Department of Management Services

Weight Management Pilot Program

 

Weight Management Pilot

The Department of Management Services (Department) will offer a Weight Management Pilot Program (Pilot) for the 2018 Plan Year to provide coverage for the treatment and management of obesity and related conditions. The Pilot will cover medical services provided by treating physicians and all Federal Drug Administration-approved medications prescribed for chronic weight management. Pilot participants will be responsible for all applicable medical and prescription drug copayments, 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 United Healthcare in the 2017 and 2018 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 2017;
  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 2017 plan year; and
  7. Agree to enroll in a Department-approved wellness program during the 2018 plan year.

  

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 or Florida Health Care Plans during the 2017 and 2018 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.

  

Participant Responsibilities

  • Pilot participants will be required to follow the treatment plan prescribed by their physician, engage in a Department approved wellness program, and submit two progress reports to the Department during the 2018 plan year.
  • The first progress report is due no later than May 30, 2018, 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 31, 2018, 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 application window for the Weight Management Pilot is closed.

Applicants will be notified in December, and those who are accepted into the pilot will be enrolled in a department approved wellness program by their health plan.

Please contact weightmanagement@dms.myflorida.com with any questions. 

     

Forms and Resources

Physician Referral From (Adobe PDF Document 202.26 KB)

Frequently Asked Questions (Adobe PDF Document 244.40 KB)

Online Application