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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. Open House The Fund office will be holding an "Open House" from November 28, 2005 through November 30, 2005 whereby you can stop into the Fund office from 8:00 a.m. to 7:00 p.m. on the specified dates to receive individual education on the Choice Plan and assistance in selecting benefit credits that suit your needs. You may also call the Fund office at 1-800-458-8618 to schedule an appointment to meet with a Fund representative at a time that may better suit your schedule. Enrollment materials must be received by December 16, 2005 for a January 1, 2006 effective date. How to Enroll You can enroll by mail or by visiting the Fund office. In either case, the following information is required: If you are electing the Dual Income Option, you must complete and return the Choice Benefits enrollment form, proof of other coverage form and enclose a copy of your other medical identification card. If you are electing the KPOS Flex Series Plan, you must complete and return the Choice Benefits enrollment form. In order to complete this form, you will need to select a primary care physician from the KPOS provider directory for each eligible dependent. To obtain this directory, please contact the Fund office by phone at 1-800-458-8618 or e-mail us at fund@ufcw1776benefitfunds.org before returning your enrollment form. Return the completed forms to: UFCW Local 1776 and Participating Employers Health and Welfare Fund 3031B Walton Road Plymouth Meeting, PA 19462 A reply envelope is also enclosed for your convenience. 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. 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 change your medical plan, you receive benefit credits. The Dual Income option will free up the most dollars; and, therefore, give you the most benefit credits. .
You will earn benefit credits on a monthly basis. If you become ineligible to participate in the Health and Welfare Fund benefit program at any time during the year, you will stop earning 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. For other than the Retirement and Savings 401(k) Plan, you will not have another opportunity to change your option until January 1, 2007 (unless you have a qualified Life Event.)
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