Re: Healthy Behaviors Rewards Program. Dear Plan Member,

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1 WLREFER Re: Healthy Behaviors Rewards Program Dear Plan Member, GOOD NEWS! You have been referred to the Healthy Behaviors Rewards Program checked below. The referral may have come from your doctor, a case manager, Plan reports showing that you qualify, and you might have even referred yourself. All of these programs are offered to make sure our members get an extra boost as they try to improve their health. Your good health is very important to us. You can learn how to improve your health and earn valuable rewards while you do it. Alcohol and Drug Abuse Healthy Behaviors Rewards Program Maternity Healthy Behaviors Rewards Program Quit Smoking and Using Tobacco Healthy Behaviors Rewards Program Weight Management Healthy Behaviors Rewards Program Well Child Visits Healthy Behaviors Rewards Program In this package: A Promise Form for you to sign and send to tell us you want to be in this program. A stamped, addressed return envelope. A description of the program so you know what will be involved. Getting started is as easy as 1, 2, 3, 4, 5 Read the program description. Call us if you have any questions. Fill out the Promise Form and check boxes to show you plan to follow the program. Fill out the section with your name, address, and phone. Sign and date the form. Your doctor needs to sign the form too. Use the stamped envelope with our address and send us your form. It s FREE! Healthy Behaviors, Simply Healthcare Plans, 9250 W Flagler Street, Suite 600, Miami, FL Do you have questions? Phone Fax HealthyBehaviors@simplyhealthcareplans.com

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4 WLMEMPROMISE PROMISE FORM MANAGING MY WEIGHT Do you want to be at a safe and healthy weight? I want to lose weight and be healthy. If your answer is yes, you can be part of the Weight Loss Rewards Program. Please fill out and sign this form.your doctor needs to sign this form also. Check the boxes below here, and Fill in the blanks below here I want to start losing weight by this date The weight loss program that I picked is The exercise program that I picked is I talked to my doctor about these weight loss and exercise plans. We made a care plan. I will keep a log of my daily food and exercise. Check only the boxes that are important to you. I want to be healthy I want to be at a healthy weight I want to do healthy activities I will eat mostly healthy food in regular size portions We need your name, address, phone, and . Print First Name Middle Initial Phone Number Print Last Name Other Phone Address City Zip Code You need to take this form to your doctor. Your doctor needs to sign this form too. Sign Your Name REQUIRED Your Doctor Signs REQUIRED Today s Date We sent you an envelope that you can use to return this form to us. The postage is paid. Just drop it in the mail box. Our address is Healthy Behaviors, Simply Healthcare Plans, 9250 W Flagler Street, Suite 600, Miami, FL Do you have questions? Phone Fax HealthyBehaviors@simplyhealthcareplans.com

5 HBMEMPHONE Did you know that most people who have Medicaid in Florida can get a free cell phone with air time and texting? Cell phones give you a life line in case of emergency. Sometimes you can also get texts that remind you about healthy behaviors. These texts may be free as well. Want to find out more? All of the vendors below provide this phone service. Each vendor may have a different plan so check carefully. If the service is not FREE, do not enroll. We are only telling you about phones that should be free to you. Company Access Assurance Safelink How to reach the company DON T FORGET TO ASK ABOUT PROGRAMS FOR FREE HEALTH TEXT MESSAGES