Get Reimbursement Form - Univera Healthcare

Completing the Reimbursement Form for Univera Healthcare is a straightforward process that ensures you receive the compensation you deserve for your fitness activities. This guide will provide you with detailed instructions to assist you through each section of the form, making your experience seamless and efficient.

Follow the steps to complete your reimbursement request effectively.

1. Press the ‘Get Form’ button to download the Reimbursement Form and open it in your preferred editor.
2. Provide your personal details by completing Part A: Member Information, which includes your name, health plan ID, date of birth, and address.
3. Indicate the specific six-month period for which you are requesting reimbursement by checking the appropriate box and noting the dates.
4. Ensure you include proof of payment that shows your name, the fitness facility's name, payment amount, and the dates of the payments. This documentation is required.
5. If your fitness facility does not provide a printout of your workout sessions, fill out Part B: Exercise Log, detailing each visit to the facility.
6. Having your fitness facility complete a Fitness Facility Member Verification Form is required to validate your sessions.
7. Review all information for accuracy before signing to certify correctness and compliance with program rules.
8. Save any changes made to the form, and then print or download your completed Reimbursement Form to have a physical record.
9. Finally, mail your completed Reimbursement Form along with all necessary documentation to ExerciseRewards at the provided address.

Start completing your documents online to ensure you receive your reimbursement!