Group Administrative Guide Plan Year 2017

Confidence comes with every card.®

Healthy Blue LivingSM HMO

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Thank you for choosing Healthy Blue Living as a health care

plan for your employees. By offering this wellness incentive plan,

you’re showing your commitment to your employees and their

health. We look forward to working with you this year.

This reference guide provides valuable information to help

you administer Healthy Blue Living and answer

questions your employees may have.

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Employer guidanceYour responsibilitiesOffering Healthy Blue Living to your employees comes with tasks for you. Here are your responsibilities:

Tell your employees to complete a health assessment, and remind them to have their primary care physician complete and electronically submit their qualification form within the first 90 days of enrollment or renewal.

Give your employees instructions for taking the health assessment. They can take it by:

– Logging in to their member account at bcbsm.com.

– Clicking on the Health & Wellness tab, which will take them to Blue Cross® Health & Wellness, powered by WebMD®.

– Clicking on the Healthy Living tab.

– Clicking Health Assessment.

Institute and maintain a smoke-free workplace.

Encourage employees to participate in wellness programs. See Page 8.

Remind your employees that they must select an in-network primary care physician to coordinate their care.

WebMD Health Services is an independent company supporting Blue Care Network by providing health and wellness services.

Your requirements (by group size)

1–50 enrolled employees

Select at least one of the optional programs

51–300 enrolled employees

Select at least two of the optional programs

301–1000 enrolled employees

Select at least three of the optional programs

1001+ enrolled employees

Select at least four of the optional programs

Req

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Provide smoke-free environment

Required Required Required Required

Op

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Health fair Not required 1 time per year 2 times per year 2 times per year

Distribute health-related articles for employees (brochures, newsletter, posters)

2 times per year 2 times per year 2 times per year 3 times per year

Provide on-site class or discounts for weight loss

1 time per year 1 time per year 2 times per year 2 times per year

Provide healthy foods in cafeteria and vending machines

Ongoing Ongoing Ongoing Ongoing

Provide stress-relief class 1 time per year 1 time per year 2 times per year 2 times per year

Provide discounts to exercise facilities, or exercise classes 2 times per year, or exercise facility on site

Ongoing Ongoing Ongoing Ongoing

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Time frames for new hiresHere’s a breakdown of the timing for your new hires:

Hired in first or second quarter Hired in third quarter Hired in fourth quarter

Employee has enhanced benefits for 90 days.

The employee must complete the plan requirements within the first

90 days of his or her effective date for everyone on the contract to

keep enhanced benefits.

Employee has enhanced benefits for 90 days.

The employee must complete the plan requirements within the first

90 days of his or her effective date for everyone on the contract to

keep enhanced benefits.

Primary care physician does not need to submit the qualification form for the employee at the start of

the new plan year.

Employee has enhanced benefits for the remainder of the plan year.

At the start of the new plan year, the employee must complete the plan requirements within the first

90 days of his or her effective date for everyone on the contract to

keep enhanced benefits.

*Blue Care Network does not control this website or endorse its general content.

RehiresAny employees reinstated within six months or less from the date their plan lapsed are placed into their former benefits level. If the lapse is more than six months, Blue Care Network follows the new-hire process.

Employees who are terminated and then reinstated during the 90-day qualification period are given whatever remains of their 90 days to complete the initial requirements.

Employees added retroactivelyWe discourage retroactive contract additions because adding an employee after the plan’s effective date will jeopardize his or her ability to have the full 90 days to comply with initial enrollment requirements. You must notify us of any enrollment changes before your plan’s effective date.

Employees older than 65 are eligible, tooActive employees and retirees older than 65 are eligible for Healthy Blue Living. However, if Medicare is the primary health care coverage for an employee, retiree or covered spouse, that person cannot enroll in Healthy Blue Living. Individuals eligible for Medicare may be able to enroll in a Medicare product. For detailed eligibility information, go to medicare.gov.*

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Guiding your employeesPlan requirementsAt the start of the plan year, new employees automatically receive enhanced benefits for the first 90 days. To keep them, they must meet plan requirements. If they don’t, everyone on their health care contract moves to standard benefits on Day 91 and stays there for the rest of the plan year.

Renewing employees start at the level of benefits they had in the previous plan year. If they were most recently at the enhanced benefits level, they’ll stay there as long as they complete all necessary requirements. If they were at the standard benefits level, they’ll start the new plan year there, but can still work to meet the enhanced requirements.

