New wellness incentive plan Healthy Blue Achieve^SM PPO rewards members for making better health choices

Blue Cross Blue Shield of Michigan’s Healthy Blue Achieve PPO is a new wellness incentive product that goes into effect Jan. 1, 2014. The Blues will offer two benefit levels for this product: enhanced and standard. Members with the enhanced benefit level will have lower out-of-pocket costs compared to the standard benefit level.

Members automatically receive enhanced benefits at the start of the plan. In order to maintain enhanced benefits, members must do the following within 90 days of their plan’s effective date:

• Complete a health assessment — Members must visit bcbsm.com and complete the Succeed^® online health assessment.
• Submit the qualification form — BCBSM has updated its qualification form. Members will bring their pre-populated qualification form to your office and ask you to complete the form, sign it and fax it to the number listed on the form.
• Meet specific health targets — If a member doesn’t meet the blood pressure, blood sugar or cholesterol targets, they’ll lose enhanced benefits unless they commit to work with you to improve the missed measure. For these three health targets, please use the check boxes on the qualification form to indicate the member has agreed to follow your plan.
• If a member doesn’t meet the tobacco use target, he or she will be required to enroll in BCBSM’s tobacco cessation program for the remainder of their plan year, or until tobacco use has stopped.
• If a member doesn’t meet the Body Mass Index target, he or she will be required to participate in BCBSM’s walking program and walk an average of 5,000 steps per day for the remainder of their plan year or until their BMI falls below 30.

If a member has a medical condition that makes it inadvisable for him or her to meet the health measure or activity requirements, you can request a medical waiver on their behalf. You must complete and submit a Physician Verification Form to request a medical waiver for the member. You can access the Physician Verification Form in two different ways as follows.

1) From web-DENIS by logging in to Provider Secured Services:

• Visit bcbsm.com and log in as a provider.
• Click on the Provider Publication and Resources link.
• Click on Newsletters and Resources.
• Click on Physician Verification Form, located under Frequently Used Forms on the right side of the screen.

2) From the provider section of our website:

• Visit bcbsm.com and click on the Providers tab.
• Click on Quick Links.
• Click on Healthy Blue Achieve.
• Click on the Physician Verification Form.

For your Healthy Blue Achieve patients, the Physician Verification Form can be used to:

• Request that a member is waived from meeting a health measure due to a medical condition.
• Request that a member is waived from the walking requirement and the member will alternatively be required to participate in BCBSM’s food journaling program.
• Notify BCBSM when your patient has met a health measure he or she previously missed.

If you have any questions regarding the Healthy Blue Achieve product, contact your provider consultant.