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Health Risk Reduction Reimbursement

Health Risk Reduction Reimbursement. 2012 Guidelines. Health Reimbursement. Goals Reward sustained commitment to healthy lifestyle and healthy actions for individuals who have identified health risks for heart disease or diabetes. Reimbursement, tied to payment for services

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Health Risk Reduction Reimbursement

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  1. Health Risk Reduction Reimbursement 2012 Guidelines

  2. Health Reimbursement • Goals • Reward sustained commitment to healthy lifestyle and healthy actions for individuals who have identified health risks for heart disease or diabetes. • Reimbursement, tied to payment for services • “Easy” for Employee • “Manageable” for EWP

  3. Weight Watchers Reimbursement 2011 • Eligibility • Benefits-eligible County / Courts employee • 25+ BMI • 20%+ body fat (men), 30% body fat (women) • Must register/pay at a County Weight Watchers at Work Program • Reimbursement • If 25-30 BMI, At the end of each pre-paid, multi-week session, 50% reimbursement for weight loss (equivalent to ½ lb/week x # weeks paid for a WW@W session) paid via claims process • If 30+ BMI, At the end of each pre-paid, multi-week session, 50% reimbursement for weight loss (equivalent to ½ lb/week x # weeks paid for a WW@W session) paid via claims process; 50% reimbursement for keeping weight off for next six months (signed affidavit) paid via claims process.

  4. Weight Watchers Reimbursement 2012 • Eligibility • Benefits-eligible County / Courts employee • 25+ BMI • 20%+ body fat (men), 30% body fat (women) • Must register for Weight Watchers on the County Weight Watchers website • Must pay for Weight Watchers on the County Weight Watchers website

  5. Weight Watchers Reimbursement 2012 • Criteria • Health Improvement Indicator: Equivalent of ½+ lb / week of weight loss • Reasonable alternative: 80% Weight Watchers attendance for the reimbursement period (1 mo = 3 classes, 2 mo = 6 classes, 3 mo = 10 classes)

  6. Weight Watchers Reimbursement 2012 • New “Triggering Event” • Instead of end of session triggering when an employee can submit a reimbursement claim, it will now be determined by a calendar. • Reimbursement “window periods” occur four times a year – January, April, July, October. • Employee submits County claim form and documentation for all/part of the previous three months. • There will be one claim request for one three-month period of services.

  7. Employee Wellness Program (EWP) will verify employee eligibility, registration and payment status, as a WW website administrator. • EWP will calculate reimbursement for the entire 3-month period using the documentation that has been submitted by the employee. • If employee has continuously registered and paid for Weight Watchers during the entire quarter and has met the health improvement goal for reimbursement, employee will be approved for $54.00 in reimbursement. • 2012 Monthly Card = $35.95; • Monthly 50% reimbursement = $18.00 • Quarterly Reimbursement = $18.00 x 3 = $54.00

  8. If the employee has registered, paid and participated partially during the quarter and has met (prorated) health improvement goal required for reimbursement, EWP will approve prorated reimbursement at the rate of $4.50/week. • Example: • Registered/paid on February 15, paid monthly through April 15 • Loses 5 lbs between Feb 15 – Mar 31 (according to WW Card) • In April, submits reimbursement request to EWP with photocopy (front and back) of WW Card showing beginning and ending weights for the period (Feb 15 – Mar 31). • EWP verifies employee eligibility, registration and payment for Jan-Mar period on website, confirms that it is a six-week period, and determines that employee must lose 3+ lbs to be eligible for 50% reimbursement. • EWP determines that employee is eligible for reimbursement, calculates prorated reimbursement of $27.00 (6 weeks x $4.50/week), and approves request.

  9. It might get Messy • Partial / Prorated periods • Everyone will have at least one, when “starting” and/or “ending” • Start-stop-start-stop commitment, breaks/lapses • Yikes! Is this a commitment? • Activating WW monthly card towards the end of the quarter • Probably better to defer reimbursement request to next period • How to handle WW 6-week Maintenance Period (before becoming LifeTime member) • Probably should switch over to attendance rather than weight loss criteria for reimbursement for this 3-month period

  10. FOR MORE INFORMATION • County Weight Watchers website • http://wellness.weightwatchers.com • Company ID: 7590 Password: WW7590 • Health Risk Reduction Reimbursement Program • http://www.smcgov.org/hr/hf • Guidelines, County Claim Form, FAQs • Employee Wellness Program • Pamela Gibson • pjgibson@smcgov.org • 363-4344

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