental coverage that gives you something
to smile about.
Our DentalBlue ® insurance plans for individuals offer
a variety of valuable benefits — from essential preventive
services to major restorative services. We offer the
three DentalBlue plans below for people of all ages.
• DentalBlue Bronze SM provides basic, preventive
care such as initial and periodic exams, prophylaxis
(teeth cleanings), fluoride treatments, X-rays and
sealants.
• DentalBlue Silver SM covers these preventive services
and adds minor restorative services such as
fillings and simple extractions.
• DentalBlue Gold SM covers preventive services,
minor restorative services and builds in major restorative
services including endodontics (root canals),
oral surgery, surgical extractions, inlays, onlays,
crowns, bridges, partials and dentures, implants and
periodontics (treatment of gum diseases). An annual
available for all ages
maximum rollover
benefit allows
you to “roll over”
a portion of your
unused calendaryear
maximum to
the next year.
With DentalBlue,
you’ll receive other
important benefits including:
• Freedom to choose any dentist.
• Maximum plan benefits when you visit a dentist in
the DentalBlue participating provider network.
• No claim forms to complete when you choose a
participating dentist.
So break out into a big toothy grin. With Arkansas
Blue Cross, you can afford to keep your teeth in tip top
shape. To find out more, contact your local independent
or Farm Bureau agent or give us a call, toll free,
at 1-800-392-2583.
11
DentalBlue Plans BRONZE SILVER GOLD
Individual Deductible $50 $50 $50
Calendar-Year Maximum $1,000 $1,000 $1,000
Annual Maximum Rollover No No Yes
What the plan pays after the deductible is met
Preventive & Diagnostic 100% 100% 100%
Minor Restorative Services Not covered 80% 80%
Major Restorative Services Not covered Not covered 50%
Implants Not covered Not covered 50%
Waiting Periods
Minor Services Not applicable 6 months* 6 months*
Major Services Not applicable Not applicable 12 months
Rates
Individual $17.77 $21.68 $28.83
Individual + Spouse $35.54 $45.97 $61.13
Individual + Child(ren) $34.46 $44.97 $59.80
Family $52.23 $67.95 $90.63
* The 6-month waiting period for Minor Restorative Services for DentalBlue Silver or DentalBlue Gold will be waived if:
1. Your DentalBlue application is received within 30 days of the termination date of your prior coverage;
2. You have had at least 6 months of prior continuous coverage for minor restorative benefits; and
3. You provide us with a copy of your Certificate of Coverage verifying your previous dental coverage within 30 days of your Dental Blue effective date.
To be eligible for a DentalBlue insurance plan, you must be an Arkansas resident. Other eligibility rules may apply.
Blue & You Autumn 2010

12
Can you keep the health insurance
plan you have?
As a member of one of our
health insurance plans, you may be
wondering if the insurance plan you
currently have is a “grandfathered”
plan or not. You may even be wondering
what the term “grandfathered”
means. Or, if it matters. Let
us help you understand it better.
The passage of the Patient
Protection and Affordable Care
Act (PPACA) on March 23, 2010,
changed the way health insurance
works. Let’s take a look
at how the law may affect you
as parts of it begin to take effect.
What is a
grandfathered plan?
A grandfathered health insurance
plan, whether it is a plan you
bought yourself or one that you are
enrolled in through your employer, is
a plan that was in place on or before
March 23, 2010. Simple enough.
But what if you joined a company
on June 1, 2010, and the company
had an insurance plan that was in
place as of March 23, 2010 (this plan
had not been changed, you simply
joined that plan)? Are you then part
of a grandfathered plan? Yes.
What is a
non-grandfathered plan?
A non-grandfathered plan is a
new plan, either a plan you bought
yourself or one that your employer
Blue & You Autumn 2010

Making sense of “grandfathered” and “non-grandfathered” plans
purchased, that went into effect
a cost. Some industry consultants
as PPACA.
after March 23, 2010. A non-grandfa-
have said that adding preventive
• Allowing current or new employ-
thered plan also may be a plan that
services to health plans with no
ees to add dependents.
was changed in some way (even if
cost sharing (such as copayments)
The following will cause your em-
this plan was in place prior to March
could add as much as 3 to 4 per-
ployer to lose grandfathered status:
23, 2010) that caused the plan to
cent to the cost of health insurance
• Eliminating benefits or treat-
lose its grandfathered status.
coverage if the current plan did not
ments for certain types of
Changes that apply to
all plans
There are some changes that
apply to all plans. It doesn’t matter
whether they are grandfathered or
not. Plans must:
• Cover the dependents of policyholders
until they are age 26.
• Provide coverage for children
under age 19 regardless of
health status and must cover any
pre-existing conditions for these
children.
• Offer health services defined
as “essential” under the law
with no lifetime dollar limits. In
2014, annual dollar limits will be
eliminated for all health plans.
(The federal government has not
yet defined which services are
essential.)
Is there a cost?
Non-grandfathered health plans
must provide coverage for a specific
group of preventive (wellness)
services to health plan members at
no cost to the member; however,
this enhanced coverage does have
cover these services already.
If you have a grandfathered individual
or family plan, should
you keep it?
• PPACA-mandated benefits are
expected to drive rates up for
non-grandfathered health plans.
• Some industry consultants claim
that premiums for new individual
non-grandfathered plans may
double in 2014.
• The situation is fluid and
uncertain.
• The best approach is to be
cautious.
• In order to maintain your grandfathered
status, you must keep the
plan you have with a very few
limited exceptions.
If you have a grandfathered
fully insured plan through an
employer (small business or
large corporation), what will
happen?
The following will not cause your
employer to lose grandfathered
status:
• Changes made to comply with
state and federal laws as well
conditions.
• Increasing employees’ coinsurance
by any amount.
• Increasing employees’ contributions
by more than 5 percent.
• Other decreases in benefits with
a very few limited exceptions.
Although the final rules have not
been determined as to what might
cause a plan to lose its grandfathered
status, we do know that if an
employer makes changes in benefits
or shifts costs to the employees
the plan is likely to lose its grandfathered
status.
One last thought
It’s important to remember that
if you like your health insurance
plan the way it is, you should keep
it unless you feel you would benefit
by making changes. Be cautious.
Remember, after you lose your
grandfathered status, you can’t get
it back.
13
Blue & You Autumn 2010

