(For Eligible Employee and Spouse Only)

Every two calendar years, the Fund will pay wellness benefits up to the amount listed in the Schedule of Benefits for you and your spouse. These benefits include:

1. Physical examinations,
   
2. Blood tests,
   
3. Pap Smears,
   
4. X-rays,
   
5. Mammograms,
   
6. EKGs,
   
7. Smoking cessation programs, and
   
8. Other routine services and covered supplies that contribute to maintaining your wellness, if approved in advance by the Fund Office, and are not covered elsewhere under the Plan. A request for such pre-approval constitutes a pre-service claim.

You do not need to pay a deductible or co-payment for these benefits and you may use either PPO or non-PPO health care Providers.

Wellness benefits are provided only for you and your spouse and are not provided for your Dependent Children. However, Inpatient nursery charges, Physician office visits and immunizations are covered under the comprehensive Major Medical Benefit for your Dependent Children up to the age of sixteen.

Please note that wellness benefits will only be paid when your Physician uses a diagnosis code that qualifies for reimbursement under the Fund. For more information, please contact the Fund Office.