I Want Additional Health and Wellness Benefits

If you’re eligible, SASMI will set up and maintain an HRA for you as an active member. To open an HRA, you must have enough employer contributions from the previous year to fund your account with a minimum of 250 credits. Note that each credit is equal to $1.

Your account will be funded each July with a percentage of the previous year’s employer contributions.

And, if you don’t need to use your reimbursement now, your HRA balance is there for you later. Your HRA is funded each year and can accumulate as long as you meet eligibility requirements. There is no use-it-or-lose-it rule. At retirement, any balance remaining in your active plan HRA rolls into your retiree HCRA.

You can use the HRA to pay for eligible expenses for yourself and your dependents covered by your SMART Health Plan.

You can also use your HRA funds to purchase allowed everyday health items from a retail pharmacy or the on-line FSA store. Here’s a sample of what’s eligible:

• Prescription drugs 
• First-aid supplies 
• Contact lens solution 
• Aspirin, fever, and pain relievers 
• Antacids 
• Allergy and sinus medications and sprays 
• Smoking cessation products 
• Cold and cough medicine

In order to get an HRA debit card, you must first register for your card on the Member Portal.

About two weeks after you register for a card, you will receive it from WEX, our HRA partner.

Once you receive your card, activate it and start using it to pay for medications and allowable health items at a drug store or grocery store pharmacy counter, or online at the FSA Store at fsastore.com.

Note that a regular grocery or pharmacy checkout counter will not accept the card.

Where you can use the card

Members can use the HRA card at the pharmacy counter of their pharmacy or grocery store, or online

Yes, you can use the card at:

• Pharmacy counter of pharmacy
• Pharmacy counter of grocery store
• Online at FSAstore.com

No, you can’t use the card at:

• Regular register or checkout at the pharmacy
• Regular register or checkout at the grocery store
• A store that does not accept debit cards and does not sell qualifying items

If you are not able to get a SASMI HRA debit card

If you are a participant in Locals 5, 15, 54, 67, 85,214, 399, 435 or an employee of CI Metal Fabrication, you will not be able to receive an HRA debit card, but you can still use your HRA funds.

Why am I not able to get an HRA card?

Certain members have prescription drug coverage that presents a claims-processing technological complication. This prevents these participants from being able to use the HRA debit card.

What do I do instead?

The good news is you can still use the HRA for your prescription and allowed over-the-counter expenses!

• Pay for your prescriptions as you currently do and submit your claim to your insurance carrier. When you receive your Explanation of Benefits (EOB), use the SASMI/HCRA mobile app to upload the EOB so that you can receive reimbursement.
• If you shop for eligible over-the-counter items, you’ll need to upload your itemized receipt through the app to receive reimbursement.
• Download the SASMI/HCRA app on the App Store or Google Play and use it to manage your HRA and get reimbursed.

Spending your HRA dollars is simple at the FSA Store

Although most online pharmacies will allow purchases with your HRA debit card, the FSA Store is SASMI’s approved online merchant.

You can shop for over-the-counter meds online and generally, the items sold there are preapproved to use with an HRA. The FSA Store lets you set up automatic renewals and shipping for items you use often. Just provide your HRA card information and let your HRA pay for your health items.

If you’re not sure whether an item is eligible, use the SASMI/HCRA mobile app to scan the item to confirm before making a purchase.

Managing your HRA is easy with these resources:

Access to your account is available 24/7 by using the SASMI/HCRA mobile app or by calling SASMI and opting into the HRA Help Line at 800-858-0354.

You’ll be able to:

• View (or hear) your account balance
• Review debit card transactions (if applicable)
• Request a new card if you lose it (if applicable)

Here’s an example of a member, let’s call him Sam. He had $6,000 in employer contributions in 2022.

• For his initial HRA balance, he’ll have 1,200 credits allocated or a $1,200 opening balance. (That’s 20% of $6,000)
• He’s eligible for all SASMI benefits and registers on the Member Portal to get his HRA Card.
• He uses $200 of the HRA balance on eligible expenses between July 2023 and June 2024 reducing his balance to 1,000 credits.
• In both 2023 and 2024, he has the same employer contributions as in 2022 (total of $12,000) for a (total Active Plan HRA contributions of 3,600 credits). He claims $300 worth of eligible expenses during each following July to June for a total of $600 in claimed expenses.
• He retires October 2025 with 35 future service credits. Total lifetime contributions = $100,000. He took $20,000 in other active benefits (travel, unemployment, etc.).

