P. R. E. P. Prevention Reward Employee Program. Tolleson Union High School District Plan Document

Transcription

1 P. R. E. P. Prevention Reward Employee Program Tolleson Union High School District Plan Document

2 ii Table of Contents Table of Contents 1 Welcome to P.R.E.P. 1 Program Overview. 2 Eligibility. 2 How to Participate 2 2 Completing your P.R.E.P. Options 3 Wellness Visit. 3 Health Assessment. 4-5 Additional P.R.E.P. Options. 5-7 Rewards. 7 3 Program Alternatives Additional Resources 10 Glossary Preventive Communication. 11 Diabetes Flyer 12 Wellness Form. 13 Work it Off Exercise Program Log. 14 DPCA Verification Form. 15 How do I get my EOB?. 16

3 1 Welcome to P.R.E.P! Tolleson Union High School District is committed to supporting optimum health and wellness for district employees and their families. P.R.E.P. (Prevention Reward Employee Program) encourages members to get healthy and stay healthy. Members are encouraged to read the P.R.E.P. guide to gain an understanding of the program specifics, requirements, and available options. Why Prevention? One in eight women in the U.S. will be affected by invasive breast cancer in their lifetime, and thirty women each day are diagnosed with cervical cancer. Despite increased awareness and education surrounding women s health, breast cancer is still the leading cause of death among women. and over 27,000 died as a result of the disease in Heart disease is still the leading cause of death among men, followed by cancer. Annual recommended wellness screenings take only about eight to ten minutes and can alert you and your doctor of signs or symptoms of serious disease or illness, including diabetes and pre-cancerous cells. When found early, most conditions and cancers are highly treatable. Don t wait! Schedule your Wellness Preventative Exam today to ensure you are on the best possible path for a long and healthy life and keep reading to see how you can take advantage of additional rewards for doing what s best for you and your family s wellbeing! Prostate cancer is the most common cancer among men in the U.S.

4 2 P. R. E. P. Program Overview P. R. E. P. is designed to make participation as streamlined as possible while focusing on key practices of good health. Members are asked to complete three (3) wellness activities. The first two are required. There are seven additional options from which members choose the third requirement. Think of it as a 2 + 1! Primary Requirements: 1. Annual Wellness Exam (Required) 2. Health Assessment (HRA) (Required) 3. Additional Options (choose one) Complete a Smoking Cessation Program (State, county, or online with UHC coaching) Enroll in DPCA Program if applicable (Diabetes Prevention & Control Alliance) Complete a UHC Online Health Coaching Program Flu Vaccination Enroll in Healthy Pregnancy Program if applicable Preventive Cancer Screening as recommended based upon age & gender (Mammography, Colonoscopy, Prostate Screening). For more information about preventive care, visit www. uhcpreventivecare.com Complete eight months of the Work It Off Exercise Program (10 hours of self-reported exercise per month) Eligibility & Enrollment TUHSD employees enrolled in the District Gold 2500 Plan (employee only tier) are eligible to participate in P.R.E.P. Separate enrollment is not required. Participation is voluntary and at the sole discretion of the employee. See page 7 for reward information. If employment or benefits are terminated prior to the end of the P.R.E.P. plan period, rewards are forfeited. How long do I have to complete my P.R.E.P. items? TUHSD plan period for P.R.E.P. is April 1, 2013 through March 31, You may obtain your wellness exam, take your HRA, and complete one of the other seven options anytime during the P.R.E.P. plan period. All three wellness activities must be completed by March 31, 2014 to be eligible for the reward. All documentation must be provided to the P.R.E.P Coordinator (see page 10) by April 15, How to Participate Review the P.R.E.P. guide and supporting materials to familiarize yourself with the options and benefits. Decide which of the optional items you would like to complete and review the correlating section of this guide to assist you in successfully completing your choice.

