HealthbyChoice plan designs
HbC Motivations plan
Providers document the health indicators, which are identical to those for HbC Progressions and Achievements (see chart, below).
- If the member has a medical condition that makes meeting the health criteria inadvisable or unreasonably difficult, the provider is asked to certify this fact.
- No alternate goals are necessary.
- For the patient, there are no changes to benefit levels.
- The patient's rewards for meeting the healthy criteria and/or consequences for failing to meet them are set by the employer.
HbC Incentives, Progressions and Achievements plans
The provider documents the health criteria and whether or not the patient has a health condition that makes meeting the health criteria medically inadvisable. See chart below for details. Plan members must meet the plan's health criteria to move from Standard to Choice benefit level.
| Plan feature | HbC
Incentives | HbC
Progressions | HbC
Achievements |
|---|
| Qualification period: |
90 days from effective date |
At any time |
At any time |
| Benefit levels: |
- Standard
- Choice (lower deductible, copays)
|
- Standard
- Choice (lower deductible, copays)
|
- Standard
- Choice (lower deductible, copays)
|
Health criteria: Tobacco, BMI and BP must be measured within the last 6 months. |
- Tobacco non-user (cotinine testing required only if patient was previously a smoker and is re-applying)
- BMI < 30
- BP < 140/90
|
- Tobacco non-user (cotinine testing required only if patient was previously a smoker and is re-applying)
- BMI < 30
- BP < 140/90
- Blood sugar (< 126 fasting, < 180 non-fasting, patients with diabetes HbA1C < 8%)
- LDL cholesterol <160
Cholesterol and blood sugar must be measured within the last 5 years, depending on the patient's health.* |
- Tobacco non-user (cotinine testing required only if patient was previously a smoker and is re-applying)
- BMI < 30
- BP < 140/90
- Blood sugar (< 126 fasting; < 180 non-fasting; patients with diabetes, HbA1C < 8%)
- LDL cholesterol <160
Cholesterol and blood sugar must be measured within the last 5 years, depending on the patient's health.* |
Alternate goals
if patient has medical condition making the health criteria inadvisable: |
Complete blood sugar and LDL cholesterol criteria; agree to physician-defined follow-up plan |
Defined by physician on the form |
Defined by physician on the form |
Alternate goals
if NO medical condition makes the criteria inadvisable: |
Complete blood sugar and LDL cholesterol criteria; agree to physician-defined follow-up plan |
Defined by Priority Health (all these requirements are listed on the form): - Reduce body weight by 5%
- Reduce systolic BP by 10 mm, diastolic by 5 mm
- Reduce LDL by 20 mg/dl
- Without diabetes, FBS < 126, non-fasting BS <180; with diabetes, reduce HbA1C by 1%
|
No alternate goals needed. Patient works with a health coach to meet criteria. |
*National guidelines recommend cholesterol testing for healthy individuals every 5 years and blood glucose testing when indicated. The physician may decide whether test results already on file reflect the patient's current health and can be used or if the patient should be retested.
