All the information you need for a 2023 points appeal.
Members and covered spouses who wish to appeal a 2023 points distribution for well-being activities completed in 2023, please use the forms below for instruction and submission.
Appeals, along with the requested documents, must be submitted by 5:00 pm, ET January 31, 2024. Points Appeals submitted after this date will be denied.
All appeals approved after December 1, 2023, will apply only towards redemption of well-being incentive credits.
Level 1 – Points appeal
To file a Points Appeal, complete all applicable sections on the Level 1 – 2023 Points Appeal form, sign and date the form and submit according to the instructions on the form.
If the 2023 Incentive Action in question was not satisfied due to circumstances beyond your control, you should explain why in the space provided on the 2023 Points Appeal Form. Examples of circumstances beyond your control include, but are not limited to, the following: long-term hospital stay and hospice stay.
You should submit the form, along with the supporting documentation. An example of appropriate supporting documentation includes:
- A copy of the completed 2023 Physician Screening Form and proof that it was sent to Sharecare by November 30, 2023 (if applicable).
- A copy of the Know Your Numbers Form as proof of participation and completion of a biometric screening at an SHBP-Sponsored Screening Event.
- Print screen or take a snapshot of the incentive status when activities through the Sharecare App or online platform are complete.
Level 2 – Formal appeal
If your Level 1 – 2023 Points Appeal is denied, you may file a Formal Appeal, which must be postmarked within fifteen (15) calendar days following the date of the 2023 Level 1 – Points Appeal decision. To file a Formal Appeal, you must complete the Level 2 – 2023 Points Appeal Form and attach a copy of the 2023 Level 1- Appeal decision, along with any supporting documentation.
Generally, a decision by the Formal Appeal Committee will be issued within thirty (30) calendar days following receipt. The written notice of the decision by the Committee is the final step in the administrative proceedings and will exhaust all administrative remedies.
How to submit
Complete the required forms, sign and date and then submit using one of the following:
Attention: State Health Benefit Plan Appeal
701 Cool Springs Blvd.
Franklin, TN 37067