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The Tufts Navigator Fitness form offers a valuable opportunity for Tufts Health Plan members to stay active while enjoying potential monetary rewards. Members can receive reimbursement for gym memberships or fitness classes, with options that include getting back the cost for one month of membership or up to $200 annually. This program caters to most small group and individual plans in Massachusetts, and its availability extends upon renewal in 2022. To qualify, members must maintain a consistent membership with both Tufts Health Plan and their chosen fitness center for at least four consecutive months. Eligible fitness centers should provide equipment and programs aimed at enhancing physical fitness, with exclusions for certain types of facilities and personal training services. A range of exercise classes, from Pilates to Zumba, are also included in the reimbursement criteria. The straightforward rebate application process allows members to submit their requests online or via mail, ensuring a hassle-free experience as they work towards their fitness goals.

Tufts Navigator Fitness Example

FITNESS

REWARDS

Stay in Shape and Save

Get Money Back On Your Fitness Membership

Members can get reimbursed for one of the following options, whichever has the greater value:

The cost of one month of individual or family fitness center membership per benefit year, or

Fitness center membership costs up to a maximum of $200 per benefit year

This benefit applies to most Massachusetts (small group) and individual plans and is available upon renewal in 2022. You may confirm your fitness benefit by viewing your health plan coverage in your secure member account, visit mytuftshealthplan.com.

Rebate Rules:

1.You’re eligible for the rebate once you’ve been a member of Tufts Health Plan and the gym for at least 4 consecutive months in the applicable benefit year.

2.The fitness center must offer cardio and strength-training machines and other programs for improved physical fitness. The rebate does not include martial arts centers, gymnastics centers, country clubs, or pool-only centers, sports teams and leagues, social clubs and tennis clubs, personal trainers, sports coaches, or the purchase of personal or at-home exercise machines.

3.Exercise classes include, but are not limited to: Pilates, Zumba, yoga, aerobics, online fitness classes, and kickboxing. In-person classes held in a residential setting or dance classes are not included.

Tufts Health Plan will pay up to the reimbursable amount based on your plan.

GET YOUR REBATE

Submit your rebate form online at: mytuftshealthplan.com under the Forms tab. Or, you can mail in the rebate form on the reverse side.

REBATE FORM ON BACK

699210935-SG-0921

FITNESS

REWARDS

Stay in Shape and Save $150

Get Money Back On Your Fitness Membership

$150 per family, per benefit year for fitness center membership fees and/or exercise classes

This benefit applies to most Massachusetts and Rhode Island (large group) plans and is available upon renewal in 2022. You may confirm your fitness benefit by viewing your health plan coverage in your secure member account, visit mytuftshealthplan.com.

Rebate Rules:

1.You’re eligible for the rebate once you’ve been a member of Tufts Health Plan and the gym for at least 4 consecutive months in the applicable benefit year.

2.The fitness center must offer cardio and strength-training machines and other programs for improved physical fitness. The rebate does not include martial arts centers, gymnastics centers, country clubs, or pool-only centers, sports teams and leagues, social clubs and tennis clubs, personal trainers, sports coaches, or the purchase of personal or at-home exercise machines.

3.Exercise classes include, but are not limited to: Pilates, Zumba, yoga, aerobics, online fitness classes, and kickboxing. In-person classes held in a residential setting or dance classes are not included.

Tufts Health Plan will pay up to the reimbursable amount based on your plan.

GET YOUR REBATE

Submit your rebate form online at: mytuftshealthplan.com under the Forms tab. Or, you can mail in the rebate form on the reverse side.

REBATE FORM ON BACK

699210935-LG-0921

MEMBER FITNESS REBATE FORM

You must complete all fields. Please print clearly. Retain a copy of all receipts and documents for your records. Please be sure to sign the form.

To qualify for the fitness rebate, you must complete 4 consecutive months of membership with Tufts Health Plan and 4 months with the gym in the applicable benefit year.

