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FOND DU LAC COUNTY GROUP 76-440020 2016 HEALTH CLUB REIMBURSEMENT FORM NAME UMR MEMBER ID FITNESS CENTER REIMBURSEMENT AMOUNT 200. 00 Maximum for Covered Employee FORWARD TO WCA Group Health Trust Attn Amy Wald 18550 West Capitol Drive Brookfield WI 53045 OR FAX TO 262-781-0026 BE SURE TO ATTACH RECEIPT FROM FITNESS CENTER SHOWING SINGLE OR FAMILY MEMBERSHIP PAYMENT NO CONTRACTS PLEASE Please note that your health club reimbursement payment takes about 2-3 weeks to receive and will be...
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How to fill out 2016 health club reimbursement

01
Gather all necessary documents such as receipts, membership confirmation, and relevant medical information.
02
Access the online portal or obtain a physical form from your employer or insurance provider.
03
Fill out the personal information section, including your name, address, and contact details.
04
Enter your health insurance information, including your policy number and provider.
05
Provide details about your health club membership, such as the club name, address, and membership fee.
06
Attach copies of your receipts and any supporting documents that prove your eligibility for reimbursement.
07
Review the completed form for any errors or missing information.
08
Submit the form either online or by mail, following the instructions provided by your employer or insurance provider.

Who needs 2016 health club reimbursement?

01
Employed individuals who have a health insurance policy or employee benefits that include health club reimbursement.
02
Individuals who actively use a health club for fitness and wellness purposes.
03
People who have paid out-of-pocket for health club membership fees and want to be reimbursed.
04
Those who wish to take advantage of their employer's wellness programs and incentives.
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The health club reimbursement form is a document used to request reimbursement for expenses related to health club memberships.
Employees who have health club benefits through their employer may be required to file a health club reimbursement form.
To fill out a health club reimbursement form, employees typically need to provide their personal information, details of the health club membership, and proof of payment.
The purpose of the health club reimbursement form is to request reimbursement for expenses incurred for health club memberships that are covered by the employer.
The health club reimbursement form typically requires information such as the employee's name, membership details, amount to be reimbursed, and proof of payment.
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