14
SilverSneakers ®
dynamo inspires
others
Maudie stops to chat with
her exercise buddies, Betty
Foster (left) and Lavinda
Counce (right).
Maudie Rogers
Who inspires you? Celebrities?
Professional athletes? Our service
men and women? At the Northeast
Arkansas Baptist Clinic Wellness
Center in Jonesboro, many folks are
inspired by Maudie Rogers, a tiny
89-year-old lady whose dedication
to her own fitness has changed the
lives of those around her.
If you don’t know Maudie, the
best way to find her at the Wellness
Center is to look down. She will be
the one wearing the silver and purple
sneakers she won in the “100
Miles in 100 Days” SilverSneakers ®
exercise competition in 2009. She
came in second in the state, logging
862 miles on the treadmill, exercise
bicycle, in water aerobics classes
and in the Muscle Strength and
Range of Motion (MSROM) class
in a little more than three months.
She even beat her son, Robert Rogers,
who attends SilverSneakers
classes in Cabot!
Maudie also recently was recognized
as one of the top five national
finalists for the 2010 Richard L.
Swanson Inspiration Award, which
recognizes SilverSneakers participants
whose healthy behavior has
made a difference in his or her own
life and inspired others. Maudie was
one of nearly 200 nominees for this
year’s award.
Maudie has participated in the
SilverSneakers Fitness Program
since the Wellness Center began
offering it in 2007. SilverSneak-
Blue & You Autumn 2010

ers is the nation’s leading exercise
program designed exclusively for
older adults. The program offers an
innovative blend of physical activity,
healthy lifestyle and socially oriented
programming.
“Maudie is an inspiration to our
gym members as well as our community,”
said Kara Fowler, the Silver-
Sneakers Fitness Program instructor
at the Wellness Center. “She shows
up to class early
and visits with her
class members
and other gymgoers.
She always
has a smile on her
face and strives to
do her best.”
Maudie always
was aware of her
health, and made
healthy choices,
but it was tragedy
that brought her
to the gym. Five
years ago her
husband, Aaron,
passed away and soon after she fell
and broke her shoulder. Determined
to get her strength back, she laced
up her sneakers and headed to the
Wellness Center.
“I felt stronger all over,” she remembered.
In fact, Maudie credits
the MSROM class for helping her
maintain a healthy and independent
lifestyle.
“SilverSneakers has been great
for me,” Maudie said. “I’ve not only
made friends but I’ve managed
to keep myself in shape. It’s good
for our bodies and outstanding for
people like us to get together. I
think the world of the program and I
look forward to each visit.”
Many folks are
inspired by
Maudie Rogers,
a tiny 89-yearold
lady whose
dedication to
her own fitness
has changed the
lives of those
around her.
Maudie’s friends in SilverSneakers
also have rallied to her side as
she tackles another rough time
in her life — a battle with cancer.
Although she has
never smoked,
Maudie was diagnosed
last year
with lung cancer. It
has been difficult
lately for her
to exercise, but
she comes to
classes as often as
she can.
“The class has
been my support
group; they’ve
all been great,”
Maudie said.
Maudie’s spirit
has inspired others in the class to
push themselves harder.
“I’ve never met anyone quite like
Maudie,” said Betty Foster, Maudie’s
close friend. The two met in the
MSROM class and became fast
friends, often riding together to
the gym.
“She is an inspiration,” added Lavinda
Counce, another friend.
To find out if you are eligible for
SilverSneakers, please contact your
health plan provider. For more information
regarding the SilverSneakers
Fitness Program visit silversneakers.
com or call 1-888-423-4632.
About the Healthways
SilverSneakers ® Fitness
Program
SilverSneakers was founded in
1992 and is the nation’s leading
exercise program designed exclusively
for older adults, offering
an innovative blend of physical
activity, healthy lifestyle and
socially-oriented programming.
This unique program is available
to Medi-Pak and Medi-Pak Advantage
(PFFS) members at no
additional cost at wellness centers,
YMCAs and Curves ® locations
in all 50 states, Puerto Rico
and D.C. For more information on
SilverSneakers, call 1-888-423-
4632 or visit silversneakers.com.
SilverSneakers ® is a registered
mark of Healthways, Inc. The SilverSneakers
Fitness Program is
provided by Healthways, Inc., an
independent company that operates
separately from Arkansas
Blue Cross and Blue Shield.
15
Blue & You Autumn 2010

16
Fall into fitness
Fall is in the air. Now that the temperature is dropping, it’s the perfect
time to take your fitness back outdoors. Take advantage of the crisp air
and enjoy the fall foliage by going on a hike. Other fun fall activities are
biking, rollerblading and even playing flag football. Even better, you can
enjoy these outdoor activities with your family.
Blue & You Autumn 2010
Take it
easy with
the sugar
Sugar added to foods makes them taste sweeter,
but your health can sour from too much of it.
The American Academy of Family Physicians
suggests how you can limit added sugar:
• Cut back on candy, desserts, baked goodies and
other sweet treats.
• Stick to fresh and healthy foods, such as vegetables,
fruit, whole grains and lean forms of
protein.
• Drink water instead of sweetened drinks.
• Avoid foods that are processed.
• Opt for lower-sugar recipes when baking.
• Substitute applesauce (unsweetened) or an
artificial sweetener, instead of sugar.
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 to
join The Healthy Weigh!

