HPHC Fitness Reimbursement Form Instructions

Fitness Reimbursement Form Instructions Please read the instructions below, then 昀椀ll out the Fitness Reimbursement Form on page 3. Want your reimbursement faster? Submit your request online at harvardpilgrim.org/昀椀tnessreimbursement. Getting reimbursed is easy Please enclose copies of the following: Copy of your health/昀椀tness membership agreement Mail to: Completed Fitness Reimbursement Form Harvard Pilgrim Health Care P. O. Box 9185 Receipts showing that you paid for at least four months Quincy, MA 02269 in a calendar year for membership or subscription fees (must show your name and the facility or program name). Fees must equal or exceed amounts being claimed. You have questions? We have answers! How do I qualify for a reimbursement? What quali昀椀es for 昀椀tness reimbursement? • You must be eligible for 昀椀tness reimbursement • Full-service health/昀椀tness facilities that have cardiovascular through your Harvard Pilgrim plan. and strength-training equipment qualify, as well as facilities • Fitness facility or other quali昀椀ed 昀椀tness for exercising and improving physical 昀椀tness. membership must be for at least four months • Fitness studios/facilities that offer yoga, Pilates, Zumba, in a current calendar year. aerobic/group classes, indoor cycling/spinning classes, kick- • Current Harvard Pilgrim membership must boxing, CrossFit, strength training, tennis, indoor rock climb- be at least four months in a calendar year ing and personal training (taught by a certi昀椀ed instructor). and must coincide with four months of • Virtual 昀椀tness subscriptions. 昀椀tness membership or subscription. • Not eligible for reimbursement: fees you pay for group When can I submit my Fitness classes or personal training outside of a 昀椀tness facility/ Reimbursement Form? studio, and health club initiation fees or costs that you pay for instructional dance studios, country clubs, social clubs • Starting on May 1 of the current calendar (such as ski, riding or hiking clubs), spas, gymnastics facili- year and when you have met the above- ties, martial arts schools, pool-only facilities, road race fees, stated criteria. sport camps, ski passes, sports teams or leagues, and school sports athletic user fees. • Validation is subject to approval by Harvard Pilgrim. Continued  Harvard Pilgrim Health Care includes Harvard Pilgrim Health Care, Harvard Pilgrim Health Care of New England Page 1 of 3 Page 1 of 3 and HPHC Insurance Company.