Local 400 Health & Welfare

Questions? Please contact the administrative office toll-free at 1-866-562-4004 (WI Only) or (414) 577-3705. They can also help you with dollar bank balances and requests for short-term disability forms.

Address: Local 400 Health & Welfare, c/o Benefit Plan Administration

One Park Plaza, 11270 West Park Place, Suite 950, Milwaukee, WI 53224

fax: (414) 577-3710

Please visit the BPA website: http://www.bpalja.com. You will be able to get SPDs, Enrollment Forms, Beneficiary Forms, Dollar Bank Reimbursement forms and Benefit Bulletins at this site. Contact the union hall or BPA for the logon id and password under Client Access.

Please inform BPA in writing of any changes, such as: change of address, martial status (marriage, death, divorce or legal separation); the death or disability of you or any of your dependents; the birth or adoption of a dependent child, or the addition of a stepchild due to marriage; and a child’s dependent status due to age, student status, marriage, financial dependency on someone else or financial independence. You may also request a Beneficiary Designation form if you wish to change your life insurance beneficiary.

For prescription drug questions, please call Catalyst Rx. You may contact them at 1-866-795-6816. Their website is: http://www.catalystrx.com.

Remittance Address: Please use the following address for health insurance premium payments ONLY. Working members, this does not apply to you unless you are laid off for a period of time and your dollar bank runs empty. In that case, you would receive a notice from BPA informing you that you owe something for health insurance premium. Below is the remittance address:

Plumbers & Steamfitters Local 400

Health & Welfare Fund

P.O. Box 3016

Milwaukee, WI 53201-3016

PPO Service Link: To find out if your health care provider is a part of the UnitedHealthcare Choice Plus PPO network for Local 400: http://directory.uhis.com.

Effective April 1, 2010, Affinity & Holy Family Medical in Manitowoc are no longer in the provider network. You can still utilize their services; however, claims will be paid at the out-of-network rate. The EPA (Employee Assistance Program) and Health Dynamics Program provided by Affinity will not be affected.

Health Dynamics Preventive Care Program: http://www.healthdynamics.com/

Health Dynamics is a preventive care promotion program that offers a medical and fitness examination to you and your spouse as part of your benefit plan through your Health Fund. Their goal is to educate you on your current level of health and fitness and prevent disease by helping you develop a healthier more productive lifestyle.

Your first visit includes:

¨ Health history questionnaire ¨ Complete blood chemistry analysis ¨ Body composition ¨ Resting blood pressure ¨ Height and weight measurements ¨ Pulmonary function test ¨ Strength evaluation ¨ Flexibility testing ¨ 12-Lead EKG ¨ Cardiovascular fitness test

¨ Physician-directed examination ¨ Urinalysis ¨ Colorectal cancer screening (multi-slide available) ¨ Chest X-ray (OSHA Guidelines) or Mammography (ACS Guidelines) ¨Pap smear available upon request ¨ PSA Test (ACS Guidelines)

Your second visit includes:

¨ Results report booklet

¨ Personal Consultation

Health Dynamics Provider Locations for Scheduling Appointments:

Affinity Occupational Health St. Elizabeth’s Hospital Cardiac Rehab 1506 S. Oneida Street Appleton, WI 54915 (920) 727-8715 Prevea WorkMed 3021 Voyager Drive Green Bay, WI 54311 (920) 405-1420 St. Mary’s – Prevea 1715 Dousman Street Floor 2R Green Bay, WI 54303 (920) 405-1420

Saints Health Services for Business 5412 Hwy. 10E, Ste. D Stevens Point, WI 54481 (715) 346-5243, Option 2 Saints Health Service Good Samaritan 601 S. Center Ave. Merrill, WI 54452 (715) 346-5243, Option 2 St. Nicholas Hospital 3100 Superior Street Sheboygan, WI 53081 (920) 459-5176

Ripon Medical Center 933 Newbury Street Ripon, WI 54971 (920) 748-9156 Bay Area Mobility Center 3117 Shore Drive, Ste. 101 Marinette, WI 54143 (715) 732-5100 *Other locations in Western and Southern WI are available—please call the Health Dynamics Milwaukee office: (414) 443-0200.

Last Updated: 5/28/2010