Sodium overload
According to the Centers for Disease Control and Prevention (CDC), American
adults consume an average of 3,466 milligrams (mg) of sodium (salt) each day.
This is twice the recommended limit.
While some sodium is necessary, too much can lead to high blood pressure,
a major risk factor for both heart disease and stroke. The CDC estimates that
about 77 percent of the sodium consumed comes from processed and restaurant
foods.
The 2005 Dietary Guidelines for Americans recommend less than 2,300 mg of
sodium per day. Specific groups — those with high blood pressure, middle-aged
adults and African-Americans — should consume less than 1,500 mg per day.
Source: The Centers for Disease Control and Prevention
Self-monitoring blood pressure
helps patients keep it low
According to a study by British researchers, patients
with high blood pressure were able to more effectively
control their condition through home monitoring.
When properly trained, patients who monitored
their own blood pressure and
adjusted their medications according
to physician guidelines
experienced greater reductions
in blood pressure during a six to
12-month period than did patients
who received standard care.
High blood pressure is a major
risk factor for things like heart attack,
heart failure, stroke and kidney failure and
should be treated with the utmost care.
While this discovery represents a hopeful new treatment
option for patients with high blood pressure,
researchers involved in the study also point out it is not
without drawbacks.
Not everyone is well suited or even willing to participate
in self management, and family doctors will need
to be involved in setting up patients’ schedules.
However, the study’s initial results are very positive.
Patients who managed their own blood pressure
by taking daily readings saw their systolic
blood pressure drop an average of 12.9 points
during a six-month period, while patients
on standard care saw an average
drop of only 9.2 points during the
same period.
After a year, the self-managed
patients’ systolic pressure dropped
17.6 points, as compared to 12.2 points
for the standard-care patients.
The self-managing patients who participated
in the study were trained in the proper use of
automated blood pressure monitors and taught how to
transmit their readings to their physician through automated
modems.
Source: National Institutes of Health
17
Blue & You Autumn 2010

Great options
again for
Medicare
beneficiaries
18
Blue & You Autumn 2010

If you are a Medicare beneficiary, November 15 is
an important date for you. From November 15 until
December 31, Medicare beneficiaries can purchase a
Part D prescription drug plan or Medicare Advantage
plan. You also can change the plan you have. The federal
government’s Centers for Medicare and Medicaid
Services (CMS) calls this time period the Annual Election
Period (AEP). If you join a plan during AEP, or make
changes to an existing plan, your new benefits will be
effective Jan. 1, 2011.
Medi-Pak Choice, a selection of products you
can count on
For 2011, Arkansas Blue Cross and Blue Shield will
continue to offer Arkansans the same great selection
of Medicare Advantage and Medicare prescription drug
plans, as well as Medicare supplement plans, you’ve
come to expect from us.
For 2011, Arkansas Blue Cross will offer:
• $0 premiums for Medi-Pak Advantage
MA-PD private fee-for-service (PFFS)
(includes drug coverage) in 27 counties
and affordable premiums in all Arkansas
counties. Medi-Pak Advantage MA-
PD plans are Medicare PFFS plans,
which combine all the benefits of original Medicare
(Part A hospital and Part B medical) with valuable
extras. Medi-Pak Advantage members have access
to our extensive network of more than 6,000 doctors
and hospitals across the state. When you use
these doctors and hospitals, you’ll have lower outof-pocket
costs than when you visit out-of-network
providers. In addition, Medi-Pak Advantage MA-PD
members receive a membership in the popular SilverSneakers
® Fitness Program at no additional cost.
• $0 premiums for Medi-Pak Advantage MA (PFFS)
(does not include drug coverage) in 52 counties.
These plans offer all the health benefits of our Medi-
Call your local
Medi-Pak Choice
licensed agent or
1-800-392-2583 to
learn more.
Pak Advantage MA-PD plans, but do not include drug
coverage. Members have the same access to our
network of more than 6,000 doctors and hospitals
throughout Arkansas, and a SilverSneakers membership
also is included.
• Two Medi-Pak Rx prescription drug plans (PDP) with
competitively priced monthly premiums –
Basic at $31.30 and Premier at $83.50. More than 95
percent of Arkansas pharmacies are in our network.
• Four Medi-Pak supplement plans, including Plan F,
our most comprehensive supplement plan, and Plan
N, one of our lowest-priced supplement plans, which
is ideal for Medicare beneficiaries who don’t mind
cost sharing for physician office and emergency
room visits during the year.
Attention Medicare Advantage
plan members
If you have a Medicare Advantage or Medicare Part D
plan (prescription drug plan), during October,
you will receive an Annual Notice
of Change (ANOC), which will explain
any changes to your current plan that
will become effective in January. If you
are satisfied with your current plan,
you are not required to change anything. Every year,
CMS requires companies to inform members of these
changes prior to AEP so that those who would like to
shop their coverage have the opportunity to do so.
If you would like to learn more about our Medicare
plans
Call your local Medi-Pak Choice licensed agent or
1-800-392-2583 to learn more. You also can visit our
Web site, arkansasbluecross.com/MedicarePlans. If
you have a friend or family member who doesn’t have
our Part D prescription drug plan or Medicare Advantage
plan, we hope you’ll recommend Medi-Pak Rx and
Medi-Pak Advantage during AEP!
19
Blue & You Autumn 2010

