UFCW LOCAL 1776 and PARTICIPATING EMPLOYERS
HEALTH and WELFARE FUND

Table of Contents
Summary Plan Description		Medical Flexible Spending Account
Introduction		How it works
Who Provides My Benefits ?		Tax Advantages
How to use This Booklet		Reimbursement
Benefits at a Glance		"Use It or Lose It"
Who is Eligible		Medical Emergency Benefit
Changes in Coverage		Allergy Benefit Plan
Retiree Benefits		Mental, Nervous, Drug & Alcohol Benefits
If You Terminate Employment		Dental Coverage
If You Become Disabled		Prescription Drug Benefits
Termination of Dependents' Coverage		Prescription Incentive Program
Continuing Coverage Under COBRA		Overview of the Program
Other Federal Law Requirements		Medical Expenses Reimbursable Under the Program
Medical Coverage		Vision Care Plan
Personal Choice Preferred Provider Network		Disability Benefits
Convenience and Security Across the Country		How to file a Claim
How the BlueCard PPO Program Works		Coordinating With Third Parties (Subrogation or Reimbursement)
Plan Provisions		Life Insurance Benefits
Pre-certification		Accidental Death and Dismemberment
How to Submit Claims		Child Care Assistance
What the Plan Covers		Educational Benefit Program
General Exclusions		Physical Well-Being Program
Keystone Point Of Service (KPOS) Program		Claim Filing Deadlines
How the KPOS Program Works		Appealing a Denied Claim
Some Important Terms		Coordination of Benefits ("COB")
You Need Medical Care		Coordinating With Medicare
Pre-certification		Important Information
Dual Income Option		ERISA Statement
		Administrative Information