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Insurance and Flex Pay


Insurance Reimbursement



Insurance carriers are inconsistent and vary greatly in their policies regarding claim payment for weight management programs, and in general, most insurance companies do not reimburse for weight loss services, supplies and maintenance fees. Because of this, with the exception of SmartPlan holders, St. John Weight Loss Institute does not do any third party billing from insurance companies. However, we are happy to provide participants any paperwork, letters, or documentation to help individuals seek reimbursement.



SmartPlan Reimbursement Guidelines




  1. Participant is an active SmartPlan or SmartPlan PPOM holder.

  2. Participant must have a BMI greater than or equal to 30 kg/m2 OR a BMI that is greater than or equal to 27 with one or more of the following co-morbid conditions (documentation from a physician must be provided at the time of enrollment to verify that one of the following conditions exists.):



  • Coronary artery disease

  • Diabetes mellitus Type 2

  • Obstructive sleep apnea

  • Obesity-hypoventilation syndrome (Pickwickian syndrome)

  • Hypertension (systolic blood pressure greater than or equal to 140 mm Hg or diastolic blood pressure greater than or equal to 0 mm Hg on more than one occasion

  • Dyslipidemia




What benefits are included for medical weight loss?


  • 50% of the medical cost of a SmartPlan physician-supervised weight loss programs at St. John Weight Loss Institute by Smart Plan and 20% of products are covered by the program itself.

What are not covered benefits?




  • Weight loss drugs

  • Nutrition/dietitian & exercise services

  • Diet supplements and/or meal replacements

  • Other weight loss programs including (Jenny Craig, Weight Watchers, etc.)




What are the Limitations ?




  • One per member per lifetime for comprehensive weight loss

  • Participant may use funds in flexible spending accounts (FSAs) for weight loss expenses as well. This excludes the cost of food or food supplements.

  • Flexible Spending Accounts (FSA)




If you have a Medical FSA for the current year, you are eligible to pay for your weight loss expenses. Documentation from a physician stating the diagnosis of obesity and its treatment program is the key to FSA claims. Your tax advisor and/or human resources contact would be able to give you more information on this topic.