Laughing, sneezing, coughing … leaking
Tips to controlling bladder leakage
too active, you may feel a strong urge to go to the bathroom
when you have little urine in your bladder. This is
urge incontinence or overactive bladder.
The good news for individuals who suffer from both
types of bladder leakage is that there are treatments
and medications to help decrease or eradicate the
problem. Women who suffer from stress incontinence
can do simple exercises to strengthen the pelvic floor
and the muscles that control the bladder and urethra.
Following are tips to improve bladder health:
20
If a good joke, a bad cold or a unexpected cough
make you a little nervous … you might be one of the 13
million Americans who experience bladder leakage.
Bladder control (or urinary incontinence) symptoms
can range from mild leaking to uncontrollable wetting.
It can happen to anyone, but it becomes more common
with age.
Most bladder control problems happen when muscles
are too weak or too active. If the muscles that
keep your bladder closed are weak, you may have accidents
when you sneeze, laugh or lift a heavy object.
This is stress incontinence. If bladder muscles become
1. Kegel exercises to improve pelvic floor muscle
strength.
2. Decrease or eliminate caffeinated beverages.
3. If you are overweight, losing weight might relieve
pressure on the bladder. (A new study published
in the journal, Obstetrics & Gynecology, suggests
that overweight women often can improve bladder
control problems by losing 5 to 10 percent of their
body weight.)
4. Eat a fiber rich diet and drink plenty of water to
prevent constipation.
5. See your physician if symptoms persist.
Visit womenshealth.gov for more information.
Are you secure in your personal
People who feel insecure in their relationships may
be more at risk for cardiovascular disease and other
health problems, according to a new study.
In fact, those who felt insecure in relationships or
avoided getting close to others appeared to have a
greater risk of developing several chronic diseases.
Researchers studied survey data from 5,645 adults,
ages 18 to 60, and found an association between
“avoidant attachment” — people who feel unable to get
close to others or have others depend on them — and
chronic pain, such as frequent or severe headaches.
People who were insecure in their relationships had
further risks. “Anxious attachment” — a tendency to
worry about rejection in relationships, feel overly needy
Blue & You Autumn 2010

New My Blueprint designed
with members in mind
When you visit the member self-service center
of our Arkansas Blue Cross and Blue Shield Web site,
you want to find what you are looking for quickly and
with the least amount of hassle. We kept this and you
in mind when we redesigned your member site, known
as My Blueprint.
If you have used the self-service center in the past,
you’ll now find a redesigned, easier-to-use site. If you
have never registered to use the site, there’s no time
like the present.
And, if you are just curious about what you might find
behind My Blueprint or if you are unsure how to register,
view our quick demos at arkansasbluecross.com.
Select the My Blueprint link or the “Register Now” link
from the left side of the home page to get to the page
to view demos on how to register or get a quick view of
what you will find when you log in to My Blueprint.
The newly redesigned site features:
• A customer service corner that allows you to easily
order new ID cards or print temporary ID cards
when you are in a hurry.
• A claims center that gives you a quick update
on the status of the most recent claims, or you
can view the claims history for you and your
dependents.
• Access to your Personal Health Record, which
features claims data along with personal information
you enter on your own.
• Your Personal Health Statements, which updates
you on recent claims, provides information about
health benefits, and much more.
• Information on physician cost and physician
specialty quality.
• A benefit summary and coverage information.
• And much more.
Log in to My Blueprint today. It’s one more way
that Arkansas Blue Cross is good for you.
21
relationships?
and find that others are reluctant to get close — was associated
with a wide range of health problems, including
heart-related diseases, such as stroke, heart attack and
high blood pressure. Anxious attachment also was linked
to a higher risk of chronic pain and ulcers.
The study was recently published in the journal Health
Psychology.
Source: American Psychological Association
Blue & You Autumn 2010

Lifelong Health
with Dr. David
22
David A. Lipschitz, M.D., Ph.D.
Managing diabetes with
lifestyle changes
In the past 25 years, the prevalence of obesity has
increased at alarming rates. Obesity is defined using
the body mass index (BMI) that is calculated by dividing
weight by height squared. Using this measurement,
normal weight individuals have a BMI between
19 and 24. Those with a BMI between 25 and 30 are
overweight (pleasantly plump) and those above 30 are
considered obese. In 1990, less than 15 percent of the
population was obese; today the prevalence is close to
33.8 percent. And a total of 68 percent of the population
are either overweight or obese.
Most alarming is the fact that type 2 diabetes is
markedly increased in both overweight and obese
persons. Weight gain leads to metabolic syndrome in
which the ability of insulin to pump glucose out of the
blood and into cells is impaired. In a significant percentage
of the population this leads to elevated blood sugars
and type 2 diabetes. Type 2 diabetes is often related
to choices of diet and lifestyle and can be controlled
by diet.
In many overweight individuals, type 2 diabetes may
remain undetected for years, but complications caused
by the disease insidiously develop. Complications
include elevated cholesterol, heart disease, stroke,
peripheral vascular disease, kidney damage, severe
eye disease, and damage to the nervous system leading
to peripheral neuropathy, which causes burning,
numbness and tingling in the arms and legs. Blockages
to tiny blood vessels in the lower leg, together with
impaired nerve function, can cause ulcers that do not
heal, which can lead to amputation.
The solution of this
major health threat
is to commit as
a nation to serious
lifestyle
changes.
Whether
overweight,
obese,
or recently
Know
your numbers
Fasting Blood Sugar
Normal: Below 100
Prediabetes: 100-125
Diabetes: Above 125
Blue & You Autumn 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.
diagnosed with type 2 diabetes, the key element to a
longer, healthier and disease-free life is a better diet and
exercise. If diabetes is diagnosed, supervision by an
expert dietitian and exercise physiologist or trainer also
is highly recommended.
Learn everything possible about the diabetic diet.
Know how, when and what to eat to assure predictable
blood sugar levels. Under the supervision of a qualified
dietitian, it becomes readily apparent that being a diabetic
is not a life sentence to dull and tasteless food! A
diabetic diet can be nutritious, filling and delicious while
simultaneously reducing excessive calorie intake.
For all overweight adults, weight loss achieved by a
combination of diet and exercise will assure a longer
and healthier life, and for diabetics it may either reduce
or eliminate reliance on medications and prevent side
effects. Exercise must include 30 minutes of aerobic
activity daily and strength training with weights at least
three times per week. This form of resistance training
reduces fat and builds muscle, which is far more metabolically
active.
With rates of obesity and diabetes on the rise, a reaffirmation
and
commitment
to improving
lifestyle and
maintaining
healthy habits
is the only
solution to
reverse a potentially
disastrous
future.
Blood protein
linked to
Alzheimer’s
disease
High levels of a blood protein (called clusterin) have
been linked to the development of Alzheimer’s disease,
according to new research.
This new finding could be the beginning of detecting
the disease before it takes hold. Although it may
be five years from now before doctors can use this
information for an actual test, it is a big step in the
fight against Alzheimer’s.
Alzheimer’s is the most common form of dementia,
which causes a decrease in brain functions particularly
related to memory, thinking, language, understanding
and judgment. Those affected with Alzheimer’s may
behave inappropriately in social situations and have
difficulty controlling their emotions.
Thanks to this scientific breakthrough, there is hope
that in a few years Alzheimer’s could be diagnosed in
the very early stages for earlier treatment options.
23
Blue & You Autumn 2010

