Healthy Communities and member news

Healthy Communities

Tue, 07 Feb 2012 10:31:30 -0500

Healthy Communities

Part of being healthy is staying informed. That's where Healthy Communities, Fallon Community Health Plan's member magazine, can help. In it, you'll find information about how to make the most of your health plan, plus interesting articles on how to improve your general health and well-being.

Winter 2012 (pdf, 1MB)

Feature: Heart-healthy makeover
Is your diet resolution healthy?
Brand-name drugs go generic
Where does your premium dollar go?
FCHP insider tip: Choosing your PCP
When you need care now
The scoop on croup
Having a baby in 1930
Weight Watchers® program changes
Our Medicare Supplement options better than ever
Network expansions – commercial plans
And much more!

Past issues of Healthy Communities

Healthy Communities archive

Tue, 07 Feb 2012 10:22:23 -0500

Healthy Communities archive

Autumn 2011 (pdf, 390 KB)

Feature: Cutting through the clutter: FCHP, health literacy and you
NaviCare expands beyond Worcester County
Network changes – commercial plans
Member ID cards get a makeover
Food safety in your kitchen
Living well with a chronic condition
Fallon Senior Plan™ HMO – what’s new in 2012
New substance abuse program launched
FCHP insider tip: Setting your personal goals
Online tool checks drug interactions
Mail-order Rx- pay up front
And much more!

Spring/Summer 2011 (pdf, 426 KB)

Feature: Childhood obesity: What’s a parent to do?
Traveling? Pack a medical tote!
It Fits! Supports member in marathon quest
ADHD: Early treatment makes a difference
FCHP insider tip: Call readiness
Senior Care Services at FCHP
FCHP benefits update – commercial plan members
Contracted providers keep costs down
FCHP chooses OneTouch meters for diabetes monitoring
FCHP service at your fingertips
Senior program Navigator coordinates needed services
And much more!

Winter 2011 (pdf, 838 KB)

Feature: Walking the talk to fitness
FCHP plans rank among top 10
FCHP adds Medicare Supplement plan product
Managing cold-weather health problems
Kids fueling up on fats and sugars
Teen depression: When to consider treatment
Peace of Mind Program™ offers specialty choices
FCHP Insider Tip: Pregnant? We can help
Benefits update
New FCHP NaviCare program growing strong
Supporting innovative community programs
And much more!

Autumn 2010 (pdf, 443 KB)

Feature: Cost of care 101
Autumn health and safety tips
Your child and vaccine safety
New focus on food allergy safety
National reform extends dependent coverage to age 26
How your plan works: Know your benefits
MassHealth: Family Partners offers helpful support to families
The value of Fallon Senior Plan membership continues
Fallon Senior Plan connects members to savings programs
More support for living with chronic conditions
Take the Personal Wellness Profile
And much more!

Spring/Summer 2010 (pdf 339 KB)

Feature: Shake the salt habit
Hughes named President and CEO
FCHP “Excellent”—times 3
FCHP expands network on South Shore
More you on “My FCHP”
Wrestling with health care costs
To market, to market!
X-rays: Get the picture on protection
How your plan works: Deductibles
Use more of your prescription before refill
MassHealth: In-Home Therapy + Oh Baby! program
FCHP sponsors Canal Diggers race
And much more!

Winter 2010 (pdf 891 KB)

Flu review: Are you an expert yet?
FCHP health plans rank top 10 in nation
Introducing a new senior program: NaviCareSM HMO
New CVS discount card for FCHP members
Home health agency discount available through 2010
Bulking up on vitamin D
How your health plan works: Hospital connections
Do you have cyberchrondria?
FCHP insider tip: Need someone to speak for you?
Radiology services managed for cost and safety
“New” drugs may not be best choice
FCHP pilot program addresses hospital readmission costs
An urgent care alternative
And much more!

