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FITNESS REIMBURSEMENT PROGRAM 2013

Dartmouth College Employee Health Benefit Reimbursement for Fitness Memberships
As a customer of the CIGNA Medical Plan, you are eligible for a fitness reimbursement of up to $200 per calendar year (combined family maximum) in qualified fitness facility membership fees or exercise class fees.

FORMS

♦  Cigna Fitness Reimbursement Form and Log

QUALIFYING FITNESS MEMBERSHIP

Start exercising your option by picking a fitness facility that works for you. Examples of facilities that qualify include full service fitness facilities (with an array of cardiovascular and strength-training exercise equipment) as well as martial arts centers, yoga studios, gymnastics facilities, tennis, aerobic or pool only at a qualified fitness facility without an annual membership will also be covered.  The fitness reimbursement is for fitness activities that occur 2 times per week, for at least 10 out of 20 weeks. A Fitness Reimbursement Log Card with instructor/facility sign-off must be submitted along with the Fitness Reimbursement Form, and receipts, to Cigna.

HERE'S WHAT YOU NEED TO DO

Reimbursement will be provided based on receipts you accumulate and submit up to a $200 limit per family* each calendar year. Reimbursement forms and receipts must be completed and submitted within 90 days of theend of the calendar year. 

Simply send the following items to CIGNA:


•  Fitness Reimbursement Form, answering all questions (please note that the $200 is per family* per calendar year).
•  Dated, original receipts from your fitness facility, or copies of bank or credit card statements if you pay by electronic fund transfer, showing:

¤  The member's name
¤  Individual charges demonstrating a minimum of 10 weeks participation

•  A copy of your Fitness Reimbursement Log Card 
•  Sign and date the completed Fitness Reimbursement Form, then mail all of the above to:

CIGNA
Attn:  Debra  Sargent
2 College Park Drive
Hooksett, NH  03106

•  You can submit once you have met the criteria of working out at least 2 times per week for a minimum of 10 out of 20 weeks.
•  Please be sure to submit your form, log card and receipts for reimbursement within 90 days of the of the calendar year.

Program must be started no later than October 22nd of a given calendar year to meet the program's 10 week requirement.

* Family = adult member age 18 +
Always consult a physician before beginning any new exercise program.

Last Updated: 1/20/13