You will have 24 months from the date you paid your fitness club fees to submit your request for the fitness rebate. The rebate applies one time per family, one time per benefit year. The rebate is paid to the Tufts Health Plan subscriber after fitness costs are paid. We usually process reimbursements within 4 to 6 weeks of receipt. The rebate can be submitted multiple times until full reimbursement is met.

Member Information

Name (Last, First, Middle Initial): _______________________________________________________________________

Date of Birth: _______ / _______ / ________________

Tufts Health Plan Member ID Number

Fitness Center Information

Fitness Club Name: ___________________________________________________________________________________

Address: ____________________________________________________________________________________________

Telephone:__________________________________

Year(s) of fitness club membership:

Benefit Year 1: _______________________

Amount Paid: _______________________

 

Benefit Year 2: _______________________

Amount Paid: _______________________

Group Exercise Class Information (Check your benefits for this rebate)

Group Exercise Class Name: ___________________________________________________________________________

Address: ____________________________________________________________________________________________

Telephone:_________________________________

Year(s) of group exercise class(es):

Benefit Year 1: _______________________

Amount Paid: _______________________

 

Benefit Year 2: _______________________

Amount Paid: _______________________

Payment Information

Please include one of the following forms of proof of payment with this form:

An itemized receipt from the fitness club and/or group exercise class, showing the dates of membership and dollar amounts paid

A credit card statement or receipt indicating fitness club and/or group exercise class payment

A statement from the fitness club’s and/or group exercise class’ letterhead, with an authorized signature, indicating payment was made

Signature Required

I attest that the above information is true and accurate, and the services were received and paid for in the amount requested as indicated above. I acknowledge that if any information on this form is misleading or fraudulent, my coverage may be canceled and I may be subject to criminal and/or civil penalties for false health care claims. I also understand that Tufts Health Plan may request any additional information it deems necessary to verify that services were received and payment was made. I understand that the fitness rebate may be considered taxable income.

Member Signature: _______________________________________________________________ Date: _________________________

PLEASE SUBMIT THIS FORM AND ALL DOCUMENTATION:

Online at:

 

 

Mail to:

 

 

 

 

Tufts Health Plan | Member Reimbursement Claims

or

mytuftshealthplan.com under the Forms tab

PO Box 9191, Watertown, MA 02471-9191

 

 

 

 

 

 

 

Please do not staple any materials to this form

 

 

 

699210935-LG-0921

Form Characteristics

Fact Name Details
Eligibility Requirement Members must have been enrolled in both Tufts Health Plan and a fitness center for at least 4 consecutive months.
Reimbursement Amount Members can receive reimbursement for one month of membership or up to $200 per benefit year.
Massachusetts Plans This benefit primarily applies to small group and individual plans in Massachusetts, effective upon renewal in 2022.
Rhode Island Plans Available for large group plans in Rhode Island, also effective upon renewal in 2022.
Eligible Facilities Fitness centers must provide cardio and strength-training equipment; certain types of facilities, such as martial arts centers, do not qualify.
Exercise Classes Rebates cover various exercise classes, including Pilates, Zumba, and yoga, but exclude in-home or residential classes.
Submission Process Rebate claims can be submitted online or by mailing a physical form to Tufts Health Plan.
Documentation Needed Proof of payment is required, such as itemized receipts or credit card statements showing fitness-related expenses.
Processing Time Reimbursements are typically processed within 4 to 6 weeks after the claim has been received.
Tax Implications The rebate might be considered taxable income, and members should be aware of this when filing taxes.

Guidelines on Utilizing Tufts Navigator Fitness

Filling out the Tufts Navigator Fitness form accurately is essential in order to receive your fitness rebate. Follow the steps carefully to ensure all required information is provided and submitted correctly. Keep in mind that you should have been a member of Tufts Health Plan and the gym for at least four consecutive months in the applicable benefit year to qualify for this rebate.

