Smoke Signals 1 1
AUGUST 1,2009
Selff-funded Eiealfth coverage It's your money
Note: The following information is provided courtesy of the
Grand Ronde Health Committee in coordination with the
Health & Wellness Department.
The Confederated Tribes of Grand
Ronde health program for Tribal
members and employees is not a
health insurance policy, but Trib-ally-funded
coverage. The Tribe has
contracted with SHASTA Adminis
trative Services to administer the
coverage and to review claims, make
payment and process eligible costs.
The plan for Tribal Members is called
"Skookum Health Plan."
Since the payment of coverage costs
for Tribal members is funded through
Tribal funds, it is important to know
that there are ways that Tribal mem
bers can help control the costs.
The expenditures for the Tribal
health plan have increased from
$16.2 million in 2005 to approxi
mately $22.5 million in 2008. Nation
ally, health care costs are expected
to continue to rise rapidly. Today,
Tribal members can help control
these costs and maximize resources
for the Skookum Health Plan.
A primary intent of the Skookum
Health Plan is to help Tribal mem
bers cover medical costs that are not
covered by any other resources. The
other resources should be used first
to help reduce the burden on Tribal
resources. This saves the health
plan money and ultimately benefits
all Tribal members. Other resources
that should be used first include
privateemployer insurance, Medi
care, Medicaid (i.e. Oregon Health
Plan (OHP), and Veterans Affairs
benefits.
Whenever possible, Tribal mem
bers should also use the Grand Ronde
Health & Wellness Center or other
Indian Health ServiceTribal health
care faculties.
After these resources pay, any
unpaid balance may be paid by the
Tribal coverage. For those living in
the Tribal six-county service area,
Contract Health Services (CHS) can
cover additional costs that have not
been covered, provided that the care
is pre-authorized by the CHS depart
ment. The CHS services are federally-funded
and available in Polk,
Yamhill, Washington, Tillamook,
Multnomah and Marion counties.
The IHS resources and Tribal re
sources are the "payor of last resort."
This means that any other resources
should be used first.
Health Care Cost Saving Tips
1. Use urgent care faculties instead
of the emergency room, unless emer
gency care is needed. Using your local
urgent care clinic vs. the emergency
room saves the Tribe substantial
funds. Effective July 1, 2009, any
use of the emergency room for nonurgentnon-emergent
purposes will
no longer be covered by the Tribal
coverage. Tribal members who go to
the emergency room to receive nonurgentnon-emergent
services will be
responsible for the entire cost of the
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Photo by Stobhan Taytof
Tribal mtmbtf Jfiu Brandon, It, anttrtalnt th audience with
harmonica, guKar and vocals at the Picnic en tha Green In Oregon
City en July 14. Tribal members from tha Portland area provided
culture,! demonstration! at the event which was sponsored by
Clackamas Heritage Partner.
visit. If you or someone you know is
in need of medical attention and you
do not know if you should go to the
emergency room or not, take the time
to contact the 24-hour Nurse Line
at 1-800-970-7138 or your personal
physician. If you are instructed to
seek services at the emergency room
by the Nurse Line or by your physi
cian's office, it will be covered by the
Skookum Health Plan. If you have
questions about this Skookum Health
Plan coverage change, please contact
Barbara Steere at 503-879-2487 or
Jim Holmes at 503-879-2221. The
staff will follow up with you the same
day. Tribal members should locate
the urgent care faculties in their area
and note their hours of operation. For
assistance, call Barbara or Jim.
2. Use the Tribal pharmacy for
purchase of prescription drugs when
ever possible. A) The Tribe is able to
purchase prescription drugs, both
brand name and generic drugs, for
Tribal members and other Native
Americans at a substantial savings
vs. a retail pharmacy. B) All Tribal
members can use the Tribe's mail-in
pharmacy services no matter where
they live. The discounts available to
Tribal members can therefore help
reduce Skookum Health Plan costs.
It is important to carefully plan out
your medication needs to be sure
your prescription medications ar
rive as needed. C) Use generic drugs
whenever possible. The savings are
approximately 70 percent with a
generic vs. brand name drug. Please
consult your physician on the use of
generic drugs. D) Tribal members
who use the Grand Ronde Health
and Wellness Center Pharmacy do
not have a co-pay cost. E) Pharmacy
contact information: 503-879-2013;
from out of the area, call 1-800-775-0095,
ext. 2013. For refills, call 503-879-2342.
Prescriptions can be faxed
to 503-879-2030.
3. Use in-network providers when
ever possible. The health benefit is
paid at a higher rate when in-net-work
providers are used, and Tribal
members will have to pay fewer out-of-pocket
expenses.
4. Use the Grand Ronde Health
Clinic, Chemawa Health Clinic or
other IHS facilities whenever pos
sible. 5. Who to contact for more informa
tion: Allyson Lecatsas, 503-879-1359;
Jim Holmes, 503-879-2221; and Bar
bara Steere, 503-879-2487.
The Tribe is working hard to pro
vide the best possible health care
benefit through the Skookum Health
Plan. Health care costs continue to
increase each year and it will take
all of us to help maximize the use
of our resources. Please help by fol
lowing these tips and guidelines to
better serve all Tribal members and
employees.
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As elected officials, as defined by Federal Law, Tribal Council
members cannot pay into Social Security. This means that what
they earn as Tribal Council members does not count when they
claim Social Security benefits.
Our current Tribal Council has been studying the possibility of
providing an Honorarium to all past, present and future Tribal
Council members to partially off-set what they could loose as a
result of serving as Tribal Council members.
With this in mind, the Tribal Council would like to know what
you think about their receiving a monthly Honorarium, and if
past, present and future Tribal Council members were to receive
a monthly Honorarium, how it should be calculated?
Please take a few minutes and express your opinion on this
issue: Please state why they should or should not receive the
Honorarium.
At a flat rate .
Based on the number of years of service on Council .
Nothing at all .
Thank you for taking the time to answer this questionnaire.
Please send your responses to Dakota Whitecloud, TCRC, CTGU,
9615 Grand Ronde Road, Grand Ronde, OR, 97347. If you prefer
to e-mail your response, please send to dakota.whitecloudgran
dronde.org, or you may fax the form to Dakota at 503-879-5964.
Deadline Is Friday, Aug. 21, 2009.
Name
Tribal Roll U
Date