Autumn 2009 (pdf, 2.9 MB)

Budgeting for health in a bad economy
How your health plan works: What’s covered?
Chocolate milk—the new power drink?
More online tools at fchp.org
Lessons from thin people
Snort. Sniffle. Sneeze. No antibiotic, please!
With FCHP, wellness is free!
FCHP support for high-risk pregnancies
FCHP insider tip: Direct Care
The Medicare Advantage difference
Healthy pursuits support community outreach
And much more!

Summer 2009 (pdf, 1.2 MB)

Right care, right place: Emergency care vs. primary care
How to “talk” to your doctor
Tips on caring for cuts and scrapes
How your health plan works: What do you pay?
Compare hospital care online
Save money on fitness activities with FCHP
Oh Baby!—now more support for whole family
FCHP insider tip: Referrals
FCHP adds NH providers for cross-border workers
MassHealth members get new behavioral health services
Benefit change alert for PT/OT
And much more!

Winter 2009 (pdf 805 KB)

Positively Uplifting: Exercise’s role in fighting depression
Extra help to pay for prescriptions
The brown bag is back + Rice is nice! sidebar
How your health plan works: networks
New doc finder at fchp.org
More fitness reimbursement, more eligible activities
FCHP support for high-risk pregnancies
FCHP insider tip: Customer Service
SilverSneakers now includes Curves
More doctors, more choices
New option: CVS MinuteClinic

Volume 2 2008 (pdf 2.9 MB)

Seniors find more value, more choice
Working on staying healthy…and what’s new for Fallon Senior Plan in 2009
FCHP launches initiative to combat childhood obesity
New FCHP program supports depression treatment
FCHP welcomes new chief medical officer
Three tiers for prescription options
Your checklist for monitoring health
FCHP has more doctors
Being an informed patient
Weight Watchers^®new support for men
Facts about fiber
A lifetime of music: Summit ElderCare violinist

Volume 1 2008 (pdf 1.4 MB)

Breathe easy
Knowing when prescription medication may be right or
wrong for you
FCHP jointly acquires in-home services company
Faulkner Hospital, Quincy Medical Center join FCHP network
FCHP continues Pay It Forward in 2008
Oh Baby! program adds safety kits
Affordable health insurance at FCHP
MassHealth members and WIC Nutrition Program
Keep your kids safe and healthy
Ensure your kids’ future bone health
Member online tools for healthier living
Long-term medication precautions
Your Medicare prescription coverage explained

Volume 4 2007 (pdf 1,267 KB)

Our 10th anniversary issue
Growing up healthy
Overweight kids: breaking the mold
Sound bodies, sound minds
FCHP achieves top rankings in America
More doctors, more choice for FCHP members
Fallon Preferred Care benefits enhanced
Kid stuff: good nutrition
Health clubs: what’s best for you?
Keeping cholesterol in check
New policy promotes careful handling of meds
Palliative care services give hope
Summit ElderCare expands to Leominster
Changes to prescription mail-order
Medicare basics-part 3
Senior Plan members pursue fitness

Volume 3 2007 (pdf 641 KB)

Paying it forward – FCHP celebrates 30 years
FCHP achieves quality plus distinction
Health insurance is the law—and good common sense
New FCHP MassHealth benefits
Create your wellness profile on fchp.org
Experts: How does the FDA and FCHP oversee drug safety?
Poisoned? Act quickly
The ABCs of healthy snacks
Summit ElderCare—“top health care organization”
Preventing sports and exercise injuries
Cancer cautions
Eating the right stuff—quiz
Medicare basics: part two
Ask about our Value Plan option
Maximizing the benefits of Medicare

Volume 2 2007 (pdf 1.6 MB)

De-stress: you have the power!
FCHP is the choice for must-have insurance
FCHP offers Commonwealth Care options
New online tool checks drug interactions
30th FCHP anniversary—spreading the goodwill
Prescription mail-order tips
Experts: Is Priolosec OTC™ safe to take all the time?
Experts: What is oral allergy syndrome?
Kid stuff: Let your children play
Prevention and detection of STDs easier
FCHP programs work together for extra care
Your rights and responsibilities
Seniors: A recipe for long life
Seniors: Medicare basics, Part 1
Seniors: Log on for senior “phit”-ness

