Revised qualification form now available

In order to comply with federal regulations that govern wellness programs, enhancements have been made to the Blue Cross Blue Shield of Michigan qualification form. These enhancements allow BCBSM to have one consistent form that can be used for groups that purchase participation or outcome based wellness solutions.

Changes on the form include:

Cotinine test and health measure guidelines
The updated qualification form can now be used to request a cotinine test. The check box indicates that the test is required for all members that are not an admitted tobacco user. If the box is not checked, the test isn’t a required component of the group’s wellness solution. Cotinine tests are typically not a covered benefit and should only be ordered if specifically approved by the group.

In addition, we’ve also added health measure guidelines for weight, blood pressure, cholesterol and blood sugar that show normal ranges for individuals.

Health measure criteria outside of normal range
Effective Jan. 1, 2014, groups that offer outcome-based wellness programs must offer individuals unable to meet health measure criteria a reasonable alternative to satisfy the wellness requirement.

You should mark the check box on the far right of the form to indicate that the member has agreed to participate in an alternate activity to improve their health.

Note: Members who participate in Healthy Blue Achieve and are unable to meet the health measure criteria must complete the applicable check box to meet the compliance requirement. Other groups with an outcome-based wellness program may require the check boxes be complete on an ad-hoc basis. The check boxes are not required for groups that have a participation-based program.

To view the updated qualification form, click here.

As a reminder, the member or an individual from your office must fax the qualification form to BCBSM.