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2017 Wellness Incentive

Program Guide

Steps to Wellness

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Bennett is committed to inspiring health in our employees. As part of our commitment to a healthy workforce, employees and their spouses covered by Bennett’s medical plan have the opportunity to receive an HSA contribution (or FSA as applicable) of up to $1070 each, per year!

2017 Wellness Incentive Program

Program Highlights

The 2017 Wellness Incentive Program begins on October 1, 2016 and ends on

September 30, 2017. All requirements must be completed by September 30, 2017.

Bennett has contracted with On-Site Health Solutions (OHS) to provide employees the

opportunity to complete an online health assessment, participate in biometric

screenings, and join various wellness challenges and track their progress throughout

the year . Screening results will be available on the OHS web portal. All personal health information

collected by OHS is confidential. No individual health information will be shared with Bennett. OHS will

ONLY report individual participation and qualification of financial reward.

Employees and spouses unable to attend the onsite biometric screenings at the

Augusta or McDonough offices may submit biometrics obtained through their local

LabCorp. (See Page 4)

Employees unable to meet the standards for a reward under this incentive program

may qualify for an opportunity to earn the same reward through different means.

Contact Brittany Metten at brittany@healthyworksite.com or by phone at (800) 716-

5051 for more information.

LiveOn Medical Center will be available to provide initial and subsequent health

consultations for participants needing additional health counseling.

2017 Wellness Incentive Program Guide

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Who is eligible to receive the incentive?

Employees and their spouses covered by Bennett’s medical plan will have

the opportunity to earn up to $1070 per year added to their Health Savings

Account (HSA). Each insured employee must have a HSA account in order for the

spouse to be eligible to participate. Participating spouses are eligible to receive the

same amount as employees.

Employees not eligible for a HSA will receive incentives through a Flexible Spending

Account (FSA). For questions regarding Health Savings Accounts or Flexible

Spending Accounts, please contact your corporate HR representative at

(800) 866-5500 x7265 or x7718 or x7504.

Participants have three (3) ways to qualify for the 2017 Wellness Incentive.

REQUIRED: All participants must complete the online health assessment, advanced

lab screening and health consultation(s) to qualify for an incentive.

Option 1 • Complete Online Health Assessment PRIOR to Lab Screening

• Complete Advanced Lab Screening by Dec. 16, 2016

• Complete Clinical Health Consultation Session(s) by May 31, 2017. (The number of sessions

required is determined by your overall score)

Option 2 • Complete Online Health Assessment PRIOR to Lab Screening

• Complete Advanced Lab Screening by 12/16/16 & Health Consulting Session(s) by 5/31/17.

• Complete Five (5) *Wellness Challenges (listed below) by September 30, 2017

Complete one of the On-Site Health Solutions challenges provided on www.healthyworksite.com

Keep a Healthy Food

Journal for 3 months

Participation in

community service or

non-profit organization

activity (min. of 5 hours)

Participation in a 5K (all 3.1

miles) or similar group physical

activity/benefit walk

Participate in an instructor-led

weight management program

Active gym membership and/or

group exercise class

participation

Blood Donation to the American

Red Cross or LifeSouth

Complete a 7 mile

organized bike ride

Complete Bennett’s Annual

Walking Challenge

Complete Bennett’s Annual

Water Drinking Challenge

Complete Bennett’s

Biggest Loser Challenge

Attend 1 education session

How do I qualify for the incentive?

*See page 7 for more information on the various wellness challenges.

Option 3 • Complete Online Health Assessment PRIOR to Lab Screening

• Complete Advanced Lab Screening by 12/16/16 & Health Consulting Session(s) by 5/31/17.

• Complete Three (3) Preventive Screenings below and submit proof via Physician Form

(attached) or Explanation of Benefits (EOB) by September 30, 2017.

Annual Physical Exam

Vision Screening

Dental Screening

Mammogram

Gynecological Exam/Pap Smear

Immunizations (Flu, Tdap, Shingles, etc.)

Colonoscopy

Osteoporosis/ Bone Density

Dermatology/Skin Cancer Screening

PSA Test

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How do I get started?

Online Health Risk Assessment (HRA)

The online Health Risk Assessment (required) is a simple, 10-15 minute survey that

gives you a snapshot of your current health status and risk for certain diseases and

conditions.

