NEW YORK | 2015 | ISSUE I

Watch Your Weight, Eat Healthy and Move More

The number of obese and overweight people has increased in recent decades. Obesity can lead to:

• Heart disease;

• Diabetes;

• Arthritis-related conditions;

• High blood pressure; and

• Some cancers.

To watch your weight, eat a healthy diet. Exercise at least 30 minutes a day, five days a week. Some exercises you can do are walking, raking leaves, riding a bike, swimming, running or jogging, or climbing steps for 10 minutes. Children should get at least 60 minutes of brisk exercise daily.

Some suggestions for a healthy diet include:

• Eat a balanced breakfast with protein, whole grains, fruits and vegetables;

• Limit fast food and junk food;

• Drink 8 cups of water daily;

• Snack on fruits and vegetables;

• Eat low-fat and reduced-fat foods; and,

• Talk with your doctor about diet and exercise plans to fit your needs.

What Is BMI?

Body Mass Index (BMI) is a number that shows body fat. It’s a measure of your weight and height.

BMI can screen for weight issues. Men and women can have the same BMI but different body fat percentages.

BMI for children and teens is often referred to as BMI-for-age. This is different from the way BMI is calculated for adults. Talk with your primary care provider to be screened for BMI.

Source: Centers for Disease Control and Prevention, www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_ bmi.html

Source: Weight-Control Information Network, http://win.niddk.nih.gov/

• Run a damp washcloth over your baby’s gums following feedings.

• Schedule your child’s first dental visit when the first tooth comes in, but no later than his or her first birthday.

• Take your child for a dental checkup between ages 1 and 2, and then every six months until age 18.

• Brush with just water and a soft toothbrush for children younger than age 2.

• Use a pea-sized amount of toothpaste with fluoride for children ages 2 and older.

• Begin using floss after your child has two teeth that touch.

Source: MedlinePlus, www.nlm.nih.gov/medlineplus

Ask About Fluoride VarnishFluoride varnish is a coating that is painted on a child’s teeth. It’s safe. It makes teeth stronger and helps prevent or stop cavities. Ask your child’s health care provider or dentist about fluoride varnish.

Dental Care Tips for Your Child

When Should Children Get Checkups?

Children can grow quickly. This rapid growth makes checkups important in a child’s early years. A child’s first checkup should be two or three days after birth. Then checkups should come regularly between months 1 and 18. Before age 2, checkups should include a blood lead test. After a child turns 2, checkups should happen yearly.

At age 3, the checkup should include an eye screening and a flu shot.

At ages 4 and 5, checkups should include eye screenings, urine tests, vaccines and a catch-up blood lead test if the child hasn’t been tested yet.

Starting at age 6, kids need a checkup and flu shot every year. This helps doctors make sure the child is growing up healthy.

Source: www.cdc.gov/vaccines/schedules

2 Member Newsletter

Heart Disease Facts: What You Need to Know About Heart Disease, High Blood Pressure and Cholesterol

According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death for both genders.

To reduce your risk for heart disease, maintain healthy blood pressure and cholesterol levels. Ask your primary care provider (PCP) to screen you.

Here are some tips to protect your heart:

• Have your PCP check your blood pressure yearly. A reading of 119/79 or lower is normal blood pressure. If you’re taking medications, take them as directed by your PCP.

• Get your cholesterol checked at least every five years. Refer to the chart below.

• Eat lots of fruits, vegetables and low-fat dairy. Avoid too much salt and saturated fat.

• Take three brisk 10-minute walks a day, five days a week.

• Limit alcohol. Don’t smoke. If you smoke, quit as soon as you can. Visit www.cdc.gov/tobacco and www.nysmokefree.com for tips.

Make an appointment with your PCP for screenings. Or call Customer Service at the number on the back page. They can help you choose a PCP.

Sources: American Heart Association, retrieved from www.heart.org; Centers for Disease Control and Prevention, retrieved from www.cdc.gov/heartdisease/facts.htm, www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_cholesterol.htm, www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm

Healthy Cholesterol Levels

Total cholesterol Less than 200 mg/dl

LDL, or “bad,” cholesterol Less than 100 mg/dl

HDL, or “good,” cholesterol 60 mg/dl or higher

Triglycerides Less than 150 mg/dl

3Member Newsletter

Utilization Management The Right Care in the Right SettingWhat is utilization management? It’s a review process. It helps everyone get the best quality of care available. This process helps determine the right place and care for a condition.

Here are some things you should know about the process:

• Decisions are based on the best use of care and services.

• The people who make decisions don’t get paid to deny care. No one does.

• We don’t encourage denial of care in any way.

If you have questions about the utilization management program or coverage decisions, or need language assistance, please call Customer Service at 1-800-288-5441. TTY users call 1-877-247-6272.

You may also review the Utilization Management Program section of your Member Handbook. You may call to ask for materials in a different format. This includes other languages, large print and audiotapes. There is no charge for this.

CAHPS®: Health Care Quality From Your Point of View

What is CAHPS? It stands for Consumer Assessment of Healthcare Providers and Systems. It’s a program that asks members what they think about their quality of care.

In February, you may get a CAHPS survey by mail or over the phone. If you do, please complete and return it. Your answers will be kept private. They will help WellCare improve programs and services for you.

You make a difference! Topics in the survey may include:

• How well you can access the care you need;

• How well your providers communicate with you;

• Your experiences with Customer Service; and

• The health care information you get.

