HOUSE CALLNovember 2014
At KelseyCare Advantage, we are extremely proud of the plan that we have built for you. Positive feedback from members like yourself confirms that we are providing the quality of health services and customer care that you have come to expect and deserve. Nonetheless, we are determined to improve so that you and fellow members experience service that exceeds expectations…every time. For the second year in a row, KelseyCare Advantage has earned a place on the prestigious U.S. News & World Report list of Best Medicare Advantage Plans. Like last year, this 2015 list ranks us among the best Medicare Advan-tage plans* in the entire country, not just the state of Texas.
In preparing the list, U.S. News used data from the Centers for Medicare & Medicaid Services (CMS), including its rating of each Medicare Advantage plan. CMS ranks Medicare plans from one to five stars, in
half-star increments, however the U.S. News ranking is independent of CMS’. You can find KelseyCare Advantage’s CMS star rating on the
Medicare website. Go to www. medicare.gov and then look for the “Plan Quality and Performance Ratings” section. As the editors explain, for an insurer to make the U.S. News list, its Medicare Advantage plans available in a given state had to earn an average rating of at least 4.5 out of 5 stars from CMS, and all of its plans in the state had to earn a minimum of 3 stars. This assures that companies on the “Best” list maintain a consistent quality across all their plans. KelseyCare Advantage scored a 4.5-star rating, tying with one other Texas plan as the best in the state.
KelseyCare Advantage also scored a 4.5 overal Star Rating from Medicare for 2015. We invite you to check out the U.S. News list at
http://bit.ly/usnewsbestplans. And, you can find our plan’s official CMS Star Rating at Medicare.gov.
KelseyCare Advantage will continue to focus on quality and excellence to maintain our high ratings – not because CMS tells us to, but because we want to remain the best possible Medicare Advantage plan that seniors living in Southeast Texas can belong to.
KELSEYCARE ADVANTAGE RECEIVES
*This award was not given by Medicare. Our plan does not have a direct relationship with U.S. News.
KelseyCare Advantage is a Medicare Advantage HMO with a Medicare contract. Enrollment in KelseyCare Advantage is dependent on contract renewal.
Not quite sure how to access your member benefits? Have questions about what all your benefits actually are? Well, KelseyCare Advantage is hosting free Member Receptions over the next few weeks around the greater Houston area to help you out.
Plan specialists will be on hand to address any questions or concerns you may have about your Medicare coverage. Representatives from Member Services and Pharmacy Services will be available to assist you. In addition, you will find helpful Kelsey-Seybold Clinic representatives who can talk to you about medical
services and other clinic amenities. Plan on joining us for a meeting near you. But make sure to reserve your space today, as seating is limited! Call 1.866.371.4853 (TTY/TDD 1.866.302.9336) between 8 a.m. and 5 p.m. Monday through Friday and you’ll be on your way.
MARK YOUR CALENDAR FOR
9:00 AM HUMBLE CIVIC CENTER8233 Will Clayton Pkwy., Humble, Texas 77338 11/18
10:00 AM & 12:00 PM
KELSEY-SEYBOLD CLINIC, SPRING MEDICAL AND DIAGNOSTIC CENTER 15655 Cypress Woods Medical Dr. Suite 100, Houston, TX 77014
3:00 PM KELSEY-SEYBOLD CLINIC, MAIN CAMPUS2727 West Holcombe Blvd., Houston, Texas 77025
Important material has been mailed to you from KelseyCare Advantage. No, it’s not a bill! But it does require your attention, as it has to do with your coverage for 2015.
We’ve sent you two pieces. One is the 2015 Annual Notice of Changes the other is the 2015 Evidence of Coverage (EOC) booklet. We encourage all members to read this information carefully.
