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Help lamar 02Gym-Reimbursement-FormExercise Facility Reimbursement Program Reimbursement Form 2026

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The document outlines the MetroPlusHealth Exercise Facility Reimbursement Form, which allows MetroPlus Gold members to receive up to $250 every six months for gym memberships that promote cardiovascular wellness. It specifies eligible facilities, reimbursement procedures, and documentation requirements. Members must be active at their gym and cannot claim if they are receiving similar benefits from the NYC Management Benefits Fund.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your MetroPlusHealth ID Number, Last Name, First Name, and Middle Initial in the Member Information section. Ensure all details are accurate to avoid processing delays.
Fill in your complete address including City, State, and Zip Code. This information is crucial for correspondence regarding your reimbursement.
Specify the Six-Month Period Requested by entering the start and end dates in mm/dd/yyyy format.
In the Health Club Information section, provide the Gym/Health Club’s Name, City, State, Phone Number, and Amount Being Claimed. Double-check that these match your receipts.
Sign and date the form at the bottom to certify that all information is complete and accurate. Remember to include a Gym Representative’s Signature if required.

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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.

Is a gym reimbursement 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.

Are gym memberships eligible for FSA reimbursement?

Typically, no. The Internal Revenue Service (IRS) usually doesnt allow funds from an FSA to pay for membership dues at health clubs or gyms.

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.

Can you pay for YMCA membership with FSA?

Yes - depending on your plan, you can legitimately get insurance to pay for your gym membership. The physician prescription is generally a key requirement to getting this accepted, but there are some plans that include a provision for gym memberships regardless of scripts though.

Can I use FSA for gym membership?

Unfortunately, YMCA and gym memberships are not eligible for reimbursement through a flexible spending account (FSA), as they are considered by the IRS as a means of supporting ones general health, rather than a direct treatment of a specific medical condition.

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How to get reimbursed for gym membership?

For a gym membership to even be considered for reimbursement under a Health Care FSA, you must have: Approved Letter of Medical Necessity (PDF) on file for a medical condition that requires exercise at a gym. Individual gym membership contract on file (multi-person contracts will not be considered)

Help lamar 02Gym-Reimbursement-FormExercise Facility Reimbursement Program Reimbursement Form 2026

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