Wellness Premium Incentive (WPI) Program FAQs
What is the Wellness Premium Incentive?
The Wellness Premium Incentive (WPI) Program is designed to encourage ongoing health awareness and a relationship with your medical provider. Through this ongoing incentive, employees and/or spouses who undergo an annual physical/wellness exam will be eligible for the wellness premium rate (lower premium). The annual exam is to be completed by September 30 of each year. This program is a voluntary offering.
Is there a form that my doctor or I need to complete?
If you or your spouse are enrolled in a St. Johns County medical plan at the time you undergo the qualifying exam, a form does not need to be submitted by you or your doctor.
If you or your spouse are not enrolled in a St. Johns County medical plan at the time you undergo the qualifying exam, you should request the Wellness Premium Incentive Verification Form from your benefits department. Forms should be returned to the contact listed at the bottom.
Does this wellness exam need to include specific tests?
There are no specific tests that are required to earn the credit. Your physician should determine which tests to administer based on your age, gender, and physical condition. While physicals and wellness exams often include such things as a blood pressure check, cholesterol test, glucose test, and/or a height and weight checks, no specific tests are required.
Who is eligible to participate in the Wellness Premium Incentive Program?
All employees and dependent spouses enrolled in the St. Johns County medical plan are eligible to participate and receive the incentive.
Will I be assessed a charge when I have my wellness/annual/physical exam?
If you are enrolled in the St. Johns County medical plan at the time you complete the exam and your provider codes the exam with a routine/preventive primary code there should be no cost to you. If your provider includes one or more diagnostic codes when filing the claim to FloridaBlue, you may be assessed a charge for the exam. Please reach out to your provider with any further questions about codes.
What is the time frame in which the exam must be completed in order to satisfy the ongoing requirement for each Benefit Plan year?
The Wellness Premium Incentive Program reporting period will begin October 1 of the prior year and end on September 30 of the current year. Completion of your exam during this time period will provide a premium credit for the upcoming benefit year; e.g., program opens on 10/1/2021 and ends on 9/30/2022 for a credit during the 2023 plan year.
Why do I have to have a wellness exam with a physician instead of completing a biometric screening?
Receiving a biometric screening and knowing your numbers are important to achieving overall health awareness. However, a comprehensive wellness exam with a physician, including preventive services as well as age and gender appropriate screenings, encourages engagement with a medical provider to establish a longstanding relationship and early detection of any potential health concerns. Early detection and an engaged patient/physician relationship help to lower overall healthcare cost by reducing utilization of emergency room services and treating conditions in earlier stages.
Do I need to tell my doctor/doctor's office this is a wellness exam when I schedule the appointment?
The wellness exam routine code needs to appear as the primary code on the insurance claim in order for the office visit to be covered at 100%. This is both for purposes of processing the claim as a preventive service (with no charge assessed to the member) and to earn the premium credit for the following plan year.
I am concerned about my privacy, what information is being reported back to my employer?
Privacy is understandably a great concern for many of us. As part of the Wellness Premium Incentive Program, FloridaBlue will only report individual completion status (as indicated by yes/no) back to System Benefits Administration to be used for assigning the lowest premium rate. No individual medical information such as test results, doctor information, diagnosis, etc. will be provided.
I completed my wellness exam in September and am enrolling on Plan Source during open enrollment, and my credit has not been applied. What is wrong?
Participants who complete their wellness exam in September will not be reflected in the Plan Source portal due to the reporting lag. Once the program has ended on September 30, all participants who have completed their wellness exam within the program dates will be uploaded and reflected correctly in the system at that time.
Who should I contact if I have questions about participation or completion of the Wellness Premium Incentive Program?
Questions can be directed to The Bailey Group at StJohnsWell@mbaileygroup.com. Employees should also feel free to reach out to their benefits department with any questions.