2017 PREMIUM INCENTIVE PROGRAM

Transcription

1 2017 PREMIUM INCENTIVE PROGRAM

2 2017 PREMIUM INCENTIVE PROGRAM This voluntary health improvement program is designed to help you keep your good health a priority. If you are enrolled in the health plan, don t miss out on significant financial rewards! If you are covering a spouse on Safe Auto s medical plan, you and your spouse have the opportunity to participate individually to each earn a premium discount level. For example, if you complete the necessary requirements for the Level 2 discount, but your spouse does not meet his/her biometrics, you are still eligible for a percentage of a premium discount. REGISTRATION IS OPEN JULY 10 - NOVEMBER 1, 2017 Activate your account by visiting: (Employees and spouses create their own profile) 1. Follow the instructions on the site to log in and create your profile. 2. Visit the Resource Page tab to download your Provider Screening Form with instructions. 3. Revisit the portal for your screening results and other activities to enhance your well-being. Save Up To 50% On Your Premium Rate! Level 1 Complete all of the below: If you are covering a spouse, he or she must complete all incentive requirements. Provider Screening Form (Deadline 11/1/2017) Includes Health Screening results, Preventive care sign off, Non-tobacco Use affidavit. Meet 3 out of 5 Biometric Numbers Level 2 Complete all Level 1 Criteria AND: You must both be tobacco negative to receive Level 2 Incentive. Non-Tobacco User Affidavit (Deadline 11/1/2017) Non-Tobacco users who completed the affidavit on the Preventive Screening Form and all Level 1 requirements will be eligible for the Level 2 rate. Important Note! If you do not complete all of the Level 1 requirements above, you will only be eligible for the Core Cost premium rate in You cannot earn the Level 2 premium rate without meeting Level 1 criteria. Participants must be actively employed and still enrolled in the plan in order to earn credit. BIOMETRIC NUMBERS Health Screening Tests Employer Goal Alternative Goal Waist Measurement OR Body Mass Index* Blood Pressure HDL Cholesterol Glucose Triglycerides Male Female / 85 Male Female *You will receive credit for passing either waist measurement goal or BMI goal. See following page for Alternatives and Appeals Options. PLEASE NOTE: Your health plan is committed to helping you achieve your best health. Rewards for participating in a wellness program are available to all employees. If you think you might be unable to meet a standard for reward under this wellness program, you might qualify for an opportunity to earn the same reward by different means. Contact Wellness Coaches at higear@wcusa.com and we will work with you (and, if you wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status.

3 ALTERNATIVE OPTIONS If you did not meet your employer s goal, but made improvements in that area from one category level to the next, since your health screening for the 2016 premium incentive program, you can still earn the credit! BMI 1 inch Waist Reduction OR 1 point BMI Reduction Blood Pressure Systolic Diastolic Employer Goal Less than 130 Less than 85 Elevated I Elevated II Elevated III 160 or higher 100 or higher Glucose Employer Goal Less than 110 Elevated Elevated II 126 or Higher Triglycerides Employer Goal Less than 150 Elevated HDL Cholesterol Employer Goal Male 40 Female 50 Decreased I Decreased II Decreased III Decreased IV 34 or Below Elevated II Elevated III 500 or Higher What defines improvement? As an example: If your 2016 screening result in glucose is 128 (Elevated II), you would need to either improve your glucose into the Elevated 1 range of OR achieve the Safe Auto goal of <110 at your 2017 screening. Participants must be actively employed, still enrolled in the plan and have completed the reasonable alternative in order to earn credit for meeting the alternative goal. Improvement category levels are not intended to identify risk or medical appropriateness. Always consult with your medical doctor before starting any new exercise or nutrition program. If we have results from your last screening, your improvement will be automatically considered. If you didn t improve over the last year you can still request an alternative goal. Wellness Coaches will provide you the information needed to request an alternative goal. Wellness Coaches offers an appeal process if you believe your results are incorrect or think you may qualify for a medical exception. Please contact Wellness Coaches by your appeal deadline at higear@wcusa.com.

