Montana University System (MUS) - WellWeight Program

The WellWeight program is an 18 month program, available to members actively enrolled in the MUS medical plan, with a body mass index (BMI) of 30 or greater.  Plan members who are motivated to make positive, healthy changes to improve their overall health and well being are encouraged to apply.  Our WellWeight “team” consists of the plan member, Program Manager, Registered Dietician and Certified Exercise Specialists.  WellWeight is an 18 month, once in a lifetime program.  Be sure you are ready to make changes in your lifestyle to lose and maintain a healthy weight.

Program Guidelines:

1. WellWeight is a once in a lifetime, 18 month benefit. Participants have 18 months from the date they start this program to use this benefit. Expenses that occur prior to approval or after the 18 months will not be waived.
   
   
2. There is no age limit to participation in this program. (there are limitations on services based on age)
   
   
3. Participants must be insured with the MUS Employee Benefits plan for the duration of the program to be eligible.
   
   
4. Participants will work with/coordinate care with the Program Manager (PM) from the MUS Benefits office during the course of this benefit. The Program Manager will check in with you by phone or email each month.
   
   
5. Participants must be under the care of an in-network health care provider (HCP) for obesity/weight management during the entire course of this benefit. The HCP can be a Medical Doctor, Physicians Assistant, Nurse Practitioner or Nurse. Weight Management is only a covered benefit for plan members in the WellWeight program.
   
   
6. As program requirements are met, the benefit works by waiving or covering majority costs for pre-authorized, in-network obesity related medical appointments, services and/prescriptions billed through the MUS health benefit and pharmacy plan.
   
   
7. The number of plan dollars available through this benefit is limited and usage will be closely monitored by the PM, who will work with the Registered Dietician (RD), Certified Exercise Specialist (CES), you and your HCP to determine the best course of action for your success.
   
   
8. At any time that the program requirements are not being met by the participant, the benefit can be terminated.
   
   
9. Information obtained by the Program Manger from the Health Care Provider, Registered Dietician (RD), Certified Exercise Specialist (CES) ect. and information contained in logs and journals is used only to determine continuation of this benefit, and will be kept strictly confidential.
   
   
10. Participant designates one support person/friend/family with whom they talk with and get support during this weight loss program.
    
    
11. Weight loss on average of one pound per week, or 5% weight loss every 3 months.
    
    
12. Participant agrees to an evaluation of progress at 12 months, 18 months and 5 years.

Products and Services (all must be in-network and pre-authorized by Program Manager). These services are only authorized for WellWeight plan members and are free or low cost:

1. Coverage for consultations with an in-network Health Care Provider (HCP) for office visits related to weight management. Up to 7 visits are approved. Member is responsible for the co-pay or co-insurance amount. (For members on a traditional plan, the deductable is waived). Following the initial appointment/evaluation for Obesity/weight management with an HCP, the Provider will submit the HCP form to the MUS Program Manager. This provider weighs and measures the participant **every three to six months and sends the HCP form to MUS Program Manager for the duration of this benefit. The form includes but is not limited to:
   
   
• Participant’s current weight
• Participant’s goal weight
• Participants current BMI
• Participant’s goal BMI
• Participant’s waist circumference
• Participant’s goal circumference
• If medications are prescribed, list them with frequency, dose and duration
• Approval to begin an exercise program.
  
  ** The HCP form can be completed by the Certified Exercise Specialist at the 3rd, 9th and 15th month as an alternative to the HCP appointment. The HCP must be seen at the beginning of the program, the 6th, 12th and final 18th month.
  
  
2. Participant will have a personalized plan to meet your needs consisting of consultations with a Registered Dietician and Certified Exercise Specialist. You may spend up to 10 hours with each of these professionals over the 18 month program.
   
   Participant will have telephonic consultations with the WellWeight Registered Dietician on contract with the MUS. Participant may keep a food/activity/other journal (as described/provided by the Dietician).
   
