Health Assessment

The Health Assessment is approximately a 10-minute, mini-physical that includes height, weight, and body mass index measurements, a blood pressure check, as well as a blood draw (from a vein in the arm) that is tested for cholesterol, triglycerides, glucose, A1C, nicotine, and blood chemistries (e.g., calcium, protein, creatinine). Full- and part-time members and spouses/domestic partners (spouses) are eligible to complete the assessment. These assessments identify health risk factors and offer related support to participants.

Qualifying Event Health Assessment (Outside of the Annual Testing Period)

Members and spouses who join Foth’s medical plan during the year due to a qualifying event, but were ineligible to complete the Health Assessment during the previous annual Health Assessment testing period, may have the option to complete a Health Assessment within 60 days of the qualifying event to be eligible for the Outcome-Based Wellness Incentive for the current calendar year.  Options include Health Assessment kit, physician appointment, or a spouse’s Health Assessment. Please contact for approval to complete the Health Assessment outside of the annual testing period.  Note: New members are waived until the next testing period (no additional premium charge and the Outcome-Based Wellness Incentive defaults high, prorate for the remaining paychecks in the calendar year.)

Annual Health Assessment Testing Period: July – September

For those completing the Health Assessment, there are a few options available to complete the exam.  See below to find an option that works best for you. During annual testing, if you and your spouse (regardless of primary or secondary coverage) will be covered on Foth’s medical plan for the following year, BOTH OF YOU MUST COMPLETE THE HEALTH ASSESSMENT by the deadline to avoid incurring an additional premium charge, unless you are using your score from last year.  Medical plan participants will also be eligible for the Outcome-Based Wellness Incentive (see below).  The deadline to complete the annual Health Assessment is September 30.

Complete Your Online Health Assessment Questionnaire (REQUIRED for onsite and offsite Health Assessments)

All members/spouses who are participating in a Health Assessment must first submit an online questionnaire prior to scheduling your Health Assessment.

  1. All Participants are required to complete the online questionnaire: Access the Online Health Assessment Questionnaire
  2. Click “Complete your Online Consent/Authorization…”
  3. Enter Event ID: 205660
  4. Enter access code: Foth Other
  5. Complete the questionnaire and submit. Note: Do not use your browser’s back/forward function (instead use previous and next buttons if needed).   
  6. Then, schedule your appointment as indicated below.

Health Assessment Appointment Options

Green Bay – Bellin Clinic
For members or spouses in or traveling to Green Bay, OR if you are unable to attend one of the onsite biometric screening locations, there is an option to go directly to a Bellin Clinic (2020 S. Webster Ave.). To schedule your appointment, call Bellin at 800-528-7883 OR click on the following link OR enter the link into the address bar of your browser.

Marion – Physician
For participants located in Massachusetts, you will need to complete a shortened Health Assessment panel with your physician. Due to Massachusetts regulations, we are not able to offer an onsite examiner or a kit option.  You’ll need to complete the 2020 MA Provider Form.  If you completed blood tests indicated on the form after the start of the current year, you may choose to contact your physician to simply fill in the information.  If you have not, you will need to contact your physician to have the required tests complete.  Most tests are considered preventive (covered at 100%), however there may be a cost associated if you already completed a preventive exam or had similar lab work completed this year (check with your physician’s office).  The completed form will need to be sent to Healics (instructions are included on the form).

In-Clinic Assessment Kit
Kits are available to participants if no other option is available.   Participants who choose this option can take the kit to a convenient clinic to have the assessment complete.  First, visit the Healics Participant Portal to view Healics Contracted Clinics to see if one is available nearby.  If so, then email for approval. Then complete the Health Assessment Questionnaire.  Once the questionnaire is complete and the kit is approved, select the “Order Your In-Clinic Assessment Kit” link from the portal (Wellness Event ID = 205660, Access Code = Foth).  When the kit arrives, contact the clinic to schedule and complete your appointment.

You may have the Health Assessment done by your physician; however, depending on where you are in your plan (i.e., deductible, co-insurance, preventative) there may be a cost for the exam and routine tests. If choosing this option, make an appointment with your physician, bring a printed copy of the 2020 Provider Form to your appointment, and have your physician send all forms to Healics (fax/address located on bottom of form) by the completion deadline.

