2021 Screening Form **PLEASE READ REGARDING 2021 WELLNESS YEAR** The Wellness Program is
not mandatory. However, Non-Medicare Active and Retired Participants and their
spouses are encouraged to participate in the Wellness Program. If you do not meet
the acceptable biometric ranges, you may complete telephonic coaching. All
telephonic coaching for this period must begin no later than January 31, 2022, as the
coaching must be completed no later than March 31, 2022. It is your responsibility
to plan your coaching sessions ahead of the completion date.
Eligible Participants and their spouses participating in the Wellness Program may
choose one of the two incentive options, the Gift Card or the 2022 Deductible
Waiver. Please note, only Active Participants and their spouses are eligible
for the Deductible Waiver option and if you are married, both you and your
spouse must participate and elect the Deductible Waiver option.
If you have participated in a Health Screening or submitted a form to your Primary
Care Physician during the 2nd Wellness Year of January 1, 2021 through December
31, 2021, you will not be eligible to attend another Health Screening during this
period. If you are unsure if you and/or your spouse have health coverage at the
time of an event, you should contact the Health Fund Office prior to scheduling an
appointment on the web calendar.
▪ If you choose to have your biometrics performed with your Primary Care
Physician (PCP), you MUST use the “Wellness Biometric Screening form”
found on the website under Forms or you may contact the Health Fund Office.
▪ If you choose to have your biometric screening at an On-Site Wellness Event
the Wellness Biometric Screening forms will be provided upon arrival. (OnSite locations, dates and times when determined can be found on the Notices
mailed to you)

Coming to Local 330’s Area:

Fond du Lac-  Tuesday November 16  – Radisson Hotel & Conference Center, Room A 625 W. Rolling Meadows Dr. 2:30 pm – 6:30 pm

Appleton – Wednesday November 17 – Grand Meridian, South Meridian Room  2621 N. Oneida St.