Emotional Health Questionnaire
Emotional Health Questionnaire

CONSENT AND DISCLAIMERS

Please read the following information then enter your MEDICAL-GRP ID and MEMBER ID and indicate if you are the Employee (E) or Spouse (S) to affirm your understanding of this information at the bottom of the page.

CONSENT TO SHARING PERSONAL INFORMATION

Liberty Union Life Assurance Company wants to support our customer�s health and well-being now and in the future. To understand how to better support and serve its customers, Liberty Union Life Assurance Company asks its members whose employer has enrolled in the Healthy Choice Option to complete a physical and emotional well-being assessment on an annual basis. The MEMBER ID and MEDICAL-GRP ID information along with the answers to the assessments will be sent to Liberty Union Life Assurance Company. The results of these assessments will have no bearing on individual premiums, but will be analyzed in aggregate and provide Liberty Union Life Assurance Company with real-life data to apply to business planning and product development. Credit will be given to members that will reduce their calendar year deductible under the Healthy Choice Option for taking the test. The results of the test will have no bearing on the amount the that member�s calendar year deductible will be reduced. Neither Workplace Options nor Convergence assumes any responsibility or liability associated with the use of the information sent to Liberty Union Life Assurance Company as described in this paragraph.

GENERAL DISCLAIMER

The information contained on Liberty Union Life Assurance Company�s website including content, multimedia features, and assessment results and recommendations, are for educational purposes only. They are NOT to be used for medical diagnosis, medical treatment or to replace evaluation by a qualified physician.

MEDICAL INFORMATION DISCLAIMER

All information provided by ConvergenceHealth.com on the Liberty Union Life Assurance Company�s website is of a general nature and is intended for educational purposes only. The information available on this website should not be used as a substitute for professional medical care for the prevention, diagnosis, or treatment of health problems. You should consult with your personal physician or pharmacist before taking any prescription or over-the-counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your personal physician or pharmacist can provide you with advice on what is safe and effective for you. The information on this website should not be used as a substitute for the diagnosis and advice of your health care professional. Nothing on this website is to be interpreted as advocating the self-management of your health and medical condition's or those of your family. The information contained herein has been devised without reference to cultural, dietary, societal language, prescribing, or dispensing conditions, other than those of the United States , which might affect the information provided.

LEGAL INFORMATION

YOU SHOULD ALWAYS CONSULT WITH A HEALTHCARE PROFESSIONAL BEFORE STARTING ANY DIET, EXERCISE, SUPPLEMENTATION OR MEDICATION PROGRAM.

Information presented at ConvergenceHealth.com on the Liberty Union Life Assurance Company�s website is for educational purposes only; this information is not meant to substitute for the advice provided by your own physician or other medical professional.

Statements about products and health conditions have not been evaluated by the U.S. Food & Drug Administration and are not intended to diagnose, treat, cure, or prevent disease. This information is provided solely for educational and informational purposes including as a potential guideline to be used when discussing a program with a healthcare professional. None of the statements on this site are an endorsement of any particular product, or a recommendation as to how to treat any particular disease or health-related condition.



 
You must complete all three fields below to continue. Your MEDICAL-GRP and MEMBER ID can be found on your Liberty Union Life Assurance Company card.  [Click here to see an example or where to find the information on your card]
Enter your MEDICAL-GRP ID number:
Enter your MEMBER ID number:
Employee (E) or Spouse (S): (enter E or S only)

Select one of the choices below to continue:



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