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A WELLNESS PROGRAM PRESENTED BY TURNBERRY ASSOCIATES
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www.turnberry.com
Page 1 of 8862349_b 03/15 Offered by: Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company.
To apply, please complete and submit the Cigna Well-Being Award® application by following these three simple steps:
1. Download this application to your desktop and complete. 2. “Save As” your company name. 3. Submit your application to [email protected]. Deadline:
Applications will be reviewed by an internal review committee and the Cigna Well-Being Award will be presented at:
Questions? Please contact your Cigna Sales Team and/or email us at [email protected].
Directions
Name Title Address
City State Zip
Phone number Email address
Contact information of person submitting application
CIGNA WELL-BEING AWARD APPLICATION
This paperclip designates an optional attachment. If you have these supporting documents it is recommended to include them when submitting your award application.
Company information
Company name
Industry
Number of employees
Together, all the way.SM
Page 2 of 8
1 Building infrastructure
1.1 How does senior leadership drive or support the wellness program? Please give examples of executive leadership, communication and participation. (250 max word count)
1.2 Discuss how your organization’s wellness program is funded. Please include all funding sources (e.g., internal wellness funds, premium differentials/surcharges, grants). (250 max word count)
1.3 How are operational supervisors and managers involved in the wellness program initiatives? (250 max word count)
1.4 Do you have a strategic plan that includes your vision, mission statement, goals and objectives?
1.5 Does your organization have a Wellness Committee? If so, when was the committee created, how/when does the committee meet and what type of decisions is the committee empowered to make? (250 max word count)
1.6 What parts of your company are represented among your Wellness Committee (e.g., HR, senior management, non-management, field staff, representatives from various departments)? (250 max word count)
1.7 Brand, logo, mascot Do you have a wellness program branding, logo, or mission statement?
CIGNA WELL-BEING AWARD® APPLICATION
Yes If yes, please attach
No
Yes If yes, please attach
No
2.1 Please indicate which of the following most accurately reflect your current workplace polices. Select one response per category.
2.1.1 Tobacco use policy
2.1.2 Physical activity policy
2.1.3 Cafeteria/food service/ vending policy
2.2 Do worksite regulations allow time for employees to take part in Health Promotion initiatives (biometric screening events, attending health improvement classes, etc.)?
(250 max word count)
2.3 Please indicate below how your physical work environment has been structured to support improvement initiatives in the following areas. Please select all that apply.
2.3.1 Physical activity
2.3.2 Onsite health
2.3.3 Designated rooms
Page 3 of 8
2 Policy/environment
CIGNA WELL-BEING AWARD® APPLICATION
No specific tobacco use policy other than applicable state or local regulations
Written employment policy requiring employees to leave company property in order to smoke during work hours
Written employment policy outlawing employees’ use of all tobacco products during work hours, in company vehicles and while performing company business
No specific policy allowing for flexible work arrangements to participate in physical activity during the workday
Written policy allowing flexible work arrangements for employees to participate in physical activity during the workday. (extended lunch break, flexible work schedule)
Written policy allowing employees to participate in physical activity on paid company time
No specific vending/cafeteria or food service policy
Written policy making healthy food options available for vending, cafeteria and catered meetings
Written policy limiting unhealthy foods in catered meetings, while subsidizing healthy food options in vending machines and cafeterias
Fitness room/onsite gym
Bike racks
Walking path/trail
Dispensary/Pharmacy
Onsite clinic (MD/RN)
First aid station
Relaxation room
Lactation-only room
Break room
Other
Walking/standing work stations
Encourage use of stairs
Other
Health coaching room
Defibrillators
Other
Yes
No
3.1 Please indicate if you currently offer any of the following health improvement programs. Check more than one option if applicable.
