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Fitness Reimbursement Form - WellSense Health Plan 2026

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  1. Click ‘Get Form’ to open the Fitness Reimbursement Form in the editor.
  2. Begin by filling out the Member Information section. Clearly print your Member ID number, last name, first name, middle initial, address, city, state, zip code, and phone number.
  3. In the Health Club Information section, provide the name and location of your health club or fitness class. 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.
  5. Complete the Certification and Authorization section by signing your name to authorize information release to WellSense and certifying that all provided information is accurate.
  6. Finally, save your completed form and any attachments before mailing it to WellSense Senior Care Options at the specified address.

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A fitness reimbursement program is an employee perk that covers the cost of a gym membership, class fees, or even personal training sessions. Its an employer-funded plan that all employees access to fitness and wellness facilities.
A subsidy is an employer-funded plan that pays for the employees gym membership upfront. Employees pay for their fitness-related expenses with a fitness reimbursement program and file for reimbursement in your companys perks and benefits software.
Are Gym Reimbursements taxable? Gym reimbursements made by an employer may be taxable if they are considered part of an employees pay. If an employer offers a benefit to an employee, it is normally taxable as income under IRS regulations unless specifically exempt by tax law.
For those unfamiliar with the term, a fitness reimbursement program is where the employer reimburses employees for expenses related to their fitness goals; some examples include purchasing new equipment, paying for a personal trainer and coaches, paying for outside classes (like Pilates and Yoga), etc.
Eligible Expenses Your employer determines which expenses are eligible for reimbursement under the Fitness Reimbursement Program. Typical eligible expenses include: Gym, fitness center/studio, health club, swim tennis club memberships and fees. Fitness and nutrition counseling.

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GYM/FITNESS FACILITY REIMBURSEMENT- State of New Hampshire HMO members are eligible for up to $450 per subscriber contract per calendar year (January 1-December 31) that have not already taken advantage of the $200 equipment reimbursement benefit (explained above) within the same calendar year.
Our plans offer a variety of fitness and weight management resources, including health club and WeightWatchers membership reimbursements, fitness trackers, exercise equipment, therapy and counseling services, and more. Benefits vary by plan.
The fitness reimbursement program is available to employees and their covered dependents who are members of UnitedHealthcare. Qualified health clubs must include both cardiovascular (i.e. treadmills, bikes, elliptical machines) and strength training (i.e. free weights, weight machines) exercise equipment.

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