The 2015 EOC booklet is actually a legal document that you should read and then store someplace safe. It explains how to receive the health care services you need based on the plan that
you are on. A Table of Contents makes it easy to access whatever information you may be looking for, including important phone numbers and resources, a Medical Benefits Chart showing what is covered versus what you pay, an explanation of your rights and responsibilities and much more. If you have any questions about the material we’ve sent you or about your plan, don’t hesitate
to call KelseyCare Advantage Member Services at 713.442. CARE (2273), option 2 between 8 a.m. and 8 p.m. Monday through Friday.
And remember, you can visit our website for information 24/7 at www.kelseycareadvantage.com. KelseyCare Advantage is so pleased to be your health care plan and we are looking forward to serving to you throughout 2015 and beyond.
IMPORTANT PLAN INFORMATION FOR 2015
2015 ANNUAL NOTICE OF CHANGESH0332_003ANOCEOC15 Accepted
of ChangesEssential+Choice (HMO-POS) 2015 EVIDENCE OF COVERAGE H0332_002ANOCEOC15 Accepted
FOCUS ON FALL PREVENTIONEvery year, one in three adults age
65 and older falls. Falls can lead to injuries, such as hip fractures, and can even increase your risk of early death. Fortunately, falling is a problem that can often be prevented.
WHO IS AT RISK OF FALLING? To find out if you’re at risk for falling, ask yourself the following questions:
• Do you have any trouble balancing or walking?
• Have you fallen to the ground (without being pushed) within the last 12 months?
• Are you taking a medication that makes you feel dizzy or disoriented?
If you answered yes to any of these questions, you may be at risk for a fall.
You can take action in the following ways:
➊BEGIN A REGULAR EXERCISE PROGRAM
Exercise is a great way to reduce your risk of falling! It makes you stronger, and exercises like Tai Chi and walking improve balance and coordination. Ask your doctor about the best type of exercise program for you.
➋HAVE YOUR DOCTOR TO REVIEW YOUR MEDICINES As you get older, the way medicines work in your body can change. Some medicines, or combinations of medicines, can make you sleepy or dizzy and can cause you to fall. Your doctor may be able to recommend an alternative drug that keeps you more alert and balanced.
➌HAVE YOUR VISION CHECKED
Get your eyes checked by an eye doctor at least once a year. You may be wearing the wrong glasses or have a condition like glaucoma or cataracts that limits your vision. Poor vision can increase your chances of falling.
➍MAKE YOUR HOME SAFER Did you know that half of all falls happen at home? To make your home safer, remove things you can trip over (like papers, books, clothes, and shoes). Use double-sided tape to keep rugs from slipping. Keep items you use often in cabinets you can reach easily without using a step stool. Install grab bars in the bathroom, and use non-slip mats
in the bathtub. Try to wear shoes both inside and outside the house and avoid wearing slippers without non-skid soles.
To schedule an appointment with a Kelsey-Seybold Clinic physician or KelseyCare Advantage network optometrist or ophthalmologist, please call KelseyCare Advantage Concierge at 713-442-9540.
Did you know…
1 in 3 people over the age of 65 will fall this year?
More than half of all falls occur in the home?
to RememberKelseyCare Advantage Concierge 713-442-9540
For personalized assistance with physician selection, benefits
issues, billing questions To speak with a pharmacist on the KelseyCare Advantage team,
The pharmacy team can review all of your medications and help you identify cost savings opportunities.
Fraud, Waste and Abuse Hotline
THE TRUTH ABOUT THE FLU
You may be surprised to know that flu season actually lasts through the spring. If you haven’t gotten the flu yet, here is some advice about avoiding it!
“Approximately 90 percent of seasonal flu-related deaths and 60 percent of flu-related hospitalizations in the U.S. occur in people 65 years and older,” says Donnie Aga, MD, Medical Director, KelseyCare Advantage. “The immune system gets weaker with age. Seniors are more likely to get the flu, and more likely to have serious complications from it. So, I strongly recommend getting the flu shot!”
