Instructions for completing and submitting the Biometric Screening form

Please review the instructions to ensure your information is complete and sent to Virgin Pulse to earn a discount
toward your 2024 medical plan premium.

1) Print the Biometric Screening form from your Virgin Pulse account.
a) Each form has a unique member ID that is specific to your Virgin Pulse account.
b) You cannot print or use more than one form from the same account.
c) Employee ID is not required to complete form.
2) Schedule an appointment with your medical provider.
a) Request an annual preventative visit (physical) with bloodwork.
3) Request that your physician complete the Biometric Screening Form.
a) Any services or tests performed beyond what is needed to be eligible for the premium discount may not be
covered at 100% and may result in additional charges that will be your responsibility. Metrics not eligible
for the premium credit do not need to be completed on the form.
b) Review the results with your physician, and discuss your overall health goals
Metric Acceptable Range for Premium Credit Eligible for Premium Credit
BMI At or below 29.9 Yes
Blood pressure At or below 129/80 Yes
Total cholesterol At or below 199.9 OR Yes
Ratio (TC/HDL) at or below 4.0
Glucose At or below 139 Yes
(fasting or non-fasting)
HDL/LDL/Triglycerides Not applicable No
Waist Circumference Not applicable No
Body Fat % Not applicable No
A1C Not applicable No
4) Submit your completed biometric form to Virgin Pulse by Dec 1, 2023.
a) You can submit the completed form in one of two ways:
i) You can Upload the form directly to the Virgin Pulse website from your desktop computer. (The upload
function is not available via the Virgin Pulse app.)
(1) If on the Rewards page, click access your biometric form. Once clicked you are brought to the main
page where you can upload your form by selecting the Upload Form button.
(2) If not currently on Virgin Pulse, log in to your account, select Home then Rewards to access the
biometric screening form. Select Upload Form button.
(3) You will then see your form displayed under Last Uploaded File. This indicates a successful upload,
and your biometric screening form will be processed.
ii) You or your physician can fax the form to Virgin Pulse at 1-888-232-3848. Be sure to retain the fax
confirmation for your records.
5) Confirm Rewards
a) You will receive a confirmation email within 72 hours of Virgin Pulse receiving your form.
b) Processing of form may take up to 10 business days. After 10 business days, you can verify your rewards on
the Rewards page on the Virgin Pulse App or Desktop version.
c) If your rewards for your biometric screening do not show within 10 business days, please call Virgin Pulse at
833-880-4209, M-F 8:00am – 9:00pm EST, or email edwardjones.support@virginpulse.com