There are a number of reasons to consider counseling for nutrition, diet, and lifestyle changes, but when your weight impacts your health and lifestyle, then it’s important to look for support from your doctor and your health plan.

The nutritional counseling benefit is for eligible members who meet specified medical criteria and demonstrate a documented readiness to make nutrition and lifestyle changes. Eligible members should talk to their doctor to get a referral to get nutrition and dietary counseling with a nutritionist or registered dietician.

WHA is pleased to be one of the first in our area to expand coverage for nutrition and dietary counseling. This benefit was designed with help from WHA’s doctors to meet an urgent need for our members struggling with weight-related illness whether it's obesity, eating disorder, or weight loss secondary to illness. 

Talk with your doctor: members need prior authorization and to meet specified medical criteria (see below) to receive these covered services. You will have the same cost-sharing that you would have for a primary care office visit. Refer to your plan’s copayment summary for cost-sharing amounts and access this overview flyer for information.

_{Note: this program is available to CalPERS Basic plan members.}

Counseling to Address Obesity

Initial Approval: 3 monthly visits
Renewal: 3 monthly visits with demonstrated Body Mass Index (BMI) improvement

• Adults with a BMI greater than 25
• Children with a BMI percentile greater than the 85th percentile for age 

Initial Approval: 6 monthly visits
Renewal: 6 monthly visits with demonstrated improvement in BMI or related disease metrics

• Adults with BMI  greater than 25 and an obesity-related condition including but not limited to hypertension, hyperlipidemia, impaired fasting glucose, chronic back pain, knee osteoarthritis, fatty liver disease, polycystic ovary syndrome, infertility, cancer, gout, pseudotumor cerebri, gallbladder disease, obstructive sleep apnea, obstructive lung disease, lymphedema, and/or acid reflux
• Adults with BMI greater than 30
• Children with a BMI percentile greater than the 95th percentile for age

Counseling to Address Eating Disorders

Initial Approval: up to 18 visits initially and then as medically necessary
Renewal: as needed based on PCP or behavioral health provider documentation of medical necessity to achieve medical stability

• Adults and children diagnosed with eating-related disorders (e.g. anorexia or bulimia)
• Documentation of patient under the ongoing care of behavioral health provider

Counseling to Address Malnourishment and Weight Loss

Initial Approval: 6 monthly visits
Renewal: 6 monthly visits with demonstrated improvement in BMI or related disease metrics

• Adults and children with weight loss greater than or equal to 20% in the prior 12-month period due to medical conditions other than eating disorder related
• Documentation of specialist care as appropriate

For more information, you can always call our Member Services team for help understanding your plan details.

You can also find additional nutritional support from MyWHA Wellness@Home videos and WHA's healthy recipe page for eating healthy.