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HIPAA

Compliance

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    Question 1 of 10
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    Question 2 of 10
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    Question 3 of 10
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    Question 4 of 10 You must be at least 18 years old to take part in this program.
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  • 5
    Question 5 of 10 Your genes can make a difference.
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  • 7
    Question 6 of 10 Diabetes can be hereditary!
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  • 8
    Question 7 of 10
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  • 9
    Question 8 of 10 Having high blood pressure contributes to your overall risk for type 2 diabetes.
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  • 10
    Question 10 of 10 Some race/ethnic minorities have a higher prevalence of diabetes.
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    Please leave this blank and continue to the next question if you are unsure or do not know your A1c.
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  • 13
    Please leave this blank and continue to the next question if you are unsure or do not know your recent fasting glucose.
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  • 14
    This is defined as high blood sugar during pregnancy.
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  • 15
    The HabitNu program is not recommended during pregnancy.
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  • 40
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  • 41

    Based on your answers, you are not at risk for type 2 diabetes

    However you can join the program to lose weight

    Please answer the next few questions so we may complete your registration.

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  • 42

    Based on your answers, you are not currently eligible for this program
    If you have any questions, please contact us at support@habitnu.com
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  • 43

    You are eligible to participate!

    Based on your responses, our CDC-recognized HabitNu lifestyle change program is one of the most effective ways to lose weight and prevent the onset of type 2 diabetes. 

    Next, we'll ask for your contact details to register you for our program.

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  • 44
    You may be covered by insurance for the cost of the program, or you may purchase out-of-pocket for $45/mo for 12 months.
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  • 45
    In order to start the process you must give consent to participate in the HabitNu Diabetes Prevention Program. 
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  • 48
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  • 49
    Please Select
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    • Yemen
    • Zambia
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    • Other
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  • 50
    What timezone are you in?
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  • 51
    HabitNu is a covered benefit for Medicare, Medicare Advantage and some commercial insurance plans. If your plan is not listed here then you may still purchase the program, out-of-pocket for $45/mo for 12 months
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  • 52

    We'll give you a minute to get your insurance card! We need collect a few more details!

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  • 53
    Your Medicare Number is shown on the front of your Medicare card.
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  • 54
    • 1199 National Benefit Fund
    • AARP
    • Aetna
    • Aetna Better Health of Illinois
    • AR BCBS
    • Blue Cross Community Options
    • Boncura Health Solutions
    • CIGNA
    • Clear Spring Health of Illinois
    • Essence Healthcare
    • Harmony Health Plan of Illinois
    • HCH Administration Illinois
    • Humana
    • IL BCBS
    • IL Fornaio (America) Corp
    • IL Medicaid
    • IlliniCare
    • Longevity Illinois
    • Meridian Health Plan Illinois
    • Provider Partners Health Plan Illinois
    • Sunrise Advantage Plan of Illinois
    • United Health Care
    • Wellcare
    • My plan is not listed
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  • 55
    This may also be called "Plan", "Plan Number" or abbreviated as "GRP" on your insurance card.
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  • 56
    This may be called "Policy Number" or just "ID" on your insurance card.
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  • 57
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  • 58
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  • 59
    The following questions pertain to where you are right now with regards to eating habits. Answer each by selecting the option that best identifies how you feel with each statement. Select Not Sure if you either do not want to answer the question or if you don’t know the answer.
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  • 60
    The following questions pertain to where you are right now with regards to eating habits. Answer each by selecting the option that best identifies how you feel with each statement. Select Not Sure if you either do not want to answer the question or if you don’t know the answer.
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  • 61
    The following questions pertain to where you are right now with regards to exercise habits. Answer each by selecting the option that best identifies how you feel about each statement. Select Not Sure if you either do not want to answer the question or if you don’t know the answer.
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  • 62
    The following questions pertain to where you are right now with regards to exercise habits. Answer each by selecting the option that best identifies how you feel about each statement. Select Not Sure if you either do not want to answer the question or if you don’t know the answer.
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  • 63
    In order to reduce your risk of going on to develop diabetes, you will likely need to change eating, exercise and lifestyle habits. Select the option that indicates how confident you are with the following changes.
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  • 64
    In order to reduce your risk of going on to develop diabetes, you will likely need to change eating, exercise and lifestyle habits. Select the option that indicates how confident you are with the following changes.
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  • 65
    In order to reduce your risk of going on to develop diabetes, you will likely need to change eating, exercise and lifestyle habits. Select the option that indicates how confident you are with the following changes.
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  • 66
    In order to reduce your risk of going on to develop diabetes, you will likely need to change eating, exercise and lifestyle habits. Select the option that indicates how confident you are with the following changes.
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  • 67
    This program is delivered online through live meetings and habit-building tools accessed through an app on a smartphone or tablet (or through a web browser). If you are not comfortable using a smar
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  • 68
    This program is delivered online through live meetings and habit building tools accessed through an app on a smartphone or tablet.
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  • 69
    Internet access is important because this program is done online. 
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  • 74
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  • 75
    Please select all options that apply
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  • 76
    Please select all options that apply
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  • 77

    Thank you for participating

    You have begun your journey to better health.

    You will be taken back to the homepage now.

     

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  • 78

    Thank you for registering!

    Congratulations on beginning your health journey, just one last thing!. 

    To complete the registration hit the submit button below.
    Expect an email from our team with details on your personalized program!

     

     

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