Get Chp Fitness Reimbursement Form

Completing the Chp Fitness Reimbursement Form online is a straightforward process that allows eligible members to request reimbursement for health and fitness expenses. By following this guide, you will be guided step-by-step to ensure your form is filled out correctly and submitted successfully.

Follow the steps to complete your reimbursement form online.

1. Click ‘Get Form’ button to access the reimbursement form and open it for editing.
2. Provide your subscriber information as it appears on your Chp ID card. This includes your last name, first name, subscriber ID number, telephone number, and middle initial. Ensure all provided information is accurate, as it will be used for correspondence related to your reimbursement.
3. In Section 2, fill in the health/fitness center information. Enter the name, address, and type of facility or activity, along with the calendar year for which you are requesting reimbursement. Remember that the calendar year is from January 1 to December 31.
4. Complete Section 3 by submitting each required item. Check off the boxes indicating you have included the completed form, the copy of health center contracts or agreements, original receipts or bank statements showing the charges for membership, and possibly a brochure from the health club if requested.
5. Sign and date the certification and authorization section. This is a commitment that your statements in the form are true and accurate. Ensure you understand the reimbursement terms and that the expenses claimed have not been reimbursed previously in any calendar year.
6. Once you have filled out the form completely, ensure to keep copies of all documentation before mailing your Health/Fitness Center form.
7. Mail the completed form to Capital Health Plan, Claims Department, P.O. Box 15349, Tallahassee, FL 32317-5349. Allow up to 30 days for processing your reimbursement after submission.

Start filling out your Chp Fitness Reimbursement Form online today to ensure you receive your benefits!