SCREENING HRA REQUIREMENTS POINTS PER ACTIVITY MAXIMUM POINTS DATES AVAILABLE Wellness Screening (Required to receive your incentive) Download the LabCorp voucher (LabCorp Option) or Physician Screening Form (PCP Form Option) by logging into your online account at www.healthymeintempe.com Email your completed PCP Form to [email protected](PCP Form Option only) You have three options to complete screening requirement: 1) Attend an Onsite Wellness Screening in February 2018 2) Visit a LabCorp Facility for your screening 3) Submit your Physician Screening Form (PCP Form) 60 points 60 points February 2018 (onsite screenings) PCP Form must be dated: 5/01/2017 - 4/30/2018 Online Health Risk Assessment (Required to receive your incentive) Sign up at www.healthymeintempe.com to complete your HRA Complete the online health risk assessment by signing up at www.healthymeintempe.com 10 points 10 points 11/01/2017 - 4/30/2018 BIOMETRICS GOALS POINTS PER ACTIVITY MAXIMUM POINTS DATES AVAILABLE Glucose* (In Range or 10% improvement from 2017 results.) In Range, 99mg/dl or Lower American Diabetes Association Guidelines 5 points 5 points February 2018 Blood Pressure* (In Range or 10% improvement from 2017 results.) In Range, Systolic <= 130mm Diastolic <=85mm Metabolic Syndrome Guidelines 5 points 5 points February 2018 Total Cholesterol* (In Range or 10% improvement from 2017 results.) In Range, 199mg/dl or Lower American Heart Association Guidelines 5 points 5 points February 2018 Waist Circumference* (In Range or 10% improvement from 2017 results.) In Range, Men <= 40 inches Women <=35 inches Metabolic Syndrome Guidelines 5 points 5 points February 2018 Automatically Send Onsite Screening Results to Physician Elect to mail a copy of onsite biometric screening results to your primary care physician 5 points 5 points February 2018 2/01/2018 - 4/30/2018 (LabCorp Option) HEALTHY ME IN TEMPE WELLNESS PROGRAM The City, in partnership with Provata Health, brings opportunities for all benefitted employees to participate in a year-round Wellness Program that provides multiple, fun options geared towards maintaining and/ or improving your health. Starting November 1, you will have access to the Provata online portal and Provata mobile app. You will have until April 30, 2018 to participate and earn points! Earn 100 Points: Receive a $25 per paycheck reduction in your health insurance premiums starting July 2018. That’s an annual savings of $650! Earn 200 Points: Receive a $100 gift card! Contact us to learn more Email: [email protected]Phone: 1-855-483-2667
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SCREENING & HRA REQUIREMENTS POINTS PER ACTIVITY
MAXIMUM POINTS
DATESAVAILABLE
Wellness Screening(Required to receive your incentive)
Download the LabCorp voucher (LabCorp Option) or Physician Screening Form (PCP Form Option) by logging into your online account at www.healthymeintempe.com
Email your completed PCP Form to [email protected] (PCP Form Option only)
You have three options to complete screening requirement:
1) Attend an Onsite WellnessScreening in February 2018
2) Visit a LabCorp Facility foryour screening
3) Submit your PhysicianScreening Form (PCP Form)
60 points 60 points
February 2018 (onsite screenings)
PCP Form must be dated: 5/01/2017 - 4/30/2018
Online Health Risk Assessment(Required to receive your incentive)
Sign up at www.healthymeintempe.com to complete your HRA
Complete the online health riskassessment by signing up at www.healthymeintempe.com
10 points 10 points 11/01/2017 -4/30/2018
BIOMETRICS GOALS POINTS PER ACTIVITY
MAXIMUM POINTS
DATESAVAILABLE
Glucose*(In Range or 10% improvement from 2017 results.)
In Range, 99mg/dl or LowerAmerican Diabetes Association Guidelines
5 points 5 points February 2018
Blood Pressure*(In Range or 10% improvement from 2017 results.)
In Range, Systolic <= 130mm Diastolic <=85mmMetabolic Syndrome Guidelines
5 points 5 points February 2018
Total Cholesterol*(In Range or 10% improvement from 2017 results.)
In Range, 199mg/dl or LowerAmerican Heart Association Guidelines
5 points 5 points February 2018
Waist Circumference*(In Range or 10% improvement from 2017 results.)
