PUBLIC EMPLOYEES BENEFIT TRUST (PEBT) BENEFITS REPORT
VOLUME 2, ISSUE 5

REMEMBER THREE KEY WORDS WHEN SCHEDULING SURGERY: PREAUTHORIZE, PREAUTHORIZE, PREAUTHORIZE!

Preauthorization is required by your health plan for many surgical procedures and to see a specialist. To be a covered benefit, surgery must be deemed "medically necessary" no matter which plan option you have elected. Of course, emergency procedures do not require preauthorization.

A number of non-emergency surgical procedures, however, require preview prior to approval of benefit coverage, depending on the circumstances.

Some members feel that the process is an unnecessary added step. But it's important to understand that this review procedure is a primary method by which medical costs can be tamed, thereby ensuring that all participants receive the most expansive menu of benefits available.

By requiring that all surgeries be approved in advance, health plans can ensure that money is being spent properly. When health plans succeed in controlling costs everyone benefits because the alternative is increased premiums.

The preauthorization process is easy and responsive. If you believe that your authorization is not provided in a timely manner, call PacFed at 1-800-753-0222.

Don't Act Before Authorization is Provided

If preauthorization is not requested and it is later determined that the surgery is not a covered benefit, the burden of payment is on you. So obtain preauthorization before you schedule a date for any surgery so it may be confirmed that the procedure is, in fact, medically necessary rather than cosmetic.

Reconstructive surgery of any type requires preauthorization. Surgical repair procedures associated with breasts, the abdominal wall, eyes, ears, as well as scar revision, should be preauthorized.

Specific coverage exclusions appear in your Evidence of Coverage booklet. Work with your physician to initiate the preauthorization process.

Requests are reviewed in a timely manner. When appropriate, board-certified consultants are used to certify cases.

Formal written notification of authorization or denial is sent to the requesting physician.

If you have any questions about the preauthorization process, please call PacFed at 1-800-753-0222.

SPREADING YOURSELF TOO THIN LEADS TO HOLIDAY STRESS

"I feel so stretched out this time of year, I think I'm going to snap in two!"

Many of us have felt this way during the holiday season. In addition to our regular, everyday responsibilities, we take on a myriad of additional roles at this time of year: card writer, decorator, gift maker and/or buyer, party giver, gourmet cook - the list is almost endless.

For those who want to do more than just get through the season - if you want to have fun, too - here are a few suggestions:

• Be realistic. Decide what you will and will not do. Make a list and post it in a prominent place so you won't forget.
• Ask for help. Delegate tasks. Use services such as shipping directly from the store and free gift wrapping when they are available. Don't try to do it all yourself.
• Be flexible. Don't compare your holiday preparations or gift choices with anyone else's.
• Stay within your budget. Spending too much will street you out long after the holidays are over, and if that expensive gift isn't perfect, you will feel doubly bad.
• Be relaxed about food. This is not a time to stick rigidly to a diet. You don't have to stuff yourself with forbidden goodies, but you don't have to abstain either. If you eat something "low cal" before he big meal or the big party, you'll eat less later, and you'll be able to participate in the specials feeling that holiday food represents.
• Give yourself permission to have fun. It's okay to laugh when things seem to be going wrong or getting too stressful. It will help you cope and carry on.
• Put together a family budget. Nothing contributes to holiday stress more than money problems. There i no better way to control these problems than putting together a family budget and sticking to it throughout the year.

HELP CHILDREN THIS HOLIDAY SEASON

In many cultures, the winter holidays are a time of giving and sharing with family and friends. Often, we are asked to help others, as well, and none are more deserving of our help than children. Keep in mind that it doesn't take a lot form you to make a big difference in a child's life. You can take action by volunteering for local schools, youth programs, Big Brothers/Big Sisters, youth sports, Scouting organizations or children's art programs among others. The important thing is to show you care.