There are many varying opinions about getting the flu shot. We’ve asked Dr. Aga to clarify what is truth vs. myth.
CURRENT INFLUENZA VACCINES ARE A PROVEN CAUSE OF GUILLAIN-BARRE SYNDROME.
In 1976, a vaccine, was associated with an illness causing temporary paralysis, Guillan-Barre Syndrome (GBS). Influenza vaccines since then have not been linked to GBS despite careful surveillance and numerous researchers looking for this link over the past 30 years. Influenza illness and other viral illnesses have also been implicated as causes of GBS, so some individuals with GBS may be recommended to get the vaccine. People with a history of GBS should check with their doctor for individualized recommendations for vaccination.
IF I GET A RASH ON MY MOUTH WHEN I EAT EGGS, I CAN’T GET THE FLU VACCINE.
Individuals who experience severe allergic reactions to eggs (generalized hives, wheezing, swelling of the lips or tongue, etc.) should not be vaccinated with the usual vaccines. A new flu vaccine, Flu-Blok, is not made in eggs and can be given to egg-allergic individuals. It is currently approved for those age 18-49 only.
INFLUENZA IS CONTAGIOUS BEFORE SYMPTOMS BEGIN.
Most healthy adults may be able to infect others from 1 day prior to becoming sick through 5 days after they first develop symptoms. Most influenza is spread by
coughing and sneezing (droplet spread), but may also be spread by touching objects with influenza virus on them (doorknobs, stair rails) then touching your own mouth, nose or eyes.
THE SIDE EFFECTS OF THE FLU VACCINE ARE WORSE THAN GETTING THE FLU.
Influenza is a serious illness, lasting 1-2 weeks, causing high fever, muscle aches and predisposing you to secondary infections such as pneumonia or sinusitis. The worst side effect you’re likely to get from the flu shot is a sore arm or mild fever. The Intradermal vaccine causes redness, itching and swelling in the skin at the injection site – a sign that your immune system is reacting and developing protection. Even the high-dose vaccine for those ages 65 and up, which has 4 times as much vaccine antigen in it, has been shown to cause only modest fever – though the local reactions are more frequent.
Donnie Aga, MD, KelseyCare Advantage Medical Director
HEALTHY PEOPLE DON’T NEED A FLU SHOT.
Everyone older than 6 months of age can benefit from a flu shot. The elderly and young children are just two of the age groups considered to be at increased risk for
complications from influenza, but vaccination can benefit everyone over the age of 6 months.
Most of us are in contact with individuals who are at high risk for hospitalization or death from the flu. Protect yourself and your community by being immunized!
FLUZONE HIGH-DOSE IS RECOMMENDED FOR ANYONE WHO WISHES TO GET AN INCREASED IMMUNE RESPONSE TO INFLUENZA.
Fluzone High-Dose vaccine is an inactivated influenza virus vaccine indicated only for immunization of persons 65 years of age and older against influenza disease.
KelseyCare Advantage makes it convenient for our members to get
their Flu Shot.So, we’re offering you several options for getting your immunization. Whichever method you choose, your Flu Shot is covered. For each option, please present your KelseyCare Advantage Member ID card.
1. You may receive your vaccine at a network pharmacy (i.e. Kelsey, HEB, CVS, Walgreens, or any other pharmacy) for $0 copayment.
2. You may receive your vaccination from your Kelsey-Seybold Clinic physician’s office for $0 copayment. 3. KelseyCare Advantage will reimburse members who are
charged for their flu shot.
Simply submit a copy of the bill and a paid receipt to the following address:
KelseyCare Advantage Attn: Member Services P.O. Box 841569
Pearland, Texas 77584-9832
KelseyCare Advantage members are typically reimbursed 100% of the Medicare allowable amount.
Our clinics are getting a “new look”. It’s bright, open and comfortable, so you and your family members can feel at home while you’re seeing your doctor or having tests. But there’s more than the “new look” inside the clinics. Many of our clinics are providing more convenient healthcare with new specialties and increased medical services.
