Prevention & Wellbeing Consumer Support Inquiry
* Indicates a required field
First Name (as indicated on your insurance):
Last Name (as indicated on your insurance):
Date of Birth (must be in mm/dd/yyyy format):
Employer (company that offers the health plan you are inquiring about):
(The number you used to register)
Phone (ex. 555-444-3333):
I am the:
How can we help?
Please Select a Category
Website Access: I am locked out after too many login attempts
Website Access: I forgot my password
Incentive: I did not receive my incentive (please specify activity and date completed in Description).
Incentive: My incentive amount is incorrect (please specify activity and date completed in Description).
Activities: Biometric Results (Fill out additional fields below)
Activities: Health Assessment
Activities: Online Wellness Program
Activities: Telephonic Wellness Program
Activities: Trackers, Videos or Articles
Error Message Received: ERR-DUP-U-M
Error Message Received: ERR-DUP-XFID
Error Message Received: Exception 101 Detected!
Error Message Received: Exception 202 Detected!
Error Message Received: We're sorry. The page you are attempting to reach is unavailable...
Error Message Received: We're sorry. Based on the information you have submitted we're not able to verify...
Request a Health Provider Screening Form
Request a Health Assessment by Mail
Confirm Processing of Health Assessment by Mail
Request a Pedometer
Website Navigation - Where can I find...?
Any information you provide is secured and protected
(Including dates or times)
If you are inquiring about a biometric event, please provide the following information:
What type of biometric event?:
Health Provider Screening Form
Onsite Health Fair
Date event completed or form faxed: