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EG USD USE ONLY2023Verified:WELLNESS REBATE CERTIFICATION FORM For Employees withSUTTER HEALTH PLUS (SHP) Medical Coverage(Payment Authorization and Wellness Consultation Information)Form due no later
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How to fill out wellness rebate certification form

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How to fill out wellness rebate certification form

01
Obtain a copy of the wellness rebate certification form from your employer or health insurance provider.
02
Review the instructions and eligibility requirements listed on the form.
03
Fill in your personal information such as name, address, and contact information.
04
Provide details about the wellness activities or programs you participated in to qualify for the rebate.
05
Include any supporting documentation or proof of completion of the wellness activities.
06
Double check all the information provided on the form for accuracy and completeness.
07
Submit the completed form to the designated person or department for processing.

Who needs wellness rebate certification form?

01
Employees who have participated in wellness activities or programs offered by their employer or health insurance provider and are eligible for a rebate.
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The wellness rebate certification form is a document used to certify an individual's participation in a wellness program in order to receive a rebate.
Any individual who wishes to receive a rebate for participating in a wellness program is required to file the wellness rebate certification form.
To fill out the wellness rebate certification form, individuals must provide information about their participation in the wellness program, such as dates of attendance and completion of program requirements.
The purpose of the wellness rebate certification form is to verify an individual's participation in a wellness program in order to qualify for a rebate.
The wellness rebate certification form must include details about the individual's participation in the wellness program, including dates of attendance and completion of program requirements.
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