In Range, Men <= 40 inches Women <=35 inchesMetabolic Syndrome Guidelines
5 points 5 points February 2018
Automatically Send Onsite Screening Results to Physician
Elect to mail a copy of onsite biometric screening results to your primary care physician
5 points 5 points February 2018
2/01/2018 - 4/30/2018(LabCorp Option)
H E A LT H Y M E I N T E M P EW E L L N E S S P R O G R A M
The City, in partnership with Provata Health, brings opportunities for all benefitted employees to participate in a year-round Wellness Program that provides multiple, fun options geared towards maintaining and/or improving your health. Starting November 1, you will have access to the Provata online portal and Provata mobile app. You will have until April 30, 2018 to participate and earn points!
Earn 100 Points: Receive a $25 per paycheck reduction in your health insurance premiums starting July 2018. That’s an annual savings of $650! Earn 200 Points: Receive a $100 gift card!
Onsite Health Coaching(Provata will automaticallycredit points)
Call 1-855-483-2667 or contact [email protected] to schedule a session
Engage with the health coach 5 points 20 points 12/01/2017-4/30/2018
Tobacco Cessation Program(Provata will automaticallycredit points)
Sign up for 2Morrow Health at www.2MorrowHealth.net/CoTempe
Download 2Morrow Health &Complete the 8-Session Program
15 points 15 points 11/01/2017- 4/30/2018
Provata Weight Management ProgramProvata will automatically credit points.
Call 1-855-483-2667 to sign up. Cost of $125 ($100 reimbursed by the City of Tempe upon completion)
Complete the 12-Session Program (includes digital scale and online health coach)
15 points 15 points 11/01/2017- 4/30/2018
E-learning(Provata will automaticallycredit points)
Complete review of online session material 5 points 10 points 11/01/2017-
4/30/2018
On Your Own Weight Loss Program(Provata will credit points after proof of completion is emailed to [email protected])
Provide proof of membership or participation 5 points 5 points 11/01/2017-
4/30/2018
Financial Wellness(Provata will credit points after proof of completion is emailed to [email protected])
Meet with Financial planner, Nationwide, Galloway;
Attend Retirement Expo;
Attend City-Sponsored Financial Lunch ‘n Learns
5 points 10 points 5/01/2017-4/30/2018
Provide proof of acupuncture, massage therapy visits 2 points 10 points 5/01/2017-
4/30/2018
Guided Meditation - Provata VR(Provata will automatically credit points)
Download mobile app Provata VR from the App Store or Google Play store.
Complete a meditation session 2 points 10 points 11/01/2017-4/30/2018
Stress Management(Provata will credit points after proof of completion is emailed to [email protected])
ACTIVITIES REQUIREMENTS POINTS PER ACTIVITY
MAXIMUM POINTS
DATESAVAILABLE
Individual Walking Challenge (Provata will automatically credit points)
5,000 average steps per day 4 points per month
24 points
11/01/2017-4/30/2018
8,000 average steps per day 6 points per month
44 points
10,000 average steps per day 9 points per month
54 points
Physical Activity Challenge(Provata will automatically credit points)
Track your minutes of physical activity online/on the Provata mobile app and earn points monthly when you reach 400 minutes
3 points per month 18 points 11/01/2017-
4/30/2018
Community Physical Activity(Provata will credit points after proof of completion is submitted)
Participate in a community based activity; such as a walk for cancer, diabetes, 5K, 10K, etc.
5 points per event 20 points 5/01/2017-
4/30/2018
Complete a ½ Marathon(Provata will credit points after proof of completion is submitted)
Complete a ½ Marathon 7 points 14 points 5/01/2017-4/30/2018
Complete a FULL Marathon or Triathlon(Provata will credit points after proof of completion is submitted)
Complete a full marathon (e.g. Rock n Roll) or Triathlon 10 points 20 points 5/01/2017-
4/30/2018
Gym Membership(Provata will credit points after proof of completion is submitted)
Provide proof of membership at a gym 5 points 5 points 5/01/2017-
4/30/2018
Participation in Fitness Class Series(Provata will credit points after proof of completion is submitted)
Provide proof of participation in fitness classes such as yoga, pilates, etc.