5 P. R. E. P. 3 Completing Your P.R.E.P. Items Annual Wellness Visit (Documentation necessary from employee. To facilitate physician communication on preventive care, you maywish to print a copy of the physician letter on page 11 to accompany you on your wellness visit). It is important to establish a relationship with your primary care physician. Seeing your primary care doctor at least once a year for your annual Wellness Visit is essential in providing you and your doctor an overall snapshot of your current state of health. For TUHSD benefited employees, your annual wellness visit is at no cost to the member, and typically only takes about ten to fifteen minutes to complete. What can you expect at your visit? 1 Patient History: Your doctor will ask you some questions to determine how you are currently feeling and if you have any concerns. Typically he or she will also ask you questions that relate to your habits (diet, exercise, smoking etc.) as well as your vaccination status. Vital Signs: Your doctor will check your blood pressure, heart rate, respiration & temperature. Heart & Lung Exam: Your doctor will listen to your heart and lungs. Physical Examination: This would include checking your throat, mouth, tonsils, nose, sinuses, eyes, lymph nodes and thyroid Neurological Exam: This includes testing your nerves, strength, balance and reflexes. Dermatological Exam: Some doctors will check the condition of your skin and nails. Men: Depending on your age, most doctors will check for hernia, testicular cancer and prostate health during your annual exam. Women: If you do not see your OBGYN for your annual cervical and breast exam, your primary care doctor can perform these exams at the time of your annual physical. Lab Tests: Doctors will sometimes order a metabolic blood panel to include glucose (blood sugar) levels, cholesterol and lipids, etc. as well as a urinalysis. 1The above list is a sampling of what your doctor may order or perform during a routine annual physical. Tests and procedures may vary by physician and/or the age of the individual receiving the exam.

6 4 P. R. E. P. Prevention is Key! The main purpose of obtaining your annual wellness exam is to discover potential risk factors or conditions that require attention, management and/or treatment. Oftentimes, if caught early, many diseases or conditions can be successfully treated, controlled or eliminated by following your doctors recommendations. To complete your P.R.E.P. Wellness Visit, you will need to contact your primary care physician and schedule your visit. If you do not have a primary care doctor, you can search for an in-network physician at Use the Provider Search Tool at to find a doctor conveniently located in your area, call, make your appointment and be certain to inform the office that your visit is for your Annual Wellness Exam. You can also call UnitedHealthcare s customer service at: 1(866) for assistance in finding a physician. For more information regarding preventative care, visit You are not required to have your physician provide proof of your visit, nor are members required to provide anything to the District. An annual report will be provided to the Program Administrator listing those who have completed their wellness exam. NO RESULTS OR DETAILS regarding the visit will be provided to the District or Program Administrator. Remember! Your exam must be completed between April 1, 2013 and March 31, 2014 to qualify for the reward. Health Assessment (No documentation necessary from employee) Take your first step towards a healthier life by taking a personalized health assessment at myuhc.com. By taking the online health assessment, you can identify your personal health needs, learn healthy habits and compare your lifestyle score to others of the same age and gender. The assessment takes approximately 15 minutes to complete and you will be provided with immediate feedback on the current state of your health. In addition, your responses are used to help create a personalized online experience specifically for you. Plus, you will have access to several health improvement resources and interactive tools, such as quizzes, exercise programs, planned meals, and action steps to help you achieve your personal health goals. Based upon your score, an interactive online Health Coach may recommend up to three health improvement programs to help you achieve your personal health goals, such as: Nutrition Exercise Smoking Cessation Diabetes Lifestyle Heart Healthy Lifestyle Weight Loss Stress Management To get started, visit myuhc.com. Once you are logged in on the home page click on Health Assessment. If you haven t yet registered with myuhc.com, click Register Now. It s quick and easy!