Medication safety
and your children
24
As the father of three children
all under 4 years old, I understand
how difficult it is to keep an eye
on children in hopes of preventing
them from getting into what they
have been told not to get into. I also
understand how much they look up
to the adults in their lives and want
to mimic what they do at every opportunity.
The favorite saying of my
nearly 2-year-old daughter is, “Me,
too!” If you have children, or are
around children, then you know that
they always are watching, learning
and mimicking.
My 3-year-old son consistently
asks about the vitamins that my
wife takes. He even pretends that
some of his treats are vitamins.
While this is cute, it makes me a
little nervous. What if he actually got
his hands on some of the real adultstrength
vitamins and took them because
he wanted to be like mommy
and daddy? He shouldn’t be able to
open that bottle, but I know that he
is as sharp as a tack. As parents, we
know that it just takes an instant for
the unthinkable to happen.
This is why it is so important to
keep your medications out of the
hands of children. The Centers for
Disease Control and Prevention
(CDC) estimates that there are
98,000 emergency department
visits each year for children less
than 5 years old who found and ate
or drank medications in the absence
of adult supervision. The CDC offers
the following tips to lessen the
chance of this happening to one of
your loved ones.
• Never leave children alone with
medicines. If you are giving or
taking medicine and you have
to do something else, take the
medicine with you.
• Do not leave medicines out after
using them. Store them in medicine
cabinets or other childproof
cabinets.
• When purchasing medicines for
young children, check to make
sure they are in child-resistant
packaging.
The CDC also recommends that
you put the poison control number,
1-800-222-1222, on or near every
home telephone and save it on your
cell phone.
I implore you to put your medications
somewhere out of the reach
of children (place purses out of
reach if you carry medicine in them)
and have the phone number for poison
control readily available. While
it may not be possible to keep our
eyes on our children all the time, we
can take steps to make our homes
safer for our children, especially
when it comes to keeping medication
out of their hands.
For more information on medication
safety please visit:
cdc.gov/ncidod/dhqp/medicationsafety.html
cdc.gov/ncidod/dhqp/ps_forParents.
html
From the
Pharmacist
by Brandon Griffin, Pharm D.,
Arkansas Blue Cross and Blue Shield
Blue & You Autumn 2010

The
Doctor’s
Corner
Counting down the top
10 ways to stay healthy
Number 10
Number 7
Wash your hands frequently. The
most common way a person be-
by Ray Bredfeldt, M.D.,
Regional Medical Director
Northwest Region, Fayetteville
Take your vitamin D. Studies show
that most American adults have low
levels of vitamin D (sunlight is necessary
for the body to make the active
form of vitamin D). Low levels
comes infected with a virus is from
hand-to-hand contact. Wash your
hands frequently, especially before
eating, and pay particular attention
during the cold and flu season.
learn about your condition. People
who work with their doctor are
more likely to receive recommended
care for their condition.
of vitamin D have been associated
with increased risk of heart disease,
some cancers, high blood pressure,
migraine headaches, memory
problems, rheumatoid arthritis,
inflammatory bowel disease, and
other health issues. The U.S. Food
and Drug Administration recommends
that adults take 200-600 IU
of vitamin D-3 every day.
Number 6
Eat fish once a week. Eating fish
that is high in omega-3 fatty acids
once a week has been shown to
reduce the risk of stroke and heart
attacks by one-third. Taking omega-3
fatty acid supplements is a good
alternative. Fish high in omega-3
include salmon and tuna. Walnuts
and soy are also high in omega-3
Number 3
Take a walk. Be sure to engage in
moderate exercise (such as brisk
walking) for 30 minutes at least five
days per week. Studies show that
the more time you spend sitting,
the shorter your life expectancy.
Number 2
Maintain a healthy weight. Being
overweight is not only associated
25
Number 9
fatty acids.
with heart disease and diabetes,
Get a flu shot every year. New
research has found an additional
benefit from flu vaccine. Studies
indicate that for as long as one year
after a flu shot, the risk of a heart
attack is reduced by 50 percent!
Number 5
Get enough sleep. Studies show
that people who get less than 7-8
hours of sleep per night are at a
much higher risk for heart attack,
stroke, sudden death, high blood
but evidence strongly indicates that
overweight people are more likely
to die from many types of cancers.
Number 1
Don’t smoke. Smoking-related diseases
cause an estimated 440,000
Number 8
pressure, diabetes, obesity, and
deaths in the United States each
Floss every day. Gum disease has
memory problems.
year and cost the nation more than
been associated with an increased
rate of stroke, heart disease, rheumatoid
arthritis, premature labor and
worsening diabetes.
Number 4
Know yourself. If you have a medical
condition such as high blood
pressure, diabetes or asthma —
$150 billion annually in health care
costs. Contact your local chapter of
the American Lung Association for
help in quitting smoking.
Blue & You Autumn 2010

