Follow the steps to complete the Upmc Fitness Discounts claim form online.

1. Press the ‘Get Form’ button to access the Upmc Fitness Discounts claim form and open it for editing.
2. Fill in the member information section completely. This includes entering your last name, first name, middle initial, and UPMC Member ID number as shown on your member card. Additionally, provide your sex, date of birth, and contact information including your street address, city, state, phone number, zip code, and county. An optional email address can also be provided.
3. In the fitness benefit claim information section, select whether you are submitting an annual or monthly fitness benefit claim by checking the corresponding box. For the annual claim, indicate the year submitted. For the monthly claim, specify the month and year.
4. Enter the name and address of your fitness center or gym. Ensure this information is accurate and detailed.
5. In the member authorization section, read the declaration carefully. Sign and date the form to confirm that all information provided is true and correct to the best of your knowledge.
6. Compile the completed claim form with a copy of your paid receipt from the fitness center that shows your payment details. Ensure this receipt meets all requirements stated, such as displaying the facility name and the amount paid.
7. Mail the completed claim form along with the paid receipt to the specified address: UPMC for Life, P.O. Box 2997, Pittsburgh, PA 15230.
8. After submitting, monitor your reimbursement status and remember to keep copies of your documents for your records.

Submit your Upmc Fitness Discounts claim form online today to take advantage of your fitness benefits!