State Health Plan's Wellness Initiative

In 2009, the North Carolina General Assembly enacted legislation requiring the State Health Plan to develop a Comprehensive Wellness Initiative (CWI). The CWI is designed to encourage members to take responsibility for their health and well-being by engaging in healthy behaviors. It also represents potential cost savings to members and the Plan. The Plan projects a cost savings of approximately $13 million for 2010-2011. Data will be collected and, further out, progress reports will be provided.

Is a similar plan right for your company?

Each company is different and must look at its own numbers to determine where health improvements and cost savings might exist. But the state's plan offers a template that may be helpful to private businesses.

NC Plan details

Tobacco use and obesity are the two areas the North Carolina Legislature selected for the CWI because they are leading risk factors for a number of chronic diseases, including heart disease, cancer, stroke and diabetes. They are also linked to preventable deaths in North Carolina.

According to the Plan's research, medical expenses for the Plan's estimated 70,000 smokers are approximately $2,400 higher each year than for non-smokers, and members who have a Body Mass Index (BMI) greater than 35 cost the Plan approximately $1,000 more than those that are not obese.

"Using tobacco products and being extremely overweight are significant risk factors for chronic disease. Encouraging Plan members to make healthier lifestyle choices will lead to a better health outcome for them and a better bottom line for the Plan over the long-term," said Anne Rogers, Director of Integrated Health Management for the State Health Plan.

Some key points about participation in the Comprehensive Wellness Initiative

• All members who are not on Medicare are enrolled in the 70/30 Plan as of July 1, 2010.
• If members and their dependents do not use tobacco products (starting July 1, 2010) and have a BMI less than 40 (starting July 1, 2011), they can sign an attestation form to move to the 80/20 Plan.
• If members do not want to participate in the Comprehensive Wellness Initiative, they and their dependents can remain in the 70/30 Plan. Also, members may decide to select the 70/30 Plan for their dependents because of its lower cost.

"The goal of the Comprehensive Wellness Initiative is to empower and support members in taking responsibility for their health. We have excellent smoking cessation and weight management programs in place to help our members succeed," Rogers explained.

Tobacco Cessation component begins July 2010

By July 1, 2010, members must declare that they and their covered dependents do not use tobacco products to be eligible for the 80/20 Plan. It is important to note that members will qualify for an exemption if they participate in a tobacco cessation program.

The State Health Plan offers members a number of resources and tools to help them quit using tobacco, including free and low-cost prescription medications, counseling and access to QuitlineNC, an 800 number they can call for help with quitting (1-800-QUITNOW). In addition, QuitlineNC offers a similar program for all North Carolinians who would like assistance with tobacco cessation counseling.

Weight Management component begins in July 2011

A weight management component will be added to the CWI requirements for enrollment in the 80/20 Plan for Plan year 2011-12. Starting July 1, 2011, members must declare that they and their covered dependents have a Body Mass Index (BMI) less than 40, in addition to not using tobacco products, to be eligible for the 80/20 Plan.

BMI Examples