Brown & Toland’s
        HealthLink
            A Wellness Magazine for the San Francisco Bay Area




FALL 2006

Adopt a
...
STAYING HEALTHY



          Vaccinate, Don’t Vacillate: New
          Vaccine Prevents Cancer in Women
          by Mark ...
Brown & Toland’s
                                                                                             Patient Bill...
HEALTHY LIVING



    Making Your Lifestyle Heart-Healthy
    T    he millions of Americans diagnosed with heart
         ...
Brown & Toland employees formed teams to raise money for the Heart Walk. Training took
                                   ...
WOMEN’S HEALTH



      Reduce Your Risk for Breast Cancer
      Y       ou may think that the only news about breast
    ...
IN THE COMMUNITY



   Brown & Toland Sponsors
   Race for the Cure, Stresses
   Education and Prevention
   T     his fal...
8   Brown & Toland’s HealthLink, Fall 2006   www.brownandtoland.com
HEALTHY SENIORS




                   Easy Ways for the Elderly
                        to Prevent Falls
        E      a...
10   Brown & Toland’s HealthLink, Fall 2006   www.brownandtoland.com
DIABETES CARE




                                   Essential Eye Care
                                      for Diabetes...
BENEFITS FOR SENIORS



                                            Making Medical
                                       ...
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HealthLink Summer 2006

