UFCW LOCAL 1776 and PARTICIPATING EMPLOYERS                                   HEALTH and WELFARE FUND

Notification requirements

You must notify us In the event you are divorced, you or your spouse becomes covered under Medicare, or one of your children no longer qualifies as a dependent under the Plan, you must notify the Fund Administrator no later than 60 days after the event. IMPORTANT: It is your responsibility to advise the Fund office in writing when one of your dependents or your spouse is no longer eligible for coverage. If the Plan pays benefits to your former spouse or former dependents because you failed to properly notify the Plan, you will be responsible for all amounts paid to them on your behalf. We will notify you The Fund Administrator will notify you and your spouse of continuation coverage options within 14 days of the date you advise us of the above events or of the date your employer advise us of your termination of employment, reduction in hours or death. Election of continuation coverage You, your spouse and dependents will have at least 60 days to elect continuation coverage. This election period will end on the later of:    60 days from the date you would otherwise lose coverage, or    60 days from the date we mail the notice of continuation coverage to you and your spouse. Once you have made your election, you are required to pay the premium within 45 days of the date of the election. Note: If you incur covered expenses during the election period before you have made an election, your claims will not be processed until we receive your election forms. Termination of coverage Your continuation coverage will end when one of the following occurs:    The last day of the 18,29 or 36 month period as described above.    You fail to pay the premium for your continuation coverage when it is due. Your payment is due by the 30th of the month for that month's coverage. However, you have until the 10th of the following month before we will actually cut-off coverage for failing to pay your premium.    The date you become covered under another group health plan, unless the new plan contains a preexisting conditions exclusion or limitation with applies to any pre-existing condition you may have.    The date you become covered by Medicare. Coordination with  subsidized coverage If there is a qualifying event, but your employer or the Fund provides coverage without charge on account of your disability, or on account of your taking a leave of absence pursuant to the Family and Medical Leave Act of 1993, then COBRA continuation coverage does not begin until the date you lose coverage because the subsidized coverage ceases. This rule applies to self-pay coverage as well. So, if you elect to receive self-pay coverage, you will be entitled to COBRA continuation coverage after your self-pay coverage ends. You will have at least 60 days to make an election to accept or reject COBRA coverage beginning with the later of the date you would otherwise lose coverage or the date we provide you with the notice of your COBRA rights and election form. Certificates of Creditable Coverage for Participants and Dependents (HIPPA) The Health Insurance Portability and Accountability Act (HIPPA) may be important to you if you have a pre-existing condition, cease coverage under the Fund and  join a new group health plan which has a pre-existing condition exclusion. A pre-existing condition exclusion in an insurance plan means that your new insurer can refuse to pay for conditions for which you or your family members received medical advice , diagnosis, care or treatment within a certain number of months before you became covered under the new plan. HIPPA provides that if you obtain group health coverage under another plan within sixty-three(63)days of ceasing coverage under this Fund, the new group health plan may have to reduce the time during which it will not pay benefits for pre-existing conditions by the amount of time you had coverage under the Fund. You will have to present a "Certificate of Creditable Coverage" to your new health plan showing the amount of time you had coverage under the Fund. You will automatically receive a Certificate of Creditable Coverage after you cease coverage under the Fund. In addition, you have the right to request a certificate at any time within 24 month after you cease participating in the Plan.