State of Mississippi
State and School Employees' Health Insurance Plan
Obesity Treatment Program
On July 1, 2009, the State and School Employees’ Life and Health Insurance Plan (Plan) began a two-year limited Obesity Treatment Program (Program) for the treatment and management of obesity and related conditions. Under this Program, the Plan provides benefits for medically necessary bariatric procedures for those Plan participants selected for inclusion in the Program. Participation in the Program is limited to no more than one hundred (100) individuals per year, to be randomly selected. The first one hundred (100) participants were selected in November 2009.
The application process for year two of the program will begin in January 2010. Criteria include, but are not limited to, participation in the Plan for at least twelve (12) consecutive months prior to June 1, 2010; completion of the HealthQuotient health risk assessment through the Plan’s wellness and health promotion program; a BMI (Body Mass Index) of greater than forty (40), or a BMI greater than thirty-five (35) with two (2) or more co-morbidities such as diabetes, hypertension, gastro-esophageal reflux disease, sleep apnea or asthma; two or more physician-supervised weight loss attempts such as Weight Watchers®, the Atkins™ diet, the South Beach Diet®, or Sugar Busters®, within the last twenty-four (24) months; and consent to provide personal and medical information to the Plan.
Applicants must agree to comply with any and all terms and conditions of the Program including, but not limited to, participation and reporting requirements. This includes participation in a twelve (12) month post-surgery case management program administered by the Plan’s medical management vendor. Applicants must also agree to comply with any and all requests by the Plan for post-surgical medical and productivity information, with such agreement to survive applicants’ participation in the Plan. Applicants must acknowledge that the terms and conditions of the Program may be amended at any time and must agree to abide by such amendment(s).
From the qualified applicants, one hundred (100) participants will be randomly selected by an independent consulting firm. The selected participants will be eligible to receive a multi-disciplinary health evaluation at a facility designated by the American Society for Metabolic and Bariatric Surgery (ASMBS) as a Bariatric Surgery Center of Excellence located within the State of Mississippi. Benefits for bariatric surgery are provided only when the participant is approved in the Program and the services are performed at a Center of Excellence within the State of Mississippi. Currently, Mississippi has three facilities designated as Centers of Excellence: Central Mississippi Medical Center in Jackson; Baptist Memorial Hospital - North Mississippi in Oxford; and Singing River Hospital in Pascagoula.
If the Center of Excellence determines that bariatric surgery is medically appropriate, the participant must contact CareAllies, the Plan’s medical management vendor, to enroll in a case management program and to receive prior authorization for the surgery. CareAllies will review medical criteria to determine qualified applicants for the Program, provide case management, and patient follow-up services.
If you are interested in applying to participate, you and your physician must complete and submit an Obesity Treatment Program Application Applications must be faxed to CareAllies at (877) 492-4746 (toll-free) by June 1, 2010. Incomplete applications will not be considered for participation in the Program.
Click here for the Obesity Treatment Program Application
