Submit Your 2023 Biometric Screening Verified Form
This file provides detailed instructions on how to submit your biometric screening verified form for the 2023 Annual Wellness Assessment program. Make sure your biometric screening is done between Aug. 1, 2022, and July 31, 2023. Follow the steps mentioned to properly fill out and submit the form.
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How do I fill this out?
To fill out this form, first have your biometric screening completed by your primary care provider. Then, follow the provided steps to submit the form through your Virgin Pulse account. Ensure all necessary information is filled out correctly and the form is signed.
How to fill out the Submit Your 2023 Biometric Screening Verified Form?
1
Complete the biometric screening with your primary care provider.
2
Print the form from your Virgin Pulse online portal.
3
Fill out the required metrics and sign the form.
4
Log in to your Virgin Pulse account to upload the completed form.
5
Submit the form before the July 31, 2023, deadline.
Who needs the Submit Your 2023 Biometric Screening Verified Form?
1
Employees participating in the 2023 Annual Wellness Assessment program need this form to submit their biometric screening results.
2
Spouses covered under an eligible health plan require this form to submit their individual biometric screenings.
3
Employees seeking a 2024 premium discount need to complete and submit this form before the deadline.
4
Primary care providers must use this form to report biometric screening metrics for their patients.
5
HR departments may need this form to assist employees in the wellness assessment process.
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Use the available editing tools to complete the necessary fields.
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Ensure all required metrics are filled out correctly.
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Sign the form electronically using our signature feature.
5
Save the edited form and proceed with the submission process.
What are the instructions for submitting this form?
Scan your completed and signed form and save it to your computer. Log in to your Virgin Pulse account and select the 'Benefits' tab, then locate the 2023 Biometric Screening Verified Form. Click on 'Start Now' and upload the form from your computer. Alternatively, you can fax the form to 401-735-5853 but be sure to keep a copy of the fax receipt. Ensure all required metrics and signatures are complete before submission. Submission deadline is July 31, 2023. For any questions or assistance, contact Virgin Pulse customer support at support@virginpulse.com or call 855-954-1861.
What are the important dates for this form in 2024 and 2025?
The important dates for this form are Aug. 1, 2022, to July 31, 2023, for the current program year. The submission deadline is July 31, 2023. Make sure to complete and submit the form within this period to be eligible for the 2023 Annual Wellness Assessment program.
What is the purpose of this form?
The purpose of this form is to record and submit biometric screening results for participants of the 2023 Annual Wellness Assessment program. Completing this form ensures you and your covered spouse, if applicable, provide the necessary health metrics to Virgin Pulse. Timely submission is essential to receive wellness credits and qualify for potential premium discounts in the following year. By submitting the form, you help your organization collect vital health data that can improve future wellness programs. This data allows for more personalized health plans and effective wellness initiatives within the organization. Participating in the wellness assessment program emphasizes the importance of preventive care and maintaining a healthy lifestyle. Ensuring that all required fields are completed accurately and submitted before the deadline is crucial. Missing or incorrect information can result in delays or disqualification from receiving wellness credits for the program year. Adhering to the instructions and guidelines provided helps streamline the process for both participants and administrators.
Tell me about this form and its components and fields line-by-line.
- 1. Member Information: Includes personal details such as name, unique member code, and contact information.
- 2. Biometric Metrics: Contains fields for recording health metrics like blood pressure, cholesterol levels, and glucose levels.
- 3. Primary Care Provider Information: Includes PCP's name, contact information, and signature fields.
- 4. Member Signature: Fields for the signature of the member confirming the accuracy of the submitted information.
- 5. Submission Instructions: Provides guidance on how to submit the completed form through various methods.
What happens if I fail to submit this form?
Failing to submit the form can result in disqualification from receiving wellness credits and potential premium discounts for the following year. It is important to adhere to the deadlines and submission guidelines to avoid negative consequences.
- Loss of Wellness Credits: You will not receive the wellness credits that contribute to your rewards and assessments.
- Disqualification from Program: Ineligibility for the 2024 premium discount and other program benefits.
- Delays in Approval: Submission after the deadline may result in processing delays and additional follow-up requirements.
How do I know when to use this form?
- 1. Completed Biometric Screening: Use this form if you have completed your biometric screening with your PCP between Aug. 1, 2022, and July 31, 2023.
- 2. Submitting for Wellness Program: This form is necessary to participate in the 2023 Annual Wellness Assessment program and receive related credits.
- 3. Spouse Participation: Covered spouses need to use their individual forms to submit biometric screening results.
Frequently Asked Questions
How do I fill out the biometric screening form?
First, complete the biometric screening with your PCP, then print the form from your Virgin Pulse online portal and fill out all required metrics.
Can I edit the form on PrintFriendly?
Yes, PrintFriendly offers PDF editing tools to help you fill out the form accurately.
How can I sign the form electronically?
Use PrintFriendly's signature feature to add your electronic signature to the document.
How do I submit the form?
After completing the form, log in to your Virgin Pulse account and upload the completed form through the 'Benefits' tab.
Can my PCP submit the form on my behalf?
No, your PCP cannot submit the form for you. You must upload it to your Virgin Pulse account.
What if I need help with the form?
Contact Virgin Pulse customer support at support@virginpulse.com or call 855-954-1861 for assistance.
Will I receive a confirmation after submitting the form?
Yes, you will receive an email confirmation from Virgin Pulse after the form is received if submitted online.
Can I fax the completed form?
Yes, you can fax the form to 401-735-5853, but you will not receive an email confirmation.
What is the deadline for submitting the form?
The form must be submitted before the July 31, 2023, deadline.
How do I check if my form was successfully submitted?
Log in to your Virgin Pulse account and check for a green check mark under the 'Rewards' tab for successfully completed items.
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