In 2017, Healthy Blue Living requirements will no longer apply to covered spouses. Only your employees will be responsible for meeting the plan requirements. Your employees will earn everyone on their health care contract enhanced benefits by completing the tasks below.

Earning enhanced benefits

The employee must:

✓ Visit a Blue Care Network primary care physician and have the doctor complete and electronically submit to us a Blue Care Network Qualification Form.*

✓ Meet six health measures or commit to the doctor’s treatment plan to improve his or her health. See the next page.

✓ Complete a health assessment* by logging in to their account at bcbsm.com. A paper copy can be requested by calling 1-855-326-5098.

Within the first

90 DAYSof plan year

If the employee:

✓ Is a tobacco user, and he or she is ready to set a quit date, he or she must enroll at no extra cost in Tobacco Cessation Coaching, powered by WebMD. If he or she isn’t ready to set a quit date, then participating in Lifestyle Coaching is required until the end of the plan year or until the employee quits using tobacco. This must be confirmed by a new qualification form showing a negative cotinine test.

✓ Has a body mass index of 30 or more — confirmed through his or her qualification form — then he or she must enroll and participate at no extra cost in our weight-management program until his or her BMI falls below 30.

Employees should consult with their primary care physician before starting any regular exercise or weight-management program.

If any employees are required to participate in our tobacco-cessation program or weight-management program, we’ll send them letters with enrollment information.

* Renewing employees who scored all A’s on their most recent qualification form may not need to complete another health assessment or qualification form this year. How often they must meet requirements depends on their age. See Page 6.

Within the first

120 DAYSof plan year

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Moving to standard benefitsAll of your Healthy Blue Living employees have the same great benefits package as one another no matter which benefits level they’re in. However, if an employee doesn’t meet the enhanced benefits requirements, everyone on the employee’s health care contract moves to the standard benefits level on Day 91 and will stay there for the rest of the plan year. That means higher out-of-pocket costs for everyone on the employee’s contract.

6 key health measures

Healthy Blue Living focuses on six areas of health that increase the likelihood of a person developing a chronic or disabling condition. These six health measures also affect health care costs. One of the goals

of Healthy Blue Living is to help employees achieve these wellness targets to avoid

illness and higher health care costs.

Tobacco

Weight

Blood

pre

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Cholesterol

Blood sugar

Dep

ress

ion

LDL-C below target (based on risk factors: <100, <130 or <160)

Body mass index below 30

Below 140/90At or below target (fasting

blood sugar or A1C)

Any depression is in full remission

Doesn’t use (confirmed by primary care physician through blood or urine cotinine testing)*

* After one negative test, no testing is needed again. Self-reported tobacco users don’t need the test.

Blue Care Network is committed to helping members achieve their best health status. Rewards for participating in our wellness program, Healthy Blue Living, are available to all contract holders who meet all qualification requirements. If any contract holder thinks they might be unable to meet a standard or requirement for a reward under this wellness program, they might qualify for an opportunity to earn the same reward by different means. They can work with their BCN primary care physician to find an alternative that’s right for them in light of their health status.

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The ABCs of the Blue Care Network Qualification FormEach health measure on the qualification form tracks an employee’s status using a simple “A, B, C” grading system. A’s and B’s will earn an employee enhanced benefits and one or more C’s moves everyone on his or her contract to standard benefits. C’s mean that an employee hasn’t met a wellness target and hasn’t committed to treatment to improve a condition.

All A’s relax the rules

Completion of the health assessment and qualification form aren’t required every year for employees who scored all A’s on their most recent qualification form. It’s required every two or three years, depending on their age. We’ll send a letter to them when it’s time to complete a new health assessment and qualification form.

Age Under 40 40 or older

How often Every three years Every two years

Qualification form status

We provide a paper qualification form in each employee’s renewal packet only as a sample of the form his or her primary care physician electronically submits. Your employees should take the qualification form to appointments to remind the doctor that he or she is enrolled in Healthy Blue Living. We don’t accept paper qualification forms.

Your employees can check online to see if their qualification form has been submitted. They can also view their health measure grades, lab values, test results and requirements for weight management or tobacco cessation by:

• Logging in to their member account at bcbsm.com.

• Clicking My Coverage, Medical and then To-do List.

They can also call the Customer Service number on the back of their Blue Care Network ID card.

