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EG USD USE ONLY2024Verified: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 wellness rebate certification form from your employer or health insurance provider.
02
Fill out your personal information such as name, address, and member ID.
03
Provide details about the eligible wellness activities you have participated in, including dates and descriptions.
04
Attach any required documentation or proof of completion of the wellness activities.
05
Sign and date the form before submitting it to the designated department for processing.

Who needs wellness rebate certification form?

01
Employees who have participated in eligible wellness activities and are seeking reimbursement or incentive from their employer or health insurance provider.
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Wellness rebate certification form is a document used to certify an individual's participation in a wellness program in order to receive a reimbursement or rebate.
Employees who have participated in a wellness program and are eligible for a reimbursement or rebate may be required to file the wellness rebate certification form.
To fill out the wellness rebate certification form, individuals typically need to provide their name, employer information, details of the wellness program they participated in, and any required documentation.
The purpose of the wellness rebate certification form is to verify an individual's participation in a wellness program and to facilitate the reimbursement or rebate process.
Information such as the individual's name, employer details, wellness program participation, and any supporting documentation may need to be reported on the wellness rebate certification form.
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