SECTION I: WELLNESS GRANT PROGRAM

The Washington Counties Insurance Fund (WCIF) is committed to managing health care costs and maintaining affordable
premiums for member employers, and health promotion is an important part of that commitment.

I. Purpose

Support WCIF member employers in the implementation of long-term worksite wellness programs that will benefit employees
and employers through healthy lifestyles, improved morale and productivity, and more prudent use of the health care system.
The WCIF Wellness team will work with the member employers to provide examples of employee wellness programs. The
team will also provide support including recommended training and resources to assist member employers with their wellness efforts.

II. Employer Responsibility

The employer must demonstrate a commitment to employee wellness by designating a wellness coordinator and/or wellness
committee, supporting wellness coordinator and/or wellness committee member training, adopting a wellness mission
statement and creating healthy workplace policies.

If awarded a wellness grant, employers and their eligible members must actively participate in the WCIF wellness
program provided through the Sonic Boom health portal (See section I.a. under Regulations).

In order to be eligible to apply for a wellness grant, the employer must have achieved at least 10% participation in the
wellness program in its prior year unless it is the employer’s first time applying. Exceptions may be made upon approval of the WCIF Wellness Director. Groups exceeding 40%+ participation in its prior year may be awarded additional funds.

III. Wellness Grant Fund Structure

WCIF uses a 5-class structure when awarding wellness grant amounts, as well as the criteria for wellness activities being
proposed. All employees can participate in grant-funded programs and earn prizes, but fund amounts are awarded
only on the number of employees currently enrolled in a WCIF medical plan.

IV. Criteria for a WCIF-Approved Wellness Program

1. The member employer must complete a program planning process that includes; creating a Wellness Mission
   Statement and program goals, and developing an operating plan and timeline.
2. Wellness program activities must be promoted effectively using multiple methods (ex. bulletin boards, emails,
   newsletters, interoffice communications, posters, verbal communications, etc.).
3. Wellness program must include activity programs designed to promote behavior change and ongoing healthcare education.
4. The member employer must evaluate program success through satisfaction surveys and/or tracking program
   participation.

The WCIF Wellness team is available for consultation and assistance in setting up and evaluating the member employer
programs.

Wellness grants may only be used to expand existing targeted risk programs, or support new targeted risk programs.

Examples of targeted risk programs that do qualify include:

– Cholesterol education and screening
– Blood pressure education and checks
– Physical activity programs
– Mental health improvement
– Weight management
– Diabetes prevention and control
– Stress management

Other programs will be considered if the proposed program is designed to reduce health risks.

Funds also may be used for employee classes, training, participation incentives and program materials.

SECTION II: REGULATIONS

I. Participation in the WCIF Wellness Program

a. Grant recipient employers must foster and maintain employee participation in the WCIF wellness
program provided through the Sonic Boom health portal.

II. Reimbursement

a. Funds will only be paid out via reimbursement. Accurate documentation of expenditures in the form of itemized
receipts must be provided before WCIF will send payment.

b. Initial payment for services or items is solely the responsibility of the employer. WCIF will not accept direct invoices
from third parties.

c. Reimbursement requests must be done by completing a Request for Reimbursement Form and attaching copies
of backup documentation.

Note: It is the responsibility of the grant recipient to fill out all requests for reimbursement accurately according to
regulations stated in this document. Incomplete requests for reimbursement may be sent back to the grant recipient
to be corrected and re-submitted for reimbursement.

d. If an employer uses funds to purchase incentive prizes, the request for reimbursement of these expenditures must
be submitted with a list of the first and last names of all incentive prize recipients.

e. WCIF will only make reimbursement via ACH or checks payable to the applicable wellness grant recipient employer or
employer-instituted account (e.g., Sample County or Sample County Wellness Account, but not to individuals or
outside vendors).

f. WCIF reserves the right to deny payment for any unqualified wellness reimbursement request, regardless of past
practices or perceptions.

III. Use of Grant Funds

a. Funds may only be used for wellness-related purposes; that is, for reasons relevant to achieving sustainable
healthier lifestyles and lifestyle practices for employees.

b. If an employer uses funds to purchase gift cards (ie. prepaid Visa/MasterCard) or issue a check to incentivize
participants, the amount purchased or issued may not exceed $100 per gift card or check.

c. Funds may not be used for voluntary gift-giving (eg. a gift card purchased for a volunteer in gratitude for his or her
services is not an acceptable use of wellness grant funds).

d. Funds may not be used to pay employees or volunteers for time spent in implementation, planning, conducting
or any other matter relating to wellness activities.

IV. Repurpose of Grant Funds

a. Wellness grant funds may be repurposed for wellness activities and/or incentives with the approval of the WCIF
Wellness Director. The employer may submit activity proposals in writing for pre-approval (ie. what the activity
is, how it benefits the employees, etc.).

V. Deadline for Submitting Requests for Reimbursement

a. Reimbursement requests must be submitted to WCIF by November 30, 2023. Any requests submitted after this date
will not be accepted.

VI. Disclaimer

Total wellness grant awards are subject to the approved budget appropriation. WCIF may place additional limits on
grant amounts based on available funding, grant request criteria, and the number of employees participating in the
WCIF wellness program.

SECTION III: WELLNESS GRANT PROGRAM APPLICATION FORM