Frequently Asked Questions: Overview of the Comprehensive Wellness Initiative

  1. Why is the State Health Plan implementing a Comprehensive Wellness Initiative (CWI)?
  2. Who is eligible for the wellness initiative?
  3. When does the comprehensive wellness initiative begin?
  4. How and when does the CWI take effect? What steps do members have to take?
  5. What if subscribers do not want to fill out the attestation form because they consider it personal information?
  6. If the subscriber is the only family member who smokes or has a BMI over 40, why can’t the subscriber be on the 70/30 plan and the dependents on the 80/20 plan?
  7. If members quit using tobacco or lower their BMI during the benefit year, may they change plans?

1.) Why is the State Health Plan implementing a Comprehensive Wellness Initiative (CWI)?
In April 2009, Senate Bill 287 became law (Session Law 2009-16). Contained in the Law is a section calling for a Comprehensive Wellness Initiative (CWI) for members of the State Health Plan for Teachers and State Employees (Plan). This initiative was developed to encourage Plan members to make healthy lifestyle choices. It also provides supports to help members quit using tobacco and maintain a healthy weight. The goal of CWI is to engage members in managing their health effectively, while saving money for themselves, the Plan and taxpayers in the process.

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2.) Who is eligible for the wellness initiative?
Both the smoking cessation and weight management components of the Comprehensive Wellness Initiative apply to all members who are active employees and retirees, as well as their covered dependents. Members enrolled in the Plan through COBRA are also included in this initiative. CWI does not apply to members whose primary coverage is Medicare.

3.) When does the comprehensive wellness initiative begin?
Effective July 1, 2010, all Plan members will move to the 70/30 plan. Members who apply and qualify for the 80/20 plan will be allowed to choose that option.

Year 1: The tobacco cessation component will begin on July 1, 2010. Subscribers and their covered dependents who do not use tobacco products, or who qualify for an exemption, will have the option to enroll in the 80/20 plan.

Year 2: The weight management component will begin on July 1, 2011. Subscribers and their covered dependents who do not use tobacco products, and who have a BMI less than 40 or qualify for an exemption, will have the option to enroll in the 80/20 plan.

Year 3 and going forward: The weight management component will be changed on July 1, 2012 to include members who have a BMI less than 35.

A member education program will outline all components of the Comprehensive Wellness Initiative in advance of implementation.

4.) How and when does the CWI take effect? What steps do members have to take?
Effective July 1, 2010 and going forward, all State Health Plan members will be enrolled in the 70/30 plan. In Year 1, July 1, 2010 - June 30, 2011, subscribers who want to enroll in the 80/20 plan must declare on an attestation form that neither they nor their eligible dependents use tobacco products, or indicate that they qualify for an exemption.

In Year 2, July 1, 2011-June 30, 2012, and beyond, subscribers must declare on an attestation form that they and their covered dependents do not use tobacco products, have a BMI within the specified weight range, or qualify for an exemption. An attestation form is a legally binding document that subscribers must complete each year to apply for the 80/20 plan. This form must be completed at annual enrollment, or when a new member first enrolls in the Plan. Subscribers who want to stay in the 70/30 plan do not have to complete an attestation form.

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5.) What if subscribers do not want to fill out the attestation form because they consider it personal information?
Subscribers who do not submit a completed attestation form will remain in the 70/30 plan, along with any covered dependents.

6.) If the subscriber is the only family member who smokes or has a BMI over 40, why can’t the subscriber be on the 70/30 plan and the dependents on the 80/20 plan?
In order to be on a separate policy, a member must be eligible because of employment or retirement. Dependents are not eligible for their own policy with the Plan. Therefore, dependents must be on the same policy as the subscriber and have the same plan type (70/30 or 80/20) as the subscriber.

7.) If members quit using tobacco or lower their BMI during the benefit year, may they change plans?
Not at this time. After the first year of the program, the Plan will assess the costs and processes required to allow a status change mid-year.

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