  1. Start by printing the form clearly, ensuring all handwriting is legible.
  2. Fill in your personal information, including your name, date of birth, and Tufts Health Plan Member ID Number at the top of the form.
  3. Provide details about your fitness center. Include the name of the club, address, and telephone number.
  4. Document the years of membership in the fitness center. Specify the benefit year and the amount paid for each year.
  5. If applicable, provide information regarding any group exercise classes you attended. Fill in the class name, address, and telephone number.
  6. Record the years of the group exercise class and the amounts paid for each benefit year, if any.
  7. Gather proof of payment. Attach one of the following: an itemized receipt, a credit card statement, or a statement from the fitness club or class indicating payment was made.
  8. Sign and date the form in the required sections. This signature confirms the information is accurate and truthful.
  9. Keep a copy of the completed form and any attached documents for your records.
  10. Submit your completed form either online at mytuftshealthplan.com under the Forms tab or by mailing it to the specified address.

What You Should Know About This Form

What is the Tufts Navigator Fitness form, and how does it work?

The Tufts Navigator Fitness form enables members to receive a rebate on their fitness membership costs. Members can get reimbursed for either one month of individual or family fitness center membership or up to $200 for the entire benefit year, depending on which amount is greater. This benefit is available to most Massachusetts individual and small group plans, with the option to confirm eligibility through your secure member account on mytuftshealthplan.com. To take advantage of this benefit, members must be registered with both Tufts and the fitness center for at least four consecutive months during the applicable benefit year.

Who is eligible for the rebate?

To qualify for the rebate, members must have held a membership with Tufts Health Plan and the fitness center for a minimum of four consecutive months within the relevant benefit year. It’s essential to ensure that the chosen fitness center offers appropriate facilities that focus on cardio and strength training. The rebate does not extend to martial arts centers, country clubs, personal trainers, or similar venues. Additionally, eligible exercise classes include options such as Pilates, yoga, and aerobics, among others, although some specific classes held in residential settings may not qualify.

How do members submit the rebate form?

Submitting the rebate form can be done in two convenient ways. Members can either fill out the form online by visiting mytuftshealthplan.com and navigating to the Forms tab or can mail in a completed form. It is critical to provide accurate information and submit all required documentation. Members should keep a copy of all receipts and relevant documents for their records to ensure smooth processing.

What should I include when submitting the form?

When submitting the Tufts Navigator Fitness rebate form, members need to provide a few crucial details. This includes their name, date of birth, and Tufts Health Plan Member ID number. Additionally, include the name, address, and payment details of the fitness center or exercise class. Members must also attach proof of payment, such as an itemized receipt or a credit card statement indicating the payment made. Remember, accuracy matters! Providing clear, truthful information ensures that the process goes smoothly and helps avoid potential delays.

Common mistakes

Completing the Tufts Navigator Fitness form can be straightforward, but it’s not without pitfalls. One common mistake is not providing clear and complete information. When filling out the member information section, it is vital to clearly print the name, date of birth, and Tufts Health Plan Member ID number. Omitting even a single detail can delay processing or lead to outright rejection of the claim.

Another frequent error involves misunderstanding eligibility requirements. Members must be active with Tufts Health Plan and the fitness center for at least four consecutive months within the benefit year. Failing to meet this requirement means the rebate request will automatically be denied. Before submitting, ensure you’ve satisfied this condition.

It’s important to remember that not all fitness facilities qualify for reimbursement. Members tend to assume that all gyms provide the necessary cardio and strength-training equipment. However, facilities such as martial arts studios or tennis clubs do not qualify. Furthermore, any classes conducted in residential settings are also excluded. Clarifying which fitness centers and classes are eligible can prevent disappointment later.

Inadequate documentation often leads to mistakes as well. The Tufts Navigator Fitness form mandates the inclusion of proof of payment. Acceptable forms include itemized receipts or credit card statements. Without this documentation, even fully completed forms may be dismissed. Double-check to ensure that the required proof accompanies your submission.