3.1.1 Smoking cessation
3.1.2 Physical activity
3.1.3 Nutrition
3.1.4 Stress management
Page 4 of 8
3 Program implementation
2 Policy/environment (cont.)
CIGNA WELL-BEING AWARD® APPLICATION
2.3.4 Onsite nutrition
Online Onsite By phone
Online Onsite By phone
Online Onsite By phone
Online Onsite By phone
Cafeteria with healthy options/labels
Employee kitchen
Vending machine with healthy options/labels
Water cooler
Snack bar with healthy options/labels
Farmers’ market/produce stand
Other
3.1.5 Weight management
3.1.6 Chronic condition support (disease management)
3.1.7 Maternity/lactation support
3.1.8 Behavioral/mental health
3.2 Is your wellness program integrated with disability and absence management?
3.3 Do you partner with any local organizations (e.g., food co-op, local hospital – not including local or third-party wellness vendors)? If yes, please explain. (250 max word count)
3.4 Communication plan Does your organization communicate wellness programs to employees?
Page 5 of 8
3 Program implementation (cont.)
CIGNA WELL-BEING AWARD® APPLICATION
Yes If yes, please attach
No
Yes
No
Yes
No
Online Onsite By phone
Online Onsite By phone
Online Onsite By phone
Online Onsite By phone
Page 6 of 8
4 Data collection and incentives
CIGNA WELL-BEING AWARD® APPLICATION
4.1 How are the results of the health assessments and biometric screenings used to drive health promotion initiatives? (250 max word count)
4.2 How have you gathered feedback and suggestions to enhance your wellness program (focus groups, surveys, testimonials, etc.)? How have you incorporated these to improve the program? (250 max word count)
4.3 Are these results shared with your employees and/or their families?
4.4 Are any incentives offered to spouses and/or adult dependents for any of the following? Health assessment completion, validated biometric screening results, annual physical exam, preventive screenings or health coaching programs.
Yes
Yes
No
No
Page 7 of 8
What makes a workplace wellness program succeed can vary from one organization to another. Key ingredients to a successful well-being program include senior management support, a culture that promotes health, a strong wellness committee, strategic incentives and communication to drive engagement, creativity and outcomes that make an impact on an employee population. Discuss how your organization utilizes some or all of these key ingredients in your program. Provide a summary of the accomplishments of your health improvement program (reduction in risk shown through biometric screening, health assessment, claims, workers’ comp, absenteeism, etc.) (1,000 max word count)
CIGNA WELL-BEING AWARD® APPLICATION
5 Cigna-Well-Being Award essay
Application checklist
Optional attachments:1. Strategic wellness plan including vision, mission statement, goals and objectives2. Wellness program logo or mascot artwork 3. Communication plan
Page 8 of 8
Risk identification Participation Participation % Trend (change from previous year)
Health assessment Employees
Employees plus dependents
Biometric screening Employees
Employees plus dependents
Annual preventitive care exam Employees
Employees plus dependents
Age/gender appropriate screenings (for example: mammogram, cervical, colonoscopy)
Employees
Employees plus dependents
Health coaching programs (engagement) Participation Participation % Trend (change from previous year)
Lifestyle coaching (e.g., smoking cessation, weight management, stress management)
Employees
Employees plus dependents
Chronic condition coaching Employees
Employees plus dependents
Other (e.g., onsite coaching, maternity coaching) Please specify: Employees
Employees plus dependents
Incentive activity Eligible participants Type of incentive Annual value of incentive
Health assessment
Biometric screening
Preventive screening (e.g., annual physical, mammogram, colonoscopy)
Health coaching (telephone, online, onsite)
Biometric outcomes (Meet/improve target for BMI/waist circumference, blood pressure, cholesterol, etc.)
Non-tobacco use
Other (e.g., corporate challenge) Please specify:
Use the table below to provide key metrics on the applicable components of your well-being program for the most recent plan year. Please work with your account team to obtain these metrics.
“Cigna”, the “Tree of Life” logo and “Cigna Well-Being Award” are registered service marks, and “Together, all the way.” is a service mark, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries, and not by Cigna Corporation. Such operating subsidiaries include Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc.
CIGNA WELL-BEING AWARD® PARTICIPATION AND ENGAGEMENT DATA SHEET
862349_b 03/15 © 2015 Cigna. Some content provided under license.
After you complete, please attach this and all other supporting documents. Good luck!
The Cigna Well-Being Award® is only available to existing Cigna clients. Information submitted in the application and the attachments may be used for purposed outside the application process.
A WELLNESS PROGRAM PRESENTED BY TURNBERRY ASSOCIATES
AVE
NTU
RA M
ALL
FO
NTA
INEB
LEA
U M
IAM
I BEA
CH
TU
RNBE
RRY
ISLE
MIA
MI D
ESTI
N C
OM
MO
NS
HIL
TON
NA
SHVI
LLE
DO
WN
TOW
N H
AM
PTO
N IN
N
DO
C H
OLL
IDAY
HA
RLEY
DA
VID
SON
& P
OW
ERSP
ORT
S C
OU
RTYA
RD B
Y M
ARR
IOTT
AVE
NTU
RA R
ESID
ENC
E IN
N
AVE
NTU
RA C
OU
RTYA
RD B
Y M
ARR
IOTT
ORL
AN
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CEN
TURY
HA
RLEY
DA
VID
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FO
NTA
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www.turnberry.com