Well sense gym reimbursement 2026

1. Click ‘Get Form’ to open the well sense gym reimbursement form in the editor.
2. Begin by entering your Member Information. Clearly print your Member ID number, last name, first name, address, middle initial, city, state, zip code, and phone number.
3. Next, provide Health Club Information. Enter the name and address of your health club. Ensure you attach photocopies of dated receipts or statements as required.
4. Indicate the total number of receipt copies attached and specify the reimbursement amount requested. Remember that you can request up to $200 per family per year.
5. Finally, complete the Certification and Authorization section by signing the form. This confirms that all information is accurate and that you have not submitted for these services previously.
6. Once completed, fold and mail your form along with the required documents to Well Sense Health Plan at the provided address.

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