Are you a
Healthy Lives Member
Healthy Lives Staff
Other
Last Name
Last Name required
First Name
First Name required
Date of Birth
Date of Birth required
Date must be between 1900 - 2500
Date must be mm/dd/yyyy
Member Type
N/A
Employee
Spouse
Dependent
Member Type required
Organization
Organization required
Preferred Phone Number
Preferred Phone Number required
Phone number format 555-444-2222
E-mail Address
E-mail Address required
E-mail address must be valid
Category
Rewards
Services
Member assistance
Request information
Other
Questions
Submit an appeal
Submit a physician/provider attestation
Other
Category required
Preferred Contact Method
Phone
Email
Preferred Contact Time
7:30 am - 9:30 am
9:30 am - 11:30 am
11:30 am - 1:30 pm
1:30 pm - 3:30 pm
3:30 pm - 5:00 pm
Customer Comments
Comment required
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