Apex Award Nomination Form

2012 Apex Award Nomination Form

Note: The 2012 Apex Awards are open to current UnitedHealthcare National Accounts customers only (companies, non-public sector, with 3,000 or more employees). Public sector clients and companies with fewer than 3,000 employees are encouraged to apply for the annual Well Deserved awards, which recognize employers for implementing exemplary wellness programs aimed at reducing health risks and improving prevention among their employees. For information about the Well Deserved program, please contact Carol Calvin, carol_p_calvin@uhc.com.

Company nominated
Where is the company headquartered?
What is the company's core business?
Number of employees
Person Submitting Nomination
Name of person submitting nomination
Title
Phone number
Email
Person submitting nomination is: An employee of the nominated company A UnitedHealth Group employee submitting the nomination on behalf of the nominated company
Primary Contact at Nominated Company
Name of primary contact at the nominated company
Title
Phone number
Email
The senior-most benefits executive* at the nominated company is aware of this nomination: Yes No
Who is the company's primary contact at UnitedHealthcare?
NEW Would you be interested in/willing to present this nominated program during a breakout session at the 2012 National Accounts Customer Forum, May 9-11? Yes No
Please answer the following questions regarding the nominated program. Entries will be judged on a range of factors, including recognition of a pressing health care benefits challenge and innovation in developing a unique and creative solution. Perhaps the most significant criteria for the judges' consideration are the program's impact and measurable results. Answers are limited to 1,000 characters per question.
Please give a brief overview of the program you are nominating.
What challenges led to the creation of the program?
What are the program's overall objectives?
What was/is the timeframe for the program's creation and launch?
How was this program communicated to employees and/or other stakeholders?
What difficulties were encountered during implementation and have they been addressed? How?
How was this program measured and what have been the results?
What has been the feedback from employees and/or other stakeholders?

Award Details
There are no entry fees for the Apex Award program. The deadline for entry has been extended to Friday, March 2, 2012. Nomination forms must be submitted online. A panel of independent representatives from the health care industry, including past Apex Award winners, will review the nominations and vote on the winners.

All Apex Award finalist programs will be profiled at the 2012 UnitedHealthcare National Accounts Customer Forum – May 9-11 in Palos Verdes, Calif. – and winners will be announced live at the event's Apex Awards dinner. Each winner can also be profiled in an optional press release highlighting the company's innovative program.

Questions
If you have further questions, please contact Matthew Yi at matthew.yi@uhc.com.

Person Submitting Nomination

Primary Contact at Nominated Company