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AvMed's Weight Watchers Reimbursement Program

®

and keep it off!

AvMed Health Plans collaborates with Weight Watchers to help you take that important step toward losing weight. Learn how to eat right and live healthy. Lose weight

AvMed offers you 3 ways to do it!

1. Local Meetings - Join at any Florida location.* 2. At Work Meetings - Minimum of 18 employees must participate to start the program.* 3. At Home - Delivered right to your doorstep. No fuss...convenience of home!**

See other side for your AvMed/Weight Watchers reimbursement program.

* Once you reach lifetime status, AvMed will reimburse up to one year of the meeting fees you have paid to Weight Watchers. This offer excludes accessory purchases and maintenance fees. ** Once you have reached your weight-loss goal, re-visit your AvMed physician and obtain a prescription note verifying your start, goal and end weight. AvMed will then reimburse you the Weight Watchers standard At Home fee.

Health plans with your health in mind.

MP-5472 (9/12)

You can do it!

Name: Address: City: AvMed Member ID:

AvMed/Weight Watchers

Date Joined: State: Phone Number:

®

Zip

Doctor's Name (If you are using the At Home program): Number of Pounds Lost:

Amount of Reimbursement Requested:

The reimbursement process is simple and generally takes 60 days. For reimbursement, send in this completed request form along with the following items:

3 3 3

Copy of your Weight Watchers attendance booklet or physician proof of weight loss, if you've used the At Home program Copy of your Weight Watchers Lifetime Membership card (not applicable for At Home program) AvMedmembershipnumber(filledinabove)oraphotocopyofyourAvMedIDcard

SEND TO: AvMed Health Plans, Health Promotions, ATTN: Weight Watchers Reimbursement 9400 S. Dadeland Blvd., Suite 370 Miami, FL 33156 To contact the Weight Watchers nearest you, call 305-221-9411 in Broward and Miami-Dade counties; in all other counties, call 1-800-651-6000. Contact AvMed Member Services at the number listed on yourAvMedIDcard. Important information:

· EligibilityforthereimbursementprogrambeginsthedayanAvMedmemberjoinsWeightWatchersortheday aWeightWatchersclientjoinsAvMed.YoumustalsobeanAvMedmemberatthetimeofreimbursementto be eligible for reimbursement. ThisoffermaynotapplytoSelf-Fundedgroups.ReferenceyourAvMedcontractorcontactMember Services for additional information. Duetofederalregulations,AvMedMedicaremembersarenoteligibleforthisreimbursementprogram, but willreceivetheAvMeddiscountwhenjoiningataWeightWatcherslocation. Thisofferisforfirst-timeWeightWatchersLifetimemembersonly.

· · ·

Health plans with your health in mind.

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