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healthy mind

healthy body

y o u r Ox f o rd g u i d e t o l i v i ng w e l l

healthy mind

healthy bodyF a l l 2 0 0 4

MS-04-1588

Whos responsible for your health?

Smart choices at the pharmacy

SIDS Reducing your babys risk

The HappinessFactor


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Dear Oxford Member,

On July 29, 2004, Oxford Health Plans and UnitedHealthcare announced a merger, uniting two highly

complementary and like-minded organizations focused on creating more choice and access in our markets.

We are pleased to continue to offer you an array of plan designs and a robust provider network. We look

forward to leveraging the national resources of UnitedHealthcare to offer you even broader choice and access.

We realize that you may have questions about how this merger will affect you. Since the merger has closed,

much progress has been made in setting the agenda for blending the best abilities of both organizations for

the benefit of our customers. As we work through the details, we will keep you updated through this magazine,

and through our web site, www.oxfordhealth.com. In the meantime, you should continue to use your health

plan as you do today.

We remain committed to helping you along your road to health and to your continued relationship withOxford Health Plans. If you have any questions, please call Customer Service at the number on your Oxford

ID card or 1-800-444-6222.

Sincerely,

Charles G. Berg

Chief Executive Officer

Oxford Health Plans,

a UnitedHealthcare Company


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Did you know?Statins, hailed as a major drug advance of the last 20 years, are aclass of drugs that can lower serum cholesterol and reduce the incidence

of heart attacks and stroke by 30 percent. Recently, researchers began

looking into other possible therapeutic uses. Because statins also reduce

inflammation in the central nervous system, scientists are investigating a

possible future application in treating the symptoms of multiple sclerosis.

Other uses being investigated include treatments for osteoporosis, diabetes

and Alzheimers disease. O

Long valued for their companionship, dogs may actually play apositive role in controlling borderline high blood pressure, particularly

for people who live alone. A study conducted at the State University

Hospital in Buffalo, New York involved 60 participants with similar blood

pressure readings. Half of the study participants agreed to adopt a dog

from a shelter as a condition of the study; the other half attended a

transcendental meditation program. Three months later the beneficial

pet effect could be seen. Notably, those who adopted dogs consistently

experienced a less dramatic rise in blood pressure when subjected to a

psychological stress test, as contrasted with those in the meditation program who showed no improvement.

Likewise, only the dog-adopters had significantly lower blood pressure readings when resting or walking. O

Oxford wants to knowwhat youre interested in readingabout in the pages ofHealthy Mind, Healthy Body. Is there a medical

condition youd like to know more about? Are you interested in exploring

a complementary and alternative treatment method? Would you like to

better understand or make the most of your benefits? Please e-mail

your suggestions to us [email protected], or write to:

Oxford Health Plans, c/o Member Publications, 55 Corporate Drive,

Trumbull, CT 06611. O

CorrectionIn the Spring 2004 issue ofHealthy Mind Healthy Body, we inadvertently published incomplete information about the origins of the Pilates method. While it is

true that the original Pilates program was developed by Joseph Pilates, it was created initially to help rehabilitate soldiers with limited mobility, and not explicitly

designed for dancers, actors or opera singers. This error was made by the editorial staff ofHealthy Mind Healthy Body this information was not provided by

STOTT PILATES. For more background on Joseph Pilates, please consult The Pilates Method Alliance atwww.pilatesmethodalliance.org/index.html. O


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Coming down with a cold or cough can disrupt your

day or even your week, but its nothing compared to

getting influenza, commonly known as the flu. Flu can

keep you housebound for longer and may even send

you to the hospital. Colds and influenza are both caused

by a virus, but while colds rarely affect more than your

nose and sinuses, flu takes a heavy toll on the whole

body, triggering a potent mix of fever, chills, muscle

aches, intense headaches, fatigue, nausea, coughing,

sneezing, and sore throat. And in certain vulnerable

people, it can easily set the stage for more serious

secondary diseases such as bacterial pneumonia,

bronchitis, even inflammation of the heart and brain.

While medical science has yet to come up with a

reliable vaccine for colds, there is protection against the

viruses most likely to cause the flu this winter. So, consult

your physician to see if he/she thinks you should receive

the flu vaccine. While youre discussing the flu vaccine

with your physician, ask if you are up-to-date on your

protection against bacterial pneumonia. Pneumococcal

disease usually gets its start in the wake of a severe upper

respiratory infection that might be the flu, but could

even be a bad cold. The bacterial pneumonia shot

typically provides immunity for ten years. For most

plans, the Member copayment is waived when the

vaccine is the only service rendered during the visit. O

Preparing foranother flu season

OO X F O R D I N F OIn response to the shortage of injectable flu vaccines thisseason, Oxford has extended its flu vaccination coverageto include the nasally administered flu vaccine, FluMist.

For most plans, there is no extra cost for either the injectable

or nasally administered flu vaccine when given by your primary

care physician and when the vaccine is the only service

rendered during the visit. Consult your physician to find out

if an injectible or nasally administered flu vaccine is appropriate

for you. A copayment may apply for these vaccines if

additional services are provided during your office visit.

P R E V E N T I O N

W h o s h o u l d g e t t h e v a c c i n e ?

Because of the vaccine shortage, the Centers for Disease Control and

Prevention (CDC) has changed its guidance about who should get vaccinated

this season. The existing flu vaccine supplies should be administered to people

who are at greatest risk from serious complications from influenza disease:

People 65 years of age and older

Children ages 6 months to 23 months

Adults and children 2 years of age and older with chronic lung or heart

disorders including heart disease and asthma

Pregnant women

Adults and children 2 years of age and older with chronic metabolic diseases

(including diabetes), kidney diseases, blood disorders (such as sickle cell

anemia), or weakened immune systems, including persons with HIV/AIDS

Children and teenagers, 6 months to 18 years of age, who take aspirin daily

Residents of nursing homes and other chronic-care facilities

Household members and out-of-home caregivers of infants under the age

of 6 months (Children under the age of 6 months cannot be vaccinated.)

Healthcare workers who provide direct, hands-on care to patients

T h o s e w h o s h o u l d n o t g e t

f l u s h o t s i n c l u d e :

Anyone who is allergic to eggs (the vaccines are cultured in eggs)

Anyone who had a severe reaction to a flu shot in a previous year

Anyone with a history of Guillain-Barr Syndrome

Anyone who is currently suffering from a fever or a severe illness


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The

HappinessFactorFor years now,

researchers have been

studying subjective well-

being, life satisfaction, the

experience of fulfillment and

happiness call it what you

will and they have come

up with quantifiable evidence

to show that a merry heart

can actually have a positive affect

on health.

Research indicates that people with

an optimistic outlook not only enjoy life more, but actually

live longer. In fact, in a Mayo Clinic study that tracked 839

people over a period of 30 years, those who scored highin pessimism on a standardized scale had a 19 percent

greater chance of premature death than those who scored

more optimistically. Optimists also seem to get fewer colds,

have more effective immune systems and recover from

major surgery sooner and with less trauma. Theres not

some miracle going on, says Dr. Christopher Peterson,

University of Michigan professor of psychology. Optimists

simply act in different ways. They believe theyre masters

of their own fate. Peterson goes on to say that this belief

in the ability to exercise

control over ones own circumstances leads

optimists to take better care of themselves. They sleep

better, dont drink or smoke as much, exercise regularly,

and are more free from depression. Peterson continues,

And when optimists do fall ill, they go to the doctor

and believing this will make a difference follow

the doctors advice. They allow themselves to heal.

Of course, thinking positively doesnt guarantee optimists

a charmed life. Like pessimists, they encounter plenty of

ups and downs, but optimists are simply more resilient.

UCLA psychologist Shelley Taylor explains, Optimism

The Book of Proverbs tells us A Merry Heart doeth good like

medicine Is this statement just an agreeable thought, or couldit be scientifically sound?

C O V E R S T O R Y


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enables people to meet stressful events with better

resources, so the adverse physical effects are not as severe.

An optimist, to whom others naturally gravitate, builds a

close network of family and friends who happily share in

the good times. In turn, when the optimist experiences

difficulties he or she can count on these people to be

there to lighten the burden, literally and emotionally.

Pessimist or optimist?Dr. Martin Seligman of the Center for Applied

Cognitive Studies at the University of Pennsylvania says

that optimists and pessimists are easily identified through

the ways they interpret adversity and success. He narrows

the differences to three words: personalization,permanence and pervasiveness.

