Mo. Code Regs. tit. 22 § 10-2.120

Current through Register Vol. 49, No. 23, December 2, 2024

Section 22 CSR 10-2.120 - Partnership Incentive Provisions and Limitations

PURPOSE: This rule establishes the policy of the board of trustees in regards to the Strive for Wellness® Partnership Incentive and the method and timeframes in which the requirements of the incentive must be completed and submitted.

(1) Strive for Wellness^® Partnership Incentive-The Partnership Incentive is a voluntary program that eligible members may elect to participate in to earn a reduction in premium. Eligible members are responsible for completing requirements.

(2) Partnership Incentive-The Strive for Wellness^® Partnership Incentive is a reduction in premium of twenty-five dollars ($25) per month per eligible member who is compliant with this rule.

(3) Eligibility-The following members enrolled in a Missouri Consolidated Health Care Plan (MCHCP), Preferred Provider Organization (PPO), or Health Savings Account (HSA) Plan are eligible to participate in the Partnership Incentive:

(A) Active employee subscribers; and

(B) Non-Medicare subscribers.

(4) Limitations and exclusions-The following members are not eligible to participate in the Partnership Incentive:

(A) Subscribers under the age of eighteen (18) years;

(B) Dependents;

(C) TRICARE Supplement Plan subscribers;

(D) Subscriber (with the exception of active employee subscriber) who has Medicare as primary coverage; and

(E) When Medicare becomes a subscriber's primary insurance payer, the subscriber (with the exception of active employee subscriber) is no longer eligible to participate and will lose the Partnership Incentive the first day of the month in which Medicare becomes primary.

(5) Participation.

(A) In order to receive the Partnership Incentive, eligible members must complete all of the following every plan year for the incentive to be effective the first day of the second month after the requirements are completed:

1. The Partnership Promise;

2. The Health Assessment; and

3. The Health Education Quiz. A series of questions administered by MCHCP designed to measure understanding of MCHCP benefits and/or general health knowledge.

(B) The requirements must be completed through the member's myMCHCP account.

(C) Eligible members adding medical coverage must complete all of the following within thirty-one (31) days of his/her medical coverage effective date (unless otherwise specified) for the incentive to be effective the first day his/her medical coverage is effective:

1. The Partnership Promise;

2. The Health Assessment; and

3. The Health Education Quiz.

(D) An employee earning the Partnership Incentive who then terminates all employment with the state and is rehired as a new state employee with medical coverage effective in the same plan year, will receive the Partnership Incentive effective the first day his/her medical coverage is effective after s/he is rehired.

(E) An eligible member completing the Partnership Incentive requirements in October of a plan year, who is eligible for but not currently receiving the Partnership Incentive, will receive the incentive for December of the current plan year, in addition to the next plan year.

(F) Eligible members who have earned the incentive may earn a de minimis gift for completing one (1) or more of the following MCHCP-approved health actions. An eligible member must report the completion of the health action to MCHCP by December 31 of each plan year, and may receive only one (1) gift per year. MCHCP-approved health actions are as follows:

1. Receiving a preventive lab screening such as cholesterol and blood sugar;

2. Receiving an annual preventive exam;

3. Attending three (3) Strive for Wellness^® sponsored health education or physical activity events;

4. Participating in physical activity such as walking, jogging, Zumba, yoga, or weight-training for one hundred fifty (150) minutes each week for three (3) months;

5. Standing for at least two (2) hours during each workday for three (3) months; or

6. Walking one (1) million steps.

(G) The Partnership Incentive shall begin January 1 and end December 31 of each plan year.

(6) A waiver may be granted, in whole or in part, for the applicable plan year if a member requests a waiver of a requirement(s) in writing along with a provider's written certification that it is medically inadvisable for the member to participate in the applicable require-ment(s).

(7) MCHCP and/or its vendor may audit participation information for accuracy. Misrepresentation or fraud could lead to loss of the Partnership Incentive and/or prosecution.

(8) MCHCP and/or its vendor may utilize participation data for purposes of offering additional programs in accordance with MCHCP's privacy policy.

22 CSR 10-2.120

AUTHORITY: section 103.059, RSMo 2000.* Emergency rule filed Aug. 28, 2012, effective Oct. 1, 2012, terminated Feb. 27, 2013. Original rule filed Aug. 28, 2012, effective Feb. 28, 2013. Emergency amendment filed Aug. 23, 2013, effective Oct. 1, 2013, expired March 29, 2014. Amended: Filed Aug. 23, 2013, effective March 30, 2014.

Amended by Missouri Register February 17, 2015/Volume 40, Number 04, effective 3/31/2015

Adopted by Missouri Register February 16, 2016/Volume 41, Number 04, effective 3/31/2016

Adopted by Missouri Register February 15, 2017/Volume 42, Number 04, effective 3/31/2017

Adopted by Missouri Register March 1, 2018/Volume 43, Number 5, effective 4/30/2018

*Original authority: 103.059, RSMo 1992.