Quarterly Goals. If the AGENCY has a quarterly goal in the Scope of Work in “Exhibit A”, and that goal has not been reached at the end of the quarter for which the AGENCY has included in the reporting, the AGENCY shall submit a corrective action plan at the time they submit the Quarterly Report. A narrative explanation for any variance of ten percent (10%) or greater of quarterly goals shall be submitted in addition to the report.
Quarterly Goals. (To be submitted by September 30th, December 31st, March 31st and June 30th) Choose from the following to complete your participation each quarter: • Use Rally to track and complete 3 missions each quarter* • Enroll in Telephonic Health Coaching (this could cover more than one quarter)* • Enroll in the Diabetic Prevention Program (this program lasts all year, use reporting sheet quarterly) • Complete at least three of the following items each quarter (use reporting sheet): (The following can only be used once per enrollment year) ▪ Watch MyHealthcare Cost Estimator Video xxxx://xxx.xxx.xxx/individual-and-family/why-uhc/programs- tools/myhealthcare-cost-estimator ▪ Set up your xxxxx.xxx account ▪ Go to xxx.xxxxxxxxxxxxxxxxx.xxx and print of a list preventative health screenings for your age and gender ▪ Get a dental cleaning (submit verification form) ▪ Get a vision exam (submit verification form) ▪ Download Health4me App (The following can be used more than once) ▪ Get a preventative screening ▪ Keep an exercise log or a food log for at least 30 days ▪ Attend a Wellness Class (financial, health, mental) ▪ Watch a video from a link distributed by HR Department ▪ Read a wellness related article ▪ Be tobacco free for 30 days (for tobacco users only) I understand that failure to meet these obligations may forfeit my eligibility for the wellness premiums and I may be required to repay the difference between the participant and non-participant premiums. Print Name Signature Date I CHOOSE TO: □ waive participation in the wellness program WAIVE PARTICIPATION Signature Date
Quarterly Goals. (To be submitted by September 30th, December 31st, March 31st and June 30th) Choose three of the following to complete your participation each quarter: ▪ Set up your BCBS Portal login ▪ Go to BCBS Wellness Tab and review the Preventive Care list ▪ Get a dental cleaning (can only be used twice per plan year) ▪ Get a vision exam (can only be used twice per plan year) ▪ Get a preventative screening ▪ Keep an exercise log or a food log for at least 30 days ▪ Attend a Wellness Class (financial, health, mental) ▪ Watch a wellness related video ▪ Read a wellness related article ▪ Be tobacco free for 30 days (for tobacco users only) If you are participating in a health related activity that is not listed, please contact HR for potential credit. I understand that failure to meet these obligations may forfeit my eligibility for the wellness premiums and I may be required to repay the difference between the participant and non-participant premiums. _ Print Name Signature Date WAIVE PARTICIPATION I CHOOSE TO: □ waive participation in the wellness program
Quarterly Goals. (To be submitted by September 30th, December 31st, March 31st and June 30th) Choose three of the following to complete your participation each quarter: Set up your BCBS Portal login Go to BCBS Wellness Tab and review the Preventive Care list Get a dental cleaning (can only be used twice per plan year) Get a vision exam (can only be used twice per plan year) Get a preventative screening Keep an exercise log or a food log for at least 30 days Attend a Wellness Class (financial, health, mental) Watch a wellness related video Read a wellness related article Be tobacco free for 30 days (for tobacco users only) If you are participating in a health related activity that is not listed, please contact HR for potential credit. I understand that failure to meet these obligations may forfeit my eligibility for the wellness premiums and I may be required to repay the difference between the participant and non-participant premiums. _ Print Name Signature Date WAIVE PARTICIPATION I CHOOSE TO: □ waive participation in the wellness program