When bad things happen, says

Seligman, the pessimist thinks, Its my fault (personaliza-

tion); its inevitable and never going to get better again

(permanence); and its going to affect every aspect of mylife (pervasiveness). The optimist, by contrast, takes the

same event and says to himself, A lot of us contributed

to this problem and I will do better next time; the problem

is temporary and addressable; and meanwhile it wont

affect other areas of my life, which are still good.

When good things happen, the pessimist and the

optimist reverse their instinctive explanations, Seligman

continues. The pessimist thinks, Someone else deserves

the credit for this good fortune (depersonalization);

it wont last anyway so why get excited (impermanence);

and it wont help me in other areas of my life anyway

(limited scope). The optimist, always looking on the

bright side, says, My actions helped to make this successhappen; this happy event is just a foretaste of more good

things to come; and its benefits are bound to spread into

other areas of my life.

Recipe for happinessContrary to common belief, enduring happiness

doesnt come from being rich and famous, comments

psychologist David Myers, author ofThe Pursuit of

Happiness. Research based on hundreds of interviews

and questionnaires indicates that happiness has almostno correlation to an individuals social

status, income, gender, educational level,

physical attractiveness, or skin color.

Having more stuff doesnt seem to do

it either, Myers adds. Many people no

sooner achieve one level of material

comfort then they aspire to the next,

a reaction that puts satisfaction

continually out of reach.

So what secrets have happy people

somehow stumbled on that others

can learn from? Researchers have

found that happy people tend to:

Have higher self-esteem

Be outgoing and cooperative

Have close friendships and/or a satisfying marriage

Have work and leisure activities that engage their skills

Have a meaningful set of values or religious beliefs

Sleep well and exercise regularly

Turning pessimism into optimismDr. Seligman, who has described himself as a born

pessimist, says that even if you are predetermined

by genes or family upbringing to be a pessimist and

to see the glass as half empty, there are some steps

you can take to increase your satisfaction with life

and be happier.


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C O V E R S T O R Y

Here are some suggestions that may help you change

your outlook:

Accept that enduring happiness doesnt come from

financial successWhile total hardship may breed misery,

having lots of money doesnt guarantee happiness.

Associate with optimistic people Optimism is

contagious. Let pessimists know that you will not

tolerate their negativism.

Enjoy your successesWhen things go well, dont

dismiss them as just dumb luck. Think of the ways in

which you contributed to things going right and give

yourself credit for your hard work.

Take control of your time Happy people feel in charge

of their lives, set reasonable goals and develop strategiesto achieve them.

Act happy Put a smile on your face and youre likely

to feel better. Talk positively youll get positive

feedback and that tends to lift your mood.

Be willing to try new things Each of us starts with

some preconceived notions about what we are good

at and what we do poorly. These are largely untested

beliefs rather than facts, and if you blindly hold

onto them they will forever limit your possibilities.

Challenge these assumptions whenever you can.

Check it out Be sensitive to your negative or self-defeat-

ing thoughts and when one comes on, evaluate it for

accuracy. Is it really true, or is it something left over from

childhood or from an unwarranted criticism? Gather

evidence to the contrary.

Decatrastophize Dont allow an anxious thought

to escalate to a rising flood of fears. If something bad

happens, view it as a particular event and not a trend

that will eventually sweep you away.

Be responsible to your body Sound minds reside in

sound bodies, which require exercise and sufficient

sleep to function. Getting enough sleep may help to

reduce levels of cortisol, a primary stress hormone.

Give a littleVolunteer work invariably restores your

sense of worth and may also give you a better perspective

of your own circumstances.

When pessimism wont go awayTheres a real difference between pessimism and clinical

depression. Depression is severe and all-consuming and

cannot be willed away with positive thinking. If your

moods are consistently low, especially if you find itdifficult to carry out normal activities, seek professional

help. A therapist can help you reduce the

frequency and severity of

depression and, in some

cases, prescribe medication

to assist in the process. Only

then can you begin to explore

the brighter side of happiness

and its many benefits. O

L a u g h t e r

a s t h e r a p y

Along with contributing to a sense

of well-being, we now know that a

good laugh has many immediate

health benefits including short-term

increases in breathing rate, oxygen use

and heart rate. Humor also increases pain tolerance by releasing the

bodys own flood of feel good endorphins. And scientific study has

demonstrated that unhealthy stress-related hormones (cortisol and

adrenaline) decrease during laughter. Writer/editor Norman Cousins

wrote about the power of humor in his own attempt to recover from

ankylosing spondylitis, an extremely painful, crippling form of arthritis.

InAnatomy of an Illness, published in 1979, the hospitalized Cousins

credited a regimen of watching Marx Brothers movies several times

a day as the primary reason for his full recovery. He quipped that,

Hearty laughter is a good way to jog internally without having to go

outdoors. He also regarded humor as an antidote to apprehension

and panic, two negative emotions that can become barriers to

recovery in many illnesses.

RR E S O U R S E SFurther reading on happiness:Authentic Happiness, by Martin E.P. SeligmanLearned Helplessness: A theory for the age of personalcontrol, by Martin Seligman and Christopher Peterson

The Tending Instinct, by Shelley E. Taylor

The Pursuit of Happiness, by David Myers

Anatomy of an Illness, by Norman Cousins

The Positive Psychology Center, www.positivepsychology.org


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L I V I N G W E L L

At Oxford, we know a good thing when we see it, and it seems that you do,

too. We hear good things about our Healthy Bonusprogram from Members,

and this feedback has helped us to expand the program in new directions.

This year, we have more than doubled the number of offers. In addition to

the existing savings on weight loss programs, fitness equipment, nutrition, and

publications, we have added offers that can help you keep your kids healthy, and

help Members manage special conditions. Oxfords Healthy Bonusprogram is justone more example of our ongoing commitment to helping you keep your mind,

body and spirit healthy.

Healthy BonusGet happy with

values

N e w o f f e r s :

ConsumerLab.com 20 percent off the book Guide to Buying Vitamins and Supplements

Coping with Allergies and Asthma $10 for one-year subscription

Coping With Cancer $13 for one-year subscription

DiabeticCandy.com 10 percent off all products

Diabetic Express 10 percent off select diabetes products

Foot Solutions 10 percent off all products

Grandmas Healthy Kids Club 10 percent off all products

Health Press 10 percent off online orders from the wide selection ofhealth-related publications

ActiveForever 10 percent off all products

JumpSport/AlleyOop Sports AlleyOop OutbackTent ($169 value) included when you purchasea full size trampoline system

Kids Eat Great 20 percent off all products

LA Weight Loss 25 percent off weight loss program

MY GYM $10 off any 8-10 week session; new gym members receive additional$10 off membership fee

National Allergy Supply Inc. 10 percent off all products

Nutrition For Kids 40 percent off the bookHow to Teach Nutrition to Kids

Russell Stover 10 percent off sugar-free candy

SpaWish $10 off your order of $100 or more

TCBY $1 off any no-sugar added frozen yogurt menu item over $2

Continued on next page


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L I V I N G W E L L0

N e w o f f e r s c o n t i n u e d :

The Bicycle Planet 15 percent off bicycle helmets, 10 percent off clothing

Theracycle No additional charge for shipping ($250 value) when purchasinga Theracycle at $2,995

Yogateers $5 off the Yogateers kit

I n a d d i t i o n , m a n y o f l a s t y e a r s H e a l t h y B o n u s p a r t i c i p a n t s a r e a g a i n o f f e r i n g O x f o r d M e m b e r ss p e c i a l s a v i n g s :

Body and SoulMagazine $11 for 8 issues

Brookstone 15 percent off select products

General Vision Services (GVS) Savings on eyewear at participating locations

Cooking Lightand Health Magazines Cooking Light 11 issues for $16, Health 10 issues for $10

Health Journeys 20 percent discount

OMNI Fitness 10 percent off fitness equipment; 15 percent off fitness accessories

QuitNet 35 percent discount on a lifetime membership

Princeton Ski & Tennis $15 off any purchase of $100 or more

Puritans Pride Vitamins 10 percent off on all products

Rob Nevins 15 percent off a regular membership fee

Safe Beginnings 20 percent off published prices

Scholasticstore.com 20 percent off all products

Spa Finder $15 off a gift certificate or spa store purchase of $100 or more

STOTT PILATES 15 percent off items purchased, including fitness equipment and videos

Tiger Schulmanns Karate $49 for one month, plus a free uniform

Weight Watchers Free registration, $10 off at-home kit, $10 off 3-monthonline subscription

WellQuest Fitness Network $49 one-time fee, low monthly fee thereafter

Yoga Journal 68 percent off one-year subscription; 7 issues for $11, plus 2 bookletsat no additional charge

For more information on how to redeem these discounts and take advantage of special offers available to

you, visitwww.oxfordhealth.comand click on the oxfordhealth Center on your account page. Once in the

oxfordhealth Center, click on Member Discounts.

