Houston County Personnel Board

February 1, 2012 Attention:

Wade Baxley
Chairman

Jerry White
Member

Manning Sanders
Member

In November of 2011, we offered an on-site wellness screening for our employees that would result in a significant savings to our insurance if we were able to get an 80% participation rate. We did not achieve that goal. The Alabama State Employees' Insurance Board has given us another opportunity to get our numbers where they need to be. Your name is on the list of employees that did not complete the health screening. You might have attended, signed in or started the process but you did not complete the screening. You will need to have your Healthcare Provider complete the enclosed form by March 15, 2012. If you visited your provider anytime between the qualifying dates of June 1, 2011 to March 15, 2012, those screenings may be used. The Personnel Department will be happy to mail the completed form if you would like us to, however to maintain your health privacy, you may mail the completed form to the following address: State Employees' Insurance Board Attn: Wellness Program P.O. Box 304900 Montgomery, AL 36130-1900 I recommend that you keep a copy for your records. in October 2012. Your participation is not optional. If you have any questions, please call. Failure to provide this

Brad Burgess
Member

Velma Tribue
Member

Sheri Thompson
Board Secretary

form may result in a surcharge on your health insurance premiums beginning

Sincerely,

,9240 erzorefrew
P.O. Drawer 6406 Dothan. Alabama 36302 (Phone) 334.677.4777 (Fax) 334.677.4779 www.houstoncounty.org

Personnel Director