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1 healthymoves SPRING 2011 superiorhealthplan.com _SHP_SHM Go Online Learn more about your health coverage and how to live healthy. Go online to superiorhealthplan.com. Under Members, you ll see a link to newsletters. You can read about: Your rights and responsibilities Case management ADHD Topics in your Member Handbook Also on our website: appointment wait times. To request a hard copy of any materials, call Member Services. DID YOU KnoW? Superior HealthPlan offers many types of health plans: Medicare Advantage, STAR, STAR+PLUS, STAR Health and CHIP. PRSRT STD U.S. POSTAGE PAID Stevens Point, WI Permit #422 Eat Well for Your Baby A re you pregnant? Congratulations! Now s the time to eat healthy food. This means no junk food, coffee or alcohol. Instead, you need foods with good vitamins and proteins. Low-fat milk, beans and yogurt have lots of protein, which helps your baby grow. Folic acid is good for your baby, too. It helps prevent birth defects. You can get folic acid by eating green, leafy vegetables like spinach and kale. Your doctor may also suggest a prenatal vitamin to make sure you re getting all the nutrition you need. Also, talk to your doctor about TXC_H 6070 Gateway East Suite 400 El Paso, TX superior HealthPlan your weight. Most women gain about 25 to 35 pounds while they are pregnant. You will put on the most weight at the end. This is when the baby grows the fastest.

2 disease management How Can We Help You? Do you think you are at risk for getting a serious disease? Our Disease Management program can help. It can show you how to live healthier. A disease manager teaches you how to make smart choices about your health. This will help you stay out of the hospital. Here s an example. If you have high blood pressure, you are at risk for having heart disease. Our disease management program can help you live better to lower your high blood pressure. When you take part in disease management programs, you ll talk with a nurse over the phone. You ll learn a lot about taking care of your health. To learn more or sign up, call Member Services. Q A ask the doctor Dear Doctor: I have asthma. My doctor and I made a plan to control my asthma. I feel pretty good. Do I need to see my doctor again? Even if your asthma feels under control, it s good to visit your doctor regularly. You have a good plan now, but sometimes how you control your asthma needs to change. Here are three reasons you might need to change how you manage your asthma. 1 Your symptoms change. You might have new asthma triggers. Your asthma might be worse (or better). Or you may have symptoms at different times of the day. 2 Your peak flow meter doesn t work well. You might need to practice how to use the meter the right way. Or you might need a new one. 3 Your weight has changed. This can affect the amount of medicine you need. Stay on top of the disease by talking with your doctor. He or she is the best person to help you adjust your asthma plan.

3 P R Estimado médico: Tengo asma. El doctor y yo hicimos un plan para controlar mi asma. Me siento bastante bien. Tengo que ver al doctor otra vez? Aun si siente que el asma está bajo control, es bueno ver al doctor periódicamente. Por el momento tiene un buen plan, pero a veces hay que cambiar cómo controla usted el asma. Estas son 3 razones por las cuales quizás tendrá que cambiar cómo controla el asma. 1Cambian los síntomas. Tal vez tenga nuevos irritantes del asma. El asma podría estar peor (o mejor). O podría tener síntomas a diferentes horas del día. 2El medidor de flujo máximo no funciona muy bien. Tal vez tenga que practicar cómo usar correctamente el medidor. Puede que necesite uno nuevo. 3Ha cambiado su peso. Esto puede afectar la cantidad de medicamentos que necesita. Manténgase al tanto sobre el padecimiento hablando con el doctor. Es la mejor persona para ayudarle a ajustar el plan del asma. pregunte al médico control de enfermedades En qué le podemos ayudar? Piensa usted que corre riesgo de contraer alguna enfermedad grave? Nuestro programa de control de enfermedades puede ayudar. Le puede enseñar a vivir más sano. El coordinador de control de enfermedades le enseña cómo tomar decisiones inteligentes sobre la salud. Esto le ayudará a evitar ingresar al hospital. Aquí tiene un ejemplo. Si usted tiene la presión arterial alta, corre riesgo de sufrir enfermedades del corazón. Nuestro programa de control de enfermedades le puede ayudar a vivir mejor y así bajar la presión arterial alta. Cuando participa en programas de control de enfermedades, hablará con una enfermera por teléfono. Aprenderá mucho acerca de cómo cuidar la salud. Para saber más o para inscribirse, llame a Servicios para Miembros.

