Wellness Program Agreement

Introduction

This Wellness Program Agreement ("Agreement") is entered into between [Your Company Name] ("Employer") and the undersigned employee ("Employee") voluntarily participating in the wellness program ("Program"). This Agreement outlines the terms and conditions of Employee's participation in the Program.

Program Description

Program Purpose: The Program aims to promote the overall health and well-being of employees by offering various wellness initiatives, resources, and activities.

Program Components: The Program may include, but is not limited to:

• Health assessments

• Fitness activities

• Nutrition counseling

• Stress management

• Smoking cessation support

• Wellness challenges

Eligibility

The Program is open to all eligible employees of [Your Company Name], subject to the following conditions:

• The Employee must be an active, full-time, or part-time employee.

• The Employee must complete any required enrollment forms or assessments.

• The Employee must adhere to Program guidelines and policies.

Participation Requirements

Employee agrees to actively participate in the Program, which may include:

• Completing health assessments or screenings.

• Attending wellness workshops, seminars, or activities.

• Setting and working towards wellness goals.

• Engaging in fitness or nutrition-related activities as applicable.

Confidentiality

The Employee understands that personal health information provided or obtained as part of the Program will be kept confidential and used solely for Program purposes. The Company will comply with all applicable privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA).

Incentives

The Employee may be eligible to receive incentives or rewards for participating in the Program. Incentives may include, but are not limited to, discounts on health insurance premiums, gift cards, or wellness-related prizes. Eligibility criteria and incentive details will be communicated separately.

Program Duration

The Program duration is June 10, 2050 to June 20, 2050. The Company reserves the right to extend, modify, or terminate the Program, with notice to participating employees.

Cancellation or Termination

The Company may cancel or terminate the Program at its discretion, with notice to participating employees. In the event of Program cancellation or termination, the Company will provide information on the next steps and any applicable alternatives.

Rights and Responsibilities

Employee Responsibilities: Employee agrees to attend Program activities as required, report progress, and adhere to Program guidelines and policies.

Employer Responsibilities: The Company will provide access to Program resources and activities, communicate Program updates, and ensure compliance with relevant laws and regulations.

Signature and Date

By signing below, the Employee acknowledges that they have read, understood, and voluntarily agree to the terms of this Wellness Program Agreement.

_____________________________

Employee

June 5, 2023

_____________________________

Authorized Representative

June 5, 2023

Disclaimer: Participation in the Program is voluntary and does not guarantee employment or specific health outcomes. The Program is not a substitute for professional medical advice or treatment. This Wellness Program Agreement is in compliance with all applicable federal and state laws and regulations, including HIPAA.

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