FAQs for Employers

Q&A for HealthbyChoice Incentives: What Employers Want to Know

The following are questions typically asked by employer groups regarding Priority Health's HealthbyChoice Incentives health plan.  If you don't see your specific question, contact your agent or Priority Health for information. (Feel free to print a copy of this Q&A document to keep for your reference.)

Why Consider HealthbyChoice Incentives

Who Can and Should Consider HealthbyChoice Incentives

Member Requirements and Specifics

Enrollment Information

Miscellaneous

Why Consider HealthbyChoice Incentives

Q. Why should my company consider a product like HealthbyChoice Incentives?

A.  HealthbyChoice Incentives takes a different approach to consumer-directed health plans. It uses the better of two benefit levels (which can save money) to encourage members to make healthier lifestyle choices and to maintain healthy lifestyles. In addition:

• It enables you to encourage your employees to take greater responsibility for their health and health care costs.
• It's a turnkey solution; Priority Health works directly with members. There is little for employers to do.
• The plan can generate up 13% savings over comparable plans while enabling employers to offer their employees an outstanding level of benefits (which makes a great recruitment and retention tool.)
• It's available to groups with two or more employees, so even the smallest groups can encourage better employee health while saving on their company's health care premiums.
• It provides members with access to an abundance of outstanding wellness resources, from fitness classes to Web-based tools, to support them in pursuing healthier lifestyle choices - regardless of the benefit level they are on.
• With four HMO options and four PPO options, it offers flexibility and can meet the needs of a diverse range of employers.

Q. How can HealthbyChoice Incentives save my company money?

A.  HealthbyChoice Incentives can help your company save money on health care costs in many ways, including these:

• All HealthbyChoice Incentives plan options (HMO and PPO) are copayment aligned. Members pay higher copayments for higher cost services, which helps to reduce employer premiums by 3-5%.
• The dual-benefit level design also enables Priority Health to offer a combined rate for a plan that offers access to a higher level of benefits. The combined rate is less (6-9%) than the rate would be for a standard Priority Health plan offering only the higher level of benefits.
• The plan encourages healthier lifestyle choices. This may translate into less absenteeism and increased productivity, which ultimately impacts your company's bottom line.

Q. How is HealthbyChoice Incentives different from comparable plan products on the market?

A.  Several things distinguish HealthbyChoice Incentives from comparable products in our market. Among them:

• Priority Health's comprehensive wellness programs and services, along with our custom-designed online tracking systems, tools and resources.
• It's a turnkey solution. Priority Health works directly with plan members; there's little involvement required of employers.
• It's easy to understand. There are only three differences between the two benefit levels (copayments, deductibles/out-of-pocket costs and coinsurance). There are only two requirements that members must meet to maintain the better level of benefits, neither of which requires lab work. (However, members that don't meet the health indicator criteria in the second requirement can meet alternative requirements, which do include laboratory testing.)
• It's based on Priority Health's highly acclaimed HealthbyChoice wellness program. In the three years that program has been in the market, it has demonstrated 7-15% better adherence to clinical measures such as physical exams and asthma medication usage.  It also showed documented changes in health behaviors, early detection of chronic illness and disease and demonstrated a positive impact on health costs.

Q. How is HealthbyChoice Incentives different from HealthbyChoice Rewards?

A. HealthbyChoice Rewards is an employer-driven wellness program. It's sold as an add-on to other Priority Health products.  HealthbyChoice Incentives is a health plan combined with a wellness program. There are 4 HMO and 4 PPO options available. It is a full replacement product and cannot be purchased with other Priority Health products.
     

Who Can and Should Consider HealthbyChoice Incentives

Q.  Is HealthbyChoice Incentives available to any size of company?

A.   HealthbyChoice Incentives is available to groups with two or more employees.


Q.  Is HealthbyChoice Incentives available to companies that self fund their health plans?

A.   No, not at this time.


Q.  The HealthbyChoice Incentives health plan is a good start for encouraging my company's employees to be healthier. Does Priority Health offer other programs that can help?

A.  HealthbyChoice Incentives is more than a health plan. Members have access  to a wide range of wellness resources, including web-based tools and free exercise classes. Visit priorityhealth.com/healthwellness to see an example of what's available, from advice on losing weight to help to quit smoking. Onsite wellness services are also available to groups of 51 or more. (Ask your agent or Priority Health representative for details, requirements and fee schedules.)


Q. My company would like to make consumer-directed health plans available to our employees. Can my company purchase HRAs, HSAs or other Priority Health products along with HealthbyChoice Incentives?

