| PRODUCT | REWARD AMOUNT | HEALTHY ACTIVITY | QUALIFYING AGE | REWARD RULES | HOW ACTIVITY IS MEASURED |
|---|
ENHANCED (HARP) PLAN | $75 per calendar year | Annual PCP Visit | Age 21+ | Based on claims, encounter, and supplemental data | Based on claims, encounter, and supplemental data |
| $5 per 30-day fill
$30 per 90-day fill
$120 dollar max | Antidepression Medication Management | Age: 18+ | Refill antidepression medication
To be eligible for this reward, the requirement is clinical eligibility – diagnosis of depression. | Based on claims / pharmacy data |
| $5 per 30-day fill
$30 per 90-day fill
$120 dollar max | Antipsychotic Medication Management | Age: 21+ | Refill your antipsychotic medication as prescribed | Based on claims / pharmacy data |
| $5 per 30-day fill
$30 per 90-day fill
$120 dollar max | Asthma Medication Management | Age: 5-64 | Refill asthma controller medication To be eligible for this reward, the requirement is clinical eligibility –
diagnosis of persistent asthma, for prescribed long-term controller medication only and does not include rescue medications. | Based on claims / pharmacy data |
| $50 or $20
depending on screening in current year or within 2 years prior | Breast Cancer Screening | Age: 50-74 | Complete mammogram | Based on claims, encounter, and supplemental data |
| $50 or $20
depending on screening in current year or within 4 years prior | Cervical Cancer Screening | Age: 24-64 | Complete cervical cancer screening | Based on claims, encounter, and supplemental data |
| $100, $40, $20
depending on screening type and year screened | Colon Cancer Screening | Age: 45-75 | Complete colon cancer screening $100 for colonoscopy in current year OR $20 for colonoscopy within 9 years prior. OR $40 for FIT-DNA in current year OR $20 for FIT-DNA within 2 years prior. OR $20 for FOBT, FIT | Based on claims, encounter, and supplemental data |
| $50 per calendar year | Diabetes Eye Exam | Age: 18-75 | Completion of diabetic retinal eye exam To be eligible for this reward, the requirement is clinical eligibility – diagnosis of type 1 or type 2 diabetes. | Based on claims, encounter, and supplemental data |
| $30 per calendar year | Diabetes Screening for People Using Antipsychotic Medications | Age: 21-64 | Complete glucose or HbA1c testing To be eligible for this reward, the requirement is clinical eligibility – prescribed Antipsychotic Medications | Based on claims, encounter, and supplemental data |
| $30 per calendar year | Flu Shot | Age: 21-64 | Complete annual flu vaccine | Based on claims, encounter, and supplemental data |
| $30 per calendar year | Kidney Health Monitoring | Age: 18-85 | Complete eGFR and uACR testing | Based on claims, encounter, and supplemental data |
| $75 per calendar year | New Member PCP Visit | Age: 21+ | Complete visit with PCP within 90 days of enrollment | Based on claims, encounter, and supplemental data |
| $5 per 30-day fill
$30 per 90-day fill
$120 dollar max | Statin Medication Management | Age Males: 21-75
Age Females: 40-75 | Refill your statin medication as prescribed | Based on claims / pharmacy data |
PARTNERSHIP IN CARE (PIC)
HIV-SNP | $5 per 30-day fill
$30 per 90-day fill
$120 dollar max | Antidepression Medication Management | Age: 18+ | Refill antidepression medication To be eligible for this reward, the requirement is clinical eligibility – diagnosis of depression. | Based on claims / pharmacy data |
| $5 per 30-day fill
$30 per 90-day fill
$120 dollar max | Antidepression Medication Management | Age: 18+ | Refill antidepression medication To be eligible for this reward, the requirement is clinical eligibility – diagnosis of depression. | Based on claims / pharmacy data |
| $5 per 30-day fill
$30 per 90-day fill
$120 dollar max | Asthma Medication Management | Age: 5-64 | Refill asthma controller medication To be eligible for this reward, the requirement is clinical eligibility –
diagnosis of persistent asthma, for prescribed long-term controller medication only and does not include rescue medications. | Based on claims / pharmacy data |
| $50 or $20 depending on screening in current year or within 2 years prior | Breast Cancer Screening | Age: 50-74 | Complete mammogram | Based on claims, encounter, and supplemental data |
| $50 or $20 depending on screening in current year or within 4 years prior | Cervical Cancer Screening | Age: 24-64 | Complete cervical cancer screening | Based on claims, encounter, and supplemental data |
| $30 per calendar year | Chlamydia Screening | Age: 18+ | Complete chlamydia screening | Based on claims, encounter, and supplemental data |
| $100, $40, $20 depending on screening type and year screened | Colon Cancer Screening | Age: 45-75 | Complete colon cancer screening $100 for colonoscopy in current year OR $20 for colonoscopy within 9 years prior. OR $40 for FIT-DNA in current year OR $20 for FIT-DNA within 2 years prior. OR $20 for FOBT, FIT | Based on claims, encounter, and supplemental data |
| $225 for visit(s)
in the first half of
the year, $225 for
visit(s) in the
second half of the
year, $450 dollar
max | Comprehensive Care for People Living with HIV | Age 2+ | Complete PCP check-ups that support viral load monitoring and suppression $225 in each half of the year:
Members with viral suppression must have 1 visit; Members not suppressed or without a viral load
test must have 2 visits | Based on claims data |
| $50 per calendar year | Diabetes Eye Exam | Age: 18-75 | Completion of diabetic retinal eye exam To be eligible for this reward, the requirement is clinical eligibility – diagnosis of type 1 or type 2 diabetes. | Based on claims, encounter, and supplemental data |
| $30 per calendar year | Flu Shot | Age: 6 months+ | Complete annual flu vaccine | Based on claims, encounter, and supplemental data |