Please note: Offers are valid through June 30, 2005. These discounts are offered in addition to, and separate from, your benefit coverage throughOxford Health Plans. These arrangements have been made for the benefit of Members, and do not represent an endorsement or guarantee on the partof Oxford. Discounts may change from time to time and without notice and are applicable to the items referenced only. Oxford Health Plans cannot

assume any responsibility for the products or services provided by vendors or the failure of vendors referenced to make available discounts negotiatedwith Oxford; however, any failure to receive discounts should be reported to Oxford Customer Service by calling the number on your Member ID card.


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A A

Menopause begins for most women between the ages of 39 and 59, as estrogen and

progesterone production decline. Besides loss of periods, menopause can be associated

with hot flashes, vaginal dryness, urinary tract problems, mood swings, and sleep

difficulties, as well as loss of muscle mass, increase in fat tissue, joint and musclestiffness, and thinning of skin. Two significant but less visible changes are the rising

risk of heart disease and the gradual loss of bone tissue that can result in osteoporosis.

Alan M. Mun ey, MD, MHA ,

is the Chief Medical Officer and an

Executive Vice President for Oxford

Health Plans. Dr. Muney received hisbachelor of science in biology and

medical degree from Brown University

in Providence, RI. He also received a

masters in health administration from

the University of La Verne, California.

James Dillard, MD, DC, CAc,

is the founding Medical Directorof Oxfords Complementary &

Alternative Medicine Program

and is Chairman of the Oxford

Chiropractic Advisory Board. Heis a board certified medical doctor,

a doctor of chiropractic and a

certified medical acupuncturist.

Conventional ResponseA short-term regimen of combined progesterone/

estrogen hormone replacement therapy (HRT) or

estrogen only (ERT) therapy may be advised for women

who experience significant symptoms of menopause.

Short-term use is advised, as recent studies suggest thatlong-term use may pose health problems in some women.

For vaginal discomfort, a water-based vaginal lubricant (not

petroleum jelly) or a topical estrogen cream (which does

not pose the risks associated with estrogen/progesterone

taken in pill form) may provide relief. Your physician may

address diminished urinary control with pelvic muscle

exercises and/or biofeedback training.

As for bone and heart health, discuss personal health

risk factors with your doctor. Measures to maintain and

enhance bone strength range from taking calcium andvitamin D supplements to doing weight-bearing exercises

such as walking, jogging, running, or dancing at least

three times a week. If you fit certain risk profiles, your

doctor may also recommend a bone density test to

establish your current status and, if findings indicate

the need, prescribe a calcium-fixing drug such as

Fosamax to stabilize and enhance bone strength and

decrease the risk of bone fractures. Similarly, your

doctor will reevaluate your risk of heart disease. If

blood pressure, cholesterol or glucose levels areelevated, you may be advised to lose weight, change

your diet, increase exercise, and/or take medications.

Complementary & Alternative ResponseA complementary approach should begin with natural

interventions to control symptoms and to enhance the

bodys innate healing abilities. Exercise, especially walking,

is a good way to ease symptoms. Add a program of relax-

ation and stress reduction, such as yoga or acupressure.

Good nutrition is critical. Diets rich in fiber and low in

fat have been recommended to help control symptoms

associated with menopause. Drink plenty of water, eat

whole, unprocessed or minimally processed foods and

emphasize green leafy vegetables and fresh fruits. Do

not use nutritional supplements as a substitute for a

healthy diet; discuss any supplements you do use with your

doctor. Research herbal remedies, and discuss them with

your doctor to ensure that they do not interact with any

supplements or medicines you may be taking. The National

Institutes of Health (NIH) is currently funding studies of

ginseng, red clover, hops, black cohosh, flax seed, dong

quai, and dietary soy, but supporting evidence is lacking

to date. Several servings of soy products a week may offer

some benefit, although excess intake should be avoided

as soy has estrogen-like properties.

Stop smoking, use alcohol in moderation, if at all, and

avoid spicy foods and very hot drinks, which may trigger

hot flashes. Cut back on facial make-up to allow your skin

to breathe, and dress in layers of clothing so you can adjust

body heat quickly when needed. O

P A T H S T O W E L L N E S S

QIs there relief during menopause?


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W E L L N E S S

Americans have watched the growth of hi-tech medicine in

the United States with fascination and pride for several

decades. The federal government alone spends $28 billion

a year on medical research to find cures for what ails us.

Weve seen amazing advances in identifying, treating and

curing many diseases, and much of that new knowledge is

translated into better drugs, advanced diagnostic tests and

technologies that produce medical miracles every day. With

so much talent at work in our labs and medical schools, it is

not difficult to imagine that it will soon become possible to

mend almost anything that gets broken or functions below

par in our bodies.

Whos respons

2


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But no magic pill or costly new medical device is

a match for staying healthy. Medical advances and

top-notch doctoring cannot replace individual

responsibility for day-to-day good health practices.

Its up to you to make healthy decisions about what

you eat and how you deal with stress, to take control

of your exercise and sleep habits, to become a better-

informed patient, and to take corrective actions if youare at high risk for certain diseases. Your doctor can

make suggestions and prescribe treatments, but

carrying out the prescribed program is your choice.

Taking your medicineDoctors know that getting their patients to comply

with treatment is both important and challenging.

Up to 50 percent of patients are non-compliant in

taking their medications.

Non-compliance means not taking medications on time,

taking an improper dosage, not reporting adverse effects

to the doctor, or a patient stopping early in the regimen

simply because he or she may feel better (or worse). A few

statistics from the Food and Drug Administration (FDA)

illustrate the incidence of non-compliance dramatically:

only 55 percent of tuberculosis patients, 48 percent

of diabetes patients, 46 percent of asthmatics, and

42 percent of glaucoma patients use their medicines

as directed. Another 14 percent to 21 percent of

patients never fill their original prescriptions, and

virtually the same number experiment with other peoples

prescriptions rather than get their own. According to

some estimates, failure to take medications correctly

could be the cause of as many as 10 percent of all hospital

admissions and nearly one-fourth of all nursing home

admissions. Non-compliant patients have also been found

to need three times as many doctor visits on average. This

is primarily because drugs taken improperly make it more

difficult, if not impossible, to control a condition. Non-

compliant patients can suffer prolonged or additional

illness as a result. Even more disturbing, each year over

125,000 patient deaths in the United States are attributed

to non-compliance with drugs, which is twice the number

of Americans killed in automobile accidents annually. So

remember, be sure to take your medicine as directed and

contact your doctor if you have any questions or concernsregarding any medication you are taking.

Changing behaviorsAn equally distressing problem in patient care is the

failure to change lifestyle habits that have been shown

to contribute to chronic illnesses, especially cancer,

heart disease and diabetes. According to a study

published recently by the Journal of the American

Medical Association, almost half the early deaths in

America can be traced to negative health behaviors.Smoking, poor diet and physical inactivity, and drinking

to excess remain at the top of the list of such behaviors.

Yet, despite a decade or more of persuasive studies that

prove the close connections, Americans have done little

to change or lower health risks by adopting better health

habits. The Centers for Disease Control (CDC), which

tracked Behavioral Risk Factors over a decade, found

that virtually as many Americans smoked in 2000 as

did in 1990, and on the whole, barely became any

more active. As for individuals who fit the description

of being either obese or overweight, numbers rose

alarmingly. In fact in 2002, former U.S. Surgeon

General David Satcher announced, Being overweight

[or] obese may soon cause as much preventable disease

and death as cigarette smoking (approximately 300,000

deaths and 400,000 deaths, respectively).

Today, the case for taking personal responsibility for

your health and adopting healthier habits is stronger

lefor your health?


14/32

W E L L N E S S

than ever because we know so much more.

(Read how adopting a more positive outlook

can improve your health on page six.) Each

of us is already equipped with tools to help

address some of our biggest health risks.

Cancer, heart disease, diabetes, kidney disease,

and a host of other chronic life-diminishing

diseases may not be inevitable. By choosing

to work together more effectively with your

medical practitioners and by taking greater

responsibility for your own health, you can

change your health odds for the better. O

4

A r e y o u t h e p i c t u r e o f h e a l t h ?