Volume 1 2007 (pdf 867 KB)

A change of heart (featuring Nancy Robidoux)
Key provider group added in pioneer valley
FCHP boost fitness reimbursement
New dependent age verification begins
FCHP: Excellent times three
www.fchp.org improved
Referral process simplified
Post-mastectomy benefits reminder
Experts: Whooping cough and immunization
Experts: Fosamax^® safety
Kid stuff: Boost your child’s self-esteem
Take care with your OTC medications

Volume 4 2006 (pdf, 375 KB)

Invest in yourself: planning for a healthy retirement
Experts: Antibiotics don’t help viruses—the cause of colds and flu
Kid stuff: Say goodbye to separation anxiety
Generic drugs getting more attention
Preparation is key to disaster survival
What is bird flu? Get our brochure!
Be clear about cough medicine
Fallon Senior Plan: What’s new for 2007
FCHP expands to Western Mass.
FCHP acquires benefits administrator
Transitioning from hospital to home
Dependent age now up to 26
Taking care of you every day

Volume 3 2006 (pdf, 290 KB)

FCHP’s recipes for a healthier lifestyle
What immunizations do adults need?
I have poor night vision. What can I do?
FCHP adds key providers north and south of Boston
New hospital comparison tool and more added to www.fchp.org
FCHP support for high-risk pregnancies
Road trip survival with kids
Blood tests reveal secrets
Staying healthy with diabetes
Drug safety takes a front seat
Pleasant dreams in later years
Emergency care worldwide
Introducing Fallon Senior Plan Value

Volume 2 2006 (pdf, 504 KB)

Cuddles and courage: helping your child through a hospital stay
Do glucosamine and chondroitin supplements work?
Can you tell me more about restless leg syndrome?
Kid stuff: food allergy or food intolerance?
Meditation: good for body and soul
Check your asthma daily
How to find a behavioral health therapist
Showing your grandkids a good time
Seniors covered for clinical trials
FCHP network grows in Nashoba and Merrimack valleys
Summit ElderCare expands to Charlton
Our community outreach
An overview of Fallon Preferred Care
Important FCHP phone numbers

Volume 1 2006

A message to our members about rising health care costs
My everyday health credo: a member’s story
Do you need extra dental care when pregnant?
Does cold weather trigger asthma symptoms?
Rotavirus—no ordinary bug
MP3 players and hearing loss
Safe heating for health
Breathe easier: carbon monoxide detectors
Is tanning indoors safe?
Figuring fitness—calculate your BMI
Seniors: Keep the winter blues at bay
Seniors: A healthier you at no extra cost
Medicare Part D deadlines
You can count on us
It Fits! even better
More for you at www.fchp.org
Link to information about your care

Health care reform - tax year 2011 and Massachusetts legislation

Mon, 23 Jan 2012 12:55:12 -0500

Health care reform - tax year 2011 and Massachusetts legislation

Health care reform legislation requires Massachusetts state residents age 18 and over to have health care coverage. Residents whose coverage does not meet the state's minimum creditable coverage (MCC) standards, or who have a lapse in coverage greater than 63 consecutive calendar days, may be subject to a penalty for each month of non-compliant coverage during the year. The following are frequently asked questions designed to explain how the law affects state tax filings.

Am I required by the state to have health insurance?

Most Massachusetts residents who are 18 years or older are required to have health insurance that meets minimum creditable coverage standards, and not have a lapse in coverage of more than 63 consecutive days, or they may be subject to a penalty for each month of non-compliance. The penalty is $101 per month or $1,212 per year for 2011 for individuals above 300% of the federal poverty level.

What is minimum creditable coverage?

Minimum creditable coverage (MCC) is the least amount of coverage that an individual must obtain to be in compliance with the health care reform individual mandate.

What if I have a plan that does not meet minimum creditable coverage requirements?

The requirement to meet MCC guidelines may not apply to all individuals. For information on MCC, affordability or waivers, the Commonwealth Connector Public Information Line is available at 1-877-MA-ENROLL (1-877-623-6765) or visit the Connector via their Web site at www.mahealthconnector.org.

