St. Joseph School District Employee Wellness Program of 8 Activities - 30 minute Swedish massage from Feel the Heal or

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1 St. Joseph School District Employee Wellness Program Our goal and focus will be to enhance organizational health by fostering interest and encouraging employees to initiate or expand healthier lifestyles, provide more diverse wellness programs to meet a wide range of personal health needs, recognize employees for participating in healthier lifestyles activities, decrease absenteeism due to illness and stress, and develop a positive school culture that is focused on celebrating and improving the quality of life for all employees. The evolve WELLNESS program provides SJSD employees with opportunities to earn incentives in exchange for learning about and making healthy lifestyle choices and decisions. To participate, you must be an employee of the St. Joseph School District, and eligible to receive benefits from the district. Employees who participate in, and complete activities at the following level will qualify for one (1) incentive from the appropriate level: 6 of 8 Activities - 30 minute Swedish massage from Feel the Heal or $45 certificate to Natural Grocers or $45 certificate to your choice of the following Genesis Gym, YMCA, or Rec Center 7 of 8 Activities - 60 minute Swedish massage from Feel the Heal or $60 certificate to Natural Grocers or $60 certificate to your choice of the following Genesis Gym, YMCA, or Rec Center 8 of 8 Activities - 90 minute Swedish massage from Feel the Heal or $100 certificate to Natural Grocers or $100 certificate to your choice of the following Genesis Gym, YMCA, or Rec Center or FitBit Charge 2 or Wellness personal day to be taken at your discretion the following school year, CAN NOT BE USED AFTER APRIL 30, 2019

2 evolve WELLNESS ACTIVITES The activities listed below may be completed to earn credit towards your evolve reward. 1. ANNUAL PHYSICAL: You must have a physical exam AND age appropriate tests within the year (April 1, 2017 to April 1, 2018) Documentation of exam must be provided via a sign off sheet for your physician to sign stating that you have had each of the necessary and/or age appropriate tests (exam results or bills will no longer be accepted). The goal is to reduce the amount of paper that must be turned in. Age appropriate tests A. Mammogram after age of 40. Yearly after 50 years. B. Pap smears yearly or physicians recommendation C. PSA prostate exam for men. Yearly after age 40. D. Colorectal Screening. May be done any time, but must have one after age 50 E. Sign off sheets may be turned in any time during the year, but last day to submit will be April 1, WEAR SEAT BELTS EVERY TIME YOU ARE IN A MOVING VEHICLE 3. COMPLETE ONE (1) ONLINE INSERVICE AND THE CORRESPONDING QUIZ (These will be released on our wellness page located at 4. NO TOBACCO USE or A. Participate in a structured cessation program/doctor managed program. 5. COMPLETE ONE (1) SIX WEEK WELLNESS CHALLENGE (Links will be released in an prior to start) A. Keep it Steady - Begins 11/27/2017 B. BOUNCE Begins 1/8/2018 C. Fitness Finale Begins 1/22/ PARTICIPATE IN WELLNESS CLINIC SCREENINGS A. With Cholesterol and Glucose levels in normal range OR on a doctor managed program. (May be completed at your doctors or the BCBS Lab Clinic or any private lab) Labs must be completed between April 1, 2017 and April 1, 2018) If you complete the lab through BCBS you do not need to provide documentation. If you complete the lab in your doctor s office or lab, they will need to complete the sign off sheet. The Health Risk Assessment at must be completed as part of this. B. The District will contribute $ towards health insurance premiums for all eligible employees carrying district insurance for completion of the wellness screening. For those who choose not to participate, the District will contribute $ towards the employee cost of insurance. 7. EARN 3000 POINTS IN THE BLUE CROSS BLUE SHIELD MEMBER PORTAL (Available 10/1/2017) (If you do not have SJSD insurance, you may complete a second in-service in lieu of and must indicate this on your contract that must be turned in by 11/1/17) A. BCBS will provide a report showing each member who has earned 3,000 points or more between 10/1/2017 and 4/1/2018. In addition, points may be used to enter raffles for gift cards offered by BCBS. 8. MUST HAVE A DENTAL EXAM WITHIN THE YEAR (APRIL 1, 2017 to APRIL 1, 2018) and dentist complete sign off sheet. This includes people with dentures. A. Exam is to check for Gingivitis, Periodontal Disease and Cancer of the mouth. It will be the employee s responsibility to scan & or send original documents via inner school mail to Britten LeMoine, Benefits Manager, no later than April 1, All incentives will be awarded in May 2018.

