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My Health Pays® Program

What is the My Health Pays Program?

The My Health Pays Program is meant to promote healthy behaviors. It includes activities that can help your child live a healthier life. And your child can earn rewards for completing them!*

Use Your My Health Pays rewards to help pay for:

  • Getting recommended wellness checks for your child
  • Working with your child’s providers to manage illness (like diabetes)
  • Participating and completing activities within the Smoking Cessation, Weight Loss or Substance Use Disorder programs

* Rewards cannot be transferred. If your child leaves our plan, rewards may not be received.

My Health Pays Programs

We offer programs to help keep your child healthy and to help your child live a healthier life (like losing weight or quitting smoking). We call these healthy behavior programs. Your child can earn rewards while participating in these programs. The plan offers the following programs:

Additional Incentives

Focus Area

Activity Criteria

Incentive Value

Tobacco Cessation Health Coaching Sessions

Age 10 and up. Must submit a consent form signed by member’s parent/guardian, verbally pledge to stop tobacco use and complete all four sessions within six months of the first session. $5 reward after each completed session.

Up to $20

Weight Loss Health Coaching Sessions

Age 10 and up. Must submit a consent form signed by member’s parent/guardian, verbally pledge to lose weight within 30 days and complete six sessions within six months.

 $20

Substance Use Health Coaching

Age 12 and up. Complete three coaching sessions with a Care Manager in three months. Enrollment in Case Management and signed consent form by member’s parent/guardian are required.

$10

Comprehensive Diabetes Care

Age 13-20. Complete both HbA1c test and retinopathy screening (dilated eye exam) once in the calendar year

$25

Post-Behavioral Health Admission Follow up Visit

Earn rewards for attending an outpatient follow up appointment with a behavioral health provider within seven days after discharge from an inpatient facility

$20

Notification of Pregnancy Form (First trimester)

Age 12-20 years. Complete and sign a Notification of Pregnancy form within first trimester

$20

 

Prenatal Care

 

Complete a prenatal visit

$20

Children’s Health

Focus Area

Activity Criteria

Incentive Value

Immunizations for Adolescents (Combo 1)

Ages 10-13. Complete both Tdap and meningococcal vaccines.

$20

Well Child Visit: 0–30 months

Annual Well Child Visit with a PCP, one per year

$10

Annual Well Child Visit (age 15-20 years)

Annual Well Child Visit with a PCP, one per year

 

$20

Please remember that rewards cannot be transferred. If your child leaves the plan for more than 180 days, your child may not receive the reward. For any questions or for how to join any of these programs, please call 1-866-799-5321 (TTY 1-800-955-8770).

My Health Pays reward dollars are added to the rewards card after we process the claim for each activity your child completes.  If your child is earning the first reward, a My Health Pays® Visa® Prepaid Card will be mailed to you.

This My Health Pays Rewards Visa Prepaid card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank; Member FDIC. Card cannot be used everywhere Visa debit cards are accepted.

Children’s Medical Services (CMS) Health Plan believes that healthy behaviors can lead to better health outcomes. Healthy behaviors include taking care of medical needs, cutting out habits that hurt your health and getting regular preventive screenings. CMS Health Plan believes in these healthy behaviors so much that we offer rewards for them.

CMS Health Plan members can earn rewards for:

  • Yearly primary care provider visit
  • Well-child and adolescent preventive check-up visits
  • Diabetes management
  •  Prenatal and postpartum care
  • Women’s screening
  • Alcohol and substance abuse recovery
  • Quitting smoking
  • Weight loss

The healthy behaviors program evaluation period is July 1 to June 30 each year. The table below lists the number of CMS Health Plan members that earned rewards during this period ending in 2021.

CMS Health Plan members that earned rewards

Program

Members Enrolled

Members Completed

Members Completed (%)

Annual Adolescent Check Up: 7-20 years

423

423

100%

Chlamydia Screening

2

2

100%

Completion of Second Prenatal Care Visit

5

5

100%

Diabetes: Annual Eye Exam

4

4

100%

Diabetes: Annual Hb1A1C

6

6

100%

Diabetes: Blood Pressure Control

6

6

100%

Initial Prenatal Care Visit

9

9

100%

Initial Primary Care Provider (PCP) Visit

77

77

100%

Medically Directed Weight Loss Program

67

67

100%

Postpartum Care Visit

1

1

100%

Well-Child: 0-15 Months

28

28

100%

Well-Child: 3-6 Years

143

143

100%

Barriers to rewards and success in the program:

  • Lack of knowledge about needing to complete attestations for rewards
  • Limited doctor’s office hours and appointments due to COVID-19
  • Delay of care due to COVID-19

Interventions include:

  • Care Managers and Patient Care Advocates educate members on how to complete programs
  • Quality Practice Advisors educate providers about the programs and ask them to help  members complete healthy behaviors
  • Members no longer needing to complete an attestation to receive rewards

Effective Oct. 1, 2021, CMS Health Plan’s rewards program will change to a claims-based model where rewards will be given to a member when a claim is received that proves a healthy behavior has been done. We expect use of the program to increase over the next year.

The Children’s Medical Services (CMS) Health Plan believes that health behaviors can lead to improved health outcomes.  Healthy behaviors include managing medical needs, improving or discontinuation of habits that are known to affect health, and taking advantage of preventive screenings. To emphasize the importance of healthy behaviors, CMS Health Plan members choosing to improve health receive a reward after completing one of the healthy behavior programs.

CMS Health Plan healthy behavior reward programs:

  • Annual primary care provider visit
  • Well-child and adolescent preventive check-up visits
  • Diabetes Management
  • Prenatal and postpartum care
  • Women’s screening
  • Alcohol and substance abuse recovery
  • Stop smoking/tobacco cessation
  • Weight Loss

The Healthy Behaviors Program evaluation period is July 1, 2020, to June 30, 2021. The table below lists the number of CMS members that earned rewards during the evaluation period.

CMS members that earned rewards

Program

Members Enrolled

Members Completed

Members Completed (%)

Annual Adolescent Check Up: 7-20 years

83

83

100%

Diabetes: Annual Eye Exam

2

2

100%

Diabetes: Annual Hb1A1C

3

3

100%

Diabetes: Blood Pressure Control

2

2

100%

Initial Primary Care Provider (PCP) Visit

27

27

100%

Medically Directed Weight Loss Program

8

8

100%

Well-Child: 0-15 Months

1

1

100%

Well-Child: 3-6 Years

16

16

100%

Barriers to enrollment and completion of programs include:

  • Knowledge deficit about needing to complete an attestation before receipt of reward
  • Provider office hour and appointment limitations due to the COVID-19 pandemic
  • Member and parent/caregiver hesitation regarding seeking preventive care due to fear of COVID-19 exposure

Interventions include:

  • Care Managers and Patient Care Advocates educate and encourage members who meet the criteria to enroll and complete programs
  • Quality Practice Advisors educate providers about the reward programs and seek their partnership in engaging and encouraging members to complete healthy behaviors
  • Members no longer needing to complete an attestation to receive rewards

Effective Oct. 1, 2021, CMS Health Plan’s rewards program will change to a claims-based model where rewards will be distributed to a member when a claim is received that confirms a healthy behavior has been completed. We expect utilization to increase over the next year.