REIMBURSEMENT / FORMS
For caleendar year 2012, employees have one year from the date on the receipt, when they purchased their membership, or paid their dues to submit for reimbursement.
Fitness Reimbursement Program Log Card
Fitness Reimbursement Form
QUALIFYING FITNESS MEMBERSHIP
Benefits-eligible employees and retirees enrolled in ANY of the Anthem health insurance programs are now eligible to receive a $200 reimbursement from their medical plan for the expense of purchasing a membership. To receive this benefit, you must exercise twice a week in the gym for 12 out of 20 weeks. Additionally, you must complete a Fitness Reimbursement Program Log Card and Fitness Reimbursement Form and have it initialed by a fitness club staff member each time you exercise. Included with these, you should have a detailed receipt including the following information: your name, date of payment, date (range) of membership, a dollar amount for your membership, and proof of payment.
For more information, please visit Anthem’s Web site and follow the steps listed below.
PROGRAM INFORMATION:
The Log Card and the Form are also available via links on the HR Forms page.
LOCAL ELIGIBLE LOCATIONS INCLUDE:
Dartmouth Athletics, including FLIP classes
(Note: This list is a sampling of local gyms that you may visit to use your Fitness Reimbursement. It is in no way a complete list and Dartmouth does not endorse any locations located off campus.)
If you would like to locate more eligible locations, you should visit Anthem's website or contact Anthem directly. If your gym of choice is not available for reimbursement, you should contact our office to ask for consideration to be given to this location to be eligible for the Fitness Reimbursement.
If you have any questions about the Fitness Reimbursement Program, please contact Anthem Customer Service at 1-800-437-9282 or the Dartmouth College Benefits Office at 603-646-3588.