Priority Health HMO Members
HealthbyChoice Incentives Plan
Question & Answer Document
Q1
What steps must I take to qualify for Choice benefits under the HealthbyChoice
Incentives (HbCI) HMO plan?
A1
You and your spouse (if enrolled) must complete these requirements in order for your family
to qualify for Choice benefits.1
1. Complete the online health risk assessment (HealthQuotient) at
www.priorityhealth.com.
2. Make an appointment to see your Primary Care Physician (PCP) and have your
physician complete the HealthbyChoice Incentives qualification form.
3. If your qualification form indicates that you met the criteria for the three health
indicators, you qualify for Choice Benefits.
If you or your covered spouse didn’t meet the health indicator criteria, you can still
maintain the Choice benefit level by:
a. completing a fasting cholesterol test,
b. completing a fasting blood sugar test, and
c. agreeing to the physician’s treatment plan.
This could require a lab visit and/or follow-up with your provider. Be sure to allow time
for this to be completed before April 1st.
Q2
What happens if I don’t meet all of the requirements? What if my spouse does not
meet all of the requirements?
A2
You will be moved to the Standard plan effective April 2, 2010. If your spouse is also
enrolled, both you and your spouse must complete the requirements in order to qualify. If
one of you does not meet the requirements, both of you and any enrolled children will be
moved to the Standard plan.
Q3
Once I complete my health-risk assessment, how long does it take for Priority Health
to recognize that I have completed that requirement?
A3
Results are reflected in Priority Health’s system the following day after you complete your
HRA on their website.
Q4
What happens if I am unable to get an appointment with my Priority Health Primary
Care Physician (PCP) to have my Qualification Form completed before March 31st?
A4
You shouldn’t have to wait more than one month to see your PCP for a routine visit.
Schedule your appointment before March 1st to ensure that you will be able to see your PCP
before the end of March. If your appointment is later in the month, remind your PCP that
your qualification form must be completed and sent to Priority Health by March 31st.
Q5
How can I get a HbCI qualification form to take to the appointment with my PCP?
A5
The form is available online at www.priorityhealth.com or from your provider.
Q6
When will I be moved to Standard benefits if I don’t complete the HbCI requirements?
A6
Priority Health moves members that did not meet the health-engagement qualifications to
Standard benefits effective April 2, 2010. Any medical services rendered on or after April 2,
2010 would be paid based on Standard benefits.
Q7
How will I know when I have completed all the requirements to remain in Choice
benefits?
A7
Priority Health sent members a reminder on February 15th that explained how to qualify for
Choice benefits.
You can view your status when you login as a member on the Priority Health website (use
your contract number shown on your ID card to create an account).
Once you have completed your requirements you will receive a letter telling you that you
have qualified for Choice benefits.
If you don’t qualify, you will receive a letter from Priority Health confirming that after April 1st.
Q8
Are there any instances when follow-up visits with my PCP are required to maintain
Choice benefits?
A8
You are encouraged to follow your physician’s treatment plan. It is up to the physician to
determine your level of compliance with the treatment plan.
Q9
If I get married during the year, does my spouse have to comply with the
requirements?
A9
New spouses added any time after enrollment will be assigned to your benefit level when
enrolled in your contract during the year. However, the spouse would be required to qualify
for Enhanced benefits in the next calendar year.
Q10
Where can I get more information about my plan?
A10
Your Priority Health Member Handbook includes more detailed instructions on completing
your HRA, HbCI program requirements, and other important information about your
coverage. You should have received one in the mail. You can also download one on the
Priority Health website at www.priorityhealth.com.
Feel free to call Priority Health Customer Service at 1-888-389-6646 if you need further
assistance.
Q11
I am a new hire that is eligible for benefits after January 1, 2010. Do I have to meet
any requirements in order to receive Choice benefits?
A11
If your coverage is effective between 1/2/10 and 9/30/10, you are required to meet the
requirements shown in Answer #1 within 90 days of your effective date. Your spouse (if
enrolled) must meet those same requirements in order for you and any family members to
qualify for Choice benefits. If one of you does not meet the requirements, all members in
the family will be moved to the Standard benefits after the 90 day qualification period.
Your next opportunity to qualify for Choice benefits will be the following January through
March for an April 2nd effective date.
1
Adult members with Medicare as their primary insurance are not required to meet the
requirements to receive Choice benefits. Contact UHR if you are not sure whether Medicare is
the primary insurer for you or your spouse.