   Participant will have live consultations with a Certified Exercise Specialist approved by the WellWeight program, for the purpose of developing a safe and personalized exercise plan. Participant agrees to engage in a regular exercise/activity plan as mutually agreed upon with Exercise Specialist and may keep a food/activity journal (as described/provided by ES). The name and contact information of the Certified Exercise Specialist in your area will be provided by the PM. The funding for the CES will be paid directly to you to reimburse the CES. If you currently belong to a gym or fitness center, and wish to use a Certified Exercise Specialist there, the PM will simply need their name, contact information and a copy of their certification.
   
   *The RD and CES are Independent Contractors. PLEASE do all you can to not cancel or miss appointments. It is lost time and money for them and their business. The second cancelation under 24 hours or missed appointment we will deduct $40 from the next program incentive you are eligible for.
   
   
3. Mental Health Counseling with an in- network provider. (The first 8 face to face visits are free! The co-pay or co-insurance amount and benefit plan maximum apply after that). *Please notify the Program Manager prior to going to a Counselor to assure your coverage is pre-authorized.
   
   
4. 100% coverage for the costs of the following lab work when obtained through MUS Employee WellCheck. This is a onetime covered expense.
   
   The following tests are approved:
   
   -Complete blood count (CBC)
   -Chemistry panel
   -Vitamin D screening
   
   *MUS Wellness offers “WellChecks” on each campus/site one time per year at least. This program will utilize this service for blood work. Please see the WellCheck schedule for your area on the wellness website: www.montana.edu/wellness. Send the receipt for blood work to the Program Manager for reimbursement through the benefit.
   
   
5. Plan exception approval to tier B for the following FDA approved medication (generic brand) for weight reduction in participants 18 years and older. These medications can be prescribed for 3 months at a time for a maximum of 6 months. These medications will be tier B under the URx Pharmacy plan and the member will pay the $15 co-pay for a 30 day supply at retail, or $30 co-pay for a 90 day supply at mail order. *Must have pre-authorization through the Program Manager prior to filling prescriptions.
   • Phendimetrazine
   • Phentermine
   • Alli – over the counter (Orlistat)

Eligibility Requirements:

• Participant must be on the MUS Medical plan for entire duration of this program.
• Medicare Prime plan members are not eligible.
• Applicant must have an initial Body Max Index (BMI) of 30 or above.
• Applicant must agree to program requirements, sign attached contract, and agree to 3 follow up evaluations.

Paperwork Requirements:

1. WellWeight Release of Information
2. WellWeight Contract
3. WellWeight Questionnaire.

Please complete and mail, fax or e-mail to the Benefits office.

Financial Rewards!! Up to $600 reimbursement for your weight loss!

At each “official” three month weigh in/measurement, if the member has successfully engaged in the program by the above criteria, (including met their goal weight for the 3 month period), the MUS Benefits plan will reimburse 50% of weight/health equipment up to $100.  (Program cannot reimburse items eligible for benefit plan coverage, medical flex, vitamins or medications) This is an 18 month program – this is $600 dollars in reimbursable expenses!  Examples of reimbursable products are:  exercise equipment, walking/running shoes, iPod, WII-Fit, athletic club dues.  Participant submits receipts to PM after the three month HCP visit or meeting with the CES.  When the report is received by the PM and program requirements are verified, the reimbursement will be submitted. Participant can accumulate for larger items if desired (discuss with PM).  Member is not eligible for reimbursement if they are terminated from the program or discontinue.

After 5 years, if participant is still employed and insured under MUS Medical plan, and has maintained a goal weight within 5% of ending goal weight in the program, and completes a 5 year evaluation, they are eligible to be reimbursed 50% up to $200 for weight/health equipment.

WELLWEIGHT FORMS

WellWeight Contract

Contact Person:
Cindy Millard M.S, SPHR, CWS
Montana University System
Employee Wellness and Benefits Coordinator
2500 Broadway, Helena, MT  59620-3201
1-877-501-1722