Get Health New England Gym Reimbursement Form

Completing the Health New England Gym Reimbursement Form online is a straightforward process that allows you to claim reimbursement for fitness activities. This guide provides step-by-step instructions to ensure that you accurately fill out the form and submit the necessary documents.

Follow the steps to successfully complete your reimbursement form

1. Click 'Get Form' button to access the Health New England Gym Reimbursement Form and open it for editing.
2. Begin by confirming your HNE membership status. Check the box labeled 'Current HNE member' to affirm your eligibility.
3. Indicate the date your benefits became effective; it must be more than four months ago. Fill in the 'Benefit effective' section.
4. Provide the amount you are requesting to be reimbursed in the designated field.
5. Fill out your Subscriber Information by entering your Subscriber ID number, last name, first name, street address, city, state, and zip code.
6. In the Member Information section, list all covered family members for whom you are submitting a request. Include each person's name, relationship to you as the subscriber, effective date for Weight Watchers® or name of the health club, date of payment, and amount paid.
7. Attach the required documentation for reimbursement. This includes a copy of the health club contract or membership agreement and dated receipts or bank statements showing the payment.
8. If you are requesting reimbursement for Weight Watchers®, include a copy of the stamped membership book and proof of payment.
9. Ensure all covered family members aged 18 and older sign and date the certification section to authorize the release of information to HNE.
10. After verifying that all sections are complete, save your changes, and decide whether to download, print, or share the form for submission.

Start filling out your Health New England Gym Reimbursement Form online today to claim your fitness expenses!