Get The Right Stuff - Benefits.gentex.com

Filling out The Right Stuff - Benefits.gentex.com form is an essential step towards accessing valuable health benefits provided by Gentex. This guide will walk you through each section of the form, ensuring that you understand how to complete it accurately and efficiently.

Follow the steps to fill out the form correctly

1. Click the ‘Get Form’ button to obtain the form and open it in the designated editor.
2. Begin by filling out the 'Patient Information' section. Enter your last name, first name, phone number, social security number, and birth date in the specified format (MM/DD/YYYY). You will also need to indicate whether you are a Gentex employee by selecting 'Yes' or 'No'.
3. Next, read the agreement regarding participation in the Gentex Wellness Program and sign to attest that you have read the Gentex Wellness Program Notice. Keep in mind that participation is voluntary.
4. If the policyholder is different from the patient, fill out the 'Policyholder Info' section. Again, provide last name, first name, phone number, social security number, birth date, and whether they are a Gentex employee.
5. In the 'Health Indicators' section, ensure the healthcare provider completes the necessary health criteria. This involves documenting routine physical results, assessing the target health goals for BMI, blood pressure, LDL cholesterol, and glucose levels.
6. For each health criteria, mark 'Yes' or 'No' based on whether the targeted health goals have been achieved. Note any pregnancy exceptions if applicable.
7. In the 'Physician Approval' section, ensure the healthcare provider signs to certify that the information is complete and accurate. Include the physician's printed name and NPI number.
8. Once all sections are completed, save changes, download the form, or share it via email, fax, or mail as indicated in the form's submission instructions.

Complete your form online today to secure your health benefits!