4 REGISTRATION Registration is open July 10 - November 1, 2017 To register, visit: Follow the directions to create a profile. 1 Click Log In on top right of screen 3 Complete User Profile 2 Read License and click Agree

5 SCREENING WITH YOUR PROVIDER When scheduling your screening appointment, it s important to provide your healthcare provider s office with the correct information for a successful visit. Visit the Programs Page on the higearwellness.com site to download your Provider Screening Form or get a hard copy from your coach. I recently had a preventive health screening. Can I submit those results? Results from health screenings that took place on or after November 1, 2016 will be accepted. What type of appointment am I scheduling? When calling your healthcare provider s office to schedule your appointment tell them you would like to schedule a preventative screening visit or annual wellness visit. These are the frequently used industry terms and your healthcare provider s office should be able to easily accommodated your request. What type of blood test should I request? Your healthcare provider s office should perform a standard lipid panel blood test for you. For the most accurate results, fasting hours prior to your health screening is recommended. What should I bring with me to the appointment? Do not forget to bring your screening form with you to your appointment. Your healthcare provider is required to fill out this form and sign it. This form can be obtained at on the Programs page. Who is permitted to sign the form or complete the appointment? If your provider is an M.D., N.P., P.A., or D.O., their signature is acceptable to process the form. Please remember that a participant signature is also required to process the form. If you are filing an appeal due to pregnancy, a midwife (CNM) is also considered an approved provider. Once completed & signed, can my healthcare provider submit my form? No. As the participant, it is ultimately your responsibility to ensure the completed form is sent to Wellness Coaches on or before your completed by deadline of November 1, How do I submit my provider screening form? You may submit your form in person by handing it in to your wellness coach, ing to higear@wcusa.com or uploading it to on the Programs page.

6 SCREENING TIPS FOLLOW THE STEPS BELOW TO ENSURE A SUCCESSFUL SCREENING EXPERIENCE Fast for 10 to 12 hours prior to your screening. Take All Medications As Prescribed. Speak with your healthcare provider if you feel fasting will affect any medical condition that you have. Stay Hydrated one week prior to screening, and consume 6-8 oz. of water before your screening. Remember to follow your Physicians recommendations. DON T FORGET: Review the completed form to verify accuracy. Carefully read and sign the participant notice and consent. Ensure your physician has signed your completed form. Fully complete the Tobacco Use Confirmation and Participant Signature section on your form. HEALTH SCREENING TESTS The following biometric measurements will be collected as part of the premium incentive program. Body Mass Index Body mass index (BMI) is a measurement of your weight distribution compared to your height. Many health conditions, including cholesterol levels and total heart health, are related to your body mass. Elevated BMI can result in health problems associated with heart and kidney disease. Blood Pressure Blood pressure is the force of blood against the walls of the arteries. It is recorded in two numbers: the systolic/top number (pressure as the heart beats) and diastolic/bottom number (pressure as the heart relaxes between beats). HDL Cholesterol Cholesterol is a waxy substance in the blood stream and the body s cells which aids in forming some hormones and other body functions. Cholesterol is broken down into HDL and LDL. HDL is labeled the good cholesterol as it may protect against heart attack - but low levels may actually be harmful. Glucose Most of the food you eat is broken down into glucose, a form of sugar in the blood. Glucose is the main source of fuel for the body. After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. Uncontrolled glucose levels increase risk of diabetes. Triglycerides Triglycerides are a type of fat found in your blood. Your body makes some triglycerides but it also comes from the food you eat. If you eat more calories than your body needs, your triglyceride level may be high.

7 SCREENING RESULTS & SUPPORT Your results will be posted on the Programs page of the portal. Your Overall Incentive Results Whether or not your numbers qualify. Your Screening Results and Employer Goals. *Note: Current Values will show 2016 values until your 2017 values are entered. Your Screening Results and Employer Goals. *Note: Current Values will show 2016 values until your 2017 values are entered.