What if I had coverage for non-consecutive months?

Gaps in health care coverage may exist without a penalty providing they are no greater than 63 consecutive days, according to legislation. If you are enrolled in health insurance that meets minimum creditable coverage standards anytime during the year, you will receive a 1099-HC form indicating full year coverage, or, if there are gaps in coverage, showing each month you had health insurance that meets minimum creditable coverage standards for at least 15 days or greater.

How do I prove that I have obtained health insurance?

If you are enrolled in health insurance that meets minimum creditable coverage standards anytime during the year, you will receive a 1099-HC form in the mail in January from your health insurance company. The form is proof of coverage and can be used to help fill out the Schedule HC form, which is a required part of the Massachusetts income tax return.

I am an employer that offers health benefits through FCHP and pharmacy benefits through a separate pharmacy benefits manager. How will FCHP know if I meet minimum creditable coverage standards?

FCHP will mail an attestation form to employers whose FCHP plan does not meet minimum creditable coverage standards. Employers receiving the form are required to complete and mail it back to FCHP attesting to meeting minimum creditable coverage standards. FCHP will then send 1099-HC forms to employees by January 31, 2012.

What if I had coverage from different insurers?

If you have coverage from different health care insurers during 2011, you will receive a 1099-HC from each health insurance provider from which you had coverage.

What if I live outside of Massachusetts but have a dependent that lives in Massachusetts?

FCHP subscribers living in or outside of Massachusetts will be sent a 1099-HC form. Subscribers and dependents can use the form to obtain information needed to complete their Massachusetts Schedule HC filing. Subscribers that are not filing Massachusetts state income taxes may disregard the form.

How do I obtain a form if I am a dependent?

FCHP will send a 1099-HC form to each subscriber who has health coverage that meets minimum creditable coverage standards in 2011. Dependents can use the subscriber form to obtain information needed to complete their Massachusetts Schedule HC filing.

What if I am on a government-subsidized health plan (Medicare/MassHealth/Commonwealth Care)?

Individuals on a Medicare/MassHealth/Commonwealth Care plan at any time during 2011 will receive 1099-HC information from the state showing proof of coverage. The form is proof of coverage and can be used to help fill out the Schedule HC form, which is a required part of the Massachusetts income tax return.

What information does the 1099-HC form contain?

The 1099-HC indicates:

Name of insurance company or administrator, and its Federal Identification Number (FID) number (or, Employer Identification Number)
Subscriber’s name, address, member number and date of birth
Whether an individual had full-year coverage that meets minimum creditable coverage standards, or, if not full-year coverage, the number of months covered (a month of coverage is any month in which you had 15 or greater days of coverage)
Dependents’ names, dates of birth, member numbers and coverage data

What if my address or name is incorrect on my form?

If the 1099-HC has an incorrect address and you received the form, please let FCHP know your new or correct address. If you received a 1099-HC form, you will not need another one. If your name changed in 2011 or is incorrect on the 1099-HC form, please let FCHP know right away and we will make the correction for you and send you a corrected form.

How do I obtain a 1099-HC form?

FCHP subscribers over the age of 18 that have health insurance that meets minimum creditable coverage standards will be mailed a 1099-HC form from Fallon Community Health Plan by January 31. If you, as a subscriber, misplace or don’t receive a form, please call Customer Service at 1-800-868-5200 to request a new one.

If you are a dependent over the age of 18 and filing separately, you can use the information from the subscriber’s 1099-HC form to complete your state tax filing.

Why did I receive more than one 1099-HC form?

If you have coverage from different health care providers during 2011, you will receive a 1099-HC form from each health insurance provider from which you obtained coverage.

When will subscribers receive a 1099-HC form?

Fallon Community Health Plan will mail 1099-HC forms to subscribers by January 31, 2012, for the 2011 state tax filing.

If I receive health care coverage through my employer, will the employer send me a 1099-HC form?

