Wellness Program Fitness Reimbursement
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1 Wellness Program Fitness Reimbursement Working out is good preventive medicine. With AmeriHealth Administrators fitness reimbursement program, it s affordable, too. We want to help you feel better, look better, stay better Keeping you healthy is just as important as helping you get well when you re sick. And when more people need medical care, the costs of providing coverage go up for everyone. So it s in everybody s best interest to encourage members to enjoy a healthier lifestyle. That s why we offer reimbursements for certain fitness facility fees as part of our wellness program. Now you have one fewer excuse to avoid the gym Working out on a regular basis is good preventive medicine. It s well known that exercise reduces your risk of many major illnesses. And there s nothing like a good cardiovascular workout to control weight and stress and to help reduce your chances of heart attack and stroke. And now it s easier than ever to afford. If you are 40 years of age or older, overweight, have a history of high blood pressure or heart disease, or if there is any reason why you may doubt the safety of exercise for you, we encourage you to consult your physician before beginning any exercise program. We ll give you up to $300 per year As a member of a health benefits plan administered by AmeriHealth Administrators, you can enjoy a 100% reimbursement of your membership fee, up to $300 per 365-day period. Personal fitness instructor fees are not eligible for this reimbursement program. Here s how to give it a workout This Wellness Program is designed to help you make exercise a part of your life, as well as to help you pay for it. Just follow the simple steps outlined here, and if you have any questions, call the Wellness Service Unit at You may attend any fitness facility, as long as it offers a cardiovascular conditioning program that is guided and graded with direct supervision. A program that is competitive or recreational in nature does not qualify. 2. To be eligible for reimbursement, you must be a member in your health benefits plan for the entire 365-day period, and you must complete and record 120 workouts within 365 days. You may record (see #3 below) a maximum of 1 workout per day and each workout must last at least 45 minutes. Your benefit year begins with the date of your first workout. There is no age requirement for employees. However, members other than employees must be at least 18 years of age. 3. If your facility offers a computer printout of your attendance, you may submit that listing in place of the workout log included with this brochure. Just attach the listing to the reimbursement form. While we allow members to use a fitness facility s computer printout as their method of logging workouts, AmeriHealth Administrators does not assume any responsibility for the reliability of fitness facility computer systems. Therefore, if you select a fitness facility computer printout as your method of logging your workouts, you also accept the risk that some of your workouts may not be credited toward your reimbursement should your fitness facility have system difficulties.
2 Participate in an eligible conditioning program at the fitness facility of your choice, submit the appropriate paperwork, and get reimbursed up to $300 annually when you qualify. To prevent such an occurrence and to ensure you have documentation, we recommend having you or your instructor or gym staff member date and sign your log each time you work out. 4. You must submit proof of membership fee payments. Fitness facility receipts/ contract or payroll deduction statements are acceptable. 5. No later than 90 days after the end of your 365-day benefit period, submit your Reimbursement Request Form attached to your workout log, with your proof of membership payment fees, to AmeriHealth Administrators. If you meet all of the requirements of the fitness reimbursement program, we will send you a check for the qualifying amount! Eligible programs The fitness reimbursement program is designed to provide an incentive for individuals to begin a comprehensive exercise program that includes continuous cardiovascular, flexibility, and resistance training. Eligible facilities are those whose primary business is being a full-service fitness center. These facilities offer a variety of activities in a supervised setting, such as: aerobic class treadmill cardio kickboxing class stair climber pool for swimming laps rowing machine nordic-style skier resistance training track for running/walking stationary bicycle Lifetime and Family Memberships If you purchase a lifetime membership for a fitness facility, you are eligible to receive up to the applicable maximum reimbursement amount of the membership fees paid during your 365-day fitness program benefit period. If you purchase a family fitness facility membership, you will be eligible to receive your portion of the total annual fees paid during your 365-day fitness program benefit period, based upon the number of family members 18 years of age and older included on the fitness facility contract. Ineligible Programs and Facilities Membership for athletic clubs that focus primarily on a single competitive or recreational sports activity are not eligible for reimbursement even if the activity includes elements of a comprehensive exercise program. While we recognize that activities such as martial arts, rowing, tennis, and basketball are excellent ways to stay fit, they often do not require consistent, year-round attendance or proper supervision. Nor do these activities incorporate all the elements of a comprehensive exercise program. Therefore, participation in these programs does not qualify for reimbursement: tennis chiropractic services racquetball pilates sculling/rowing sports league basketball swim clubs martial arts/karate yoga squash golf dance school outdoor boot camp style program personal fitness instructor
3 Wellness Program Fitness Reimbursement Fitness Reimbursement Program Enrollment/Reimbursement Request Form Congratulations on making the commitment to a healthier lifestyle! When you join a fitness facility, you must complete this form to enroll in the fitness reimbursement program and start recording your reimbursement-eligible workouts. Your 365-day benefit year begins on the date of your first workout. You must be enrolled in a health plan administered by AmeriHealth Administrators for the entire 365-day fitness benefit period in order to be eligible for reimbursement. You must request reimbursement within ninety days after the end of your 365-day benefit period, and if you have completed and can provide a record of at least 120 workouts within that timeframe. Please see the program brochure for reimbursement requirements. Have the fitness facility s management certify your workout log by completing and signing the lower part of this form; you may also attach a computer printout from your fitness facility instead of filling out the log (see instructions above). Attach your completed workout log or computer printout and proof of membership fee payment to this form. Complete a separate form for each member requesting reimbursement. Please print clearly. Membership type: q Single q Family Estimated Fees: $ per Enrollment fee: $ Member Name: Employer Name: Group #: Member ID #: Last 4-digits of SS #: Address: City: State: Zip: Phone (Day): Phone (Evening): Fitness Facility Management Certification Facility Name: Questions? Call AmeriHealth Administrators Wellness Service Unit at: Address: City: State: Zip: Phone: Authorized Representative s Name: Title: Signature: : Mail this form with your completed workout log and all payment receipts to: Wellness Program/Fitness Reimbursement Program AmeriHealth Administrators P.O. Box 988 Horsham, PA Or fax to:
4 Member s name: Group name/number: 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 11: 12: 13: 14: 15: 16: 17: 18: 19: 20: 21: 22: 23: 24: 25: 26: 27: 28: 29: 30: 31: 32: 33: 34: 35: 36: 37: 38: 39: 40: 41: 42: 43: 44: 45: 46: 47: 48: 49: 50: 51: 52: 53: 54: 55: 56: 57: 58: 59: 60: Workouts must be a minimum of 45 minutes in length, limit 1 workout per day.
5 Member s name: Group name/number: 61: 62: 63: 64: 65: 66: 67: 68: 69: 70: 71: 72: 73: 74: 75: 76: 77: 78: 79: 80: 81: 82: 83: 84: 85: 86: 87: 88: 89: 90: 91: 92: 93: 94: 95: 96: 97: 98: 99: 100: 101: 102: 103: 104: 105: 106: 107: 108: 109: 110: 111: 112: 113: 114: 115: 116: 117: 118: 119: 120: Workouts must be a minimum of 45 minutes in length, limit 1 workout per day.
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