Healthy Blue Living Qualification Form
If you want to get lower deductibles and copays, your doctor needs to electronically submit this form within 90 days after you enroll in or renew the Healthy Blue Living plan.
This applies to only the contract holder of the plan.
Access the form here: Healthy Blue Living BCN Qualification form (PDF)
It's a good idea to print a copy and take it with you to your appointment as a reminder for your doctor.
The form uses a simple A, B, C grading system:
A = You've met the health target
B = You have a health condition that may not be controlled, but you are actively participating in treatment to improve the condition.
C = You're not meeting the wellness target, and you haven’t committed to treatment to improve your condition.