Kelsey-Seybold Clinic – Tanglewood (formerly Kelsey-Seybold Clinic – West)
A major renovation completed in August has added 24 exam rooms for doctors and increased the number of specialties at the clinic to 25. The Tanglewood clinic is the first Kelsey-Seybold Clinic to offer Mohs (advanced micrographic) surgery to treat skin cancer.
Kelsey-Seybold Clinic – Clear Lake
This new 55,000 square-foot multi-specialty care center across from Bay-brook Mall opened on August 4. The facility combines two previous loca-tions in the Clear Lake area and brings 18 medical specialties under one roof for member convenience. The new clinic will accommodate 27 physicians and includes an onsite pharmacy. Medical and diagnostic testing ca-pabilities have been expanded, and include CT, lab, mammography, MRI and x-ray services.
Kelsey-Seybold Clinic – Summer Creek
This new two-story clinic opened on October 13. The new facility is twice the size of the original Humble clinic and has room for 15 physicians. Onsite services include lab, x-ray, CT, MRI and a Kelsey-Seybold pharmacy.
The address of the new location is 8233 N. Sam Houston Pkwy. E., Humble.
COMING DECEMBER 2014 Kelsey-Seybold Clinic – The Woodlands
The 80,000 square-foot clinic scheduled to open December 15 will be the largest clinic constructed this year. It will replace the existing clinic at 17350 St. Luke’s Way. The new location is directly off I-45 South on Vision Park Boulevard. The new facility more than doubles the previous clinic’s capacity for physicians. New services will include 3D mammography, long length imaging (for scoliosis) and arterial vascular ultrasound. New specialties will include rheumatology, sport medicine, neurology, podiatry, urology and optometry.
A BRIGHT NEW LOOK TO
MORE CONVENIENT CARE
Kelsey-Seybold Clinic – Tanglewood
Kelsey-Seybold Clinic – Tanglewood 1111 Augusta, Houston
OPENING SPRING OF 2015
The new Cancer Center at Kelsey-Seybold Clinic – Main Campus The current staff and services of the Cancer Center will all move into the 51,000 square-foot rotunda under construction at the west end of the clinic. The new Cancer Center will include a Radiation Therapy Center and a PET CT suite. Members
currently have to go off-site to receive these services. With the addition of these services under one roof, the cancer team will be able to extend their personalized, compassionate care throughout a patient’s treatment. With more medical services and doctors closer to you, it’s easier for you to get the medical and preventive services you need to stay healthy. For more information about the specialty services offered at specific clinic
locations, visit KCAlocations.com. Kelsey-Seybold Clinic – Summer Creek
8233 N. Sam Houston Pkwy. E., Humble
Kelsey-Seybold Clinic – Clear Lake, reception Area
11511 Shadow Creek Parkway Pearland, TX 77584
Dear KelseyCare Advantage Members
Our emphasis on quality and service continues! Serving our members to the utmost of our ability is more than a goal — it’s our mission. So, we are very excited to share with you that KelseyCare Advantage has recently received several recognitions for high quality care and excellent customer service.
• U.S. News and World Report names KelseyCare Advantage One of the Best Medicare Plans in Texas for 2015 (http://bit.ly/usnewsbestplans)
• Highest Member’s rating (92%) in Medicare & You for 2015
• National Committee for Quality Assurance (NCQA) gives KelseyCare Advantage their highest possible score in Customer Satisfaction, Prevention and Treatment (http://healthplanrankings.ncqa.org/2014).
• One of the few Texas Medicare plans to be awarded an overall 4.5 star rating by Medicare in 2015 (http://medicare.gov).
We will keep working hard to maintain your trust in us. So, the next time a friend tells you they’re looking for a new Medicare plan, you can feel confident recommending KelseyCare Advantage!
President, KelseyCare Advantage