CDPHP® Fitness Reimbursement Form
Log in at member.cdphp.com and click the. Health & Wellness tab. Eligible subscribers can be reimbursed up to $400 per benefit year for going to the gym and/or.
CDPHP Fitness Reimbursement
Fees paid for attending aerobic/fitness classes at a qualified health club that does not require an annual membership are also eligible for reimbursement. A
fitness-reimbursement-flyer-2021.pdf
CDPHP® makes it easy to get reimbursed for getting fit. We enhanced the fitness reimbursement to include paid online fitness classes and.
CDPHP Fitness Reimbursement Form
Fitness Reimbursement Form. Submitting for reimbursement online is easy! Log in at member.cdphp.com and click the. Health & Wellness tab.
Fitness and Gym Reimbursement Form
See plan contract for complete benefit information. Discrimination is Against the Law. Capital District Physicians' Health Plan Inc. (CDPHP®) complies with
CDPHP MyFitRx Kids on the Move Reimbursement
MyFitRxTM are available at CDPHP Fitness Connect at the Ciccotti Center and the Champlain Valley. Physicians Hospital. Kids on the Move is available at
CDPHP Asthma Resources
Rx For Less is for all CDPHP members with prescription drug coverage Additional CDPHP Resources. Fitness. Weight Management. Reimbursement.
CDPHP 2023 Small Group Rates - Q1 Syracuse
be reimbursed up to a combined $100 for designated wearable fitness trackers. This benefit is part of the CDPHP fitness reimbursement and the funds count
CDPHP 2023 Small Group Rates - Q1 Utica
be reimbursed up to a combined $100 for designated wearable fitness trackers. This benefit is part of the CDPHP fitness reimbursement and the funds count
CDPHP 2022 Changes You Should Know
from the CDPHP Care Team gym youth sports fees
Get Fit, Get Reimbursed
GET REIMBURSED FOR UP TO $600 JUST FOR STAYING ACTIVE! Get reimbursed for up to $400 for going to the gym, and your spouse can earn up to $200 for a total of $600 per family!* Here"s how to get started: 1.Join a Fitness Center
You may join any qualified fitness club or exercise center that is open to the general public. Feespaid for attending aerobic/fitness classes at a qualified health club that does not require an annual
membership are also eligible for reimbursement. A qualified fitness club or exercise center houses exercise equipment for the purpose of physical exercise. Memberships in sports clubs, country clubs,
weight loss clinics, spas, or other similar facilities are not eligible. 2.Visit the Gym
Go to the gym 50 times within six months - about two times per week. Use the Fitness Participation Log
to record your visits. Be sure to have it signed by the instructor/facility each time you go. Alternately, you
may provide a printed record of your visits from the fitness center or receipts that indicate each time you have visited the center.
3. Complete the Fitness Reimbursement Form and Submit All DocumentationComplete the Fitness Reimbursement Form, along with your fitness participation log(s), a copy of your
current bill, and proof of payment. Mail all documentation to: CDPHPP.O. Box 66602
Albany, NY 12206
* Subscriber is entitled to $200 every six months. Spouse is entitled to $100 every six months. See plan contract for complete benefit information. Discrimination is Against the Law Capital District Physicians' Health Plan, Inc. (CDPHP
) complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.Multi-language Interpreter Services
ATENCIÓN: Si habla otro idioma que no es el inglés, tiene a su disposición servicios gratuitos de asistencia lingüística.
CDPHPFitness Reimbursement Form
Use this form to request reimbursement for fitness center fees. Call member services at the number on your ID card with questions. 1.Member Information
Name:Member ID #:
Address:
Phone:
Employer Name:
Date of Birth:
2.Fitness Center(s) Information:
FITNESS CENTER NAMEADDRESSPHONE NUMBER
Total Number of receipts/documents attached: Total Amount Submitted: 3. Certification and Authorization (must be signed by the subscriber)Reimbursement is subject to approval by Capital District Physicians' Health Plan, Inc. I certify that the
information on the form and all supporting documents are complete, accurate, and unaltered, and thatI am claiming reimbursement only for eligible expense incurred during the applicable plan year and for
eligible members. I certify that these expenses have not previously been reimbursed in this or any other year.
Any person who knowingly and with intent to defraud any insurance company or other person files anapplication for insurance or statement of claim containing any materially false information, or conceals
for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent
insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed $5,000 and
the stated value of the claim for each such violation.Subscriber"s Signature
Date: Please mail this form and all supporting documents to: CDPHPP.O. Box 66602
Albany, NY 12206
DATEEXERCISE AND FACILITY
INSTRUCTOR
INITIAL
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DATEEXERCISE AND FACILITY
INSTRUCTOR
INITIAL
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Fitness Participation Log
Member Name:
Member ID #:
Address:
Phone:
All workouts must occur within a six-month period.Capital District Physicians' Health Plan, Inc.
Inc. 17-4206
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