UFCW LOCAL 1776 and PARTICIPATING EMPLOYERS
HEALTH and WELFARE FUND

Physical Examination (Option A only)

The best way to keep medical costs down and maintain good health is to have regular physical examinations. The Plan pays a benefit of up to $100 for routine physical exams. If you are covered for physical exams under any other plan, please check the section titled “Coordination of Benefits” to see how to submit your claims.

If you are under 40 years old, you may have a routine physical exam once every two years. After you reach age 40, you may have a routine physical once each year. The $100 maximum includes your doctor’s charges and the cost of any routine tests. You pay any expenses over $100.

For a claim form, contact the Fund office. Both you and your doctor must complete the form. The Plan can pay the benefit directly to you or to your doctor, whichever you choose. Claims must be submitted no later than 1 year from the date of service. Otherwise, the Plan will deny your claim.