A.  HealthbyChoice Incentives is sold primarily as a full replacement policy. It is not available with other Priority Health plans or even with HealthbyChoice Rewards. However, groups of 50 or more employees are eligible for Health Savings Accounts (HSAs).  HealthbyChoice Rewards, our wellness program, can be sold with other Priority Health products. See your agent or Priority Health representative for details.


Q. Can I receive a quote on HealthbyChoice Incentives and regular HMO, POS, and PPO plans so I can compare my company's options?

A.  Yes. We^'ll provide you with all the information you need to choose the right health plan solution for your company and employees.


Q.  Will my company's employees need computer and Internet access in order to participate in this plan?

A.   One of the two requirements to maintain the Choice level of benefits for the plan year requires Internet access. Members need to complete an online health risk assessment form (available at priorityhealth.com). In addition, many of the wellness resources and tools available to members are available through the Priority Health web site.

To make online access easier, Priority Health offers its members discounts on Dell computers. It is one of the many value-added components of HealthbyChoice Incentives that gives members and employers much more for their money.


Q. Are mid-year changes allowed?

A.  No. HealthbyChoice Incentives is available only to new and renewing customers.

Member Requirements and Specifics

Q. What are the two requirements for members to qualify for the Choice level of benefits?
   
A. Members (employee and spouse, if the spouse is covered under the plan) must complete the following within 90 days of the effective date of coverage:

1. Complete an online health risk assessment that takes about 10 minutes. It^'s available at priorityhealth.com.
2. Have their health care provider complete and submit a qualification form (paper or electronic) that notes their status on three health indicators.

Q. Why were the three health indicators chosen?

A. The three health indicators represent controllable health behaviors commonly linked to chronic illness and other health issues. The U.S. Centers for Disease Control and Prevention estimate that 50 percent of today^'s health care costs are attributable to health risks that can be modified by lifestyle behaviors such as diet and activity.


Q. What happens if the member or his or her spouse don^'t complete both requirements in 90 days?

A.  They are both automatically transferred to the Standard level of benefits. Benefit coverage is the same as the Choice level but they will pay more for copayments, deductibles/out-of-pocket costs and coinsurance.


Q. What happens if a member or his or her spouse complete both requirements (the health risk assessment and the qualification form) but didn^'t meet the criteria for one of the health indicators on the form?

A.   Anyone who doesn^'t meet the criteria for the health indicators can still maintain the Choice level of benefits by doing the following within the same 90 days of his or her effective date of coverage:

• Complete a fasting cholesterol test
• Complete a fasting blood sugar test
• Agree to follow his or her health care provider^'s treatment plan.

Q. Do plan members have to see their health care providers in order to have them complete the qualification form that's required in order to maintain the Choice level of benefits?

A.  Health care providers can report the required data collected up to six months prior to the member's effective date.  As long as health care providers have documented information in the member file for tobacco use, BMI and blood pressure, this data can be used for members to qualify for the Choice level of benefits. Members don't need to see their health care providers unless additional lab work or an action plan is required.  


Q.  Why does a member's spouse have to meet the program requirements?

A.  Studies show that couples working together have a better chance of successfully changing their lifestyles. This is necessary to achieve the rate relief targets we are providing and to assure the greatest level of successful long-term lifestyle changes.


Q.  Do the husband and wife both have to qualify?

A.  Yes. If the spouse is covered through the entire 90-day qualification period, both must meet the program requirements to maintain the Choice level of benefits.
 

Q.  What if a member cannot get in to see his or her health care provider?

A.   Priority Health's network of health care providers have timely access requirements that ensure that members can obtain an appointment if they are required to within the 90-day period. In addition, health care providers have been trained on the time sensitivity of meeting the timelines for the Choice benefit level.


Q.  Are all members required to have a fasting glucose and cholesterol test?

A.   No.  Only members who do not meet the criteria for the three health indicators listed on the qualification form must complete additional lab work. They also must agree to a follow their health care provider's treatment plan as a HIPAA-mandated "reasonable alternative" in order to maintain the Choice level of benefits.


Q. Do members living outside the Priority Health service area need to meet the same requirements for maintaining the Choice level of benfeits?

A.  Yes. Out-of-area members must still meet program requirements to continue on the Choice level of benefits. 


Q. What does Priority Health do with the health indicator scores and any test results?

A.  All information obtained from either the health care provider or an outside lab (in the case of any additional tests) is stored in the member's Patient Profile record. It is only available to the member and the member's health care provider. Only the scores for the three health indicators are used to determine whether someone qualifies for Choice level of benefits.  Information will be used by Priority Health to develop Wellness programming and services for members.


