UFCW Unions & Participating Employers Health and Welfare Fund

MemberXG Benefit system

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Summary Plan Description (“SPD”) Booklets

SMMs (Benefit Changes) for Plan JS SPD
SMMs (Benefit Changes) to Plan JSS2 SPD
Plan Y SPD
SMMs (Benefit Changes) to Plan Y SPD
Plan Y20 SPD
SMMs (Benefit Changes) for Plan Y20 SPD
Plan Y30 SPD
SMMs (Benefit Changes) for Plan Y30 SPD
Plan Y40 SPD
Plan T SPD
SMMs (Benefit Changes) to Plan T SPD
Plan Z SPD

COVID-19 Vaccine SMM
SMM Telemedicine

Shoppers Dependent Audit Verification

Dependent Audit Initial Notice and Verification Notice
Frequently Asked Questions

Summary of Benefits and Coverage (“SBC”)

2021 SBC for Plan JS
2021 SBC for Plan JSS2
2021 SBC for Plan Y
2021 SBC for Plan Y20
2021 SBC for Plan Y30

Benefit Summaries

Plan Y40 Benefit Summary November 2020

Shoppers Open Enrollment

Plan JSS2 Full Time
Plan JSS2 Part Time
Plans Y and Y20 Full Time
Plan Y Part Time
Plan Y 20 Part Time

Payroll Deduction
Plan Y and Y20 (Full Time) and Plan JSS2 (FT & PT)
Plan Y20 (Part Time)
Plan Y30 (Part Time)

Enrollment Forms
Plan JS, JSS, JSS2
Plan Y Full Time
Plan Y20 Part Time

Downloads (Forms)

Coordination of Benefits Form
HIPAA Authorization Form
LabCorp Facility List (Plan Y20 Participants Only)
Notice of Continuation or Termination of Disability for Group Accident & Sickness Benefits
Subrogation Agreements
Weekly Accident and Sickness Claim Form

Important Notices

Notice of Privacy Practices
UFCW ACA Preventive Services Benefits
Notice of Creditable Coverage

Retiree Information

Non-Discrimination Notice

Useful Links

CareFirst PPO
GVS – Group Vision Service
Kaiser Permanente
Informed Rx
UFCW Local 400
UFCW Local 27
Beacon Health Options

Useful Numbers

Catamaran Rx 800-645-3332
Group Dental Service 800-242-0450
InforMed 866-290-8147
Beacon Health Options 800-454-8329
Group Vision Service 866-265-4626

For Your Benefit Newsletters

September 2021
June 2021
March 2021
December 2020
March 2020
December 2019
September 2019
June 2019
March 2019

December 2018
September 2018
June 2018
March 2018
December 2017
September 2017
June 2017
March 2017
December 2016
September 2016
June 2016
March 2016
December 2015
September 2015
June 2015
March 2015
December 2014
September 2014
June 2014
March 2014
December 2013
September 2013
June 2013
March 2013
December 2012
September 2012
June 2012
March 2012


These forms are published on this page by Associated Administrators, LLC
on behalf of the Client Fund and are meant solely for the use of their participants.