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Wellness Reimbursement Request : health,wellness,benefitsView Wellness Reimbursement Request

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Key Takeaways

  • Complete HR toolkit: Offers, warnings, terminations, reviews, and acknowledgments.
  • Best template flexibility: Start with a proven Wellness Reimbursement Request and customize every section as needed.
  • Consistent wording: Reduce admin time and ambiguity.
  • Confidentiality/IP where applicable: Include protective clauses when appropriate.
  • Simple tailoring: Edit names, dates, and roles quickly.
  • Tracking friendly: Capture approvals, dates, and next steps.
  • Works with agreements: Align with employee and contractor contracts.
Wellness Reimbursement Request

How to write your Wellness Reimbursement Request

We include this 3 page template with Human Resources Contract Pack and the Proposal Kit Professional. You will get more content and software automation for data merging, managing client documents, and creating proposals with line item quoting with a Contract Pack or the Professional.

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The Wellness Reimbursement Request form is used for employees to request reimbursement for authorized expenses that fall under the company's health and wellness reimbursement policy.
Document Length: 3 Pages
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Use cases for this template

Nimbus Byte streamlines wellness reimbursements during a rapid hiring surge

The Challenge

As Nimbus Byte doubled headcount, HR lead Lila Chen faced inconsistent wellness claims, unclear eligible activities, missing receipts, and confusion about the three-month participation rule, monthly caps, taxable income handling, and the calendar-year submission deadline.

The Solution

They adopted the wellness reimbursement contract template and used the Proposal Kit only for supporting documents, not to write or update the contract-leveraging document assembly to produce a step-by-step employee guide, an eligibility checklist, and a supervisor sign-off memo, AI Writer to draft FAQs and a training outline, and line-item quoting to model allowance amounts by plan for individual plans and family plans.

The Implementation

Lila compiled examples of qualifying classes like licensed pilates, zumba, and indoor cycling, outlined exclusions (equipment, initiation fees, country clubs, pool-only facilities), created a receipt standard (business Tax ID, dates, covered period), and packaged submission options and timelines into a clear packet assembled with the Proposal Kit.

The Outcome

Employees submitted complete requests on time, supervisors validated participation before routing, payroll coded reimbursements correctly as taxable or non-taxable per policy, and leadership gained predictable quarter-by-quarter visibility into spend without last-minute rushes.

Granite Forge educates shift workers on what qualifies-and what doesn't

The Challenge

At Granite Forge, HR director Priya Rao saw rising denials as employees attempted reimbursement for used equipment, outdoor gear, tennis and indoor rock climbing fees, and termination fees, while others weren't sure how to document CrossFit memberships from licensed providers.

The Solution

Keeping the contract template intact, the team used Proposal Kit to create supporting materials: a "What's Covered" catalog, a licensed provider verification checklist, and a quarterly leadership report; AI Writer generated communications and scenario-based FAQs; line-item quoting projected the annual allowance by department to prevent overspend.

The Implementation

They issued a concise submission guide showing how to attach receipts, member ID, and an explanation of benefits when insurance might apply, plus a cover sheet for submission online or by mail; the Proposal Kit's document assembly bundled everything with supervisor sign-off instructions and examples that matched the three-month rule.

The Outcome

Accurate submissions increased, denials dropped, and audits were smoother because documentation arrived complete the first time, while employees felt confident choosing licensed classes without risking rejected claims.

Blue Spruce Clinics scales clarity for remote and onsite staff across locations

The Challenge

With staff spread across clinics and home offices, CFO Dana Ruiz struggled with uneven understanding of online classes eligibility, one reimbursement per year limits, and differences between family plans and individual plans, leading to missed deadlines and unpredictable costs.

The Solution

They retained the wellness reimbursement contract as the controlling document and used Proposal Kit to build supportive assets only: a reimbursement calendar, a manager coaching brief, and a receipt checklist; AI Writer produced a wellness impact summary and rollout script; line-item quoting forecasted quarterly split reimbursements against the monthly cap.

The Implementation

The team published a clear flow: complete three consecutive months, perform an eligibility check, collect receipts from a licensed business, avoid excluded items like gift card purchases, shipping and assembly fees, and social clubs, then submit by the deadline via the specified channel, with Proposal Kit assembling the packet into a single, easy-to-follow bundle.

