Your Medical Plan Options Your Choice Benefits Supplemental Life Insurance What You Must Do Now Who's Eligible? Choose Your Benefits Carefully Home

Benefits Focused on Employee Needs The UFCW Local 1776 and Participating Employers Health & Welfare Fund offers you three medical plan options. All medical plans offered through the Fund protect you in the case of illness or injury. However, it’s important to remember that when you choose a plan which better fits your family’s needs you receive "benefit credits" (additional dollars that you can use to improve other benefits). The Fund’s giving away money! If you haven’t enrolled in the Keystone POS or Dual Income Option, you’re missing out. Get your benefit credits for the year 2004. Here’s how!

OPTION 1 Personal Choice This is the most expensive option. You will not receive benefit credits. You're Done

OPTION 2 Keystone POS Go with the Keystone POS plan AND Earn Benefit Credits Choose additional benefits

OPTION 3 Dual Income Option If you have coverage elsewhere, you can choose the Dual Income option that frees up the most money. Earn the most Credits Choose additional benefits

If you are satisfied with your current election, do nothing. If you want to make a change, look for "Open Enrollment Material" which will be sent around October, 2004

Who’s Eligible? In general, you and your covered dependents are eligible to participate in the Choice Benefits Program if you: Are employed by any food employer, are a participant in Local 1776 and Participating Employers Health and Welfare  Fund and are at least age 30 with 5 or more years of service, are eligible for plan II, III or IV, in accordance with your collective bargaining agreement. Choose Your Benefits Carefully It’s important that you understand your options because you need to make choices about the benefits you want. In addition, the elections you make during annual enrollment stay in effect the entire year unless you have a qualified Life Event. The following qualify as Life Events: change in legal marital status (including marriage, divorce, annulment, legal separation, or death of spouse); change in number of dependents (including birth, adoption or placement for adoption, or death of a spouse or dependent); change in dependent’s eligibility status because of age or change in student status; change in employment status, work site, or work schedule of an employee, spouse, or dependent that results in a gain or loss of eligibility for health coverage (including switch between full-time and part-time); entitlement to Medicare or Medicaid (applies to the person entitled to Medicare or Medicaid); and change to comply with a state domestic relations order pertaining to medical coverage of a participant’s child. You must notify the Fund Office in writing of your request for a change in coverage within 30 days of the Life Event, and you must provide proof of the event.