completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered independently of medical services and contingent upon completion/participation, 4: Not supported Participation in Multi, Checkboxes. Percent. Yes/No. weight-loss program 1: Waive/adjust out-of-pocket payments N/A OK. for tests, treatments, Rx contingent upon (exercise and/or From 0 to 100. completion/participation, diet/nutrition) 2: Part of program with reduced Premium Share contingent upon completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered independently of medical services and contingent upon completion/participation, 4: Not supported Success in weight-loss Multi, Checkboxes. Percent. Yes/No. or maintenance 1: Waive/adjust out-of-pocket payments N/A OK. for tests, treatments, Rx contingent upon From 0 to 100. completion/participation, 2: Part of program with reduced Premium Share contingent upon completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered independently of medical services and contingent upon completion/participation, 4: Not supported Participation in Multi, Checkboxes. Percent. Yes/No. 1: Waive/adjust out-of-pocket payments tobacco cessation N/A OK. for tests, treatments, Rx contingent upon From 0 to 100. completion/participation, 2: Part of program with reduced Premium Share contingent upon completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered independently of medical services and contingent upon completion/participation, 4: Not supported Success with tobacco Multi, Checkboxes. Percent. Yes/No. 1: Waive/adjust out-of-pocket payments cessation goals N/A OK. for tests, treatments, Rx contingent upon From 0 to 100. completion/participation, 2: Part of program with reduced Premium Share contingent upon completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered
completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered independently of medical services and contingent upon completion/participation, 4: Not supported Participation in weight-loss program (exercise and/or diet/nutrition) Multi, Checkboxes. 1: Waive/adjust out-of-pocket payments for tests, treatments, Rx contingent upon completion/participation, 2: Part of program with reduced Premium Share contingent upon completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered independently of medical services and contingent upon completion/participation, 4: Not supported Percent. N/A OK. From 0 to 100. Yes/No. Success in weight-loss or maintenance Multi, Checkboxes. 1: Waive/adjust out-of-pocket payments for tests, treatments, Rx contingent upon completion/participation, 2: Part of program with reduced Premium Share contingent upon completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered independently of medical services and contingent upon completion/participation, 4: Not supported Percent. N/A OK. From 0 to 100. Yes/No. Participation in tobacco cessation Multi, Checkboxes. 1: Waive/adjust out-of-pocket payments for tests, treatments, Rx contingent upon completion/participation, 2: Part of program with reduced Premium Share contingent upon completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered independently of medical services and contingent upon completion/participation, 4: Not supported Percent. N/A OK. From 0 to 100. Yes/No. Success with tobacco cessation goals Multi, Checkboxes. 1: Waive/adjust out-of-pocket payments for tests, treatments, Rx contingent upon completion/participation, 2: Part of program with reduced Premium Share contingent upon completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered Percent. N/A OK. From 0 to 100. Yes/No.
Qualified%20Health%20Plan%20Certification%20Application%20Fourth%20Quarter%202017%20Smal....docx