New Hampshire Code of Administrative Rules
Ins - Commissioner, Insurance Department
Chapter Ins 400 - FILINGS FOR LIFE, ACCIDENT, AND HEALTH INSURANCE
Part Ins 403 - Standard Wellness Plan Rate and Form Filing Standards
Appendix B - NH HealthFirst Wellness Design
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Employees and Spouses |
Reward Per Adult |
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Year One |
Establish and continue relationship with a Primary Care Provider Complete a Health Risk Questionnaire Remain Smoke-Free or Participate in a Smoking Cessation Program Get a BMI measurement and Blood Pressure reading, and maintain a BMI of 25 and BP of 140/90 or participate in a health management program Get your Blood Glucose and Cholesterol levels checked, and maintain acceptable levels or participate in a health management program |
$200 for Meeting All Requirements |
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Year One - Within 8 Months of Employee's Effective Date |
Submit a Wellness Verification Form for Year 2 Deductible Credit |
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Year Two |
Complete a Health Risk Questionnaire Remain Smoke-Free or Participate in a Smoking Cessation Program Maintain a BMI of 25 and a BP of 140/90 or participate in a health management program Maintain acceptable Blood Glucose and Cholesterol levels or participate in a health management program |
$1,000 Deductible Credit for Meeting All Requirements |
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Year Two - Within 8 Months of Benefit Year Start Date |
Submit a Wellness Verification Form for Year 3 Deductible Credit |
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Year Three |
Complete Health Risk Questionnaire Remain Smoke-Free or Participate in Smoking Cessation Program Maintain a BMI of 25 and BP of 140/90 or participate in a health management program Maintain acceptable Blood Glucose and Cholesterol levels or participate in a health management program |
$1,000 Deductible Credit for Meeting All Requirements |
(1) $200 reward is granted to the subscriber, or to both the subscriber and the spouse or civil union partner, upon completion of all requirements and submission of the Wellness Verification Form. To receive the $200.00 reward for a family policy, both the subscriber and spouse or civil union partner shall establish compliance with all requirements.
(2) Deductible Credits are awarded for the benefit year period following submission of the form.
(3) For policies that cover 2 or more persons, the subscriber and spouse or civil union partner shall comply to obtain the deductible credit. If both satisfy the requirements, then the single deductible amount is reduced by 1 x the credit, and the family is reduced by 2 x the credit (i.e., one credit for each adult parent)
(4) The deductible for children covered under a family plan shall match that of the parents.
(5) The Form shall be submitted within 8 months of the benefit year start date to obtain the rewards.
