New: HealthbyChoice Achievements coming soon
Our newest commercial benefits plan will be effective Jan. 1, 2011.
HealthbyChoice Achievements provides opportunity for members and their covered dependents to move from Standard to Choice benefits if they meet the program requirements, which include five health indicators. At the Choice level, members have lower deductibles, copays and coinsurance.
5 health indicators to qualify Members will contact their primary care doctors if they want to qualify for Choice benefits. An office visit is required unless the member has received care within the past six months and you have the required information on file. Physicians or staff must complete the
HealthbyChoice Achievements qualification form to certify all five health indicators:
- No tobacco use
- BMI <30 (exception: pregnant patients)
- Blood Pressure < 140/90
- Cholesterol < 160 LDL
- Blood Sugar
- < 126 (fasting)
- < 180 (non-fasting)
- HbA1C < 8% for diabetics
There’s no deadline for earning Choice benefits.
If a patient doesn’t meet all 5 indicators Patients who can reasonably meet the five health indicators by living healthier should be encouraged to work to improve their health. If at any time throughout the year they are able to meet all criteria, they will be moved to Choice benefits.
If the five health indicators are medically unreasonable or inadvisable for a patient, you may specify reasonable alternatives. We’ll provide suggested alternatives, or you can define your own. We’ll automatically assign a Priority Health case manager to a member with alternative goals in support of your treatment plan.
Qualification form completion We will pay providers an additional administrative payment quarterly for completion of the qualification form.
- $30 per-patient payment for submitting the required information online
- $15 per-patient payment for faxing the form to us
- $10 per-patient for resubmission of qualification form for members who originally did not meet all criteria
Note: You may still have patients with our
HealthbyChoice Incentives plan, which can be renewed but is no longer available as a new plan.
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