Home | Forms | Documents | News | Employment Opportunities | Contact
Hanover Township
Wellness Reimbursement Form

The Wellness Benefit is payable at 100% with no deductible, and not subject to reasonable and customary provisions. The maximum benefit is $200 per health year, (June 1 - May 31), for employee’s coverage. Please note that Human Resources will contact you for verification of your request to use the Wellness Benefit.

Your Name:
Your Supervisor:
Today's Date:
Employee Department:
Total Amount Spent on Item
Description of Purchase:
Need additional help?