The BMC HealthNet Plan MassHealth Fitness Reimbursement Form helps members offset the cost of staying active. If you have been a member of both a fitness club and the BMC HealthNet Plan MassHealth program for at least three months in the same calendar year, you can request up to $200 per family to cover gym fees and related fitness costs.
You must gather specific documents before submitting. These include receipts or proof of payment for fitness expenses and a copy of your Health Club Agreement. All materials, along with the completed form, need to reach BMC HealthNet Plan by March 31 of the year following the expense period.
The form contains a member information section where you enter your name, member ID, and contact details. A separate certification section requires your signature confirming the accuracy of the submitted information. This two-part structure helps BMC HealthNet Plan verify each request quickly and process reimbursements without unnecessary delays.
| Question | Answer |
|---|---|
| Form Name | Bmc Healthnet Plan Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | HealthNet, certify, MassHealth, bmc health net viscosupplemental form pdf |