According to a telephone survey conducted by Central Marketing Inc.

of New York City for Oxford Health Plans in April 2002, nearly one in

five surveyed live in denial when it comes to self-evaluating their behavior

and the risks it poses. Out of the 1,450 randomly selected employed

individuals surveyed, one group, which surveyors dubbed the Health

Illusionists, rated their health as excellent (9 or 10 on a scale of 1 to

10) despite revealing the following in their responses:

55 percent are overweight by 25 pounds or more

36 percent never exercise and do not take work breaks

31 percent smoke

29 percent drink four or more cups of caffeinated coffee or tea daily

28 percent describe themselves as workaholics

25 percent do not eat a balanced breakfast

25 percent favor fried foods and salty/sugary snacks in their daily diet

21 percent drink three or more servings of alcoholic beverages daily

Based on the results of this study, and Oxfords belief in promoting

the importance of wellness and prevention, Oxford created the Healthy

Living Quiz to help individuals assess their health. To take this quiz,

simply choose the box that most closely describes your health behaviors

from the following chart. Understand that this quiz is by no means

intended as a replacement for sound medical advice, and addresses

only general health habits; there are many more factors that can affect

your overall health. You should continue to work with your healthcare

provider to monitor your state of health.

H o w n o t t o b e a p a s s i v e p a t i e n t

Here are some good ways to get actively involved in your healthcare:

Make sure you choose a doctor with whom you are comfortable

Understand the basics of how your body works

Know your family health history and discuss it with your doctor

Be a good historian of your health, which means keeping a log of the frequency,

duration and intensity of symptoms when they occur, and reporting them accurately

to your doctor

When prescribed a medication or treatment plan, be sure you understand the pur-

pose, potential side effects and precisely how and when the drug or plan fits into yourday or week (for example, many medicines restrict your ability to drive); take notes if

necessary, keep your doctor informed about any unexpected reactions and maintain

the regimen until your doctor determines you should stop or change

If your doctor recommends changes in nutrition, exercise, drinking habits, or any other

practice, do your very best to follow the recommendations; if you have trouble making

the changes, seek additional support and/or new ways of achieving your goals; do not

simply give up and remember only you can take charge of your health

Healthy Living Quiz

If you: Exercise Dont smoke

Eat a balanced diet

Drink plenty of water

Get plenty of rest

Are the picture of health and know it

You are a Truly Healthy

Tips:

Keep up the good work!

If you:

Are 25 pounds or more overweight

Smoke Drink three or more glasses of alcohol each day

Drink four or more cups of coffee or tea each day

Never exercise

Know you are unhealthy but dont mind

You are a Health EvaderTips:

You may feel healthy now, but watch out for the long-termhealth complications

Visit a physician for a physical and health advice

Tackle each unhealthy habit one at a time

Set realistic exercise and dietary goals

Reward yourself for making progress against your goals

If you: Exercise

Dont smoke

Eat a balanced diet

Drink plenty of water

Get plenty of rest

Are the picture of health, but worry you arent healthy enough

You are a Worried But Well

Tips:

Give yourself a break!

If you:

Are 25 pounds or more overweight

Smoke Drink three or more glasses of alcohol each day

Drink four or more cups of coffee or tea each day

Never exercise

Believe you are the picture of health

You are a Health Illusionist

Tips:

Get real!

Tackle each unhealthy habit one at a time

Visit a physician for a physical and health advice

Evaluate current health habits

Set realistic exercise and dietary goals

Reward yourself for making progress against your goals


15/32

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

Blood chemistry and urine tests,

as well as temperature and blood

pressure readings are familiar

tests performed routinely at your

doctors office. But occasionally,

your doctor will prescribe a more

definitive test. Most tests arepainless or merely uncomfortable

for a few minutes; in exchange

they provide an enormous amount

of useful information. Below are

brief descriptions of some of the

more common procedures, and

what the patient can expect:

Arteriogram (or Angiogram):

This test is used to examine a patients arteries,most often the arteries of the heart. The patient is

sedated, and the cardiologist inserts a flexible tube

(catheter) into a vessel in the arm, chest, neck, or

groin, threading it along until it reaches the artery of

concern. A contrast dye is pumped into the area and

exposed to x-rays revealing any narrowing, blockage

or weakening of the arterial walls. Sometimes the

procedure is linked to angioplasty, a procedure that

allows the doctor to remove small blockages at the

same time. Most arteriograms are performed in a

hospital outpatient setting. The procedure typically

causes only short-term local discomfort.

Biopsy: Depending on the location of the tissue to

be examined, a small section of skin or organ is removed

and prepared for laboratory examination. In a needle

biopsy, no more than a small pinch will be felt, as a

small number of cells are withdrawn. Open and closed

biopsies require incisions,

a local or general anesthesia

and are typically done in

a hospital setting. Biopsies

are used to determine

whether abnormal tissue

is malignant (cancerous)or benign (non-cancerous),

or to determine the

cause of a problem (e.g.,

bacterial or viral infection,

or inflammation).

Bone mineral density

(BMD) scan: BMD testing

is one of the most accurate ways to assess bone mass

and strength and is used chiefly in early detection ofosteoporosis (the gradual loss of bone mass often

associated with aging). Several machines are used for

testing, but low-dose x-rays of the lower spine and

hips are considered the most accurate. The test is

quick and painless.

CT or CAT scan:A thin x-ray beam rotates around

the patient to construct a sophisticated 3-D image

of sections of the brain, chest or abdomen. The

patient, lying on a narrow table, travels through a large

enclosure while a series of rapid ray images are made

of the area in question. The newest scanners can image

the entire body in less than 30 seconds. There are rarely

complications with these procedures, although some

patients may experience uneasiness from being in an

enclosed space, or mild discomfort from the IV placed

in a vein of the hand or arm if a contrast solution is

needed to enhance pictures.

Tests:Removing the fear factor


16/32

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

Electrocardiogram (ECG or EKG): This test involves

a series of flat metal discs (electrodes) held in place

on the arms, legs and chest with a sticky paste. The

electrodes record electrical activity which is used to

measure the rate and regularity of heartbeats, the size

and position of heart chambers, the presence of any

damage, and the effects of drugs or devices (such as

pacemakers) used to regulate the heart. An ECG may

be combined with an exercise stress test. An ECG or

stress test should not cause any pain for the patient.

Electroencephalogram (EEG): This test also involves

flat metal discs (electrodes), in this case, held in place on

the hair and scalp with a sticky paste. The discs pick up

electrical signals which are amplified and transmitted by

wire to a recording machine. The test, which causes no

physical discomfort, measures several kinds of brain waves

to evaluate head injuries, tumors, infections, seizures,

certain degenerative diseases, and metabolic disturbances

that affect the brain. An EEG may also be used to evaluate

sleep disorders.

Glucose tolerance test: The patient drinks a

measured dose of glucose (sugar) dissolved in water;

then blood samples are taken at intervals over a few

hours to track how well the body absorbs the substance.

Sustained high levels may indicate diabetes mellitus.

Endoscopy:An endoscopy is a procedure that

permits a physician to examine the gastrointestinal (GI)

tract. The doctor threads a tiny, flexible fiber-optical

instrument (endoscope) into the GI tract to inspect the

structures and look for signs of bleeding, polyps or other

abnormalities and take small biopsies of any suspicious

findings. An endoscopy can be used to investigatethe large intestine (a colonoscopy), or the esophagus,

stomach and upper intestine (upper endoscopy).

Patient preparation for these outpatient procedures

may involve taking an enema the night before and/or

fasting for several hours.

Laparoscopy:A laparoscopy is a test that permits

examination of the abdominal and pelvic organs.

A laparoscopy is used for many purposes, including

removing adhesions, repairing a hernia or removing

an organ. One or two small incisions are made, and a

needle is inserted so that carbon dioxide gas can be

pumped into the space to improve visibility. A thin,

lighted tube called a laparoscope is inserted into the

abdomen. Additional tools may be inserted into another

incision, if necessary. A laparoscopy can often be done

without requiring an overnight stay in the hospital.

Mammogram: In this test, an x-ray is used to detect

the presence of tumors or cysts in breast tissue.

Undressed from the waist up, the patient rests one

breast at a time on a flat surface containing an x-ray

plate. The technician uses a device to flatten the tissue

to near-uniform thickness while frontal and side pictures

are taken. Other than not wearing deodorant, perfume,

powders, or ointments under arms or on breasts, there

is no preparation required. Momentary pain while the

breast is squeezed may be expected, but overall the test

is quick and easy.

Magnetic resonance imaging (MRI): This scanning

procedure uses radio waves emitted in a powerful magnetic

field to create detailed images of organs and other soft

tissue internal structures. Diagnostic applications and

restrictions of an MRI are similar to those for CT scanning.

The test is painless, but patients that feel uncomfortable

in confined spaces should notify their doctor.

