BP Physician Certification Form Secure Submission

Upload your completed Physician Certification Form by December 15, 2024.

Before you submit your form, please review it for accuracy:

• Information is printed clearly.
• Confirm the date of your metabolic screening is between January 1, 2024 – December 15, 2024.
• Confirm all screening exam results are provided on the form unless your physician indicated you are exempt due to a medical condition or pregnancy in Step 1 of the form.
• Confirm 3 of 5 target measures are met and if not, you must complete three coaching calls with a WebMD Health Coach before the December 15, 2024 deadline.
• Confirm physician signature and phone number are included on the form.
• Be sure to provide a valid email address so we can communicate with you regarding the status of your form.

Failure to provide the items above on your form will eliminate you from HSA incentive eligibility.