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Tools to Help

SIHO provides a wealth of information and tools to help members become better health care consumers.

Preventive Health Benefits

Medical Management Programs

Our Preventive Health Benefits (PHB) were developed by our Quality Management Committee comprised of many local physicians. They are revised annually based on emerging recommendations for preventive care. The current PHB consists of over 35 age and gender appropriate recommended services. With the SIHO HRA and HSA, all PHB services are provided at no cost to the member. SIHO also mails many notices to members’ homes, reminding them to get their PAP Smears, immunizations etc. We are working hard to keep our members healthy!

SIHO’s staff of nurses, working under the direction of our Medical Directors, provides personal, caring service to all of our members. Their goal is to ensure that our members receive the right service in the right setting at the right time. For those members with acute or chronic health issues: Onsite review at local hospitals. Case Management and Utilization Review Services. Education and assistance for members with Asthma, Diabetes, Cardiovascular Disease. Members in good health may want to take advantage of "Ask-a-Nurse" days offered at the work site."

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	www.siho.org Members can find our participating provider directory on our website and search for providers by location and specialty. They can also review their health plan claim history including cost, check eligibility records, and e-mail SIHO’s Customer Service Center.
www.caremark.com SIHO’s prescription drug coverage is managed by Caremark, the recognized leader in pharmacy benefit management (PBM). Members can review their prescription drug activity and cost, learn about various health conditions, and access self-care centers. Members can also check drug prices at any participating pharmacy.	My SIHO Health Zone Our interactive and customizable health and wellness portal provides invaluable information and tools to help people live healthier. It includes a complete health encyclopedia, a Goal Setting Wizard, and topical health information.

EXAMPLES OF QUALIFIED MEDICAL EXPENSES:

Acupuncture	Alcoholism treatment	Ambulance
Artificial limbs/teeth	Braille – books and magazines	Chiropractors
Co-payments	Contact lenses prescribed by a Dr.	Contraceptives
Cost of physical or mental illness Confinement	Crutches	Deductibles
Dental fees	Dentures	Diagnostic expenses
Dietary supplements with doctor’s letter of medical necessity	Electrolysis (medically necessitated)	Drug & medical supplies (i.e. syringes, etc.)
Eyeglasses prescribed by a Dr. Eye exam fees and eye surgery	Handicapped persons (care and support)	Hair transplants (medically necessitated)
Hearing devices & batteries	Home improvement for medical considerations (i.e. ramps, widening doorways, etc.)	Hospital bills
Insulin	Laboratory fees	Laser eye surgery
Licensed osteopaths	Licensed practical nurses	Nutrition counseling
Obstetrical expenses	Oral surgery	Orthodontia
Orthopedic shoes	Over-the-counter meds (see Page 5 or look on the website)	Oxygen
Physician fees	Prescriptions	Psychiatric care & fees
Routine physicals & other non-diagnostic services or treatments	Seeing-eye dog (including its upkeep)	Smoking cessation programs
Smoking cessation over-the-counter drugs	Surgical fees and expenses	Substance abuse treatment
Swimming pool/spa equipment costs & maintenance (doctor recommended)	Therapy treatments (physical, speech, etc.)	Transportation expenses for medical purposes, e.g. rail/airfare to hospital or convalescent home, cab fare in obstetrical cases
Vasectomy & sterilization	Vitamins with doctor’s letter of medical necessity	Well-baby care
Wheelchairs	X-rays	Weight loss programs with doctor’s letter of medical necessity

EXAMPLES OF NON-QUALIFIED MEDICAL EXPENSES:

Cosmetic surgery & procedures	Dental bleaching	Marriage & family counselling
Illegal operations or illegal drugs	Travel your doctor told you to take for a rest	Health club dues for general health

This brochure is for informational purposes only and it is not intended to serve as a legal interpretation of benefits. The entire provisions of benefits and exclusions are contained in the Summary Plan Description (SPD), Certificate and Schedule of Benefits. In the event of a conflict between the SPD and this Guide, the terms of the SPD will prevail.