Positron emission tomography (PET scan): This

imaging procedure allows doctors to observe chemical

and metabolic processes in motion. It is used to detect

tumors and locate the source of epileptic activity in the

brain. It may also be valuable in studying blood flow and

cell activity in the damaged heart. During this procedure,the patient lies on a narrow table, and a scanner passes

over the area to be scanned. On some occasions, patients

may be asked to avoid eating or drinking for eight to 12

hours before the test. This test is painless.

Prostate specific antigen (PSA) test: This is a blood

test used for the early detection of prostate cancer in

men. It looks for the presence of a protein that is a

marker for the disease. O

6


17/32

Dietary supplements: getting it rightAs Americans search for ways to improve their health,

many are turning to a broad category of substances called

nutritional supplements. For the past ten years, regulation

of these supplements has fallen under the Dietary

Supplement Health and Education Act (DSHEA) of

1994. Although under the supervision of the U.S. Food

and Drug Administration (FDA), the DSHEA leaves

responsibility for product safety and the accuracy of

labeling claims largely to manufacturers and distributors.

Unfortunately, DSHEAs results have not lived up to

expectations. Voluntary guidelines have proved insuffi-

ciently clear, so that even well intentioned manufacturers

and distributors have failed to meet the laws intent on

safety and quality; others have boldly ignored restrictions.

Funding for education and research has also been

inadequate. Despite this legislation, there have been a

series of high profile cases involving patient sickness and

even death as the result of the misuse, mislabeling and

contamination of some nutritional supplements.

But judging from legislation currently working its

way through Congress, changes are coming. Bills

seeking to revise and strengthen the FDAs supervisionof supplements are under consideration and could be

voted into law later this year or in 2005. Meanwhile, as

an Oxford Member, you can get independent test results

and information on specific nutritional products from

ConsumerLab.com. Only those products that have

met ConsumerLab.coms rigorous tests for purity,

consistency, potency, and accurate labeling receive

their seal of approval. For more information about

ConsumerLab.com, visitwww.oxfordhealth.com.

New Medicare LawUnder Congresss new Medicare Modernization Act

(MMA), the first phase of which took effect in June 2004,

private insurance providers have contracted with Medicare

to present a choice of discounted prescription drug cards

offering reductions on retail drug purchases of between

10 and 25 percent. In many cases, individuals wishing to

sign on for this new option must pay a small annual

premium (up to $30) to the provider to receive the

discount card. However, individuals enrolled in Oxford

Medicare Advantage get their cards at no additional

charge. Thats because Oxford pays the premium directly

to Medco, our pharmacy benefit manager. Oxford

Medicare Advantage Members whose incomes fall below

certain established levels may also be eligible for an

additional $600 annual drug benefit under the new law.

Other features of MMA to be phased in gradually

include additional preventive screenings, which will be

available at no charge in 2005, and a more comprehensive

drug coverage plan slated for January 1, 2006. Whether

you have a family member eligible now or you are

anticipating your own eligibility soon, it is wise to monitor

these federally mandated changes as they occur. O

Legislativeupdate

I N T H E N E W S


18/32

N E W S Y O U C A N U S E8

Americans with Disabilities Act of 1990Under this Act, Disability means, with respect to

an individual, a mental or physical impairment that

substantially limits one or more of the major life activities

of an individual, a record of such impairment, or being

regarded as having such an impairment. Title III of

the Americans with Disabilities Act (ADA) prohibits

discrimination on the basis of disability in places of

public accommodations, including those of your

healthcare provider.

Oxford supports Members equal access to care rights,

as well as the right to an interpreter. We are committed

to nondiscriminatory behavior when conducting

business with all Oxford Members. Oxfords long-term

commitment to the ADA encompasses the following:

Materials available in alternative formats, such as

Braille and audiotapes

Staff trained in the use of telecommunication

devices (TTY/TDD) for Members who are deaf or

hard of hearing, as well as the use of state relay for

phone communications and access to sign-language

interpreters upon request

Staff and resources available to assist individuals

with cognitive impairments in understanding office

procedures and materials

New Member orientation available through the

assistance of an interpreter

If you need help arranging sign language interpreter

services, please call Oxfords TTY/TDD (hearing-

impaired services) line at 1-800-201-4875.

Oxfords grievance proceduresAlthough Oxford strives to provide Members with the

programs and services that they have come to expect,

we understand that from time to time a Member may

wish to formally report an injustice he or she believes

may have occurred. That is why Oxford has developed

a meaningful, dignified and confidential grievance

procedure to hear and resolve Member grievances.

If a Member has followed the required grievance

procedures and is not satisfied with Oxfords final

OO X F O R D | B E N E F I T S U P D A T E


19/32

decision, the Member may be entitled to appeal the

decision with an independent, external agent of the

appropriate state. Information on how to submit an

external appeal is outlined in your Certificate of

Coverage and Member Handbook, as well as in the initial

denial letter and all subsequent appeal decision letters.

For information about grievances and external appeal

procedures, please call Oxfords Customer Service

Department at the number on your Oxford ID cardor at 1-800-444-6222.

Coordination of careFragmented care can negatively affect the quality of

care that you receive primary care physicians (PCPs)

and specialists may treat you at the same time, but may

not be aware of other providers treatment or involve-

ment. PCPs and specialists capture different information

when determining your treatment plan, and combining

this information is essential to forming a complete picture

of your health status. It is important that all providers

rendering your care share treatment information. It is

equally important for you to be an active partner in your

care; you should maintain an open dialogue with your

providers about all forms of treatment.

At Oxford, we understand that behavioral health is a

sensitive and important issue. It is especially important

that behavioral health (BEH) care be coordinated

with traditional care, as well as complementary and

alternative medicine (CAM) care. A BEH provider may

be treating a disorder with a medical basis that impacts

your physical health. Likewise, a PCP may be treating

a medical illness that can lead to BEH conditions,

such as depression. CAM providers can be used to

assist in the treatment of both medical and behavioral

health problems. These possibilities also make it

necessary and important for providers and patients to

keep each other informed.

Please note:The Behavioral Health Department, in

conjunction with a panel of participating behavioral health

specialists, has developed a Release of Information form

that allows BEH specialists and PCPs to share treatment

information. This form can be signed by you in the presence

of your behavioral health provider (but is not mandatory),

and gives him or her permission to contact your PCP.

Chest x-ray policy updateSeveral medical professional associations, including

the American College of Chest Physicians, the U.S.

Preventive Services Task Force, the National Cancer

Institute, and the American Cancer Society, have

concluded that chest x-rays for screening should not

be a part of a routine periodic physical examination.

Effective July 1,2004, chest x-rays

performed routinely

for screening

purposes as part

of a periodic

health maintenance

examination in

the absence of

symptoms, signs

or disease states

will not be covered.

Please note:

Oxford will

continue to provide

coverage for chest x-rays that are medically necessary

based on symptoms, signs or disease states.


20/32


Updated Member Handbooks forNew York Members

If you are a New York Member and have coverage

through your employer or purchase individual

coverage directly from Oxford, we would like to inform

you that an updated electronic version of your Member

Handbook is available on www.oxfordhealth.com.

Visit the Resource Center on your account page, and

selectGuide to Oxford Coverage to read the online

version. The new Member Handbook may contain

some language that differs from the provisions in

your current Certificate of Coverage and Member

Handbook (or your individual contract) and replaces

certain sections of your Certificate of Coverage.To request a printed copy, please call our Customer

Service Department at the number on your Oxford ID

card, or call 1-800-444-6222. You can also contact us

by mail at:

Oxford Health Plans

Managed Care Act Request

48 Monroe Turnpike

Trumbull, CT 06611

Hospital closing informationMembers in the Westchester County, New York vicinity

should note that St. Agnes Hospital has closed. Oxford

has an extensive network in Westchester County and

in adjacent counties. If you need assistance finding a

network hospital, please call Oxfords Customer Service

Department at 1-800-444-6222.

Also, Members in the Richmond County, New York

vicinity should note that Staten Island UniversityHospitals Concord location at 1050 Targee Street

has closed. Oxford has an extensive network in the

Richmond County and in adjacent counties. If you need

assistance finding a network hospital, please call Oxfords

Customer Service Department at 1-800-444-6222.

2004 Member Satisfaction Survey resultsThe National Committee for Quality Assurance

(NCQA) 2004 Member Satisfaction Survey results have

been reported.

Members perception of Oxford improved from last

year, especially in New Jersey and Connecticut. The

greatest improvements were in getting needed care

and obtaining care quickly. There was a increase in

Members getting flu shots, and the number of Members

undergoing smoking cessation also increased. Member

ratings of net-

work doctors

remain above

the nationalaverage, while

complaints

reported in

2004 decreased

significantly in

New York,

New Jersey and

Connecticut.

