Oxford Sweat ®

Equity Program

The only thing better than getting in

shape is getting rewarded for it.
=
We listened.
It’s our goal to help people live healthier lives. Making exercise a part of So many ways to get
your daily or weekly routine can be one of the most important steps you
take toward being the healthiest “you.” To better help you1 on your way,
fit – and get rewarded.
we’ve expanded our standard gym reimbursement program. Examples of qualifying fitness
The new Oxford Sweat Equity Program was developed with your lifestyle in facilities and classes:
mind. You wanted more exercises to choose from and a program with more ƒƒ Aerobics
flexibility. The new program offers you more types of qualifying exercises ƒƒ Boot camps
and the option to combine your fitness facility visits with your physical ƒƒ Boxing/Kickboxing
fitness classes to more easily reach the required 50 “workouts” in a ƒƒ CrossFit
six-month period. ƒƒ Indoor rock climbing
ƒƒ Martial arts
The new Sweat Equity program is even better. ƒƒ Personal training
ƒƒ Pilates
Eligible Oxford plan members1 can get reimbursed up to $200 in a
ƒƒ Pure Barre
six-month period. That’s right; we will send you $200 for every six-month
ƒƒ Standard gym, including YMCAs and
period that you are in the program, provided you meet the required goals
community centers where fitness services
and submit a completed reimbursement form.
are offered
You can apply for reimbursement under the program as long as you: ƒƒ Swimming
ƒƒ Tennis/Racquetball
• Are an active member of an eligible Oxford health plan.
ƒƒ TRX
• Have gone to the gym and/or exercise classes 50 times in six months. ƒƒ Weight/Resistance
Your reimbursement period begins on the date of your first fitness facility ƒƒ Yoga
visit or class and ends after you have completed 50 visits, 50 classes, or a ƒƒ Zumba®
mix of visits and classes that add up to 50. The reimbursement period
Examples of cardiovascular
ends six months from your first visit. You can start a new reimbursement
equipment:
period one day after your other reimbursement period ends.
ƒƒ  lliptical trainer/Cross-trainer
E
ƒƒ Rowing machine
To get started, choose a gym or sign up for
ƒƒ Stair climber
fitness classes. ƒƒ Stationary bicycle
Decide on a cardio (aerobic) workout that you’ll enjoy and find a facility with ƒƒ Treadmill
the equipment or classes that promote cardiovascular wellness.3 To get
reimbursed, the facility and classes you choose must be open to the
general public. Remember to check with your doctor before you start
exercising or increasing your activity level.
What we need from you.
After you’ve completed a total of 50 workouts — either gym visits, classes or a mix of the two — in a six-month period, send us:
1. Y
 our completed Oxford Sweat Equity Program Reimbursement Form. Find the form at oxfordhealth.com >
Members > Tools & Resources > Forms & Materials > Download Forms or ask your benefits administrator for a copy.
2. P
 roof of your payment (e.g., receipt, automatic bank withdrawal statement) for the gym fee, as well as any money you
paid for fitness classes, during the six-month period.
3. C
 opy of the brochure or flier that describes the cardio (aerobic) machines at the gym you used or the cardio benefits of
the class you took.
4. Mail these documents to: Oxford Sweat Equity Program
P.O. Box 29130
Hot Springs, AR 71903
NOTE: These documents must be mailed to us (postmarked) no later than 180 days from the last date of
the six-month period for which you are asking for reimbursement. Requests postmarked after this date will
not be reimbursed.

If you are unable to meet the reimbursement requirements of this program, you might be able to earn the same reward in a
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different way. Call us at the toll-free phone number (“For Members”) on the back of your health plan ID card and we will work
with you and, if necessary, your doctor, to find another way for you to earn the same reward.
The total annual reward amount for your participation in incentive-based programs cannot generally exceed 30 percent of
the cost of coverage.

