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© 2013 H

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10M 335 9/13 0096

HAP AspireHealth Engagement

Health

Alliance Plan

2850 W. G

rand B

oulevard

Detroit, M

I 48202

Your Member Kit Includes• Program Information• Qualification Form• Instructions

Dear Valued Member:

We are happy you are taking part in Aspire, a Health Engagement program. This program rewards healthy lifestyle choices by saving you money on out-of-pocket costs.

Save money—Choose the Aspire Enhanced Plan!When you choose the Aspire Enhanced plan (lower out-of-pocket costs), both you and your covered spouse are required to complete these three easy steps by your qualification end date:

1. Have your personal care physician (PCP) complete the Member Qualification Form located in the middle of this booklet.

2. Demonstrate your commitment to good health with a score of at least 80 on your Member Qualification Form.

3. Log in at hap.org and complete the free SUCCEED® Health Risk Assessment

If you choose the Aspire Standard Plan, you may have significantly higher out-of-pocket costs.

Remember, every dollar counts! Aspire provides you with an affordable quality health plan that rewards you for making healthier lifestyle choices. Complete the three easy steps to qualify for the Enhanced plan. You could save hundreds of dollars on your out-of-pocket costs.

If you have any questions about Aspire, call Client Services Monday through Friday, 7 a.m. to 7 p.m., and 8 a.m. to noon on Saturday toll-free at (888) 819-2540. If you are deaf, hard of hearing or speech impaired please use our toll-free Telecommunications Device for the Deaf at (800) 649-3777 or log in at hap.org.

As always, your membership is appreciated, and we look forward to serving as your health plan for many years to come!

Sincerely,

Richard D. ChaneyVice President, Client Services

IF YOU ASPIRE TO BE HEALTHIER, HAP IS HERE TO HELP

We believe a health insurance plan should always look out for your well-being. That’s why we created Aspire, a Health Engagement program designed to reward you as you participate in making healthier lifestyle choices.

It pays to enjoy a healthy lifestyle

Aspire offers two plan options:

• Enhanced plan The Enhanced plan can save you money on your out-of-pocket costs, but requires a commitment on your part. In the first 90 days, you’ll visit your doctor and get a deeper understanding of your health risks*. This will help you make healthy lifestyle choices and set healthy goals. New Aspire members automatically start in the Enhanced plan for the first 90 days.

• Standard plan The Standard plan provides access to the same quality care, but with higher copays and deductibles. At the end of the 90-day period, if you and/or your covered spouse have not completed the three steps, you will automatically be placed in the Standard plan. You and your spouse will stay in the Standard plan for the first 90 days of your next benefit period.**

* HAP covers these preventive services visits once every calendar year (January 1 through December 31).

** A typical benefit period is 12 months.

Changes to how you get preventive services benefits

Avoid cost-sharing and schedule your office visit once every calendar year—January 1 to December 31

Preventive services that are recommended once a year will be covered once in a calendar year without cost-sharing to you. If you receive preventive services more than the recommended guideline of once in a calendar year, you may be responsible for cost-sharing.

Don’t forget your 90-Day Qualification Period!

HAP will cover your annual exam for the Aspire Health Engagement Program once per calendar year. In order to qualify for the Aspire Enhanced plan, you will still need to get your Member Qualification Form completed within your 90-day qualification period.

Your HAP health plan covers the recommended screenings and immunizations, as well as additional tests that may be appropriate for your age, gender, and health. Your doctor can work with you to set your appointments at the appropriate time.

• Some preventive services may be recommended every three or every five years instead of once a year. These services will be covered based on the specified timeframe at no cost-sharing to you.

• If your plan allows cost-sharing such as a copay or coinsurance, you may have to pay out of pocket if you receive preventive services beyond the guidelines.

Step 2. Add up to 80 points.

To remain in the Enhanced plan, you will need to meet the wellness targets below to earn 80 points. If you do not or cannot meet the wellness targets, you still may be able to meet the program requirements by working with your doctor.

If you’re not willing to commit to lifestyle changes or work with your doctor to meet the 80-point program requirements, you will be moved to the Standard plan with higher out-of-pocket costs.

