UFCW LOCAL 1776 and PARTICIPATING EMPLOYERS
                                     HEALTH and WELFARE FUND
 

Who Provides My Benefits ?

The Fund provides health insurance benefits for hospitalization, doctor visits, and certain other medical care through the Personal Choice Program (or if you live outside the Personal Choice Preferred Provider Network area, through the Preferred Provider Organization Program) administered by the QCC Ins. Co., a subsidiary of Independence Blue Cross. Independence Blue Cross administers the Personal Choice Program and the Preferred Provider Organization Program and generally makes determinations with respect to claims for benefits. The address is:

Independence Blue Cross
1901 Market Street
Philadelphia, PA 19103


The Plan pays directly for, or self-insures, other benefits including dental, vision, mental health treatment, physical exam, child care, physical fitness, and education. The Board has contracted with outside providers to process the claims for certain of these benefits, including mental health treatment, child care, and vision, as described in the appropriate sections of this booklet. When you submit a claim for a charge for these services, the applicable provider is responsible for following the schedule of benefits established by the Board of Trustees and making payment in accordance with that schedule. The Fund pays these providers a fee to perform these administrative services. The names and addresses of the providers that the Board of Trustees has hired to administer these benefits are:

MENTAL HEALTH BENEFITS:
Mental Health
Consultants, Inc.
1878 Sugar Bottom Road
Furlong, PA 18925		 VISION BENEFITS:
Group Vision Associates
2811 Lord Baltimore Drive
Baltimore, MD 21244
 CHILD CARE BENEFITS:
Time for Tots, Inc./Tot Time
P.O. Box 796
Plymouth Meeting, PA
19462-0796

If you disagree with an action taken or a final decision made by any provider that administers your benefits, you should write to the Fund Administrator to request a review of the provider’s action or decision, as described in the section titled “Appealing a Denied Claim.” (You must also follow the claims procedure to dispute a decision made by the Fund about any of your benefits.)