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Get Quit For Life Incentive Reimbursement Form
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How to fill out the Quit For Life Incentive Reimbursement Form online
Filling out the Quit For Life Incentive Reimbursement Form online is a straightforward process that allows participants to request their rewards for successfully completing the program. This guide will provide step-by-step instructions to help you complete the form accurately and efficiently.
Follow the steps to complete your reimbursement request.
- Click ‘Get Form’ button to obtain the Quit For Life Incentive Reimbursement Form and open it in your chosen document editor.
- Begin by entering the name of the Quit For Life participant in the designated field. Specify if the participant is either an employee or a spouse by selecting the appropriate checkbox.
- Input the date of enrollment in the Quit For Life program in the specified section, ensuring the information is accurate.
- Fill in the date of completion for the five live quit coaching calls, which is crucial for verifying eligibility for the reward.
- Provide the date when you completed the six-month survey administered by Quit For Life in the relevant field.
- Fill in your name, employee ID, messenger mail address, email address, and phone number in the employee subscriber section. Make sure all information is clear and legible.
- Indicate your preferred payroll cycle by selecting either bi-weekly or monthly in the appropriate checkbox.
- Sign the form in the designated area to acknowledge and agree to the terms and conditions regarding the reward.
- Once you have completed all sections, review the form for accuracy. You can then save changes, download, print, or share the completed form as needed.
Complete your Quit For Life Incentive Reimbursement Form online today to secure your reward.
What codes are used to bill for these services? G0375—Smoking and tobacco-use cessation counseling visit; intermediate session of more than 3 minutes and up to 10 minutes. G0376—Smoking and tobacco-use cessation counseling visit; intensive session of more than 10 minutes.
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