June 10, 2016 Re: Wellness Reimbursement Program – Effective July 1, 2016 Dear Member: As we transition to Aetna, our new medical benefits administrator, the Blue Cross HealthyLifestyles™ program will be ending effective July 1, 2016. Moving forward, the Bucks and Montgomery County Schools Health Care Consortium (BMCS) will be offering members a new Fitness Center and Weight Watchers® Reimbursement program similar to your current program. This communication is intended to provide details regarding our new program. Fitness Center Reimbursement ($150 for completing 120 visits) Reimbursement Obtained in Four Easy Steps: 1. Join an approved Fitness Center  Choose a full‐service fitness center that includes amenities for continuous cardiovascular, flexibility, and resistance training. A description of what constitutes an approved fitness center is described on page 2. 2. Exercise at your chosen fitness center regularly  You must work out 120 times during the 12 month period from July 1st – June 30th. Note, for the first year of the program, workouts recorded from January 1, 2016 – June 30, 2017 will be eligible for reimbursement. This 18‐month period is only occurring in the 2016/2017 plan year to ensure workouts prior to July 2016 are not forfeited. Moving forward, eligible workouts must be logged between July 1st and June 30th of the following year. 3. Record your workouts  Record your workouts using one of the tracking methods described on page 2. You may record only one workout per day. 4. Submit your documentation and request your reimbursement  Upon completion of 120 fitness center visits, submit the following information to the designated Wellness Point Person at your school entity:  Proof of payment (receipt must be submitted on the fitness facility’s letterhead, or a copy of the fitness center contract must accompany the receipt); and  Record of your workouts (i.e., completed logbook enclosed with this letter or a computer printout of your workouts from the gym). Your reimbursement will be in the form of a bank gift card sent directly to your home shortly after the benefit plan year in July. The gift card will be for the amount of your annual fitness center membership, but will not exceed $150. 1 Who Is Eligible? In order to be eligible for the Wellness Reimbursement Program, participants must be enrolled in your school entity’s medical benefits program at the time they attain the 120 visits, and the member must be age 18 or older. Selecting an Approved Fitness Center The Wellness Reimbursement Program rewards you for incorporating a well‐rounded exercise program in your routine. To be eligible for the fitness center reimbursement, you must be a member of a full‐service fitness center that offers a variety of cardiovascular, flexibility, and resistance training in a supervised setting. It is your responsibility to ensure that the fitness center meets the criteria described in the table below. The BMCS or your school entity reserves the right to contact the fitness center to confirm they meet these standards. Eligible Fitness Centers Ineligible Fitness Centers Eligible full‐service fitness centers generally feature Centers that are not eligible are athletic clubs that most of the following amenities: focus on competition or recreational sports activity. Examples of ineligible programs and facilities include:  Group exercise classes (e.g., aerobics, spinning,  Tennis/squash/racquetball kickboxing)  Basketball, Golf or sports leagues  Resistance training equipment (e.g., weight machines)  Pilates/yoga classes/outdoor boot camp style programs  Free weights  Cardiovascular training equipment (e.g., treadmills,  Martial arts/karate class stationary bikes, elliptical trainers)  Recreational swim clubs  Pool for swimming laps  Dance instruction  Track for running/walking Reimbursement Rules and Requirements  You must complete 120 workouts during the 12 month period from July 1st – June 30th. Note, for the first year of the program, workouts recorded from January 1, 2016 – June 30, 2017 will be eligible for reimbursement. This 18‐month period is only occurring in the 2016/2017 plan year to ensure workouts prior to July 2016 are not forfeited. Moving forward, eligible work outs must be logged between July 1st and June 30th of the following year.  You can submit your proof of payment and recorded workouts anytime during the year following the attainment of 120 gym visits; however, this information must be submitted to your school entity’s designated Wellness Point Person no later than July 1.  You must be enrolled in your school entity’s medical benefits program at the time you reach 120 visits and submit your recorded workouts.  You are only eligible for one reimbursement per program, per plan year.  Dependents must be at least 18 years old to be eligible for reimbursement.  Falsification of information to receive the reimbursement is strictly prohibited. Any form of falsification or intent to falsify information can result in disciplinary action up to termination of employment. How to Record Your Workouts Choose a primary method of recording your workouts that works best for you:  Logbook that is included with this communication o Submitted logbooks must be signed and dated by a gym representative each time you workout  Computer printout from your fitness center that shows all workout dates o The BMCS and your school entity cannot assume any responsibility for the reliability of fitness center computer systems 2 Other Important Notes  If you purchased a Lifetime membership at a fitness center, you are qualified to receive reimbursement of up to $150 once per plan year as long as the required number of workouts are completed.  Family memberships are eligible as long as each family member who requests reimbursement is listed on the fitness center membership contract, and each family member who requests reimbursement has individually attained the required number of workouts during the specified period. (Note, dependents must be at least 18 years old to be eligible for reimbursement.)  BMCS has no guarantees of solvency of any fitness center and, therefore, should have no liability if a fitness center were to close.  The Wellness Reimbursement Program is a value‐added program and is not part of your health benefits that have been purchased on your behalf and, therefore, is subject to change without notice.  We encourage all members to adopt and maintain a regular fitness program. However if you are 40 or older, overweight, have a history of high blood pressure, heart disease, or have any other health concerns you are encouraged to consult your doctor before beginning an exercise program. Weight Watchers Program® Similar to the Blue Cross HealthyLifestyles™ program you will continue to be eligible to receive a reimbursement for enrollment and participation in Weight Watchers®. Starting July 2016, if you pay for and participate in Weight Watchers® from July 1st – June 30th you are eligible to receive a $150 reimbursement. Simply submit proof of payment and participation (in the form of current Weight Watchers materials) to your designated Wellness Point Person. You can submit your Weight Watchers® proof of payment and participation at any time during the year; however, this information must be submitted to your school entity’s designated Wellness Point Person no later than July 1st of each year. Members must be 18 years of age to receive the Weight Watchers® reimbursement. If you should have question about the Wellness Reimbursement Program or any of the details explained in this letter please see your school entity HR Representative. 3 FITNESS REIMBURSEMENT PROGRAM VISIT LOG MEMBER NAME: _______________________________ MEDICAL INSURANCE ID# (ON ID CARD): _________________ Instructor/fitness facility representative must acknowledge each workout with date and signature. Credit will only be issued for workouts completed during supervised hours. Date Signature Date Signature 1. 26. 2. 27. 3. 28. 4. 29. 5. 30. 6. 31. 7. 32. 8. 33. 9. 34. 10. 35. 11. 36. 12. 37. 13. 38. 14. 39. 15. 40. 16. 41. 17. 42. 18. 43. 19. 44. 20. 45. 21. 46. 22. 47. 23. 48. 24. 49. 25. 50. Date Signature Date Signature 51. 86. 52. 87. 53. 88. 54. 89. 55. 90. 56. 91. 57. 92. 58. 93. 59. 94. 60. 95. 61. 96. 62. 97. 63. 98. 64. 99. 65. 100. 66. 101. 67. 102. 68. 103. 69. 104. 70. 105. 71. 106. 72. 107. 73. 108. 74. 109. 75. 110. 76. 111. 77. 112. 78. 113. 79. 114. 80. 115. 81. 116. 82. 117. 83. 118. 84. 119. 85. 120. FITNESS REIMBURSEMENT PROGRAM