Get the free 2016 WELLNESS NON-SMOKING Attestation Form

2016 NONSMOKING ATTESTATION From A cash wellness incentive equivalent to 2.5% of your medical and prescription premiums will be available to you if you are a nonsmoker or if you will be completing

How to fill out 2016 wellness non-smoking attestation

How to fill out 2016 wellness non-smoking attestation:

1. Obtain the 2016 wellness non-smoking attestation form either from your employer or from the relevant healthcare provider.
2. Carefully read through the form and understand the questions and requirements.
3. Fill in your personal details such as your full name, date of birth, and employee ID number, if applicable.
4. Answer the questions honestly and accurately. Provide information about your smoking status for the specified period (2016 in this case) by indicating whether you are a smoker or a non-smoker.
5. If you are a smoker, you may be asked to provide additional information such as the number of cigarettes smoked per day or the date you quit smoking, if applicable.
6. Sign and date the attestation form once you have completed all the required sections.
7. Submit the form as instructed, either by hand-delivering it to the designated department or mailing it to the provided address.

Who needs 2016 wellness non-smoking attestation:

1. Employees who are required to complete an annual wellness non-smoking attestation as part of their workplace wellness program.
2. Individuals who decided to participate voluntarily in a wellness program and need to demonstrate their non-smoking status for the specified period.
3. Healthcare providers or insurance companies who may require individuals to complete the attestation form for eligibility or qualification purposes related to wellness benefits or programs.

For pdfFiller’s FAQs

What is wellness non-smoking attestation form?

The wellness non-smoking attestation form is a document where individuals attest to their non-smoking status as part of a wellness program.

Who is required to file wellness non-smoking attestation form?

Employees who are part of a wellness program that includes a non-smoking component are required to file the wellness non-smoking attestation form.

How to fill out wellness non-smoking attestation form?

Employees can fill out the wellness non-smoking attestation form by providing their personal information and confirming their non-smoking status.

What is the purpose of wellness non-smoking attestation form?

The purpose of the wellness non-smoking attestation form is to track the non-smoking status of individuals as part of promoting a healthy lifestyle.

What information must be reported on wellness non-smoking attestation form?

The wellness non-smoking attestation form typically requires personal details such as name, employee ID, and confirmation of non-smoking status.

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