Healthy Blue Achieve℠: What providers need to know
Healthy Blue Achieve is Blue Cross Blue Shield of Michigan’s wellness PPO plan. Healthy Blue Achieve members get lower out-of-pocket costs for making a commitment to live a healthy lifestyle.
There are two cost share levels: enhanced and standard. Members get the enhanced level with lower out-of-pocket costs when they:
- Take their online health assessment.
- Submit their Qualification Form. Members will bring their Qualification Form to you to complete and submit. Michigan providers may complete this form online. Providers who can't complete the form online can fax it to the number listed on the form. Instructions for submission are included on the form.
- Meet the plan’s health measure targets. We monitor five key health measures: Blood pressure, cholesterol, blood sugar, weight and tobacco use.
What if a member misses a health measure target?
- If they don’t meet the blood pressure, cholesterol (LDL) or blood sugar targets: They’ll need to work with you on an improvement plan. For these three health measure targets only, check the boxes on the qualification form to let us know the member is working to improve. If you submit a member's form without checking the boxes, their out-of-pocket costs will go up.
- If they don’t meet the weight (BMI) target: They’ll need to sign up and participate in the Blue Cross® Health & Wellness Steps walking program, powered by WebMD®, for the rest of their benefit year or until their body mass index falls below 30.
- If they use tobacco: They’ll need to sign up and participate in the Blue Cross Health & Wellness Tobacco Cessation Coaching program, powered by WebMD, for the rest of their benefit year or until they stop using tobacco.
Once your patient achieves the health measure targets, you can submit a Physician Verification Form. After Blue Cross Blue Shield of Michigan receives and processes the form, your patient will no longer need to participate in the wellness improvement program.
If you believe your patient can’t meet the health measure targets or activity requirements because of a medical condition, you can request a medical waiver for them. You’ll need to complete the medical waiver section of the Physician Verification Form (PDF) and return it to us within 120 days of the member’s plan effective date.
WebMD Health Services is an independent company supporting Blue Cross Blue Shield of Michigan and Blue Care Network by providing health and wellness services.