UFCW LOCAL 1776 and PARTICIPATING EMPLOYERS
                                   HEALTH and WELFARE FUND
 
Benefits At A Glance
Benefits Amount Who's Covered
Prescription Benefits
Deductible   $5 co-pay at preferred pharmacies*
   $7 co-pay at non-preferred pharmacies*
   *Plus the difference between generic and
    brand cost if generic equivalent is available		Participant & Dependents
Preferred Pharmacy 50% of net savings to FundParticipant & Dependents
Non-Preferred Pharmacy 40% of net savings to FundParticipant & Dependents
Dental
Participating Dentists $5 office visit co-pay for routine care;
additional patient co-payment for more extensive care		Participant & Dependents
Non-Participating Dentists Reimbursement based on fee scheduleParticipant & Dependents
Vision Care (provided by (GVA)
Exam 100% once every 12 monthsParticipant & Dependents
Basic Lenses100% once every 24 months Participant & Dependents
Frames$25 allowance once every 24 months Participant & Dependents
OR      Participant & Dependents
Contact Lenses$75 allowance once every 12 months instead
of all other vision care benefits		 Participant & Dependents