FAQs

For questions about your healthcare plan(s) and Ascend to Wholeness as well as what to expect during the coming months and into 2018, please emailAscendToWholeness@adventistrisk.org.

 

For questions about eligibility issues, billing or to appeal a claim, please continue to email healthcare@adventistrisk.org.

Please contact your Adventist Risk Management (ARM) Account Executive or email AscendToWholeness@adventistrisk.org. We will be happy to review your request and coordinate with you for the best solution for your employee meeting presentation.

 

Large groups (100+ employees) We will try to coordinate a team of presenters such as those at the NAD HR Conference (as schedules permit).
Mid-sized groups (50-100 employees) We will coordinate with one key presenter.
Smaller groups (Less than 50) We are happy to arrange a personalized webinar/video conference meeting. We also will be recording a webinar version of this presentation which can be shared via web.

ARM is requesting permission from each NAD employer to directly contact health plan members to promote the NAD HCAP and Ascend to Wholeness. This communication would include direct mail pieces so that health plan members and their families can have the plan summary and FAQ information conveniently at their homes. The permission would also allow us to connect with them via email so they can be alerted to upcoming milestones such as the biometrics screening process, wellness topics, webinars about the plans, and how they can take advantage of the many resources and opportunities now offered to them and families.

 

During open enrollment the members/spouses will choose either the Accelerate Plan or Access Plan. If they choose the Accelerate Plan, they are agreeing to participate in care coordination. Adventist Health will provide coaching and information to address specific health concerns. When health plan members sign up on the Ascend to Wholeness portal (a requirement for those on the Accelerate Plan), they will be asked to provide an email addresses and phone number to be used to contact them about additional free resources such as exercise challenges, newsletters, etc.

As we transition to Ascend to Wholeness, the new 2018 integrated wellness program, we want to ensure that you have the opportunity to redeem the points you have accrued under the NAD Healthy for Life Rewards program. In partnership with HealthSCOPE Benefits, we have streamlined your gift card requests. The form can be accessed from the HealthSCOPE Benefits member portal in the Resources section entitled REWARDS GIFT CARD ORDERS.

 

It is critical that you allow enough time for processing of the claims that are eligible to earn 2017 Healthy for Life Rewards points such as an annual physical exam or dental cleaning. These type of visits need to be completed before the final quarter of 2017. We do not want to discourage you from getting these essential preventive exams in the final quarter of 2017 if you were unable to do so previously. However, please understand that if these visits are done within the last there months of the year, we cannot guarantee the claims adjudication process will be completed in time for you to be awarded points.
 

Listed below are the deadlines for redeeming 2017 and 2017 points:

• 2016 points deadline – June 30, 2017
• 2017 points deadline – January 31, 2018

The biometrics screenings and health assessments are structured to make it very easy for the health plan members to complete. Members may choose to attend a local biometrics event or visit their doctor and then fill out the assessment questionnaire.

Achieving the necessary amount of activity points may be a new concept for some health plan members and they will need clear instructions. However, during ARM’s due diligence which included studying other employer-offered health plans, this approach not only helps members to be more aware of their own health status but also drives member satisfaction.

Tracking points will be much easier for members as we move to the Ascend to Wholeness portal. This new version is mobile friendly and will be available as an app. Ease of use for health plan members has been a constant focus.

In addition, it will be possible to track steps or other activities using a variety of wearable devices. These can be set to synchronize with the portal to automatically post activities that accrue points.

Biometrics screenings will be coordinated through one of our vendors. Those NAD employers that have large concentrations of employees will coordinate with the vendor for the screenings to be conducted on-site. This is the most efficient and cost effective option. For health plan members who can’t make it to an on-site screening, the biometrics vendor will work with each employer to distribute doctor/lab slips so the members can be screened locally. In extreme circumstances, health plan members will be sent a home kit where they will conduct the screening themselves and mail in the results. This is the most expensive option.

Several NAD employers have developed robust wellness programs and we are confident Ascend to Wholeness will be complementary to those efforts. We will be reaching out to employers to find out more about their existing wellness programs so that we can determine how these programs can work synergistically.

During the current plan year, the covered employee and spouse will have the opportunity to complete the biometrics screening and wellness assessmentto assist them in their health journey. Eighty points can be earned through activities such as preventive care (a dental exam, annual physical, or vaccinations for instance) healthy lifestyle habits (examples include logging exercise, fruit/vegetable intake and water intake) and wellness webinars. Earning the activity points can vary each year and be selected to suit a health plan member’s personal goals. This is an example of empowering employees to manage their own whole person health.

The Accelerate Plan clearly provides the most value with lower out of pocket maximums, and integrated care coordination. However, employers are not allowed to force an employee to choose a plan with these requirements. Employees must be given the option to enroll in a plan that does not require wellness or other participation requirements.

Therefore, it is critical we collectively communicate the advantages of the Accelerate Plan to employees and their families. They would be missing out on the best value if they chose the Access Plan. 

Each health plan member will have the opportunity for a biometrics screening which will collect data such as cholesterol, body mass index numbers and blood sugar. In addition, each member will also have the opportunity to complete an on-line wellness assessment in a secure portal. The information from both sources will be shared with our Adventist Health team. With this information, various healthcare professionals will reach out to members as needed with specific issues to assist them in living healthier lifestyles. For example, if my results showed I was pre-diabetic, they would coach me on lifestyle changes that could prevent me from becoming diabetic. If my results show I’m already diabetic and on medication they will work with me as well. The Adventist Health team members also will have access to claims and pre-authorization data. If they pick up in the data that I have claims related to cancer, they will reach out and talk me through what to expect and assist with the treatment process.

The Adventist Health team has a medical director on staff who will be advocating as needed with the doctors and other providers in our network on the best treatments for the best outcomes for our health plan members.

Your personal doctor is always your first contact for your health. However, the Adventist Health team is advocating on behalf of you as a health plan member, and has had a very successful experience doing this for over 32,000 members covered by its own health plan. It would be foolish not to take advantage of the advice and expertise they can provide.

 

Ascend to Wholeness is an activity-based wellness program as opposed to a results-based program. This means that we as employees/spouses must agree to engage with the Adventist Health team. If for example, the results of my biometrics screening reveal that I’m 40lbs overweight, the Adventist Health team will discuss with me lifestyle changes to lose weight. If at the end of the year, I have not lost 40lbs, that does not prevent me from remaining in the program the next year. The key is that I’m participating in the program.

NOTE: The results from other Adventist health care employers across the country show that employees/spouses choose to be engaged once they have these kinds of resources made available to them. By participating in the wellness programs and care coordination, they have enjoyed positive lifestyle changes and improved health.

Our provider network is not changing. Only out-of-network services will be provided for emergency/urgent care and for specialized care that is not available within the network of our preferred provider organization (PPO). If the member believes there is no in-network physician or services available, the Unavailable Service Request needs to be submitted for pre-certification (done by the member and/or by provider). If the care coordination team confirms there is no in-network option, the pre-certification will be authorized. With the approved pre-certification, the claim would process overriding the “out-of-network” status of the provider. Without an approved pre-certification, the claim will be denied for payment.