UFCW LOCAL 1776 and PARTICIPATING EMPLOYERS
                                  HEALTH and WELFARE FUND
 

Who is Eligible?
You are eligible to participate in the Plan if you are an active employee, as provided in your collective bargaining agreement. (Refer to your collective bargaining agreement to determine your eligibility for benefits.) You are entitled to all benefits discussed in this booklet (either Option A or Option B). Your dependents are not eligible for benefits under the Plan, except that unmarried dependent children may be eligible for the Educational Benefit Program. For this purpose, children include your natural children, legally adopted children or children legally placed for adoption, foster children, and stepchildren. (Stepchildren must live with you and you must claim them as dependents on your federal income tax return.) You may also claim other children if they live with you, you claim them as dependents on your federal income tax return and you are their legal guardian. There are special rules on dependent eligibility for the Educational Benefit. Please refer to that section for more details. There are two benefit options you can choose from under this Plan. Each option offers different benefits. Here are the benefits each option provides:
Plan I Option A

   Dental
   Vision
   Mental, Nervous,
     Drug & Alcohol (Referral Only)
   Physical Exam
   Child Care
   Educational Benefit
   Physical Well Being
Plan I Option B

   Personal Choice Plan B
   Dental
   Vision
   Mental, Nervous,
     Drug & Alcohol
     Inpatient/Outpatient Coverage
You are automatically enrolled for Option A benefits. You may, however, select Option B benefits instead. To select Option B benefits, you must complete and return the enclosed Plan Selection Form within 60 days of the date you become eligible for benefits. The option you choose depends on your personal needs. For example, Option A offers more types of benefits, but does not include medical coverage. If you already have medical coverage under another benefit plan, such as your spouse's group health plan, then Option A may be the best selection for you. If you do not have any other medical coverage though, you may want to be covered under Option B.

Make your selection carefully. Whether you remain in Option A or change to Option B, your selection will remain in effect until you become eligible for a plan upgrade in accordance with your collective bargaining agreement. If there is no plan upgrade, you may change your selection effective September 1 of each year by notifying the Fund office. You will not be entitled to change your selection at any other time during the year.

IMPORTANT: If your child ceases to qualify as a "dependent" under the terms of the Plan, you must notify the Fund office immediately. If you fail to notify the Fund office of a change, and the Fund pays benefits to or on behalf of your former dependent, the Fund may sue you for reimbursement or instead may deny you future benefits until the amount owed is recouped.