MEMBER SERVICES

2018 PLAN OPTIONS

Ascend To Wholeness

The Accelerate Plan

Offers industry-best practice benefits at the best value in exchange for activity-based member engagement, integrated wellness and care coordination in partnership with Adventist Health. This plan also adds lifestyle management programs such as CHIP, Full Plate and Weight Watchers.

Ascend To Wholeness

The Access Plan

Provides quality, market-competitive benefits but no requirement for participation from members.

MEMBER FAQs

Plans

  • What are my health plan choices? 

    Effective January 1, 2018, the NAD is offering you two health plan choices which include exciting new features and enhanced customer service:

    The Accelerate Plan — offers industry-best practice benefits at the best value, in exchange for your engagement in the Ascend to Wholeness program, and activities such as integrated wellness and care coordination. This plan also incorporates lifestyle management programs such as CHIP, Full Plate and Weight Watchers.

    The Access Plan — provides quality, market-competitive benefits but requires no healthy lifestyle participation from plan members.

  • What does the Accelerate Plan require?

    Requirements for the Accelerate Plan help identify and reduce health risks to help you feel your best. Biometric screenings, wellness assessments, and health coaching are free and confidential. As an Accelerate Plan member, you (and your covered spouse if applicable), must each earn 200 points to qualify for the 2020 plan. If one of you does not reach the 200 points both of you will be defaulted to the Access plan in the next Open Enrollment.

    The requirements and related points are: 

    • biometrics screening (60 points)
    • online wellness assessment (60 points)
    • activity points (80)
    • participation in personalized health coaching and/or care coordination when suggested
  • What do biometrics screenings involve?

    Biometrics screenings are free confidential screenings for all Access and Accelerate plan members and their spouses. Screenings include total cholesterol, HDL cholesterol, glucose, blood pressure, height and weight, and BMI (Body Mass Index). You will receive further information regarding how and when to complete your biometrics screening.
  • What are activity points and how do I earn them?

    You can easily accrue the 80 activity points by engaging in your choice of a wide range of activities including:

    • Preventive care such as dental cleaning, an annual physical exam, Mammograms, Colonoscopy or vaccinations
    • Healthy lifestyle habits including tracking your steps, exercise, water intake or food and weight logs
    • Wellness webinars which span an array of important and informative health topics
    Choose activities you enjoy which meet your specific needs.
    There are options for everyone!
  • What is a wellness assessment?

    Along with the biometric screening, the secure online wellness assessment helps identify risk for diabetes, heart disease, hypertension and other conditions often preventable with lifestyle changes. This personal health questionnaire helps you learn what you’re doing right, track your progress and set health goals. The assessment is easy and takes approximately 15 minutes to complete. Upon completion, you will receive an actionable wellness plan based on your responses.

  • What is Care Management and Health Coaching?

    Confidential health coaching and care management are available to all Accelerate and Access plan members. If you are at risk for serious or potentially serious health issues, the Accelerate Plan requires you to participate in confidential care management. This free, phone-based program provides education and support through one-on-one health coaching. You will learn how to reduce risk, identify resources, overcome barriers and set goals to make lifestyle changes and improve your health. 

    If you or your family are enrolled in the Accelerate Plan and are contacted by care management but choose not to participate, you and your family will be moved to the Access Plan for the following year. You also may be contacted with an offer of confidential health coaching and care management services, available to all Accelerate and Access plan members.

     

  • What points are required in 2018 to enroll in the Accelerate Plan for 2019?

    To be eligible for the 2019 Accelerate Plan you must earn points in 2018 based on the following points structure:

     

    TOTAL POINTS Biometrics Screening/Wellness Assessment (required) Activities Points Date Eligible for Health Plans
    200 120 80 Jan 1 – Mar 31, 2018
    160 120 40 Apr 1 – Jun 30, 2018
    0 0 0 Jul 1 – Dec 31, 2018

Privacy

  • Will my employer have access to my health information?