In most cases, health insurers, not employers, will send out 1099-HC forms. FCHP will send 1099-HC forms to our members.

If I do not receive the 1099-HC form or if I misplace the one that I did receive, can I obtain another form?

Additional copies of a subscriber’s 1099-HC form issued by FCHP can be obtained by contacting our Customer Service Department at 1-800-868-5200 (TTY users please call TRS Relay 711), Monday through Friday from 8 am. to 6 p.m. Due to HIPAA privacy regulations, forms can only be requested by the subscriber. The caller may be asked certain questions to confirm that he or she is the actual subscriber. We are not able to provide 1099-HC tax information over the phone.

Do I need more than one 1099-HC form if I am married but my spouse and I file separate tax returns?

No, you will only need one form. Health insurance companies will issue one 1099-HC per subscriber. If you need more than one form, you may make a copy of the original document.

Do I need to attach the 1099-HC form to my state income tax filing?

If you are filing your state income tax electronically, you do not need to submit a copy of your 1099-HC form. If you are filing a paper return, please attach a copy of your 1099-HC form to your tax return. If you need more than one form, you may make a copy of the original document. If you have not received a copy of your 1099-HC form by January 31, please contact our Customer Service Department at 1-800-868-5200 (TTY users please call TRS Relay 711), Monday through Friday from 8 a.m. to 6 p.m. You may submit your return without the form attached; however, please be advised that this could delay the processing of your tax return. As always, electronic filing is the quickest and most efficient way to file your tax return with the Department of Revenue.

What is the Schedule HC tax form?

The Schedule HC form is a required part of your Massachusetts income tax filing which indicates whether or not you had health insurance that meets minimum creditable coverage standards at any time during 2011.

Where can I get a copy of the Schedule HC tax form?

The Massachusetts Department of Revenue will have the Schedule HC tax form available on their Web site, www.mass.gov/dor. Forms should also be available anywhere you obtain your state income tax forms or through your tax preparer.

More information can be found on the Massachusetts Department of Revenue (DOR) Web site at www.mass.gov/dor or by phone at 1-617-887-6367 (toll-free at 1-800-392-6089).

Updated on December 30, 2011

Seeing non-contracted providers

Tue, 18 Oct 2011 13:28:17 -0400

Seeing non-contracted providers

In an effort to manage the overall cost of healthcare, FCHP attempts to contract with as many providers as possible. However, some providers choose to remain non-contracted.

For emergency room physicians, we pay the “usual and customary” fee for their services. The usual and customary fee is based on what is usually charged for the service in the area the service was received.

Since we don’t have a contract with these providers, we can’t require that they accept the usual and customary fee as payment in full. As a result, the provider may directly bill you, the member, for the balance. If this happens, contact the providers directly to let them know that, in accordance with communication they received, your insurance company has paid the usual and customary fee.

For non-contracted ambulance, pathology and anesthesiology providers, we pay you the full amount of the bill, minus any copayment/coinsurance/deductible you may have. You then pay the provider. Note: If the person who received the service is under the age of 18, we will send this payment to the subscriber on the policy, unless there are alternate arrangements in place.

If you have any questions, please feel free to contact FCHP Customer Service at 1-800-868-5200.

New FCHP ID cards

Tue, 07 Jun 2011 16:31:21 -0400

Important information about proton pump inhibitor (PPI) medications

Tue, 09 Nov 2010 16:19:07 -0500

Important news about proton pump inhibitor (PPI) medications

You'll pay less for the same acid relief

Studies and medical experts agree—if you currently take a proton pump inhibitor (PPI) medication such as Aciphex^®, Nexium^®, omeprazole, pantoprazole, Prevacid, Prevacid^® Solutabs^™, Prilosec^®, Protonix^®, or Zegerid^®for stomach acid conditions, you’ll get just as much relief from an over-the-counter PPI.

Starting January 1, 2010, FCHP will cover prescriptions for the following over-the-counter PPIs: Prilosec OTC^®, Prevacid^® 24HR and generic over-the-counter omeprazole. These prescriptions will be covered with just a $5 copayment* for 42 tablets for FCHP Direct Care, FCHP Select Care, FCHP Commonwealth Care, and Fallon Preferred Care members.