Some individuals fail to retain copies of their completed forms and receipts. Keeping these records serves as a safeguard should any issues arise during processing. Documentation can be crucial if a discrepancy occurs or if Tufts Health Plan requests further verification.

The signature section is another area where mistakes frequently occur. Omitting the signature or date invalidates the submission, leading to processing delays. Always ensure that this crucial step is completed accurately before sending the form.

Being aware of the submission timelines is essential as well. Members have 24 months from the date of payment for fitness services to submit the rebate request. Missing this deadline can result in forfeiting the rebate altogether. Keeping track of deadlines can maximize your chances of reimbursement.

Lastly, misunderstandings surrounding the reimbursement amount can lead to confusion. The Tufts Navigator Fitness program offers a maximum rebate of $200 per benefit year. Members often overlook this cap or miscalculate their total eligible expenses. Familiarizing yourself with the rebate limits aids in setting realistic expectations.

Addressing these common mistakes can help ensure a smoother experience when submitting the Tufts Navigator Fitness form, leading to quicker rebates and greater satisfaction.

Documents used along the form

The Tufts Navigator Fitness form is designed to help members receive reimbursement for their fitness membership or classes. This document often accompanies several other forms and documents that facilitate the process of obtaining fitness benefits. Below are five commonly used forms and documents related to the Tufts Fitness program.

  • Member Fitness Rebate Form: This form is specifically for members to request their fitness rebate. It requires details such as member information, fitness center name, and proof of payment. Members must complete specific fields accurately to qualify for the rebate.
  • Proof of Payment Documentation: Members need to provide proof of payment when submitting the rebate form. Acceptable documents include itemized receipts, credit card statements, or letters from the fitness center confirming payment.
  • Tufts Health Plan Enrollment Form: This document is used when individuals are enrolling in the Tufts Health Plan. It provides important details about the member’s health insurance coverage and eligibility for benefits, including fitness reimbursements.
  • Health Risk Assessment (HRA): While not required for fitness rebates specifically, HRAs can be beneficial for members. They help assess individual health risks and can guide members in choosing appropriate fitness programs that align with their health goals.
  • Benefits Overview Document: This outlines the various benefits provided under the Tufts Health Plan, including fitness-related reimbursement options. It serves as a quick reference for members to understand their available benefits.

Each of these documents plays a key role in ensuring that members can successfully navigate their fitness reimbursement benefits with Tufts Health Plan. It's important to keep these forms organized and readily available to streamline the process when the time comes to submit a fitness rebate or make inquiries related to health benefits.

Similar forms

  • Health Savings Account (HSA) Claim Form: Both forms provide members with a means to claim reimbursements for health-related expenses. The HSA Claim Form requires documentation of eligible medical expenses, while the Tufts Navigator Fitness form necessitates proof of fitness memberships and classes.

  • Flexible Spending Account (FSA) Reimbursement Form: Similar to the fitness rebate, the FSA Reimbursement Form allows members to obtain reimbursement for health expenses. Each form requires submission of proof of payment along with completed paperwork.

  • Wellness Program Reimbursement Form: This form also aids in receiving funds back for wellness-related activities. Both forms emphasize program participation and require documentation to claim reimbursements.

  • Annual Preventive Care Form: Individuals must provide proof of their preventive care visits to claim benefits. Like the fitness form, it mandates a copy of the service receipt to ensure eligibility.

  • Chiropractic Claim Form: Similar in function, this form enables members to seek reimbursement for chiropractic services. Both necessitate a record of visits including date of service and payment details.

  • Acupuncture Reimbursement Form: Members can receive funds back for acupuncture sessions by submitting this form. The requirement for an itemized receipt parallels that of the fitness rebate form.

  • Prescription Reimbursement Form: This document allows members to claim back costs for prescription medications. It, too, requires a valid proof of purchase and submission of a completed form.

