Unicare fitness form reimbursement 2025

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The document is a Fitness Club Reimbursement Form for members of the UniCare State Indemnity Plan, effective July 1, 2013. It outlines the process for members to request reimbursement for fitness club membership fees, requiring proof of membership and payment. The form must be completed with personal details and submitted along with necessary documentation to receive an annual lump sum reimbursement.

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Click ‘Get Form’ to open the UniCare Fitness Club Reimbursement Form in the editor.
Begin by entering your name in the 'Name of Enrollee' field, ensuring you include your last name, first name, and middle initial.
Next, input your UniCare ID Number in the designated field to verify your membership.
Fill out your address accurately in the 'Enrollee Address' section to ensure proper communication.
Provide the name and address of your fitness club along with a contact phone number for verification purposes.
Enter your date of birth in the specified format to confirm eligibility.
If applicable, fill in the 'Name of Member' and their relationship to you as the enrollee.
Attach proof of membership by checking the appropriate box and including a copy of your fitness club membership agreement.
Indicate the amount paid for your fitness club membership in the corresponding field.
Select one option under 'Proof of payment' that best describes how you paid for your membership, ensuring all receipts are clear and legible.
Finally, sign and date the form at the bottom to validate your submission. Remember that providing false information can lead to disqualification from the program.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (82 Votes)
2018	4.3 Satisfied (58 Votes)
2013	4.4 Satisfied (245 Votes)

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Got questions?

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 to get gym reimbursement?

In most cases you simply file a claim with copies of your receipts, and youre reimbursed for eligible fitness expenses. While your employer may not require them for reimbursement, its always a good idea to keep receipts for any eligible out-of-pocket expenses you pay.

Can I ask the gym for a refund?

Unless your agreement is drastically different from any Ive seen, your payment to the gym is the same whether you go or not. So no, you cant go back and get a refund. The gym has no control over whether you went or not.

How to get a refund from a gym?

Unless the gym is kind enough to agree to refund you, you dont get your money back. The Terms Conditions of virtually all subscription based services will lay out the process for cancellation. Unless you cancelled ing to the TC, the gym has no obligation to refund your money.

What are eligible expenses for fitness reimbursement?

A Fitness Reimbursement Program is a benefit offering that reimburses employees for certain health and fitness expenses which encourages them to live a healthy lifestyle. The employer determines the type of fitness related expenses that can be reimbursed.

Can I get reimbursed for my gym membership?

Check for a reimbursement option Many health insurance providers offer a full or partial reimbursement for gym membership fees, though there are usually a few requirements that must be met, said Martin.

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Can a doctor write a prescription for a gym membership?

Yes, a doctor can write a prescription for a gym membership, and some insurance plans may cover it as part of a wellness program.

What is the employer fitness reimbursement program?

How does the program work? The LabCorp Fitness Reimbursement Program supports your efforts to stay active by reimbursing you up to $300 per year for eligible fitness-related expenses such as gym memberships, program fees and fitness/exercise equipment.