4 Members, Take Note learn more Know what you can expect. As a member, you have many rights and responsibilities. These rights cover your treatment, privacy and access to information. It s important to learn and understand your rights. We list some of your rights here. There are more. We encourage you to check your Member Handbook or our website to learn about all of them. If you need a paper copy, just call Member Services. Being able to file an appeal, a grievance (complaint) or state hearing Some of your responsibilities include: Asking questions if you don t understand your rights Keeping your scheduled appointments Having an ID card with you at your appointments Always getting in touch with your primary care physician (doctor) first if you have a medical need that isn t an emergency Telling your doctor if you had care in an emergency room Your rights include, but are not limited to: Receiving all services that we must provide Being treated with respect, and with your dignity and privacy in mind Knowing that your medical record information will be kept private Being able to ask for and get a copy of your medical records, and being able to ask that the record be changed/corrected if needed

5 next steps Learn About Your Plan! You can find these topics in your Member Handbook: Important numbers to remember if you have questions, call Member Services Information about your plan benefits: how to access care Accessing pregnancy care and care services just for women Special services who to call if you need help How to access emergency care and other medical services How to send us a complaint How to start an appeal Rights and responsibilities Making care easier who to call if you need interpreter services Don t Forget To Follow Up Does your child take medicine for ADHD? Then you should work closely with your child s doctor. The doctor will want to check how the medicine is working for your child. He or she may decide that a different medicine will work better. Also, it s important that your child takes the medicine just like the doctor says to. You re Not Alone Are you living with a long-term, complicated illness? Case Management can help. They can help you understand your options. And help you get the right care. Case managers can make life a little easier. To request a paper copy or to learn more about getting extra support from our Case Managers, call Member Services.

6 Aviso a los miembros aprender más Sepan qué pueden esperar. Como miembro, usted tiene muchos derechos y responsabilidades. Estos derechos cubren el tratamiento que recibe, la privacidad y el acceso a información. Es importante aprender y entender sus derechos. A continuación hay una lista de algunos derechos, pero tiene más. Sugerimos que revise el Manual para Miembros o nuestro sitio web para aprender sobre todos sus derechos. Si necesita una copia impresa, llame a Servicios para Miembros. Pedir y recibir una copia de sus expedientes médicos, y pedir que se cambie o corrija el expediente cuando sea necesario Presentar una apelación, un agravio (queja) o una audiencia ante el estado Algunas de sus responsabilidades son: Hacer preguntas si no entiende cuáles son sus derechos Ir a las citas programadas Llevar la tarjeta de identificación a las citas Siempre comunicarse primero con el proveedor de cuidado primario (doctor) si tiene una necesidad médica que no es una emergencia Decirle al doctor si recibió atención en la sala de emergencias Algunos de sus derechos son: Recibir todos los servicios que nosotros tenemos que ofrecer Ser tratado con respeto, dignidad y privacidad Saber que la información en sus expedientes médicos se mantendrá privada

