Health Checklist Bonus Challenge

Health Checklist 2023 Bonus Challenge (the “Challenge”)

TERMS & CONDITIONS

NO PURCHASE NECESSARY. Void where prohibited. All federal, state, and local laws and regulations apply.

SPONSOR: Well Dot Inc., 1254 Chestnut St, Suite 304. Newton, MA 02464.

ELIGIBILITY: To be eligible for the bonus points, Well Members must:

1. Be activated on the Well platform before September 30, 2023 at 11:59pm ET;
2. Meet the Eligibility requirements for one or more of the Actions listed below; and
3. Be a Well Member with an Anthem benefit plan at the time the points are awarded (which may be after the Challenge Period (as defined below) due to processing timing and claims data lags as further described below.)

Eligibility Requirements per Action:

PREVENTATIVE VISIT: Preventative Visit shall mean a check up or primary care visit that is billed with the following CPT or ICD10 codes:

• Preventive Exam:
  CPT: 99201-99205, 99211-99215, 99241-99245, 99341-99345, 99347-99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99401-99404, 99411, 99412, 99429, G0438, G0439, G0463, G0402, T1015
• General Encounter:
  ICD10: Z00.00, Z00.01, Z00.8, Z02.0, Z02.1, Z02.2, Z02.3, Z02.4, Z02.5, Z02.6, Z02.71, Z02.79, Z02.89, Z02.9
• Note: OB/GYN visits and Preprocedural exams do not count as Preventive Visits for this Challenge.

ELIGIBLE MEMBERS FOR PREVENTATIVE VISIT ACTION BONUSES: Members 18 years of age or older who have not had a qualifying Preventative Visit within the previous 12 months

CERVICAL CANCER SCREENING: Cervical Cancer Screening (Pap smear, HPV) shall mean a cervical cytology or human papillomavirus (“HPV”) screening that is billed with the following CPT and IC10 codes:

• Pap smear:
  CPT: (88141-88143), 88147, 88148, 88150, (88152-88154), (88164-88167), 88174, 88175, G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, P3000, P3001, Q0091
• HPV Test:
  CPT: (87620-87622), (87624-87625), G047

ELIGIBLE MEMBERS FOR CERVICAL CANCER SCREENING ACTION BONUSES: Members who are assigned the female sex at birth, who are: (i) 21 to 65 years of age, and have not had a cervical cytology (Pap smear) in the previous 36 months, or, (ii) 30 to 65 years of age and have not had an HPV test in the previous 60 months.

Eligible Members whose doctor requires that they receive a Cervical Cancer Screening more frequently than the timeframes listed above are eligible for the bonus points associated with this Action if they have not yet obtained a Cervical Cancer Screen within the time period that is recommended for them by their doctor. Such Members can claim their bonus points by chatting or calling a Well Guide upon scheduling and/or completing their Cervical Cancer Screening.

COLON CANCER SCREENING: Colon Cancer Screening shall mean a fecal occult blood test, stool FIT test, stool fecal DNA test, or FIT DNA test, flexible sigmoidoscopy, virtual colonoscopy or colonoscopy that is billed as follows:

• Fecal immunochemical test
  CPT: 82274, G0328
• Fobt:
  CPT: 82270
  Fit test:
  CPT: 81528, G0464
• Flexible sigmoidoscopy:
  CPT: 45330, 45331, 45332, 45333, 45334, 45335, 45337, 45338, 45339, 45340, 45341, 45342, 45345, 45346, 45347, 45349, 45350, G0104
• Colonoscopy:
  CPT: 44388-44394, 44397, 44401-44408, 45355, 45378, 45379, 45380-45393, 45398, G0105, G0121
• CT colonography:
  CPT: 74261-74263

ELIGIBLE MEMBERS FOR COLON CANCER SCREENING ACTION

BONUSES: Members 45 to 75 years old who have not had a fecal occult blood test or stool FIT test in the previous 12 months, stool fecal DNA test or FIT DNA test in previous 36 months, flexible sigmoidoscopy or virtual colonoscopy (CT scan) in previous 60 months (5 years), or colonoscopy in previous 120 months (10 years). Eligible members whose doctor requires that they receive a Colon Cancer Screening more frequently than the timeframes listed above, are eligible for the bonus points associated with this Action, if they have not yet obtained a Colon Cancer Screen within the time period that is recommended for them by their doctor. Such Members can claim their bonus points by chatting or calling a Well Guide upon scheduling and/or completing their Colon Cancer Screening. Members whose doctors have indicated that screenings are unnecessary (e.g., full colectomy) are not eligible.

