Department of Management Services

Weight Management Pilot Program

  

The Department of Management Services (department) will offer a third year of the Weight Management Pilot Program for the 2020 Plan Year. The pilot will cover medical services provided by in-network physicians and Federal Drug Administration-approved medications prescribed for chronic weight management. Pilot participants will also be enrolled in a wellness program through their health plan for the 2020 plan year. Pilot participants will be responsible for all applicable medical and prescription drug co-payments, coinsurance, deductibles, and out-of-pocket expenses.

Who is eligible?

The pilot is open to 2,000 enrollees and their dependents in the State Group Health Insurance Program who meet  ALL  of the following eligibility criteria: 

  1. Enrolled in Aetna, AvMed, Florida Blue, or UnitedHealthcare in the 2019 and 2020 plan years; 
  2. Body Mass Index (BMI) of 27 or higher and at least one weight-related comorbid condition (e.g., hypertension, high cholesterol, type 2 diabetes) or BMI of 30 without a comorbid condition; 
  3. 18 years or older; 
  4. Completed a health risk assessment in 2019; 
  5. Consent to provide personal and medical information to the department; 
  6. Referred and supervised by a licensed physician in-network with the health plan during the 2020 plan year; and 
  7. Agree to enroll in a department-approved wellness program during the 2020 plan year.
  8. If enrollees participated in year two of this pilot, they must have submitted a completed Mid-Year Progress Report and End of Year Progress Report.

Who is not eligible?

The following enrollees or their dependents covered under the State Group Health Insurance Program are not eligible to participate in the Pilot:

  • Enrollees and their dependents enrolled in Capital Health Plan during the 2019 and 2020 plan years;
  • Enrollees or dependents under the age of 18;
  • Enrollees in COBRA;
  • Women who are pregnant, plan to become pregnant, or are nursing;
  • Enrollees or dependents who do not meet all of the pilot’s eligibility criteria.
  • Enrolless in the following Medicare Advantage and Prescription Drug Plans
    • Humana MA-PD
    • UnitedHealthcare MA-PD
    • Capital Health Plan MA-PD

Participant Responsibilities

  • Pilot participants will be required to engage in a department-approved wellness program and submit two progress reports signed by their supervising physician to the department during the 2020 plan year.
  • The first progress report is due no later than May 29, 2020, and must document any reduction in BMI, weight, and any change in comorbid conditions, if applicable. The report must be signed by the participant’s supervising physician.
  • The second report is due no later than October 30, 2020, and must document any reduction in BMI, weight, and any change in comorbid conditions if applicable. The report must be signed by the participant’s supervising physician.

Forms and Resources

To apply, click on the ‘Submit Application’ tab in the left-hand navigation under ‘Weight Management Pilot Program’.

If you are already enrolled in the pilot program and need to submit a report, click on the ‘Submit Reports’ tab in the left-hand navigation under ‘Weight Management Pilot Program’.