7 P. R. E. P. 5 Just like your Wellness visit, you are not required to provide proof of completing your HRA. An annual report will be provided to the Program Administrator listing those who have completed the HRA. NO RE- SULTS OR SCORING from your risk assessment will be provided to the District or Program Administrator. Additional P.R.E.P. Options You are only one option away from earning your additional HSA deposit. DPCA Program (Documentation necessary from employee) Diabetes is one of the fastest growing diseases in the country. More than one in four adults is pre-diabetic and one in ten adults is diabetic. While these statistics raise concern, others uncover opportunity. For instance, in a National Health and Nutrition Survey, the Center for Disease Control identified 64.5 percent of U.S. adults as being over weight. Not only is obesity the primary factor causing pre-diabetes, it also plays a key role in health complications among individuals living with diabetes. Choose any one of the items below to meet your final goal of Preventive Cancer Screenings (Documentation necessary from employee) Screening means checking your body for cancer before you have symptoms. Getting screening tests regularly may find breast, cervical and colon cancers early when treatment is likely to work best. EOB (explanation of benefits) is required for proof of completion. Visit myuhc.com to locate your EOB. Fax, or mail to P.R.E.P Coordinator. Work it Off Exercise Program (Documentation necessary from employee) We know that regular exercise and a commitment to fitness is a vital component of healthy weight loss and overall wellness. The Work it Off Program allows members the freedom to choose their preferred method of exercise. Members must log 10 hours of exercise per month for 8 months to meet program qualifications. Exercise logs can be turned in monthly or at the end of April to the P.R.E.P Coordinator. A Work it Off log can be found at the back of this program guide or on your District Benefit Portal. Fortunately, there are actions that can be taken to reduce the prevalence of pre-diabetes, the clinical complications associated with diabetes, and the financial burden the epidemic places on employers. The Diabetes Prevention and Control Alliance, an innovative new program from UnitedHealthcare, is at the center of the solution. Members of UnitedHealthcare who are diabetic or pre-diabetic are invited to participate in a free program aimed at lowering patient costs and complications related to diabetes. If you have been diagnosed with diabetes or prediabetes, call the appropriate number below to find out if you qualify to enroll. 1(800) for diabetics 1(800) for pre-diabetics If it is determined that you are a qualified candidate for the DPCA program and enroll, please print the

8 6 P. R. E. P. DPCA enrollment form verification on page 15 and have your DPCA counselor/advisor sign and return the form via , fax or mail to your P.R.E.P. Coordinator. An informational program flyer can be found at the back of this guide. Flu Vaccinations (Documentation necessary from employee) It s more important than ever to take care of your health. By getting a single flu shot you can protect yourself against the seasonal flu, H1N1 and other forms of the flu virus. There are several ways you can obtain a flu vaccine: Visit your physician or call the member number on your health plan ID card to find a provider near you. EOB (explanation of benefits) is required for proof of completion. Visit myuhc.com to locate your EOB. Fax, or mail to P.R.E.P Coordinator. Visit a network Convenience Care Clinic or one of the participating national UnitedHeathcare network. EOB (explanation of benefits) or receipt of service is required for proof of completion. Fax, or mail to PREP Coordinator. Visit a school site within your District when notified vaccinations are available on site. EOB (explanation of benefits) is required for proof of completion. Visit myuhc.com to locate your EOB. Fax, or mail to P.R.E.P Coordinator. Complete a Smoking Cessation Program (Documentation necessary from employee) One out of five deaths in America can be attributed to cigarette smoking. Now is the perfect time to make the decision to quit and get paid for making a lifelong commitment to your health! Complete a state, county, or UHC health coaching cessation program to meet your additional P.R.E.P. requirement. Visit the links below to find a program option that is right for you. Arizona Smoker s Helpline (800) Maricopa Tobacco Use Prevention Program (602) United Healthcare Online Health Coach 1(888) You can also speak directly to your doctor about smoking cessation options such as medications and other support tools. Please fax, or mail your proof of program completion to P.R.E.P Coordinator UHC Online Health Coaching Program (No documentation necessary from employee) UnitedHealthcare s Health Coaching programs through offer a variety of personal tools and topics to explore. Members move through a personalized program that provides education and options for improvement. Program options include: Nutrition Exercise Smoking Cessation Weight Loss Visit and once you are logged in select the Health & Wellness tab then Online Health Coach to begin your program today! An annual report will be provided to the Program Administrator at the end of the program listing those who have completed the online coaching program. No details of the coaching will be provided to the District or Program Administrator.