  • Therapy Claim Form: Members seeking reimbursement for therapy sessions are required to fill out this form similarly to the fitness rebate form. Supporting documentation of services rendered is necessary.

  • Vision Care Reimbursement Form: Members can reclaim costs for vision-related expenses through this form. Similar to the fitness form, it necessitates a completed document and proof of purchase.

  • Nutrition Counseling Reimbursement Form: This form assists members in claiming benefits for nutrition services. Both forms necessitate detailed records of services received and associated costs to validate the claims.

Dos and Don'ts

When you’re filling out the Tufts Navigator Fitness form, it’s important to follow certain guidelines to ensure a smooth process. Here are seven key things to keep in mind:

  • Do fill out all fields completely. Incomplete forms can lead to delays.
  • Do print your information clearly. Legibility is crucial for processing.
  • Do retain copies of all your receipts and documents. This is essential for your records.
  • Do sign the form. Your signature is a requirement for verification.
  • Don't forget to confirm your eligibility before submitting. Make sure you’ve met the 4-month membership requirement.
  • Don't include non-qualifying centers or classes. Only fitness centers with cardio and strength machines qualify.
  • Don't staple any materials to the form. Staples can complicate the processing of your rebate.

Adhering to these guidelines will help you navigate the reimbursement process smoothly.

Misconceptions

When it comes to the Tufts Navigator Fitness form, people often have misconceptions that can lead to confusion or missed opportunities for benefits. Here are four common misconceptions:

  • Anyone can get reimbursed for any type of gym membership. Many believe that they can submit any fitness-related expenses for reimbursement. However, the fitness center must provide specific services, such as cardio and strength-training equipment. Certain facilities, like martial arts or country clubs, do not qualify.
  • You only need to submit the form once. Some individuals think they can only submit the rebate form once for the entire benefit year. In fact, members can submit multiple times until they reach the maximum reimbursement limit allowed for that year.
  • All types of exercise classes are eligible. There is a misconception that all exercise classes can be reimbursed. While classes like Pilates and Zumba may qualify, classes held in residential settings, including in-home dance classes, do not qualify for the rebate.
  • You can receive the rebate immediately after signing up. Many new members assume they can receive the rebate as soon as they join a gym. Eligibility requires at least four consecutive months of membership with both Tufts Health Plan and the fitness center before claiming the rebate.

Understanding these misconceptions can empower members to take full advantage of their fitness rewards while avoiding common pitfalls.

Key takeaways

When it comes to the Tufts Navigator Fitness form, there are several important points to keep in mind. This form is designed to help members get reimbursed for fitness-related expenses, ensuring a healthier lifestyle while saving money.

  • Eligibility Criteria: You must be a member of Tufts Health Plan and a gym for at least 4 consecutive months within the benefit year to qualify for the rebate.
  • Reimbursement Limits: Members can receive reimbursement for either one month of individual or family fitness center membership or fitness center costs up to $200 per benefit year, whichever amount is greater.
  • Qualified Fitness Centers: The fitness center should provide cardio and strength-training machines and programs aimed at improving physical fitness. Certain facilities, like martial arts centers and social clubs, do not qualify.
  • Exercise Classes: Reimbursement also covers a variety of group exercise classes, such as Pilates, Zumba, and yoga; however, dance classes held in residential settings are not included.
  • Submission Process: You can submit your rebate form online or by mailing it in. Be sure to include appropriate proof of payment, such as receipts or credit card statements.
  • Document Retention: Always keep a copy of your receipts and documents. It is essential for your records and may be needed for verification.
  • Processing Time: The processing of reimbursements typically takes about 4 to 6 weeks after submission, so patience is key.

By following these guidelines carefully, you can ensure a smoother experience with the Tufts Navigator Fitness form, helping you receive the benefits to which you are entitled. Remember, living a healthier lifestyle is just a form away!