Health Physical Incentive Program

Get your annual health physical.

Submit the form.
Get Paid $150 upon completion of your Health Physical.
Yes, it’s that simple.

Program available January 1st, 2024 thru December 31st, 2024.

The 2023 Health Incentive Request deadline is March 31st, 2024.

Available to all Local 400 members and spouses only.

Print the Health Physical Reimbursement Program Form

*
- Yes, I am requesting Health Physical Incentive
Local 400 Welfare Fund Employee Participant or Spouse Full Name*
Please Choose One*
Mailing Address*
Street Address City State ZIP Code
Email Address*
Phone Number*
Last 4-Digits of SS Number*
Date of Annual Health Physical*
Date Format: MM slash DD slash YYYY
Physician’s Name*