HealthbyChoice Achievements

Our newest commercial benefits plan was 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. If the five health indicators are medically unreasonable or inadvisable for a patient, you may specify reasonable alternatives.

"Is criteria medically inadvisable for patient?"

• This section should only be checked if the patient does NOT meet one of the health criteria.
• If you mark "NO" it means you feel the patient does not have a medical condition that would make it unreasonably difficult or medically inadvisable for the patient to achieve the requirement.
• If you mark "YES" it means that the patient does have a medical condition that would make it unreasonably difficult or medically inadvisable to achieve the requirement.
• If you do mark "YES" then go to "Alternative Goals" and fill in the goal that you feel the patient could achieve. (The patient will then also be assigned Case Management services through Priority Health to help assist in reaching the Alternate Goal.)

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