    No personally-identifiable information will be shared with your employer (including Human Resources, your manager or supervisor). NAD employers receive only aggregated data stripped of personally-identifiable information. The NAD takes your privacy and confidentiality seriously.

     

    As your health plan administrator, ARM and all partners adhere to all HIPAA privacy regulations.

Important Deadlines

  • When do benefit changes take effect?

    These changes take effect January 1, 2018.
  • What if I forget to enroll or miss the deadline? Will I end up having no health coverage?

    You must take action! Enrolling is required for coverage under the 2018 Ascend to Wholeness Healthcare Plans.

     

    Changes in plans can only occur during open enrollment, unless you have a qualifying life event such as marriage, divorce, birth or adoption of a child, or a spouse losing or gaining other coverage. As you are accustomed, your employer will send out clear communications on the open enrollment process.

Biometric Screenings

  • What if I am not at a location where screenings are being held or I work remotely? Or what if my spouse cannot attend an on-site screening?

    If you work remotely or at a location where screenings are not offered, or your spouse is unable to attend an on-site screening, please contact your HR department to discuss your options for completing a health screening.
  • Do I have to participate?

    Yes, if you want to qualify for the 2019 Accelerate Plan.
  • On the day of the screening, what do I need to do?

    Bring your health plan ID card with you and wear sleeves easy to roll up for blood pressure measurement. If you’ve chosen the optional LDL/triglycerides screening, you will need to fast.

  • What tests will be performed?

    The screening measures height and weight, blood pressure, glucose, total and HDL cholesterol (finger stick) and calculates body mass index and body composition LDL cholesterol and triglycerides will be measured for those who fast.
  • How is a fingerstick performed?

    A small puncture is made in the 2nd or 3rd finger, and approximately four drops of blood are withdrawn. The blood from the capillary tube is then placed in a cassette, which is inserted into the reading instrument. The reading instrument requires less than six minutes to process the specimen.
  • Do I have to fast?

    Fasting is encouraged, but not required. A fast is not required for accurate results for total cholesterol, HDL cholesterol and glucose measurement. If you would like LDL and triglycerides measured, you will need to fast for 8-12 hours before your appointment. Fasting means no food or drink other than water, and no chewing gum. Participants should continue to take their medications as prescribed.” Be sure to DRINK PLENTY OF WATER and arrive fully hydrated.
  • How long will the screening take?

    The entire screening process typically lasts 15-25 minutes. This includes completing your registration form and the option to discuss your results with a health coach. Scheduling your appointment online will help your screening process run smoothly.
  • When and how will I get the results of my screening?

    Results from the finger stick blood draw are analyzed in about 5 minutes. Your results are recorded on a Health Screening Results form for you to view privately. These same results will be posted on your Wellness portal, as part of the requirements for Accelerate plan, in about 3 weeks after you have taken it.
  • Are the results accurate?

    Stringent guidelines for quality control and adherence are used in all screening procedures. Research indicates that blood samples processed by the Cholestech analyzer correlate highly (r > 0.95) with those processed by the CDC’s Cholesterol Reference Method Library Network. When Cholestech collection procedures are followed, you can be confident that your results are accurate.

    Your blood pressure is influenced by physical activity and stress. If you would like to help assure the most accurate blood pressure measurement, arrive 5-10 minutes early to your appointment to allow your heart rate to return to normal after walking.

  • Can I talk to someone about my results?

    Yes. You’ll have the opportunity to meet with a health coach to review your results and receive some suggestions for prospective next steps to improve your health, and to prevent illness and disease. The purpose of the screening is not to provide a medical diagnosis, but rather an overview of your results as well as to offer some tips to improve your health. The biometric screening is an opportunity to Know Your Numbers, build awareness, and help you determine if a follow-up visit with your personal care provider to further discuss your results is necessary.
  • Will my individual results be shared with my employer?

