Empire Plan offers new asthma-management program

If you have asthma, you make want to take advantage of a new Empire Plan program to help you reduce your symptoms.

During negotiations for the current PEF/NYS contract, PEF and the state agreed to implement a disease-management program for PS&T employees and their dependents enrolled in the Empire Plan. The program began October 1, 2000, with the introduction of the cardiovascular-risk-reduction program for enrollees who have a recent history of angioplasty, open-heart surgery and/or heart attack.

The second program focuses on asthma and just began January 1, 2002. A program for enrollees with diabetes is planned for the future.
Strictly voluntary, these disease-management programs supplement the medical care of patients by providing them with the tools needed to be knowledgeable about their disease and treatment plan and to improve control of their condition. Managing a disease in this manner, can reduce a patient’s symptoms and treatment costs and gradually improve the patient’s quality of life.

Asthma is a lung disease that causes breathing problems. It’s one of the most common and costly diseases in the U.S. And death rates from asthma among 25- to 45-year-old adults are substantially higher in New York City than in other metropolitan areas and the nation as a whole.

If you or your dependents have received recent treatment for respiratory problems, you may be invited to participate in this program, called “Managing for Tomorrow.”
You will receive a letter from The Empire Plan’s medical director and then be asked to complete a health-risk assessment survey. Participation is voluntary, and your benefits will not be reduced if you don’t participate. All information you provide is kept confidential.

If you agree to participate, you will receive an easy-to-read booklet based on your responses to the survey. Asthma sufferers will also receive educational materials and other free services and rewards. As you learn to better manage your asthma, the severity of symptoms and the number of medical emergencies related to your asthma should be kept to a minimum.

The Managing for Tomorrow Asthma Program is provided by United HealthCare in conjunction with Landacorp, a company specializing in disease-management programs.

Injured in an accident? You may hear from Empire Plan

Some Empire Plan enrollees may be entitled to benefits for medical care under more than one insurance plan (including Workers’ Compensation and automobile insurance).

When this is the case, the Empire Plan uses two methods to provide the maximum benefits available to you while avoiding duplication or overpayment — coordination of benefits (COB) and subrogation.

Most enrollees are familiar with COB. You may not, however, know about subrogation. If you or one of your covered dependents is injured, another person or their insurance company may be legally responsible for your resulting medical expenses, not the Empire Plan. Common examples are a motor-vehicle accident or a medical-malpractice judgement that includes payment of an injured party’s medical expenses.

The Empire Plan is “subrogated” to your legal claims. That means the Empire Plan carriers “stand in your shoes” and can make claims against the third party. Under the law, the Empire Plan carriers have a right and an obligation to seek repayment for claims they have paid for treatment of your injuries that are the responsibility of another carrier such as an automobile insurer.

Until recently, Empire Blue Cross and Blue Shield (BCBS) and United HealthCare (UHC) have administered the Empire Plan’s subrogation and right-of-recovery provision. Effective July 1, 2001, Healthcare Recoveries Inc. (HRI) began administering this provision on behalf of Empire BCBS and UHC. The carriers have decided that contracting with HRI will be more efficient and result in a greater number of overpayment recoveries. In addition, enrollees will receive subrogation letters only from HRI, rather than from both Empire BCBS and UHC.

You are responsible for cooperating with the Empire Plan recovery efforts. Please make sure you or your health-care providers indicate on each claim form that your condition is related to an accident. If you receive a letter from HRI, it’s important that you respond promptly. The money recovered through this process helps keep the Empire Plan costs and premiums affordable. — Lorraine Simpkins

For answers to these questions and more, check out the “new and improved” Health Benefits section of PEF’s Website at www.pef.org. Click on Health Benefits in the left column.

The pages have been redesigned to make them more attractive and user-friendly. Important news about health, prescription-drug, dental and vision benefits for PEF-represented state employees will be featured. Other articles about medical care, links to health-related Websites and other general health news will also be highlighted.

Easy-to-use links on each page will help members find Empire Plan, HMO, dental and vision plan phone numbers and Websites. Other links connect you to help with benefit problems, where to file complaints, frequently asked questions about health benefits, and information about doctors and other licensed health professionals.

An extensive list of links is provided to Websites that offer reliable information about various illnesses including AIDS, arthritis, asthma and allergies, diabetes, heart disease, and mental illness. Also included are links to the public Websites of health-care facilities where PEF members work.

The mission of the Joint Committee on Health Benefits, which oversees health benefits for PEF-represented state employees, is described on another page of the section.
New features and articles will be added on a regular basis. Send your suggestions for additions to the site to dstayman@pef.org. — Deborah Stayman

GO TO HEALTH BENEFITS WEBSITE

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