DIABETES HBA1C TEST: Diabetes HbA1c test shall mean a diabetes HbA1c test billed as follows:

• HbA1c Test:
  CPT: 83036, 83037, 3051F

ELIGIBLE MEMBERS FOR DIABETES HBA1C TEST ACTION BONUSES: Members 18 years old or older with a Type 1 or Type 2 diabetes diagnosis who have not had an HbA1c test performed in the previous 12 months.

Note: The time frames used to determine the eligibility for the bonus points are those set forth by the Healthcare Effectiveness Data Information Set (“HEDIS”) guidelines.

CHALLENGE PERIOD: The Challenge begins at 9:00 am ET May 28, 2023 and ends at 11:59 pm ET on September 30, 2023.

CHALLENGE REDEMPTION: Sponsor will award bonuses to Eligible Members for the above Actions, in three parts: “Schedule,” “Complete,” and “Validation” as follows:

1. Schedule an Action–the Schedule Bonus Points.

An Eligible Member who schedules an Action after May 28, 2023 and prior to September 30, 2023, regardless of the appointment date, shall receive 1,000 bonus points upon informing Well by responding to an in-app communication or by chatting or calling a Well Guide. Members will receive bonus points the first time they schedule the Action only.

2. Complete the Action–the Complete Bonus Points.

A Member who completes an Action prior to September 30, 2023 and informs Well by responding to an in-app communication or chatting or calling a Well Guide shall receive 2,000 points.

3. Validation of the Action-the Validation Bonus Points.

Members who complete an Action for which they are Eligible will receive an additional 7,000 points once Well receives the processed claim from Anthem, provided that the date of the completed Action as shown in the claims data is within the Challenge Period.
Bonus points will be awarded to Members for claims received by Well after the Challenge Period provided that the date of the completed Action as shown in the claims data is within the Challenge Period.

BONUS POINTS AWARDS.

1. Payment Timing: Members who qualify for multiple bonuses may receive these bonuses at different times. Please allow at least 72 hours for the Schedule and Complete bonus points to be credited to registered Well user accounts. Please allow at least 2 months after the completion of an Action for the Validation bonus points to be credited to registered Well user accounts to account for claims lag inherent in the “Validation” bonus.
2. Non-Payment: Members who schedule an Action after the Challenge Period ends, who complete an Action after the Challenge Period ends, or who fail to have the Action validated with a claim record, will not receive the Schedule, Complete or Validation bonus points, respectively. Members who were not eligible for the Action will not receive bonus points.
3. Approximate Retail Value. The approximate retail value of 1,000 up to 40,000 points is $10.00-400.00. Points redeemable in the Well Marketplace. No substitutions or cash-outs unless determined in the sole discretion of the Sponsor.

RELEASE / LIMITATION OF LIABILITY: By participating in the Challenge, participants agree to accept and abide by these Terms & Conditions and agree that any dispute with regard to the conduct or administration of this Challenge or the interpretation of these Terms & Conditions shall be submitted to Sponsor, whose decision shall be binding and final. By participating in this Challenge, participants further agree to release and hold harmless Sponsor and its dealers and retailers, affiliates, sales representatives, distributors and promotional and other vendor agencies, their respective parent companies, affiliates, subsidiaries, service agencies, independent contractors, and the officers, directors, employees, agents and representatives of any of the above organizations (collectively, the “Released Parties”) from any injury, loss or damage to person, including death, or property due in-whole or in-part, directly or indirectly, to participation in this Challenge or participation in any Challenge-related activity.

Notification of the Challenge does not necessarily mean a Well user is eligible to receive Rewards as part of the Challenge. Qualifying CPT and ICD10 codes are subject to change.

Sponsor is not responsible for any typographical or other error in the printing of the Challenge, administration of the Challenge, or errors relating to the announcement of eligibility or qualification for the Challenge. Sponsor reserves the right, in its sole and absolute discretion, to modify, cancel, or suspend this Challenge, or to amend the Terms & Conditions at any time, without prior individual notice, should any factor interfere with the administration, security, or proper play of this Challenge as contemplated by these Terms & Conditions.