Q. What if a health care provider does not submit the qualification form on time?

A.  Members qualify based on meeting the requirements during the 90-day timeframe. Priority Health has set up procedures to catch information that is reported late. In cases where members are moved to a different benefit level and we later receive documentation that they met their requirements within the 90-day qualification period, members will be moved back to the appropriate benefit level. Claims will be adjusted.


Q. Do members have to meet the Choice level of benefits requirements every year?

A.  Yes. Members are expected to maintain their healthy lifestyles for as long as they are in the program.


Q. How will members be notified that they have another chance to qualify for the Choice level of benefits at renewal?

A.  This information will be covered in the member materials as well as in the renewal information.


Q. How do members know what benefit level they are in?

A.  For new members, everyone starts out in the Choice level. Those who meet the requirements for maintaining the Choice level within 90 days keep the Choice benefits for the remainder of the plan year. (Upon renewal, they also start out the new plan year with the Choice level benefits for the first 90 days.) Those who don^'t meet the Choice requirements each year are automatically transferred to the Standard level. We^'ll send new ID cards to them that note their benefit level.

Enrollment Information

Q. What happens if a group is set up after their effective date (retro enrollment)?

A.  This will not affect their 90-day qualification period, which will begin with their effective date of coverage.


Q.  What happens when someone is added to the plan?

A.   Members who enroll during the first eight months of the plan year are treated as any other member. They have the same 90 days from their effective date to meet requirements to maintain the Choice level of benefits. Members who enroll in the last 120 days of the plan year are placed on the Choice level of benefits and will re-qualify for them the next year.

Contracts that lapse and are reinstated (for whatever reason) within six months are placed into their previous level of benefits if they already were given a 90-day qualification period. If they did not complete a 90-day qualification period before the contract lapse, they'll have a new 90-day qualification period.


Q. Would a member who enrolled in the third quarter have to turn around and re-qualify a few months later?

A. No. Data can be used up to six months prior to the effective/renewal date and can be re-used. Information submitted (including the completion of the online     health risk assessment) for a late enrollee that falls within the last six months  of the plan year will also meet the following year's requirements.


Q.  What happens when someone moves to COBRA?

A.   Members moving to COBRA are treated as though they are still enrolled in the HealthbyChoice Incentives plan. They remain on the Choice or Standard level of benefits that they were enrolled in as of the date of their COBRA Qualifying Event. They will qualify/re-qualify for the HealthbyChoice Incentives benefit levels as if they were an active employee, following the same HealthbyChoice Incentives rules and requirements applied to active employees.

Spouses/ex-spouses who elect COBRA coverage are treated just the same as HealthbyChoice Incentives members, and must follow HealthbyChoice Incentives program guidelines.  Dependents enrolled under a parent's COBRA policy will follow the benefit level assignment to the parent on the COBRA policy and do not have to meet program guidelines, regardless of age.

Dependents that are below the age of 18 and elect their own COBRA contract (a single COBRA contract) will always automatically be assigned to the Choice benefit level and do not have to follow program guidelines to qualify for the Choice benefit level. Dependents who are age18 or older and elect their own COBRA contract (a single COBRA contract) are treated as the subscriber and must follow HealthbyChoice Incentive program guidelines.


Q. What happens when someone is added retroactively? Can they get an extension on the 90-day period?

A.  No. Employers are expected to submit additions in a timely manner. Extensions to the 90-day qualification period are not available.

Miscellaneous

Q.  Will my company pay different rates based on how many of our employees are on the Choice or Standard level of benefits?

A.  No, it doesn't matter how many employees are on either benefit level. Your company will pay a "combined" rate no matter what.  In addition, employers never know who among their employees are on the different benefit levels.


Q.  Can my company get a report regarding the breakdown of the number of employees on each benefit level?

A.   Priority Health will provide a report indicating how many of your members are on each benefit level (Choice or Standard), but we can't tell you which employees are on each level.

Groups of 51 or more may be eligible for additional HIPAA-protected aggregate reports based on data collected. We can work with groups to help with wellness program development.  If groups/members have questions, they should be directed to customer service.


Q.Are there other designs available besides the 4 HMO and 4 PPO options?

A. Currently, other options are only available to groups sized 100 or more.


Q. What coverage riders are available?

A. Only the contraceptive rider is available. Non-coverage riders such as the domestic partner rider are available for groups of 51 or more, according to current rules.


Q. Are small groups (fewer than 50 employees) eligible for wellness resources under the HealthbyChoice Incentives plan?

A.  Yes. All HealthbyChoice Incentives members, regardless of the size of their company, have access to a wide variety of free wellness resources. This includes wellness and disease management classes held at Priority Health's offices, tobacco cessation programs, web-based tools and more. On-site programs and consulting services are also available to groups of 51 and over. Contact your agent or Priority Health representative for delivery details, requirements and fee schedules.