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  1. 1. Brown & Toland’s HealthLink A Wellness Magazine for the San Francisco Bay Area FALL 2006 Adopt a Healthful Lifestyle Simple Changes Yield Great Benefits Breast Cancer Reduce Your Risk For Seniors Prevent Complications From Diabetes
  2. 2. STAYING HEALTHY Vaccinate, Don’t Vacillate: New Vaccine Prevents Cancer in Women by Mark Finch, M.D., Senior Medical Director, Brown & Toland Medical Group patients experience slight soreness at I n June, the U.S. Food and Drug Administration (FDA) licensed a new vaccine, Gardasil (quadrivalent human papilloma virus recombinant vaccine), which prevents 90 percent of the most common sexually transmitted infections (STI), human papilloma virus (HPV), the injection site. Young women who are vaccinated may still be at risk for cervical cancer, and 70 percent of cervical cancers. HPV is responsible for 6.2 million new cases of STI, albeit much reduced. Thus, they still need to have regular Pap tests as recommended 10,000 cases of cervical cancer and 3,000 deaths each year in the United States. by the American College of Obstetrics and Following on the heels of the FDA The ACIP selected 11- to 12-year- Gynecology and their physician. license, the Advisory Committee on old girls for routine vaccination If you, your loved ones or friends have Immunization Practices (ACIP), a group because the vaccine is most effective a daughter in the recommended age that advises the Centers for Disease Con- in preventing cervical cancer when group, encourage them to speak with their HealthLink trol and Prevention on indications for given to girls before the onset of sex- physician about getting this vaccine. All of Fall 2006 vaccines, recommended that all 11- and ual activity. The vaccine is given in the major health plans are or soon will be 12-year-old girls receive the vaccine three shots over a six-month period. covering this vaccine for young women in 4 Healthy Living routinely and that girls as young as The vaccine is extremely safe, does not the target age group. Additional informa- Simple lifestyle changes 9 and between the ages of 13 and 26 contain any live virus and has no seri- tion is available online at: www.cdc.gov/ reduce your risk for be offered the vaccine. ous side effects. A small percentage of nip/vaccine/hpv/default.htm. ■ heart disease. 6 Women’s Health Mammograms and regular checkups lead to early detection of breast cancer — and more successful treatment. 9 Diabetes Care People with diabetes PREVENTION have a higher risk for vision disorders. Learn how to preserve your sight. Brown & Toland’s HealthLink editor: Richard Angeloni, Associate Vice President, Public Relations and Communications, Brown & Toland Medical Group, 415.972.4307. Brown & Toland’s HealthLink is published quarterly and printed in the United States. Copyright 2006 by StayWell Custom Communications, 780 Township Line Road, Yardley, PA 19067, 267.685.2800. Articles in this newsletter are written by professional journalists or physicians who strive to present reliable, up-to-date health information. Our articles are reviewed by medical professionals for accuracy and appropriateness. No magazine, however, can replace the care and advice of medical profes- sionals, and readers are cautioned to seek such help for personal problems. Some images in this publication were provided by ©2006 PhotoDisc, Inc. PhotoDisc models used for illus- The Advisory Committee on Immunization Practices, a group that advises the Centers for Disease Control and Prevention trative purposes only. (306) on indications for vaccines, recommended that all 11- and 12-year-old girls receive the vaccine routinely. 2 Brown & Toland’s HealthLink, Fall 2006 www.brownandtoland.com
  3. 3. Brown & Toland’s Patient Bill of Rights Patient Rights The physicians of Brown & Toland Medical Group are dedicated to quality patient care. As a patient of a Brown & Toland Medical Group physician, you will receive: Courteous, considerate and respectful treatment at all times Candid discussions of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit options Access to preventive health care services PREVENTION Information about benefits, where and how to seek care, and the risks involved in treatment Why Flu Shots Matter Timely response to requests for services, inquiries and complaints Second opinions when medically appropriate Titles and specialties of the health care professionals F lu shots are important because the virus that causes the flu changes constantly, and a new strain appears almost every spring. “So the shot that protects you one to ask for a shot in October or Novem- responsible for your care Privacy and confidentiality regarding your medical and health conditions year won’t necessarily protect you the ber, before the flu season starts,” says Information regarding the medical group and health next,” says Suzanne Bradley, M.D., Dr. Bradley. “But even if you miss your plan grievance procedures associate professor of internal medicine shot in the fall, you should still get one Recognition of your rights to make decisions regard- at the University of Michigan. Scientists as late as February if there is an out- ing your medical care and to complete an advance track mutations of the virus and break in your area.” directive, thereby extending your rights to any per- develop new vaccines against it. The shot doesn’t guarantee you son who may make decisions on your behalf regard- won’t get sick, nor will it protect you ing your medical care against other respiratory diseases, The right to make recommendations to your patient The flu vaccine is 90 percent Dr. Bradley says, “but it’s important rights and responsibilities effective in preventing deaths to remember that the flu kills — colds don’t.” Patient Responsibilities