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Fitness Reimbursement Form - WellSense Health Plan 2026

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The document is a Fitness Reimbursement Form for members of the WellSense Senior Care Options plan. It outlines the process for submitting claims for reimbursement of fitness class or health club expenses, specifying that eligible services must be from contracted providers and submitted within one year. Members can request up to $150 in reimbursement per year and must provide necessary documentation, including receipts and a signed certification.

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Click ‘Get Form’ to open the Fitness Reimbursement Form in the editor.
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.
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.
Indicate the total number of receipt copies attached and specify the reimbursement amount requested.
Complete the Certification and Authorization section by signing your name to authorize information release to WellSense and certifying that all provided information is accurate.
Finally, save your completed form and any attachments before mailing it to WellSense Senior Care Options at the specified address.

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2022	4.7 Satisfied (35 Votes)
2016	4.4 Satisfied (58 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How does fitness reimbursement work?

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.

How does gym membership reimbursement work?

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 income?

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.

How do you spend fitness reimbursement?

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.

What fitness expenses qualify for reimbursement?

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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Does NH Medicaid cover gym membership?

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.

Will WellSense pay for gym membership?

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.

Does United Healthcare have a fitness reimbursement?

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.

Fitness Reimbursement Form - WellSense Health Plan 2026

Here's how it works

How to use or fill out Fitness Reimbursement Form - WellSense Health Plan with our platform

See more Fitness Reimbursement Form - WellSense Health Plan versions

Complete this form in 5 minutes or less

Got questions?

How does fitness reimbursement work?

How does gym membership reimbursement work?

Are gym reimbursements taxable income?

How do you spend fitness reimbursement?

What fitness expenses qualify for reimbursement?

Security and compliance

Complete this form in 5 minutes or less

People also ask

Does NH Medicaid cover gym membership?

Will WellSense pay for gym membership?

Does United Healthcare have a fitness reimbursement?

wellsense gym reimbursement

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