Condition Management
If you or your eligible dependents who are enrolled in the medical plan are diagnosed with one of five conditions, or have Metabolic Syndrome, Condition Management nurses can help educate you about your condition and assist with lifestyle changes.
If you are a Healthy Options plan member with one of the five conditions listed below, you also can receive help from your Condition Management nurse to understand and receive the Basic Care Requirements (BCRs) for your condition. Call a Condition Management nurse toll-free at (555) 580-8743.
Receive help with these five conditions:
Congestive heart failure- Asthma
- Coronary artery disease
- Diabetes
- Chronic obstructive pulmonary disease (COPD)
BCRs are basic medical services, tests, supplies and prescription drugs that are important for managing the five conditions listed above. The BCRs are based on nationally recognized clinical guidelines for treatment and are reviewed and evaluated at least annually.
The Healthy Options medical plan pays 100 percent of the cost for each BCR provided by an in-network provider. To qualify for BCRs, you must be covered by a Healthy Options medical plan, comply with a care plan established with a Condition Management nurse and be diagnosed with one of the five eligible conditions.
NOTE: Only the services outlined on the BCR lists are provided at no cost. All other care that your doctor prescribes for you, whether for your condition or not, is paid according to normal plan rules.
Money Saving Tip 
Healthy Options members enrolled in the Condition Management program can save a significant amount of money on prescriptions. For example, the cost of a 90-day supply of Humalog (a diabetes medication), with a fill quantity of 60, was $1104.44 at the end of 2014. Diabetic patients who are active in the Condition Management program would get this drug at $0.00. To be eligible to receive Basic Care Requirements, including prescriptions, Healthy Options members must comply with a care plan established with a Condition Management nurse and be diagnosed with one of the five covered conditions.