9 P. R. E. P. 7 Healthy Pregnancy Program (Documentation necessary from employee) It s more important than ever to take care of your health and your baby s health during your pregnancy. UnitedHealthcare offers this program to provide you with useful information regarding proper nutrition, warning signs, preparing for childbirth, things to avoid during pregnancy and how important it is to exercise during pregnancy. This program is at no cost to you and offers 24 hour toll-free access to experienced maternity nurses, website access for pregnancy and childbirth, educational materials, recources and a complimentary book: Your Journey Through Pregnancy. To enroll, call (800) For more information, visit Rewards! Congratulations for completing your P.R.E.P.! The District Medical Plan you are enrolled in determines which reward you are eligible to receive. Gold 2500 Plan with HSA Employee Only Tier Reward: $350 HSA deposit Once verification of completion (or participation) has been received by the Program Administrator at the end of the program, for those members enrolled in the Gold 2500 Plan (employee only tier) with Health Savings Account will receive an additional deposit of $350 in their Optum HealthBank Savings Account in June Valley Schools and TUHSDreserve the right to alter HSA deposit date(s) if necessary.

10 8 P. R. E. P. Program Alternatives* 1. Wellness Exam If a member is unable to complete an Annual Wellness Visit, a physician s note is required confirming the member s inability to complete the visit. A detailed explanation is not necessary. The physician s note can be mailed or faxed to: Fax: 1(877) Mail: Valley Schools Rebecca McGonigle P.R.E.P. Coordinator (Confidential) PO Box Phoenix, AZ Health Assessment If a member is physically unable to complete the Health Risk Assessment online, the member can fill out the alternate request form at the back of this guide and choose one of the alternate P.R.E.P. options to complete in place of the HRA. 3. DPCA Program The DPCA Program is open only to members who are diabetic or pre-diabetic. If a member does not qualify for the DPCA program, they can elect to complete one of the other alternate P.R.E.P. options. 4. Smoking Cessation If a member does not smoke, they may choose to complete one of the other alternate P.R.E.P. options. 5. Flu Vaccinations If a member is physically unable to receive a flu vaccination, they may choose to complete one of the other alternate P.R.E.P. options. 6. Work it Off Exercise Program If a member is unable to participate in the self-reported Work it Off Exercise Program, they may choose to complete one of the other alternate P.R.E.P. options. 7. Healthy Pregnancy Program If a member is unable to participate in the program, they may choose to complete one of the other alternate P.R.E.P. options.

11 P. R. E. P Health Coaching If a member is unable to participate in the online health coaching, they may choose to complete one of the other alternate P.R.E.P options. 9. Cancer Screenings If a preventive cancer screening is not recommended based upon the person s age and gender, the member may choose to complete one of the other alternate P.R.E.P options. * If a member is physically unable to complete any of the P.R.E.P. options, please contact the P.R.E.P. Plan Administrator for further guidance at: (623)

12 10 Glossary Glossary of Terms Annual Wellness Visit Physical examination conducted by your physician to detect possible disease states or risk factors. Some examples of a wellness visit would be: annual physical, well woman exam, well man exam, colonoscopy. HDHP - High Deductible Health Plan District Sponsored Health Plan Option that focuses on consumerism and is often paired with a health savings account. DPCA - Diabetes Prevention and Control Alliance UnitedHealthcare special program to assist and educate diabetics and pre-diabetics. HRA - Health Assessment An online survey which provides members a score representing their current state of health & alerting members of possible areas for improvement. HSA - Health Savings Account Tax free savings account associated with members who are enrolled in a high deductible health plan or consumer driven health plan. EOB - Explanation of Benefits A statement provided by a health insurance company to covered individuals explaining what medical treatment and/or services were paid for on their behalf. P.R.E.P. COORDINATOR Rebecca McGonigle rmcgonigle@vsit.org Fax: 1( ) Mail: Valley Schools P.R.E.P. Coordinator (Confidential) P.O. Box Phoenix, AZ *Be certain to retain a copy of your EOB from United Healthcare of your wellness exam should further verification be necessary. All EOB s and claims summaries can be found at: myuhc.com.

