HealthbyChoice® plan designs

Using our online HealthbyChoice qualification form:

  • Document your patient's status for the health criteria.
  • Indicate whether or not the patient has a health condition that makes meeting the health criteria medically inadvisable, and set an alternate goal if indicated.

Qualification period

HbC Achievements: 90 days from effective date

HbC Incentives: 90 days from effective date

Patient can earn

HbC Achievements: Choice level benefits (lower deductible, copays, coinsurance)

HbC Incentives: Choice level benefits (lower deductible, copays, coinsurance)

Health criteria

Tobacco, BMI/waist circumference and BP must be measured within the last 6 months.

HbC Achievements: non-user, including electronic cigarettes1

HbC Incentives: non-user, including electronic cigarettes1

HbC Achievements: < 302 or,

Waist circumference

Male: < 41"

Female: < 35"

HbC Incentives: < 302 or,

Waist circumference

Male: < 41"

Female: < 35"

HbC Achievements: < 140/90, or

With diabetes: <140/80

With CVD3: < 140/90

Age 60+: < 150/90

HbC Incentives:

< 140/90, or

Age 60+: < 150/90

If any of those are not met, additional requirements are:

  • Fasting cholesterol test (82465)4
  • Fasting blood sugar test (82947)4
  • Provider follow-up plan

HbC Achievements:

Healthy: < 190, most recent within the last 5 years or,

With diabetes: < 100

With CVD3: < 100

HbC Achievements:

With diabetes: < 7% HbA1C5

With CVD: < 126 FBC6

1 Any type of tobacco use

2 A member who is pregnant can meet the BMI criteria at the provider's discretion. Write "Pregnant" in the RESULT box and check Yes for CRITERIA MET

3 Cardiovascular disease (CVD) = Heart disease and possible indicators of heart disease, including hyperlipidemia and hypertension

4 Suggested CPT code

5 Suggested CPT code for patients with diabetes: 83036

6 Suggested CPT code for patients with CVD: 82947

National guidelines recommend cholesterol testing for healthy individuals every 5 years and blood glucose testing when indicated.