ALL EMPLOYEES - completing the online assessment will enable you to print a lab form

for your Advanced Lab Screening.

NEW PARTICIPANTS may register by copying and pasting the following link into your

internet browser - https://assessment.healthyworksite.com/?c=Bennett$McDonough

(Username will be your individual email address)

PREVIOUS PARTICIPANTS may complete the online assessment by logging on to

www.healthyworksite.com using your USER ID (email you provided last year) and

password. If you forgot your password, click “forgot password” or call 800.716.5051.

Click on the following tabs for the 2017 Health Risk Assessment:

Participant Login

myWellnessPlan

myResults

OPTION 1

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Click here to take the HRA

Assessment must be completed PRIOR to lab screening and PRIOR to sending

in any incentives (preventive screenings and challenges).

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Advanced Lab Screening

The Advanced Lab Screening (required) is a comprehensive panel of tests (listed below)

using a blood draw, which helps identify hidden risks for heart disease and diabetes.

Participants will have biometric measurements taken including: height, weight, BMI, waist

circumference, blood pressure, and body composition. Your individual lab results will be

loaded directly into your account and you will receive an email letting you know your results

are ready to be viewed. No lab results will be mailed to participants or physicians.

ALL EMPLOYEES will need to print a lab form for the Advanced Lab Screening by logging

on to www.healthyworksite.com and selecting “myWellnessDocs”. Complete the personal

information portion of the form and bring to your lab screening.

To schedule your Advanced Lab Screening:

• All Locations: To find the nearest lab, go to www.labcorp.com and click “Find a Lab”.

You will need to type in your address in the search field and also click “Employee

Wellness with Body Measurement”, then click Search. Please have the form filled out

prior to arriving. You may need your identification. Bring lab form to the LabCorp office.

All tests needed will be pre-marked on the lab form. Instruct the technician to only

perform tests that are marked unless age specific tests are needed as noted on the

form. Appointment is not necessary but recommended.

OPTION 1 (cont)

LAB TEST PURPOSE

hsCRP Inflammation may indicate infection or a chronic inflammatory disease

non-HDL Cholesterol A low level of non-HDL cholesterol means a higher risk of heart disease

HbA1c Measures risk for type 1 or type 2 diabetes

Vitamin D Low levels of Vitamin D can cause your bones to become thin and brittle

Triglycerides Measures risk for heart disease

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Clinical Health Consultations

The individual Clinical Health Consultation Session(s) are designed to help participants

understand their lab report and screening results, and set goals for health improvement.

Coaching sessions can only be completed after the Advanced Lab Screening has taken

place and you have received your results. Participants may complete their coaching

sessions by telephone or onsite at select office locations. The first consult will include a

quick exam. To schedule your consultation, call LiveOn Medical Center at 844-255-9407.

OPTION 1 (cont)

What is the reward for completing OPTION 1?

Each employee and/or eligible spouse who completes the 1) Online Health Assessment, 2) Advanced Lab Screening and 3) Clinical Health Consultation(s) as prescribed, by the deadline, can earn up to $700 (one-time HSA or FSA deposit). The amount each participant will receive will depend on the total points earned. HSA/FSA deposits will not be made prior to January, 2017.

GOLD 1 2400-2600 points = $700

SILVER 2 1500-2399 points = $400

BRONZE 3 1-1499 points = $250

MEASUREMENT STANDARD POINTS

TOBACCO STATUS NON-USER 600

BLOOD PRESSURE < 130/80 150/150

hsCRP < 1.9 400

NON-HDL CHOLESTEROL < 130 400

HbA1c < 5.4 300

VITAMIN D > 30 300

TRIGLYCERIDES < 150 300

MAXIMUM POINTS 2600

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1 Clinical Health Consultation

2 Clinical Health Consultations

3 Clinical Health Consultations

Tobacco Use Affidavit

To qualify for the 600 points, you must certify that you are and commit to be tobacco/nicotine-free for 2017 by completing this form and submitting by December 16, 2016. Definition of tobacco/nicotine-free: Not having used any tobacco products including cigarettes, e-cigarettes, cigars, pipes, smokeless tobacco, vaping, nicotine replacement products or used any other form of product containing nicotine within the past three months. STATEMENT OF FRAUD/Falsification of information in order to receive an incentive Bennett reserves the right to reclaim your incentive if it is found that you falsified information.

