[PDF] [PDF] Gym Reimbursement

[PDF] Oxford® Sweat Equity Program Reimbursement Form

Completing and Submitting This Form 1 Record the 50 fitness facility visits and/ or classes that you went to in a six-month period on the chart shown below

[PDF] Reimbursement Form - MyUHCcom

Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates You must hold an active fitness facility or class membership

[PDF] Get rewarded for exercising - Oxford Health Plans

With the Oxford® Sweat Equity™ program, you may earn up to $200 in 6 Your reimbursement period begins on the date of your first fitness facility visit, class or event and Your completed Sweat Equity Program Reimbursement form 2

[PDF] Gym Reimbursement

membership fees 1 The reimbursement benefit is limited to you and your spouse or Oxford P O Box 7082 Bridgeport, CT 06601 Gym Reimbursement Form

[PDF] New York Essential Plan Gym Reimbursement - UnitedHealthcare

To help you stay motivated and achieve your fitness goals, we provide reimbursement toward fitness center membership fees You can get reimbursed for going to 

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22 juil 2020 · UnitedHealthcare's presentation materials and responses to your UMR, All Savers, Oxford, Sierra and The following provisions for prior authorization, reimbursement of authorizations for services that were completed before Oct 1, 2019, Wellness amount is limited only to any dollars that UHC is 

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This 2019 UnitedHealthcare Care Provider Administrative Guide (this “guide”) applies to Oxford: • Oxford Health Plans, LLC • Oxford Health Insurance, Inc • Investors Guaranty Life include a gym membership, or outpatient prescription

[PDF] UnitedHealthcare Care Provider Administrative - UHCprovidercom

If you are a UnitedHealthcare or Optum participating care provider or facility with an active Pass-through Billing/CLIA Requirements/Reimbursement Oxford: • Oxford Health Plans, LLC • Oxford Health Insurance, Inc • Investors Guaranty Life Eff Dt 04/21/2019 The Provider Demographic Change Form is available on

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25 mar 2019 · UnitedHealthcare Network Bulletin March 2019 2 For more Learn about Medicare policy, reimbursement and guideline changes PAGE 25 Center for Youth Wellness, founded by Dr Nadine Burke Harris The center's Coverage Criteria for UnitedHealthcare Commercial and Oxford A pharmacy 

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Stay in shape

Starting or staying with an exercise routine isn"t always easy. To help you stay motivated and achieve your fitness goals, we provide reimbursement toward fitness center membership fees. 1

The reimbursement benefit is limited

to you and your spouse or domestic partner 2 ;no other dependents are eligible. In order for your spouse or domestic partner to be eligible for this benefit, he or she must also be enrolled in an Oxford product.

Selecting a gym

To receive reimbursement, you must participate in a gym and/or program that promotes cardiovascular wellness. Memberships in sports clubs, country clubs, weight loss clinics, spas, or other similar facilities will not be reimbursed. For a gym to be considered eligible, it must provide at least two pieces of equipment or activities that promote cardiovascular wellness from the following list: •stationary bicycle •treadmill •elliptical crosstrainer •group exercise •squash/tennis/racquetball courts •stepper •rowing machine •walking/running group •pool

How much can I get reimbursed?

Depending on your plan, Oxford offers subscribers up to a$200 reimbursement per six-month period; covered spouses or domestic partners 2 receive up to a $100 reimbursement per six-month period. 1 To receive reimbursement for going to the gym, you must take the following steps:

1. Visit the gym - You must complete a minimum of

50 visits per six-month period (you must wait until six

months has passed even if you complete 50 visits sooner than six months).

2.Send paperwork - Provide a copy of your current

gym bill, showing the monthly cost of your membership, along with a brochure that outlines the services the facility offers.

3. Complete form - Fill out the Gym Reimbursement

Form on the reverse side. You may also obtain additional forms from your benefits administrator, from our web site wwwwww..ooxxffoorrddhheeaalltthh..ccoomm, or by calling Customer Service number on your Oxford I

D Card. Please make sure a

representative from your gym signs the form.

4. Mail form - Submit the Gym Reimbursement Form to:

Oxford

P.O. Box 7082

Bridgeport, CT 06601

Gym Reimbursement Form

To be eligible for reimbursement, you must complete the information below and send the following three items to:

OOxxffoorrdd

PP..OO.. BBooxx 77008822

BBrriiddggeeppoorrtt,, CCTT 0066660011

1. This reimbursement form with 50 visits completed

within a six-month period.

2. A copy of a bill from your gym, showing the monthly

cost of your membership.

3. A copy of the gym"s brochure outlining the services

provided. 1

This level of reimbursement is not available to Members of all groups and is not available to Connecticut groups. Check your Certificate of Coverage to determine eligibility for this reimbursement.

Oxford subscribers and covered spouses/domestic partners will receive the lesser of their corresponding reimbursement amount or the facility membership f

ee per six-month period. 2

Reimbursement for domestic partners is limited to Members of groups that have purchased domestic partners coverage. Oxford Members and their spouses/domestic partners must

be covered Oxford Members for the entire six-month period to receive reimbursement.

8904 R2

Gym Reimbursement

Receive reimbursement for visiting the gym.

Gym reimbursement form substitutes

One of the following pieces of documentation may be u sed as a substitute for the Gym Reimbursement Form: (Note: Your documentation must include a signature from a gym representative for verification purposes.) • A photocopy of your fitness program card or your records kept on file at the gym. An original signature must appear on the photocopy (photocopied signatures are not valid • A computer printout of your visits to the fitness center • Receipts that indicate each time you have visited the gym or • Verification from your employer that indicates your use of the employer"s gym

Name of Gym: __________________________________

Gym Representative Signature: ____________________The gym representative signature constitutes agreement

that the gym facility promotes cardiovascular wellness. False statements will result in a denial of reimbursement. My signature below affirms that all of the information listed is full, complete and true to the best of my knowledge.

Member Name: ___________________________________

Oxford ID Number: ________________________________

Member Address: _________________________________

Member Signature: ________________________________

Date: ___________________________________________

Date of visit:

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If you have any questions regarding gym reimbursement, please call Customer Service at 1-800-444-6222.quotesdbs_dbs17.pdfusesText_23