As part of

Oxfords overall

efforts to

enhance the

quality of care, the company remains committed

to improving these results. The data collected from

Members is being analyzed so that Oxford may

target areas for improvement. Oxford anticipates

developing quality improvement activities during

the second half of 2004.

Radiology precertification updatefor out-of-network servicesAs noted in your Summary of Benefits, Members who

are part of New York large and small groups, Connecticut

large and small groups or New Jersey large groups will

need to obtain precertification for radiology services

when seeing an out-of-network provider, if this coverage


21/32

is available under your plan. Radiology services requiring

precertification are generally: MRI, Magnetic Resonance

Angiogram (MRA), CT, PET, Nuclear Medicine, and

ultrasound. You are responsible for obtaining

precertification for these services. If you have anyquestions about the precertification process,

please contact Oxfords Customer Service Department

at 1-800-444-6222 or the number on your Oxford

Member ID card.

Laboratory network reminderOxford has an arrangement with Quest Diagnostics,

Inc. to manage laboratory and pathology services,

directly and through subcontracted entities. Referrals

are not required to access lab services at a Quest lab

or a lab participating in the Quest arrangement. Your

provider completes a requisition form for you to bring

to the lab in order to specify the required services.

If your plan has an out-of-network component, lab

services rendered by a non-participating laboratory

will be subject to out-of-network cost sharing provisions.

For a complete listing of Oxford participating labs,

log on to www.oxfordhealth.comor contact Customer

Service at 1-800-444-6222.

Reminder: Reconstructive breastsurgery law

Federal law requires that all health plan Members

be notified of The Womens Health and Cancer Rights

Act of 1998 on an annual basis. This Act applies toall commercial policies that started or have been

renewed since October 21, 1998. The Womens Health

and Cancer Rights Act, which amended existing federal

law (ERISA and the Public Health Service Act), requires

health insurance carriers of group and individual

policies that cover

mastectomies to

cover reconstructive

surgery or related

services following

a mastectomy.

Oxford offers

this benefit in

all commercial

products. Essentially,

the Act guarantees

coverage for any

plan Member who

is receiving services

in connection with

a mastectomy and

who elects breast

reconstruction in connection with that mastectomy.

The health insurance company that issues the policy

is required to provide coverage for:

Reconstruction of the breast on which the

mastectomy has been performed

Surgery and reconstruction of the other breastto produce a symmetrical appearance

Prostheses

Treatment for physical complications arising at

any stage of mastectomy, including lymphedema

If you have any questions about this benefit, please

refer to your Certificate of Coverage or call Oxfords

Customer Service Department at the number on your

Oxford ID card or at 1-800-444-6222.


22/32


Services and coverageOxfords Healthcare Services (HCS) Department

evaluates requested treatments based on medical

necessity, the site of service and the availability of a

benefit. Oxford does not specifically reward or offer

incentives to practitioners or other individuals for issuing

denials of coverage or service care. Financial incentives

for UR decision makers do not encourage decisions that

result in underutilization. Oxfords Medical Management

Department does not assess whether the maximum dollar

or visit limit for a treatment has been reached.

Roster of Participating Physicians

and Providers reminder

We would like to remind

you that the information

listed in our Roster of

Participating Physicians

and Providers is available

online and is updated

regularly. Simply log on

to www.oxfordhealth.comand use the Doctor

Search tool.

You can request a

Roster of Participating

Physicians and Providers

specific to your network

by clicking on Request

Materials on the left

navigation bar, or by

contacting Oxfords

Customer Service

Department at 1-800-444-6222 or at the number on your

Oxford ID card.

New Member ID cards for 2004-2005

Currently, prescription ID numbers located on your

Oxford ID card are derived from the primary Members

Social Security number. In an effort to protect you from

identity theft and comply with legislation in various

states, Oxford and Medco are coordinating the removal

of Social Security numbers from all Oxford commercial

Member ID cards.

What does this mean to you?

Over the course of the next year, if you have

prescription drug coverage, you will be mailed a new

Member ID card

containing a new Rx

ID number. This new

number will be based

on your medical ID

number, rather than

your Social Security

number. All existingtransactions

(e.g., valid prior

authorizations,

deductibles) will

be automatically

transferred to the

new Rx ID number.

Simply bring your

new ID card toyour pharmacy

when obtaining

your prescription.


23/32

KEY: to be performed! to be performed for patients at risk

s subjective, by historyo objective, by a standard testing method

the range during which a service may be provided,with the dot indicating the preferred age.

Recommendations for Preventive Pediatric HealthcareInfancy Early Childhood

Age Prenatal Newborn 2-4d By 1mo 2mo 4mo 6mo 9mo 12mo 15mo 18mo 24mo 3y 4y

History

Initial/Interval Measurements

Height and Weight

Head Circumference

Blood Pressure

Sensory Screening

Vision s s s s s s s s s s s o o

Hearing o s s s s s s s s s s s oDevelopmental/

Behavioral Assessment

Physical Examination

Procedures General

Hereditary/Metabolic Screening

Immunization

Hematocrit or Hemoglobin

Urinalysis

Procedures Patients at Risk

Lead Screening ! !

Tuberculin Test ! ! ! ! ! !

Cholesterol Screening ! ! !

STD Screening

Pelvic Exam

Anticipatory Guidance Injury Prevention

Violence Prevention

Sleep Positioning Counseling

Nutrition Counseling

Dental Referral

Please note: There is no copayment for pediatric immunizations or preventive care visits. If additional services are received during those visits, a copayment may apply.

Recommendations for Preventive Pediatric HealthcareEach child and family is unique. Therefore, Recommendations for Preventive Pediatric Healthcare are designed for

the care of children who are receiving competent parenting, have no manifestations of any important health problems

and are growing and developing in satisfactory fashion. Additional visits may become necessary if circumstances suggest

variations from the norm.

These guidelines represent a consensus by the Committee on Practice and Ambulatory Medicine in consultation with

national committees and sections of the American Academy of Pediatrics (AAP). The Committee emphasizes the

importance of continuity of care in comprehensive health supervision and the need to avoid fragmentation of care.


24/32


Recommendations for Preventive Pediatric Healthcare (continued)

Middle Childhood Adolescence

Age 5y 6y 8y 10y 11y 12y 13y 14y 15y 16y 17y 18y 19y 20y 21y

History

Initial/Interval

Measurements

Height and Weight

Head Circumference

Blood Pressure

Sensory Screening

Vision o o o o s o s s o s s o s s s

Hearing o o o o s o s s o s s o s s s

Developmental/ Behavioral Assessment

Physical Examination

Procedures General

Hereditary/Metabolic Screening

Immunization

Hematocrit or Hemoglobin

Urinalysis

Procedures Patients at Risk

Lead Screening

Tuberculin Test ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

Cholesterol Screening ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

STD Screening ! ! ! ! ! ! ! ! ! ! !

Pelvic Exam ! ! ! ! ! ! ! ! ! ! !

Anticipatory Guidance Injury Prevention

Violence Prevention

Sleep Positioning Counseling

Nutrition Counseling

Dental Referral


25/32

2004 Adult Preventive Screening Guidelines

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

Health Screenings

Routine Preventive Health Assessment Every 5 years Every 2 years Annually

Blood PressureC At least every 2 years Annually

Serum CholesterolE Every 5 years

HemoglobinB Age 20 or older, at least once every 5 years

UrinalysisB At clinicians discretion

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

Chlamydial Infection G L Under age 25 &sexually active,

regularscreening

Cancer Detection

Clinical Breast ExamA,I L Every 3 years or Annually at clinicians

discretion

MammographyD,G L At clinicians Every 1 to 2 yearsdiscretion

Pelvic Exam and Pap SmearH L Pelvic exam: annually starting at age 19, regardless of thefrequency of cervical cancer screening. Pap Smear: 3 years after firstsexual intercourse or by age 21, whichever comes first. Up to age 30,annually. Age 30 and older, every 2-3 years after negative pap smearson three consecutive annual tests, or no more frequently than every3 years after one negative combined pap and HPV test.