13 Why preventive care is important Preventing disease and detecting disease early, if it occurs, are important to living a healthy life. And the better your health, the lower your health care costs are likely to be. Following certain guidelines, along with the advice of your doctor, can help you stay healthy. Talk to your doctor about your specific health questions and concerns, and follow his or her recommendations. Under the health reform law, members in most health plans are eligible to receive certain preventive care services, based upon age, gender and other factors, with no cost sharing (copayments, coinsurance and deductibles) as long as services are rendered by physicians and other health care professionals who participate in the plan s network. Getting started: The importance of your preventive health visit. Making an appointment for a preventive health visit can help you establish the baseline for your current health, and identify any health issues before they become more serious. Preventive checkups and screenings can help you and your doctor discuss care options that may help maintain or improve your health. During a preventive visit your doctor will usually determine what tests or screenings you need based on many factors such as your age, overall health status and any chronic conditions you might have. For more information on preventive care, visit our website at to identify your age and gender-specific preventive care guidelines, based on recommendations of the U.S. Preventive Services Task Force and other health organizations. When you schedule your preventive health visit, share the letter below with your Physician to help prevent common coding or billing errors that may occur. Certain services can be done for preventive or diagnostic reasons. When a service is performed for the purpose of preventive screening and is appropriately reported, it will be processed under the Preventive Care Services benefit. When a service is done for diagnostic purposes it will be billed under the applicable non-preventive medical benefit. Dear Physician or Healthcare Provider: As part of the federal Patient Protection and Affordable Care Act of 2010, your patient may be enrolled in a health plan that covers certain preventive care services with no cost sharing (copayments, coinsurance and deductibles) as long as services are rendered by an In-Network provider. UnitedHealthcare has updated its Preventive Care Services Coverage Determination Guideline (CDG) to help physicians identify and correctly code preventive services they deliver to UnitedHealthcare members. UnitedHealthcare notifies network providers of all CDG changes through the Network Bulletin and the UnitedHealthcareOnline portal. Please use these resources to determine what preventive services will be covered with no cost share for your patient. The health care professionals online portal can be accessed at You can also use this site to verify a member s eligibility in the plan. Your local network contact is also available to answer questions or assist in any way. UnitedHealthcare is dedicated to helping people live healthier lives, and we encourage our members to receive age- and gender-appropriate preventive care services.

14 Are you one of the P. R. E. P. million Americans living with diabetes or pre-diabetes? Members of UnitedHealthcare who are diabetic or prediabetic are invited to participate in a free program aimed at lowering patient costs and complications related to diabetes. Diabetes prevention program includes: 16-week session, 1 hour/week, at YMCA Tips for reducing risk of developing type 2 diabetes Healthy lifestyle management Ongoing education and behavior modification Diabetes control program includes: Private meetings w/ Walgreens pharmacist Monitoring of medication, blood pressure, weight, labs Coordination w/ primary care physician Self-management education For more information, contact united healthcare: for diabetics for pre-diabetics

15 P. R. E. P. 13 Dear P.R.E.P. Coordinator: I certify that I am unable to complete the Health Assessment online at myuhc.com. I choose the following P.R.E.P. option below to complete in place of the HRA. Smoking Cessation DPCA Program Flu Vaccination UHC Online Health Coaching Work it Off Exercise Program Healthy Pregnancy Program Cancer Screenings Name: Signature: District: Date:

16 WORK IT OFF P.R.E.P. HEALTH CHALLENGE Name: District: School: Please log your minutes and fax to: Rebecca McGonigle at: ; or mail to: VSEBT P.R.E.P. Coordinator, P.O. Box 41760, Phoenix, AZ You must complete at least 10 hours of exercise per month, for 8 months in order to fulfill the requirement. MONTH OF TYPE OF EXERCISE DATE HOURS/MINUTES TOTAL:

17 Name of PREP member/employee Dear DPCA Counselor/Advisor, DPCA Verification Form The above employee is participating in a district wellness program called PREP. Our employees, who qualify, receive an incentive for enrolling in the DPCA program for either pre-diabetics or diabetics. They are required to provide proof of enrollment between April 1, 2013 through March 31, Please verify by signing this form that the employee listed has enrolled in the DPCA program. Date Employee Name DPCA Counselor/Advisor Signature PREP MEMBER: Please fax, or mail this completed form to: Fax: (877) rmcgonigle@vsit.org Mail: PO Box Phoenix, AZ Thank you, Sincerely, Valley Schools Employee Benefits Trust PREP Coordinator DPCA Verification Form 4/22/13

18 How do I get my EOB??? Log on to Enter your username and password OR Register, if you haven t done so already Click on Manage My Claims Scroll down your claim summary to find the exam you are looking for Once you find it, click on View Claim Click on Explanation of Benefits Not sure if this is the right EOB? Scroll down to the At a Glance portion of the screen for a detailed description of the claim