Important Schedules of Benefits and Plan Descriptions
Plan DocumentsThe Plan may be amended by the Trustees in the manner provided in the Trust Agreement. Amendments may apply to all groups covered or to certain groups only. Amendments may be made retroactively only to the extent permissible under ERISA, the Internal Revenue Service and other applicable laws.
The following information is current as of the date indicated. The Plan is modified by the Board of Trustees from time to time. Please check with the Fund Office for very recent changes before making decisions that may impact your benefits. Only the Board of Trustees has the power to construe the Plan and its terms.
For more information please email UFCW Member Support at [email protected]
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AMRI Rennselaer, Inc.
– no new docs provided –
Aristech
– no new docs provided –
AYR Nevada dba BP Solutions
Summary Plan Description (English)
Summary Plan Description (Spanish)
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Best Buds
Summary Plan Description (English)
Summary Plan Description (Spanish)
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Buffalo Trace Distillery
Summary of Benefits and Coverages
Summary of Material Modifications — Short Term Disability and Life Insurance Benefit
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Summary of Material Modifications – Termination of Short-Term Disability and Death Benefits
CAL HGH, LLC
Summary Plan Description (English)
Summary Plan Description (Spanish)
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Campari America, LLC
Cantu Services Inc.
– no new docs provided –
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages — PPO Buy-Up Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Catalyst – East Side
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Compassionate Care Research Institute, Inc. dba Fresh Delaware
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Constellation Brands U.S. Operations, Inc. – Mission Bell Winery
CSL Behring EPO Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
CSL Behring PPO Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Delano Growers Grape Product
Diageo Select Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Provider Network Transition Notice
Summary of Material Modifications – Provider Network Transition Notice
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Diageo Standard Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Provider Network Transition Notice
Summary of Material Modifications – Provider Network Transition Notice
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
DW Richards & Sons, Inc.
The Wine Group – Franzia (Ripon)
Summary Plan Description (English)
Summary Plan Description (Spanish)
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages
Dental Benefit Summary (English)
Dental Benefit Summary (Spanish)
Vision Benefit Summary (English)
Vision Benefit Summary (Spanish)
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
TWG Franzia (Sanger)
G3 Enterprises, Closure Division
Gallo Wine Sales of NJ
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Summary of Material Modifications – Applied Behavioral Analysis
Summary of Material Modifications – Provider Network Transition Notice
Gary & Leo’s Fresh Foods of Harvre
Summary of Benefits and Coverages
Summary of Material Modifications (SMM)
Gleason – Buy Up PPO
Summary of Benefits and Coverages
Gleason B-60 – Plan Basic PPO
Summary of Benefits and Coverages
Glendive BN Federal Credit Union
Golden State Vintners, Inc
Have a Heart Local 3000
Healthcare Service Group, Inc
Summary Plan Description Amendment
Summary of Benefits and Coverages
Summary of Material Modifications – Provider Network Transition Notice
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
LB Green Room
Summary Plan Description (English)
Summary Plan Description (Spanish)
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Long Beach Wellness Center
Summary Plan Description (English)
Summary Plan Description (Spanish)
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Minnesota Freezer Warehouse Company
Food Service Inc. of Gainesville
Mountaineer Park, Inc. – Buy Up Plan
Summary of Benefits and Coverages
Mountaineer Park, Inc. – Core Plan
Mr. Nice Guy
Summary Plan Description (English)
Summary Plan Description (Spanish)
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Nouryon Surface Chemistry, LLC
Summary of Benefits and Coverages (100/50 Elite Plan)
Summary of Benefits and Coverages (90/70 PPO Plan)
Summary of Benefits and Coverages (HMO Plan)
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Summary of Material Modifications – Dental Plan Benefit Change
Pacific Roots Marina
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Red Wing Shoe Company, Inc
High Option HSA Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Summary of Material Modifications – Deductible
Summary of Material Modifications – Deductible and Out-of-Pocket Maximum Increase
Low Option HSA Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Summary of Material Modifications – Deductible
PPO Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
S.B. Foot Tanning Co
International Union of Operating Engineers Local 302
Summary Plan Description – Plan A
Summary of Benefit Coverages – Plan A
Service Linen Supply Management Staff
Summary Plan Description – Plan A
Summary Plan Description – Plan B
Summary of Benefit Coverages – Plan A
Summary of Benefit Coverages – Plan B
Teamsters Local 117
Summary Plan Description – Plan A
Summary of Benefit Coverages – Plan A
UFCW Local 3000
Summary Plan Description – Plan A
Summary Plan Description – Plan B
Summary of Benefit Coverages – Plan A
Shaw’s Supermarkets, Inc. – Methuen Distribution Center
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Shaw’s Supermarkets, Inc. – Southern Region Stores and Wells Distribution Center
Summary of Benefits and Coverages
Summary of Benefits and Coverages – Southern Region Stores Plan B
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Silgan Containers Manufacturing Corporation
South Coast Safe Access
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Sterling Care Frostburg Village
Summary Plan Description Amendment
Summary of Benefits and Coverages
Summary of Material Modifications – Provider Network Transition Notice
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Sterling Care Frostburg Village Assisted Living
Summary Plan Description Amendment
Summary of Benefits and Coverages
Summary of Material Modifications – Provider Network Transition Notice
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Sun-Maid Growers of California
Superior Linen Service, Inc. Management Staff
Summary Plan Description – Plan A
Summary Plan Description – Plan B
Summary of Benefit Coverages – Plan A
Summary of Benefit Coverages – Plan B
Teamsters 117
Summary Plan Description – Plan A
Summary of Benefit Coverages – Plan A
UFCW Local 3000
Summary Plan Description – Plan A
Summary Plan Description – Plan B
Summary of Benefit Coverages – Plan A
Summary of Benefit Coverages – Plan B
The Station
Summary Plan Description (English)
Summary Plan Description (Spanish)
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
TWG Almaden Madera Winery
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
Unicann Plan
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
The 420 Plan
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Dental Plan Summary (if elected)
Vision Plan Summary (if elected)
Cannabis High Deductible Plan
Summary Plan Description – High Ded Plan
Schedule of Benefits – High Ded Plan
Summary of Benefits and Coverages – High Ded Plan
Dental Plan Summary (if elected)
UFCW National Fund Medigap Plans
UFCW National Health & Welfare Fund Staff Plan
Union Club Bar & Grill
Ventura Foods, LLC
Summary of Benefits and Coverages
Dental Benefit Summary – Basic
Dental Benefit Summary – Buy-UP
Vision Benefit Summary – Basic
Vision Benefit Summary – Buy-UP
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Summary of Material Modifications – Participating Provider Network Changes
Summary of Material Modifications – Change in Annual Deductibles and Out-of-Pocket Maximum
Vie-Del Company, Plants I & II
Vivendi
WEPCO Federal Credit Union
Summary Plan Description Amendment
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Summary of Material Modifications – Plan Change Adding Short Term Disability Benefit
Summary of Material Modifications – Participating Provider Network Changes