If you are eligible to participate in the UFCW Local 1776 and Participating Employers Flexible Benefits Plan, you may elect medical coverage under the Dual Income Option instead of the Personal Choice Program. You should refer to the Flexible Benefits Plan Summary as well as your collective bargaining agreement to determine whether you are eligible to participate in the UFCW Local 1776 and Participating Employers Flexible Benefits Plan.

If you have, or can enroll in, other medical coverage which provides sufficient medical benefits for you and your family (for example, through another job or through your spouse's employer, including a Contributing Employer), you may want to elect coverage under the Fund's Dual Income Option. You must provide proof of other medical coverage for you and your family, and you must waive your medical coverage options under the Personal Choice Program and the Keystone Point of Service Program.

The Dual Income Option will give you the most options to elect other benefits under the Flexible Benefits Plan. You should refer to the Summary of the Flexible Benefits Plan for more details about your options under the Flexible Benefits Plan.

Under the Dual Income Option, you will be eligible for up to $5,200 in reimbursement of eligible medical expenses such as co-payments, deductible and coinsurance amounts.

Under the Dual Income Option, the Plan provides payment for the first $200 of eligible medical expenses and 20% of the next $25,000 of eligible medical expenses, up to an annual maximum benefit of $5,200 ($200 plus 20% of $25,000) per person. The Plan does not pay expenses under the Dual Income Option for services that are not covered for any reason under the terms of your other medical plan or expenses that are incurred as a result of failure to pre-certify or otherwise follow the procedures of the other medical plan.

If you, your spouse or a dependent incurs an eligible medical expense, you should submit the claim for payment first to your other medical plan in accordance with the usual claims procedures for that plan. When you receive an Explanation of Benefits ("EOB") from the other plan, submit the EOB and the other itemized bill to the Fund office along with a claim form. You should contact the Fund office to obtain the appropriate claim form. The Fund provides all administrative services related to medical coverage under the Dual Income Option and makes determinations with respect to claims for benefits.