Weight Management

The weight management component of the Comprehensive Wellness Initiative (CWI) was developed to help members achieve and maintain a healthy weight and to lower the costs associated with the treatment of health conditions caused or complicated by obesity.

July 1, 2011:

  1. All Plan members will be enrolled in the 70/30 Basic Plan
  2. Members may elect and qualify for the 80/20 Standard Plan if they or their dependents:
    • Have a body mass index (BMI) less than 40, or
    • Are actively trying to lose weight, or
    • Have a medical condition that prevents them from attaining the specified weight range as certified by a physician
  3. Plan members and their dependents may obtain an exemption to elect the 80/20 Plan if they have their doctor, nurse pratitioner or physician's assistant complete and sign a Physician Certification Form.  *To quality for an exemption, a member must be enrolled in a weight management program or have a medical condition that prevents them from attaining the specified weight range.

Body Mass Index (BMI) is a calculation using height to weight ratio to determine healthy weight and is a widely accepted and evidence-based tool used to screen for weight categories that may increase chronic disease.  www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html

Body Mass Index Examples:


Height

30 BMI

35 BMI

40 BMI

5’ 4”

174 pounds

204 pounds

232 pounds

5’ 8”

197 pounds

230 pounds

262 pounds

6’ 0’

221 pounds

258 pounds

294 pounds

TOOLS & RESOURCES

The Plan will make the following weight management resources available to members in January 2010.




WEIGHT MANAGEMENT TOOLS & RESOURCES

Nutrition Counseling

Four (4) nutrition counseling office visits with a licensed dietician will be available per Plan year for members and their dependents. 

Weight
Management Medications

Your physician may recommend medication or other supports to assist you in managing your weight.  Brand-name medications, such as Meridia and Xenical, have a $35 copay and will not require prior authorization.

Bariatric Surgery

Bariatric surgery is offered as a Plan benefit. 

*Members eligible for NC HealthSmart Services are members whose primary health coverage is through the State Health Plan. Federal law prohibits the State Health Plan from using your personal health information to discriminate against you in any way or from giving this information to your employing agency/school or other unauthorized third party, unless required by law.