Get Fitness Reimbursement Form

This guide provides step-by-step instructions for completing the Fitness Reimbursement Form online. It aims to empower all users, regardless of their experience with digital documents, to navigate the process with ease and confidence.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the designated editor.
2. Begin by entering your member name in the designated field. Make sure to input your full name as it appears in your membership documents.
3. In the next field, enter your Member ID#. This number is critical for identifying your account, so double-check for accuracy.
4. In the Fitness Center/Provider Information section, provide the name of the fitness center or provider you are submitting for reimbursement.
5. Fill in the street address, city, state, and zip code of the fitness center. Ensure that all details are current and correct to facilitate the reimbursement process.
6. Indicate the date(s) you utilized the facility for the month. If you have not provided a printout, make sure to clearly list the specific dates in the space provided.
7. Calculate the amount of reimbursement due by entering the number of times you used the facility this month in the designated space and multiply that by $3. Record this amount in the corresponding field labeled (a).
8. Input the monthly membership fee you paid in the space labeled (b).
9. Attach a receipt for your payment if necessary, ensuring it is clear and legible.
10. Review the reimbursement conditions: you will be reimbursed the lesser of line (a) or line (b) up to $36 per month for in-network facilities and $18 per month for out-of-network facilities.
11. The final step requires the signature of a fitness center employee. Ensure that this is completed before submission.
12. After you have filled out all tabs correctly, you can save your changes, download, print, or share the completed form as needed.

Complete your Fitness Reimbursement Form online today for a seamless reimbursement process.