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
MyFitRx
TM and Kids on the Move Reimbursement Form Eligible members can be reimbursed up to $50 per benefit year for participating in and completing the MyFitRx TM (ages 16 and over) or the Kids on the Move program (ages 7-15). See your plan contract or call member services to confirm that this benefit applies to your plan.MyFitRx
TM are available at CDPHP Fitness Connect at the Ciccotti Center and the Champlain Valley Physicians Hospital. Kids on the Move is available at CDPHP Fitness Connect at the Ciccotti Center.Visit for program information.
Member Name:
Date of Birth:
Member
ID #:Phone Number:
Please submit separate forms for each member seeking reimbursement. PROGRAM NAMEENROLLMENTDATEPOST-
ASSESSMENT
DATEFEES PAID*
TOTAL Acceptable proofs of payment include a copy of a bill from facility showing fee(s) paid, or a credit card statement. Documentation must include member name, facility name, amount paid, and dates of payment. Reimbursement will be made to the subscriber and sent to the address on file. CERTIFICATION AND AUTHORIZATION (must be signed by the subscriber) Any person who knowingly and with intent to defraud any insurance company or other person files an application 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.Signature Date SignedPlease mail this form, and proof of payment to:
CDPHPPO Box 66602
Albany, NY 12206-6602
Notice of Non-Discrimination
Capital District Physicians' Health Plan, Inc. (CDPHP ) complies with federal civil rights laws. CDPHP does not exclude peopleMulti-language Interpreter Services
Inc. | Capital District Physicians' Healthcare Network, Inc. 21-18761 | 1121quotesdbs_dbs14.pdfusesText_20
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