and 80 percent effective in As your health care partner, we ask that you: preventing hospitalizations. Warding off pneumonia Provide professional staff with all health care infor- If everyone who should have Immunization also can lower the risk mation needed to ensure the best possible outcome for pneumonia. Many kinds of bacteria Communicate with your primary care physician when one got one, it would save lives. can cause pneumonia, and the vaccine you have questions or concerns about your health care — Suzanne Bradley, M.D., won’t protect you against all of them. But Adhere to instructions and guidelines given for associate professor of internal medicine, University of Michigan if you are over 65, talk with your doctor health care services about when to get the shot and when to Cooperate with health care professionals providing get a booster, because it can protect you service to you, except in those instances when you The flu can be deadly in older against a number of them. have exercised your right to refuse service individuals and those with chronic Dr. Bradley says getting a pneumo- Educate yourself on your health benefits and services illnesses. Changes in your immune nia shot is even more important today. and how to correctly obtain them system increase your chance of getting When bacteria cause pneumonia, “we If you have questions about your benefits, call it, and the flu’s effects can be especially use antibiotics to treat it. Some of the Brown & Toland Medical Group’s Customer Service severe if you have a chronic lung or bacteria are becoming resistant. So you Department at 415.972.6002, or your health plan’s heart condition. “The flu vaccine is 90 really gamble if you don’t get the shot. member services division. ■ percent effective in preventing deaths There’s a chance that the medicine The California Department of Managed Health Care is respon- and 80 percent effective in preventing won’t work” if you wait until you have sible for regulating health care plans. The department has a toll- hospitalizations,” Dr. Bradley says. “If pneumonia. free number (888.HMO.2219) to receive complaints regarding everyone who should have one got one, Viruses also can cause pneumonia. health plans. If you have a grievance against a health plan, you should contact the health plan and use the plan’s grievance pro- it would save lives.” There is no immunization against cess. You may call the California Department of Managed Health Your body can take weeks to respond those types of pneumonia, which don’t Care for assistance with an emergency grievance or a grievance to the vaccine. “That’s why it’s important respond to antibiotics. ■ that has not been satisfactorily resolved by the plan. www.brownandtoland.com Brown & Toland’s HealthLink, Fall 2006 3
  4. 4. HEALTHY LIVING Making Your Lifestyle Heart-Healthy T he millions of Americans diagnosed with heart and cardiovascular diseases can benefit from making healthful choices in their day-to-day lives. Get the equivalent of 3 cups of fat free or low-fat milk or dairy products. 60 minutes of moderate exercise most days of the week. Do weight training and stretching Exercise more exercises several times a week. “While it’s certainly necessary to take Regular exercise keeps your heart and medications to lower high cholesterol or the rest of your body in shape. Stop smoking blood pressure, it’s equally important to To add more activity to your life: Smoking is a major risk factor for have a healthy lifestyle,” says Richard Check with your doctor before start- heart disease. Stein, M.D., chief of the department of ing an exercise program if you’ve been To live smoke-free: medicine in the Singer Division at Beth sedentary and/or have a chronic disease. Decide to quit and set a quit date. Israel Hospital in New York City, and a Start slowly and increase your Try again if you fail. Successful quitters spokesman for the American Heart Asso- activity gradually to a total of 30 to have “quit” an average of nine times. ciation. “People who are informed and proactive when it comes to lowering their health risks are very likely to avoid heart disease and heart attacks.” Eating a healthful By following these recommendations, diet will reduce people at normal risk for heart disease the risk for can reduce their risk and make their lives heart disease. more enjoyable. While it’s certainly necessary to take medications to lower high cholesterol or blood pressure, it’s equally important to have a healthy lifestyle. — Richard Stein, M.D. Eat a healthful diet Eating a healthful diet has been proven to reduce the risk for heart disease. To eat a heart-healthy diet: Eat 2 cups fresh fruits and 2½ cups of vegetables every day. Limit saturated and trans fats by using olive oil or other vegetable oils instead of butter or margarine. Eat more chicken and fish and less red meat. Eat 6 ounces of grains, of which at least 3 ounces should be from whole- grain bread and cereal. Limit or eliminate fast foods, which are often loaded with salt, sugar and fats. If you drink alcohol, do so moderately — no more than two drinks a day if you’re a man, one if you’re a woman. Limit your salt/sodium to 2300 mg per day or less. 4 Brown & Toland’s HealthLink, Fall 2006 www.brownandtoland.com
