Let’s face it, your health and wellness is important! It’s true you’re important to your employer for the work you contribute to the company’s success, but it’s equally important for you to recognize that your health affects “who you are!” Sure you’re an employee, but you’re also a son or daughter, a Father, Mother, friend and/or care provider! When you’re as fit as you can be, even if you’re dealing with some health issues, you have more time, energy and a stronger will to accomplish the career goals you establish for yourself! You’re also a better asset to society, and if you have dependents, you’re better energized to deal with life’s opportunities for the sake of your dependents. Your health is not only important to you and your co-workers, but to everyone in your life. Striving for fitness then, is a wonderful goal.
Working with Simplicity Health Plans’ StayFit Plan, your employer now offers you some tremendous incentives for you to live a healthier life. You can now substantially reduce your out-of-pocket, HSA qualified expenses with employer contributions. To earn those incentive contributions, you just have to meet some very liberal health standards and then stay fit from year to year! It’s a win-win opportunity! Now, it literally pays to stay fit!
If you qualify according to a simple set of health standards, your employer will make incentive contributions to your HSA when you need the money to pay for qualified expenses. In short, the health incentive employer contributions are made available to every employee, even those with wellness issues, but they are tied to your individual health performance, and if you have dependents, to their performance in Simplicity Health Plans’ StayFit Plan.
In the StayFit Plan, Simplicity Health Plans examines, monitors and assists your Health and Wellness in three ways:
- According to Four Critical Wellness areas: Blood Pressure; Cholesterol & Triglycerides, Body Mass and Smoking;
- With certain wellness guidelines for particular health issues;
- Against four “at risk,” lifestyle behavioral “can’t do’s,” which if violated, disqualify you from the StayFit Plan.
The most encouraging feature of the StayFit Plan is that everyone has the opportunity to get fit in order to receive the employer contribution incentive awards. The most dramatic effect of this StayFit Plan is that it establishes a personal responsibility for each person’s health. You can lower your health costs if you improve your health. Your employer contributions are not dependent upon the health of others in the employment “pool.” So, if you work at being healthy, you will realize significant savings. It’s that simple! Now, it literally pays to get fit and to stay fit!
MAXIMUM ALLOWABLE: 139/89 (known as prehypertension)
“Blood Pressure” is the force of blood against the walls of arteries. “Hypertension” (140/90 and above) is caused when one’s blood pressure stays elevated for long periods of time. Basically, if you have high blood pressure, it’s an indication your heart is working too hard. It also causes hardening of the arteries, which is called “atherosclerosis.” If you have high blood pressure, your risk of heart disease and/or stroke increases significantly. Heart disease and stroke are the 1st and 3rd leading causes of death for Americans. High blood pressure can also cause other problems, such as heart failure, kidney disease, and blindness. The bad news is that most people have high blood pressure at some point in their lives. The good news is a healthy lifestyle with the proper attention can bring your blood pressure down to acceptable levels where you are not “at risk.”
Note: Maximum Allowable for those with Diabetes: 129/79
Ratio of LDL to HDL: Must be GREATER than 4.5
Total Cholesterol: MAXIMUM ALLOWABLE: 189
LDL is considered the “bad” cholesterol and you want lower levels. HDL is the good cholesterol and you want higher levels. If your LDL cholesterol level is 240mg/dL or higher, you are considered a high risk for heart attack and stroke. You also have twice the risk of other coronary problems, so you MUST consider this condition seriously! An HDL of 60 or more gives you some protection against heart disease. A triglyceride level of 150 mg/dL or higher is also one of the risk factors for heart disease and other disorders, including diabetes. Your screening tests will examine your LDL, HDL and your Triglycerides. Then, the values will be plugged into the following formulae to determine IF you pass:
The Ratio of LDL to HDL is calculated: LDL/HDL; Total Cholesterol is calculated: Total = (LDL + HD + (.2*Triglyceride Level))
MAXIMUM ALLOWABLE: 29 (which is borderline obese)
The body mass index (BMI) is a calculation that generally estimates a person’s body fat using a formula that considers your weight and height. The actual formula is: BMI = Kg / (m)2 where your Body Mass Index equals your weight, measured in kilograms, divided by your height squared, in meters (m). Your BMI tells whether you are underweight, average weight, at risk of becoming overweight, or overweight. People who are overweight increase their risk of developing health problems such as diabetes and high blood pressure. The BMI must be administered by Simplicity Health Plans or an approved physician familiar with BMI.
NOT ALLOWED
Smoking is the number ONE cause of preventable deaths in the developed world. It is estimated that 1 out of every 6 deaths are due to smoking. Smokers have more acute and chronic illnesses, more bed disability days and miss more work and school days than non-smokers. They account for a substanitally greater use of inpatient and outpatient hospital services and take far less advantage of preventative care services. Coronary artery disease, cerebrovascular disease, abdominal aortic aneurysm and peripheral vascular diseases are all caused by smoking. In men under 65, smoking accounts for about HALF of all coronary artery disease deaths. In women, there is even a greater risk of coronary artery disease when oral contraceptives and smoking are combined. The fact is, SMOKING IS BOTH ADDICTIVE AND DEADLY, and the average smoker spends about $2,000 more per year on medical expenses than non-smokers. So, if you elect to smoke, you shouldn’t expect your neighbor to pay your medical bills with higher premiums to cover your costs. It’s that simple. It’s not easy to quit smoking, but given the right incentives with the StayFit Plan, you now have a better than ever reason to quit. It pays to quit smoking!
