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Healthy Behaviors Programs

Prestige Health Choice offers Healthy Behaviors programs whereby members are eligible to earn rewards for completing certain health milestones.

All of the Healthy Behaviors programs require members to fill out a completion form (PDF) and return it to Prestige Health Choice before joining. The form should be filled out entirely and returned to the Prestige Health Choice Rapid Response and Outreach Team at 1-855-236-9281, or mailed to:

Prestige Health Choice
P.O. Box 7181
London, KY 40742

For the three programs listed below, members who are interested must see their primary care providers (PCPs), must qualify to participate in the program they are interested in, and must agree to participate in Prestige Health Choice’s Care Management program before joining and committing to the program.

A Care Manager will reach out to each member to discuss the selected programs in more detail once Prestige Health Choice receives the completed form. The Care Manager will contact the PCP’s office to confirm the member has received services required for receipt of the reward. Once the services have been verified, a gift card will be mailed to the member (or to the minor member’s parents or guardians). If the services cannot be verified, the member must provide documentation that the services were received.


These three programs don't expire or have a form deadline.

Members may participate in more than one program if they qualify.

  • Weight loss (provider signature required on form).
  • Smoking cessation.
  • Alcohol and substance use recovery.

The following programs require members to fill out and return a completion form (PDF).

These programs have a completion form (PDF) return deadline of January 31, 2020. The last day for completing services is December 31, 2019, which is also when these programs expire.

  • Maternity.
  • Postpartum.
  • Well-child (31 days to 15 months old).
  • Well-child (3 to 6 years old).
  • Adolescent well-care.
  • Adult access to preventive or ambulatory services.
  • Lead screening.
  • Diabetes testing.
  • Diabetes eye exam.
  • Behavioral health.
  • Breast cancer screening.
  • Cervical cancer screening.

After the member has completed the required number of visits for one or more programs, you can fax completion forms (PDF) to the Rapid Response and Outreach Team at 1-855-236-9281, or the member may mail the signed form in the prepaid envelope provided to the Prestige Health Choice address listed above. The completion form (PDF) may be used for participation in multiple programs as well.

Once the form is returned to Prestige Health Choice and once the services have been verified, a gift card will be mailed to the member (or to the minor member’s parents or guardians). If claims for services cannot be verified, the member will be responsible for providing proof of service. Members may enroll in more than one Healthy Behaviors program (if they qualify), and can receive a reward of up to $50 per program, per year. Members may only join each Healthy Behaviors program once per year.


Program details

Weight loss management

The Commit to Be Fit program provides members with weight loss resources and support, as well as rewards for dietary and nutritional counseling, behavioral therapy, and physical activity.

This weight loss program is for members who have a documented body mass index (BMI) of 35 or above and requires a provider signature on the completion form (PDF). The member will be engaged with his or her PCP and have initial and follow-up BMI assessments (initial, at five to seven weeks, and at three months) to maintain a medically supervised weight loss program.

BMI screenings will be conducted by the PCP at each visit to document improvement. Members can be referred to a participating dietitian or nutritionist and will earn a gift card for attending this appointment as well.

The Prestige Health Choice Care Management team will follow the member's progress by communicating with the member’s PCP. The overall goal is for members to reduce their BMI and decrease their risk of comorbidities.

Smoking cessation

This program will provide members with resources for smoking cessation. Care Managers will help members sign up for the Tools to Quit and Quit Smoking Now programs. A provider may also prescribe smoking cessation medication. Members will be coached by their Care Managers on following through with health goals and taught how to earn rewards for completing certain activities, such as attending a smoking cessation seminar and submitting a certificate of completion to Prestige Health Choice.

Please refer to the tobacco quick reference guide (PDF) for more information on smoking cessation.

Alcohol and substance use recovery

This program will provide members with resources for alcohol and substance use recovery services. Members will be referred to Prestige Health Choice’s current behavioral health vendor for program management. Treatment options include attending community support groups, such as Narcotics Anonymous and Alcoholics Anonymous. Providers will monitor each member's medication management, therapy, and psychosocial rehabilitation.

In collaboration with the current behavioral health vendor, Prestige Health Choice Care Management will follow each member's progress through communication with the member’s treating provider. The Behavioral Health Care Manager will also educate the member about rewards for completing health milestones, such as maintaining sobriety for 30, 90, and 180 days.

