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, in accordance with your collective bargaining agreement. If you become a full-time employee, you may be eligible for a different plan of benefits under the Fund. If your employment terminates, you retire or you become disabled, your coverage under the Plan ends as described below. Your coverage will also end if your participating employer does not pay the required contributions to the Fund.
If You Terminate Employment

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

If You Become Disabled

If you are unable to work because of a disability, your coverage under the Fund continues while you are disabled for up to six calendar months beginning with the first month following your last day of work. If you are still not working at the end of the six-month period and you are still disabled, you must contact the Fund office. At that time, you may continue your health coverage for up to 12 months under the self-pay option. You pay the premiums for this self-pay coverage. Alternatively, you may elect to continue your health coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA) at this time. If you elect coverage under the self-pay option, you will also be entitled to elect COBRA continuation coverage at the end of the 12-month period of self-pay coverage.

 Termination of Dependent’s Coverage
Your dependent’s 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 dependent ( for example, your child reaches the age of 19).
   The date a dependent enters armed forces on full-time, active duty.