8 FREQUENTLY ASKED QUESTIONS Does everyone have to participate? No. Participation in this program is voluntary. However, if you choose not to participate, you may miss out on significant financial impacts, and may be responsible for contributing an additional amount towards your health insurance premium if you enroll in the health plan. How will I receive my results? Results will be posted on the Programs page of the secure portal. You will receive an notification to alert you when they are available.?? Will my employer see my results? No. Wellness Coaches will not share your individual results with your employer. They will be given a summary of the number of premium incentives each employee received as a result of the health screening, but will not know which category or any specific laboratory results. Do spouses need to participate? If you are covering a spouse on Safe Auto s medical plan, you and your spouse have the opportunity to participate individually to each earn a premium incentive level. For example, if you complete the necessary requirements for the Level 2 incentive, but your spouse does not meet his/her biometrics, you are still eligible for a percentage of a premium incentive. Is this program legal? Can my employer really base my premium on my health results? Yes. Wellness Coaches administers programs in compliance with the Affordable Care Act s (ACA) Incentives for Non-Discriminatory Wellness Programs in Group Health Plans. This allows employers to adjust healthcare cost for those on the health plan who meet certain health goals. We also adhere to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Protected Health Information (PHI) protocols. This ensure that your personal information, including your results, will not be shared with any unauthorized parties, including your employer. What if I don t meet my program goal? If your program requires the achievement of a goal, there may be alternative ways to qualify. If we have results from your last screening, your improvement will be automatically considered. If you didn t improve over the past year you can still request an alternative goal. You will be provided the information you need to request an alternative goal in your results. Alternatives are typically based on improvement from prior results or on completion of a program that is related to health improvement within a certain biometric. Contact Wellness Coaches and we will work with you (and, if you wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status. What if my results are not consistent with recent tests? In the event that the screening results differ significantly from recent medical results, a Type 1 (dispute of accuracy) appeal may be submitted with supporting documentation within 30 days of the date displayed on your original results. Any retesting may be at the expense of the participant. What if I have a medical condition and I cannot meet the goal or the alternative goal (if applicable)? If your employer s goal(s) or reasonable alternative goal(s) are considered unreasonably difficult due to a medical condition or medically inadvisable (Type 2 Appeal), Wellness Coaches manages appeals and coordinates personalized alternatives for these goals. Any retesting may be at the expense of the participant. Contact Wellness Coaches at higear@wcusa.com for more information.?

9 FILING AN APPEAL For Type 1 & Type 2 Appeals Why would I file an appeal? You would file an appeal if you dispute the accuracy of your results (Type 1) or your healthcare provider feels it is unreasonably difficult due to a medical condition or it s medically inadvisable for you to meet the employer s goals or the alternative goals (Type 2). How soon should I file an appeal? Appeals must be filed by the deadline date listed on your results, which is typically 30 days. Submit your appeal and supporting documentation by ng it to higear@wcusa.com or giving it to your wellness coach in person. What paperwork is needed to file an appeal? 1. A completed appeal form with documentation and signature by an approved provider is required. Approved providers include: doctor of medicine (M.D.), doctor of osteopathy (D.O.), physician assistant (P.A.), or nurse practitioner (N.P.). If you are filing an appeal due to pregnancy, a midwife (CNM) is also considered an approved provider. AND 2. Copies of any additional testing results and supporting documentation may be required. The details for following an appeal are outlined on your appeal form. Where do I obtain an appeal form? An appeal form may be printed from your web portal at or contacting your wellness coach. Who pays for the re-testing when an appeal is submitted? Any re-testing will be at your expense. When will I be notified of the decision of my appeal? A notification will be sent via within 3-7 business days that your appeal has been received and is being processed. Typical appeals can be resolved within business days unless additional documentation or results are required. What happens when my appeal is approved? If the appeal is approved, it will be as if you passed the category originally. Any necessary financial adjustments will be made by your HR Team.