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Health Risk Assessment Form

After you enroll, you will need to fill out our Health Risk Assessment Form. The information you give us on this form will help us decide what special programs, if any, are right for you.

We will send this form to you in your member welcome kit. We will also send an envelope for you to return the form. You will not have to pay for postage.

However, you can also download this health risk assessment form. When you fill it out, you can mail it to this address:

Passport Advantage
Attn: Health Risk Assessment
305 W. Broadway, 3rd Floor
Louisville, KY 40202

If you need help completing the form, you can call 1-800-578-0603, press 0, then press 8227.

 
 
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