February 7, 2018
More than 29 million U.S. adults are diagnosed with diabetes and 84 million live with prediabetes. Health insurance providers know prediabetes is a serious health condition that raises a person’s risk of developing type 2 diabetes, a costly chronic disease.
Pittsburgh, Pa.-based Highmark is addressing the problem and now covers a new diabetes prevention program at 100 percent as a preventive benefit for people with group insurance coverage. This means patients don’t have to pay any out-of-pocket costs.
The structured lifestyle and health behavior change program—which is recognized by the Centers for Disease Control and endorsed by the Centers for Medicare and Medicaid Services (CMS)—can help prevent type 2 diabetes in employees who are prediabetic.
Eligible employees have two program options: in person through a local YMCA (where available) or online/mobile through Retrofit, a leading provider of weight-management and disease-prevention programs. Both options include structured sessions led by a trained Lifestyle Coach that includes food, weight, and activity tracking, as well as group support.
The benefit is available to fully insured commercial groups and self-funded commercial groups that choose to cover it. For groups that cover the benefit, eligible Highmark-covered members (and their covered dependents over the age of 18) can access the in-person or digital programs through the Highmark member portal and take an assessment to see if they qualify and enroll. The YMCA site includes a zip code finder to help members search for a local YMCA’s Diabetes Prevention Program location.
Highmark aims to help participants achieve at least 5 percent weight loss. Estimates show employers could see $400 to $1,300 in savings per year per member when a participating member reaches that goal.
“Prediabetes is a serious health condition, but it’s reversible,” said Lori Hough, vice president of Clinical Care and Wellness for Highmark. “We’re committed to helping our members complete the program, achieve their goals and live a healthier lifestyle. That’s why we cover the diabetes prevention program at 100 percent as a preventive medical benefit with no member cost share.”