Sam’s HCRA Calculation at Retirement

$100,000 x 150% = $150,000

– $20,000 in other benefits

– $3,600 for Active Plan HRA allocations

$126,400

To which is added:

$12,000 service-based HCRA *If qualified

+$3,000 remaining in his active HRA

Total starting HCRA balance at retirement = $141,400

What is the new SASMI Active Plan benefit?

Starting July 2023, the SASMI Active Plan will include an HRA (Healthcare Reimbursement Account) for eligible participants. Note that owners are not eligible to participate (for details, see Active Plan Definitions and Article II, Section 5 of the Active Plan).

What is the SASMI Active Plan HRA?

The SASMI Active Plan HRA is an account that eligible members can use for reimbursement of certain medical expenses. It is funded with distributions from SASMI, based on the employer contributions received by SASMI. The Active Plan HRA is considered a “limited HRA,” which means that SASMI chooses the expenses that are eligible. Only prescription drugs and allowable over-the-counter medical items can be purchased through the Active Plan HRA.

When is my Active Plan HRA first available to me?

For your Active Plan HRA to become available:

• You must have a total of at least 250 credits (currently $1 = 1 credit) allocated to you; and
• You must be eligible for SASMI benefits, not have lost eligibility under the plan, not have terminated participation, and not have lost qualification for benefits. For details, see Active Plan Article II and Article XII. Also refer to additional FAQs, below.

How will my Active Plan HRA be funded?

On or about July 1 of each year, credits will be added to your Active Plan HRA, based on the contributions SASMI receives for work you performed in the prior calendar year. Credits are determined in an amount equal to 20% of the contributions received by SASMI, and each credit is worth one dollar. For example, Sam had $6,000 in contributions in 2022. Around July 1, 2023, he will have 1,200 credits (worth $1,200) added to his Active Plan HRA.

How do I access the HRA?

The Active Plan HRA will be accessible to eligible members through a debit card administered by WEX, which eligible participants can use to pay for covered medical expenses. (If you are a member of a local where the HRA debit card is unavailable, see the question below).

What do I need to do to start using the HRA?

IMPORTANT: The debit card won’t automatically be sent to you. You must visit the member portal and register for it.

• Go to sasmi.org > Member Portal Login to get your card.
• Once you receive the debit card from WEX, the Active Plan HRA administrator, activate it and then you can start using it.

What happens if I lose my card?

Call the SASMI HRA Help Line at 800-858-0354 to request a replacement card.

What members can’t get a HRA debit card?

If you are a participant in the Sheet Metal Workers National Health Fund (Locals 5, 54, 67, 214, 399, 435) the employees of CI Metal Fabrication, or Locals 85 and 15, an HRA debit card is unavailable to you.

Can I still use the HRA if an HRA debit card is unavailable to me?

Yes! You can still use the HRA for your prescription and allowed over-the-counter expenses:

• Pay for your prescriptions as you currently do and submit your claim to your insurance carrier. When you receive your Explanation of Benefits (EOB), use the SASMI/WEX HCRA mobile app to upload the EOB so that you can receive reimbursement.
• If you shop for eligible over-the-counter items, you’ll need to upload your itemized receipt through the app to receive reimbursement.

Download the SASMI / HCRA app on the App Store or Google Play and use it to manage your HRA and get reimbursed.

What types of expenses are covered?

The Active Plan HRA can be used to pay for prescription medication and allowable over-the-counter (OTC) items such as pain relievers, antacids, allergy and sinus medications, and first-aid supplies, at the pharmacy counter of your local drug store or grocery store. The HRA can also be used to purchase eligible items from a participating online FSA vendor. Currently, SASMI partners with the FSA Store at fsastore.com.

Can I use the HRA to pay for doctor visit copays or a dental or vision exam?

No. The SASMI HRA is considered a “limited HRA.” This means that only certain expenses are eligible: prescription drugs and allowable over-the-counter medical items.

What are examples of ineligible HRA expenses?

Examples of ineligible items include diapers, hand lotion, cosmetics, general dental products such as standard toothpaste, general daily vitamins, and dietary supplements without a doctor’s note.

Can I use my funds for my family members’ expenses?

Yes. You can use these funds to pay for prescription drugs and allowable over-the-counter medical items for you, your spouse, and your eligible dependents if they are covered under your SMART Health Plan.