5 points 10 points 5/01/2017-4/30/2018
EXAMS REQUIREMENTS POINTS PER ACTIVITY
MAXIMUM POINTS
DATESAVAILABLE
Flu Shot(Provata will credit points after proof of completion is emailed to [email protected])
Receive a flu shot at an onsite event or from your physician or medical provider
10 points 10 points 5/01/2017-4/30/2018
PSA Exam(Provata will credit points after proof of completion is emailed to [email protected])
Receive a PSA test at an onsite event or from your physician
10 points 10 points 5/01/2017-4/30/2018
Mammogram Exam(Provata will credit points after proof of completion is emailed to [email protected]))
Receive a mammogram test at an onsite event or with your physician
10 points 10 points 5/01/2017-4/30/2018
Dental Exam(Provata will credit points after proof of completion is emailed to [email protected])
Receive a dental preventive exam/cleaning
10 points 10 points 5/01/2017-4/30/2018
Annual Physical Exam(Provata will credit points after proof of completion is emailed to [email protected])
Receive an annual physical with your physician 10 points 10 points
5/01/2017-4/30/2018
Vision Exam(Provata will credit points after proof of completion is emailed to [email protected])
Receive a vision exam 5 points 5 points 5/01/2017-4/30/2018
REASONABLE ALTERNATIVE: If it is unreasonably difficult due to a medical condition for you to achieve thestandards for the reward under this program, call us at 1-855-483-2667 and we will work with you to develop another way to qualify for the reward.
ONLINE HEALTH RISK ASSESSMENT
Completing the online health risk assessment is required to earn the reduction in your health insurance premium by earning 100 points.
HOW TO TAKE THE ASSESSMENT?
Upon completion of the assessment, you will receive a personalized report of risks and recommendations as well as access to the Provata online portal.
HRA POINTSEarn 10 points by completing your online health risk assessment.
1. Go to www.healthymeintempe.com
2. Select Sign Up at the top right section of thepage
3. Complete the fields to create your Provataonline account and click Sign Up
4. You will be automatically directed to theonline health risk assessment.
WALKING CHALLENGE
All City of Tempe benefited employees are eligible to receive a wireless wristband activity tracker at no cost to you! The tracker syncs with your online account and the Provata mobile app making it easy to seamlessly track your steps.
HOW TO GET STARTED
WALKING CHALLENGE POINTS• For each month from November 2017 through April 2018:
• Walk an average of 5,000 steps per day each month and receive 4 points each month
• Walk an average of 8,000 steps per day each month and receive 6 points each month
• Walk an average of 10,000 steps per day each month and receive 9 points each month
2. Download the Provata app from the AppStore or Google Play store
3. Sign in and select ‘More’ at the very bottom
4. Select ‘Sync Device’ from the menu
SCAN
5. Follow the next few steps to scan and sync aProvata Tracker or another compatible devicethat tracks steps
1. Complete your Health Risk Assessment by creating youronline account at www.healthymeintempe.com.Upon completion, you are prompted to order a tracker (atno cost to you) and provide your address for delivery.
PHYSICIAN SCREENING FORM
Completing a screening with your primary care provider (PCP) is an alternative to attending an onsite biometric screening event in February 2018.
HOW IT WORKS
You or your primary care provider must submit the completed PCP Form, signed by your physician, by email to:[email protected] with your name at the top.
Your screening must be dated between May 1, 2017 – April 30, 2018.
SCREENING POINTS
Earn 60 points by submitting your completed PCP Form(The PCP Form option is one of your three options for completing the biometric screening requirement in addition to attending an onsite event or visiting a LabCorp location to receive your screening.
1. Log into your account atwww.healthymeintempe.com
2. Click on the “Resources” tab
3. Download the LabCorp Voucher
4. Bring the PCP Form to your primary careprovider to complete. If you have received ascreening after May 1, 2017, you may send thePCP Form to your physician to complete andsubmit to Provata.
CITY OF TEMPE ARIZONA PRIMARY CARE PROVIDER FORM
PATIENT INFORMATION
BIOMETRIC SCREENING INFORMATION
Patient Email: (Required to provide form receipt confirmation)
Date of Screening:
Physician Name: Physician Phone Number:
Physician Signature:
Glucose: Total Cholesterol: HDL: TC/HDL Ratio: LDL: Triglycerides:
Blood Pressure: Height: Weight: Waist:
Patient First Name:
Patient Phone Number:
Patient Last Name:
Patient Date of Birth: (mm/dd/yyyy)
Gender: Male Female
Have you fasted for at least 8 hours? (No food. Only water and black co�ee permitted) Yes No
Are you pregnant? Yes No N/A
Systolic Diastolic Ft. Inches Lbs Inches
Patient Printed Name:
Patient Signature: Date:
I understand that Provata Health may utilize the above health information to track participation and provide me with health guidance. This information will be used only to provide services to me and to gather aggregate statistical data for the city of Tempe AZ. Under no conditions will information be sold to a third party. I understand that my basic statistics will be aggregated and presented in reports only to show trends in health conditions and use of services to the cityof Tempe AZ and that no personal health information will be provided to my health plan.