A
good for you
starts with …
t Arkansas Blue Cross and Blue Shield, we recognize that every one of us is in Customer Service, and we
have a saying — “good for you starts with me.” For many of our employees, serving others doesn’t end with the
workday or the work place. Here are just a few examples of how this dedication to helping people has spread to
reach all Arkansans.
26
David Bridges
A deep love of Arkansas motivates
David Bridges in almost
everything he does — whether it’s
in his job as Arkansas Blue Cross
executive vice president of Operations
and
president
and CEO of
HMO Partners,
Inc., or
volunteering
in his personal
life.
“As the
song says,
Arkansas runs deep in me,” said
David. “I always want to do things
to make our communities better.”
David spends much of his free
time working with non-profit organizations
and charities. He has held
leadership positions with the Boy
Scouts of America, worked in several
Salvation Army capital campaigns
and been involved in the Downtown
Kiwanis Club for nearly 25 years.
“Additionally I serve on the board
of the Arkansas Rice Depot. That’s a
statewide organization that’s really
helping a lot of people in need,”
David said.
David Bridges (with his sons) participates in the
Three Miles of Men.
When the
Susan G.
Komen Race
for the Cure
came to central
Arkansas,
David was
asked to be a
team captain
for the
Arkansas Blue Cross Three Miles of
Men. He’s done it every year since.
“Ironically, after doing this for
three or four years, my wife, Sharon,
was diagnosed with breast
cancer,” he said. “So it meant even
more to me.”
Thankfully, after surgery, radiation
treatments and medication, Sharon
was given a clean bill of health by
her doctor — almost five years after
her diagnosis. She has participated
in the Race for the Cure before and
after her diagnosis. The Race in
2009 marked her five-year anniversary
of being a survivor. “She is my
hero for always having a positive
outlook and facing the challenge
with an optimistic attitude.”
Jim Bailey
Jim Bailey, Arkansas Blue Cross
senior vice president for National
Business, doesn’t get a lot of free
time, but what
time he does have
goes to Junior
Achievement of
Arkansas, where
he has served
on the board
since 2001.
“Junior
Achievement touches about
14,000 students across the state,”
said Jim. “It is a program in which
Jim Bailey devotes
community a
Blue & You Autumn 2010

time to several
ctivities.
students — elementary through
high school — are taught basic
economic principles, from how to
balance a checkbook to how a business
operates.”
Jim also served on the Conway
Chamber of Commerce for two
years, on the board of the American
Lung Association for four years, on
the board of the Arkansas Sports
Hall of Fame for two years, chaired
the Baptist Foundation Bolo Bash
(luncheon and golf tournament) in
2009, and currently works with the
Miss Arkansas Scholarship Foundation,
a program designed to help
young women with scholarship opportunities
that are available through
the Miss Arkansas Pageant.
“Numerous young ladies have
gone through that system to further
their education,” Jim said. “Many
have gone on to law
school. One is in her
last year of medical
school. Money
earned through the
Miss Arkansas Pageant
helped fund part
of that education
and we’re very proud
of that.
“Without the people volunteering
their time and without the funds, a
lot of these organizations in Arkansas
that help people just would not
be there,” he said. “That’s why I
think it is so important for people to
serve their communities.”
Linda Kyzer
When Linda Kyzer hears someone
share a story like, “My family
and I went to Disney World and I sat
on a bench because I couldn’t keep
up,” it breaks her heart.
Just about everything Linda does
at Arkansas Blue Cross and Blue
Shield is fitness related. She serves
on the Blue & You Fitness Challenge
core committee, is involved with the
employee wellness program, and
negotiates discounts with wellnessrelated
businesses for Arkansas
Blue Cross members.
“I’m passionate about people
living an active lifestyle and living an
independent life,” she said. “I love
to see people succeed.”
Linda also is vice chair of the
Governor’s Council on Fitness. “Our
main goal is to promote physical activity
and through that improve the
health of Arkansans,” she said.
The council partners with other
entities to promote fitness all across
the state. “We provide money, education,
and sometimes labor to help
them be more successful,” Linda
said. “For example, we sponsored
workshops to show teachers how
to integrate movement into the
classroom.”
And, while she can’t stand to
hear someone say that they couldn’t
keep up with their family, she loves
it when they come back later and
say, “This year they couldn’t keep
up with me.”
“It’s a big thrill to me — it sometimes
moves me to tears — to hear
of people’s success,” Linda said.
“It’s an emotional thing with me.”
Linda Kyzer participating in the
2008 Little Rock Marathon.
27
Blue & You Autumn 2010