    No. Personal health information (PHI) is not shared with the participant’s employer. In conjunction with claims and demographic information, biometric screening data is used to determine general health status. A small percentage of individuals will be identified as candidates for care management. Those identified will be contacted by a care manager. Individual biometric data is not shared with anyone at Adventist Health outside of the care management team. All information is kept confidential and complies with the requirements of HIPAA.
  • Does it cost me anything?

    No. Your employer is funding the cost of this program and your participation is free. This is part of our commitment to your health.
  • Who administers the screening?

    Ascend To Wholeness has contracted with an independent biometric screening company to offer onsite screening services for eligible employees. Interactive Health is a professional health screening company that provides highly skilled, trained and certified professionals to perform the screenings.
  • I just had my annual physical or am scheduled to have one soon; should I still participate?

    Yes, we encourage you to complete the screening and share your results with your doctor. Completing the screening is one of the requirements for eligibility for the 2019 Accelerate Plan. You’ll also need to complete a wellness assessment on the Wellness portal in the Ascend To Wholeness website. Employees and spouses enrolled in the Access Plan are also encouraged, but not required, to participate.
  • Will this worksite preventive screening replace going to my doctor for an annual physical?

    No. Worksite screenings do not replace a complete preventive annual exam with a physician. It is meant to alert you to potential risk factors and you are encouraged to follow-up with your personal physician.

Families

  • Can my spouse be on a different plan? For example, may I choose the Accelerate Plan, while my spouse enrolls in the Access Plan?

    No, all participants in the same family must be on the same plan.

     

    The one exception to this rule is if you and your spouse are both NAD employees enrolled individually under your own coverage.

  • Do my children need to meet the wellness requirements for the Accelerate Plan?

    No, only you and your covered spouse are required to complete the Accelerate Plan requirements outlined in the open enrollment materials.

Cost Coverage and OUT-OF-POCKET

  • How much will my monthly contribution rate be?

    Contribution rates vary depending on the NAD employer. Please check directly with your human resources representative regarding your contribution rates.
  • Can I change my coverage after open enrollment?

    If you experience a life change during the plan year — such as marriage, divorce, birth or adoption of a child, or a spouse losing or gaining other coverage — you could qualify to make changes to your benefit plan.

    You are required to notify HR within 30 days of the date of the event to make benefit plan changes. Failure to notify HR within 30 days may disqualify you and require you to wait until the next open enrollment to make plan changes.
  • Am I able to continue seeing my current doctor?

    Our provider network is not changing, so unless your doctor leaves the preferred provider organization (PPO) network, you would be able to continue seeing that provider.
  • Can I go to any hospital I want?

    Our health plans only cover hospitals that are in our PPO.

     

    There are two exceptions:
    1) emergency/urgent care, and/or
    2) unavailable care.
    If specialized care is unavailable at a PPO facility, the health plan’s member services will help you complete an Unavailable Service request which, upon approval, would allow payment at a non-PPO facility.

  • What is an out-of-pocket maximum?

    An out-of-pocket maximum (OOP) is the most you’ll pay during a policy period (usually a year) for health care services.

     

    Once you’ve reached your OOP, your plan begins to pay 100 percent of the allowed amount for covered services.

  • Will it cost more for my prescriptions?

    Co-pays for prescriptions will remain the same on both plans.
  • Will there still be a vision and dental benefit?

    Yes, the dental and vision benefits will remain unchanged.

Additional Information

  • How do I find details of what is covered under each plan in order to make an informed decision?

    This information will be provided to you prior to open enrollment. Also, you may always visit your new, member-friendly website, www.AscendToWholeness.org.
  • Are these plans intended to “ration” care?

    Absolutely not. These plans enable you to get the right care at the right time to avoid preventable conditions, as well as to manage conditions you may already have. The plans are not designed to discriminate against the sick by denying them care. Quite the contrary — they are designed to extend preventive services and care coordination to those who are most in need.

MEMBER SERVICES

  • Will my HR representative still be able to help me when I have questions about my benefits or will I have to call a centralized number?

    HR representatives will continue to offer assistance with benefits and there will continue to be an 800-number available for claim and benefit specific questions.

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