Aetna fitness reimbursement form 2022-2025

1. Click ‘Get Form’ to open the Aetna Fitness Reimbursement Form 2022 in the editor.
2. In Part 1, fill in your Participant Name, Date of Birth, Member ID Number, and Address. Ensure all details are accurate to avoid delays.
3. Complete the Spouse’s Name(s) and Gender fields if applicable. This information is crucial for processing your claim.
4. Move to Part 2 and provide the Fitness Program Address and Date(s) attended. You may attach gym utilization reports for verification.
5. Sign the Participant Certification section confirming that expenses were incurred by you or an eligible dependent. Include the date of signing.
6. Attach any required documentation such as fitness club verification showing at least 50 visits within six months, and submit your completed form to Aetna at the address provided.

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