Summary of Benefits
		Election of Coverage and Eligibility Provisions
		Comprehensive Medical Benefits
		Income Protection Benefit
		Dental Benefit
		Dental Schedule of Benefits
		Prescription Drug Benefit
		Vision Benefit
		Life Insurance Benefit
		General Exclusions and Limitations

		Summary of Benefits
		Election of Coverage and Eligibility Provisions
		Comprehensive Medical Benefits
		Prescription Drug Benefit
		General Exclusions and Limitations

		How to File a Claim
		When to Call Us
		Request an ID Card
		Continuation of Coverage (COBRA)
		Claim Appeal Procedure
		Coordination of Benefits
		Privacy Practices
		Health Benefits Plan Claim Procedures
		Summary of the Cafeteria Plan
		Forms & Publications

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This website provides benefits information for persons enrolled in Plan D5 and Plan B5 and whose employer contributes to this Health Fund based on contracts negotiated between the stores and the UFCW local unions.

The Benefits Fund Office is located in Illinois and our coverage area is, generally, Illinois and the surrounding states.

Benefit information on other plans offered by the Fund—Plan 7, Plan 8, and Plan M—is not included in this website presentation. For information on these plans, refer to your Summary Plan Description (plan booklet) or contact the Benefits Fund Office.

Maternity Benefits

Disability Income Protection

Work-Related and On-the-Job Injuries

Surgical Benefits and Information

Stop Smoking Benefits

Coverage for Retirees

Traveling Outside of the United States or Canada

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Grandfathered Plan

The UFCW Unions and Employers Midwest Health Benefits Plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the “Affordable Care Act”). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when the law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans; for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act; for example, the elimination of lifetime limits on benefits.

Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at UFCW Midwest Benefits Fund, 1300 Higgins Road, Suite 300, Park Ridge, IL 60068, 847-384-7000. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.

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(Updated 04/09/12)