Lifestyle Health Plans strives to make our plans as easy to administer as possible. Please find below a listing of our brochures and common forms available for your downloading convenience. For information related to the Lifestyle Healthy Rewards Wellness Program, log into your account via our Wellness Center. If you have questions or need additional information on any of the information or forms associated with our program please do not hesitate to contact us. We look forward to assisting you with your healthcare benefit needs.
Our plan design overview brochure, "A Better Way to Control Your Healthcare Costs," serves as an introduction and overview to the Lifestyle Health benefits program. It highlights our wellness-inspired benefit offerings, our turn-key wellness program, and the innovative and flexible solutions that Lifestyle Health provides. It also outlines the covered benefits and additional features integrated into each Lifestyle Health Plan design. With Lifestyle Health, you can design a plan that's right for your group benefit needs!
For employers or groups interested in obtaining a quote from Lifestyle Health Plans, please complete and submit a Company Profile Form along with the minimum informational requirements listed on this form. A Lifestyle Health Plans representative will contact you within 7 business days to review an initial proposal and rate quote and provide additional details on how our program works and the savings we can provide to you.
In order to initiate the quoting process through Lifestyle Health Plans, we will need to receive a completed employee census for all eligible, full-time employees. For convenience, we have provided a formatted Employee Census Form with the required information for your completion and submission along with the Company Profile Sheet. Please include all eligible full-time employees on the census and indicate if they have other insurance coverage in place currently.
In order to initiate the quoting process through Lifestyle Health Plans, we will need to receive a completed employee health application for all eligible, full-time employees. For your convenience, we have provided a pdf version of our Lifestyle Employee Health Application with the required information for your completion and submission along with the Company Profile Sheet and Census.
Our Coordination of Benefits Form is the verification of other insurance coverage on yourself and/or your dependents so we can accurately coordinate benefit payments with primary and/or secondary payors for you, based on the rules detailed in the plan. We request this information at least every 12 months. Please provide information regarding any other insurance coverage you currently have.
For your convenience, we've included our Points Verification Form as a pdf for easy accessibility and viewing. You may print out this form and use any time you are verifying activities as part of our Lifestyle Healthy Rewards Wellness Program. For other program collateral, log into your secure Wellness Center account.
In the event that you incur medical expenses that exceed your “elected” deductible amount described in your specific Lifestyle Health Plans benefit program, please submit a Medical Expense Reimbursement Form along with a copy of the Explanation of Benefits (EOB), provider statement or any other supporting documentation for the medical expenses incurred. Lifestyle Health Plans will review your medical expense reimbursement request and upon approval, provide direct reimbursement to you within 7-10 business days from the receipt of the reimbursement request. Please make sure that all data requirements are submitted for timely processing.
If you are a plan member with Prescription Coverage through Prescription Network, please submit a Prescription Claim Form - Prescription Network in order have your prescription processed for reimbursement.
If you are a plan member with Prescription Coverage through Medtrak, please submit a Prescription Claim Form - Medtrak in order have your prescription processed for reimbursement.
If you incur a “Qualified Status Change” event during the time you are enrolled in Lifestyle Health Plans, submission of a Change of Status Form is required to facilitate the requested changes. Your human resource director should be able to assist you with any questions on whether you qualify for this status change. If so, notification to Lifestyle Health Plans is required so that we may facilitate the needed change directly with the sponsoring carrier(s). Specific details and restrictions may vary by sponsoring carrier. Likewise, additional carrier forms may be required to complete this process.
Form for providers requesting pre-certification of out-patient surgery & imaging services. Pre-certification is required for all Out-patient Imaging (MRI, CT-Scan, PET-Scan, Nuclear, and Cardiology Imaging services) and all out-patient surgery. Failure to comply will result in additional up to a $500 Copay for Imaging services, and $1,000 for out-patient surgery. For more information call Lifestyle Care Coordination at: 1-844-643-5104.