  5. 5. Brown & Toland employees formed teams to raise money for the Heart Walk. Training took place during lunchtime and included walks around the Embarcadero. Ask your doctor for information about cessation aids, such as a patch, inhaler and counseling or support program. Monitor your health Be proactive when it comes to your heart’s health. To do so, work with your health care provider to reduce your heart disease risk by following up with him or her for treatment for high blood pressure and cholesterol levels. “Denial is the number one risk factor for having a heart attack,” says Dr. Stein. RAISING AWARENESS “Call 911 immediately if you have chest pain if you’re a man, or are short of breath, dizzy and have a burning sensation in the Walking the Talk: chest area if you’re a woman. If you can get to a hospital in the same hour these symptoms start, it’s possible to prevent a Brown & Toland Employees heart attack or limit the damage.” ■ Join in Heart Walk 2006 LEARN TO RELAX Chronic anger and stress can damage your heart. To better O n Sept. 15, employees from various departments within Brown & Toland Medical Group descended upon Justin Herman Plaza in San Francisco to walk in support of research and education for heart disease. cope with life’s pressures: Try to be positive instead The American Heart Association’s annual Heart Walk raises more than of negative in your outlook $1 million nationwide to fund research and educational programs to help on life. reduce risk, disability and death from the nation’s number one and num- Take 15 to 20 minutes a ber three killers: heart disease and stroke. day to sit quietly and Brown & Toland employees were enthusiastic about the walking chal- breathe deeply. lenge, which dovetailed well with the medical group’s lunchtime “Walk This Way” program. Twice each week, employees are encouraged to join Take time for yourself each We were proud in half-hour and hour walks around the South of Market area. day. Read a book, listen to music or enjoy a hobby. to be part of the “Heart Walk gave our walking program one more goal for the year,” says Brown & Toland Walk This Way committee member Ann Hardesty. San Francisco “Walking at lunch is something many of our employees enjoy, and we community, used the Heart Walk as an opportunity to train and recruit more members raising aware- into our program.” Employees formed teams to raise money for the Heart Walk, and train- ness and mak- ing took place during the lunchtime walks around the Embarcadero and ing an impact. AT&T Park. Ann Hardesty, “We wanted our team to be prepared and ready to make a splash at the Brown & Toland Heart Walk,” says Hardesty. “It was a great day for all Brown & Toland Walk This Way committee member employees. We were proud to be part of the San Francisco community, raising awareness and making an impact.” With its own comprehensive disease management program for con- gestive heart failure, Brown & Toland strives to help its members man- age their health and avoid hospitalization. For more information on this free program, go to www.brownandtoland.com and click on “Our Medical Services.” ■ www.brownandtoland.com Brown & Toland’s HealthLink, Fall 2006 5
  6. 6. WOMEN’S HEALTH Reduce Your Risk for Breast Cancer Y ou may think that the only news about breast cancer is bad news. Although more women die of it than from any other cancer except lung cancer, A mammogram is a special X- ray that can show breast cancer. Mammograms can detect can- there also is good news. If you find breast cancer cer sooner than you or your doc- tor can feel it. early, you can get treated more successfully. Research also shows that making some lifestyle changes, such as exercising more and cutting down on alcohol, can reduce the risk for breast cancer. Are you at risk? If you are a woman, you are at risk for breast cancer, and your risk increases Research as you get older. Some factors, such as shows that having a close relative (for example, a exercise may mother or sister) who had breast cancer help prevent or having had it yourself in the past, breast cancer. increase your risk. Having your first child after age 30 also can make your risk slightly higher. Another risk factor for breast cancer is being obese or overweight, the American Cancer Society says. This is especially true for women after meno- pause. The Society says that although your ovaries produce most of your estrogen, fat tissue in your body can What can you do? that women who consume one alco- change other hormones into estrogen. Take action: Have mammograms holic drink a day have a very small Higher estrogen levels increase your and breast exams performed by your increase in risk, and those who have risk for developing breast cancer. The doctor, and develop healthy habits. two to five drinks daily have about link between weight and breast cancer Schedule a checkup with your 1½ times the risk of women who risk is complicated: Women who have doctor every year. Discuss when you drink no alcohol. Many women who been overweight since childhood have should get a mammogram, a special X- Team up with your doctor. get breast cancer less of a risk than women who gained ray that can show breast cancer. Mam- Your doctor can help you stop smok- extra weight as adults. Excess fat tissue mograms can detect cancer sooner than ing or drinking, and lose weight if have no family around the waist increases the risk you or your doctor can feel it. At your you are overweight. history of the more than extra fat on the hips checkup, your doctor should also do a Also, talk with your doctor if you and thighs. manual breast exam. take birth control pills or are on hor- disease and no Some studies of dietary fat and breast Develop healthy habits. Exercise mone or estrogen replacement therapy. known risk factors cancer risk have found that women with has many benefits, such as lowering HRT and ERT may help relieve meno- diets low in saturated fat and total fat high blood pressure, keeping your pausal symptoms and help prevent for breast cancer. have less of a risk. Other studies have not heart healthy and lowering your osteoporosis, but they increase other found any connection between dietary fat chance for stroke. And research shows health risks. Talk to your health care and breast cancer risk. that it may help prevent breast cancer. provider to find out what is best for you. Many women who get breast cancer Smoking and drinking alcohol The thought of cancer can be scary, have no family history of the disease and may also increase your risk for but knowledge and action can help you no known risk factors for breast cancer. breast cancer. The Society says stay in charge of your life and health. ■ 6 Brown & Toland’s HealthLink, Fall 2006 www.brownandtoland.com
