UFCW LOCAL 1776 and PARTICIPATING EMPLOYERS
                                   HEALTH and WELFARE FUND
 
Benefits At A Glance
BenefitsAmount Who's Covered
Dental
Participating Dentists

Non-Participating Dentists		 No co-pay for routine care; limited patient co-payment
for more extensive care.
Reimbursement based on fee schedule		Participant Only
Vision Care (provided b GVA)
Exam100% once every 12 monthsParticipant Only
Basic Lenses100% once every 24 monthsParticipant Only
Frames$25 allowance once every 24 monthsParticipant Only
OR
Contact Lenses$75 allowance once every 12 months instead
of all other vision care benefits		Participant Only
Allergy Benefit
Testing$1.25 per test, up to a maximum of 60 testsParticipant Only
Injections$5 per injection, up to 2 injections per visitParticipant Only
Serum $3 per c.c. serum
20% of UCR after $100 of  benefits
paid in calendar year		Participant Only
Physical Well Being
Participating  Facility$300 allowance per calendar year Participant Only
Non-participating Facility$250 reimbursement per calendar yearParticipant Only