After I begin using my HRA, are there any ongoing eligibility requirements to meet?

Yes. You must be eligible for SASMI benefits and not have terminated participation. If you lose eligibility, then your HRA debit card will temporarily be unavailable for use until you regain eligibility. See FAQ 10–16 for how the HRA debit card could be suspended or forfeited. (For details, see Active Plan Article II and Article XII, and additional FAQs below).

Note: You will not lose the ability to use your HRA card simply because you are ineligible for other benefits under the 200% rule or because you are ineligible for supplemental unemployment or underemployment benefits based on a failure to work 10% of the applicable group hours.

If my credit balance drops below $250, can I continue to use my HRA debit card?

Yes. Your HRA needs to be at 250 credits for the account to become available the first time. After that, unless your account is suspended or forfeited you can continue to use the balance in your account. See additional FAQs below for more info.

What happens if my HRA balance drops to $0?

No need to maintain a certain amount in the HRA. If your account balance drops to $0, your account will be inactivated until the next July credit allocation, when your card will be reactivated and ready to use.

Is there anything else that can cause my HRA card to be suspended or inactivated?

Yes. Firstly, if you lose eligibility in your local SMART Group Health and Welfare Plan, your Active Plan HRA will be suspended. Secondly, SASMI pays a monthly fee for each card. If there is no activity on your card for 12 consecutive months, your card will be inactivated and you will be notified. You can call 800-858-0354 to get your card reactivated.

If my card is suspended or inactivated, will I get future allocations?

Yes. Each July, if you are eligible, an allocation will be made to your Active Plan HRA whether you have activated your HRA card or your HRA card has been suspended for inactivity. All allocated credits will remain available until used unless forfeited or otherwise lost (see FAQ 14–16 below).

Can I lose (forfeit) my Active Plan HRA benefit?

Yes. As with all SASMI Active Plan benefits, your Active Plan HRA can be forfeited if you lose eligibility, terminate participation, or lose qualification for benefits (as stated in the Active Plan), including if:

• You accept any employment in the sheet metal industry from an employer who is not party to a collective bargaining agreement with the international union or a local union;
• Your home local union takes an action that terminates or will at some future date terminate the provisions of the local union’s contracts; or
• You permanently cease employment in the sheet metal industry, accept permanent employment outside the sheet metal industry, whether or not you remain in your home local union, or become a partner or the sole proprietor of a business in the sheet metal industry.

If you transfer to a local union with no contracts or one with a contract only requiring contributions to HCRA-B, you will lose access to your Active Plan HRA. However, the remaining balance will be added to your Retiree HCRA at retirement if you are eligible. (See Active Plan Article XII(b)(2).)

What happens to my Active Plan HRA if I die?

If you have surviving dependents who were covered by your local SMART welfare plan, they can continue to use your Active Plan HRA as long as they remain covered. Your Active Plan HRA account balance will be forfeited if you die while an active participant and you don’t have any surviving dependents covered under your SMART welfare plan immediately prior to your death.

What else could cause me to lose my Active Plan HRA?

Like all SASMI benefits, the Active Plan HRA is not a vested benefit and, while the Trustees don’t anticipate this happening, they can at any time discontinue the benefit or modify the value of the credits (currently $1 per credit) in your account.

Can I choose to let my Active Plan HRA account “grow” without using it?

Yes. You are not required to take the steps to get your HRA card nor are you required to use the benefit if you do have the card. There is currently no limitation on how large the account can grow. See the question below for what happens if you have an Active Plan HRA balance at retirement. Also, see the FAQ on information about forfeitures and how the value of the credits in your account can change.

Is the allocation to my Active Plan HRA treated as an active benefit?

Yes. When the Active Plan HRA allocation is made each July, the calculation of your active benefits taken will be increased by the amount of the HRA allocation for purposes of the 200% rule (100% if you have more than $125,000 in contributions). The allocations will also be counted as active benefits when your severance (if applicable) and retiree HCRA are calculated.

If I don’t use all of my Active Plan HRA, what happens to the balance?

Any Active Plan HRA balance remaining when you retire will continue to be available to you and your eligible dependents. The amounts from your Active Plan HRA, your retiree HCRA, and, if applicable, your service-based HCRA will all appear as a single account.