If you now have or get one or more of the following medical conditions, your employer contributions will rely on your compliance with certain norms for health treatment. Your condition must first be revealed in a signed, Health Risk Assessment disclosure statement at the time of enrollment in the StayFit Plan, and/or subsequent to enrollment, you must contact your StayFit Plan Health Coach within 15 days after learning you have one or more of the following medical conditions. IF you follow the guidelines for health that are issued to you for your specifice health condition, you will be fully eligible for the employer incentive contributions. If you are non-compliant, you will be ruled ineligible (see “ineligibility rules”) Members’ dependents shall be held equally accountable for these eligibility rules.
1. Pregnancy
2. Athsma
3. Diabetes |
4. Coronary Artery Disease
5. Aids or any other Immune Deficiency
6. Cancer |
If you or your covered dependents conduct your lives in a reckless or risky manner, you will automatically be disqualified from the StayFit Plan. So, it pays to stay clean and sober, and to use seatbelts in cars! It also pays to work together as a family to get these valuable incentives. Following are the THREE disqualifiers:
1. Use of Illegal Drugs (everyone who applies shall be subject to a drug test)
2. Not using a seat belt in a Car Accident
3. Citations for Drunken Driving, either Driving Under the Influence, (DUI) or Driving While Intoxicated (DWI). |
In order to give every Member an equal opportunity to modify their behavior, seat belt and/or DWI or DUI citations issued prior to the StayFit Plan enrollment date shall not be considered. The same citations issued after the StayFit Plan enrollment date will invalidate all Employer incentive contributions retroactive to the beginning of the StayFit Plan year AND you will be ruled ineligible for the StayFit Plan for a subsequent 12-month period before you can enroll again.
Application: EVERY EMPLOYEE, regardless of their current health condition, shall have the opportunity to enroll in the StayFit Plan and to benefit from it. To enroll in Simplicity Health Plans’ HSA program, you must complete and sign a RISK ASSESSMENT and Application form. This form will also be used by the StayFit Plan for an initial assessment of your health.
Test: Then, to enroll in the StayFit Plan, you will either be given a Screening Test by Simplicity Health Plans, or you will be responsible for obtaining a Screening Test from a qualified Provider. Your personal Provider must be a physician. The purpose of the test is to establish benchmarks for your StayFit Plan. Your employer will make a contribution to your HSA to cover the cost of Simplicity Health Plans’ Screen Test, which is $50 for individuals and $100 for families.
Nominal Fee: There is a small Wellness Coaching fee of $10 per month, which is drawn automatically from your Simplicity Health Plans HSA. It’s a small investment that can pay big dividends! The StayFit Plan is simple and the savings are great!
Following are the schedules for the wellness incentives. As you will see, the StayFit Plan IS NOT an “all or nothing” opportunity to realize Employer contributions. The StayFit Plan gives you tremendous incentives for fitness, but it also gives you the opportunity to get fit and to stay fit for the life of the StayFit Plan.
Employer Contributions: Your employer may contribute up to $1,800 for Individuals and $4,500 for families to your HSA to help you pay your qualified medical expenses.
Amount of Employer’s Contributions: The total contributions your employer will make to your HSA qualified expenses are dependent upon:
1. Your Basic Qualification in the StayFit Plan
2. The Percentage of Critical Wellness Incentives that You Pass
3. Your Compliance with Compulsory Guidelines (if you have a wellness issue)
4. Not Being Disqualified from the StayFit Plan.
1. Your Basic Qualification in the StayFit Plan.
In order to first qualify for the StayFit Plan, you must fill out a Health Risk Assessment & Application Form. You must also take a Screening Test. The Screening Test will indicate in a “pass/fail” manner whether or not you qualify for the StayFit Plan at the time of enrollment. To qualify, YOU AND YOUR dependents MUST PASS AT LEAST 50% of the Four Critical Wellness Incentives. In subsequent years, you must also pass a screening test within 30 days of the anniversary date of your enrollment to remain enrolled in the StayFit Plan. If you do not pass the minimum 50% qualifying level after the first screen test, you will be given a “second chance” opportunity, six months after the first denial. This “second chance” is available ONLY during your first year in the StayFit Plan. You employer will even pay for 1/2 of the cost of the “second chance” screening test. If you qualify with your “second chance,” you will be entitled to six months’ worth of the eligible contributions.
