Medical Coverage: Personal Choice Program - Plan A

The Fund provides health insurance for hospitalization, doctors’ visits, and certain other medical care for you and your eligible dependents through the Personal Choice Program (or if you or your eligible dependents live outside the Personal Choice Preferred Provider Network, through the Preferred Provider Organization Program) administered by the QCC Ins. Co., a subsidiary of Independence Blue Cross ("IBC"). The Personal Choice Program is structured as a Preferred Provider Organization (PPO), as described in further detail in this section. If you are covered under any other medical plan, check the section titled “Coordination of Benefits” to see how you should submit your medical claims.

This section summarizes the current provisions of the Personal Choice Program. As a summary, it cannot contain all the details and provisions of the program. The underlying documents with respect to the program are incorporated by reference as if fully set forth in this booklet. If there are any differences between the benefit descriptions set forth in this booklet and the underlying documents, the underlying documents prevail. If you wish to review the underlying documents, please contact the Fund office. For further details about specific coverages, you should contact the IBC/UFCW Local 1776 Dedicated Customer Service Unit at 1-800-335-9596.

Participants who are eligible to participate in the UFCW Local 1776 and Participating Employers Flexible Benefits Plan may elect to forego their medical coverage under the Personal Choice Program and instead elect medical coverage under either the Keystone Point of Service Program or the Dual Income Option. These other medical coverages are described more fully in later sections of this booklet. 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.