  7. 7. IN THE COMMUNITY Brown & Toland Sponsors Race for the Cure, Stresses Education and Prevention T his fall, Brown & Toland celebrated its commit- Money raised by the Susan G. Komen Breast Cancer Foundation supports ment to finding a cure for breast cancer by spon- research, education, screenings and soring the 2006 Susan G. Komen Race for the Cure. treatment. According to race organizers, The event, which drew more than 75 percent of all funds raised directly 100,000 runners, walkers and other impact local community organizations. participants, converged on the Embar- Last year, the Race for the Cure helped cadero Ferry Place on Sept. 24. Teams, fund a program for free breast cancer individuals, friends and family raised screening and mammography services money to walk in solidarity to help for uninsured Bay Area women. bring awareness to the third leading Brown & Toland has been a sponsor cause of death for women. of this event for years, and executives were pleased to continue the relation- ship with the Komen Foundation and Brown & Toland understands the San Francisco community in 2006. the importance of education “Brown & Toland understands the and prevention. By partnering importance of education and preven- tion,” says Brown & Toland Marketing with organizations that feel Specialist Erin Hovendick. “By partner- Women age 40 and older should have a the same way, we are one step ing with organizations that feel the mammogram every year. They are a same way, we are one step closer to valuable and effective tool for detecting closer to curing the disease. curing the disease.” breast cancer early, improving the effec- — Erin Hovendick, Brown & Toland Marketing Specialist A mammogram is the best way to tiveness of treatment. This year, remem- detect cancer at its earliest stages. ber to make time for a mammogram! ■ A mammogram is the best way to detect cancer at its earliest stages. Women age 40 and older should have a mammogram every year. www.brownandtoland.com Brown & Toland’s HealthLink, Fall 2006 7
  8. 8. 8 Brown & Toland’s HealthLink, Fall 2006 www.brownandtoland.com
  9. 9. HEALTHY SENIORS Easy Ways for the Elderly to Prevent Falls E ach year, thousands of older men and women are disabled, sometimes permanently, by falls that result in broken bones. Yet small changes in homes and lifestyles can prevent such falls. The changes associated with aging include a decrease in Limit how much alcohol you drink. Even a small vision, hearing, muscle strength, coordination and reflexes. amount can affect your balance and reflexes. These changes can make people more likely to fall. Wear rubber-soled, low-heeled shoes that fully Older people also are more likely to have disorders that support your feet. Don’t wear smooth-soled slippers or may affect their balance, such socks on stairs or waxed floors. as diabetes and conditions of Exercise regularly. Doing the heart, blood vessels, nervous so can help you maintain system and thyroid. In addition, your strength and muscle they often take medications that tone and keep your joints, may cause dizziness or tendons and ligaments more lightheadedness. flexible. Ask your doctor or a physical therapist to plan an Steps to take exercise program suitable for Taking these steps will you. Weight-bearing exercise reduce your chances of falling: can keep your bones stronger Talk to your doctor or and help prevent fractures pharmacist about the side should a fall occur. effects of the drugs you take. Always keep one hand Could they affect your coordi- on a handrail when using nation or balance? a stairway. Have your vision and hearing tested often. Wear a properly fitted hearing aid Make your home safe and eyeglasses if recommended by your doctor. Many older people fall because of unsafe surroundings at Don’t get up too quickly after eating, lying down home. Use the following suggestions to safeguard against or resting. A sudden decrease in blood pressure caused some likely household hazards. by standing too quickly may cause dizziness at these times. Besides being clutter-free, stairways, hallways and pathways This can be made worse by medications, particularly those should have good lighting and firmly attached carpet with used to regulate blood pressure and to treat benign pros- rough texture or abrasive strips to ensure secure footing. tatic hypertrophy, or enlarged prostate. Stairways also should have tightly fastened handrails running If you get too hot, especially when taking any the whole length of all stairs. You may want to double up on medications, you might get dizzy and faint. Drink handrails, adding railing to the opposite side of the stairs. adequate amounts of water and other liquids and limit Bathrooms should have grab bars placed both in and out exercise on hot days, according to your doctor’s instruc- of tubs and showers and near toilets. Nonskid mats and tions. Try to stay in an air-conditioned place during the abrasive strips or carpet should be installed on all surfaces hottest part of the day. that may get wet. If your gait is unsteady, use a cane, walking stick Bedrooms and living areas should have carpet or area rugs or walker to help stay balanced. This is especially that are firmly attached to the floor, and electrical cords important on uneven or unfamiliar ground. Use special and telephone wires should be placed away from walking care when walking outdoors on wet or icy sidewalks. paths. ■ www.brownandtoland.com Brown & Toland’s HealthLink, Fall 2006 9
