Human Resources
Wellness Incentive Program
Full-Time Faculty Program Overview 2015–2016
Here is all the information that you need to know in order to earn your Wellness Incentive — $240.00 (prorated per pay period) off
your annual health insurance premiums.
• Requirements must be completed between July 1, 2015 and June 9, 2016 and submitted to Human Resources by June 13, 2016.
Refer to the Faculty Contract for specific information on types of eligible requirements.
• Proof of Completion — See the requirements for proof of completion listed for each activity. Names of participants for
the Annual Health Power Profile are held on file in HR, therefore, no proof of participation is required.
• In order to earn the reduction in your health insurance premiums, you must complete the following requirements listed below. If
approved for the Wellness Incentive, Faculty on 26 pays will get a $10.00 reduction that will begin the first payroll of the fiscal year
and continue for 24 payrolls. Faculty on 20 pays will get a $12.00 reduction that will begin the first payroll of the academic year and
continue for 20 payrolls. This also applies if a spouse has been approved for the Wellness Incentive.
• Complete the Annual Health Power Profile offered each year. This is a mandatory requirement.
In addition to participation in the mandatory Annual Health Power Profile, you will need to provide proof of completion of three (3)
of the following requirements in the same fiscal year as the Health Power Profile.
1) Minimum of one activity class at COD or equivalent. Accepted activity classes include:
• Any PE Activity Class
Proof of Completion: Copy of final grade report or transcript for COD PE class or letter from instructor or fitness program for
PE classes taken outside of COD.
• Health Club Membership
Proof of Completion: Copy of Health Club Membership receipt of payment indicating current fiscal year enrollment and active
participation or record of health club visits.
• Participation of run or walk in “Laps with the Chaps” 5K
Proof of Completion: Documentation that you participated in the run or walk. Other activity equivalents are handled on an individual
basis. Please contact Human Resources if you have a question or to verify activity eligibility.
Two (2) different activities in the above category may be used towards satisfaction of the three (3) required in addition to
the Health Power Profile.
2) TLC Class Offering (or TLC Self-Study Class)
Only classes approved for this benefit, taken voluntarily by the Faculty Member and not used for any other benefit under this
agreement. Specific class offering eligibility requirements will be noted in the TLC offering announcements as they become available.
Proof of Completion: Copy of certificate of completion.
3) Supervised Weight Loss Program
Participation in a supervised weight loss program for a minimum of 10 weeks.
Proof of Completion: Copy of weight loss program enrollment and completion and receipt for payment.
4) Healthwise Handbook
Usage of the Healthwise Handbook.
Proof of Completion: Healthwise Handbook “Getting Healthwise” Form. This form should indicate how the book has benefited
you or a family member over the past year.
5) Physical Examination
Completion of a physical exam every three (3) years can be submitted. PPO Members can receive a physical exam through a
preferred provider, Northwestern Medicine Occupational Health (formerly Cadence) every three (3) years. Northwestern Medicine
Occupational Health can be reached at (630) 539-5270. Similar physical examinations can be scheduled through your personal
physician and submitted for this benefit once every three (3) years. Please contact Human Resources if you have a question or
to verify eligibility.
Proof of Completion: Signed and dated document from the physician’s office indicating completion of physical examination.
The same requirements listed above must be fulfilled by the employee’s covered spouse in order to earn the Wellness Incentive of an
additional $240 annually (prorated per pay period) in their health insurance premiums. However, some activities (i.e., TLC Courses) are
only available to COD employees.
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HR-15-19759(8/15)
Full-Time Faculty Wellness Incentive Program 2015–2016
Overview Form
Please print all information clearly. This form must accompany the proof of completed requirements. Do not send
form or supporting documents separately. Send all forms together to Human Resources. In order to receive credit,
all materials must be received no later than June 13, 2016.
Name: ____________________________________________________________________
Date: _________________________
Department: _______________________________________________________________
Extension: _____________________
Supervisor/Associate Dean’s Name: ___________________________________________________________________________
From the choices below, I am providing the required proof of completion documents for the Wellness Incentive Program:
__X__ Annual Health Power Profile in Spring 2016. This is mandatory to participate in the employee Wellness
Incentive Program. Names are held on file in HR, therefore proof of participation is not required.
_____ PE Activity Class (maximum of two only) — including Health Club Membership which counts as one activity.
_____ TLC Wellness Class (non-mandatory class sessions only)
_____ Healthwise Handbook “Getting Healthwise” Form.
_____ Physical Examination (once every three years) between July 1, 2015 and June 9, 2016.
_____ One 10-week supervised Weight Loss Program between July 1, 2015 and June 9, 2016.
_____ Laps with Chaps 5K run or walk.
An email confirmation will be sent to you upon verification of enclosed documents and approval of incentive.
—HR USE ONLY—
Full-Time Faculty Wellness Incentive Program
RECEIPT OF PROGRAM PACKET MATERIALS
Date Review: __________________________
Authorized by: ________________________________________________
Requirements Verified:
______ Health Power Profile — Mandatory ______ 10-week Supervised Weight Loss Program
______ PE Activity Class
______ Physical Examination (once every 3 years)
______ Health Club Membership ______ Healthwise Handbook
______ TLC Class Approved for Wellness Incentive?
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❑ yes ❑
______ Laps with Chaps 5K Run or Walk
no (if no, state reason: ______________________________________)
Getting Healthwise
2015–2016
Complete this form if you are using the Healthwise Handbook to earn your Wellness Incentive. Please print and return along
with your Overview Sheet. All sections must be completed with specific examples or information.
1. How long have you had a Healthwise Handbook (all versions)?
___ year(s)
___ month(s) (if less than one year, state how many months)
2. Where is your copy of the Healthwise Handbook?
❑ home
❑ work
3. How often do you (or your family) use the Healthwise Handbook?
❑ once in a awhile ❑ monthly ❑
weekly
4. List which chapters you found to be the most helpful and state why below:
Chapter #______: Title: ________________________________________________________________________
Chapter # ______: Title: ________________________________________________________________________
5. What are the two most common reasons you use the Healthwise Handbook?
❑ injuries
❑ sickness (colds, flu)
❑ tips on prevention
❑ accidents
❑ first aid
❑ learn how to work with my doctor better
❑ other _____________________________________________________________________________________
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Getting Healthwise 2015–2016 (cont.)
6. Over the past 12 months, the Healthwise Handbook has helped me and my family to save time and money
by doing the following (please enter the number of times for each below):
_____ # of phone calls to doctors saved
_____ # of visits to family doctor(s) saved
_____ # of visits to Urgent Care/Walk-In Clinic saved
_____ # of visits to Emergency Room saved
7. How have the Employee Wellness programs and services benefited you and/or your family? (check all that apply)
❑ improved my/our ability to prevent problems (i.e. accidents, injuries, diseases, aches, pains)
❑ improved my/our ability to better handle health problems
❑ helped me to be more productive at work
❑ reduced the number of times I got sick
❑ reduced the number of times family members got sick
❑ improved my/our early detection efforts
❑ improved my/our health
❑ helped to make me feel like College of DuPage cares about me and my family
❑ other (please specify): ______________________________________________________________________
_________________________________________________________________________________________________________ _________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Name: _____________________________________________________________________________________________________
Signature: _______________________________________________________________
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Date: _______________________