What is the Oxford Gym Reimbursement Form?
The Oxford Gym Reimbursement Form is a document used by members of the Oxford® Sweat Equity Program to request reimbursement for gym expenses. Members must provide proof of fitness facility visits, payment, and related documentation to receive reimbursement.
Who is eligible to submit this form?
Eligible individuals include Oxford plan subscribers and their covered spouse or domestic partner. Other covered dependents are not eligible. Participation is voluntary and only available to active employees at the time of application.
What information do I need to fill out the form?
You must provide your name, address, date of birth, Oxford member ID number, and the start and end dates of your six-month program period. You will also need to record the dates of your facility visits and include payment proof and documentation of your cardio activities.
How do I document my fitness facility visits?
Record your visits on the chart provided in the form. You can also attach a computer printout or receipts showing the dates and facility names. Make sure to get a signature from a facility representative or class administrator to validate your visits.
What types of payments are acceptable for reimbursement?
Acceptable proof of payment includes receipts, payroll deductions, or automatic withdrawal statements. Just be sure to redact any unnecessary personal account details on these documents.
What documents must I submit with the form?
In addition to the completed reimbursement form, you need to attach proof of payment, documentation of your visits or classes, and a brochure or flyer that describes the cardio equipment or class benefits.
What is the submission deadline for the form?
Your request must be postmarked within 180 days of the last date of the six-month period for which you are applying. Late submissions will not be reimbursed.
What happens if my form is incomplete or incorrect?
If the form is missing information or if details cannot be substantiated, processing may be delayed or your reimbursement request may be denied. Ensure all information is accurate and complete.
Are there any exclusions or limitations for this program?
Yes, memberships in certain clubs, spas, or weight loss clinics are not eligible for reimbursement. Only visits that promote cardiovascular wellness and that are taken while you are an active Oxford member qualify. Lifetime memberships are also not eligible.
How do I get assistance if I have questions about the form?
If you have questions, call the toll-free number listed on the back of your health plan ID card. There is support available to help you navigate the form and reimbursement process.