Get Metroplus Health Exercise Facility Reimbursement Form 2021-2025

Completing the MetroPlus Health Exercise Facility Reimbursement Form can facilitate your health and fitness journey by allowing you to claim up to $250 for your exercise facility membership. This guide provides clear, step-by-step instructions on how to properly fill out the form online.

Follow the steps to complete your reimbursement submission.

1. Click ‘Get Form’ button to access the form and open it in your chosen document editor.
2. Fill out the member information section, including your MetroPlusHealth ID number, last name, first name, middle initial, address, city, state, and zip code.
3. Indicate the six-month period for which you are requesting reimbursement by entering the start and end dates in the format mm/dd/yyyy.
4. In the health club information section, provide the gym or health club’s name, the city and state, and their phone number.
5. Enter the amount you are claiming for reimbursement in the designated field.
6. Read the certification statement carefully and then provide your signature and the date to confirm that all information is complete and accurate.
7. If required, have a representative from the gym sign the form.
8. Once you have filled out all necessary fields, review the form for accuracy. Then, save the changes, download the document, and prepare to submit it.
9. Submit your completed form along with the required documentation via mail or fax to the provided MetroPlusHealth address or fax number.

Start completing your MetroPlus Health Exercise Facility Reimbursement Form online today to take advantage of your fitness reimbursement benefits.