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Get Harvard Pilgrim Fittness Reimbursement Form

Ill out the Fitness Reimbursement Form. Mailing Instructions Please enclose the following: Keep copies of all documentation before sending in your Fitness Reimbursement Form. 1. Copy of your health club membership agreement 2. Completed Fitness Reimbursement Form 3. Copy of at least four consecutive months of receipts (cash/check/credit/electronic) for health club membership dues clearly documenting your name and the health club name. Dues must equal or exceed amount being claimed. 4. Mail to:.

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