Wisconsin Sheet Metal Workers Health and Benefit Fund moves to Anthem

Effective January 1, 2025, Wisconsin Sheet Metal Workers Health and Benefit Fund will offer a PPO plan with Anthem. Medical benefits for Wisconsin Sheet Metal Workers Health and Benefit Fund retirees will be provided through an PPO from Anthem, which includes the National Access Plus benefit. The PPO plan allows members to receive services from any provider, as long as the provider is eligible to receive payments from Medicare Advantage.

Wisconsin Sheet Metal Workers Health and Benefit Fund members’ copay or coinsurance percentage will be the same whether their provider is in-or out-of-network. Locally or nationwide, doctors or hospitals, member share-of-cost (SOC) will not change.

Non-contracted providers may continue treating Wisconsin Sheet Metal Workers Health and Benefit Fund members and will be reimbursed 100 percent of Medicare Advantage’s allowed amount for covered services, less any member SOC.

The Medicare Advantage plan offers the same hospital and medical benefits that Medicare covers while covering additional benefits that Medicare does not, such as LiveHealth Online and SilverSneakers.

The prefix on the Medicare Advantage member ID cards is WZV.

Detailed prior authorization requirements are also available to contracted providers by accessing the Provider Self-Service Tool at https://Availity.com.

Providers will follow their normal claim filing procedures for Wisconsin Sheet Metal Workers Health and Benefit Fund member claims.

Call Provider Services at 833-910-4432 for eligibility, prior authorization requirements, and any questions about the Wisconsin Sheet Metal Workers Health and Benefit Fund member benefits or coverage.