The Outcome

Participation rose without budget surprises, submissions met timing rules, and finance recorded reimbursements correctly while employees, from virtual fitness enthusiasts to traditional gym members, navigated the process with confidence.

Abstract

This employer wellness reimbursement program provides a fitness reimbursement to encourage healthy habits among full-time employees. It covers qualified wellness program activities such as a qualified membership at a full-service facility and instructor-led classes. To be eligible, the employee must participate for three consecutive months, provide receipts, and stay within a monthly cap. Previously paid qualified expenses may be reimbursed if incurred within six months of the request and during active employment.

Eligible items typically include licensed, instructor-led classes that improve fitness or health education. Examples can include pilates classes, zumba classes, kickboxing classes, indoor cycling, online classes, and other virtual fitness offerings, provided they are delivered by a licensed business. Weight management or smoking/tobacco cessation programs (for example, WW Weight Watchers) and nutrition counseling from licensed providers can also be appropriate. Plan coverage may vary, and plan benefits vary by employer.

The plan excludes personal training fees and any personal fitness or sports equipment, including cardiovascular equipment, strength training equipment, stationary bikes, treadmills, weights, and exercise bands, whether new or used. Recreational sports programs and events are excluded (for example, road race fees, golf or ski passes, sport camps, or similar activities) unless they are included in regular health club dues. Massage, medical or psychological therapy, and fees not part of regular dues (such as certain finance charges) are not eligible.

Classes must be provided by a licensed business or instructor. Expenses cannot be double-counted with an FSA, HSA, or MRA.

To submit your request, your supervisor completes the form and files it with Human Resources. You must submit forms with a paid receipt showing the purchase, date, business Tax ID, and the period covered. Multi-month purchases are handled as a split reimbursement up to the monthly cap and paid on a quarterly basis.

HR may request additional documentation or deny expenses covered by health insurance. For questions, call HR or member services. Tax considerations can vary; consult a tax advisor. While this policy routes requests through HR, some employers use an online form, allow submission by mail, or issue a reimbursement check, direct deposit, or a prepaid Mastercard; processing time and reimbursement decisions vary by plan administrator and plan year.

Use cases: a gym membership at a fitness facility after three months of attendance; licensed virtual fitness courses; martial arts schools offering licensed classes. Proposal Kit can help teams assemble the policy and request form, automate allowance amounts with line-item quoting, and use its AI Writer and template library to produce related documents with ease.

Beyond the basics, employers should set clear expectations for timing and documentation. Many wellness programs run on a calendar year and establish a submission deadline to manage budgets and approvals. Some require you to submit by March 31 for prior-year activity, allow one reimbursement per year, or ask you to submit a request once per year to apply an annual allowance.

Others define allowance amounts by plan and confirm member eligibility during member enrollment. The plan varies by employer, but processes commonly include an eligibility check tied to a member account and member ID, with options to submit online or by mail through online reimbursement or mail-in reimbursement. Processing time can run up to eight weeks.

Covered activities should remain licensed and structured. CrossFit, pilates, zumba, kickboxing, indoor cycling, or online classes can qualify when offered by a licensed business or exercise physiologists, while recreational sports like indoor rock climbing or tennis are usually excluded unless included in regular club dues. Fees not part of normal dues are excluded, which often covers initiation fees, termination fees, and finance charges.

Country clubs, social clubs, and pool-only facilities may not qualify as a full-service facility. Equipment is not covered in this plan; many employers also exclude used equipment, outdoor gear, shipping and assembly fees, and any gift card purchase, even if bought from a licensed retail establishment or participating retailers. If a health plan may cover related services, HR can request an explanation of benefits before making reimbursement decisions. Reimbursements may be treated as taxable income; discuss details with a tax advisor.

Employee situations vary. A current member on an individual plan might complete three consecutive months at a fitness facility and then submit forms with receipts for a quarterly, split reimbursement within the monthly cap. A family plan holder might take instructor-led classes together but still submit a single claim according to plan rules.

Some plans let you choose direct deposit or a reimbursement check; others allow online reimbursement or submission by mail. Keep receipts within four months of purchase if your employer uses a tighter window, and remember that plan coverage may vary.

Proposal Kit helps organizations codify these rules across departments. Teams can assemble clear policies and request forms, automate allowance amounts with line-item quoting, and use the AI Writer and extensive template library to produce workflows, instructions, and supporting documents with ease.

