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Is the DPP a Covered Benefit?

There are three important steps that employers can take to make the Diabetes Prevention Program (DPP) lifestyle change program available to employees:

  1. Action Step 1: Ask if the DPP lifestyle change program is a covered health benefit,
  2. Action Step 2: Discuss the DPP lifestyle change program with your team of executives and stakeholders, and 
  3. Action Step 3: Promote diabetes prevention to employees. 

Continue reading about Action Step 1 and related resources or download the San Diego Diabetes Prevention Employer Toolkit by clicking on the button below.

 

Action Step 1:

Ask if the DPP Lifestyle Change Program is a Covered Health Benefit

Contact your health insurance carrier(s) and ask if the DPP lifestyle change program is a covered health benefit for your employees. Although many healthcare plans offer chronic disease management programs, they typically focus on managing existing diseases. In contrast, the DPP lifestyle change program is an evidence-based program developed specifically to prevent type 2 diabetes. 

If the DPP Lifestyle Change Program Is a Covered Benefit…

Great! Ask about coverage details from your business’s health insurance carrier(s). Consider the following questions:

  • What do you need for enrollment?
  • Are there any situations where the DPP lifestyle program would not be covered?
  • Are there any conditions for enrolling in the program?
  • What percentage of the program cost is covered?
  • What happens if someone drops out of the program? 
  • How can you promote the DPP lifestyle change program to eligible employees?
  • How do you find and connect with local DPP lifestyle change program providers who accept this insurance benefit?

If the DPP Lifestyle Change Program is NOT a Covered Benefit…

Talk to Your Health Insurance Carrier

Start a discussion with your health insurance carrier(s) about how to add the DPP lifestyle change program as a covered benefit for employees. You can ask the following questions: 

  • Which chronic disease prevention or treatment programs are included?
  • Why is the DPP lifestyle change program not a covered benefit?
  • Can you explain how coverage of this program could work and if there are any conditions that we should be aware of regarding coverage?
  • What would be the total additional cost for adding the program as a benefit? 
  • What would be the additional cost per program participant?
  • Would only a certain percentage of the DPP lifestyle change program cost be covered?

 

Or, Consider Covering the DPP Lifestyle Change Program Costs Directly

If your health insurance carrier(s) are not prepared to cover the DPP lifestyle change program, assess if your business can cover all, or a portion, of the costs for eligible employees as part of your organization’s wellness program. Here are some steps you might take:

  • Locate a local DPP program provider and discuss the possibility of partnering to offer the program to your employees. 
  • Determine the cost per participant and a payment structure. Find out what works best for your worksite and the DPP lifestyle change program provider(s). Some options include:
    • The employer pays the entire cost of the program and employees participate free of charge.
    • The employer covers part of the cost and employees make up the difference.
    • Employees pay up-front, or monthly, and are reimbursed by the employer after meeting specific program milestones.

Learn about recommendations on how to start a DPP lifestyle change program.

Now that you've contacted your insurance carrier(s), the second action step is to discuss the DPP lifestyle change program with your team of executives and stakeholders.