Important Schedules of Benefits and Plan Descriptions

Plan Documents

The 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 UFCWFundSupport@ufcwnationalfund.org

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ALSCO – American Linen

Summary Plan Description

Schedule of Benefits

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

AMRI Rennselaer, Inc.

– no new docs provided –

AOC Resins LLC

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Aramark

Summary Plan Description

Schedule of Benefits

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

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

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

Gleason B-60 – Plan Basic PPO

Summary Plan Description

Schedule of Benefits

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Buffalo Trace Distillery

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

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

Summary of Material Modifications – Discount Coupon CoPay

Campari America, LLC

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Cannabliss

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

CannTech PA, LLC

Summary Plan Description

Summary Plan Description Amendment

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

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

Dental Plan Summary (if elected)

Vision 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)

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

Central Co-op

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Charles Krug 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

Summary of Material Modifications – Discount Coupon CoPay

Compassionate Care Research Institute, Inc. dba Fresh Delaware

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

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

Summary of Material Modifications – Discount Coupon CoPay

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

Summary of Material Modifications – Discount Coupon CoPay

CSL Behring EPO Plan

Summary Plan Description

Schedule of Benefits

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 Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Curia New York, Inc

Summary Plan Description

Schedule of Benefits (PPO Plan)

Schedule of Benefits (HDHP Plan)

Summary of Benefits and Coverages (PPO)

Summary of Benefits and Coverages (HDHP)

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Delano Growers Grape Product

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

Summary of Material Modifications – Discount Coupon CoPay

Diageo Select Plan

Summary Plan Description

Schedule of Benefits

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 Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Discovery Behavioral Healthcare

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

EJ Gallo Wineries

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

Summary of Material Modifications – Discount Coupon CoPay

Food Front Cooperative Grocery

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Franklin Labs, LLC

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

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

Summary of Material Modifications – Discount Coupon CoPay

Summary of Material Modifications – Life Insurance Benefits

TWG Franzia (Sanger)

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

Summary of Material Modifications – Discount Coupon CoPay

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

Summary of Material Modifications – Discount Coupon CoPay

Summary of Material Modifications – Vision Benefit

Gallo Wine Sales of NJ

Summary Plan Description

Schedule of Benefits

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 Plan B

Summary Plan Description

Schedule of Benefits

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 Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

GAC PPO Plan

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

GAC HDHP Plan

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Gleason – Buy Up PPO

Summary Plan Description

Schedule of Benefits

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 Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Glendive BN Federal Credit Union

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Golden State Vintners, Inc

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

Summary of Material Modifications – Discount Coupon CoPay

GSD NJ, LLC

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

Have a Heart Local 8 Golden State

Summary Plan Description

Schedule of Benefits

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 Plan Description

Schedule of Benefits

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

Healthcare Service Group, Inc

Summary Plan Description

Summary Plan Description Amendment

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

Huhtamaki, Inc

Summary Plan Description

Summary Plan Description Amendment

Schedule of Benefits

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Summary of Material Modifications – Notice of Medical and Prescription Drug Benefit Plan Changes

Jim Beam Brands Co. Local 111-D

Summary Plan Description

Schedule of Benefits

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 Plan Description

Schedule of Benefits

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

JLL EPO Plan

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications

JLL PPO Plan

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications

JST Global, LLC

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Justin Tanks, LLC

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

LAZ Parking

Summary of Benefits and Coverages

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

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

Local 2D

Summary Plan Description

Schedule of Benefits

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Summary of Material Modifications – Provider Network Transition Notice

Local 8 – Golden State

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

Summary of Material Modifications – Discount Coupon CoPay

Local 18

Summary Plan Description

Schedule of Benefits

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Summary of Material Modifications – Provider Network Transition Notice

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

Local 496

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

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

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

Maryland Medical Solutions, LLC

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Metropolitan Baltimore Council AFL-CIO

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Minnesota Freezer Warehouse Co. Local 1155

Summary Plan Description

Schedule of Benefits

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 – Termination of Short Term Disability, Life Insurance and AD&D Benefits

Summary of Material Modifications – Participating Provider Network Changes

Minnesota Freezer Warehouse Co. Management Staff

Summary Plan Description

Schedule of Benefits

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 – Termination of Short Term Disability, Life Insurance and AD&D Benefits

