Get Wellness For Life

Filling out the Wellness For Life Program Rewards Qualification Form is an essential step for individuals looking to qualify for wellness rewards linked to their life insurance policy. This guide will provide clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete your form with confidence.

1. Click ‘Get Form’ button to obtain the form and open it for filling out.
2. Begin by entering the name of the insured in the designated field. Ensure that this is the full name as it appears on the insurance policy.
3. Indicate the gender of the insured by marking the appropriate box for 'Male' or 'Female'.
4. Provide the insured's Social Security number in the specified format (###-##-####). This information is crucial for identification.
5. Input the birth date of the insured using the format (mm/dd/yyyy). This will help in verifying age-related criteria for the program.
6. Enter the policy number assigned to the insured policy. This number is necessary for reference and processing.
7. Fill in the insured’s address including street, city, state, and zip code, ensuring all details are accurate.
8. Record the insured’s weight in pounds in the corresponding field. If there are extenuating circumstances affecting this measurement, note them in the designated area.
9. Document the date when the routine physical was conducted in the format (mm/dd/yyyy). This is important for establishing compliance with the program requirements.
10. Provide the name and address of the doctor or healthcare provider who performed the physical exam.
11. Have the doctor or authorized representative sign the form, confirming the details submitted are accurate.
12. Enter the date of the doctor's signature using the format (mm/dd/yyyy). This step finalizes the verification process.
13. Once all fields are completed, review the form for accuracy. After confirming all information is correct, save changes, download, print, or share the completed form as necessary.

Complete your Wellness For Life application online today and take a step towards earning your wellness rewards!