Prostate Specific Antigen (PSA)D,G I At clinicians discretion

Digital Rectal ExamD,G At clinicians discretion

Fecal Occult Blood (FOB) TestA,I At clinicians discretion Annually

Sigmoidoscopy/ColonoscopyA At clinicians discretion Flexible sigmoidoscopy every

5 years OR Double contrastbarium enema every5-10 years OR Colonoscopy

every 10 years

Immunizations

Diptheria and Tetanus Booster F Every 10 years

Hepatitis B Vaccine F One series for persons with medical, behavioral,occupational or other indications

Hepatitis A Vaccine F One series for persons with medical, behavioral,occupational or other indications

Influenza Vaccine F Annually with chronic Annually

disease/high-riskPneumococcal Vaccine*,F Initial dose for those at high risk One dose for

unvaccinated.Revaccinateafter 5 yearsfor high-risk

L Women Only I Men Only * Revaccinate if less than age 65 when initial dose was received and if received more than five years ago.

Sources for information presented in guidelines above:

A. American Cancer Society, 2002. www.cancer.org

B. Centers for Disease Control and Prevention, 2002

C. Joint National Committee on Detection, Evaluation, and Treatment ofHigh Blood Pressure, 7th report, 1997

D. National Cancer Institute. Cancernet.nci.nih.gov/clinpdq 2002, 2003

E. National Cholesterol Education Program Adult Treatment Panel III, 2001

F. Summary of Adult Immunization Recommendations, Centers forDisease Control and Prevention, 2003-2004

G. U. S. Preventive Services Task Force, 2nd Edition.www.ahcpr.gov/clinic/uspstfix.htm

H. American College of Obstetrics and Gynecology, 2003

I. American Medical Association, 2004


26/32

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

2004 Drug Formulary UpdateThe following is an update to the preferred drug

list for Oxfords three-tier prescription drug benefit.

Oxford reviews new drug products approved by the

Food and Drug Administration (FDA) and reviews

current products when new information becomes

available. Please note that under your plan, different

copayments may apply to non-preferred brand,

preferred brand and generic drugs. Changes in tier

status may or may not affect how Members pay for

their diabetic medications and supplies. Members

who receive diabetic supplies through their base

medical benefit will continue to pay the applicable

copayment noted in their Summary of Benefits.

The following medications were reviewed by Oxfords

Pharmacy and Therapeutics Committee in May and

August 2004. Coverage for the listed items may be

limited or excluded based on a Members eligibility

or plan design. Unless otherwise noted, all changes

are effective October 1, 2004.

Additions:The following drugs have been added to Oxfords

preferred drug list. This means that if you have a

three-tier prescription drug plan, you may pay a

lower copaymentas a result of the change to preferred

(2nd tier) status.

Drug Therapeutic Use

Copegus Antiviral

Lexiva HIV/AIDS Therapy

Pegasys Interferon Hepatitis C

Phenytek Anticonvulsant

Spiriva Chronic obstructive pulmonary disease

Deletions:

The following drugs have been deleted from Oxfords preferred drug list. This means that if you have a

three-tier prescription drug plan, you may pay a higher copaymentas a result of the change to non-preferred brand

(3rd tier) status. A listing of generic and preferred brand alternatives is provided. Please speak with your physician

about whether they may be appropriate alternatives for treatment.

Drug Therapeutic Use Generic and Preferred Brand Alternatives*

Accuretic Antihypertensive therapy quinapril/hydrochlorothiazide (generic)Ceftin tablets Anti-infective cephalosporin cefuroxime (generic), Omnicef

Cipro 250 mg, 500 mg, Anti-infective fluoroquinolone ciprofloxacin (generic)and 750 mg tablet

Cytovene Antiviral ganciclovir (generic)

Dynapen Anti-infective penicillin dicloxacillin (generic)

Efudex 2% and 5% solution Misc. dermatological fluorouracil (generic)

Eskalith CR Misc. psychotherapeutic agents lithium carbonate, controlled release (generic)

Fioricet w/Codeine Headache therapy codeine/apap/caffeine/butalbital (generic)

Glucovance Diabetes therapy glyburide/metformin (generic)

K-Lyte/Cl 25 mEq Electrolyte potassium chloride/potassium bicarbonate/citric acid (generic)

Nolvadex Antiestrogen tamoxifen (generic)

Ocuflox Ophthalmic antibiotic ofloxacin (generic)

Purinethol Antimetabolite mercaptopurine (generic)

Rebetol (effective May 1, 2004) Antiviral ribavirin (generic), Copegus

Uniphyl Asthma therapy theophylline, timed release (generic)

Vepesid Misc. antineoplastic drugs etoposide (generic)

Viroptic 1% drop Ophthalmic antiviral trifluridine (generic)

Wellbutrin SR 100 mg and 150 mg Antidepressant bupropion, sustained-release (generic)

*Please speak with your physician about whether these generic or preferred brand drugs may be appropriate alternatives for treatment.

6


27/32

No Change:

There has been no change in the formulary status of the following drugs. This means that if you have a three-tier

prescription drug plan, you will continue to pay a higher copaymentas a result of the non-preferred (3rd tier) brand

status. A listing of generic and preferred brand alternatives is provided. Please speak with your physician about

whether they may be appropriate alternatives for treatment.Drug Therapeutic Use Generic and Preferred Brand Alternatives*

C aduet C ombination: A ntihypertensive/Lipid/ nifedipine (generic), Norvasc/lovastatin (generic),

cholesterol lowering therapy Lipitor, Zocor

C limara Pro Hormone replacement therapy FemHRT, Premphase, Prempro

C restor Lipid/cholesterol lowering lovastatin (generic), Lipitor, Zocor

Estrasorb Estrogen therapy estradiol patch (generic), C limara, Vivelle/Vivelle DO T

Inspra Antihypertensive and CHF therapy lisinopril (generic), Accupril, Coreg, Toprol XL

K emstro M uscle relaxant baclofen (generic)

Namenda Alzheimer disease Aricept

Prevacid Naprapac Combination: Ulcer therapy/Non-steroidal omeprazole (generic)/naproxen (generic)anti-inflammatory drug

R ythmol SR Antiarrhythmic agent propafenone (generic)

*P lease speak with your physician about whether these generic or preferred brand drugs may be appropriate alternatives for treatment.

Medications requiring precertificationPrecertification, also known as prior authorization,

requires that your physician formally submit a request

to, and receive approval from, Medco in order to receive

coverage for a prescription for certain medications.

The following drugs have been added to the list of

medications that require precertification. If you have

any questions regarding these or any other medication

that requires precertification, please call Pharmacy

Customer Service at 1-800-905-0201, 24 hours a day,

seven days a week (except for Thanksgiving Day and

Christmas Day).

Drug Name Therapeutic Use

Actiq Breakthrough cancer pain

Duragesic Chronic pain

Elidel Atopic dermatitis

Lamisil O nychomycosis

Penlac O nychomycosis

Protopic Atopic dermatitis

Sporanox O nychomycosis

Zegerid Ulcer therapy

Please note:Precertification requirements may vary depending

on your specific benefit plan. To obtain precertification, please

have your physician call Medco directly at 1-800-753-2851,

Monday through Friday between 8:00AMand 9:00PM.


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the pharmacy

OO X F O R D I N F OIf you have a chronic condition, such as diabetes,hypertension or epilepsy, you may be entitled to use theMedco Home Delivery Pharmacy Service, Oxfords mail

order option, which offers Members the ability to obtain

up to a 90-day supply of certain long term maintenance

medications.* For more information, please call Pharmacy

Customer Service at 1-800-905-0201, 24 hours a day,

seven days a week (except Thanksgiving and Christmas).

* Not all plans offer the mail order option. Please check yourCertificate of Coverage.

O T C p a i n k i l l e r a l e r t

When using OTC drugs, be sure you read all of the small print and

know what the active ingredients are. A case in point is acetaminophen.

Probably the most widely used class of pain relievers in the world,

acetaminophen can be highly toxic when taken in excess and, as a

recent study published inAnnals of Internal Medicine shows, overdoses

happen all too often. According to this study, acetaminophen toxicity

in the United States accounts for more than 56,000 trips to the hospital

emergency room, 2,600 hospitalizations, some 450 deaths annually,

and may be responsible for 50 percent of all acute liver failure.

For adults, the current recommended 24-hour dose of acetaminophen

as a headache remedy is no more than four grams or eight extra-strength

pills of 500 milligrams each. And when used as directed, it can provide

fast, safe and effective relief. But the problem is that acetaminophen

is also a secondary ingredient in over 600 cough and cold remedies,

prescription pain relievers and other products that do not list it prominently

on the label. Consequently, people who take multiple OTC and

prescription products are at risk of ingesting more than the safe limit

of acetaminophen, with potentially dangerous results. The toxicity of

acetaminophen may also be boosted when taken in combination with

alcohol. So look for acetaminophen as an additive when taking OTCs

and use these medications appropriately, as you should any drug.