3 evolve WELLNESS CONTRACT Due by 11/1/2017 (Wellness Contract & Incentive Selection) You must COMPLETE and RETURN BOTH Wellness Contract & Incentive Selection together by 11/1/17 in order to signify your intent to participate in the evolve WELLNESS program. NAME SCHOOL ID# AGE By signing below, I indicate my intention to participate in the evolve WELLNESS program for I understand that in order to receive my incentive, I must complete 6 or more of the below items, and return appropriate documentation to Britten LeMoine, Benefits Manager, no later than April 1, ANNUAL PHYSICAL: You must have a physical exam within the year (April 1, 2017 to April 1, 2018) AND Age appropriate tests as follows: A. Mammogram after age of 40. Yearly after 50 years. B. Pap smears yearly or physicians recommendation C. PSA prostate exam for men. Yearly after age 40. D. Colorectal Screening. May be done any time, but must have one after age 50 E. Sign off sheets may be turned in any time during the year, but last day to submit will be April 1, WEAR SEAT BELTS EVERY TIME YOU ARE IN A MOVING VEHICLE (This MUST be MARKED yes or no when contract is turned in by 11/1/17) YES NO 3. COMPLETE ONE (1) ONLINE INSERVICE AND THE CORRESPONDING QUIZ (These will be released monthly on our wellness page located at 4. TOBACCO USE (This MUST be MARKED yes or no when contract is turned in by 11/1/17) YES NO OR Participate in a structured cessation program/doctor managed program. (Must provide documentation of program completion) 5. COMPLETE ONE (1) SIX WEEK WELLNESS CHALLENGE (Links will be released in an prior to start) A. Keep it Steady - Begins 11/27/2017 B. BOUNCE Begins 1/8/2018 C. Fitness Finale Begins 1/22/ PARTICIPATE IN WELLNESS CLINIC SCREENINGS (At BCBS, Doctor s office or Independent Lab) The Health Risk Assessment at must be completed as part of this. 7. EARN 3000 POINTS IN THE BLUE CROSS BLUE SHIELD MEMBER PORTAL (Available 10/1/2017) (If you do not have SJSD insurance and will be completing a SECOND ONLINE in-service in lieu of this, you must indicate by marking here: 8. MUST HAVE A DENTAL EXAM WITHIN THE YEAR (APRIL 1, 2017 to APRIL 1, 2018)

4 Incentive Selection (Please mark (X) by the incentive you wish to receive on EACH level. Actual incentive awarded will be based upon actual level of activities completed.) 6 of 8 Activities - 30 minute Swedish massage from Feel the Heal or $45 certificate to Natural Grocers or $45 certificate to your choice of the following Genesis Gym, YMCA, or Rec Center (Circle one) 7 of 8 Activities - 60 minute Swedish massage from Feel the Heal or $60 certificate to Natural Grocers or $60 certificate to your choice of the following Genesis Gym, YMCA, or Rec Center (Circle one) 8 of 8 Activities - 90 minute Swedish massage from Feel the Heal or $100 certificate to Natural Grocers or $100 certificate to your choice of the following Genesis Gym, YMCA or Rec Center (Circle one) or FitBit Charge 2 or Wellness personal day to be taken at your discretion the following school year, CAN NOT BE USED AFTER APRIL 30, 2018 Signature Employee # Date School

5 evolve WELLNESS Physician Sign-Off 17/18 year (Also used for Lab Incentive) Due by 4/1/18 Name Emp # Age Annual Physical (Must have physical AND age appropriate tests) Physical Exam - Date exam completed / / AND (Age appropriate tests) Mammogram (Women, after age 40) Date / / Pap Smear (yearly OR Dr. recommendation) Date / / PSA Prostate (Men, yearly after age 40) Date / / Colorectal Screening (all, after age 50) Date / / Cholesterol/Glucose results within normal levels (or dr. managed program) (Completion of this will also apply for $30/mo lab incentive) (You MUST complete the HRA in conjunction with labs to received credit for both Lab Incentive and/or evolve WELLNESS program ) Results: Cholesterol Glucose Physician Signature License # Date

6 evolve WELLNESS Dentist Sign-Off 17/18 year Due by 4/1/18 Name Emp # Age Dental Exam Date exam completed / / Screen for: Gingivitis Periodontal Disease Oral Cancer Dentist Signature License # Date Your health plan is committed to helping you achieve your best health. Rewards for participating in a wellness program are available to all employees. If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for an opportunity to earn the same reward by different means. Contact us and we will work with you (and if you wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status.