I certify that the information supplied on this form has been provided to me by my health care provider, and Provata Health may contact myprovider regarding the information.
INSTRUCTIONS:
(to be completed by YOU)
(to be completed by YOUR HEALTHCARE PROVIDER)
Print form.
Complete all Patient Information and sign the form.
Take the form to your appointment for your physician to complete Biometric Screening Information and sign.
Deliver the completed form to a Provata representative at an onsite screening event between (insert dates).* Documents sent by email and fax are HIPAA compliant encrypted email and fax.
YOU -AND- YOUR PHYSICIAN MUST SIGN IN ORDER FOR THIS FORM TO BE COMPLETE.
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SUBMIT THIS FORM ONE OF THE FOLLOWING WAYS:
LABCORP SCREENING
Visiting a LabCorp location to receive your biometric screening is an alternative to attending an onsite event in February 2018. You may visit any LabCorp location between February 1, 2018 – April 30, 2018.
HOW IT WORKS
Please submit verification after your screening by email to [email protected] with your name at the top.
SCREENING POINTSEarn 60 points by completing your biometric screening (LabCorp is one of your three options for completing the biometric screening requirement in addition to attending an onsite event or submitting your Primary Care Physician form.
1. Log into your account atwww.healthymeintempe.com
2. Click on the “Resources” tab
3. Download the LabCorp Voucher
4. Bring the voucher to any LabCorp locationbetween February 1, 2018 – April 30, 2018.
Visit https://www.labcorp.com/labs-and-appointmentsto find your nearest lab location.
MEET WITH THE ONSITE HEALTH COACH
HOW TO CONTACT A HEALTH COACH
1. Call 1-855-483-2667 or send an email [email protected] schedule a time to speak with the City of Tempeonsite health coach. Coaching is available in personand by telephone.
2. Engagements must include adiscussion of health goals or progressmade toward a health goal for pointsto be awarded.
HEALTH COACH POINTSEach coaching session will earn you 5 points with a maximum of 20 points.
SMOKING CESSATION PROGRAM
HOW IT WORKS
2Morrow Health® is an evidence-based smoking cessation program that is 2-3 times more effective than trying to quit on your own. The program is delivered via a Smartphone app, so it is private, easy to use and always within reach. 2Morrow Health delivers an 8 day program that is completed before your quit day. Using the app, you will create a personal quit plan. The app will continue to support your efforts with customized messages, tips and tools through your quit day and beyond. You’ll have access for a full 6 months.
HOW TO GET STARTED
SMOKING CESSATION POINTSComplete the program by 4/30/2018 and receive 15 points. Email your Certificate of Completion to [email protected].
1. Sign up for 2Morrow Health at www.2MorrowHealth.net/CoTempeto receive your username and password
2. Download 2Morrow Health from the App Store andlog in with your assigned username and password
3. Select the Smoking program within theapp. The app then creates a customprogram for you with:
WEIGHT MANAGEMENT PROGRAM RULES• The Provata weight management program is a 12-week program that includes a digital scale synced to your online account
• Before each session, step on the scale to track and monitor your progress
• Your dedicated online health coach provides motivation and support as you proceed through the program
WEIGHT MANAGEMENT PROGRAM POINTSComplete the 12-week program by 4/30/2018 to receive 15 points. ($100 of the $125 cost of the program will be reimbursed by the City of Tempe upon program completion)
PROVATA WEIGHT MANAGEMENT PROGRAM
COST$125 ($100 reimbursed by the City of Tempe upon program completion)The weight management program cost of $125 includes an online health coach, a digital scale synced to your online account, and a clinically validated 12-session program. Upon completion of the program, (at least 9 out of 12 sessions), the City of Tempe will reimburse $100 of the cost of the program.
