Get the free Well Wisconsin Exception Form UH01242 - Unity Health Insurance

2015 Wellness Assessment Exception Form This form should be completed to report your biometric measurements to Unity Health Insurance when you do not receive your biometric measurements at a workplace

How to fill out well wisconsin exception form

How to fill out the Well Wisconsin Exception Form:

1. First, obtain a copy of the Well Wisconsin Exception Form. This form is typically available on the official Well Wisconsin Program website or through your employer's HR department.
2. Begin by filling out your personal information at the top of the form. This will include your name, address, phone number, and email address.
3. Provide your employee identification or member number, which can usually be found on your insurance card or through your HR department.
4. Indicate the reason for requesting an exception on the form. This could be due to a medical condition, disability, or other circumstances that prevent you from participating in the requirements of the Well Wisconsin Program.
5. If applicable, provide any supporting documentation or medical records that support your request for an exception. This could include doctor's notes or test results.
6. Review the form carefully to ensure all information is accurate and complete. Make any necessary corrections or additions before submitting it.
7. Sign and date the form to certify that the information provided is true and accurate to the best of your knowledge.
8. Once the form is completed, submit it to the designated HR representative or the Well Wisconsin Program administrator. Follow any specific instructions provided by your employer or the program.
9. Keep a copy of the filled form for your records in case it is needed in the future.

Who needs the Well Wisconsin Exception Form?

1. Employees or members who have a medical condition or disability that prevents them from participating in the requirements of the Well Wisconsin Program may need to fill out the Well Wisconsin Exception Form.
2. Individuals who have submitted a health risk assessment or have completed the biometric screening but are unable to meet the program's other requirements may also need this form.
3. Those who believe they qualify for an exception based on other circumstances should consult the guidelines provided by their employer or the Well Wisconsin Program to determine if they need to fill out the form.

Remember, it is always recommended to check with your employer or the Well Wisconsin Program for specific instructions on how to fill out the exception form and who needs to complete it in your particular situation.

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What is well wisconsin exception form?

The Well Wisconsin exception form is a document that allows eligible individuals to opt out of certain wellness activities.

Who is required to file well wisconsin exception form?

Employees who are eligible for the Well Wisconsin Program but choose not to participate in certain wellness activities are required to file the Well Wisconsin exception form.

How to fill out well wisconsin exception form?

The Well Wisconsin exception form can be filled out online through the Well Wisconsin portal or by requesting a paper form from the employer.

What is the purpose of well wisconsin exception form?

The purpose of the Well Wisconsin exception form is to provide eligible individuals with an alternative to completing certain wellness activities while still receiving the associated incentives.

What information must be reported on well wisconsin exception form?

The Well Wisconsin exception form requires the individual to provide their personal information, employer information, and the reason for opting out of the wellness activities.