Health Insurance Wellness Program Participation Form

Streamline Your Health Insurance Wellness Program Enrollment

Health insurance wellness programs offer valuable incentives for members who prioritize their health, but enrollment can often feel complicated. This Health Insurance Wellness Program Participation Form template helps insurance providers, HR departments, and wellness coordinators make the sign-up process simple and clear.

Whether you're managing employee wellness benefits, coordinating with insurance carriers, or helping individuals understand their coverage options, this template captures everything you need: provider details, covered services, incentive eligibility, and claims submission requirements—all in one professional, easy-to-complete form.

Built for insurance professionals and HR teams

Perfect for insurance agents, HR managers, benefits coordinators, wellness program administrators, and healthcare navigators, this form helps you gather accurate information while educating participants about program benefits. It's designed for small to mid-sized businesses, insurance brokerages, employee benefits firms, and healthcare organizations that want to boost wellness program participation without drowning in paperwork.

What makes this template valuable

This form includes sections for participant demographics, current health insurance details, provider network information, wellness services covered (like gym memberships, health screenings, smoking cessation programs, and mental health support), incentive tracking structures (premium discounts, HSA contributions, gift cards), and clear guidance on how to submit claims or proof of participation.

By using conditional logic, you can show different sections based on the type of wellness program selected—whether it's preventive care, fitness-focused, chronic condition management, or mental wellness support. This keeps the form relevant and prevents overwhelming participants with unnecessary questions.

Integrate with your existing benefits stack

Connect this form seamlessly with your HR systems, insurance platforms, and communication tools. Use Stepper to automatically route completed forms to benefits administrators, trigger follow-up emails with program details, update enrollment databases, and notify wellness coaches when new participants join. You can even set up automated reminders for quarterly check-ins or incentive claim deadlines.

If your wellness program requires signed acknowledgments or liability waivers, integrate Papersign to send enrollment confirmations and program agreements for eSignature right after form submission—keeping everything compliant and documented.

Professional, accessible, and on-brand

This template is fully customizable to match your company or insurance brand guidelines. Adjust colors, fonts, and logos, add your own wellness program descriptions, and embed the form directly on your benefits portal or website. The clean, straightforward design ensures high completion rates, even for employees unfamiliar with wellness programs.

Whether you're launching a new wellness initiative, running open enrollment, or simply making it easier for members to take advantage of their benefits, this Paperform template gives you a reliable, automated starting point that saves time and reduces administrative burden.