Spouse’s Employer’s Health Assessment
If you will have a Health Assessment administered by Healics or Bellin at your spouse’s employer you can use your results for Foth.  The Health Assessment must be completed within the last six months. To use the results for Foth, participant needs to complete the Consent and Authorization Form, write “Duplicate my results from XXX Company to Foth Company” on the form, and email to:

Important Note: At your Health Assessment appointment, it is your responsibility to verify the accuracy of your measurements and blood pressure. If there is any question as to the accuracy, please ask for a recheck at the time of the Health Assessment.

 If no option is available within a reasonable travel distance, please email

Prepare For Your Health Assessment

This year, the Health Assessment process for appointments will look slightly different.  Appointments will be spaced to avoid contact with others. Examiners will take even more safety precautions to keep all equipment and spaces sanitized. There will be no food or drinks at any appointments, so plan accordingly.

  • Fast (don’t eat) for 8-12 hours prior to your screening appointment to get the most accurate results.  Only sugar free gum.  If you are diabetic, follow your physician’s dietary guidelines.
  • Drink at least 24 ounces of water within 2 hours of your blood draw.  The blood draw will be easier if your blood vessels are hydrated.
  • Continue taking prescribed medication, including insulin.
  • Avoid vigorous exercise for at least 12 hours (may cause you to be dehydrated).
  • For males over 50, avoid activities that may affect your prostate specific antigen (PSA) test.
  • Avoid alcohol for at least 24 hours.  Drinking alcohol may affect your blood results.
  • Avoid caffeine and nicotine (tobacco use) for at least 30 minutes prior to your screening.
  • Wear shoes that are easy to remove.
  • Wear a shirt that is short-sleeved, sleeveless, or easy to roll up over the elbow.
  • Avoid wearing bulky clothing or anything that bunches at the waist.
  • Notify the examiner if you are allergic to latex or have an adhesive allergy.
  • Your height and wrist will be measured; however the result will remain the same as your first year of testing unless you request an adjustment at your appointment.
  • Review the weight, waist, hip measurements, and blood pressure recorded by the examiner.  If you do not feel they are accurate, request a recheck at your appointment. You will be asked to initial the form indicating you agree with the measurements recorded.


Healics will mail your results to your home address within 4-6 weeks.  Or you can visit the Healics Participant Portal to view your results electronically (Individual Health Profile).

Outcome-Based Wellness Incentive

The Foth medical plan participating member and spouse will each be eligible to receive the Outcome-Based Wellness Incentive shown below, based on their individual Health Assessment score.  Scores from the annual Health Assessment testing period will be used to determine the incentive for the following calendar year.

To receive the Outcome-Based Wellness Incentive, you must be an eligible Foth medical plan participant, eligible for HSA contributions*, and participate in the Health Assessment (as must your spouse if he/she is a Foth medical plan participant, regardless of primary or secondary coverage).  The incentive will be contributed to your HSA bank account at either Associated Bank or Optum Bank.

*If you are Medicare enrolled, can be claimed as an IRS-tax dependent on someone else’s return or have secondary coverage that is not a High-Deductible Health Plan, you are not eligible for HSA contributions.

Health Assessment Score86-10071-8561-700-60Scores under 60 w/ a 5 pt. improvement over previous year
Member Incentive$1,000$500$250$0$250
Spouse Incentive$1,000$500$250$0$250

Reasonable Alternative Standard and Wellness Notice

If you think you will be unable to meet a standard for an incentive under the wellness program, you might qualify for an opportunity to earn the same reward by different means. You may also set up a reasonable alternative standard once you receive the Health Assessment results. We will work with you (and, if you wish, with your doctor) to find a wellness program (typically 3 months in length) with the same incentive that is right for you in light of your health status.   Participation in the reasonable alternative standard will require a set number of visits with our onsite nurse and completion of a wellness program. To learn more about the reasonable alternative standards, contact us at  Deadline to complete the Reasonable Alternative Standard is April 30.

Wellness Plan Notice


If you have a medical condition and either previously received a waiver or believe that the Reasonable Alternative Standard would not be appropriate (e.g., pregnancy), contact to review your options prior to your Health Assessment.

Flu Shots

Foth medical plan participants can receive the flu shot as a covered insurance expense (no deductible/co-insurance). You can go to any flu shot clinic and provide them with your medical ID card. If the clinic will not process the flu shot directly through insurance, keep a copy of your receipt and complete a Medical Reimbursement Claim Form.

As a convenience, a few Foth offices may offer onsite flu shots to adults, if available. Full- and part-time members not on the Foth medical plan can receive the flu shot at no cost if they receive it at a Foth location.

Questions?  Contact