Also starting January 1, 2010, FCHP will remove the following PPI medications from our covered drug list: Prevacid, Prilosec, Protonix, Zegerid, lansoprazole, omeprazole and pantoprazole.

FCHP has added a new prescription PPI called Dexilant^® (formerly known as Kapidex^™) to our formulary. Dexilant is covered as a Tier-3 drug with the applicable Tier-3 copayment. Two other PPI drugs, Aciphex and Nexium, remain on FCHP’s formulary as Tier-3 drugs and will require prior authorization.

You may currently pay $45 or more a month for a prescription PPI, costing a total of at least $540 a year. By paying only a $5 copayment* for 42 tablets (about $43 for one year) for an over-the-counter version, you'll save $497 a year. To take advantage of this cost-saving choice, you should get a new prescription from your primary care physician for one of the covered over-the-counter PPIs.

Questions you may have about the PPI changes

Why is FCHP making this change?

FCHP is making this change to offer our members a cost savings by covering over-the-counter PPI medications with a $5 copayment*. Prilosec OTC, omeprazole OTC and the new Prevacid 24HR are available over-the-counter in the same dosage as the prescription versions. Studies and medical experts agree that they work just as well and are just as safe, but have a much lower retail price than prescription versions. For more information, you can read Consumer Reports summary article: Evaluating Drugs to Treat Heartburn, Gastric Ulcers and Stomach Acid Reflux: The Proton Pump Inhibitors. Comparing Effectiveness, Safety and Price (pdf).

Will any of the drugs in the class be covered under the FCHP formulary?

Yes. We have added a new PPI medication called Dexilant to our formulary as a Tier-3 drug effective January 1, 2010. The applicable Tier-3 copayment will apply.

Two other drugs, Aciphex and Nexium, remain on FCHP’s formulary as Tier-3 drugs requiring prior authorization. Your provider would have to submit a request for prior authorization to FCHP in order for you to obtain a prescription for either of these drugs.

How does this change save me money? How much can I save?

If you have been purchasing PPI medications, you may have been paying $45 or more a month for a prescription PPI. So, you would have paid at least $540 a year for this prescription. By paying only a $5 copayment* for a 42 day supply (about $43 for one year) of an over-the-counter version, you will be saving $497 or more a year. Also, if you were paying out of pocket for these medications, the $5 copayment* will be considerably less than the standard retail price for over-the-counter PPIs.

I am on a qualified high deductible plan, how does this change help me save money?

If you are on a qualified high deductible plan, please keep in mind that copayments only apply after your deductible is satisfied for the year. If your doctor agrees that over-the-counter PPI medication is right for you, you will be paying less for the over-the-counter version since these drugs have a much lower retail price than the brand name prescription versions. Once your deductible is satisfied, you'll pay a $5 copayment* for 42 tablets with a prescription from your doctor.

I take Prevacid, Prilosec, Protonix, Zegerid, lansoprazole, omeprazole or pantoprazole. Since it will no longer be covered, what am I supposed to do?

First, ask your doctor if an over-the-counter medication is right for you. All FCHP contracted providers have been notified of the change to cover prescriptions for over-the-counter PPI medications. If your doctor agrees that an over-the-counter medication is right for you, he or she can write a new prescription for one of the covered over-the-counter drugs which you can fill at your local pharmacy for the $5 copayment*.

Will I need a new prescription from my doctor to get over-the-counter drugs?

If your doctor agrees that an over-the-counter medication is right for you, he or she can write a new prescription for one of the covered over-the-counter drugs which you can fill at your local pharmacy for the $5 copayment*.

I’ve tried over-the-counter PPI drugs in the past and they didn’t work. What should I do?

Please talk to your doctor about which over-the-counter PPI may work for you. You can also ask your doctor about a new PPI drug that has been added to the FCHP formulary called Dexilant. This drug is a Tier-3 drug. If your doctor writes you a prescription for Dexilant, you can fill the prescription at your local pharmacy and pay your Tier-3 copayment.

