Get Unicare Ec729 2021-2025

The Unicare EC729 Fitness Club Reimbursement Form allows UniCare plan members to request reimbursement for their fitness club membership fees. This guide provides step-by-step instructions for completing the form accurately to ensure a smooth reimbursement process.

Follow the steps to fill out the Unicare EC729 form seamlessly.

1. Click ‘Get Form’ button to access the Unicare EC729 online document and open it for editing.
2. Begin with Part A of the form, which requires information about the UniCare enrollee. Fill in the last name, first name, UniCare plan ID number, birth date, middle initial, street address, city, state, and ZIP code accurately.
3. Proceed to Part B to provide details regarding the fitness club membership. Enter the name of the fitness club and the individual who holds the membership if they differ from the UniCare enrollee.
4. Specify the months for which reimbursement is being requested. Use the format: month/year (e.g., 7/2021 through 12/2021). Ensure this date range corresponds with your membership duration.
5. Indicate the relationship of the member to the UniCare enrollee by selecting the appropriate options such as Self, Spouse, Child, or Other. If selecting 'Other', briefly explain the relationship.
6. Enter the requested reimbursement amount. Double-check that it aligns with your proof of payment documents.
7. At the bottom of the form, sign and date it, affirming that all provided information is accurate to the best of your knowledge.
8. Once you have completed the form, gather your proof of payment documents. Make sure to write your UniCare member ID number prominently on all documents.
9. Submit the completed form along with proof of payment either by mailing to the specified address, faxing it, or emailing it. Ensure you retain copies for your records.

Complete the Unicare EC729 Fitness Club Reimbursement Form online today for a hassle-free reimbursement experience.