Name ___________________________________________________/______/_____ First MI Last Date of Birth

TOBACCO/NICOTINE-USE CERTIFICATION

I certify that I do NOT use any tobacco/nicotine products and commit

to remain tobacco/nicotine free in 2017.

I certify that I am currently enrolled in an approved tobacco/nicotine cessation program and upon

completion of the program, will re-certify as a user/non-user . I understand that the incentive is

dependent on completion of the program. Proof of program completion is required and must be

submitted via one of the options below by April 30, 2017

Signature _________________________________________ Date _______________________

~ PLEASE BE AWARE ~

If you begin using any type of tobacco or nicotine-containing product at any time, you are required to recertify as a tobacco/nicotine user.

You may submit your completed form any of the following ways:

• MAIL: On-Site Health Solutions:10605 Meeting Street # 103 Prospect, KY 40059

• FAX: 502-426-1177, Attention: Bennett Tobacco Free Form

• EMAIL: brittany@healthyworksite.com Subject Line: Bennett Tobacco Free Form

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How do I get started?

Online Health Risk Assessment (as described on page 3)

Advanced Lab Screening (as described on page 4)

Complete Five (5) Challenges (below) between 10/1/16 – 9/30/17 to earn a

one-time $250 deposit to your HSA/FSA account. HSA/FSA deposits will not be made

prior to January, 2017. Challenges may be completed only once for credit. You must

provide documentation showing completion via email or fax to Onsite Health Solutions

by September 30, 2017.

• Subject Line: Bennett Wellness Challenge

• Include your printed name and company name

• Email to: brittany@healthyworksite.com OR Fax to: 502-426-1177

OPTION 2

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CHALLENGE OPTIONS

1. Complete one (1) of the On-Site Health Solutions challenges provided on www.healthyworksite.com

2. Keep a Healthy Food Journal for 3 months. Food Journal Calendars can be found in the

“myWellnessDocs” section of the portal.

3. Complete a 7 mile organized bike ride.*

4. Participation in community service or non-profit organization activity (min. of 5 hours)*

5. Participation in a 5K (all 3.1 miles) or similar group physical activity/benefit walk*

6. Participate in an instructor-led weight management program, lose 5% of body weight and maintain loss

for 3 months. Must get initial weight & end weight from facility or Dr. office.*

7. Active gym membership and/or group exercise class participation (Requires proof of gym usage or

class participation on an avg. of 3x/week over a 3 month period)

8. Blood Donation to the American Red Cross or LifeSouth*

9. Complete Bennett’s Annual Walking Challenge

10. Complete Bennett’s Annual Water Drinking Challenge

11. Complete Bennett’s Biggest Loser Challenge (must Lose 5% of starting weight)

12. Attend 1 education session (may be provided by Home Office or Community Facilities)

• Lunch-n-Learns

• Stress/Diabetes/ Blood Pressure Management

• Webinars

• Financial Wellness

• Tobacco Cessation

• Nutrition Counseling

• CPR Training

• Heart Disease Prevention/Management

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How do I get started?

Online Health Risk Assessment (as described on page 3)

Advanced Lab Screening (as described on page 4)

Complete Three (3) Preventive Screenings (listed below) between 10/1/16 – 9/30/17.

Proof of screening can be in any of the following forms:

• This form (completed, signed & stamped by the physician’s office)

• Receipt from physician’s office with the following information: Name of

Employee/Spouse, Bennett International Group written or typed on the receipt, the

appointment date and description of screening.

• EOB Statement

Patient Name (Please Print):_______________________________________

OPTION 3

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Available to ALL Bennett employees (insured through Bennett’s insurance plan or not) and

all Bennett insured spouses.

• Insured Employees & Spouses may complete 3 of the preventive screenings listed

below to earn a one-time $120 deposit to the primary insured member’s HSA/FSA

account. HSA/FSA deposits will not be made prior to January, 2017.

• Employees NOT insured through Bennett may complete 3 of the preventive

screenings listed below to earn a one time $50 check.