Two other PPI drugs, Aciphex and Nexium, remain on FCHP’s formulary as Tier-3 drugs requiring prior authorization. Your provider will have to submit a request for prior authorization to FCHP in order for you to obtain a prescription for either of these drugs.

I’ve discussed my options with my physician, and he/she wants me to keep taking my brand name PPI. What can I do?

Your doctor has been notified that Prevacid, Prilosec, Protonix, Zegerid, lansoprazole, omeprazole and pantoprazole have been removed from the FCHP formulary. The brand name PPIs that remain on the FCHP formulary are Dexilant, Aciphex and Nexium.

If your doctor believes you should be taking a brand name prescription PPI drug, he may write you a prescription for one of the PPIs that remain on the FCHP formulary.

Dexilant does not require a prior authorization from the plan. However, Aciphex and Nexium do require a prior authorization. Your doctor would have to complete a prior authorization form for Aciphex or Nexium and submit it as instructed on the form. If the authorization is approved, you will be able to obtain Aciphex or Nexium for your Tier-3 copayment.

If my physician submits a prior authorization form, is it automatically approved?

No. Drugs requiring a prior authorization must be approved by FCHP.

* Commonwealth of Massachusetts members have a $10 copayment for covered prescription over-the-counter PPI medication. MassHealth member copayments are $2.

Frequently asked questions about flu

Mon, 25 Oct 2010 11:03:55 -0400

Frequently asked questions about flu

As we approach flu season, Fallon Community Health Plan is doing all we can to help our members with prevention of both the seasonal flu and the H1N1 flu. Below are some frequently asked questions about the flu and the flu vaccine, now available.

If you are concerned that you or a family member may have the flu, or have been exposed to the flu, call your health care provider.

Is the H1N1 vaccine available to all members?
Will FCHP cover the flu vaccine for its members?
Where can I get a flu shot?
Will I have to pay for my flu shot upfront?
What do I have to do to get reimbursed?
Do I have to show my FCHP card at a flu clinic?
Can I get the flu from a flu shot?
What can I do on my own to prevent getting flu?
Where can I get more information about the H1N1 flu?

Question:
Is the H1N1 vaccine available to all members?

Answer:
In Massachusetts, H1N1 vaccine is being distributed by the Department of Public Health (DPH). The Massachusetts DPH has indicated that by October 9 many providers in Massachusetts will have received small quantities of H1N1 vaccine. The DPH expects that more vaccine will be distributed each week to build on those quantities.

Pregnant women
Household contacts and caregivers for children younger than 6 months of age
Healthcare and emergency medical services personnel
All people from 6 months through 24 years of age
Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.
These groups of people have been identified as being at higher risk of complications from the H1N1 flu by the CDC.

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Question:
Will FCHP cover the flu vaccine for its members?

Answer:
Yes. FCHP will cover in full the cost of a health care professional administering both the seasonal flu vaccine and the H1N1 vaccine. The government is supplying the vaccine. (Please note: The flu shot is considered preventive care and is therefore not subject to the deductible.)

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Question:
Where can I get a flu shot?

Answer:
You can get seasonal flu or H1N1 vaccinations from a variety of resources:

Your primary care provider (PCP), or from another plan provider such as an obstetrician if you are pregnant
Through a clinic sponsored by your employer or school
At a public or private clinic, such as a senior center, where the vaccine will be administered by a community vaccinator or mass immunizer
At a public clinic sponsored by your city or town

Listing of clinics in Massachusetts

Through a retail store or pharmacy, such as CVS or Walgreens

You may have to pay out-of-pocket for the vaccination(s) if you go anywhere but a network doctor's office for your flu shot, but FCHP will reimburse you in full.

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Question:
Will I have to pay for my flu shot upfront?

Answer:

Typically, if you receive either the seasonal flu or H1N1 vaccinations at a retail store such as CVS or Walgreen’s, you will be required to pay for the vaccinations out-of-pocket. For worksite flu vaccination clinics, please check with your HR Department on how payment will be handled.