Organizations can strengthen this wellness reimbursement program by defining the full request lifecycle and audit trail. Require supervisor sign-off at purchase and again after three consecutive months, then archive receipts with dates, business Tax ID, and covered period in a central repository. Align monthly caps and quarterly payouts with payroll cycles, and publish a year-end close process so employees know when prior-period requests will be cut off. Because reimbursements may be treated as taxable income, coordinate with payroll early so approved amounts appear correctly on pay statements and year-end tax forms.

Clarify plan design choices up front. Document how allowance amounts apply to family plans versus individual plans, whether multi-month purchases are prorated under the monthly cap, and how to handle requests near an employee's hire or termination date, given the rule that expenses must occur during employment. Spell out what qualifies as a licensed provider and how HR will verify business licensing when needed. Consider a simple reconsideration path for denied requests, especially when a health plan's coverage is unclear and an explanation of benefits is pending.

Communications matter. Offer a short eligibility checklist, a receipt example, and a step-by-step submission guide that explains when to submit, what to attach, and who to contact. Provide situations, such as a virtual fitness subscription, a licensed martial arts class, or a standard health club membership, so employees can self-assess eligibility before they spend.

Proposal Kit can help teams operationalize these rules by assembling clear policies and request forms, organizing allowance details with automated line-item quoting, and using the AI Writer and extensive template library to produce instructions, acknowledgments, and manager checklists that keep the process consistent and easy to follow.

How do you write a Wellness Reimbursement Request document? - The Narrative

Wellness Reimbursement Request Date: Current Date. Employee: First Last Department: Department Supervisor: Supervisor. Employee Job Information Position: Contract Job Title Status: Full-time Y/N Date of Hire: Work Type: Hourly ? Salary ? Shift Type: Day ? Night ? Swing ? Other ? Supervisor must complete the following form and file it with the Human Resources Department.

Employee must provide receipt(s) for all reimbursed wellness activities. Description of Wellness Program or Activities Describe the wellness program or activities you are seeking reimbursement for. Qualifications Does employee have receipt(s) of payment for the activities being submitted for reimbursement? Yes ? No ? Are the activities submitted for reimbursement "Qualified Wellness Program" activities? Yes ? No ?

Qualified Wellness Program Activities

Purpose of Company Name Wellness Reimbursement Plan:

The purpose of this plan is to provide our full-time employees with financial incentives and assistance to encourage participation in health and wellness activities and programs, such as health club memberships, aerobic / exercise classes, health education classes, and smoking and tobacco cessation or weight management programs.

Who can participate in Wellness Reimbursement:

Full-time, regular employees are eligible to participate in the wellness reimbursement program. The maximum benefit an employee can receive is limited to Insert $ Amount/month for all qualified activities. For an activity to be considered "qualified," the employee must participate in the activity for three consecutive months to be eligible for reimbursement. The company will also reimburse any previously paid qualified wellness expense so long as it is within six months of the reimbursement request, subject to documentation requirements.

The following activities shall be excluded from the Wellness Reimbursement plan:

Recreational sports programs (unless included in health club membership dues). Recreational sports events (including marathons, triathlons, tournaments). Personal trainer fees and personal fitness or sports equipment.

Classes, training, or instruction that is not provided by a licensed business or instructor (proof may be required). Meals, supplements, or aids for weight loss, body building, or for smoking / tobacco cessation. Massage programs. Medical treatment programs or therapy.

Psychological treatment programs or therapy. Fees, finance charges, late fees or other charges not a part of regular health club or classroom dues.

Payment Requirements:

All reimbursement requests must have a paid receipt showing the wellness activity purchased, date of purchase, the business Tax ID, and the period of time that the purchase covers. For multi-month purchases made up front, company shall reimburse up to Insert $ Amount/month, paid on a quarterly basis. Company will reimburse only wellness expenses incurred during employment with Company Name. Expenses prior to employment with Company Name shall not be considered.

Company reserves the right to request additional information or documentation on all requested reimbursements. Company may also deny a reimbursement expense if that expense is determined to be covered under an applicable health insurance plan or other reimbursable program. Employees may not submit a wellness reimbursement request for any expense that has already been submitted or paid out through a Flexible Spending Account (FSA), Health Savings Account (HSA), or Medical Reimbursement Account (MRA).

If you have any questions concerning the eligibility of any wellness expense, please consult the Human Resources Department.

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