HealthbyChoice Progressions

Standard vs. Choice level

Standard

Everyone starts at the Standard level, with great medical coverage but a higher deductible and copayments. You and your spouse (if applicable) have 90 days from the plan effective date to qualify for the Choice cost-sharing level by meeting the requirements. Children don't have to meet requirements, they are covered at their parents' level.

Choice

If you and your covered spouse meet the Choice level requirements, everyone on your plan will move to the money-saving Choice level on day 91.

Additional time: If you and/or your covered spouse meet the Choice level requirements after the first 90 days, you will then be moved to the money-saving Choice level for the remainder of the plan year.

Plan renewal and requalifying for Choice level

At the start of the next plan year, you will keep the level you are in—Choice or Standard—for the first 90 days while you complete the requirements to earn the Choice level again.

Requirements for Choice level

You and your spouse (if applicable) can earn the Choice level by meeting two requirements:

Complete the online health assessment

  • You and your spouse, if applicable, must complete the online health assessment.
  • You can easily identify health issues you need to work on and receive recommendations for improving your health.
  • You can update your health assessment at any time to track your progress toward health goals and wellness criteria.
  • Your health assessment information and results are confidential and will not be shared.

Meet criteria for five health indicators

You must ask your doctor to complete the HealthbyChoice Progressions qualification form to indicate you've met criteria for five health indicators:

  • Tobacco use: Must be tobacco-free, including e-cigarettes
  • Body mass index (BMI): Must be under 30, OR waist circumference must be under 41 inches(men)/ 35 inches (women)
  • Blood pressure: Must be under 140/90, or under 150/90 for those 60 years of age or older
  • Cholesterol: LDL must be under 190 or under 100, based on risk factor*
  • Blood sugar: For members with diabetes, HbA1c number must be lower than 7%. For members with heart disease, fasting blood sugar must be lower than 126.

Using alternate health indicator targets

When you don't meet the criteria for the health indicators, your doctor can set alternate targets for the BMI, blood pressure, cholesterol and blood sugar indicators. When you have met the alternate targets, you will be moved to Choice level.

Using health criteria information from past doctor visits

You and your spouse may not have to visit your doctors to complete the qualification form. Doctors can use health criteria information collected in the past if the information was collected within these time frames:

  • Tobacco use, BMI or blood pressure in the last six months
  • Cholesterol and blood sugar (depending on health condition) in the last five years*

You may need to see your doctor about any criteria you didn't meet. Remember, if you see your PCP before the plan effective date, expenses for that visit are covered by the previous plan, not the new plan.

*Health criteria are established by our industry-leading team of physicians using evidence-based medical guidelines. Requirements may be adjusted for those with diabetes or heart disease.