2022 Screening Form **PLEASE READ REGARDING WELLNESS YEAR 3**
January 1, 2022 – December 31, 2022
All Active participants and their spouses may participate in a Biometric Screening in Wellness Year 3. Arrive 15 minutes ahead of your scheduled screening to complete the health forms. You may choose to have your deductible waived under the Health Plan for 2023 OR you may choose the gift card. Please not that if married, both the member and spouse must agree and sign to have their deductible waived rather than accept the gift card. Non-Medicare Early Retirees are not eligible for deductible waiver but are eligible for the gift card. If you MET the acceptable ranges, you would receive $225. If you DID NOT meet the acceptable ranges, you would receive $75. If you DID NOT meet the Fund’s acceptable biometric ranges, you may participate in health coaching and you would receive the additional incentive(s) based on the incentive option you selected.
If you opted for the Gift Card and participate and complete health coaching, you would be entitled to an additional $150 incentive in the form of a check and a one-time $100 (HRA) credit. If you opted for the Waiver of your Deductible and participate and complete health coaching, you would be entitled to a one-time $100 Health Reimbursement Account (HRA) credit. The $100 credit will be posted to your HRA after the Health Fund receives confirmation that you have completed your coaching. (NOTE: the HRA credit does not apply to Early Retirees)
Remember, you may only participate in the Wellness Program once during a Wellness Year. If you have participated in a Health Screening or submitted a form to your Primary Care Physician during the 3rd Wellness Year of January 1, 2022 through December 31, 2022, you would not be eligible to participate again until the 4th Wellness Year of January 1, 2023 through December 31, 2023. 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.
Limited appointments available so hurry to schedule your appointment today. Call Local #330 for help scheduling. (920) 722-2104
Coming to Local 330’s Area:
Fond du Lac- Tuesday, November 15, 2022 3pm – 7pm Radisson Hotel & Conference Center, Room A – 625 W. Rolling Meadows Drive
Appleton – Wednesday, November 16, 2022 2:30pm – 6:30pm Grand Meridian, South Meridian Room – 2621 N. Oneida Street