Overview of the State Health Plan’s Member Wellness Initiative
Overview of the Member Wellness Initiative
The State Health Plan for Teachers and State Employees has a comprehensive member wellness initiative supporting healthy lifestyles and striving to keep members’ premiums and out-of-pocket expenses from increasing.
Statistics show that the two leading causes of preventable deaths in North Carolina are tobacco use and unhealthy diet/physical inactivity1 which may lead to the development of chronic diseases such as diabetes and heart disease.
The Plan estimates that claims for tobacco related issues may accumulate to over $137 million per year, while claims for chronic diseases related to obesity may be as high as $107.8 million per year. Given the significant impact on health status and cost, the Plan proposes an initial focus on tobacco cessation and weight management which calls upon members to take responsibility for their lifestyle choices.
The Plan asks members to self-report tobacco use and height/weight for the calculation of Body Mass Index (BMI).2 Those members who do not use tobacco, or have a BMI less than 40, would be able to choose the PPO Standard 80/20 plan or the PPO Basic 70/30 plan. Tobacco users and members with a BMI 40 or higher would automatically be placed on the PPO Basic 70/30 plan.
The member wellness initiative includes all covered dependents. (The initiative does not apply to Medicare-primary members.) The tobacco cessation component will begin on July 1, 2010. The weight management program will begin on July 1, 2011. A member education program will outline all components well in advance of implementation.
For more information, click here to view frequently asked questions (FAQs).
Please Note: All state and federal laws around privacy and confidentiality will be considered in the development of rules for the tobacco use and weight management programs. The legislation also includes a provision for a medical waiver for conditions that prevent the attainment of the specified weight range.
1 NCMJ July/August 2002, Volume 63 Number 4
2 Body Mass Index, or BMI, is a common measure expressing the relationship (or ratio) of weight to height. BMI is the CDC recommended indicator of body mass for most people and is used to screen for weight categories that may lead to health problems.
