Health status discussion reward form

Did you have a conversation with your doctor about exercise, fall risk and bladder control? Fill out this form to get your reward. Prefer to print your form and mail it in? Print or download a copy (PDF).

Note: If you have more than one eligible person in a household, please fill out a separate form for each person.

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HAP Senior Plus (HMO)/(HMO-POS)/(PPO) and HAP Primary Choice Medicare (HMO) are health plans with Medicare contracts. HAP Empowered Duals (HMO SNP) is a Medicare health plan with a Medicare contract and a contract with the Michigan Medicaid Program. Enrollment in the plans depends on contract renewals. HAP Senior Plus (PPO) is a product of Alliance Health and Life Insurance company, a wholly owned subsidiary of HAP.

This information is not a complete description of benefits. For more information call Medicare Michigan customer service at (800) 868-9885 (TTY: 711) 8 a.m. to 8 p.m., seven days a week (Oct. 1 – March 31) / 8 a.m. to 8 p.m., Monday through Friday (April 1 - Sept. 30).

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  • HAP Medicare Sales:

    (800) 868-9885 (TTY: 711)

  • (800) 868-3153 (TTY: 711)

    HAP Senior Plus®

    (800) 801-1770 (TTY: 711)

  • HAP Senior Plus®(PPO)

    (888) 658-2536 (TTY: 711)

  • Alliance Medicare Supplement:

    (800) 873-7526 (TTY: 711)