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Open Enrollment Period The Open Enrollment period begins NOW. Enrollment forms will be accepted through December 16, 2005 for a January 1, 2006 effective date. How to Enroll If you are electing to participate, you must complete and return the enclosed Choice Benefits Enrollment Form, Proof of Other Coverage form and provide a copy of your medical insurance card. Return the completed forms in the self addressed stamped envelope. 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 this open enrollment period stay in effect for the entire year of 2006 unless you have a Qualified Life Event. The following constitute as Qualified 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,
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 the 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);
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 Qualified Life Event and you must provide proof of the event. Who is Eligible? You and your covered dependents are eligible to participate in the Choice Benefits Program if you:
are employed by a contributing employer
Are a participant of the UFCW Local 1776 and Participating Employers Health
and Welfare Fund and are at least 30 years of age with 5 or more years of
service; and
are eligible for Personal Choice Medical coverage in accordance with your
collective bargaining agreement.Earning Benefit Credits Remember, if you choose to waive your Personal Choice medical plan, you will receive up to $1,800 in benefit credits .You will be entitled to benefit credits you earn up to the date you become ineligible. If You Do Not Return an Enrollment Form
Your current medical
plan of benefits will remain unchanged.
You will not have another opportunity to
change your option until January 1, 2007 (unless you have a qualified Life
Event.)You
may, however, elect to participate in the Retirement and Savings 401(k) Plan in
accordance with the terms of that Plan. |
