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, in accordance with your collective bargaining agreement. Your dependents are not eligible under the Plan, except for the Educational Benefit and if elected, the Keystone Point of Service medical plan. There are special rules on dependent eligibility for the Educational Benefit. There are three benefit options you can choose from under this Plan. Here are the benefits each option provides:

Option I

  Child Care
  Educational Benefit
  Physical Well Being

Option II-Single Coverage

  Child Care
  Educational Benefit
  Physical Well Being
  Keystone Point of Service - $80.00 per month co-payment.

Option III - Family Medical Coverage

  Child Care
  Educational Benefit
  Physical Well Being
  Keystone Point of Service - $150.00 per month co-payment

You are automatically enrolled in Option I benefits. You may, however, select Option II  or III benefits instead. To select Option II or III benefits, you must complete and return the enclosed Plan Selection Form within 60 days of the date you are notified that you are eligible for benefits. The option you choose depends on your personal needs. For example, Option I offers benefits at no cost, 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 I 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 II or III.

Your decision is final - so make your selection carefully. Whether you remain in Option I or change to  Option II or III, your selection will remain in effect until you are eligible for a plan upgrade in accordance with your collective bargaining agreement.