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Broomfield Healthy Rewards
Get the Certification Form!
The Broomfield Healthy Rewards Program is a new initiative
for 2012!
The purpose of the Broomfield Healthy Rewards program is to
reward employees and spouses (on the Medical Care Expense Plan) for knowing
their health numbers. This program will provide a discount on your health
insurance premiums if you meet the requirements. In order to qualify for
the discounted family rate, your spouse must participate if he/she is on the
plan. If your spouse chooses not to participate, you will not receive any
benefit.
| Type of Coverage |
Regular 2012 Monthly Rate |
Broomfield Healthy Reward
Monthly Savings |
Broomfield Healthy Reward 2012
Monthly Rate |
| Single |
$30 |
$10 |
$20 |
| Family |
$270 |
$20 |
$250 |
How it Works
You have two ways to qualify for this benefit. You must
meet 5 out of the 6 requirements, and be TOBACCO FREE.
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BMI under 30, or Body Fat % in the healthy range (see
charts below)
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Fasting Blood Glucose <100
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Triglycerides <150
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Cholesterol Ratio <4.98
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LDL Cholesterol <100
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Blood Pressure <120/80
OR if you do
not meet 5 out of the 6 above requirements, you can take your biometric data and
the Certification Form to your doctor.
Your doctor will then complete Option II on the form, certifying the items
listed below:
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he/she has discussed these health factors with you
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you and your doctor have discussed steps that can be
taken to bring these factors into acceptable ranges and
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you are tobacco free or your
doctor feels you are unable to stop using tobacco products and he/she has
made a recommendation for an alternative method of achieving tobacco
cessation usage.
How do I let HR know I qualified?
Once you have determined which way you will qualify for this
benefit, check out the two ways you can notify the Wellness Coordinator to make
it effective. Please note that the deadline for qualification
for 2012 is November 30th, 2011 at 5 pm.
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Bring your health information and Certification Form to
the Wellness Coordinator in Human Resources for certification. HR will
NOT keep a copy of your health information on file. HR will only keep
the Certification Form.
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Take your health information and Certification Form to
your doctor for verification and completion. Then bring form to Wellness
Coordinator in Human Resources. HR will NOT keep a copy of your health
information on file. HR will only keep the Certification Form.
Please note that on both options you must sign the back of
the form, agreeing to the following:
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I certify that 1) I am
tobacco free and I must be
tobacco free
for the duration of this program unless my doctor has certified that I
am unable to stop using tobacco products and he/she has made a
recommendation for an alternative method of achieving tobacco cessation
usage, 2) I provided my health care provider or Wellness Coordinator
with a copy of my biometric data from the past 12 months for
verification, and 3) that all information contained within this form is
factual and true to the best of my knowledge.
If I am an employee, I also understand that
falsification of any information on this form is a violation of the
Personnel Merit System, and I may be subject to corrective or
disciplinary action.
Further, I understand that any falsification may also result
in disqualification from the premium reward program. |
Body Fat Guidelines:

BMI Chart:

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