Summary of Material Modifications – Participating Provider Network Changes

MitchCo International

Summary Plan Description

Schedule of Benefits

Mountaineer Park, Inc. – Buy Up Plan

Summary Plan Description

Schedule of Benefits

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 Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Mr. Green Cannibis

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

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

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

Nouryon Surface Chemistry, LLC

Summary Plan Description

Schedule of Benefits

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

Pennsylvania Dispensary Solutions, LLC

Summary Plan Description

Schedule of Benefits

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Pennsylvania Medical Solutions, LLC

Summary Plan Description

Schedule of Benefits

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

Red Wing Shoe Company, Inc

Summary Plan Description

Schedule of Benefits

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, Coinsurance, and Out-of-Pocket Maximum Increases

Rich’s Food Town, Inc

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Riedell Shoes, Inc

Summary Plan Description

Schedule of Benefits

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 Plan Description

Schedule of Benefits

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 Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

PPO Plan

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Roscommon County Transit Authority

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Royal Wine Corporation

Summary Plan Description

Schedule of Benefits

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 – Notice of Existing Mandatory Mail Order on Maintenance Prescription Drugs

Summary of Material Modifications – Provider Network Transition Notice

S.B. Foot Tanning Co

Summary Plan Description

Schedule of Benefits

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 Plan Description

Schedule of Benefits

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Service Linen Supply Management Staff

Summary Plan Description

Schedule of Benefits

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Teamsters Local 117

Summary Plan Description

Schedule of Benefits

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

The LLW Plan

Summary Plan Description

Schedule of Benefits

Schedule of Benefits – Plan B

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Shaw’s Supermarkets, Inc. – Methuen Distribution Center

Summary Plan Description

Schedule of Benefits

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 Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Sheet Metal, Air, Rail & Transportation Workers Union Local 103

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Silgan Containers Manufacturing Corporation

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

Sira Naturals, Inc

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

Smith’s Food & Drug Centers, Inc

Summary Plan Description

Schedule of Benefits

South Coast Safe Access

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

Southern Glazer’s Wine and Spirits of New York, Inc

Summary Plan Description

Schedule of Benefits

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

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

Starfire Lighting, Inc

Summary Plan Description

Schedule of Benefits

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 and Out of Pocket Maximum Increases

Sterling Care Frostburg Village

Summary Plan Description

Summary Plan Description Amendment

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

Sterling Care Frostburg Village Assisted Living

Summary Plan Description

Summary Plan Description Amendment

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

Sun-Maid Growers of California

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

Summary of Material Modifications – Discount Coupon CoPay

Superior Linen Service, Inc. Managment Staff

Summary Plan Description

Schedule of Benefits

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Teamsters 117

Summary Plan Description

Schedule of Benefits

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

The LLW Plan

Summary Plan Description

Schedule of Benefits

Schedule of Benefits – Plan B

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

The Bionetics Corporation

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

The Glenmore Distillery

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

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

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

Tomlinson Linen

Summary Plan Description

Schedule of Benefits

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Trivium Packaging USA, Inc

Summary Plan Description

Schedule of Benefits

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 – Additional Conditions That Will Delay the End of Coverage Date

TWG Almaden Madera 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

Summary of Material Modifications – Discount Coupon CoPay

UFCW Community Federal Credit Union

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

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

Dental Plan Summary (if elected)

Vision Plan Summary (if elected)

UFCW National Fund Medigap Plans

Summary Plan Description

Schedule of Benefits

UFCW National Health & Welfare Fund Staff Plan

Summary Plan Description

Schedule of Benefits

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

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Ventura Foods, LLC

Summary Plan Description

Schedule of Benefits

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

Vie-Del Company, Plants I & II

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

Summary of Material Modifications – Discount Coupon CoPay

Viscofan HMO Plan

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

W.H. Bagshaw Co., Inc

Summary Plan Description

Schedule of Benefits

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

Waveseer of Las Vegas, LLC

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

Waveseer of Nevada, LLC

Summary Plan Description

Schedule of Benefits

Summary of Benefits and Coverages

Summary of Material Modifications – Specialty Drug Cost Avoidance Program

Summary of Material Modifications – Discount Coupon CoPay

Dental Plan Summary

Vision Plan Summary

WEPCO Federal Credit Union

Summary Plan Description

Summary Plan Description Amendment

Schedule of Benefits

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

Dental Plan Summary

Vision Plan Summary