Statement Request Form

For fast, self-service: Access your account activity and download statement information HERE and follow the steps to create an account. If you already have a member account, then simply log in to your profile homepage . Next, click on "View Statement" (left menu) and then click "Generate PDF" (lower right highlighted in blue). Finally, select the months you would like to download and click "Generate" to create the PDF. 

Many health insurance plans offer fitness or healthy lifestyle benefit for being a member of the MAC! Please check with your insurance carrier to verify your specific plan benefits and requirements. Not all plans require you to obtain and submit contract or statement information.

For your convenience, a few popular insurance companies are listed below. Please follow the associated links to learn more:

  • Blue Cross Blue Shield MA – most BCBS plans do not require you to submit supporting MAC documentation; simply submit the completed BCBS form as indicated.
  • Tufts Health Plan – read the information on the form with instructions on how to request your fitness benefit.
  • Harvard Pilgrim Health Care - you may apply online with a secure HPHConnect account or you may apply by mail.

If you would like additional information, you may use this page to electronically request statement information or supporting documentation.  All submitted requests will be completed for the 2020 calendar year and documentation will be returned via the email address you provide . Requests are completed in the order they are received. Please allow approximately 10-14 business days to process, although additional time may be needed during periods of higher volume.

The Mount Auburn Club is not affiliated with any insurance plan or carrier. The Mount Auburn Club is not responsible for communicating with, submitting information to, or determining benefit eligibility for any insurance plan. By submitting the form below, you understand and accept the Mount Auburn Club is not responsible in the event your health club reimbursement claim is not accepted or approved for any reason. We strongly encourage you to submit your health club reimbursement claim to your health insurance provider as early in the process as possible so any need for additional required documentation may be procured in a timely manner.      

Statement Request Form

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