Health Risk Assessments (HRA)

Bellin Health will be conducting the City’s Health Risk Assessments (HRAs) beginning in March, 2017. By completing the HRA and requirements, eligible participating employees will earn points to be used to reduce employee health insurance premium contributions, earn Personal Benefit Account (PBA) dollars and other incentives. Earning 1265 points and completion of the HRA requirements by employee and spouse, if applicable, will provide a reduced employee health insurance premium contribution of 11.5%.

For Police Officers, Fire Fighters, Transit Mechanics and Bus Drivers completion of the HRA requirements by employee and spouse, if applicable, will provide PBA dollars and a reduced employee health insurance premium contribution of 12.5%.

HRA information and forms for Health│1265 will be tracked through employee myInertia accounts. Data can be upload to their myInertia account to insure credit toward reduced premium and PBA dollars. Police Officers, Fire Fighters, Transit Mechanics and Bus Drivers can scan and e-mail completed forms to Human Resources at HumanResources@greenbaywi.gov.

Deadline to complete HRA and requirements is September 29, 2017

Employees on the City’s Health Plan can earn up to $200 in a PBA account for single coverage and up to $400 for family coverage in accordance with the following criteria.

PERSONAL BENEFIT ACCOUNT (PBA):

$100 for employee Employee complete HRA and requirements by September 29, 2017
$100 for covered spouse Spouse complete HRA and requirements by September 29, 2017
$100 for employee only $50 per employee dental cleaning to max of $100 by October 31, 2017
$100 for covered family member $50 per family dental cleaning to max of $100 by October 31, 2017

Employees and their spouse are encouraged to complete the HRA screening and other requirements as early as possible to ensure all HRA requirements are completed and turned in by September 29, 2017.  Completed Dental Cleaning Sign-Off Forms must be turned in by October 31, 2017.

HEALTH RISK ASSESSMENT – includes the screening & MD Alert Sign-off form (if age applicable).

HRA Screening (10 minutes): Individuals must fast 8–12 hours before the screening. Do not work out the morning of your HRA and continue to take prescribed medication. You are able to drink water and are encouraged to do so prior to the screening appointment. If you are pregnant or have a health condition which warrants non-fasting (such as diabetes) do not fast. At the screening, a venipuncture blood draw will be done along with body measurements, height, weight and blood pressure. The HRA questionnaire and lab consent form will be collected at the time of the screening.

 MD Sign-Off Form: Completion of a routine physical exam and other tests are required if you have reached age 40 by January 1, 2017. If under age 40 you don’t need to complete the physical exam requirement.

Females age 40 and older need:
Routine physical every year 

Pelvic/pap smear every year
Mammogram every other year

Males age 40 and older need:
Routine physical every year
PSA, optional each year

Spouse – a spouse who has completed an HRA through their employer, may complete the Spouse Health Risk Assessment Sign-Off Form.  Please note spouses must completed the physical requirements (if age applicable) and complete the MD  Sign-Off Form.

Please note:  The City does not receive individual data on HRA participants, only an aggregate report of the overall results. 

HRA Memo 2017

HRA Questionnaire

MD Sign-Off Form

Spouse HRA Sign-off Form