Please send this form or other documentation of completion via email or fax by October 4, 2017 to Onsite Health Solutions. Use Subject Line: Bennett Preventive Screenings and include your NAME and COMPANY NAME

Email To: brittany@healthyworksite.com OR Fax To: 502-426-1177

Complete Physical Exam Vision Screening Dental Screening Mammogram Gynecological Exam/Pap Smear

Immunizations (Flu, Tdap, Shingles, etc.) Colonoscopy Osteoporosis/ Bone Density Dermatology/Skin Cancer Screening PSA Test

Physician/Provider signature:___________________________________________

Date of Service:_______/_______/_______

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Improvement Bonus

Within 3 weeks after completion of the OHS Health Risk Assessment (online Health Assessment, Advanced Lab Screening, & Required Clinical Health Consulting Session(s)), participants will receive an email confirming their results are ready to view on their secure web portal. The results will include the participant’s total points earned. For those participants who are insured through Bennett’s medical insurance, they will receive their incentive deposit into their HSA or FSA account. However, this is not the last opportunity to earn the highest incentive possible! Making better choices and adopting a healthier lifestyle is the key to taking advantage of the great improvement bonus offer. After making these lifestyle changes, participants can visit their physician (PCP) and get tested for any of the metrics included in the incentive plan. By improving these metric values to meet the threshold, participants will earn additional points that can be added to their score, which may also improve their wellness level (Gold, Silver, Bronze). To prove that you have met the threshold, please submit a report from your physician to OHS reflecting those improvements. This report must be turned in no later than April 30, 2017, and taken place after your Bennett Lab Screening was completed. This report may be sent via email to: brittany@healthyworksite.com or fax to: 502-426-1177. Call 800-716-5051 with any questions you may have. Bennett will be notified of any participant who has successfully raised their wellness level and the incentive difference will be deposited into the primary insured’s HSA/FSA account.

For Example: Bubba Bennett scored 1900 on his health risk assessment taken in October, which placed him in the Silver category- only 500 points less than necessary for the Gold category. He would receive $400 in his Health Savings Account. He decided to begin exercising and eating healthier. He went to his doctor in February and had a check-up. His doctor informed him that since the time of his health screening in October, he had lowered his non-HDL cholesterol from 150 to 120 and lowered his blood pressure from 150/100 to 130/80. Bubba sends his new health report to OHS and receives more good news! Because of the fact that his new report shows he met the required threshold in these two areas, he could now earn 700 additional points to be added to his original score of 1900 (400 for his non-HDL Cholesterol and 300 for his blood pressure), which would now place him into the Gold category. He will now receive an additional $300 deposited into his HSA account. If he had moved from Bronze to Silver, he would receive an additional $150. If he had moved from Bronze to Gold, he would receive an additional $450. The maximum incentive for this portion of the wellness initiative is $700. Please contact OHS with any questions or concerns. 2017 Incentives Expire on September 30, 2017.

How can I earn more points?

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When do I receive my incentive?

Once you complete the 1) Online Health Assessment, 2) Advanced Lab Screening and 3) Clinical Health Consultation(s) as prescribed, by the deadline, you will receive the incentive. HSA/FSA deposits will not be made prior to January, 2017.

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WELLNESS INCENTIVE Program Timeline

2016 – 2017

OCT OCT OCT

DEC DEC APR

MAY SEP SEP

Complete Online Health

Assessment.

Refer to Wellness Program Guide for

instructions.

Advanced Lab

Screenings at Home Office and Augusta

locations

4-15 1-31

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Deadline for Tobacco

Free Form to be

submitted to On-Site Health

Solutions.

Deadline for ALL Advanced Lab

Screenings to be completed.

Employees hired on or after this

date email Brittany Metten: brittany@healthyworksite.com

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2016 – 2017 Wellness Program begins

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Deadline for documentation to be submitted

to On-Site Health Solutions for Improvement

Bonus, if applicable.

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Deadline for all Health

Consultations to be

completed. You may be

required more than one

consult based on your results.

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Deadline for all Wellness

Challenges to be completed and

documentation to be submitted to On-Site Health

Solutions.

Deadline for all Preventive

Screenings to be completed and

documentation to be submitted to On-Site Health

Solutions.

Please print this page as a reference

2016-2017

DUE

ONLINE

ASSESSMENT

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