Lifestyle Behavior

Preventive Services

Tobacco/Nicotine Use

Weight Management

Blood Sugar

Blood Pressure

Cholesterol

Alcohol Use

Wellness Targets

All age/gender- and disease-specific tests are current or scheduled

Non-tobacco/nicotine user

BMI less than 30

Normal blood sugar or acceptable HbA1c (<8.0)

Below 140/90 If diabetic <140/80

Low density lipoprotein (LDL-C) at acceptable level (based on risk factors)

For men, less than or equal to 2 drinks per day on average. For women, less than or equal to 1 drink per day on average.

Points

10

25

15

10

15

15

10

A step-by-step guide to choosing the Enhanced plan

If you choose to stay in the Enhanced plan, you and your covered spouse need to complete the following three steps by the end of the qualification period:*

1. Meet with your HAP-contracted personal care physician (PCP) to complete and submit a Member Qualification Form.

2. Score at least 80 points on your Member Qualification Form (points are assigned based upon meeting specific wellness targets or by committing to participate in health improvement programs).

3. Log in at hap.org and click on the Health Engagement quick link to complete the SUCCEED® Health Risk Assessment.

Step 1. Complete and submit your Member Qualification Form.

• Schedule an appointment with your HAP-contracted PCP.

• If you don’t have a PCP, there are three ways to find one:

1. Register and log-in at hap.org and select Find a Doctor or Facility.

2. Call HAP toll-free at (888) PIC-A-PCP or (888) 742-2727

3. Use our automated services line toll-free at (877) 427-3678. You’ll need your PCP’s Provider ID when you call. The Provider ID may be found in the HAP Provider Directory or on hap.org.

Be sure the form is completed in full and received by HAP before the end of the qualification period. Either you or your doctor can submit the form, but please keep a copy for your records. If your doctor submits for you, you are responsible for verifying that HAP receives the form on time. You can view your status anytime by logging in at hap.org.

* If there are circumstances that make it difficult for you to complete any of the three steps for the Enhanced plan requirements, please call Client Services toll-free at (888) 819-2540. We’ll work with you confidentially to find the best solution for your situation. See Notice of Reasonable Alternatives.

Quitting tobacco/nicotine use

To add up to 80 points on the Member Qualification Form, you must be either tobacco/nicotine-free or commit to trying to quit.

HAP recommends several different treatment plans to help you quit:

• Smoking (tobacco/nicotine) cessation counseling services provided by your PCP

• Henry Ford Health System Smoking Intervention Program (SIP)

• Henry Ford Health System Freedom From Smoking Program (FFS)

• Prescription and over-the-counter smoking (tobacco/nicotine) cessation drugs or products, such as tobacco/nicotine patches, gum, nasal spray or inhaler*

• Electronic counseling services with the HealthMedia BREATHE® program

* HAP may ask you to send in your receipts for over-the-counter products

If you are asked for your receipts for any of the previous options, please

send them to: HAP, Attn: Correspondence Department, 2850 W. Grand Blvd.,

Detroit, MI 48202. Or fax your receipts to (313) 664-8400.

Step 3. Complete your Health Risk Assessment.

To help you understand your health risks, take the SUCCEED® Health Risk Assessment program, a free confidential online assessment. You can find this online assessment at hap.org. It takes about 20 minutes to complete.

When you finish the assessment, you’ll get a personalized plan, designed by health care professionals. This plan can help you make healthy choices, avoid pitfalls and ultimately achieve your health goals.

Remember, you must complete this assessment before the end of your qualification period if you choose to remain in the Enhanced plan.

It’s important for you to know that the personal health information you enter online in the assessment will not be shared with HAP or any other party without your specific consent, as required by law.

Log in, then select the Health Risk Assessment link from the Quick Links.

Example of how to save with the Enhanced plan.

Helen’s employer offers the Health Engagement plan. The plan provides Helen with a $1,000 deductible and higher copays if she stays in the Standard plan; but Helen will have no deductible in the Enhanced plan.* Helen is in pretty good health. Recently though, she hurt her knee while running a 5K race. Helen’s PCP referred her to a specialist to work on her knee. The specialist recommends an outpatient procedure to help Helen recover. The chart below is a breakdown Helen’s cost savings:

Enhanced Plan Standard Plan

PCP Visit $15 $30

Specialist Visit $30 $45

Outpatient Copay $100 $100

Deductible $0 $1,000

Total out-of-pocket costs: $145* $1,175*

* Costs vary based on your specific plan. This example shows a typical Health Engagement benefit plan. Please check with your benefit administrator for a complete summary and cost-sharing breakdown for your plan.

We want to help you meet your goals.