2010 Blue & You Fitness Challenge Results
28
Fourteen groups and four students
took home awards from the closing
ceremonies of the 2010 Blue & You
Fitness Challenge.
This was the seventh year for the
Challenge, an exercise contest held
from March 1 through May 31. A total
of 168 groups participated, including
11,342 individuals, representing 44
states and logging 523,083 checkpoints.
Each checkpoint represented
at least 30 minutes of exercise,
which translates — at a minimum
— to 261,541.5 hours of exercise.
Groups ranged in size from two to
more than 1,538 participants.
For the very first time, several
At Arkansas Blue Cross and Blue
Shield, Customer Service means
more than a friendly voice at the other
end of the telephone — it extends
to helping our members find doctors
that meet their needs, negotiating
discounts with health care providers
and even working with 19 other
Blue Plans to create the largest data
warehouse of its kind in the health
insurance industry.
Arkansas Blue Cross recently was
recognized for being a part of this
effort to improve health information
technology by The Data Warehousing
Institute.
The Data Warehousing Institute names Arkansas Blue Cross
a 2010 Best Practices Award winner
From more than 40 entries, Arkansas
Blue Cross received the Best
schools and student organizations in
Arkansas piloted the contest, with
almost 200 students participating,
ranging in ages from 13 to 17. Four
schools had individual winners.
Also new for 2010, the Challenge
joined the world of social media.
Challenge participants received daily
Practices Award in the Enterprise
Data Warehousing category for the
company’s use of the Blue Health
Intelligence (BHI) data warehouse,
which is housed at the Blue Cross
and Blue Shield Association.
The goal of BHI is to provide greater
health care transparency — information
about the quality and price of
health care services — by delivering
data-driven information about health
care trends and best practices. BHI
gives employers more information
about the value of their benefits by
providing cost and demographic
trends. Employer groups also benefit
from BHI because the data provides
insight into health care trends and
motivational messages by following
the Challenge on Facebook ® and
Twitter. Winners of the Challenge and
pictures from the media conference
are posted on Facebook.
The Challenge is hosted by Arkansas
Blue Cross and Blue Shield,
the Arkansas Department of Health
(ADH) and the Arkansas Department
of Human Services (DHS).
Winners of the Blue & You Fitness Challenge at
the closing ceremonies event.
ensures that their employees are
getting the right care at the right time
and at the right place.
“This award demonstrates Arkansas
Blue Cross’ commitment to a
best practice development approach,
which was done in this case using
the new national BHI data warehouse
to support health care decision
making at both the employer and
member level,” said Joseph Smith,
senior vice president of Private Programs
and chief information officer
for Arkansas Blue Cross.
Improving health care reporting
and research … just another way
Arkansas Blue Cross is good for you.
Blue & You Autumn 2010

Notice of Privacy Practices
Arkansas Blue Cross and Blue Shield and Health Advantage
THIS NOTICE DESCRIBES
HOW CLAIMS OR MEDICAL
INFORMATION ABOUT YOU MAY
BE USED AND DISCLOSED AND
HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.
By law, Arkansas Blue Cross and
Blue Shield and its affiliated company,
Health Advantage, are required to
protect the privacy of your protected
health information. We also must
give you this notice to tell you how
we may use and release (“Disclose”)
your protected health information
held by us.
Throughout this notice, we will use
the name “Arkansas Blue Cross” as
a short-hand reference for not only
Arkansas Blue Cross and Blue Shield,
but also for its affiliated company,
HMO Partners, Inc., d/b/a Health
Advantage. Please note that although
we are combining this privacy notice
in this way for convenient, short-hand
reference, and to make it more efficient
to inform you about your privacy
rights, these companies remain separate
companies, each with their own
operations, management and compliance
responsibilities.
Arkansas Blue Cross must use and
release your protected health information
to provide information:
• To you or someone who has the
legal right to act for you (your personal
representative)
• To the Secretary of the Department
of Health and Human Services,
if necessary to make sure
your privacy is protected, and
• Where required by law.
Arkansas Blue Cross has the right
to use and release your protected
health information to evaluate and
process your health plan or health
insurance claims, enroll and disenroll
you and your dependents, and perform
related business operations.
For example:
• We can use your protected health
information to pay or deny your
claims, to collect your premiums,
or to share your benefit payment
or status with other insurer(s).
• We can use your protected health
information for regular health
care operations. Members of our
staff may use information in your
personal health record to assess
our efficiency and outcomes in
your case and others like it. This
information will then be used in
an effort to continually improve
the quality and effectiveness of
benefits and services we provide.
• We may disclose protected health
information to your employer if
your employer arranges for your
insurance and serves as Plan
Administrator. If your employer
meets the requirements outlined
by the privacy law, we can disclose
protected health information
to the appropriate department of
your employer to assist in obtaining
coverage or processing a claim
or to modify benefits, work to
control overall plan costs, and improve
service levels. This information
may be in the form of routine
reporting or special requests.
• We may disclose to others who
are contracted to provide services
on our behalf. Some services
are provided in our organization
through contracts with others. Examples
include pharmacy management
programs, dental benefits,
and a copy service we use when
making copies of your health record.
Our contracts require these
business associates to appropriately
protect your information.
• Our health professionals and
customer service staff, using their
best judgment, may disclose to
a family member, other relative,
close personal friend or any other
person you identify, health information
relevant to that person’s involvement
in your care or payment
related to your care. An example
would be your spouse calling to
verify a claim was paid, or the
amount paid on a claim.
Arkansas Blue Cross may use or
give out your protected health information
for the following purposes,
under limited circumstances:
• To State and other federal agencies
that have the legal right to
receive Arkansas Blue Cross data
(such as to make sure we are making
proper claims payments)
• For public health activities (such as
reporting disease outbreaks)
• For government health care oversight
activities (such as fraud and
abuse investigations)
• For judicial and administrative proceedings
(such as in response to a
subpoena or other court order)
• For law enforcement purposes
(such as providing limited information
to locate a missing person)
• For research studies that meet all
privacy law requirements (such as
research related to the prevention
of disease or disability)
• To avoid a serious and imminent
threat to health or safety
• To contact you regarding new or
changed health plan benefits
By law, Arkansas Blue Cross must
have your written permission (an
“authorization”) to use or release
your protected health information for
any purpose other than payment or
health care operations or other limited
exceptions outlined here or in the
Privacy regulation. You may take back
(“revoke”) your written permission at
Privacy, continued on Page 30
29
Blue & You Autumn 2010