Auto renewal for our weight-management programEmployees whose qualification form still shows a BMI of 30 or more can continue in their program without re-selecting it. If they want to switch programs, they can call the Customer Service number on the back of their BCN ID card or log in to their account at bcbsm.com. Auto renewal applies only to employees who: 1) were compliant in the previous plan year; 2) are actively participating in a program; and 3) had their doctor submit an updated qualification form showing their BMI is still 30 or more.

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Member communications timelineWe send information and periodic reminders to new employees about what they need to do to earn and keep enhanced benefits. Steps are similar for renewing employees.

Day 1: Enrollment

Welcome kit, including qualification form and personalized Member Handbook of benefits

Reminder letter listing incomplete requirements

Recorded reminder phone call about incomplete requirements

Letter about outstanding online health assessment, qualification form or both, and standard benefit status

(To employees with a tobacco-cessation or weight program requirement) Letter and guide explaining details and enrollment instructions

Notice of contract’s drop to standard benefits due to unmet tobacco or weight-management

requirement or missed deadline

Letter spotlighting upcoming plan year changes

Notice of contract’s drop to standard benefits due to unmet tobacco-cessation, weight-management requirement, or both

Day 365: End of plan year

*Varies by date we receive the qualification form

Day 7

Day 45

Day 65

Day 105

Up to day 110*

Up to day 121

30 days before group’s renewal date

Up to day 364

Renewal kit to active employees with Member Guide

2 weeks before end of plan year

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Member discountsMembers have access to exclusive discounts on a variety of health products and services from groceries and fitness gear to travel and gym memberships. Members can take advantage of these offers and more by:

• Logging in to their member account at bcbsm.com.

• Clicking Member Discounts with Blue365® on the right side of the home page.

Digital Health AssistantSM programsAfter members complete a health assessment, they’ll receive recommendations for WebMD’s Digital Health Assistant online coaching programs. These include:

Let our health care plan work for your employees…

• Conquer Stress

• Eat Better

• Enjoy Exercise

• Lose Weight

• Quit Tobacco

• Feel Happier

The Digital Health Assistant programs help members set small, achievable goals that they commit to for one week. They can choose activities, create plans and track their progress on the Blue Cross Health & Wellness site.

PublicationsEmployees receive a special issue of our award-winning Good Health magazine in the spring and fall. It’s loaded with health tips and lifestyle advice. Health and wellness information is also online at facebook.com/MiBCN.

And everyone can sign up for our free monthly e-newsletter at bcbsm.com/enewsletters. Readers learn to improve their health with articles, videos, tips and recipes.

24-Hour Nurse Advice LineFor no extra cost, members can speak to a registered nurse 24/7, toll-free at 1-855-624-5214 or 711 (TTY). A registered nurse can answer health care questions, assess symptoms and provide self-care tips, and give advice on making decisions about treatment options for a condition or disease.

Outstanding customer serviceOur dedicated Customer Service representatives are trained to answer members’ questions and are just a toll-free phone call away. Members can call the Customer Service number on the back of their Blue Care Network ID card.

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…and for youGroup Secured ServicesUsing a secure, private, online account makes managing your health care plan easier. Log in to your employer account at bcbsm.com any time to access helpful tools and resources. Depending on your plan, you’ll be able to:

• View group and member information, add and update member contracts, and request ID cards.

• Access your group account through eBilling.

• View, download and email benefit guides for employees.

• Receive wellness education materials to share with your employees.

Blue Care Network agents and sales representativesTalk with them for guidance. They can help you make the best choices for your business.

Blues MarketplaceSM — Customer EditionOur monthly e-newsletter provides news and information of special interest to you. To sign up, log in as an employer at bcbsm.com.

Field ServicesIf your group has ten or more employees, call toll-free 1-877-465-5120 to have a Blue Care Network field specialist assigned to you. You’ll get concierge-level customer support, including claim and benefit assistance, on-site visits and presentations to employees at open enrollment events.

bcbsm.com gives members the power to make smart health choices.

When adult members sign up for a member account, it gives them:

An easier search: See what’s covered, and look up doctors, hospitals and treatments in one spot.

The complete picture: Plan for surgery by knowing all services involved, each of their estimated costs, and overall timing — from initial visit through therapy.

Healthy choices: Manage goals and fitness with Blue Cross® Health & Wellness, powered by WebMD®.

Find us online:

bcbsm.com | news.bcbsm.com | facebook.com/MiBCN ahealthiermichigan.org | twitter.com/bcbsm | youtube.com/bcbsmnews

R055730CB 16049 AUG 16 Blue Care Network is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.