CAHPS is a registered trademark of the Agency for Healthcare Research and Quality. To learn more about CAHPS, its products and its services, visit www.cahps.ahrq.gov.

4 Member Newsletter

Keep Your Child Safe From Lead

Why Is Lead Harmful? Exposure to lead can be bad for developing brains and other organs. It can cause serious problems, such as speech, language and behavioral problems; learning disabilities and attention deficit disorder (ADD); and damage to the brain and nervous system.

What Can You Do? Make sure your child has a blood lead test. This should happen at ages 1 and 2. Other steps you can take:

• Wash floors, windowsills, toys and pacifiers often.

• Use cold tap water for making baby formula, drinking and cooking.

• Remove peeling paint from where your child visits.

Transportation Benefit Change for Erie County

Starting January 1, 2015, transportation will be covered by regular Medicaid in Erie County. This includes both emergency and nonemergency transportation.

To get nonemergency transportation, call Medical Answering Services (MAS). The number is 1-800-651-7040. If possible, you or your provider should call MAS at

least three days before your medical appointment. You must provide your Medicaid ID number (example: AB12345C). Also provide your appointment date and time, your destination address and the doctor you are seeing. Nonemergency medical transportation includes bus, taxi, ambulette and public transportation.

How you get emergency transportation will not change. If you have an emergency and need an ambulance, call 911.

If your child has had contact with chemicals and is unconscious or having trouble breathing, call 911. You may also contact your area Poison Control Center 24/7 at 1-800-222-1222.

Source: Centers for Disease Control and Prevention, www.cdc.gov/nceh/lead

Coming soon to a WellCare office in your community: Member Feedback Sessions – We want to hear about your WellCare experience!

5Member Newsletter

Get the Screenings That Find Cancer Early

Cancer screenings help find problems before they become serious. If you catch a problem early, there’s a better chance to cure it. The American Cancer Society recommends these screening guidelines for most adults:

Breast cancer• Yearly mammograms starting at age 40

• Clinical breast exam every three years for women in their 20s and 30s, every year for women 40 and older

• Breast self-exam (BSE) is an option for women starting in their 20s

Colorectal cancer and polypsBeginning at age 50, men and women should follow one of these testing schedules:

• Tests that find polyps and cancer – flexible sigmoidoscopy every five years*, or colonoscopy every 10 years, or double contrast barium enema every five years*, or CT colonography every five years*

• Tests that primarily find cancer – yearly fecal occult blood test (gFOBT)*, **, or yearly fecal immunochemical test (FIT)*, **

The tests that are designed to find both early cancer and polyps are preferred. Talk with your doctor about which test is best for you.

*If the test is positive, a colonoscopy should be done.

**The multiple stool take-home test should be used; a colonoscopy should be done if the test is positive.

Cervical cancer• Cervical cancer

screening should begin at age 21

• Women between ages 21 and 29 should have a Pap test every three years

• Women between the ages of 30 and 65 should have a Pap test plus an HPV test every five years

• Women older than age 65 who have had regular cervical cancer testing with normal results should not be tested

• A woman who has had her uterus removed (and also her cervix) for reasons not related to cervical cancer should not be tested

• A woman who has been vaccinated against HPV should still follow the screening recommendations for her age group

• Some women – because of their health histories – may need to have a different screening schedule for cervical cancer

6 Member Newsletter

Endometrial (uterine) cancer• All women should be told about

the risks and symptoms of endometrial cancer

Lung cancerIf you meet all of the following criteria, then you might be a candidate for screening:

• 55 to 74 years of age

• In fairly good health

• Have at least a 30 pack/year smoking history AND are either still smoking or have quit smoking within the past 15 years

Prostate cancer• Starting at age 50, men should talk with

a doctor about testing

• African-American men with a father or brother who had prostate cancer before age 65 should have this talk starting at age 45

• Testing includes a PSA blood test with or without a rectal exam – how often will depend on PSA levels

Cancer-related checkups• A cancer-related checkup for adults

should include health counseling and, depending on age and gender, exams for cancers of the thyroid, oral cavity, skin, lymph nodes, testes and ovaries

Source: American Cancer Society Guidelines for the Early Detection of Cancer, www.cancer.org

Click or Call for the Latest Drug Coverage Updates

Want to find the latest about the drugs we cover? Stop by our website. You’ll find our Preferred Drug List (PDL). You can learn about recent additions and removals. You’ll also find changes to any drug requirements or coverage limits. Just go to newyork.wellcare.com. Select “For Members.” Next, click on your plan. Then choose “Pharmacy.” You can also call us for updates. The number is on the back page.

7Member Newsletter

In This Issue Numbers to Know

WellCare of New York, Inc.110 Fifth Ave., 3rd FloorNew York, NY 10011

We’re just a phone call (or click) away!

Call Customer Service:

1-800-288-5441

TTY 1-877-247-6272

Monday–Friday, 8 a.m. to 6 p.m.

Or visit

newyork.wellcare.com

Nurse Advice Line:

1-800-919-8807 (TTY 711) 24 hours a day/7 days a week

Para solicitar este documento en Español, llame al Servicio al Cliente al 1-800-288-5441 (TTY 1-877-247-6272).

We’re pleased to deliver another newsletter issue. It’s full of helpful ideas about ways to live healthier. Here’s what you’ll find:

• Helpful tips on childhood checkups;

• Information on preventing heart disease; and

• Tips on eating healthy.

There’s much more inside, so please take a moment to explore. As always, we wish you good health.

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