2. The Percentage of Critical Wellness Incentives that You Pass.
Employer’s contributions are first determined by the percentage of the Critical Wellness Incentives that you pass. For instance, if you pass all 4 incentives, you receive 100% of the employer’s contributions when you need funds to help pay your HSA qualified, out-of-pocket medical expenses. If you pass three of the four incentives, you earn 75%. You must pass at least half, or 50% of the tests, or you do not qualify for any contributions.
3. Your Compliance with Compulsory Guidelines (if you have a wellness issue).
If you have a wellness issue at the time of enrollment, or if you develop a wellness issue during the year, the employer’s contributions will be rated according to your compliance with Health Coaching Guidelines that deal with your specific health issues. Each issue shall be considered an additional incentive opportunity. Thus, if you have 2 health issues, the percent of total employer contributions will be calculated on the 4 Critical Wellness Incentives PLUS the 2 Health Issues, for a total of 6 incentive opportunities. You must then pass 3 of the 6 to qualify for the 50% minimum. The Compulsory guidelines are simple to pass and require only your compliance with specific wellness protocols from your Health Coach. Your Personal Health Coach’s guidelines will NEVER contradict your personal provider’s recommendations.
4. Not Being Disqualified from the StayFit Plan.
If you violate any one of the “Disqualifiers” (listed above), you and your dependents will be disqualified from receiving employer contributions. Disqualification will be retroactive to the beginning of the StayFit Plan year and a penalty will be imposed upon your participation in the StayFit Plan (see below).
If you or any one of your dependents are DISQUALIFIED from the StayFit Plan for any one of the Disqualifier behaviors, your Employer Contributions are forfeited retroactive to the beginning of the StayFit Plan year AND you will be ineligible for Employer Contributions for the following year. That represents a TWO-YEAR suspension penalty! A second violation will result in a three-year penalty. A third violation will result in TEN-YEAR penalty. The penalties are stiff because the risks and the costs associated with these violations are a very SERIOUS matter.
Penalty Exception for families. There is an exception to the penalty rule for families where the StayFit Plan recognizes the good behavior and efforts of family members who would otherwise qualify if it were not for a certain “disqualified” dependent(s). A Primary Member may opt to exclude a certain dependent or dependents from his/her employer sponsored high deductible health coverage and from the StayFit Plan, in which case the Member must obtain a separate, individual health insurance policy for the excluded individual. The excluded dependent is not eligible to return to the StayFit Plan for one year from the date of exclusion, violation and disqualification. If you know that a dependent is drug addicted or would be non-compliant, you may want to consider the “opt out” option upon enrollment.
Just as you are personally rewarded for your efforts to get and stay fit, you must accept personal responsibility for personal indiscretions which bear significant health and wellness risks and costs! At the very least, the contributions your employer offers you are a great incentive to get healthy, to strive for a clean and sober life, and to use car seat belts when you are traveling. The StayFit Plan provides an incentive for you to ensure that you and your dependents follow good health and wellness guidelines for existing wellness issues. It’s up to you to take advantage of the help that is offered!
As noted above, the employer contributions pay for your qualified medical expenses that are covered under your employer sponsored health plan as you incur them. If you do not spend the contributions, your employer will make a cash contribution directly to your HSA in the amount of 10% of the unused portion of the contributions. This cash award gives you a reason to be conservative with your HSA dollars and you can watch your HSA grow with interest! Example: If the unused portion of the Employer’s contribution is $2,000, then your employer will contribute $200 to your HSA as a cash reward.
What if I only pass one of the Four Critical Wellness Incentives?
You do not qualify for the StayFit Plan! However, six months after the initial screening test, you will be given a “second chance” to qualify. As an incentive to get fit, if you then pass at least 50% of the tests, you will be eligible for the next six month’s contributions. You must then pass at least 50% of the tests at the start of the next calendar year in order to stay qualified for the StayFit Plan.
What if my dependents fail the screening tests?
Your family does not qualify for the StayFit Plan. Your family would be entitled to the “second chance” test after six months. You may also “opt out” certain dependents and insure them individually.
What are the “Guidelines” for Wellness Issues?
The basic Health and Wellness “Guidelines” FOR ALL of the Compulsory Guideline Health Issues are outlined in separate literature appropriate to your wellness issue. Special considerations are granted through your Health Coach. There are certain standard guidelines for everyone with like health issues, but your Health Coach will take into account your individual concerns and your medical provider’s recommendations in determining your exact guidelines. Your Health Coach’s recommendations will NEVER contradict your Health Provider’s instructions. You will be required to prove certain performances against the guidelines. Your individual health guidelines ARE NOT an “on your honor” type of arrangement.
If I pass all the tests, does my Employer contribute the whole amount to my HSA?
If necessary, yes! Each year, you are eligible to receive the total amount for which you qualify, but ONLY IF you need that money to pay for HSA qualified medical expenses that are covered under your employer sponsored health plan. These incentive monies are deposited only as you need the money to pay for your qualified medical expenses. Employer contributions are not carried forward from year to year. Each year begins anew with fresh screening tests. Thus, it pays to stay fit each year you belong to the StayFit Plan.
