UFCW LOCAL 1776 and PARTICIPATING EMPLOYERS
HEALTH and WELFARE FUND

How to Use This Booklet

We have designed this booklet to help you understand your benefits package under the UFCW Local 1776 and Participating Employers Health and Welfare Fund. This booklet refers to your benefits package as the "Plan."

On the next few pages, you will find a "Benefits at a Glance" chart which will give you a quick overview of the benefits available to you under the Plan. In other sections, you will find details about your eligibility, what is covered, how to file or appeal a claim, whom to call when you have questions, and other important information.

If you still have questions about your benefits after you read this booklet, contact the Fund office at (610) 941-9400 or 1-800-458-8618

Specifically, the Plan provides these benefits:

For participants who elect Option A:

Dental

Vision

Mental, Nervous, Drug & Alcohol - Referral Only

Physical Exam

Child Care

Education

Physical Well Being

For participants who elect Option B:

Dental

Vision

Medical Coverage - Personal Choice Plan B

Mental, Nervous, Drug & Alcohol - Inpatient/Outpatient Coverage

There are two separate Mental, Nervous, Drug & Alcohol sections because Option A provides referral only coverage and Option B provides inpatient and outpatient counseling coverage. To understand what you are entitled to under the Plan, please read this booklet carefully. Then keep it with your important papers, so you can refer to it whenever you use your Plan benefits.

We have written this booklet in plain, everyday language to be sure you understand your rights under the Plan. If you still have questions about your benefits after you read this booklet, contact the Fund office at (610) 941-9400 or 1-800-458-8618.You can also write to the Fund Administrator at the address in the section titled "Administrative Information."

This summary plan description is just that - a summary of your benefits. Therefore, we do not discuss all provisions of the Plan here. Some of the benefits summarized herein are provided pursuant to other underlying documents. In that case, the other underlying documents are incorporated by reference as if fully set forth in this booklet. If there are any discrepancies, the underlying documents prevail. If you wish to review the other underlying documents, please contact the Fund office.