B\Well Appeal Form:
Complete this form if you are pregnant/postpartum or have a chronic illness to be exempt from a Biometric Screening.
Submit this form by using the link below or faxing 402-939-0604.
B\Well Preventive Exam Form:
- Earn credit for completing a preventive exam with your Provider between 9/21/25-9/30/26.
- Qualifying exams include annual, dental and vision.
- Forms will be processed, and credit given in 10-14 business days.
Please reach out to WebMD Customer Service with questions at 888-343-9861.
