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Open Enrollment Event             About You     Medical Conditions     Your Doctor     Enrollment Summary        Select Benefits  Sign Up  Confirm Enrollment   Exit Event   Well Aware Incentive Program Your employer has made the following Well Aware program(s) available to you. If you are eligible and successfully complete the program, you will receive a benefit premium credit in your paycheck in the amount of $xxx.xx Please Note:   In order for you to receive certain incentives, your employer may be notified of your successful completion of the program. COPD Cardiac Disease Diabetes       Medical Management Please provide the medical information requested below for each family member. This information is used by registered nurses from CIGNA HealthCare who provide phone-based outreach to assist eligible members by offering advice to manage health care. This information will not be sent to your employer and will not be used against you. None of the members listed have any conditions I decline to answer Jack Smith Select the condition(s) currently being treated with one or more prescription drugs: Anxiety or Depression Asthma   Select the condition(s) that you have been diagnosed, are currently undergoing treatment, or may be taking prescription drugs for: Acid Related Stomach Disorders Chronic Obstructive Pulmonary Disease (COPD) or Emphysema Irritable Bowel Syndrome Atrial Fibrillation Diabetes Low Back Pain Back / Neck Pain, Herniated Disk, or Spinal Stenosis Decubitus Ulcer Osteoarthritis Benign Uterine Condition (Uterine Fibroids) Fibromyalgia Osteoporosis Cancer - Breast - Diagnosed or a Positive Biopsy Heart Condition -(Heart Attack, Angina, Congestive Heart / Coronary Artery Disease) Pregnancy - Healthy Cancer - Prostate - Diagnosed or a Positive Biopsy High Blood Pressure Pregnancy - High Risk Cancer - Other - Diagnosed or Positive Biopsy (Other than Skin Cancer) Inflammatory Bowel Disease Urinary Incontinence Select the treatment / procedure(s) that you are currently undergoing or are considering: Angioplasty or Heart Bypass Surgery Cancer - Other - Chemotherapy, Radiation Therapy, or Surgery (Other than Skin Cancer) In Vitro Fertilization Cancer - Breast - Chemotherapy, Radiation Therapy, or Surgery Hip or Knee Replacement Spinal Fusion or Diskectomy Cancer - Prostate- Chemotherapy, Radiation Therapy, or Surgery Hysterectomy (Removal of Uterus)   Jane Smith Select the condition(s) currently being treated with one or more prescription drugs: Anxiety or Depression Asthma   Select the condition(s) that you have been diagnosed, are currently undergoing treatment, or may be taking prescription drugs for: Acid Related Stomach Disorders Chronic Obstructive Pulmonary Disease (COPD) or Emphysema Irritable Bowel Syndrome Atrial Fibrillation Diabetes Low Back Pain Back / Neck Pain, Herniated Disk, or Spinal Stenosis Decubitus Ulcer Osteoarthritis Benign Uterine Condition (Uterine Fibroids) Fibromyalgia Osteoporosis Cancer - Breast - Diagnosed or a Positive Biopsy Heart Condition -(Heart Attack, Angina, Congestive Heart / Coronary Artery Disease) Pregnancy - Healthy Cancer - Prostate - Diagnosed or a Positive Biopsy High Blood Pressure Pregnancy - High Risk Cancer - Other - Diagnosed or Positive Biopsy (Other than Skin Cancer) Inflammatory Bowel Disease Urinary Incontinence Select the treatment / procedure(s) that you are currently undergoing or are considering: Angioplasty or Heart Bypass Surgery Cancer - Other - Chemotherapy, Radiation Therapy, or Surgery (Other than Skin Cancer) In Vitro Fertilization Cancer - Breast - Chemotherapy, Radiation Therapy, or Surgery Hip or Knee Replacement Spinal Fusion or Diskectomy Cancer - Prostate- Chemotherapy, Radiation Therapy, or Surgery Hysterectomy (Removal of Uterus)   Josh Smith Select the condition(s) currently being treated with one or more prescription drugs: Anxiety or Depression Asthma   Select the condition(s) that you have been diagnosed, are currently undergoing treatment, or may be taking prescription drugs for: Acid Related Stomach Disorders Chronic Obstructive Pulmonary Disease (COPD) or Emphysema Irritable Bowel Syndrome Atrial Fibrillation Diabetes Low Back Pain Back / Neck Pain, Herniated Disk, or Spinal Stenosis Decubitus Ulcer Osteoarthritis Benign Uterine Condition (Uterine Fibroids) Fibromyalgia Osteoporosis Cancer - Breast - Diagnosed or a Positive Biopsy Heart Condition -(Heart Attack, Angina, Congestive Heart / Coronary Artery Disease) Pregnancy - Healthy Cancer - Prostate - Diagnosed or a Positive Biopsy High Blood Pressure Pregnancy - High Risk Cancer - Other - Diagnosed or Positive Biopsy (Other than Skin Cancer) Inflammatory Bowel Disease Urinary Incontinence Select the treatment / procedure(s) that you are currently undergoing or are considering: Angioplasty or Heart Bypass Surgery Cancer - Other - Chemotherapy, Radiation Therapy, or Surgery (Other than Skin Cancer) In Vitro Fertilization Cancer - Breast - Chemotherapy, Radiation Therapy, or Surgery Hip or Knee Replacement Spinal Fusion or Diskectomy Cancer - Prostate - Chemotherapy, Radiation Therapy, or Surgery Hysterectomy (Removal of Uterus) Legal Disclaimer,  Privacy Policy, (06/10/2006) Copyright© 2000-2006 Choicelinx Corporation. 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