There are two ways to submit your completed Wellness Screening Form. You can upload an electronic copy of the form by following the “Upload” steps below. The electronic copy can be a scan or photograph of the form. Electronic copies of the form must be in one of the following standard file formats: .PDF, .TIF, .JPG, .PNG, .GIF
If you are unable to or prefer not to upload an electronic copy you can mail the form to the address listed below.
Please double check your form is completely filled out and signed before uploading or mailing. Incomplete forms will not be processed and will need to be resubmitted before you will be eligible for your premium discount.
PO Box 390841
Omaha, NE 68139-0841
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