Obesity affects a significant portion of the American adult population, with an estimated one in three individuals classified as obese. Blue Cross and Blue Shield (BCBS) offers a variety of weight management programs designed to assist members in achieving their health goals. These programs range from digital support and health coaching to discounts on fitness and nutrition resources, and even coverage for weight-loss medications and procedures when eligibility criteria are met. This article explores the details of various BCBS weight loss programs, highlighting their features, eligibility requirements, and potential benefits.
Overview of BCBS Weight Management Offerings
BCBS provides a spectrum of resources aimed at supporting members in their weight management journeys. These include:
- Digital Weight Management Programs: Leveraging technology to provide personalized plans and ongoing support.
- Health Coaching: Connecting members with professionals for tailored guidance and motivation.
- Discount Programs: Offering savings on fitness equipment, nutrition services, and related products.
- Coverage for Medications and Procedures: Providing financial assistance for eligible members seeking medical interventions.
It's important to note that the availability of specific programs and benefits may vary depending on the BCBS plan and the member's location. The BlueCard Program is not available for Medicaid, Medicare Advantage or Medicare Part D plan members. HMO plan members can use the BlueCard Program only for emergency or urgent care when traveling or away from home for less than 90 days. Not all benefits are offered by all Plans mentioned above.
Digital Weight Management Programs
Weight Management Program by Livongo®
The Weight Management Program by Livongo® offers eligible members a digital scale and continuous support to help manage their weight and improve their health. This program is accessible to members who are 13 years of age and older. To be eligible, members must have a pediatric pharmacy or medical claim in the 85th percentile or higher within the last three years or an adult pharmacy or medical claim with a BMI of 25 or higher within the last three years. Members living overseas must have a valid APO, DPO or FPO address.
Wondr Health
Wondr Health is a clinical behavioral weight management program focusing on weight loss and diabetes prevention. State Health Plan members, including spouses and dependent children ages 18 and older, are eligible to apply. Medicare-primary members are also eligible. Some medical conditions or body mass indexes (BMIs) might prevent a member from participating in the program. Wondr Health teaches it’s not what you eat, but when and how you eat that will help you lose weight. Plus, participants will reduce their risk for chronic diseases like diabetes and heart disease while increasing their chances of living a longer, healthier life. It is a 10-week, online program that uses weekly video lessons and interactive tools to teach the behavioral skills necessary to lose weight and keep it off long-term. Each week, participants watch lessons at their convenience on their computer, or smartphone or tablet through the iPhone or Android apps. More information is available at www.wondrhealth.com/PEBA.
Read also: Does BCBS Cover Weight Loss?
Virta Health
Virta is a new type of diabetes care program that uses technology and nutrition counseling for weight loss to help reverse Type 2 diabetes. Participants naturally lower and control their average blood sugar (HbA1c) while also reducing or eliminating diabetes medication and losing weight. The program is available at no cost to eligible State Health Plan primary members. Learn more and apply at virtahealth.com/join/peba.
Personify Health (Personify)
State Health Plan members have access to Personify Health (Personify), a comprehensive solution for health and well-being engagement. Personify is an independent company that offers a digital health platform on behalf of the State Health Plan. Personify is designed to help members adopt easy-to maintain changes in behavior that can lower health risks. Everyone has different health goals and needs. Members deserve better than a one-size-fits-all platform. Whether they just want to stay healthy or they need to manage certain health concerns, Personify helps them get on a path to success. Sync their personal fitness device and join group challenges. Compete with others while exploring destinations around the world using their own steps on a virtual course along with daily, weekly step challenges to keep them engaged with their friends and family. To enroll in Personify, members can log in to their My Health Toolkit account to access Personify and take the brief health survey.
Health Coaching Programs
BlueCross offers health coaching to help members meet their weight management goals. The weight management program assists members ages 18 and older in helping achieve weight-loss goals through small changes made in the member’s everyday life. When members enroll, they receive information about weight management, as well as a confidential survey to help a registered nurse tailor the program to meet their needs.
BlueCross also offers weight management for kids and teens. This confidential program is for overweight and obese dependents ages 2-17. It is designed to teach children and their parents about healthy habits and help them work with their doctor on weight management. When a dependent enrolls, they receive a parent’s guide and tailored educational materials for the dependent. A personal health coach is assigned to the dependent and provides education and support to help both the parent and the dependent overcome barriers to living a healthy lifestyle. To connect with a coach, members can call 855-838-5897 and select Option 3.
