Health & Fitness (Rev 4/1/2013) page 1 of 1

SOP # Revision: 2 Prepared by: BLD

Effective Date: 4/1/2013 Approved by:
Title: Health & Fitness Reimbursement
Policy: GTM will contribute to the expense of maintaining a healthy lifestyle by contributing to
the annual cost of a Health Club, provided that the employee meets the standards set by
our Blue Cross Insurer with respect to 120 visits per year. Assuming all conditions met,
payment will be made in accordance with IRS guidelines regarding compensable income.

Purpose: To provide guidelines for the Health & Fitness Reimbursement.

Scope: This procedure applies to all employees in the organization who belong to a Health &
Fitness organization for the purpose of their health & well being. GTM will annually
support their efforts to the amount of $250, provided they meet the Blue Cross guidelines.

Responsibilities:
The Employee is responsible for maintaining a record of their payment for the facility
and being able to provide documentation to support their number of visits per calendar
year. The employee should provide the same documentation to GTM that they would
provide to Blue Cross for the number of annual visits generally a printout from the
facility is necessary for documentation.
Procedure:
1.1 To receive the Blue Cross reimbursement, you need to sign up for their Healthy Life
Styles (1-800-275-2583). They will provide you with the information needed to be
enrolled and procedures for their Healthy Lifestyles $150 reimbursement. They will only
count gym visits registered after you call.
1.2 For the GTM reimbursement, complete a Health & Fitness reimbursement form. Attach a
copy of your Member Visit list, and documentation associated with your actual facility
cost, both of which can be provided by your facility. If you are signed up with Blue
Cross, use the same documentation that you use for them otherwise, provide
documentation for a one year period.
1.3 Submit the Health & Fitness Reimbursement form to HR for approval. HR will verify
information and sign off, subsequently submitting document to Payroll for processing.
1.4 Payroll will process the paperwork in the next pay cycle.
1.5 GTM will contribute $250, regardless of the cost of your gym, provided you have the
documented 120 visits in 1 year.
1.6 Each employee may only receive a maximum of 1 Health & Fitness Reimbursement per
year.
1.7 This policy does not extend to family members.