Important Schedules of Benefits and Plan Descriptions
Plan DocumentsThe 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 UFCWFundSupport@ufcwnationalfund.org
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AMRI Rennselaer, Inc.
– no new docs provided –
Aristech
– no new docs provided –
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
Cantu Services Inc.
– no new docs provided –
Catalyst – 316 Florence
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
Catalyst – Bellflower
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
Catalyst – Belmont Shores
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
Catalyst – Cherry
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
Catalyst – Downtown Long Beach
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
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)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
Catalyst – EEI El Monte
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
Catalyst – EEI Pomona, LLC
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
Catalyst – F2 Palm Desert, LLC
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Catalyst – Hemet
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
Catalyst – MidCity
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
Catalyst – Normandie
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
Catalyst – RD San Bernardino
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
Catalyst – Santa Ana
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
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. – Dunnewood Vineyards, Ukiah, CA
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
Constellation Brands U.S. Operations, Inc. – Mission Bell Winery
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
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
Diageo Select Plan
Summary of Benefits and Coverages
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 – Specialty Drug Cost Avoidance Program
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
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
G3 Enterprise Closure
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
Gary & Leo’s Fresh Foods of Harvre Plan B
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Gary & Leo’s Fresh Foods of Harvre Plan A
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Gleason – Buy Up PPO
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Gleason B-60 – Plan Basic PPO
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Have a Heart Local 8 Golden State
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Have a Heart Local 3000
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 – Modification of Eligibility Rule
Jim Beam Brands Co. Local 111-D
Summary of Benefits and Coverages
Summary of Material Modifications – Increase of Short-Term Disability and Life Insurance Benefits
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Summary of Material Modifications – Changes in Benefits and Open Enrollment
Summary of Material Modifications – Elimination of Direct Payment Death (Life Insurance) Benefit
Jim Beam Brands Co. Local 227
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 – Adding Retiree Life Insurance Benefits
Summary of Material Modifications – Elimination of Direct Payment Death (Life Insurance) Benefit
LAZ Parking
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
Local 186
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 – Discount Coupon CoPay
Summary of Material Modifications – Life Insurance Benefit
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 Co. Local 1155
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 – Participating Provider Network Changes
Minnesota Freezer Warehouse Co. Management Staff
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 – Participating Provider Network Changes
Mountaineer Park, Inc. – Buy Up Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Mountaineer Park, Inc. – Core Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
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)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
Puradora, LLC
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
Riedell Shoes, Inc
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 – Participating Provider Network Changes
Summary of Material Modifications – Deductible and Out-of-Pocket Maximum Increases
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
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
PPO Plan
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
S.B. Foot Tanning Co
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 – Change in Annual In-Network Deductible
Summary of Material Modifications – Plan Design Change
Summary of Material Modifications – Participating Provider Network Changes
Summary of Material Modifications – Annual Deductible and Prescription Drug Benefit
International Union of Operating Engineers Local 302
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Service Linen Supply Management Staff
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Teamsters Local 117
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
The LLW Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
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 Material Modifications – Specialty Drug Cost Avoidance Program
Sheet Metal, Air, Rail & Transportation Workers Union Local 103
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
South Cord Holdings
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
Southern Glazer’s Wine and Spirits of New York, Inc
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Summary of Material Modifications – Provider Network Transition Notice
Speedy Weedy
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
Sterling Care Frostburg Village Assisted Living
Summary Plan Description Amendment
Summary of Benefits and Coverages
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Superior Linen Service, Inc. Managment Staff
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
Teamsters 117
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
Summary of Material Modifications – Discount Coupon CoPay
The LLW Plan
Summary of Material Modifications – Specialty Drug Cost Avoidance Program
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
UFCW Local 324
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
UFCW Local 1428
Summary Plan Description (English) – UNICANN Basic Plan
Summary Plan Description (Spanish) – UNICANN Basic Plan
Schedule of Benefits (English)
Schedule of Benefits (Spanish)
Schedule of Benefits – PPO Buy-Up Plan
Summary of Benefits and Coverages – UNICANN Basic 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
UFCW National Health & Welfare Fund Staff 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 – Change in Benefits from Contract Negotiations
Summary of Material Modifications – Change in Benefits from Contract Negotiations
Summary of Material Modifications – Revised Change in Benefits from Contract Negotiations
Summary of Material Modifications – Provider Network Transition Notice
Union Club Bar & Grill
Ventura Foods, LLC
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 – Participating Provider Network Changes
Summary of Material Modifications – Change in Annual Deductibles and Out-of-Pocket Maximum
W.H. Bagshaw Co., Inc
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 – Change in Annual Deductible, Coinsurance, and Out-of-Pocket
Summary of Material Modifications – Notice of Prescription Plan Changes for Specialty Medication
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