Follow the steps to successfully submit your reimbursement request.

1. Click ‘Get Form’ button to access the Well Sense Gym Reimbursement form and open it in the editor.
2. In the member information section, clearly print your member ID number, last name, first name, address, middle initial, city, state, zip code, and phone number. Ensure all details are accurate to avoid any delays in processing.
3. Move to the health club information section. Provide the name and address of your health club. Attach photocopies of dated, paid health club receipts, bank or credit card statements, or paycheck stubs along with a copy of your Health Club Agreement.
4. Indicate the total number of receipt copies attached and specify the reimbursement amount you are requesting. Remember, you can request reimbursement up to $200 per family per year.
5. In the certification and authorization section, read the statement carefully and ensure you understand your rights. Then, sign the form to authorize the release of your health club membership information to Well Sense Health Plan.
6. Once all sections are complete, review the form for accuracy. You have the option to save changes, download the form, print it, or share it as needed.
7. Finally, fold your form and mail it along with the required documents to Well Sense Health Plan at the provided address.

Complete your Well Sense Gym Reimbursement form online today to take advantage of your benefits.