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UFCW Local 1776 and Participating Employers Health and Welfare Fund
3031 B Walton Road, Plymouth Meeting, PA
19462
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Earn $20 Per Month | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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In addition to earning $20 per month, the KPOS Flex Series
Plan is a medical plan which provides you with medical coverage that can limit your
out-of-pocket medical costs if you stay in referred care but also allows you to use
any doctor or hospital of your choice (self-referred care) but will expose you to
higher out-of-pocket costs. Your dependents can be covered up to age 24 provided they
are enrolled as a full-time college student. Below is a summary of the KPOS Flex Series Plan. Benefits at a Glance
Plan Feature |
Referred (In-Network) |
Self-Referred (In and Out-of-Network) |
Calendar Year |
None |
$500 per person |
Deductible |
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$1,500 per family |
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Calendar Year Co-pay |
$1,000 per person |
None |
Maximum (not
including deductible) |
$2,000 per family |
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Lifetime Maximum |
None |
$1,000,000 |
Doctor's Visits |
Primary Care |
$15 co-pay |
70% of reasonable and customary amount after deductible |
Specialist |
$25 co-pay |
70% of reasonable and customary amount after deductible |
Routine Gynecological |
$15 co-pay (no referral necessary) |
70% no deductible |
Routine Mammogram |
100% |
70% no deductible |
Routine Pap Smear |
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Well Child Care/ |
Immunizations $15 co-pay |
70% of reasonable and customary amount after deductible |
Hospital |
(Semi-private room) 100% |
70% of reasonable and customary amount after deductible* |
Surgery |
100% |
70% of reasonable and customary amount after deductible* |
X-ray |
$25 co-pay |
70% of reasonable and customary amount after deductible* |
Lab |
100% |
70% of reasonable and customary amount after deductible* |
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*Pre-certification required
Plan Feature |
Referred (In-network) |
Self-Referred |
(In and Out-of-Network) Maternity Care |
$15 co-pay first visit only; then 100%(no referral necessary
for routine maternity care) |
70% of reasonable and customary |
amount after deductible Hospital Emergency |
Room Care $100 co-pay |
$100 co-pay |
Skilled Nursing Facility |
(custodial care not covered) 100% up to 120 days/yr |
70% of reasonable and customary |
amount after deductible* (60 days per calendar year) Mental Health |
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Inpatient |
100% up to 30 days/year |
70% after deductible;up to 20 days
per calendar year* |
Outpatient |
$25 co-pay up to 60 visits per year |
50% after deductible; up to 60
visits per calendar year. |
Substance Abuse |
Inpatient (90 visit lifetime
maximum) |
100% up to 30 days/year |
70% of reasonable and customary |
amount after deductible* Outpatient (120 visits lifetime
maximum) |
$25 co-pay up to 60 visits per year |
70% of reasonable and customary |
amount after deductible*
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*Pre-certification required
Your other
benefits provided by the Fund such as dental, prescription, mental health,
childcare, vision, disability, etc. will remain unchanged | Use your $20 per month in one option or divide it among several of the following options:  Deposit into the Fund's 401(k) Plan
Deposit into the Paid Time-Off Bank (receive pay for any time you could have
worked but did not)
Increase your current life insurance amount
Deposit into the Health Care Spending Account (up to a $500 maximum)
Deposit into the Extended Eligibility Bank (minimum $200)
Please refer to the page entitled "Using your Choice Plan Credits" for detailed information on each one of this options. | |||||||||||||||