Annual Physical Benefit
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 for the Annual Physical Benefit, 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.
You must be an active member and eligible for the benefit both at the time you (or your family member) get the preventive care and at the time you apply for the benefit.
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 Eligible | Annual Benefit Amount* |
|---|---|
| You | $200 |
| Your spouse | $100 |
| Your dependent child(ren) | $100 per child |
*The 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.
- 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.
- 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 the 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.