UFCW LOCAL 1776 and PARTICIPATING EMPLOYERS
                                   HEALTH and WELFARE FUND

Who Provides My Benefits?

The Fund provides health insurance benefits for hospitalization, doctor visits, and certain other medical care through the Personal Choice Program (or if you live outside the Personal Choice Preferred Provider Network area, through the Preferred Provider Organization Program) administered by the QCC Ins. Co., a subsidiary of Independence Blue Cross. Independence Blue Cross administers the Personal Choice Program and the Preferred Provider Organization Program and generally makes determinations with respect to claims for benefits. The address is:

Independence Blue Cross
1901 Market Street
Philadelphia, PA 19103

The Fund provides life insurance and accidental death and dismemberment benefits through an insurance policy purchased from Standard Insurance Company. The address is:

Standard Insurance Company
460 East Swedesford Road, Suite 1090
Wayne, PA 19087

The Plan pays directly for, or self-insures, your benefits for child care, dental, disability, education, vision, physical well-being, and mental, nervous, drug & alcohol. The Board has contracted with an outside provider to process the claims for child care, vision and mental, nervous, drug & alcohol benefits, as described in the appropriate section of this booklet. When you submit a claim for a charge for this service, the provider is responsible for following the schedule of benefits established by the Board of Trustees and making payment in accordance with that schedule. The Fund pays the provider a fee to perform these administrative services. The name and address of the providers that the Board of Trustees has hired to administer the child care, prescription, mental health and vision benefits are:
PRESCRIPTION BENEFITS:VISION BENEFITS
National Medical Health CardGroup Vision Associates
26 Harbor Park Drive2811 Lord Baltimore Drive
Port Washington, NY 11050Baltimore, MD 21244
MENTAL HEALTH BENEFITS 
Mental Health Consultants, Inc. 
1878 Sugar Bottom Road 
Furlong, PA 18925 
  
 
If you disagree with an action taken or a final decision made by the provider that administers your benefits, you should write to the Fund Administrator to request a review of the provider’s action or decision, as described in the section titled “Appealing a Denied Claim.” (You must also follow the claims procedure to dispute a decision made by the Fund about any of your benefits.)