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Level 2 2018 WELLBEING INCENTIVE CREDITS APPEAL FORM For members enrolled in Anthem Blue Cross and Blue Shield (Anthem) and UnitedHealthcare plan options Note: Not applicable to members enrolled in
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Employees who have participated in the 2018 well-being incentive program and wish to appeal the level 2 incentive credits awarded to them may need to fill out the 2018-level-2-well-being-incentive-credits-appeal-form-mb.
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The level-2-well-being-incentive-credits-appeal-form-mb is a specific form used to appeal decisions related to well-being incentive credits at a level 2 categorization.
Individuals or entities who have received a decision regarding their well-being incentive credits and wish to contest that decision are required to file this form.
To fill out the form, applicants must provide their personal information, details of the decision being appealed, and any supporting documentation that justifies their appeal.
The purpose of the form is to formally challenge and seek a review of decisions made regarding well-being incentive credits, allowing for a potential reconsideration or reversal of the decision.
Information required includes the appellant's contact details, details of the incentive credits in question, the reason for appeal, and any evidence or documentation supporting the claim.
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