By Justin Stoltzfus
With health experts and agencies pointing out the benefits of maintaining a healthy lifestyle, American society is starting to look collectively at body weight goals for all ages. From school lunch programs to local community gyms, many are investing in preventative care in the form of better overall fitness, thus lowering the risk of costly health problems such as heart disease and diabetes.
But are health insurance companies getting the picture? Here are some ways that private insurers are responding to the idea that obesity prevention could help decrease health care costs:
- Weight loss surgeries may be covered by some insurance companies. Aetna, for example, provides details about when a gastric bypass, lap band or other procedure could be covered by some of its plans. Criteria include body mass index scores as well as whether an enrolled member has sleep apnea, hypertension or other serious medical problems related to his or her weight.
- Some plans offer reimbursement for fitness programs. HealthAmerica, a medical insurance plan provided by Coventry Health Care in Pennsylvania and Ohio, offers members reimbursement for approved health programs and gym memberships if they follow certain rules.
- Not all insurers have the same rules on weight loss programs, and many will not cover commercial weight loss programs, nutritional services and diet plans — but some may offer discounts. In March 2009, Cigna announced that its Healthy Rewards program would expand to offer its members discounts and coupons for programs such as NutriSystem and other approved nutritional weight loss services.
- Individuals and families could encounter challenges using their health savings accounts (HSAs) or flexible spending accounts (FSAs) for diet or fitness programs. As required by the IRS, Cigna, for example, restricts using an HSA or other medical spending accounts to paying for gym memberships, diet plans and personal trainers, as well as for fitness equipment like pedometers and scales. Money in these accounts can be used to cover all of these — but only if the buyer can provide the proper documentation, such as a letter from a physician that shows the items or services were medically necessary. This kind of restriction is why consumer advocates and those who want to lower health care costs are clamoring for more coverage of common-sense preventative solutions.
Although health insurance might not fully cover a member’s fitness and diet efforts, some insurance companies provide tools for members to curb the cost of losing weight — and to lower medical expenses in the long run.