WebTotal Dollars requested for Qualified Fitness Expense: $ Calendar year that fees were paid: Blue Cross Blue Shield of Massachusetts will make a reimbursement decision within 30 calendar days of receiving a completed request form. Reimbursement is sent to the member's address on file with Blue Cross. Reimbursement may WebYour completed Sweat Equity Program Reimbursement form. 2. Proof of your payment (e.g., receipt, automatic bank withdrawal statement) for the gym fee, as well as any …

Fitness Benefit Reimbursement – Frequently Asked Questions

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Aetna Fitness Reimbursement Form - signNow

WebAnthem Blue Cross and Blue Shield will send reimbursement to you when approved. Please expect 6-8 weeks to process your request for reimbursement. The person signing this form is advised that the willful entry of false or fraudulent information renders you liable to be withdrawn from this fitness reimbursement program. Reimbursement instructions WebReimbursement Form. Subscribers are eligible for reimbursement once per benefit year.* Requests must be made no later than three months following a benefit year in order to receive reimbursement. For more information about other fitness discounts, visit fallonhealth.org. To find your annual reimbursement amount(s), go to WebFile Format. PDF. Size: 988 KB. Download. This Medical Reimbursement Forms would be handy for insurance agencies who have to reimburse medical expenses of their medically insured clients. The form will allow you to have complete insights on the medical services accessed by the patient and their expenses. greer septic service