Page 26 - KIPP NYC 2022 Benfits Summary

Get Reimbursed For Health Club Membership Dues Or Exercise Class Fees
Hard Work Pays Off
When you take charge of your health through regular exercise, you and your eligible spouse can save money, too. Complete 40 or more visits to a qualified health club* within six months to claim your Cigna Fitness Benefit of up to $200. You can save as much as $400 per member per household
Follow the steps below to claim reimbursement for health club membership dues or group fitness classes with a credentialed** instructor.
Complete the form on the next page and return it with your supporting documents.
• Complete the Fitness Benefit Form following the reimbursement schedule below.
• Supply dated, original receipts from your health club. Or if you pay by electronic funds transfer, supply copies of
bank or credit card statements, showing:
- Member’s name
- Individual charges for each health club membership or class
• Supply proof of qualifying visits.
- A usage report from your gym
- Receipts that indicate each time you have visited the health club
- Or verification from your employer that shows your use of the employer health club
• Supply a copy of your health club agreement or contract, showing the name and address of the health club, which includes beginning and ending dates of the membership.
• Sign and date the completed Fitness Benefit Form, then email all of the above to KIPPNYC@Cigna.com Reimbursement Schedule
January 1 – June 30 July 1 – 31 August 5 – 31 $200
July 1 – December 31 January 1 – 31 February 5 – 28 $200
BENEFIT PERIOD
SUBMISSION DATES
PROCESSING DATES
MAXIMIM REIMBURSEMENT
If you are unable to participate in or meet the requirements of the gym membership reimbursement program due to a disability or other reason, you may be entitled to a reasonable accommodation for participation, or an alternative standard for rewards. Please contact Cigna for more information.
26 KIPP NYC PUBLIC SCHOOLS
Yearly total: $400