Fitness Reimbursement

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Healthier members are happier members.

Starting or staying with an exercise routine isn’t always easy. To help you stay motivated and achieve your fitness goals, IBEW Local 400 Wellness offers a Fitness Reimbursement Program. You can now get reimbursed for going to the gym or for following a structured exercise program of your choice.

How the program works.

To receive reimbursement, you must participate in a gym and/or program that promotes physical activity. For a gym to be considered eligible, it must provide at least two pieces of equipment or activities that promote cardiovascular wellness.

How much can you get reimbursed?

Enroll at a gym or a program at the said month will earn you up to a $20 reimbursement for each month. Each month you continue your membership will qualify for reimbursement. If you commit to your fitness program for 2020, that is $240 back in your pocket!**If your monthly membership dues are less than $20 per month, you will be reimbursed for the amount your monthly membership costs. Reimbursement will not exceed the amount actually paid. The Fitness Reimbursement begins January 1st, 2020 and ends on December 31st, 2020.Deadline for Fitness Reimbursement for 2019 is March 31st, 2020 .

You should follow the steps below to receive reimbursement for your fitness participation:

Visit the gym or enroll to a structured exercise program. – You must complete a one-month gym/exercise program to be reimbursed $20 per month.
Collect paperwork. – You need to collect proof of payment for your current gym bill or exercise program showing the monthly cost of your membership. Proof of payment for each of the months you are submitting for reimbursement (i.e., credit card statements, payroll deduction, automatic bank withdrawal, receipt from gym or exercise program facility).
Complete the form below. – Please complete the form below in its entirety, or the processing of your claim may be delayed or denied. Remember to provide your Proof of Payment for the qualifying months you participated.

Important: Please complete one form per member or spouse requesting reimbursement.
The Fitness Reimbursement Program is exclusive to IBEW Local 400 members and/or spouses only. Print the Fitness Reimbursement Form

Fill out the Online Fitness Reimbursement Form Below

*
- Yes, I am requesting Fitness Reimbursement.
Local 400 Welfare Fund Employee Participant or Spouse’s Full Name*
Please Choose One*
Mailing Address*
Street Address City State ZIP Code
Phone Number*
Email Address*
Last 4-Digits of Social Security Number*
Describe the Wellness Program or Activity you are seeking reimbursement for and include the months you are requesting:*
Submit Proof of Payment*
File must be 10 MB or less