HealthbyChoice Incentives requirements
Choice vs. Standard levels
All new employees begin at the Choice level of copays, deductibles and coinsurance. To keep this level, they must meet their plan requirements within 90 days of the plan's effective date.
If they don't meet requirements within the 90-day qualification period, they move to the Standard level, which has higher copays, deductibles and coinsurance.
Both the employee and their spouse (if applicable) must meet the requirements in order to receive Choice level. Children do not need to meet the requirements; they will be covered at the parents' level.
Group premium rates are based on a combined rate, not on how many employees are at each benefit level. Group rates will remain the same, regardless of who achieves Choice benefits and who stays at Standard benefits.
Requirements for Choice level
Employees (and spouses, when applicable) must meet two requirements.
1. Complete the online health assessment
- Employees and their spouses, if applicable, must create individual online Priority Health MyHealth accounts to access the health assessment.
- They can easily identify health issues they need to work on and receive recommendations for improving their health.
- They can update their health assessment at any time to track their progress toward health goals and wellness criteria.
- Employee/spouse health assessment information and results are confidential and will not be shared.
2. Meet the criteria for three health indicators
Employees and spouses (if applicable) must visit their doctor and have the doctor document that they meet these criteria:
- No tobacco use of any kind (including e-cigarettes)
- Body mass index (BMI) under 30 or waist circumference under 41 inches (men), 35 inches (women)
- Blood pressure under 140/90 or 150/90 for those age 60 or older
If they don't meet the three criteria
They can still qualify for the Choice level if, in the same 90-day window, their doctor submits the HealthbyChoice Incentives qualification form showing they have:
- Completed a fasting cholesterol test (requires lab testing)
- Completed a fasting blood sugar test (requires lab testing) – required for members with diabetes or heart disease
- Agreed to follow their doctor's treatment plan
Keeping Choice level
After 90 days, participants who have met the criteria will stay at the Choice level for the rest of the plan year. Those who haven't are automatically transferred to the Standard level.
At the next enrollment date, employees' benefit statuses carry over for the first 90 days of the new plan year. During this 90-day period, employees and their spouses (if applicable) have the opportunity to qualify or requalify for the Choice level.