This is the fifth in a series in which Penn State Employee Benefits staff explain key concepts, terms and processes to help faculty and staff better understand and use their health benefits.
It’s important to have a basic understanding of the medical coverage and anticipated out-of-pocket expenses associated with one of the Penn State health plans, but Penn Staters should also be aware of several free or discounted health-management programs that are available to them. These programs assist in preventing the development of certain diseases or in managing current health conditions. While some are available to members of one of the Penn State Highmark plans, others are open to all employees.
Value-Based Benefit Design (VBBD): This program provides assistance to PPO Blue Plan members who have been diagnosed with at least one of three chronic medical conditions: high blood pressure, high cholesterol or diabetes. The VBBD program is designed to encourage plan members to manage these diseases with the intent of arresting or slowing their progression and thereby encourage healthier outcomes. As part of this program, office visits, lab work and medical supplies are covered at 100 percent with no co-pays, deductibles or coinsurance for these conditions. Participation in VBBD is free and voluntary, but annual enrollment in the program is required and participants should follow their in-network physician’s plan of care for their particular medical condition. To learn more or to enroll, Penn State PPO Blue members should call the Penn State Highmark dedicated unit at 800-914-4384, or visit the main page of the Highmark website at https://www.highmarkblueshield.com/home/.
Tobacco Cessation: Tobacco use is the leading preventable cause of death. Tobacco utilization affects nearly every system in the body and detracts from a person’s ability a live a life free from functional capacity limitations and illness; for every person who dies because of smoking, at least 30 people live with a serious smoking-related illness. In addition, cigarette smoking may affect the health of family members through exposure to second-hand smoke. For this reason, Penn State is committed to providing support for employees and their family members who are trying to quit.
Tobacco Cessation Medications and Products: The Affordable Care Act requires that tobacco cessation medications are provided at no cost share to health plan participants, so Penn State health plan subscribers can obtain free tobacco cessation medications, such as Chantix and over-the-counter (OTC) preparations, including nicotine gum and patches. Even though many of the products are available in OTC form, this program does require a prescription from a physician. Here’s how it works: a Penn State Highmark plan member secures a prescription for a smoking cessation medication or product and takes it, along with his or her Penn State Highmark insurance card, to a participating Express Scripts pharmacy. The pharmacist will fill the prescription and will use the individual’s Highmark insurance card as evidence of eligibility for the program. There is no cost-sharing associated with this program, so none of the products are subject to co-pays, deductibles or co-insurance fees. Since it takes an average of seven attempts to stop using tobacco, there is also no limitation on the number of times or length of time a person may participate in this program.
Tobacco Cessation Programs: For employees who wish to receive some extra assistance in the form of tobacco-cessation coaching, there are several free programs available:
- Health Advocate Take Control for Good Tobacco Cessation: This confidential 13-week program provides participants with unlimited access to their own personal coach, who assists them in creating their own quit plan while providing support every step of the way. Take Control is available to all benefits-eligible employees, their spouses, dependent children, parents and parents-in-law. To begin working with a coach, call 866-799-2728.
- Highmark Telephonic Smokeless: Telephonic Smokeless is a one-year telephone-based program that includes five scheduled outbound calls by a Highmark member’s own professional tobacco cessation specialist. Participants have unlimited inbound toll-free calls to address additional support concerns and receive support. For more information or to enroll, call Telephonic Smokeless at 800-345-2476.
- The PA Free Quitline: This tobacco cessation service, provided by the Pennsylvania Department of Health, is available to all Pennsylvanians. Participants access the program by calling 1-800-QUIT-NOW and after completing a brief intake questionnaire they are connected with a “Quit Coach” for a coaching session. Each participant receives up to five, proactive coaching sessions designed to support the quit attempt, and a two-week starter kit of nicotine replacement therapy (patches). The PA Free Quitline accepts unlimited, in-bound calls from participants to support quit attempts during high-stress times and in the face of various triggers (e.g., waking up, driving to work, out with friends). Evaluation calls are conducted at three-, six- and twelve-month intervals to establish quit rates. The PA Quitline provides services for 13,000 Pennsylvanians annually.
Personal Nutrition Coaching and Wellness Coaching are two programs available for free to Highmark members and may provide valuable assistance to an individual for planning a lifestyle modification program, understanding a health and wellness concept or and adhering to a wellness program.
- Telephonic Wellness Coaching: Members meet with a personal wellness coach, registered dietitian or exercise physiologist for sessions that last 10-20 minutes. Topics for discussion include the following: Review a wellness profile or biometric screening test and discuss how it relates to personal health risks, establish personalized goals for improving health through lifestyle behavior change, receive advice about weight management, tobacco cessation, nutrition, stress management or physical activity, or be connected to support materials and links to online tools, community programs and gym discounts.
- Telephonic Personal Nutrition Coaching: Nutrition coaching is free for Highmark members who reside in Pennsylvania, West Virginia and Delaware. This program pairs the Highmark member with a registered dietitian, who will assist that person in learning how to make healthful nutrition choices for the improvement or maintenance of overall health, gaining insight into basic principles of nutrition and addressing specific concerns such as weight loss, high cholesterol or diabetes. Highmark members are eligible for an initial 30-50 minute call, and up to two, 30-minute follow-up sessions per calendar year.
To access telephonic coaching, Highmark members may call Blues on Call at 888-BLUE-428 (888-258-3428) or the Highmark Wellness Resource Center at 800-650-8442.
Fitness Discounts: Highmark members are eligible for discounts for fitness facilities through the Healthways network, which allows them to join a network of fitness facilities at a discounted rate. Members are charged a $25 monthly rate for their membership when they pay a $25 enrollment fee and make a three-month commitment. During the month of September, Healthways is waiving the enrollment fee; use code “FallFitness2015” when enrolling.
Once in the program, members may visit any of the 8,000 nationwide participating fitness locations at any time, as often as they would like. To join the program or to view the list of participating fitness centers, please go to http://ohr.psu.edu/assets/benefits/insurance/health/documents/HealthwaysFitnessYourWay.pdf
Flu Vaccines: Annual Influenza vaccines are free for adults age 19 or over as part of the Highmark Preventive Schedule (http://ohr.psu.edu/assets/benefits/insurance/health/documents/PreventiveSchedule.pdf ). In addition, Penn State’s Office of Human Resources offers free flu vaccine clinics at all campus locations during the fall semester. These clinics allow Penn Staters to receive a flu vaccine without having to leave campus and travel to a physician’s office. Flu vaccines administered through the Penn State program are free for any employee regardless of health plan enrollment or the number of hours worked. They are also available free of charge to any spouse who is enrolled in the Penn State Highmark plan. Spouses who are not enrolled in the plan may receive the vaccine for a $24 fee. To register for a flu vaccine, go to the emPOWER registration site of the Office of Human Resources https://app3.ohr.psu.edu/emPower/frm_login.cfm