Healthy Blue Achieve℠: What providers need to know

Healthy Blue Achieve is Blue Cross Blue Shield of Michigan’s new wellness PPO plan. It starts Jan. 1, 2014. Healthy Blue Achieve members get lower out-of-pocket costs for making a commitment to live a healthy lifestyle.

There are two benefit levels: enhanced and standard. Members get enhanced benefits with lower out-of-pocket costs when they:

  • Take their Succeed® online health assessment.
  • Submit their qualification form. Members fill out their qualification forms and bring them to you to complete, sign and fax to the number listed 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 or blood sugar targets: They’ll need to work with you on an improvement plan. For these three health targets only, check the boxes on the qualification form to let us know the patient is working to improve.
  • If they don’t meet the weight target: They’ll need to sign up for Blue Cross Blue Shield of Michigan’s free walking program, Connect 2Bfit℠ Walking, for the rest of their benefit year, or until their body mass index falls below 30.
  • If they don’t meet the tobacco use target: They’ll need to sign up for Blue Cross Blue Shield of Michigan’s free tobacco cessation program, Quit the Nic, for the rest of their benefit year, or until they stop using tobacco.

If you believe a member can’t meet the health 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 and return it to us within 120 days of the member’s benefit start date.

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