Fall 2024 Spotlight on Benefits Newsletter Now Available

IN THIS ISSUE:

• Flu, COVID and RSV Vaccinations Are Free When Obtained In-Network. What Other Preventive Care Could You Be Getting at No Cost? Preventive care services (e.g., flu, RSV and COVID vaccinations, blood pressure screenings, etc.) are medical services proven to help people avoid chronic and acute illness. The Health Plan covers preventive care services at 100% of the cost when administered by a network provider. Read this article to learn more about how you can take advantage of these services while improving your long-term health. For a full list of the Health Plan’s preventive care services, visit http://www.dgaplans.org/preventivecare.
• CDC Simplifies COVID-19 Vaccination Recommendations for Those 65+ and/or Immunocompromised. The CDC considers COVID-19 vaccination the most effective way to prevent serious COVID cases. In preparation for the winter season, it has simplified COVID-19 vaccination guidelines for vulnerable groups, including those 65 years and older and/or immunocompromised. The updated recommendation for these groups is two doses of the 2024-2025 COVID-19 vaccine to be received six months apart. The CDC recommends individuals in these vulnerable groups consult with your healthcare provider to determine if a third vaccine is needed. For more information on the updated recommendations, read the full article here.
• How to Get Your Benefits Cards. Benefits cards provide important proof of coverage when visiting a provider. For convenient online and mobile access to your cards, create a login with the applicable benefit partner and download, print or mail a copy of your cards whenever you need. Read this article for step-by-step instructions.
• Are You Receiving Outpatient Mental Health, Substance Abuse or Physical Therapy Treatments? Learn How the Health Plan Covers These Treatments. A single course of treatment for mental health, substance abuse and physical therapy may continue over an extended period of time. The Health Plan will cover visits throughout the course of treatment, as long as the services are considered Medically Necessary under the terms of the Plan. To confirm medical necessity, the Health Plan uses what it calls the “20/30 visit” procedure throughout your course of treatment. Read this article to learn how the procedure works and when you may be required to submit records for medical necessity.
• What is Medical Necessity, and How Does it Impact Coverage? The Health Plan only covers services deemed to be Medically Necessary, which may or may not include a test or course of treatment ordered by your doctor. This article provides the Health Plan’s definition of Medically Necessary, which all participants should be familiar with to better understand your potential out-of-pocket costs. Read the full article here.
• Be.Well. When Feeling S.A.D. Becomes Cause for Concern. Are you oversleeping, overeating or persistently sad? Seasonal Affective Disorder, also called S.A.D., is a type of depression that impacts many people typically throughout the winter months. If you find you are experiencing S.A.D. symptoms consistently, you should contact a healthcare professional. Treatment options have proven to be effective and can range from exercise to various therapies. Read the article to learn more about S.A.D. and the mental health resources available to you.
View or download the pdf of the newsletter here