Wellness Exam Incentive

The Texas A&M University System is taking steps to encourage employees to live healthier lives by actively engaging with a health care provider through utilizing preventive services available under the A&M Care Health Plan. To promote this healthy behavior, enrolled members will be required to receive an on-going annual wellness exam/annual physical to receive the lower wellness premium rate on their insurance.

NOTE: If either you or your spouse does not complete the wellness exam incentive during the applicable reporting period, you will not qualify for the lower wellness premium rate, and will instead pay a premium differential of $30 per month for each individual who does not complete the wellness exam incentive requirement. These additional premiums will remain in effect until completion of the wellness exam is reported from BlueCross BlueShield back to System Benefits Administration (approximately 90 days). The annual additional premium could be as much as $360/$720, so act now and make your wellness appointment before the deadline.

Wellness Exam Incentive Program – What's Your Status?

The publicized target deadline to have the annual wellness exam completed with your physician is by June 30 of each benefit plan (Fiscal) year. This is the recommended target date to have the exam completed with a physician, not necessarily the date the completion needs to be recorded. This date allows enough time for the claim to be processed by BlueCross BlueShield (BCBS) and recorded with A&M System Benefits Administration prior to the premium calculation for the upcoming benefit plan year. The typical claim processing time is 4-6 weeks from the date of your appointment.

If you HAVE had your wellness exam, check your MyEvive account to verify the recording is complete. If you believe you have completed the exam requirement but do not have a completion recorded, please see FAQ below for additional information and recommendations.

A comprehensive list of frequently asked questions related to the Wellness Exam Incentive is provided below. If you have additional questions related to the program, contact BlueCross BlueShield directly at (866) 295-1212 or Benefit Services at benefits@tamu.edu or (979) 862-1718.

 

Wellness (Annual/Physical) Exam Frequently Asked Questions

What is the System Wellness Exam Incentive and why is there an exam requirement?

The Texas A&M University System is taking steps to encourage employees to live healthier lives by actively engaging with a health care provider through utilizing preventive services available under the A&M Care Health Plan. To promote this healthy behavior, enrolled members will be required to receive a wellness exam/annual physical during the designated time period to receive the lower wellness premium rate on their insurance.

According to the Center for Disease Control, "Focusing on preventing disease and illness before they occur will create healthier homes, workplaces, schools and communities so that people can live long and productive lives and reduce their healthcare costs. Better health positively impacts our communities and our economy."

The wellness incentive exam requirement facilitates employees receiving the recommended preventive services and establishing a patient/physician relationship. Early detection and an engaged patient/physician relationship helps lower overall healthcare cost by reducing utilization of emergency room services and by preventing disease and/or treating conditions at earlier stages. A healthier population reduces overall health plan expenses for the A&M Care Plan.

Is the Wellness Exam Incentive an ongoing initiative or a one-time requirement?

Yes, the Wellness Exam Incentive is an ongoing initiative.  The Wellness Exam Incentive is designed to encourage ongoinghealth awareness and relationship with a medical provider. Through this on-going incentive, employees will be expected to receive an annual physical/wellness exam to continue to be eligible for the wellness premium rate (lower base premium). The annual exam should be completed each benefit plan year by the target date of June 30 year to allow enough processing time before the new premiums are calculated for the upcoming new benefit plan year in September of each year.

Example:  A wellness exam completed in FY16 applies to determine the premium rate for FY16, a wellness exam completed in FY16 applies to determine premium rate for FY17 and so on.

Who IS required to have a wellness exam as part of the Wellness Exam Incentive?

All employees or covered dependent spouses enrolled in the A&M Care Health Plan with an enrollment date prior to the beginning of the current benefit plan year will be required to complete a wellness exam during the current benefit year to determine the premium rate for the upcoming benefit year. Employees who meet the wellness exam incentive requirements will be eligible for the lower wellness premium rate for their health insurance.

Employees or dependent spouses enrolled in coverage during the current benefit plan year will automatically receive the wellness premium rate for the  remainder of the current benefit plan year and the upcoming benefit plan year and will have the wellness exam incentive requirement activated for the next reporting cycle.

Example: An employee or spouse enrolled in coverage to begin during FY16 will automatically receive the lower wellness premium for the remainder of FY16 and will receive credit for FY17.  Those individuals will need to have a wellness exam in FY17 to determine premium rate for FY18 and so on.

Who is NOT required to have a wellness exam as part of the Wellness Exam Incentive?

The Wellness Exam Incentive does not apply to retirees, working retirees, survivors, COBRA participants, dependent children, or employees enrolled in the fully insured Graduate Student Employee Health Plan. The wellness exam requirement applies to active employees and their covered dependent spouses enrolled in the A&M Care Health Plan.

While a wellness exam is not required of retirees, survivors, COBRA participants, dependent children, or those enrolled in the Graduate Student Health Plan, we encourage all individuals to continue their regular visits to their physicians for physicals and wellness exams.

