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Effective July 1, 2010, all State Health Plan (Plan) members will move to the
70/30 plan. Members who apply and qualify for the 80/20 plan will be allowed
to choose that option. (See March Blog for more information.) According to
the overview of the Plan, expect to see the following changes:
Year 1: The tobacco cessation component will begin on July 1, 2010.
Subscribers and their covered dependents who do not use tobacco products,
or who qualify for an exemption, will have the option to enroll in the 80/20
plan.
Year 2: The weight management component will begin on July 1, 2011.
Subscribers and their covered dependents who do not use tobacco products,
and who have a BMI less than 40 or qualify for an exemption, will have the
option to enroll in the 80/20 plan.
Year 3 and going forward: The weight management component will be
changed on July 1, 2012 to include members who have a BMI less than 35.
The State has implemented the Comprehensive Wellness Initiative
(CWI). The main goal of the CWI is to help employees develop
healthy behaviors/lifestyle changes in an effort to reduce the
number of chronic diseases to include heart disease, cancer,
How and when does the CWI take effect? What steps do members have
to take? Effective July 1, 2010 and going forward, all State Health Plan
members will be enrolled in the 70/30 plan. In Year 1, July 1, 2010 - June 30,
2011, subscribers who want to enroll in the 80/20 plan must declare on an
attestation form that neither they nor their eligible dependents use
tobacco products, or indicate that they qualify for an exemption.
In Year 2, July 1, 2011-June 30, 2012, and beyond, subscribers must declare
on an attestation form that they and their covered dependents do not use
tobacco products, have a BMI within the specified weight range, or qualify for
an exemption. An attestation form is a legally binding document that subscribers
must complete each year to apply for the 80/20 plan. This form must be
completed at annual enrollment, or when a new member first enrolls in
the Plan. Subscribers who want to stay in the 70/30 plan do not have to
complete an attestation form.
Tools and Resource information from the CWI include the following
information:
http://www.shpnc.org/wellness-tobacco-cessation.html
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TOBACCO USE CESSATION TOOLS & RESOURCES
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NC Tobacco Use Quitline
1-800-QUIT-NOW
(1-800-784-8669)
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Quitline NC offers tobacco cessation coaching
and free over-the-counter Generic Nicotine Replacement Therapy patches to members,
subject to specific limitations. Quitline NC is available 8:00 a.m. to 3:00 a.m.,
7 days a week, in English and Spanish.
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Tobacco Cessation Counseling
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Counseling by a physician, nurse
practitioner, physician assistant or
behavioral health provider.
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Prescription Medications
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Nicotine Replacement Therapy Patches: $10 generic copay; $5 over-the-counter generic copay.
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Buproprion (generic for Zyban): $10 generic copay
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Nicotine Nasal Spray, Nicotine Inhaler, Varenicline (Chantix): $35 copay.
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http://www.shpnc.org/wellness-weight-management.html
Body Mass Index Examples:
Height |
30 BMI
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35 BMI
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40 BMI
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5’ 4”
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174 pounds
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204 pounds
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232 pounds
|
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5’ 8”
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197 pounds
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230 pounds
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262 pounds
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6’ 0’
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221 pounds
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258 pounds
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294 pounds
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WEIGHT MANAGEMENT TOOLS & RESOURCES |
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Nutrition Counseling
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Four (4) nutrition counseling office visits with a licensed dietician will be available per Plan year for members and their dependents.
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Weight
Management Medications
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Your physician may recommend medication or other supports to assist you in managing your weight. Brand-name medications, such as Meridia and Xenical, have a $35 copay and will not require prior
authorization.
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Bariatric Surgery
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Bariatric surgery is offered as a Plan benefit.
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1-800-817-7044
Worksite Wellness Resource Guide
Questions:
1.) What if subscribers do not want to fill out the attestation form because
they consider it personal information?
Subscribers who do not submit a completed attestation form will remain in
the 70/30 plan, along with any covered dependents.
2.) If the subscriber is the only family member who smokes or has a BMI
over 40, why can’t the subscriber be on the 70/30 plan and the dependents
on the 80/20 plan?
In order to be on a separate policy, a member must be eligible because of
employment or retirement. Dependents are not eligible for their own policy with
the Plan. Therefore, dependents must be on the same policy as the subscriber
and have the same plan type (70/30 or 80/20) as the subscriber.
7.) If members quit using tobacco or lower their BMI during the benefit year,
may they change plans?
Not at this time. After the first year of the program, the Plan will assess the
costs and processes required to allow a status change mid-year.
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