I Want Additional Health and Wellness Benefits

I Want Additional Health and Wellness Benefits

SASMI offers additional benefits to encourage members to make their health and wellness a priority.

Annual Physical Benefit

Detect and treat health problems before they become serious by making preventive care exams and screenings an annual priority.

SASMI’s Annual Physical Benefit encourages you and your family to stay on top of your preventive care. Members can receive $200 per calendar year for their own physical exam, and $100 for covered family members (up to a maximum of $600 total per family, per calendar year), just for getting a routine checkup. If you need to miss work to get your exam or if you have out-of-pocket incidental expenses, this benefit can help replace any income you’ve lost.

While health plans cover many preventive care services at 100% under the Affordable Care Act, there may be additional costs associated with a routine physical (like certain tests and screenings as well as mileage and time away from work) that may not be covered. That’s when the Annual Physical Benefit may come in handy.

Eligibility

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 Amount

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.

Who’s EligibleAnnual Benefit Amount
You$200
Your spouse$100
Your dependent child(ren)$100 per child
Maximum calendar-year benefit per family is $600

What’s Covered?

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.

What You Need to Do

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.

Frequently Asked Questions

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.

SASMI: COVID-19 Vaccination Benefits

Termination of Temporary COVID Benefits

When the Coronavirus Pandemic was first declared the Trustees approved a Resolution for a Temporary Benevolent Disaster Relief Benefit.  The Trustees modified the benefit several times and, after the vaccine, the benefit was modified effective January 2022 to provide a COVID Vaccine Interference with Work Benefit and a COVID Vaccine Benefit.  The Trustees continued to monitor both the Coronavirus and the impact on employment in the industry as well as implementation and utilization of vaccines and the SASMI benefits.

The Trustees have now determined that currently the need for the benefit no longer exists.  Accordingly, the Trustees have Terminated the Interference with Work Benefit and the COVID Vaccine Benefit but will continue to monitor the situation and will, if appropriate, implement additional benefits.

Effective December 31, 2022, all remaining temporary COVID related benefits will terminate. 

Temporary COVID-19 Vaccination Benefits

SASMI is pleased to offer participants two temporary benefits:

Vaccination Benefit

To encourage all participants to receive a vaccination to protect against COVID-19, members and their covered eligible dependents (spouse and/or children) are eligible for a vaccination benefit.

Eligibility

To be eligible for this benefit, you:

  • Must be an active participant and eligible for SASMI benefits at the time of your vaccination and until receipt of payment.
  • Must submit your application no later than six months from the date of the vaccination, except that applications related to vaccinations received prior to January 1, 2022 may be submitted during the 2022 A Stabilization Period. 

NOTE: The benefit is retroactive to vaccinations received starting in the 2020 B Stabilization Period and will continue until terminated by the Trustees. 

Benefit

Members are eligible for a single benefit of $200 for receiving a COVID-19 vaccination (first shot, second shot, single shot, or booster). Eligible dependents are eligible for a single benefit of $100 each. 

How to Apply

If you are eligible, you will need to complete the application on the member portal and provide:

  • A copy of your vaccination card, so that SASMI can verify its status with the CDC.
  • For a dependent, proof that the dependent is covered as a dependent on your local welfare coverage by verification from the local Welfare Fund or the local union.

Receipt of this benefit does not limit a participant’s eligibility for other benefits under the Plan and is not taken into account when calculating severance or HCRA benefits.

Interference with Work Benefit

If you became ill and could not work due to significant side effects from a first, second and/or booster vaccination for COVID-19, you may be eligible to receive a benefit.

Eligibility

To be eligible for this benefit, you:

  • Must be an active participant and eligible for SASMI benefits at the time of your vaccination and until receipt of payment.
  • Cannot have received more in benefits than paid in contributions (the 100% rule).
  • Must submit your application no later than six months from the date of the vaccination, except that applications related to vaccinations received prior to January 1, 2022 may be submitted during the 2022 A Stabilization Period.

NOTE: The benefit is retroactive to vaccinations received starting in the 2020 B Stabilization Period and will continue until terminated by the Trustees. 

Benefit

The benefit you receive depends on the number of days you missed or were unavailable to work because of vaccination side effects. You may be eligible for up to three days (24 hours) of wages at your home local union wage rate, per vaccination. This benefit will be reported as W-2 wages and will be counted in the future in determining whether the 200% rule applies and in determining amounts for severance and HCRA benefits.

How to Apply

If you are eligible, you will need to complete the application on the member portal and provide:

  • Certification that the vaccination affected your work or availability for work.
  • A copy of your vaccination card, so that SASMI can verify its status with the CDC.

The benefit is retroactive to vaccinations received starting in the 2020 B Stabilization Period and will continue until terminated by the Trustees.

Maternity Benefit

If you are unable to work because you are pregnant or recently had a baby, you may be eligible to receive a weekly SASMI Maternity Benefit for up to 12 weeks per pregnancy. The benefit is 60% of your average hourly wage multiplied by your regular work hours.

The maternity benefit can begin as early as four weeks before your expected delivery date. In certain circumstances, you may be eligible for the benefit to begin earlier, if your inability to work is certified by a licensed physician or midwife who is providing for your care during your pregnancy.

The maternity benefits you receive will not affect the amount of any future welfare or supplemental unemployment/underemployment benefits.

To apply for maternity benefits, log into the member portal here. You must file your application no later than 12 weeks after the birth of your child/end of the pregnancy to claim benefits.

Benevolent Relief

In times of extraordinary circumstances, such as floods, hurricanes and other natural disasters, the SASMI Board of Trustees has authorized “Benevolent Relief” to aid SASMI participants. Recently the Trustees authorized payments for participants who were unemployed due to the Covid-19 pandemic.