Spring 2010 Hoosier + Lincoln Rooms, Dining Services

• Open to faculty & staff who are eligible for Andrews University health insurance benefit. HRA is only for the employee and spouse (other dependents are not eligible).
• If the employee is married, both the employee and spouse must participate in the health screening to receive the discount on the increase in the health insurance premiums.

Components of the HRA

• Requires a 12-hour fast (water only, no coffee or juice).
• Venipuncture for blood glucose, total cholesterol, HDL, LDL, and triglycerides
• Blood pressure
• Height and weight to measure BMI (body mass index)

If you have had a recent blood test done, please make an appointment to participate in the other components of the health screening. For medical data accuracy, Lakeland Care recommends that you participate in the blood test if your most recent blood test was taken more than a month before your HRA appointment time. If you are uncertain whether your previous blood test results are still valid, please bring the lab results with you to your HRA appointment.

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Enter information for employee or spouse separately.

Your Name:					Date of Birth:		Andrews ID:
		Last Name	First Name	MI		MMDDYY

If you are not the primary insured, please complete information of the primary insured.

Name of Primary Insured:					Date of Birth:		Andrews ID:
		Last Name	First Name	MI		MMDDYY

Before choosing your appointment time, please remember that the screening test requires a 12-hour fast. Duration of HRA per person is 15 minutes. All time slots are in the morning. Choose only one appointment time by clicking on the circle before the desired time slot. Submit completed information using the green button at the bottom of the screen.

Date	Time	Slots available
April 07	10:15	4
	10:30	4
	10:45	2
April 08	08:30	1

Is the information you have entered correct? If so, please click the Submit button below. Thank you for your time.

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