| What
is the BeniComp® Advantage? |
| The BeniComp® Advantage is a fully insured supplemental product that works in conjunction with your health plan to reward you for your healthy lifestyle choices. The increasing cost of health care has required an increase in the deductible under your base medical plan. BeniComp® Advantage is a tool that your employer is offering to help you offset the impact of the higher deductible. |
| How are
employees rewarded for healthy lifestyles? |
| Under this plan, a health screening will take place to assess basic health parameters. You will be evaluated on Blood Pressure, Cholesterol, Body Mass Index and Tobacco use. If your results fall within a specific range, you will qualify for wellness credits to be used to reimburse portions of your deductibles. |
| What are
the ranges for each of the above lifestyle qualifiers? |
The National Institute of Health publishes guidelines that BeniComp® Advantage uses as benchmarks. NIH guidelines are:
- Blood Pressure: <120/80
- Cholesterol LDL: <100
- Body Mass Index (BMI): <24.9
While these are established national guidelines, your employer may choose to modify these parameters. |
| Why
are these categories “singled out”? Shouldn’t we
address accidents and serious diseases instead? |
 |
The basic intent of an insurance plan is to provide benefits that promote employee’s self-management and preventative care and to help employees afford care if a catastrophic injury or illness occurs. Your base core medical plan still does this. Recent studies have shown that 70% of illness is lifestyle related and thus may be preventable. The Centers for Disease Control have estimated that one-third of all US deaths are related to diet, physical inactivity and smoking and that 30% of cancers in the US are related to obesity and diet.
While employees may not be able to control the fact that they have a disease, illness or injury they can control their own lifestyle choices. BeniComp® Advantage is a tool that rewards employees who choose to manage their own personal health and reduce their risks for future health related issues. This is similar to the concept of a “good driver discount” you enjoy with auto insurance. |
| How often
is the screening done? |
|
The screening
is performed once a year, prior to the start of the new plan year. |
| Will spouses
and dependent children be screened? |
|
Dependent children will not be screened. Employers decide which categories spouses will participate in. Typically they go through the full screening process or are simply graded on self-reported tobacco/nicotine use. |
| How much
does the screening cost? |
|
Your employer will pay the cost of the medical screening. Unless you choose to have additional optional tests performed, there will be no cost to you. |
| Who arranges
for the screening? |
|
Your employer has contracted with BeniComp® Advantage to coordinate all the arrangements for the screenings, which will be provided at your worksite. For those employees who work in remote locations, information regarding where your screening will take place will be provided separately. |
| Does everyone
have to participate? |
|
No one is required to participate in this program. It is entirely voluntary and up to each individual. However, by not participating, you will be responsible for the entire deductible. No credits will be awarded |
| How will
the employees receive the results? |
|
Test results will be sent to your home, in a HIPAA compliant manner with an explanation and outline showing the value of the credits for which you qualified. |
| Will my
employer see my results? |
|
Your employer will not see your individual test results. They will be provided a summary of the number of credits each employee received as a result of the health screening but will not know which categories or any specific results. |
| What about
employees hired after the first of the year? |
|
BeniComp ® Advantage will arrange for each newly hired employee to be screened and participate in the program regardless of when they are hired. |
| Are exceptions granted for individuals genetically predisposed to any of the
categories being screened? |
|
If an employee has to take medication to achieve the desired results they will still qualify for the rewards available. Additionally, if it is medically inadvisable or unreasonably difficult due to a medical condition for an employee to attempt to achieve the goals, they may receive an alternative way to earn the reward. Supporting documentation from their physician is required. |
| Will
the employees receive an insurance policy from BeniComp® Advantage? |
|
Yes. In the case where you qualify for the credits under the plan, a fully insured supplemental policy or certificate of coverage will be issued. The actual policy issued will be from the insurance company that underwrites the policy in your state. |
| Can the
employees take the policy with them when they leave the plan? |
|
Yes, you can continue on the BeniComp ® Advantage plan if you elect to continue coverage under the base medical policy through COBRA. |
| Can an
employee qualify for credits mid-year? |
|
Other than new hires, you can only qualify for the credits on an annual basis in conjunction with the setting of the annual plan deductibles. |
| Can
an employee still participate if they have a pre-existing condition? |
|
Yes. This program rewards healthy lifestyle qualities. Pre-existing medical conditions will not adversely affect coverage. In fact, even if you have high blood pressure and high cholesterol you can receive credits if you are following the treatment regime prescribed for your condition and fall within the criteria set for the wellness credit. |
| What
can I do to improve my health? |
|
Discuss the results of the screening with your personal physician and ask them to help you set goals and come up with a plan that will allow you to qualify for the credits next year. Also, participate in any wellness programs your employer may offer. |
| How do I file for reimbursement? |
|
When possible, your base medical carrier will send electronic claim files with your medical expenses and what has been applied to the deductible to BeniComp® Advantage. Once your portion of the base deductible has been met, you will begin receiving reimbursement checks up to the qualified amount. No forms need to be filed with BeniComp® Advantage. It will be your responsibility to pay the provider directly the amount you owe. In most cases, you will receive the reimbursement prior to the bill being received from the provider.
You will receive two Explanation of Benefit (EOB) forms. One from the base medical plan explaining what you owe because of the higher deductible and one from BeniComp® Advantage that will include a reimbursement check based upon the credits you earned. Use the reimbursement from BeniComp® Advantage to pay your bill from the provider. |
| Who do I call with questions about the BeniComp Policy? |
|
Prior to a policy being issued, questions should be directed to your Human Resources representative. Additional questions should be directed to BeniComp® at 800-837-7400. |
How do I appeal my screening results? |
|
You will need to complete a BCA Appeal Form.
Please click here for Q&A on our Appeals Process.
Call us at 866-222-0102 if you have any questions regarding the appeal process. |
| If you have questions regarding your deductible reimbursement from BeniComp® Advantage, call 1-800-837-7400. |
