Results for Health Management Program
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2019-2020 StayWell Health Care Provider Forms
Download the 2019 Health Care Provider Form and take it to your doctor for four of your health screening measures today! And download the Self-Administered Cardiorespiratory Test Submission Form, which includes instructions on how to complete this part of your 2019 screening yourself. You must fill out both forms to complete your health screening.
Health Screening Details
You have three choices to get a free, confidential health screening:
- Download the Health Care Provider Form on StayWell’s website or the downloads section on the Quick Find and take it to your health care provider when you get your annual physical exam at any time during the year. Complete your 2019 screening by also downloading the Self-Administered Cardiorespiratory Test Submission Form and following its instructions.
- Onsite screenings will be held at certain locations this September and October.
- Order a home test kit from StayWell before the Nov. 15 deadline. After Nov. 15, you can’t order a home test kit, but you can still complete the two forms covered in step 1.
Health Screening Deadline
You must submit your completed Health Care Provider Form and your Self-Administered Cardiorespiratory Test Submission Form to StayWell by Dec. 31, 2019.
Know the Targeted Healthy Outcomes
Body Mass Index (BMI) (or waist circumference)
BMI: 18.5 to 25 OR waist circumference: less than 40” for men and less than 35” for women
Less than or equal to 120/80 mmHg
Total cholesterol less than or equal to 199 mg/dL
70 – 100 mg/dL (fasting); 70 – 180 mg/dL (nonfasting)
Recovery heart rate in the “excellent” to “average” range, based on age and gender
Meet the targeted Healthy Outcomes
You can earn $50 for every healthy target you meet based on your health screening results. If you meet all five targets, that’s an additional $250 credit toward your 2020 medical premiums!
The Health Risk Questionnaire (HRQ) is required
If you don’t complete the HRQ in 2019, you’ll pay an additional $100 on your 2020 medical premiums, and you won’t earn any incentives for the other activities.
Health Management Program Overview
Complete three steps to earn up to $450 toward your 2020 medical premiums. Here’s how it works.
- Health Risk Questionnaire (HRQ): The HRQ is essential to understanding your overall health and how your decisions now can affect you in the future. That’s why the HRQ is required in 2019. If you don’t complete the HRQ, you’ll pay an additional $100 on your 2020 medical premiums, and you won’t earn any incentives for the other activities. You can complete the HRQ later this fall.
- Health Screening: The health screening measures five healthy targets that can help identify risks and track improvement before it’s too late. You earn $50 for every healthy target you meet for up to $250 off your 2020 medical premiums. Your doctor handles four of these tests, while you check your own cardiorespiratory response. You can complete the two screening forms anytime during the year. Onsite screenings will be offered at certain locations later this fall.
- Take Action: You have options for your Take Action activities, such as challenges and coaching programs. You can complete two Take Action activities for up to $200 ($100 each) off your 2020 medical premiums.