2016-17
Wellness Program
($400)
Items must be completed between
May 16, 2016-May 31,2017
It’s no surprise...the employees are what make Chandler Unified School
District such a unique and great district. So, we want you to be healthy
emo onally, financially and physically. Not only will your wellness benefit
you personally, but it will also help CUSD achieve two of the Journey 2025
goals outstanding Staff and Culture of Success. The well being of our
employees is key to reaching these goals. To encourage you to reach your
wellness goals, we are pleased to be able to offer a wellness incen ve in
the amount of $400.00 for the 2016-17 school year.
PROGRAM DETAILS
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Must be enrolled in CUSD health plan effec ve January 1, 2017 or prior, AND
Must be on ac ve status or completed contract when incen ve is paid (June 22, 2017)
Will be paid in a Health Savings Account if enrolled in HDHP Plan or premiums reduced for the 2017-18 school year if
enrolled in PPO plan.
REQUIRED WELLNESS ACTIVITIES

1) One Physical Annual Exam (Required) ( A ach Explana on of Benefits (EOB) from www.myuhc.com.) or Biometric
Screening at the Wellness Expo.


2) UHC Online Health Assessment “Rally Survey” at www.myuhc.com (Required) (No Documenta on necessary)
3) Pick one addi onal item from the list below (Required):

Flu Vaccina on (A ach Explana on of Benefits, Chandler Care Center Authoriza on Form, or a copy of the
receipt)
A
end the Wellness Expo and One Class—(A endance maintained in My Learning Plan based on sign in sheets.
No addi onal documenta on necessary.)
__________________________________
Name of Class A ended

_____________
Time
Weight Loss Program
__ District provided Weight Loss Program (District sponsored will be documented as class on my learning plan
based on sign in sheets)
__ Non-district sponsored ( A ach a le er from weight loss coach sta ng you have a ended all sessions or obtained goal)
 If pregnant, sign up for Healthy Pregnancy Program by calling 1-800-411-7984 (No Documenta on Required)
If pregnant, complete Well Pregnancy Check (A ach note from Doctor sta ng all pregnancy check-ups have
been completed.)
Cancer Screening as appropriate, e.g. mammogram, colonoscopy, skin cancer, prostate, etc. (A
ach an
Explana on of Benefits (EOB).)
Donate Blood (A ach Post Dona on Form)
Annual Eye Exam (A ach doctors note sta ng date of service and service performed.)
One (1) Annual Dental Cleaning (A ach doctors note sta ng date of service and service performed.)
I _________________________________ confirm I have completed the three required ac vi es to qualify for payment
of the wellness incen ve.
__________________________________ ____ _________
Employee Signature
Worksite
_____________
Employee ID #
____________
Date
RETURN TO BENEFITS DEPARTMENT BY MAY 31, 2017