If you have questions, please call us at the

Printed: 07/29/15

toll-free Health
phone number
Plan (80840) (“For Members”) on
911-06111-07
Member ID: 999999999 Group Number: AJ03301
the backMember:
of your health plan ID card. Precertification is required for certain services, as described in your member
documents. You may be penalized if you fail to obtain a required precertification.
Ashley B BROWN Payer ID 06111 For Members: www.oxfordhealth.com 800-444-6222
On-Call Nurseline: 800-201-4911

Rx Bin: 610279 For Providers: www.oxfordhealth.com 800-666-1353

Rx PCN: 9999 Medical Claim Address: PO Box 29130, Hot Springs, AR 71903
PCP: $25 Rx Grp: OXFRDHP
Spec: $50

Liberty Plan (SM) Gated EPO Pharmacy Claims: OptumRx, PO Box 29044, Hot Springs, AR 71903
DOI-0501 Underwritten by Oxford Health Insurance, Inc. For Pharmacist: 855-816-6615

Printed: 07/29/15
03082 9127792 0000 0000035 0000023 210 6 336

1
 or this program, the use of “you” and “member” in communications refers to the Oxford plan subscriber or the subscriber’s covered
F
Health Plan (80840) 911-06111-07
spouse or domestic partner;
Member ID:
no other dependentsGroup
999999999 are Number:
eligible. AJ03301
For the subscriber’s spouse or domestic partner to be eligible for this
benefit, he or she must also be enrolled in an Oxford product. The program is not available
Member: to allis Oxford
Precertification required for plan subscribers
certain services, as describedand
in yourtheir
member
spouses or partners. Robert
Refer LtoBROWNyour Certificate of Coverage,Payer
Summary
ID 06111
Plan Description or other governing member document to determine
documents. You may be penalized if you fail to obtain a required precertification.
For Members: www.oxfordhealth.com 800-444-6222
eligibility for this reimbursement and to confirm your plan’s benefit. On-Call Nurseline: 800-201-4911

2
 eimbursement is generally limited to the lesser of $200Rx(subscriber)/$100
R Bin: 610279 (covered spouse/partner) or the actual amount of the qualifying
For Providers: www.oxfordhealth.com 800-666-1353
fitness costs per six-month
PCP: $25
period, but the reimbursement may9999
Rx PCN: vary by plan. Refer to yourMedical
benefits
Claimdocuments or 29130,
Address: PO Box check Hot with
Springs,your benefits
AR 71903
Rx Grp: OXFRDHP
administrator to find out how much you may be reimbursed. You may submit a request for reimbursement under the program once every six
Spec: $50
months. Consult with an appropriate tax professional to determine if you have any tax obligations from receiving reimbursement under this
program. DOI-0501
Liberty Plan (SM) Gated EPO
Underwritten by Oxford Health Insurance, Inc.
Pharmacy Claims: OptumRx, PO Box 29044, Hot Springs, AR 71903
For Pharmacist: 855-816-6615
3
 o be eligible for reimbursement under the program, the qualifying facility or classes that you choose must be available to the general
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public and promote cardiovascular wellness, as determined by us, and have staff supervision. Memberships in tennis clubs, country clubs,
social clubs, sports teams, weight loss clinics or spas or any other similar organizations, leagues or facilities will not be reimbursed. We
will not reimburse you forShipper
lessons, equipment, clothing, vitamins or other services that
ID: 00000000
may be offered by the facility
Insert #1
(e.g., massages).
Insert #2
Reimbursement is limited to actual
Shipping workout
Method: visits. Physical and rehabilitative therapies
DIRECT Insert do
#3 not apply. Insert #4
CARRIER: USPS Insert #5 Insert #6
Address: Insert #7 Insert #8
Robert BROWN Insert #9 Insert #10
Oxford HMO products are underwritten by Oxford
185 Asylum St Health Plans (CT), Inc. and Oxford Health Plans (NJ), Inc. Oxford insurance
Insert #11 Insert #12
products are underwritten by Oxford Health Insurance,
CT039-11A Inc. - R. Ciotto
ATTN: OXF
MT-1024112 9/16 ©2016 Oxford UHGHealth Plans LLC. All rights reserved. MS-16-346 16-2207 11594 (NY/NJ/CT) Cycle Date: 20150729
Hartford, CT 06103- PDF Date: Wed Jul 29, 2015 @ 09:28:30
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