NY Facility Reimbursement Form - Gannett Health Services - gannett cornell 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your name and Aetna ID number as indicated at the top of the form. This information is crucial for identifying your reimbursement request.
  3. If applicable, provide the name of your spouse or domestic partner along with their Aetna ID number.
  4. List the name and address of the exercise facility where you have been a member. If you have multiple facilities, ensure all are included.
  5. Fill in the contact details of an exercise facility representative, including their name, phone number, and email address.
  6. Indicate the total cost of your membership for a six-month period. Ensure this matches any documentation you will submit.
  7. Attach proof of payment and document your visits by signing and dating each entry as required in the Exercise Facility Documentation section.
  8. Review all entered information for accuracy before submitting your form to ensure a smooth reimbursement process.

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