UFCW LOCAL 1776 and PARTICIPATING EMPLOYERS
HEALTH and WELFARE FUND

Changes in Coverage

Plan coverage for you and your dependents continues as long as you remain an active, part-time employee. If you become a full-time employee, you may be eligible for a different plan of benefits under the Fund. If you terminate your employment, retire or become disabled, your coverage under the Plan ends. Your coverage will also end if your participating employer does not pay the required contributions to the Fund.

If You Terminate Employment

If you terminate your employment, your coverage ends on the last day of the month in which you terminate. If you take an authorized leave of absence or are laid off, you lose coverage at the end of the period for which you participating employer pays the required contribution on your behalf.

If you Become Disabled and Elected the Medical Coverage

If you are unable to work because of a disability, your coverage continues while you are disabled for a period of up to 26 weeks from your last day of work provided you continue to pay the applicable co-payment. If you are still not working at the end of 26 weeks and are still disabled, you must contact the Fund office. At that time, you may continue your medical coverage for up to one year. You pay the entire premiums for this continuation coverage. If you are judged as disabled by the Social Security Administration (SSA), you may continue to pay for coverage under the self-pay option beyond that one year period, until you become entitled to Medicare. If SSA does not find you disabled, you may then elect to continue coverage under COBRA, which is discussed later in this section.

Termination of Dependents' Coverage

Your dependents' coverage under the Plan ends after the earliest of the following:

The date your coverage ends.

The last day of the month in which a covered dependent no longer qualifies as a dependant. For example, you child reaches the of 19)

The date a dependant enters the armed forces on full-time, active duty.