The goals of this program are to successfully engage the member in substance use treatment from the treating provider and help the member achieve sobriety and become healthier.

Prestige Health Choice asks that all PCPs and treating providers screen members for signs of alcohol or substance use as part of prevention evaluation at the following times:

  • Initial contact with new member.
  • Routine physical exams.
  • Initial prenatal contact.
  • When the member evidences serious overutilization of medical, surgical, trauma, or emergency services.
  • When documentation of emergency room visits suggests the need.
Maternity

This program is for pregnant members, regardless of the member’s pregnancy risk. Each member will receive a gift card for attending at least 10 of 13 prenatal visits and a postpartum visit. The postpartum visit must have occurred within 21 and 42 days after giving birth.

The member must have delivered a child on or between November 6, 2018, and November 5, 2019.

See how you can help members stay on track with our Bright Start® pregnancy program.

Postpartum

This program is for members who complete a postpartum visit between 21 and 42 days after giving birth. The member must have delivered a child on or between November 6, 2018, and November 5, 2019.

(Members who complete the Maternity reward program will not be eligible for the Postpartum reward program.)

Well-Child (for members who have turned 15 months old during 2019)

This program is for members who complete six or more well-child visits from 31 days to 15 months old. The member must turn 15 months old during the measurement year from January 1, 2019, through December 31, 2019.

Well-Child (for members who are 3 to 6 years old during 2019)

This program is for members who complete at least one well-child visit with a provider. Members will receive $20 for having the visit on or between January 1, 2019, and June 30, 2019, or $10 for having the visit on or between July 1, 2019, and December 31, 2019. The member must be 3 to 6 years old on or between January 1, 2019, and December 31, 2019.

Adolescent well care

This program is for members who complete at least one well-care visit with a PCP or an OB/GYN provider. Members will receive $20 for having the visit on or between January 1, 2019, and June 30, 2019, or $10 for having the visit on or between July 1, 2019, and December 31, 2019. The member must be 12 to 21 years old on or between January 1, 2019, and December 31, 2019.

Adult access to preventive or ambulatory services

This program is for members who complete at least one ambulatory or preventive care visit with a provider. Members will receive $20 for having the visit on or between January 1, 2019, and June 30, 2019, or $10 for having the visit on or between July 1, 2019, and December 31, 2019. The member must be 20 years old or older on or between January 1, 2019, and December 31, 2019.

Lead screening

This program is for members who complete one or more capillary or venous blood tests for lead poisoning in 2019. The member must be 2 years old on or between January 1, 2019, and December 31, 2019.

Breast cancer screening

A female member must complete one mammogram screening for breast cancer in 2019. The member must be 50 to 74 years old on or between January 1, 2019, and December 31, 2019.

Cervical cancer screening

A female member must complete one cervical cytology screening for cervical cancer in 2019. The member must be 21 to 64 years old on or between January 1, 2019, and December 31, 2019.

Diabetes testing

This program is for members 18 to 75 years old with diabetes who have both of the following diabetes tests completed in 2019:

  • Hemoglobin (HbA1C) blood test
  • Microalbumin urine screening/monitoring (kidney disease screening)

The member must be 18 to 75 years old on or between January 1, 2019, and December 31, 2019.

Diabetes eye exam

This program is for members 18 to 75 years old with diabetes who complete a retinal or dilated annual eye exam in 2019.

The member must be 18 to 75 years old on or between January 1, 2019, and December 31, 2019.

Behavioral health follow-up

This program is for members age 6 and older who were hospitalized for treatment of select mental illness diagnoses and had a follow-up visit with their provider within seven days of discharge from an acute behavioral or mental health inpatient setting in 2019. The member must be at least 6 years old on or between January 1, 2019, and December 31, 2019.


Members may enroll in more than one Healthy Behaviors program (if they qualify), and can receive a reward of up to $50 per program, per year. Members may only join each Healthy Behaviors program once per year. Member rewards cannot be used for certain products. These include alcohol, tobacco, gambling (including lottery), drug (except over-the-counter drug), firearm, or ammunition purchases.

For more information, refer to the Healthy Behaviors Program handout or Goal Completion Grid (PDF). Members may download a completion form (PDF), or call us to request a form be mailed. You may also contact your Provider Network Management Account Executive or call Provider Services for more information at 1-800-617-5727.