HOW TO SIGN UP
1. Call 1-855-483-2667 to sign up for theProvata weight management program
2. A digital scale is shipped directly to yourdoorstep
3. You are placed on an online team of City ofTempe participants and contacted by yourdedicated health coach with your programstart date
E-LEARNING SESSIONS
The Provata portal gives you access to a 12-session lifestyle management program covering a wide range of topics. Log into the portal, to review session materials and complete the online activity for a session.
HOW TO COMPLETE A SESSION
POINTSEach completed session will earn you 5 points with a maximum of 10 points.
1. Log into your account atwww.healthymeintempe.com
2. Select a session
3. Review session materials
4. Confirm you reviewed the session materialand complete the online activity
FINANCIAL WELLNESS
Eligible activities include:• Meeting with Financial planner,Nationwide, Galloway;
• Attending a Retirement Expo;
• Attending City-Sponsored Financial Lunch ‘n Learn
Please submit verification (blacking out any financial information) by email to [email protected] with your name at the top.
FINANCIAL WELLNESS POINTSEarn 5 points per activity with a maximum of 10 points.
STRESS MANAGEMENTEligible activities include acupuncture and massage therapy visits.
Please submit verification by emailing your receipt of service to [email protected] with your name at the top.
STRESS MANAGEMENT POINTSEarn 5 points per activity with a maximum of 10 points.
ON YOUR OWN WEIGHT LOSS PROGRAM
Please submit verification by email to [email protected] with your name at the top.
Acceptable proof: Receipt of membership or class attendances.
ON YOUR OWN WEIGHT LOSS PROGRAM POINTSEarn 10 points for completing an on your own weight loss program by 4/30/2018.
GUIDED MEDITATION
Download the Provata VR app, available from the Apple App Store and Google Play, to experience fully immersive guided meditation sessions.
HOW TO GET STARTED
GUIDED MEDITATION POINTS• Earn 2 points per meditation with a maximum of 10 points.
1. Download Provata VR from the App Store orGoogle Play store
2. Select ‘Meditate’ from the very bottom andselect your Guided Meditation track andduration
3. Choose the location where you would like tomeditate
4. Place the phone in your headset and beginyour guided meditation. Make sure to selectthe VR icon if viewing in a VR headset
1/2 MARATHON, MARATHON OR TRIATHLON
Earn 7 points for completing a ½ marathon and 10 points for completing a full marathon (e.g. Rock n Roll) or triathlon between 5/1/2017 – 4/30/2018
Please submit verification by email to [email protected] with your name at the top.
Acceptable proof of completion includes your registration receipt bib number with your name, race results, roster of participants.
POINTSEarn 7 points per ½ Marathon (maximum of 2 events) Earn 10 points for each marathon or triathlon (maximum of 2 events)
GYM MEMBERSHIP
Submit proof of membership by receipt of membership or gym/fitness attendances by email to:points@ healthymeintempe.com with your name at the top.
GYM MEMBERSHIP POINTSEarn 5 points if you belong to a gym from 5/01/2017 – 4/30/2018
FITNESS CLASSES
*ÍÆ»Æiͧ [sĊÆęÆĊƧā ÆÖsÍē}§ ĜÚ»[ sÍ[āā§āz éÆÍ[Ċ§āz āéÆÖ sÍ[āā§āz iÚěÆÖ»z §Ċsî Submit proof of class attendance by email to [email protected] with your name at the top.
FITNESS CLASS POINTSEarn 5 points if you participate in fitness class series from 5/01/2017 – 4/30/2018 (maximum of 10 points)
PREVENTIVE SCREENINGSReceive an annual flu shot, PSA exam, Mammogram, Annual Physical or Dental Exam and earn 10 points. Receive a vision exam and earn 5 points
HOW IT WORKSAfter you receive a preventive exam from your medical provider, send verification (Explanation of Benefits) by email to [email protected] with your name at the top.
PREVENTIVE EXAM POINTSEarn 10 points for each preventive exam (5 points for vision exam) completed from 5/1/2017 – 4/30/2018
COMMUNITY PHYSICAL ACTIVITY
Eligible community-based activities include a 5K, 10K, Cancer Walk, or Diabetes Walk.
Please submit verification by email to [email protected] with your name at the top.
Acceptable proof of completion includes your registration receipt bib number with your name, race results, roster of participants.
COMMUNITY PHYSICAL ACTIVITY POINTSEarn 5 points per event with a maximum of 20 points.