  10. 10. 10 Brown & Toland’s HealthLink, Fall 2006 www.brownandtoland.com
  11. 11. DIABETES CARE Essential Eye Care for Diabetes M ost people who have diabetes suffer nothing more than minor eye disorders related to the disease. However, they do have a higher risk for blindness than other people, according to the American Diabetes Association (ADA). If you have diabetes, you can take steps to reduce your In some people, retinopathy progresses after several years risk for vision loss or blindness. to a more serious form called proliferative retinopathy, in Diabetes can cause the following eye disorders: which the blood vessels become so damaged that they close Glaucoma. Diabetes can lead to glaucoma, or increased off, the ADA says. In response, new blood vessels start grow- pressure within the eye that over time damages the optic ing in the retina. These new vessels are weak and can leak nerve, the ADA says. People with diabetes are 40 percent blood, blocking vision. The new blood vessels also can cause more likely to suffer from glaucoma than people without scar tissue. After the scar tissue shrinks, it can distort the diabetes. The longer a person has diabetes, the greater the retina or pull it out of place, causing retinal detachment. risk for glaucoma. The risk for glaucoma also increases Your retina can be badly damaged before you notice any with age. change in vision, and most people with nonproliferative reti- Cataracts. A cataract is a clouding of the lens of the eye. nopathy have no symptoms, the ADA says. Even with prolif- People who have diabetes are 60 percent more likely to erative retinopathy, people sometimes have no symptoms develop this condition than people who don’t. People with until it’s too late to treat the condition. That’s why it’s crucial diabetes also are more likely to develop cataracts at a for people with diabetes to see an eye care professional every younger age, the ADA says. Cataracts in someone with year for eye examinations. diabetes tend to progress more quickly than in someone without diabetes. Steps to take Retinopathy. Diabetic retinopathy is a general term for The longer you have diabetes, the more likely you are to disorders of the retina caused by diabetes. Diabetic retinop- have nonproliferative retinopathy, the ADA says. Almost athy comes in two forms: nonproliferative and prolifera- everyone with type 1 diabetes will eventually develop it, as tive, the ADA says. will most people with type 2 diabetes. But proliferative reti- In nonproliferative retinopathy, the most common form, nopathy, the form of retinopathy that destroys vision, is far capillaries balloon and form less common. pouches. Nonproliferative reti- The following steps can nopathy doesn’t usually cause WARNING SIGNS help you preserve your sight: vision loss and needs no treat- Keep your blood sugar levels See an eye care professional at ment at this stage. However, the under tight control. People least once a year for a dilated capillary walls may lose their who keep these levels closer eye exam. See your eye care ability to control the passage of to normal are less likely to professional right away if: substances between the blood have retinopathy. and the retina. As a result, the ret- Your vision becomes blurry. Control high blood pressure, ina becomes swollen, and fatty You see double. which can make eye prob- deposits form within it, the ADA You see spots or floaters. lems worse. says. If this swelling affects the One or both of your eyes hurt. If you smoke, quit. Smoking center of the retina, the prob- Your eyes get red and stay that way. is a risk factor for macular lem is called macular edema, You feel pressure in your eyes. degeneration. ■ and vision loss can result. Straight lines don’t look straight. Your side (peripheral) vision deteriorates. You have any sudden change in your vision You have trouble reading signs or books. www.brownandtoland.com Brown & Toland’s HealthLink, Fall 2006 11
  12. 12. BENEFITS FOR SENIORS Making Medical Choices After 65 C hanges to Medicare’s managed care program mean that people approach- ing their 65th birthdays this year have However, the milestone birthday often can lead to more questions than answers regarding health care cov- erage. Brown & Toland Medical Group can help seniors navigate their Medicare decisions. options beyond traditional Medicare for Brown & Toland is San Francisco’s preeminent physi- affordable and comprehensive care. cian network. Brown & Toland doctors practice quality health care at California Pacific Medical Center, UCSF Medical Center, UCSF/Mount Zion Medical Center, St. Mary’s Medical Center, Saint Francis Memorial Hospital and St. Luke’s Hospital. Brown & Toland contracts with two Medicare Advan- tage Plans to provide Medicare beneficiaries with more coverage for hospitalization and emergencies, and access to an extensive network of private practice physicians. Seniority Plus is a Medicare Advantage plan offered by Health Net. Secure Horizons is a Medicare Advantage plan offered by PacifiCare. By enrolling in one these Medicare Advantage plans, Medicare beneficiaries have a wide range of important benefits, including doctors’ visits and Medicare Part D prescription drug coverage. We encourage you to find out more about Brown & Toland’s Medicare Advantage plans: Health Net’s Seniority Plus and Pacifi Care’s Secure Horizons. To learn more about Medicare Advantage and Brown & Toland, please call 866.488.7088 or return the enclosed business reply card for a free informational packet. ■ PRSRT STD U.S. POSTAGE The Doctors Behind Every Good Health Plan PAID Effingham, IL P.O. Box 640469 San Francisco, CA 94164-0469 Permit No. 148

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