How much can I claim for 昀椀tness reimbursement?* What happens after I submit the Fitness • When eligible, up to two members on a family plan Reimbursement Form? can be reimbursed for up to $150 each, for a • Reimbursement checks will be mailed and made maximum reimbursement of $300. Any combination payable only to the Subscriber only at the Subscriber’s of subscriber, spouse or dependent is eligible for address of record. No other address will be accepted. reimbursement. For plans with one covered member, If you believe your current address is different from the maximum reimbursement amount is $150. the address we have on 昀椀le, please call the Member • Some members may be eligible for a different Services number on the back of your ID card before reimbursement amount based on their health plan. you submit the form. • Small group or individual plans in MA allow up • Please allow up to 8 weeks for processing. to $150 total for 昀椀tness membership fees and 昀椀tness trackers. • Check with your employer or contact Member Services for eligibility and reimbursement amount. * Fitness reimbursement may be considered taxable income. For tax information, consult your employer or tax advisor. Page 2 of 3