Download TO: Active Employees Along With Their Spouses Who are LMHF

3786 Broadway Street
Cheektowaga, NY 14227-1123
Phone (716) 601-7980
TO:
FROM:
RE:
Active Employees Along With Their Spouses Who are LMHF Members
LABOR-MANAGEMENT HEALTHCARE FUND
EMPLOYEE WELLNESS INCENTIVE
Starting January 1 of each year, active employees, along with their spouses who are LMHF members, are eligible to
participate in the LMHF Employee Wellness Incentive program. There are two parts available in our program. When
the participant completes the necessary steps for Part I, the member will be issued a $50.00 HRA debit card. This
debit card should be kept even if the funds are depleted at the end of the year because additional funds will be
uploaded to the original card should you participate in any further incentives in Part II and/or the following year’s
program. The funds are accruable; therefore, if you do not use the entire $50.00 by December 31, the balances will
rollover into the following calendar year. If the participant opts to enroll in Part II, there will be an additional
$50.00 added (uploaded) to their HRA card, upon completion of the required wellness activities and documents.
The following outlines the steps you must take if you wish to receive $50.00 and/or $100.00 incentives for
participating in the LMHF wellness initiatives. The HRA debit card can be used for eligible medical expenses as
indicated on the enclosed “Eligible Expenses” document.
1.) Employee can retrieve a “Wellness” packet from his/her Human Resources/Personnel Department Wellness
packet includes: (1) Instructions regarding the submission of documents, (2) Employee Verification Form (3) Annual
Physical Verification form, (4) Health Assessment & On-line Activity directions, (5) Preventive Screening Verification
form, (6) Part II Wellness Activity Redemption form; and (7) two Labor-Management Healthcare Fund self-addressed
envelopes.
2.) To complete Part I:
A. Applicant is required to receive an Annual Physical provided by his/her Primary Care Physician between
January 1 and December 31 of the same year in which you are applying. The “Annual Physical Verification”
form must be completed and signed by the physician.
B. Applicant must complete the “Employee Verification” form and attach to “Annual Physical Verification”
form.
C. The Annual Physical Verification form and Employee Verification form must be submitted to the LMHF office
via U.S. Postal Service (self-addressed envelopes provided in packets). No faxes – originals only.
D. Applicant must be an active LMHF member at the time of his/her annual physical. If you terminate your
employment or retire, you are required to use the entire balance within 30 days of your termination date, at
which time the card will no longer be valid.
3.) To complete Part II
A. Applicant must complete the online BlueCross BlueShield WNY Health Assessment along with ten additional
approved wellness activities. The LMHF Wellness Activity Redemption Form must be completed. If Part II is
fulfilled prior to Part I, your documentation will be accepted upon submission to the LMHF office and kept on
file. However, you will not be rewarded $50 for Part II until Part I has been completed.
B. The Wellness Activity Redemption form together with the Preventative Screening Verification forms (if
applicable) must be submitted to the LMHF office via U.S. Postal Service.
C. The applicant must receive preventative screenings (if applicable) in the same year in which you are applying
for Part II.
Part I and Part II documents must be submitted no later than February 15 following the year in which you
completed the prior year’s requirements. All documents must contain original signatures! Copies/faxes not
accepted.
DO NOT SUBMIT THESE DOCUMENTS TO YOUR EMPLOYER.
4.) Your debit card will be delivered to your residence via U.S. mail. Please allow three to four weeks for delivery
following the Fund’s office receipt of your documentation. Along with your card, you will receive a sample list of
eligible/non-eligible medical expenses and instructions to follow if your card is lost or stolen.