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  • ITW Health Care Provider Form Secure Submission

    Because you submitted your HCPF by 9/30/2026, although incomplete, we are allowing you until Wednesday, 10/7/2026 to submit a corrected and complete form.

     

    Forms submitted after Wednesday, 10/7/2026 will not be accepted and you will not qualify for the lower Living Well rates in 2027. 

     

    Before you submit your form, please be sure you:

    • Print clearly and review your form to ensure it is complete.
    • Write “Re-Submit” on your form
    • Provide a valid email address so we can communicate with you regarding the status of your form.

    If you do not provide a valid email address, we cannot proactively confirm that your corrected form was accepted. It can take up to 10 business days from the date of submission for your results to display in the Living Well at ITW Wellness Portal. You will need to confirm successful submission of your Health Care Provider Form by contacting WebMD Health Services Customer Service: 866-543-2053. Hours of operation: Monday-Friday 7:30 am-7:00 pm CST.

     

    For additional support or questions about your form please call WebMD Health Services Customer Service at the number above.







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