GENERAL REIMBURSEMENT CRITERIA:
• Be developed based on established best practices in the eld of health promotion and ideally
developed by health professionals with a minimum 4-year bachelor’s degree in one of the following
areas as related to reimbursement requested: Health Promotion, Public Health, Dietetics, Nursing,
Exercise Science, Community Health, Physician Assistant, Medical Doctor, Psychology, Counseling,
Behavior Change, Smoking Cessation, or a related eld.
• Be taught, at least in part, by a health professional with a minimum 4-year bachelor’s degree
in one of the following areas: Dietetics, Health Promotion, Public Health, Nursing, Exercise
Science, Community Health, Physician Assistant, Medical Doctor, Psychologist, Counseling,
Behavior Change, Smoking Cessation or a related eld. Exception: Should a class be taught by
an experienced instructor without the above credentials, it can qualify for the reimbursement only
if class content was developed by a health professional and follows best practices. (i.e. Weight
Watchers Meetings).
• All programs are subject to review.
LIFESTYLE EDUCATION
Amount of Reimbursement:
• Medical Plan Members can be reimbursed up to $500 per Calendar Year for Lifestyle Education
through this credit.
Guidelines for Weight Management Programs to be Eligible for Reimbursement:
• Slow, steady weight loss is emphasized, approximately 1-2 pounds weight loss per week.
• There is no list of forbidden or “bad” foods.
• There is no promotion of specially formulated foods or vitamin supplements.
• Balanced food choices from all food groups are emphasized, as well as sensible portion sizes and
physical activity.
• Establishing lifelong health habits is emphasized.
• Information regarding the health risks and program side-effects is provided.
• Physical activity may be included as a component of a comprehensive program, i.e. personal
training.
• Documented success, as evidenced by program outcomes.
Exclusion List (not all inclusive): Items Not Eligible for Reimbursement through this Credit:
• Co-pays or other member/patient nancial responsibility for medical, vision or prescription claims.
• Individual or Group Physical Activity or Fitness Classes (i.e. Zumba, Nia, Pilates, Yoga, Body-
shaping, Cross t), or other exercise programs that are exclusively focused on physical activity,
and Gym Memberships. Note: physical activity may be included as part of a comprehensive weight
management program, subject to review and approval for reimbursement.
• Physical Activity Event Registration Fees.
• Safety Classes.
• Personal Training, Counseling, or Wellness Coaching.
• Food, supplements, dietary aids, optional resources, or any non-educational components of class/
program.
• Metabolic Research Center, Slimgenics.
TOBACCO CESSATION
Specic Reimbursement Criteria:
• Program must be a minimum of four (4) weeks in length.
• Program must contain a minimum of four (4)classes.
• Program must contain an evaluation to identify behavior change and/or change in health risk.
Exlusion List: Items Not Eligible for Reimbursement through this Credit:
• Smoking cessation products, such as Nicorette gum, Nico Derm CQ patches and Commit
lozenges. These are available with prescription through your pharmacy benet at a $0 copay.
• Hypnosis is not eligible for reimbursement.
HDHP MEMBERS: You are responsible for paying the full cost for these programs up front and you will NOT
be reimbursed until you meet your deductible. You can use your HSA money to pay for this though if desired.
LIFESTYLE
EDUCATION
PROGRAM
OVERVIEW
The purpose of the Lifestyle
Education Program is to
encourage the participation
of Medical Plan Members
in educational classes and
programs. These programs
provide members with an
opportunity to gain knowledge
and skills, with the intention
of improving or maintaining
personal health and well-
being, including, but not
limited to:
• Weight Management
• Smoking Cessation
• Stress Management
• Chronic Disease
Management
• Disease Prevention
• Nutrition
• Emotional Health
• Financial Health