To be eligible, you must be eligible for SASMI benefits both during the stabilization period in which you (or your spouse or child) get the exam or screening and at the time you apply for the benefit. You must be covered by a Welfare Plan maintained under your Collective Bargaining Agreement, but you are eligible to receive this SASMI benefit even if your Welfare Plan covers your exam in full — as most do.

For your spouse or children to be eligible, they must be covered as a dependent under the Welfare Plan maintained under your Collective Bargaining Agreement.

Benefit amounts are per calendar year and depend on whether the person getting the exam is a member, spouse or dependent. The maximum amount you can receive for your family in a calendar year is $600. Your benefit will be directly deposited into your bank account.

For purposes of this benefit, a physical examination is a routine test your primary care provider (PCP) or OB/GYN performs to check your overall health. A PCP may be a doctor, a nurse practitioner, or a physician assistant. The exam is also known as a wellness check.

An annual physical exam may be a general annual physical exam, a well woman exam, or an annual well child exam. The exam may include:

• A comprehensive review of systems, including the cardiovascular system, respiratory system, musculoskeletal system, etc.

• A well woman exam, a pap smear, or a screening mammogram

• A PSA exam, for males

• A screening colonoscopy or other colorectal screening test

• A multi-system physical examination based on the patient’s age, gender, and identified risk factors

• Any age-appropriate counseling and risk factors assessed

It does not include annual eye exams, dental cleaning and routine visits, or routine follow-up visits after a medical incident such as a follow-up with a cardiologist or oncologist or dermatologist. It is not a visit for treatment of an illness or injury or that is scheduled because you are having symptoms of an illness or injury.

Once you get your checkup or screening, you have 12 months from the date of service to claim your benefit. If you submit your application for the benefit after December 15, it will not be processed until the next calendar year.

• To get started, log in to the member portal and click on “Applications” and then “Annual Physical Benefit” to access the form.

• Complete the online form. You need to upload a copy of your SMART-affiliated health and welfare fund’s Explanation of Benefits (EOB) that shows that you (and/or your family member) received the preventive care from a qualified professional.

• You need to provide your bank routing information for direct deposit.

You’ll be notified via email once the benefit has been deposited into your bank account.

When should I submit a claim to SASMI to receive my benefit?

You must submit the claim within 12 months of the date you received the exam. Note that you are only eligible to receive one benefit (payment) per person, per calendar year. If you submit a claim after December 15, it will not be processed until January and will be counted as the benefit for the year it is paid, not the year in which you received the physical exam.

For example:

• George has a physical exam in November 2021.

• He completes his online claim form and uploads his EOB on December 20, 2021.

• Because it’s after December 15, his benefit won’t be paid until January 2022.

• George will not be eligible to receive another benefit payment in 2022, even if he gets another exam in 2022.

Do I need to incur an expense to get the SASMI benefit? My Welfare Plan or insurance covers my annual physical and I pay $0.

No! The great thing about this SASMI income-replacement benefit is that the money is yours just for getting the preventive care. It’s not a reimbursement. You don’t have to incur an expense to get this benefit!

If I get this benefit, will it reduce what I can get from other SASMI benefits, like unemployment, severance or Retiree HCRA?

No! Receiving this benefit does not limit your eligibility for other benefits under the plan, and does not affect your future severance or Retiree HCRA benefits.

My spouse and kids aren’t covered as my dependents under my SMART Health Insurance Fund — my spouse has her own coverage and covers our children. Can they still receive this benefit?

No. To be eligible for the benefit, dependents must also be covered as a dependent under the Welfare Plan maintained under your Collective Bargaining Agreement. The benefit does apply if your dependents have dual coverage.

Do I need to submit claims for myself and my family members at the same time?

No, you can submit individual claims at any time as long as they are submitted within 12 months of the date of the exam—just remember that a maximum benefit of $600 will be paid in a calendar year. Again, if you submit your application after December 15, it will not be processed until January. You must meet eligibility requirements both at the time of the exam and at the time you apply for the benefit to receive your (or your family’s) benefit.

You can apply for your work boots through the member portal. Just log in and navigate to “Applications.” Complete the application and submit. SASMI will email you a website link, sign-in information, and coupon code.

From there, you’ll register with the link you receive and select your SASMI-approved Thorogood or Carolina boots. The Union Boot Pros will handle everything to make sure you’re satisfied.

Shipping, returns, and exchanges are free. And there’s no sales tax (unless you live in Wisconsin).

The work boot benefit does NOT reduce your future SASMI benefits.