Discount Programs
With Blue365®, you can achieve your personal fitness goals on your budget. Blue365 is a discount program available to State Health Plan members offered by BlueCross. The program has a network of licensed acupuncturists, massage therapists and fitness clubs that can be used at lower fees, often as much as a 25% discount. Blue365 also offers discounts on health centers, weight loss and nutrition programs, wearable health-trackers and much more. For more information on Blue365 or member discounts, members log in to their My Health Toolkit account.
Read also: Understanding BCBS Weight Loss Benefits
Blue365 is only available to Blue Cross and Blue Shield of Montana (BCBSMT) members with active health plan coverage. The relationship between Blue365, its vendors and BCBSMT is that of independent contractors. Blue365 is a discount program available to BCBSMT members who have medical coverage with BCBSMT. This is NOT insurance. Some of the services offered through Blue365 may be covered under your health plan. Please refer to your benefit booklet or call Customer Service at the number listed on your member ID card for specific benefit information under your health plan. Use of Blue365 does not affect your premium nor do costs of Blue365 services or products count toward your plan deductible, calendar year or lifetime maximums. BCBSMT does not guarantee or make any claims or recommendations regarding the services or products offered by Blue365 and its vendors. You may want to consult with your physician prior to use of these services and products. Services and products are subject to availability by location.
Coverage for Weight-Loss Medications and Procedures
In addition to good nutrition and physical activity, many FDA-approved weight-loss medications can help reduce weight by at least 5%. We cover weight-loss drug prescriptions to treat obesity for Service Benefit Plan members who meet eligibility criteria and get prior approval. FEP also covers procedures to treat morbid obesity. Note: Prior approval is required for surgery for morbid obesity. Beginning January 1, 2025, the tiers for some weight loss GLP-1 drugs will change for members with FEP Blue Standard® and FEP Blue Basic® plans.
Additional Programs
Disease Prevention Programs
Disease prevention programs - targeting reduction of risk for type 2 diabetes and heart disease, prevention programs provide members with a health coach and an individualized plan that meet their unique needs and address several areas of their life, including physical activity, nutrition, sleep and stress management.
Chronic Condition Reversal Programs
Chronic condition reversal programs - turn back the clock and reverse the course of chronic conditions like hyperlipidemia, hypertension, type 2 diabetes and more with the support from physician, health coaches and a supportive patient community. Dr. Dean Ornish’s Program for Reversing Heart Disease® is the first and only program that is scientifically proven to reverse the progression of heart disease by optimizing four key areas of patient’s lives including nutrition, stress management, fitness, and social support.¹ This unique program for reversing heart disease is available to Blue Shield of California commercial HMO and PPO plan members. Referring patients to the Dr. Wellvolution is a registered trademark of Blue Shield of California.
Heart Health and Diabetes Management Programs
Maintaining a healthy weight is important for your heart’s health. Hello Heart is an easy-to-use program that helps participants track, understand and manage their heart health from the privacy of their own phone. The Hello Heart program is available at no cost to eligible State Health Plan primary members and includes a free blood pressure monitor that connects to an app on their smartphone. Members can enroll and get started at join.helloheart.com/PEBA2. They can also work with a BlueCross health coach at no cost. The health coach can help them better understand their heart condition and how to manage it.
Read also: Navigating BCBS for Bariatric Surgery
The Plan also offers a heart health program and diabetes reversal program that include a weight management component to help members better manage those conditions. These programs are provided at no cost to the member. Diabetes health education through certified diabetes educators is also offered at no cost to State Health Plan primary members at a network provider. Diabetes education trains diabetics to manage their condition to avoid disease-related complications. People who receive diabetes education are more likely to use primary care and preventive services, take medications as prescribed, and control their blood glucose, blood pressure and cholesterol levels. Members can visit a network provider for more information. They can also work with a BlueCross health coach at no cost. The health coach can help them manage their diabetes.
Additional Information
Help Blue Shield of California and Blue Shield Promise Medi-Cal members make healthier choices with their diet, exercise, sleep, and overall health. Members can choose from over 60 programs, ranging from general well-being, health risk management to treatment and reversal of serious chronic conditions like type 2 diabetes. With the right tools, coaching, nutrition counseling and health professional support members can succeed with small changes today to make a big difference for a healthier tomorrow. Weight loss programs - programs specifically designed to help your patients make changes that fit their lifestyle and promote a healthy weight. Members can lose weight and keep it off with coaching support and a personalized step by step plan on how to decrease cravings, hunger and weight without dieting.
The Importance of Weight Management
Being overweight or obese significantly increases a person’s risk of diseases and other health problems, such as heart disease, diabetes, high blood pressure and high cholesterol. State Health Plan coverage includes several programs to assist members with weight management.