Get Metroplus Gym Reimbursement Form

Filling out the Metroplus Gym Reimbursement Form online is a straightforward process designed to help members receive reimbursement for their gym membership expenses. This guide provides clear, step-by-step instructions to ensure that all required information is accurately submitted.

Follow the steps to successfully complete the reimbursement form.

1. Click ‘Get Form’ button to access the Metroplus Gym Reimbursement Form online and open it in the form editor.
2. Begin by entering your subscriber information in the specified fields. This includes your MarketPlus ID number, last name, first name, middle initial, and address details (number, street, and apartment, if applicable) along with your city, state, and zip code.
3. Provide the six-month period for which you are requesting reimbursement. Format this as mm/dd/yyyy to mm/dd/yyyy.
4. Enter the health club information by filling in the gym or health club’s name, location (city and state), and their phone number.
5. Specify the amount being claimed, ensuring it does not exceed $200 or the cost of your membership, whichever is lower.
6. List the dates of your 50 gym visits, ensuring you fill in all 50 entries in the designated grid. If documentation from the facility is available, attach it as specified.
7. Affirm the accuracy of the provided information by signing and dating the form. Include the gym representative’s signature if required, such as when the gym cannot provide a printout.
8. Once all sections are complete, save your changes to the form. You can then download, print, or share the document as necessary.

Complete your Metroplus Gym Reimbursement Form online today to receive your benefits!