What is the time frame in which the wellness exam incentive must be completed in order to satisfy the ongoing requirement for each Benefit Plan year?

The wellness exam incentive is an annual requirement. This annual requirement requires completion of the wellness exam during the current benefit year to determine the premium for the upcoming benefit plan year to qualify for the lower wellness premium rate for the upcoming benefit year.  The recommended target completion date for your wellness exam is by June 30 of each year to allow enough time for the claims process and the reporting of the completion by BCBS to System Benefits Administration prior to the first payroll calculation containing the premiums for the new benefit plan year (mid-September).

Employees (or spouses) who do not complete the wellness exam incentive will not qualify for the lower wellness premium rate until they have completed the wellness exam incentive which has been recorded from BlueCross BlueShield to System Benefits Administration. The increased premium will be changed PROSECTIVELY following the recording of the completion of the wellness exam and premiums will not be refunded.

I am a new employee or recently enrolled in coverage, do I need to have a wellness exam completed?
New employees and new enrollees (employees and their spouses) are provided a grace period to allow them enough time to have a wellness exam completed. Therefore, employees or dependent spouses enrolled in coverage during the current benefit plan year will automatically receive the wellness premium rate for the remainder of the current and the upcoming benefit plan year. They will have the wellness exam incentive requirement activated for the next benefit plan year.

Example: An employee or spouse enrolled in coverage to begin during FY16 will automatically receive the lower wellness premium for the remainder of FY16 and will receive credit for FY17.  Those individuals will need to have a wellness exam in FY17 to determine premium rate for FY18 and so on.

What happens if I or my covered spouse does not get the wellness exam?

If either you or your covered spouse does not complete the wellness exam incentive by having an annual exam each benefit plan year, you will not be eligible for the lower wellness premium rate and a monthly premium differential of $30 for each individual incomplete will be added to the employee premium and deducted from your paycheck for each month for each individual that does not complete the wellness exam incentive.

Employees or their spouses will qualify for the lower wellness premium rate PROSPECTIVELY once the completion of the wellness exam incentive is reported from BlueCross BlueShield to System Benefits Administration. The increased premium rate will continue to apply until the 1st of the month following recording of the wellness exam incentive and premiums will not be refunded.

Example: If either you or your spouse does not complete the wellness exam incentive the premium differential would total $360 in additional premiums during the full benefit plan year. If both you and your spouse do not complete the wellness exam incentive the premium differential would total $720 in additional premiums during the full benefit plan year.
Example:  If you are initially charged the additional premium for not completing your exam, but later have your exam in October and the completion is recorded at the end of November, then the additional premium will be removed beginning with the December premium calculation.
Why do I have to have a wellness exam with a physician instead of just getting a biometric screening?

Receiving a biometric screening and knowing your numbers is important to achieving a certain level of overall health awareness. However, a comprehensive wellness exam with a physician which includes preventive services and appropriate physician recommended screenings encourages engagement with a medical provider to establish a patient/doctor relationship and early detection of any potential health concerns. Early detection and an engaged patient/physician relationship help lower overall healthcare cost by reducing utilization of emergency room services and by treating conditions at earlier stages.

Do I need to tell my doctor/doctor's office this is a physical/wellness exam when I make the appointment?

Yes, because the wellness exam diagnosis code (a V code) needs to appear as the primary diagnosis code on the insurance claim in order for the office visit to be covered at 100% as a preventive service with no copay and for the exam to be identified so that you will receive credit for completion of the wellness exam, the doctor's office must be notified this is your wellness exam and that the billing claim should be coded accordingly with the wellness exam diagnosis code as the primary diagnosis code.

Up to five diagnosis codes can be submitted for a physician office exam. The current BlueCross BlueShield claim system electronically pays claims based on the diagnosis code in the first coding position. In other words, if that code is not wellness exam, you may not be recorded as having had your physical/wellness exam. This can often be adjusted by calling customer service and asking the representative to review the claim and letting the individual know that the claim was for a physical/wellness exam.

BCBS has a process in place to review all diagnosis codes on submitted claim forms during an audit process to help capture wellness exam completions; however, having the V code listed as the primary code expedited the proper recording of the wellness exam completion. Employees are encouraged to emphasize the wellness exam requirement with the doctor's office at time of the office visit.

Will I be charged a copay when I have my wellness (annual/physical) exam?

Under the Affordable Care Act, most preventive services conducted by a network provider, including physicals and wellness exams are covered at 100%. Therefore, you should not be charged a copay when you have your physical/wellness exam performed by a provider in the BlueCross BlueShield network unless the visit is not coded as a physical/wellness exam when sent by your physician to BlueCross BlueShield for claim processing.

If the office visit for the wellness exam includes services outside or beyond preventive services as billed by the provider, then an office visit copay may apply. Additional information on preventive services covered at 100% plan is available here.

Does this wellness exam need to include specific tests?

There are no specific tests that are required. Your physician will determine which tests to administer based on your age, gender and physical condition. While physicals and wellness exams often include such things as a blood pressure check, cholesterol test, glucose test, and/or a body mass index check, at this time, no specific tests are being required.