HAP provides you with programs and services geared to help improve your health – and your out-of-pocket costs.

• Tobacco/nicotine cessation therapies through Henry Ford Health System; arranged by your PCP and/or our online program.

• HAP’s Restore CareTrackTM – our award-winning disease management program that includes nurse health coaches and offers meaningful support in managing chronic conditions.

• HAP’s weight management program offers nutritional counseling, doctor-supervised and prescription-assisted weight loss programs and deep discounts on Weight Watchers® memberships – only $25 for a 12-week session.

• Web-based resources that include tools you can use to manage and understand any health conditions you may have.

• Magazines, newsletters, reminder cards and other materials to help you use your benefits to optimize your health.

• HAP’s HealthierU – This event pairs two dynamic speakers who will deliver education and inspiration that will give you confidence to achieve your personal health goals.

• HAP Advantage Program – Members can get valuable discounts and extras on health- and wellness-related activities and venues, plus museums, attractions and shopping. It’s one more way that we stretch our members’ health care dollars to help improve your health and well-being.

To learn more about our programs and services, visit us at hap.org.

FAQs

How often can I see my doctor for preventive care, such as meeting with my doctor to complete the Member Qualification Form?

For those preventive services that are recommended once a year, HAP will cover them once in a calendar year (January 1 through December 31), without cost sharing to you. If your HAP plan allows cost-sharing such as a copay or coinsurance, you may have to pay out of pocket if you receive preventive services more often than once in a calendar year.

What if my spouse does not want to work toward health goals?

Both the cardholder and spouse on the contract must complete the three steps if they choose the Enhanced plan. Once they complete the steps, everyone covered on the contract – including dependent children – will be placed in the Enhanced plan.

What information will be shared with my employer?

Your privacy is very important to us. No personal information from your Health Risk Assessment or Member Qualification Form will be shared with your employer.

Can I get an extension if I am unable to schedule an appointment with my personal care physician during the qualification period?

Unfortunately, no. Both the Health Risk Assessment and the Member Qualification Form are due by the end of the qualification period. If you have any difficulty in getting an appointment with your personal care physician, call HAP’s Client Services and they will assist you.

How often can I switch plans?

Each year during the qualification period you and your covered spouse have the opportunity to decide to participate in the Enhanced or Standard plan.

Do I need to complete the same three steps each year if I choose the Enhanced plan?

Yes. To choose the Enhanced plan, you and your covered spouse must complete the three steps annually.

Can I print a Member Qualification Form?

Yes. Log in at hap.org, using your HAP ID number and password. If you have not registered for the HAP website, you must do that first. After logging in, select Health Engagement from the My Plan tab to download a form.

I recently went to my physician for a physical. Do I have to go back to get the Member Qualification Form filled out?

Please contact your personal care physician’s office to determine if there is enough information on file for your physician to complete the Member Qualification Form without the need for a return visit.

How can I tell if my Member Qualification Form has been received?

Log in at hap.org, using your HAP ID number and password. If you have not registered for the website, you must do that first. After logging in, select Health Engagement from the My Plan tab and check your status.

It’s easy to access the online tools you need

Accessing the Health Risk Assessment

Log in at hap.org using your HAP ID number and password. If you have not yet registered, select Register Now. After registering, you will be redirected to the hap.org home page to log in.

1. Click on Health Risk Assessment in the Quick Links section

2. Start the assessment Click on Start Your Questionnaire or Retake Health Risk Assessment

Checklist – three steps to the Enhanced plan

Schedule an appointment with your personal care physician to complete the Member Qualification Form

Score 80 points or higher on the Member Qualification Form by committing to behavior and/or lifestyle changes, if necessary

Complete the SUCCEED® Health Risk Assessment at hap.org

You will get this screen if it’s been less than one year since you last took the Health Risk Assessment. Click on Retake Health Risk Assessment to begin.

Access your information

Click on Health Engagement on the My Plan tab to view your Health Engagement status. To protect your privacy, you may only access your own information. Other adults on your contract will have to log in separately.

Notice of Reasonable AlternativeHAP is committed to helping you achieve your best health. Rewards for taking part in a wellness program are available to all employees. If you are not able to meet a standard for a reward under any of our wellness programs, you might qualify for an opportunity to earn the same reward by different means. HAP Client Services Specialists are standing by to help you. They will also work with your doctor, if you wish, to find a wellness program option with the same reward that is right for you.