T h e w e l l - s t o c k e d m e d i c i n e c a b i n e t

Here is a basic kit of OTC medications to keep on hand for use in routine minor complaints; you may want to add others items (e.g., vitamins,

sleep aids, acne medication) to fit your specific needs:

Health complaint OTC medication Therapeutic effect

Allergy Antihistamine Eases sneezing, runny nose

Constipation Laxative Stimulates bowel movements

Cough Cough suppressant Eases dry, hacking coughCough expectorant Thins, helps clear mucus

Diarrhea Adsorbent Attracts and retains bacteria and toxins in intestinesAntispasmodic Relieves intestinal cramping

Fungal infections Antifungal cream or powder Relieves itch, discomfort from fungal infections

Heartburn Antacid Neutralizes acid in stomachAcid reducer Reduces production of stomach acid

Itching skin Hydrocortisone cream Soothes itching from bug bites, rashesCalamine lotion Dries the oozing and weeping of poison ivy, poison oak,

poison sumac

Nasal/sinus congestion Decongestant, oral and spray Relieves nasal congestion, sinus pressure

Pain, fever NSAIDs* such as aspirin, Relieves minor aches and pains; reduces feveribuprofen, naproxen, acetaminophen and inflammation

Scrapes and skin infections Antibiotic ointment Helps wounds resist infection

Sunburn, sun tan Lotion or cream with SPF factor of 30+ Provides short-term screening against sun exposuredepending on users skin sensitivity

*Nonsteroidal anti-inflammatory drugs


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C H I L D R E N S H E A L T H

Sudden Infant Death Syndrome can be devastating for a

family. But there are steps that new parents, grandparentsand other caregivers can take to greatly reduce their babys risk.

Sudden Infant Death Syndrome (SIDS) is the medical

term for crib death, an inexplicable circumstance in

which a healthy baby under the age of one year dies

during sleep. Not a specific illness or disease, SIDS is a

diagnostic term that is used after all other explanations

for the sudden death of a healthy infant have been

ruled out. Once estimated to strike 5,000 newborns

annually, the incidence of SIDS in the United States

has declined more than 40 percent in the last decade,

although it still claims the lives of almost 3,000 infants

annually. The decline almost certainly relates to the

Back to Sleep public awareness campaign launched

in 1994 by the American Academy of Pediatrics (AAP)

in partnership with the National Institute of Child

Health and Human Development. Back to Sleep

is supported by many other groups today as well.

The campaigns primary message to parents is to put

babies to sleep on their backs rather than on their

stomachs or sides. Research has shown conclusively

that laying babies to sleep face down during the early

developmental months puts them at significantly

greater statistical risk of SIDS than does positioning

babies on their backs. And there are significant other

SIDS:Reducingyour babys risk

0


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benefits for babies: studies have shown that babies

who sleep on their backs have fewer cases of fever

and stuffy nose, and they also have fewer instances of

middle ear infections. Over time, as more has been

learned about the incidence of SIDS, additional safety

recommendations have been added:

Face up to wake up babies sleep safest on

their backs

Use a firm mattress and crib meeting Consumer

Product Safety Commission safety standards

Remove soft, fluffy or loose bedding and pillows

that can entangle or smother the baby

Dont let the baby sleep on a sheepskin, a couch,

a foam pad, a waterbed, or any soft surface

Remove all objects (including stuffed animals) from

the crib except during supervised play

Keep the babys head and face uncovered during

sleep; it is recommended that you do not use

blankets, but if necessary, use a thin, tightly

tucked blanket

If a light blanket is needed, securely tuck the edgesalong the bottom half of the crib, below the babys

arms, with his or her feet at the bottom of the crib

Do not permit smoking in the babys environment

Maintain room temperature that is comfortable

for you; dont let the baby get overheated

Make sure that anyone who is responsible for your

baby when you are away follows these safe sleep

practices; one fifth of all SIDS deaths occur in

daycare settings

The AAP also discourages parents from sharing a

bed with their baby. Sleeping parents are in danger

of rolling over onto their babies or smothering them

with their own blankets.

The information above has been provided with

the assistance of the CJ Foundation for SIDS

www.cjsids.com. O

OO X F O R D I N F OOxfords Healthy Mother, Healthy Baby program offerseducational support and helpful advice to expectant and newmothers. Of particular value are two booklets, one devoted

to prenatal preparation, the other to postnatal topics including

recommended immunization schedules for newborns. When

you notify Oxford of your pregnancy, you will automatically be

enrolled in the program. To notify Oxford, call our customer

service department at the number on your Oxford ID card,

or log in to www.oxfordhealth.com.

T u m m y t i m e

During the first year of life, an infants head is still quite soft and

malleable. Occasionally, a baby will develop an exaggerated flatness

at the back of the head or to one side, as the result of spending

too much time lying in one position. The American Academy of

Pediatrics urges parents to use waking hours for supervised

tummy time. Not only does lying on the stomach during active

time offset the tendency to flatten one part of the babys head,

but it also strengthens the muscles of the neck, girdle and

extremities, preparing the baby for crawling. If you are concerned

about your babys head shape, talk to your pediatrician.

T h e i m p a c t o f S I D S

Because the death of an infant due to SIDS is so unexpected and

unexplainable, bearing the aftereffects of guilt and blame can be

almost unbearable. Grieving parents may also have to undergo

investigations by authorities, as other possible causes of death

are considered. Anyone who suffers this tragedy should seek the

support of trained interventionists who understand the pain parents

are experiencing. One group that makes this support a major tenet

of its work nationwide is the CJ Foundation for SIDS. For more

information on how to reduce the risk for SIDS, or their support

services, go to www.cjsids.com or call 1-888-8CJ-SIDS.


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P.O. Box 7081, Bridgeport, CT 06601

PRESORTED STAND

U.S. POSTAGE

PAID

ONWARD PUBLISHIN

importantinformation

inside

Check out the latest news

about your Oxford coverage

n the Benefits Update section

of this issue and startmaking the most of

your health plan.

C U S TO M ER S E R VI C E 1 -8 00 -4 44 -6 22 2 (8 AM - 6 PM, Monday through Friday)To reach a Service Associate, please call the toll-free Customer Service number on your Oxford ID card,or call 1-800-444-6222. For a hearing impaired interpreter, you may call Oxfords TTY/TDD hotline at1-800-201-4875. Please call 1-800-303-6719 for assistance in Chinese, 1-888-201-4746 for assistance

in Korean, 1-800-449-4390para ayuda en Espaol, or the number on your Oxford ID card for assistancein other languages.

OXFORD ON-CALL 1-800-201-4911 (24 hours a day, seven days a week)Registered nurses offer you healthcare guidance, around the clock.

PHARMACY CUSTOMER SERVICE LINE 1-800-905-0201 (24 hours a day, sevendays a week)* Receive answers to your questions about pharmacy benefits, claims, prescriptions,and participating pharmacies in your area.

MEDCO HEALTH HOME DELIVERY PHARMACY SERVICE 1-800-905-020

(24 hours a day, seven days a week)* This mail-order pharmacy service provides a cost-effective, convenway for Members with a mail-order prescription benefit to order certain maintenance medications.

OXFORD EXPRESS 1-800-444-6222 (24 hours a day, seven days a week)Touch-tone phone options let you confirm eligibility, check the status of a claim, request a new OxfordID card or physician roster, and more.

OXFORDS FRAUD HOTLINE 1-80 0-91 5-19 09 (24 hours a day, seven days a week)If you suspect healthcare fraud on the part of Members, employers or providers, please call ourconfidential fraud hotline.

DIABETES PROGRAM LINE 1-800-665-4686 (8 AM - 4:30 PM, Monday through FridaOxford offers educational materials to help Members with diabetes understand their condition andbecome active participants in its management.

BEHAVIORAL HEALTH LINE 1-800-201-6991 (8 AM - 6 PM, Monday through Friday)Behavioral Health Coordinators provide information such as referrals to behavioral health providersor precertification for mental health or substance abuse services.

AS TH MA PR OG RA M LI N E 1-8 00-66 5- 46 86 (8 AM - 4:30 PM, Monday through Friday)

Learn about asthma triggers, how to avoid them and the importance of taking appropriate medication

RESOURCES ON THE INTERNET AT www.oxfordhealth.com

MY OXFORDSM

Log in with your user name and password to access your policy and benefit information, and performtransactions such as checking claims status, selecting a primary care physician and ordering materialsand Member ID cards.

WE LLN ESS RES OU RC ES

Learn more about Oxfords various wellness resources, such as our Healthy Bonus program andSelf-Help LibrarySM by logging in to our Member web site and clicking on the oxfordhealth Center.

*Except Thanksgiving and Christmas.

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

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