Get Medex Fitness Benefit Form

Filling out the Medex Fitness Benefit Form online is a straightforward process that allows you to claim your fitness benefits as a member of Blue Cross Blue Shield of Massachusetts. This guide provides clear, step-by-step instructions to help you navigate each section of the form effectively.

Follow the steps to complete the Medex Fitness Benefit Form online.

1. Click ‘Get Form’ button to access the Medex Fitness Benefit Form and open it in your preferred document editor.
2. In the Member Information section, fill in the required fields: your Identification Number, Date of Birth, Last Name, First Name, Middle Initial, Address, City, State, and Zip Code. Ensure all information is entered clearly and accurately.
3. Provide Health Club Information by entering the Name and Address of your qualified health club, along with the health club’s phone number. This information is essential to validate your fitness activities.
4. Indicate the total amount you are claiming for reimbursement under the 'Total Amount Submitted' field. This amount should reflect your health club membership fees for the eligible period.
5. Review the Certification and Authorization section. You must sign and date the form to authorize the release of your health club membership information and to confirm that the submitted details are accurate.
6. Once all fields are completed, save any changes made to the form. You have the option to download, print, or share the form as necessary for submission.

Start filling out your Medex Fitness Benefit Form online today to claim your fitness benefits.