Get Bmc Health Net Plan Wants To Help You To Get Fit Form

Filling out the Bmc Health Net Plan Wants To Help You To Get Fit Form online is a straightforward process designed to assist members in claiming their fitness benefits. This guide provides step-by-step instructions to ensure you complete the form correctly and efficiently.

Follow the steps to successfully complete the form.

1. Click 'Get Form' button to access the form and open it for editing.
2. Provide your member information in the designated fields. Include your member ID number, last name, first name, and middle initial. Fill in your current address, city, state, and zip code. If you have a new address, check the appropriate box.
3. In the health club information section, enter the name and address of your health club clearly on the provided lines.
4. Attach photocopies of dated, paid health club receipts, bank or credit card statements, or a paycheck stub to the form. Ensure these documents include your name and details of the health club membership or class fees.
5. Indicate the total number of receipt copies you are attaching in the specified field. Enter the reimbursement amount you are requesting, which should not exceed $200.
6. Review the certification and authorization section. Sign and date the form to certify that the information provided is accurate and complete.
7. After completing all fields and ensuring all attachments are included, proceed to save any changes. You may download, print, or share the completed form as needed before mailing it.

Get started now and complete your Bmc Health Net Plan Wants To Help You To Get Fit Form online.