Get Does Fidelis Cover Gym Membership

This guide provides step-by-step instructions on how to complete the Does Fidelis Cover Gym Membership form online. Follow the outlined steps to ensure a smooth and efficient reimbursement process for your fitness expenses.

Follow the steps to complete your gym membership reimbursement form online.

1. Click ‘Get Form’ button to access the Does Fidelis Cover Gym Membership form and open it in your browser.
2. Enter your member information accurately, including your name and member ID number in the designated fields.
3. Provide your address, ensuring it matches your member records with Fidelis Care.
4. Specify the fitness facility's name and address where you have a gym membership.
5. Indicate the membership fee you paid and select whether it is a monthly or yearly charge.
6. Fill in the 6-month period for which you are requesting reimbursement, using the specified date format (MM/DD/YY).
7. Sign the attestation statement confirming the membership services were for your personal use and understand the reimbursement policy.
8. Complete the member log of visits if you do not have a printed log; ensure that dates are filled out for each visit up to 50 times within a 6-month period.
9. Repeat steps 2-8 for your spouse, if applicable, using the spouse's information and ensuring both signatures are present.
10. Collect all supporting documents, such as membership bills, proof of payment, and visit logs, to create a complete submission package.
11. Email your completed form and documents to gym@fideliscare.org, fax to 347-923-7513, or mail them to the specified address for reimbursement.

Start your online form submission today to begin your fitness reimbursement process.