Question:
What do I have to do to get reimbursed?

Answer:
If you had to pay upfront for a flu shot, mail the following to Fallon Community Health Plan, Attention: Claims, 10 Chestnut St., Worcester, MA 01608:

Receipt from wherever you received your shot (CVS, Walgreen’s, WalMart, etc.)
Proof of payment (cancelled check, credit card receipt or cash register receipt)
Your name, address and member ID

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Question:
Do I have to show my FCHP card at a flu clinic?

Answer:
You will need to show your health plan ID card at worksite flu clinics. Typically, at other public flu clinics, such as those held at CVS or Walgreen’s, you do not have to show your health plan ID card, but you may want to have it with you, just in case.

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Question:
Can I get the flu from a flu shot?

Answer:
No. You cannot get the flu from the flu shot.

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Question:
What can I do on my own to prevent getting flu?

Answer:
Here are some tips to prevent flu:

Get a flu vaccine each year.
Frequently wash your hands with soap and water, or use an alcohol-based hand gel.
When you cough or sneeze, cover your nose and mouth with a tissue or your sleeve (if you do not have a tissue). Throw used tissues in a trash can.
Avoid contact with people who are sick.
If you think you are ill with flu, avoid close contact with others as much as possible, which includes staying home from work.
Avoid shaking hands.

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Question:
Where can I get more information about the H1N1 flu?

Answer:
For more information about the flu, visit any of the following Web sites for expert information about H1N1:

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Healthy Communities and member news

Healthy Communities

Healthy Communities

Healthy Communities archive

Healthy Communities archive

Health care reform - tax year 2011 and Massachusetts legislation

Health care reform - tax year 2011 and Massachusetts legislation

Am I required by the state to have health insurance?

What is minimum creditable coverage?

What if I have a plan that does not meet minimum creditable coverage requirements?

What if I had coverage for non-consecutive months?

How do I prove that I have obtained health insurance?

I am an employer that offers health benefits through FCHP and pharmacy benefits through a separate pharmacy benefits manager. How will FCHP know if I meet minimum creditable coverage standards?

What if I had coverage from different insurers?

What if I live outside of Massachusetts but have a dependent that lives in Massachusetts?

How do I obtain a form if I am a dependent?

What if I am on a government-subsidized health plan (Medicare/MassHealth/Commonwealth Care)?

What information does the 1099-HC form contain?

What if my address or name is incorrect on my form?

How do I obtain a 1099-HC form?

Why did I receive more than one 1099-HC form?

When will subscribers receive a 1099-HC form?

If I receive health care coverage through my employer, will the employer send me a 1099-HC form?

If I do not receive the 1099-HC form or if I misplace the one that I did receive, can I obtain another form?

Do I need more than one 1099-HC form if I am married but my spouse and I file separate tax returns?

Do I need to attach the 1099-HC form to my state income tax filing?

What is the Schedule HC tax form?

Where can I get a copy of the Schedule HC tax form?

Seeing non-contracted providers

Seeing non-contracted providers

New FCHP ID cards

Important information about proton pump inhibitor (PPI) medications

Important news about proton pump inhibitor (PPI) medications

You'll pay less for the same acid relief

Questions you may have about the PPI changes

Why is FCHP making this change?

Will any of the drugs in the class be covered under the FCHP formulary?

How does this change save me money? How much can I save?

I am on a qualified high deductible plan, how does this change help me save money?

I take Prevacid, Prilosec, Protonix, Zegerid, lansoprazole, omeprazole or pantoprazole. Since it will no longer be covered, what am I supposed to do?

Will I need a new prescription from my doctor to get over-the-counter drugs?

I’ve tried over-the-counter PPI drugs in the past and they didn’t work. What should I do?

I’ve discussed my options with my physician, and he/she wants me to keep taking my brand name PPI. What can I do?

If my physician submits a prior authorization form, is it automatically approved?

Frequently asked questions about flu

Frequently asked questions about flu

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