HealthbyChoice Achievements: Qualifying for Choice level
In HealthbyChoice® Achievements, you can decide to try to earn Choice level at any time.
To qualify, you and your spouse or domestic partner (if he or she is covered by the plan) must:
Complete a health assessment on this website
Complete the WebMD® health assessment. Answer all the questions to learn your health risk level and get recommendations for being healthier.
Note: It's not complete until you see your health risk score. Your answers will never be shared with your employer without your knowing.
Meet the criteria for five health indicators
Ask your doctor to complete the HealthbyChoice Achievements qualification form showing that you met the criteria for all five health indicators.
1. Tobacco use
- Non-user of tobacco, verified in the last 6 months
2. Body mass index OR waist circumference
- BMI of less than 30, verified in the last 6 months
- Waist circumference of <41" for men or <35" for women
- If you're pregnant, your doctor can waive this criteria
3. Blood pressure
- Under 140/90 if you are healthy, verified in the last 6 months
- Under 140/80 if you have diabetes
- Under 140/90 if you have heart disease
- Under 150/90 if you're age 60 or older
4. LDL cholesterol
- Under 190, verified in the last 5 years if you're healthy*
- Under 100 if you have diabetes, heart disease or possible indicators of heart disease, including high blood pressure, verified in the last 6 months*
- Under 100 if you have heart disease, verified in the last 6 months*
5. Blood sugar
Not required if you're healthy*
Blood glucose under 126 mg/dL (fasting) if you have heart disease or possible indicators of heart disease, including high blood pressure, verified in the last 3 years*
HbA1c under 8% if you have diabetes, verified in the last 6 months
*Your doctor will decide whether your test results already on file reflect your current health, or if you should be retested.
Your doctor can set different criteria for you to meet
If your doctor says it's unsafe for you to meet any of the health criteria, he or she can enter alternate goals for you on the form. That will alert Priority Health to assign a nurse case manager to you to help you improve your health.
Visiting your doctor
- If your doctor has already measured all five health criteria for you, you don't need to visit his or her office. Ask your doctor to complete the qualification form online and send it to us.
- If your doctor doesn't have the information on file - if you've never taken a blood sugar blood test, for example - then you should schedule an office visit to get the tests done. Bring the form to your appointment.
How to find out if you qualify
When we get the form, we will send you a letter telling you whether or not you qualified for Choice level benefits. You can also check by logging in to your account on this website.
Choice level starts on your achievement date
Your "achievement date" is the month and day all the requirements for Choice level were met for your family. It will be the most recent of the dates you and your spouse individually completed the health assessment or met all five health criteria.
(If you end up paying too much because claims are processed at the Standard level after you've qualified for Choice, we'll reimburse you for the difference.)
You'll stay at the Standard level, and you can try again to earn Choice level at any time. For example, if you lose weight or quit smoking within 12 months after your doctor first sent in your form, you can ask to be re-measured for just that one health indicator you failed.
Try again to meet the health indicators
- Ask for a health coach to help you
- Complete the requirements when you're ready
- See below for more help from Priority Health
Try to meet the alternate health indicators
- Visit your doctor for a customized plan to follow
- Work with a Priority Health case manager
- Complete customized criteria requirements when ready
- See below for more help from Priority Health
Help from Priority Health
If you don't meet the criteria for all five health indicators now, but you decide you want to get healthier and meet them in the future, Priority Health has help for you.
Contact us to see if you are eligible for health coaching. You can talk with expert health coaches who have experience helping people who decide to get healthier. Your health coach will give you health information and support you with advice and encouragement.
Help from a nurse case manager
If your doctor says it's not safe for you to meet the criteria for any of the health indicators, he or she will define custom health goals for you. A Priority Health nurse case manager will call you and work with you to help you improve your health and achieve your goals.
Health help on this website
You'll find many resources on this website to support you in making healthy lifestyle choices year-round, including help managing your health conditions.