To apply for reimbursement:
- Pick a qualifying fitness center, and visit at least 50 times during a period of six consecutive months.
- Complete the Fitness Reimbursement Form (PDF).
- Attach the following items:
- A copy of your current membership bill. It must show the amount you paid for membership.
- A copy of a receipt or documentation that shows you paid for each of the six months. This could include a credit card statement, payroll deduction, or automatic bank withdrawal. Receipts with price only are not valid. Please cross out any personal account identification information not relevant to your reimbursement.
- Proof of your 50 visits, all within your coverage period. This could include: a computer print out of your visits, receipts that show individual visits to the gym, or verification from your employer that indicates your use of the employer’s gym.
4. Email all documents to: gym@fideliscare.org, fax to 347-923-7513, or submit by mail to:
Fidelis Care Claims
Attn: Gym Reimbursement
480 Crosspoint Parkway
Getzville, NY 14068
Fidelis Care cannot issue a reimbursement if valid documentation is not submitted within 120 days from the end of the six-month period.
Print your name and member ID number on each receipt in case they are separated from the form.