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Wellness Incentive Program Forms

Entire Wellness Incentive Program Packet (contains all forms listed below)

Individual Forms (in PDF)

Submit to the Wellness Council of Arizona:

Mailing Address: 1670 N. Kolb Rd.
Ste. 246, Tucson, AZ 85715
Secure Fax: 520-293-3368
Secure Email: secure@welcoaz.org

Earn 5 e-Tickets..

Earn 3 e-Tickets...

  • Complete a Disease Management Program through UnitedHealthCare

Earn 1 e-Ticket...

Your Confidentiality is Assured

All personal health information will be maintained and protected by the Wellness Council of Arizona. Your health information is not shared with your employer or anyone at TUSD.

Questions?

Call the Wellness Council of Arizona at (520) 293-3369, talk to or email your Health Coaches, or email contact@welcoaz.org.

TUSD Wellness Incentive Program

Participating in the TUSD Wellness Incentive Program in 2016-2017 will qualify you for rewards and premium rebates the following plan year, plus assure that you are taking positive steps towards preventing disease and living healthier.

To receive your 2017-2018 incentive, submit the following by June 30, 2017:

Required:

Required: Pick two of the following:

  • Complete and sign Non-Tobacco User Affidavit Form
  • Complete and sign the Activity Verification Form for the following:
    • Review Rally Health Survey Report with a Wellness Council of Arizona Health Coach. Print and take a copy of your Rally Health Survey report with you to your appointment with a Health Coach.
    • Complete a Disease Management Program through a UnitedHealthcare nurse if you have a chronic condition, for example: Diabetes, Heart Disease, Hypertension or Asthma/COPD. OR Complete a multi-session Health Education program with a Wellness Council of Arizona Health Coach.
    • Participate in verified ongoing Health Coaching either onsite or telephonic with the Wellness Council of Arizona Health Coach. (4 session minimum)
    • Submit receipts of payment for gym membership, fitness facility or program or home use fitness accessories (minimum of $150, purchased in the last 12 months).
    • Submit proof of participation in fund raising fitness activity (walks, rides and runs that benefit local and national non-profits)
    • Complete 2 of 5 Wellness Challenges: FITGO Bingo 2016, The Meet Your Health Coach Challenge, Maintain Don't Gain, Biggest Winner Team Weight Loss Challenge, Power Up Nutrition.

Submit your forms to the Wellness Council of Arizona:

Mailing Address: 1670 N. Kolb Rd. Ste. 246, Tucson, AZ 85715
Secure Fax: 520-293-3368
Secure Email: secure@welcoaz.org