7 los próximos pasos Infórmese acerca de su plan de salud! Puede encontrar los siguientes temas en el Manual para Miembros Teléfonos importantes para recordar si usted tiene preguntas, llame a Servicios para Miembros Información sobre los beneficios de su plan de salud: cómo tener acceso a la atención Cómo tener acceso a la atención durante el embarazo y servicios de atención solo para la mujer Servicios especiales a quién llamar si necesita ayuda Cómo tener acceso a atención de emergencia y otros servicios médicos Cómo enviarnos una queja Cómo iniciar una apelación Derechos y responsabilidades Cómo facilitar la atención a quién llamar si necesita servicios de un intérprete No se olvide de mantener contacto con el doctor Toma su hijo medicamentos para el trastorno por déficit de atención con hiperactividad (ADHD)? Si es así, usted debe trabajar de cerca con el doctor de su hijo. El doctor querrá revisar cómo está funcionando el medicamento que toma su hijo. El doctor podría decidir que un medicamento diferente funcionaría mejor. Además, es importante que su hijo siga las instrucciones del doctor cuando toma el medicamento. No está solo Vive usted con una enfermedad crónica y difícil de tratar? La Administración de casos puede ayudar. Le ayudará a entender sus opciones. Además le ayudará a recibir la atención adecuada. Los administradores de casos pueden hacer la vida un poco más fácil. Para pedir una copia impresa o para saber más sobre cómo obtener apoyo adicional de nuestros administradores de casos, llame a Servicios para Miembros.

8 PRIMAVERA 2011 superiorhealthplan.com Use Internet Aprenda más sobre su cobertura médica y la vida sana. En Internet vaya a superiorhealthplan.com. También verá artículos sobre: Sus derechos y responsabilidades Administración de casos Trastorno por déficit de atención con hiperactividad (ADHD) Temas del Manual para Miembros También disponible en Internet: Ver los tiempos de espera. Para pedir una copia impresa, llame a Servicios para Miembros. sabía usted? El Plan de Salud Superior ofrece varios tipos de planes de salud: Medicare Advantage, STAR, STAR+PLUS, STAR Health y CHIP. Coma bien para ayudar al bebé Está embarazada? Felicidades! Es el momento de comer alimentos saludables. Eso significa nada de comida chatarra, ni café ni alcohol. Lo que necesita son alimentos con buenas vitaminas y proteínas. La leche baja en grasa, los frijoles y el yogur tienen mucha proteína, lo cual ayuda al bebé a crecer. El ácido fólico también es bueno para su bebé. Ayuda a prevenir los defectos de nacimiento. Puede obtener el ácido fólico comiendo verduras de hojas verdes, como espinacas y col de hoja rizada. Su doctor quizás sugiera una vitamina prenatal para asegurar que está recibiendo toda la nutrición que necesita. Además, hable con su doctor sobre su peso. La mayoría de las mujeres suben entre 25 y 35 libras cuando están embarazadas. Subirá más rápido al final del embarazo. El bebé crece más rápido en esta etapa. Member Services Phone Numbers Teléfono de servicios para miembros STAR, CHIP Perinatal, CHIP Member Services: CHIP RSA Member Services: STAR Health Member Services: STAR+ PLUS Member Services: Superior HealthPlan TDD/TTY: Need a Ride to the Doctor s? Do you need a ride to your doctor s appointment? We can help. Call Member Services at least two business days before your appointment to make sure we have transportation available. Necesita transporte para ir al consultorio del doctor? Necesita transporte para ir a una cita con el doctor? Podemos ayudar. Llame a Servicios para Miembros al menos 2 días laborales antes del día de la cita, para asegurarse de que sí hay transporte disponible. Published by McMurry All rights reserved. No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement not take the place of the recommendations of your healthcare provider. Consult your physician before making major changes in your lifestyle or healthcare regimen. McMurry makes no endorsements or warranties regarding any of the products and services included in this publication or its articles. Publicado por McMurry. Derechos de autor, Se reservan todos los derechos. Ningún material de esta publicación podrá reproducirse en su totalidad o en parte sin el permiso expreso y por escrito de la casa editorial. El propósito de la información de esta publicación es de complementar y no reemplazar las recomendaciones de su proveedor de atención médica. Consulte a su doctor antes de hacer cualquier cambio importante a su estilo de vida o régimen de cuidado de su salud. McMurry no hace recomendaciones ni da garantías respecto a ningún producto o servicio mencionado en esta publicación o en los artículos.

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