30
Privacy, continued from Page 29
any time, except if we have already
acted based on your permission.
Personal Health Record (PHR)
If you have a health benefit plan
issued by Arkansas Blue Cross or
Health Advantage on or after October
1, 2007, you have a Personal Health
Record (PHR). Your PHR contains a
summary of claims submitted for services
you received while you are or
were covered by your health benefit
plan, as well as non-claims data you
choose to enter yourself. Your PHR
will continue to exist, even if you discontinue
coverage under your health
benefit plan. You have access to your
PHR through the Arkansas Blue Cross
or Health Advantage Web sites. In
addition, unless you limit access,
your physician and other health care
providers who provide you treatment
have access to your PHR. Certain information
that may exist in the claims
records will not be made available to
your physician and other health care
providers automatically.
To protect your privacy, information
about treatment for certain sensitive
medical conditions such as HIV/
AIDs, sexually transmitted diseases,
mental health, drug or alcohol abuse
or family planning will be viewable by
you alone, unless you choose to make
this information available to the medical
personnel who treat you. Similarly,
non-claims data, such as your medical,
family and social history, will only
appear in your PHR if you choose to
enter it yourself. It is important to
note, that you have the option to prohibit
access to your PHR completely,
either by electronically selecting to
prohibit access or by sending a written
request to prohibit access to the
Privacy Office at the address below.
Special Note on Genetic
Information
We are prohibited by law from collecting
or using genetic information
for purposes of underwriting, setting
premium, determining eligibility for
benefits or applying any pre-existing
condition exclusion under an insurance
policy or health plan. Genetic
information means not only genetic
tests that you have received, but
also any genetic tests of your family
members, or any manifestations
of a disease or disorder among your
family members. Except for preexisting
condition exclusions, we may
obtain and use genetic information
in making a payment or denial decision
or otherwise processing a claim
for benefits under your health plan or
insurance policy, to the extent that
genetic information is relevant to the
payment or denial decision or proper
processing of your claim.
Your Rights Regarding Medical
Information
About You
You have the right to:
• See and get a copy of your protected
health information that is
contained in a designated record
set that was used to make decisions
about you.
• Have your protected health information
amended if you believe
that it is wrong, or if information is
missing, and Arkansas Blue Cross
agrees. If Arkansas Blue Cross disagrees,
you may have a statement
of your disagreement added to
your protected health information.
• Receive a listing of those getting
your protected health information
from Arkansas Blue Cross. The
listing will not cover your protected
health information that was
given out to you or your personal
representative, that was given out
for payment or health-care operations,
or that was given out for law
enforcement purposes.
• Ask Arkansas Blue Cross to communicate
with you in a different
manner or at a different place (for
example, by sending your correspondence
to a P.O. box instead of
your home address) if you are in
danger of personal harm if the information
is not kept confidential.
• Ask Arkansas Blue Cross to limit
how your protected health information
is used and given out
to pay your claims and perform
health care operations. Please
note that Arkansas Blue Cross
may not be able to agree to your
request.
• Get a separate paper copy of this
notice.
To Exercise Your Rights
If you would like to contact Arkansas
Blue Cross or Health Advantage
for further information regarding this
notice or exercise any of the rights
described in this notice, you may do
so by contacting Customer Service
at the following toll-free telephone
numbers:
Arkansas Blue Cross 1-800-238-8379
Health Advantage 1-800-843-1329
You also may get complete instructions
and request forms from our
companies’ Web sites, which are:
www.arkansasbluecross.com
www.healthadvantage-hmo.com
Changes to this Notice
We are required by law to abide by
the terms of this notice. We reserve
the right to change this notice and
make the revised or changed notice
effective for claims or medical information
we already have about you
as well as any future information we
receive. When we make changes, we
will notify you by sending a revised
notice to the last known address we
have for you or by alternative means
allowed by law or regulation. We will
also post a copy of the current notice
on Arkansas Blue Cross and Health
Advantage Web sites.
Complaints
If you believe your privacy rights
have been violated, you may file a
complaint with Arkansas Blue Cross
or its affiliated company, Health
Advantage, or with the Secretary of
the Department of Health and Human
Services. You may file a complaint
with Arkansas Blue Cross or its affiliated
company, Health Advantage, by
writing to the following address:
Blue & You Autumn 2010

Privacy Office
ATTN: Privacy Officer
P.O. Box 3216
Little Rock, AR 72201
We will not penalize or in any other way retaliate
against you for filing a complaint with the Secretary or
with us.
You also may file a complaint with the Secretary of
the U.S. Department of Health and Human Services.
Complaints filed directly with the Secretary must:
(1) be in writing; (2) contain the name of the entity
against which the complaint is lodged; (3) describe the
relevant problems; and (4) be filed within 180 days of
the time you became or should have become aware of
the problem.
Notice to
Medi-Pak Advantage
(PFFS) members
Effective Jan. 1, 2010, the Human Immunodeficiency
Virus (HIV) screening is covered for people with Medicare
Advantage who are pregnant and/or at increased risk for
the infection, including anyone who asks for the test.
Medi-Pak Advantage (PFFS) covers this test one time
every 12 months or up to three times during a pregnancy.
This lab test is covered at the same member cost-sharing
amount as any other covered lab service. Please reference
your Summary of Benefits or Evidence of Coverage
for more details on lab services cost sharing.
If you have any questions or need more information,
please see the Medicare Web site at cms.gov or call
1-877-233-7022 (TTY 1-888-844-5330).
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
blueandyoufoundationarkansas.org
31
Blue & You Autumn 2010

32
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 your Personal
Health Record behind My Blueprint. 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 National Imaging Associates (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.
Find A Doctor
Arkansas Blue Cross and Blue Shield offers you
extensive networks of doctors and hospitals serving
all 75 counties of Arkansas with more than 9,300
participating health care providers. To find a doctor
or hospital, select the “Need a provider?” link on
the main page of any of our Web sites (see a list
of Web sites on page 23). You can either search by
using your medical plan ID card number or you can
select a health plan from a list provided. By filling in
the next form, you can choose a doctor or specialist
by location, specialty, gender or language preference.
You also can select a hospital or facility by
type or location.
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 Autumn 2010