I am concerned about my privacy, what information is being reported back to my employer?

Privacy is understandably a great concern for many of us. As part of the Wellness Exam Incentive, BlueCross BlueShield will only report an individual completion status( basically a yes/no indicator) and date of completion directly back to System Benefits Administration to be used for determining the eligibility for the lowest wellness premium rate. No individual medical information such as test results, doctor information, diagnosis, etc. will be provided to System Benefits Administration or Human Resources.  Neither Human Resources of System Benefits have access to a member’s claim or Blue Access Member account.

Are there forms that I or my doctor needs to complete?

No, there are no forms that your doctor needs to complete to verify your wellness exam. The insurance claim submitted by the doctor should include a diagnosis code that indicates a wellness exam was performed which will be captured by BlueCross BlueShield during the claim payment process.

We have included a resource tool that you may take to the doctor’s office to help explain the wellness exam and the importance of a preventive diagnosis code on the claim filing.

 

How can I prepare for my exam and make the most of my appointment with the doctor?

There are steps that you may choose to take in advance of your appointment to help you get the most out of your time with the doctor during your wellness exam office visit:

  • Complete the BlueCross Blue Shield Health Assessment (HA) and bring the Provider Report with you to your wellness exam office visit. Instructions for accessing the HA are included at the conclusion of this document.
  • Print a list of current medications to bring with you to your wellness exam office visit. Instructions for accessing medication history through Express Scripts are included at the conclusion of this document.
  • Determine with your provider if any lab orders can be requested and completed in advance of your appointment in order for the results to be available for discussion during your appointment.
  • Additional tips are available at the Center for Advancing Health website.
Is a wellness exam the same thing as a physical or annual check-up?

Yes, a wellness exam is also referred to as a physical or an annual check-up.

Does an annual well-woman exam count as a wellness exam for the Wellness Exam Incentive Program?

Yes, an annual well-woman exam will count towards the wellness exam. However, women are encouraged to still consider having an annual physical checkup with a physician since a routine checkup will include different services and test than are performed during a well-woman exam.

If the A&M Care Plan is the secondary insurance plan for me or my spouse, how do I ensure the claim is reported to BlueCross BlueShield so I (or my spouse) still receive credit for completion of the wellness exam incentive?

A claim will need to be filed with BlueCross BlueShield even if our plan is considered secondary. Your doctor's office should already be filling the claim under both insurance plans, but if your doctor did not file the claim with BlueCross BlueShield as a secondary payer, please request that they refile to include BlueCross BlueShield. You can verify if a claim was received by BlueCross BlueShield by reviewing your Explanation of Benefits (EOB) documents.

How can I confirm whether or not I have received credit for completing the wellness exam incentive?

Texas A&M System in partnership with BlueCross BlueShield developed the MyEvive portal as a comprehensive gateway to your health information as a member of the A&M Care Plan.  You can easily view your current wellness exam incentive status along with when your next exam would be due.

1       Login to MyEvive at myevive.com/tamus-login

2       Click on the box Check my wellness incentive status

3       Review information contained in the Annual Physical section of the incentive page

4       Use the Click Here link to view a chart to help you determine when to have your next exam

I have not created or registered my MyEvive account. How do I register?

To activate your MyEvive account with BlueCross BlueShield, follow the below steps:

  1. Go to website myevive.com/tamus-login  
  2. Select the New User? Create an account below option
  3. Select Register
  4. Enter requested information including
  5. Complete the registration process.
If I believe I have had my wellness exam, but it is not reflected in my online MyEvive account, what should I do?

If you believe you have completed the wellness incentive exam requirement but have not received credit reflected in your MyEvive account to indicate completion of the wellness exam incentive, you should contact BlueCross BlueShield member services at (866) 295-1212 and request a review of the insurance claim from your office appointment. You will need to provide your member number along with the date of service and the provider. BCBS will review the claim and:

  • Adjust the claim as a wellness exam if a wellness annual exam code is listed as one of the diagnosis codes on the insurance claim or if they can determine from the claim that the services provided at the office visit would be inclusive of what would be performed of a wellness exam.
  • Notify you that the an annual wellness exam code is not listed as one of the diagnosis codes on the claim reviewed and information included on the claim does not support coding for a completion of the wellness exam.  If the claim cannot be determined to be reflective of a wellness exam, you will need to work with your physician to have the claim adjusted and resubmitted to BCBS.

NOTE: Claim processing time is variable and depends on when and how the claim is submitted to BCBS.

Supplemental Information

Instructions for accessing medication history with Express Scripts/Medco

  1. Go to website express-scripts.com.
  2. Log in to account or create/register new account.
  3. Click  Health & Benefits Information link.
  4. Select Prepare for My Doctor Visit from drop down menu.
  5. Select patient name.
  6. Click on View medication history link.
  7. You may also utilize the Print the Kit options that will print an entire packet that includes medication history, prescriptions benefit highlights and a RX fax form.