BCBS Wellness Claim Form

Use this claim form to file for gym membership reimbursement (up to $18/month) if you are enrolled in an LISD Medical Plan.

Include a log of 10 gym visits for one month, a receipt or contract showing gym membership payment and the completed claim form.

2021BCBSWellnessClaimForm.pdf, 103.74 KB; (Last Modified on January 11, 2021)