| $30 per calendar year | Kidney Health Monitoring | Age: 18-85 | Complete eGFR and uACR testing | Based on claims, encounter, and supplemental data |
| $30 per 90-day fill
$120 dollar max | Statin Medication Management | Age Males: 21-75
Age Females: 40-75 | Refill your statin medication as prescribed | Based on claims / pharmacy data |
MEDICARE ULTRACARE (MAP) | $30 per calendar year | Annual PCP Visit | Age: 18+ | Complete PCP visit during the year
Members are not eligible to earn if they earned the New Member PCP Visit reward | Based on claims, encounter, and supplemental data |
| $30 or $10 depending on screening in current year or within 2 years prior | Breast Cancer Screening/td> | Age: 50-74 | Complete mammogram | Based on claims, encounter, and supplemental data |
| $50, $15, $10, $5 depending on screening type and year screened | Colon Cancer Screening | Age: 45-75 | Complete colon cancer screening $50 for colonoscopy in current year OR $10 for colonoscopy within 9 years prior. OR $15 for FIT-DNA in current year OR $5 for FIT-DNA within 2 years prior. OR $10 for FOBT, FIT | Based on claims, encounter, and supplemental data |
| $30 per calendar year | Diabetes Eye Exam | Age: 18+ | Completion of diabetic retinal eye exam To be eligible for this reward, the requirement is clinical eligibility – diagnosis of type 1 or type 2 diabetes. | Based on claims, encounter, and supplemental data |
| $10 per calendar year | Flu Shot | Age: 18+ | Complete annual flu vaccine | Based on claims, encounter, and supplemental data |
MEDICAID | $30 per 90-day fill
$120 dollar max | Antidepression Medication Management | Age: 18+ | Refill antidepression medication To be eligible for this reward, the requirement is clinical eligibility – diagnosis of depression. | Based on claims / pharmacy data |
| $5 per 30-day fill
$30 per 90-day fill
$120 dollar max | Asthma Medication Management | Age: 5-64 | Refill asthma controller medication To be eligible for this reward, the requirement is clinical eligibility –
diagnosis of persistent asthma, for prescribed long-term controller medication only and does not include rescue medications. | Based on claims / pharmacy data |
| $50 or $20 depending on screening in current year or within 2 years prior | Breast Cancer Screening | Age: 50-74 | Complete mammogram | Based on claims, encounter, and supplemental data |
| $50 or $20 depending on screening in current year or within 4 years prior | Cervical Cancer Screening | Age: 24-64 | Complete cervical cancer screening | Based on claims, encounter, and supplemental data |
| $20 per calendar year | Child & Adolescent Annual Dental Visit | Age: 0-20 | Complete child or adolescent annual dental checkup | Based on claims, encounter, and supplemental data |
| $20 per calendar year | Child & Adolescent Well-Care Visit | Age: 3-21 | Complete annual check-up with a PCP or OB/GYN | Based on claims, encounter, and supplemental data |
| $50, $15, $10, $5 depending on screening type and year screened | Colon Cancer Screening | Age: 45-75 | Complete colon cancer screening $50 for colonoscopy in current year OR $10 for colonoscopy within 9 years prior. OR $15 for FIT-DNA in current year OR $5 for FIT-DNA within 2 years prior. OR $10 for FOBT, FIT | Based on claims, encounter, and supplemental data |
| $10 per calendar year | Flu Shot | Age: 6 months+ | Complete annual flu vaccine | Based on claims, encounter, and supplemental data |
| $50 per calendar year | New Member PCP Visit | Age: 31 months+ | Complete visit with PCP within 90 days of enrollment | Based on claims, encounter, and supplemental data |
| $20 per calendar year | Postpartum Visit | Age: Any | Complete postpartum visit 7-84 days after delivery | Based on claims, encounter, and supplemental data |
| $60 or $20 depending on completion of 6 visits by 15 months or 2 visits 15 to 30 months. | Well-Baby 30-Month Checkup | Age: birth through 30 months | Complete all well-baby checkups 6 visits by 15 months
2 visits between 15 and 30 months | Based on claims, encounter, and supplemental data |
MEDICARE | $30 per calendar year | Annual PCP Visit | Age: 18+ | Complete PCP visit during the year
Members are not eligible to earn if they earned the New Member PCP Visit reward | Based on claims, encounter, and supplemental data |
| $30 or $10 depending on screening in current year or within 2 years prior | Breast Cancer Screening | Age: 50-74 | Complete mammogram | Based on claims, encounter, and supplemental data |
| $50, $15, $10, $5 depending on screening type and year screened | Colon Cancer Screening | Age: 45-75 | Complete colon cancer screening $50 for colonoscopy in current year OR $10 for colonoscopy within 9 years prior. OR $15 for FIT-DNA in current year OR $5 for FIT-DNA within 2 years prior. OR $10 for FOBT, FIT | Based on claims, encounter, and supplemental data |
| $30 per calendar year | Diabetes Eye Exam | Age: 18+ | Completion of diabetic retinal eye exam To be eligible for this reward, the requirement is clinical eligibility – diagnosis of type 1 or type 2 diabetes. | Based on claims, encounter, and supplemental data |
| $10 per calendar year | Flu Shot | Age: 18+ | Complete annual flu vaccine | Based on claims, encounter, and supplemental data |
| $10 per calendar year | Health Assessment (HRA-MA) | Age: Any | Complete a MP Medicare Health Assessment (Medicare)/Universal Assessment System (UAS) (UltraCare) for CMS compliance | Based on claims, encounter, and supplemental data |
| $20 per calendar year | New Member PCP Visit | Age: Any | Complete visit with PCP within 90 days of enrollment | Based on claims, encounter, and supplemental data |
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