UFCW Unions & Participating Employers Health and Welfare Fund
MemberXG Benefit system
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Summary Plan Description (“SPD”) Booklets
Plan JSS2 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
COVID-19 Vaccine SMM
COVID-19 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 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
Dentegra/Downloads
NF Plan JSS2 Dentegra Summary
NF Plan Y Dentegra Summary
NF Plan Y20 Y30 Y40 Dentegra Summary
NF Plan J Dentegra Summary
NF Plan TR Dentegra Summary
Important Notices
Notice of Privacy Practices
UFCW ACA Preventive Services Benefits
Notice of Creditable Coverage
QDRO
NonFood – Approved Surprise Billing Public Notice
Retiree Information
Useful Links
CareFirst PPO
GVS – Group Vision Service
Kaiser Permanente
Optum Rx
UFCW Local 400
UFCW Local 27
Beacon Health Options
Useful Numbers
Optum Rx 877-645-1282
Dentegra 877-280-4204
InforMed 866-290-8147
Beacon Health Options 800-454-8329
Group Vision Service 866-265-4626
For Your Benefit Newsletters
March 2022
December 2021
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.