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For active participants needing to pay a self-payment:
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Health Fund
Links
- Express Scripts Members: Manage Your Prescriptions Online
- EBIA Health Care Expenses Table
Password: HCET2022
- Machine-Readable Files
- MemberXG
MemberXG has replaced NETime as of 2/1/16
- Delta Dental
- United Healthcare
Summary of Benefits
- FVSMHF Active Premier SBC 2024
- FVSMHF Active Standard SBC 2024
- FVSMHF Pre Apprentice SBC 2024
- FVSMHF Retiree SBC 2024
- Humana SMART MAPD Prescription Drug Guide - 2015
- SMM 1 to 2010 SPD August 2010
- SMM 10 to 2010 SPD December 2012
- SMM 11 to 2010 SPD June 2013
- SMM 12 to 2010 SPD October 2013
- SMM 13 to 2010 SPD January 2014
- SMM 14 to 2010 SPD April 2014
- SMM 15 to 2010 SPD November 2014
- SMM 16 to 2010 SPD January 2015
- SMM 17 to 2010 SPD February 2015
- SMM 18 to 2010 SPD October 2015
- SMM 19 to 2010 SPD December 2015
- SMM 2 to 2010 SPD December 2010
- SMM 20 to 2010 SPD February 2017
- SMM 21 to 2010 SPD July 2017
- SMM 22 to 2010 SPD June 2018 adopted December 2017
- SMM 23 to 2010 SPD June 2018 adopted May 2018
- SMM 24 to 2010 SPD December 2018
- SMM 25 to 2010 SPD February 2019
- SMM 26 to 2010 SPD March 2019 adopted May 2019
- SMM 27 to 2010 SPD May 2019
- SMM 28 to 2010 SPD May 2019 eff August 2019 adopted September 2019
- SMM 29 to 2010 SPD May 2019
- SMM 3 to 2010 SPD January 2011
- SMM 30 to 2010 SPD May 2019 EAP
- SMM 31 to 2010 SPD December 2019
- SMM 32 to 2010 SPD April 2020 adopted May 2020
- SMM 33 to 2010 SPD September 2020
- SMM 34 to 2010 October 2020
- SMM 35 to 2010 SPD December 2020
- SMM 36 to 2010 SPD September 2021
- SMM 37 to 2010 SPD September 2021
October 2021
- SMM 38 to 2010 SPD December 2021
- SMM 39 to 2010 SPD December 2022
- SMM 4 to 2010 SPD May 2011
- SMM 5 to 2010 SPD November 2011
- SMM 6 to 2010 SPD November 2011
- SMM 7 to 2010 SPD December 2011
- SMM 8 to 2010 SPD February 2012
- SMM 9 to 2010 SPD May 2012
- Summary Plan Description
Forms
- Accident Information Form 2012
- Authorization to Release Health Information
HIPAA Form
- Beneficiary Form
- Continuing Disability Form
- Express Scripts Reimbursement and COB Claim Form
January 2022
- FVSM Active Enrollment Form 2024
- FVSMHF Retiree Enrollment Form 2024
- FVSMHF Spousal & Dependent Coverage Form 2024
- HRA Reimbursement Form
- Loss of Time Claim Form
- Patient Advocacy Services
WI Sheet Metal
Health Fund
Links
- Express Scripts Members: Manage Your Prescriptions Online
- Machine-Readable Files
- EBIA Health Care Expenses Table
Password: HCET2022
- MemberXG
MemberXG has replaced NETime as of 2/1/16
- Delta Dental
- Medicare Retiree Human MAPD - Humana Physician Finder
- Anthem - PPO Directory
Documents
- WSMHF Medicare UHC Medicare PPO Plan Option
- WSMHF Active complete Open Enrollment packet 2024
- WSMHF Pre Apprentice complete annual Enrollment packet 2024
- WSMHF Non Medicare Retiree complete annual Enrollment packet 2024
- WSMHF Retiree over under complete annual Enrollment packet 2024
- WSMHF MedExpert Oct 2023
- WSMHF MemberXG Online Portal Oct 2023
Notices
- SMM January 2024
- CHIP Notice
- Summary of Annual Report 2022
- Prescription Drug Creditable Coverage Notice
- End of Public and National Emergency - COVID
- 2013 HIPPA Notice of Privacy Practices
- Your Rights and Protections Against Surprise Medical Bills
January 2023
- Affordable Care Act Grievance Procedure
October 2016
Forms
- Accident Information Form
- Authorization to Release Health Information
HIPAA Form
- Continuing Disability Form (Employee Supplement Form)
- Enrollment Form Active Bargained
- Express Scripts Reimbursement and COB Claim Form
January 2022
- HRA Request Form
2016
- Loss of Time Claim Form
- Maternity Benefit Claim Form
January 2023
- Medicare Eligible Retiree Enrollment Form
January 2023
- Patient Advocacy Services
- Retiree Participation Form
January 2023
- Spousal and Dependent Coverage Form
