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Departments

insurance

The Insurance Department telephone line is open
Monday thru Friday 8:30 AM to 4 PM
.

Food and Meat & Warehouse Division
Clerks, GMC, UC's &
Pharmacists
1-909-877-1110
SoCal Drug Division
Rite Aid, CVS, Pharmacists & Providers


1-909-877-2331


trust imgae

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Food Division Indemnity PPO Medical Plan Participants: Stop by a participating
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To learn more click here.


SoCal Food, Meat & Warehouse Division commomly asked insurance
Questions & Answers
QUESTIONS
ANSWERS

What is my Insurance Carriers name?

You Insurance Plan name is: UFCW Benefit Fund

Physical Adress: 6425 Katella Ave Cypress CA 90630

Mailing Adress: PO Box 6010 Cypress Ca, 90630

Office Phone: 1-714-220-2297

What is my Insurance Classification?

Plan A
If you work for Albertsons, Ralphs, Vons or Stater Bros. (Plan A) and were hired prior to March 1, 2004 you are a Platinum +. If you were hired after that date you are a A-110 Silver, Gold, or Platinum Member.
Pharmacists hired prior to September 9, 2011 are a Platinum +. Pharmacists hired after that are 110 Platinum.
Plan B
If you work for Food 4 Less or Luckys (Plan B) and were hired prior to October 1, 2004 you are a B Platinum +. If you were hired after that date you are a B-110 Silver, Gold or Platinum member.
What is the difference between a Silver, Gold or Platinum member? 
A Silver member is a Clerk’s helper, Utility Clerk or any other classification that has less than 3 ½ years of employment.

A Gold member is one who has at least 42 months of employment.

A Platinum member is one hired prior to July 22, 2007 and has at least 5 ½ years employment or if hired after July 22, 2007 and as at least 6 ½ years employment.
The Trust Fund will notify you via mail of your “Step-Up Benefits” when applicable

 

When do I become eligible for benefits?
New Hire Employees (except Clerk’s Helpers) will become eligible beginning the first day of the calendar month following their 6th month of employment. Required hours must be worked in the 5th month for initial coverage in the 7th month.

New Hire Clerk’s Helpers will become eligible for employee-only coverage beginning the first day of the calendar month following their 18th month of employment. Required hours must be worked in the 17th month for coverage in the 19th month. When a Clerk’s Helper is promoted to a higher classification then dependents may be added to the plan
How many hours a month do I have to work for benefits?
Clerk’s helpers and Utility Clerks (F4L) need 64 hours per month
Meat Cutters, Meat Wrappers and all Plan B (F4L) Clerks need 76 hours per month
Plan A workers need 92 hours per month
Sufficient hours worked on a skip month basis with payroll deductions taken in the same month worked determines your eligibility.
SEE 2016 Premium Schedule
What is a work month and does is it start the first to the end or is it different since our pay periods are different? Which months are non-qualifying?
The Standard Industry workweek is Monday through Sunday. Your monthly hours are credited to you as of the last Sunday of each month. See Calendar

Every month is a qualifying month. Eligibility is based on a skip-month; Example: Hours worked in January provides coverage in March, February for April, etc.
What family members are covered?
Spouses, Registered Domestic Partners, children, stepchildren, some foster children and legally adopted children under age 19 years of age. Children who are 19 through 26 must have a declaration of eligibility form on file. 
Enrolled Domestic Parners will have additonal costs due to Federal IRS guidlines.

Unmarried dependent children who are covered and become disabled due to physical or mental handicap while covered can remain covered permanently or until recovered.
If I Transfer from another Trust Fund or Union Local, what steps should I take?
You must contact the Insurance Department within 60 days after the start of employment from the jurisdiction of one participating UFCW Health and Welfare Fund to another. A Transferred Eligibility and Enrollment forms must be completed to determine continuous eligibility with the Trust Fund.
Those continuing to work with the same company in the So Cal UFCW areas transferring from one Union Local to another please contact the Union Office you’re transferring to verify your address and telephone number if any changes need to be made ASAP.
What if I change Employers, do I need to contact the Insurance or the Union Local Membership departments?
Yes. For the Insurance dept. when changing employers within 120 days, you need to fill out a new enrollment form with a premium authorization form (if applicable) so we can start premium deductions with the new employer. If you’re past the 120 days and returning back into the Industry from terminating employment, you will be considered a New Hire.
What if I’m Military Active Duty or Reserves?
A Verification of Military Service form must be filled out. Contact the Insurance Department for additional information.
Can I change my Medical/Dental coverage at any time and if not, When?
Open Enrollment is held once a year for a January 1 effective date with a deadline date of December 31 no later. Plan A & B Platinum + and Retiree members can change medical plans then. Participants can add and delete dependents or dis-enrollment from their Insurance coverage. A-110 and B-110 (F4L) Silver, Gold, and Platinum members cannot change medical plans but are able to change dental plans.
Special Enrollment Rights are available outside of Open Enrollment for two situations. You have 120 calendar days from the Life Event occurred to add a newly acquired spouse, baby or in the event a Loss of Coverage from other Health Coverage. Contact Insurance Department immediately
Are there pre-paid (HMO) medical plans available?
 
Kaiser and United Healthcare are available to A & B Platinum + Members only. You may change between these two (2) plans throughout the year without using a 1 in 5 year Plan Change. For details, Contact the Insurance Department
I have not received a Medical Card or Prescription Card yet. Why and who do I contact?
You will receive a medical ID card within 7-14 business days from the time enrolled in the plan. If you haven’t received an Anthem Blue Cross or Optum Rx card, please contact the Insurance Department for a replacement.
Anthem Blue Cross Providers:
W
ww.Anthem.com/Ca or call 1-800-688-3828.

For Prescriptions visit OptumRx or call 1-888-715-7573 for Q&A on RX costs/exception requests.

Kaiser and United Healthcare members may call or order via Online medical ID cards and view the Plan Summary, See contact info below:
Kaiser Members: www.kp.org or 1-800-464-4000

United Healthcare Members: www.MYUHC.com or 1-800-624-8822
If you experience eligibility problems, contact the Insurance Department ASAP
If a claim is denied, how do I appeal?
If a service is denied, you will be notified in writing and there is a specific time frame and forms to be followed and used.  Call the insurance department to request the form and ask any questions you may have.
I have to have surgery, what should I do?

Under The Indemnity Medical Plan use a contracting hospital or outpatient facility and have your doctor call for approval at 1-800-274-7767 BEFORE you go in.

Kaiser and United Health Care:  See your plan provider.

My spouse’s employer offers Health coverage, does he have to take their coverage or can we decline it? The Fund requires that if your spouse or domestic partner is eligible for medical, prescription, drug, dental, vision, chiropractor or other health care coverage through his or her own employment, he or she must enroll in that employer’s best plans whether or not enrollment requires payment of a premium.

The rule is extremely important because non-compliance could affect the amount of your spouse’s or domestic partner’s benefits. If your spouse does not enroll in his or her employer’s plan, benefits under the Fund’s plans will be paid assuming that your spouse or domestic partner is enrolled in his or her own employer’s best plan. If not enrolled for all health care benefits available through his or her employer, in its best plan, benefits under the Fund’s plans will be reduced by 60%. In other words, the Fund’s Plans will pay only 40% of covered charges.

The Fund’s health care plans coordinate with other employer’s health care plans to ensure that those other plans share some of the cost of benefits for working families. Coverage for dependent children is not affected; only your spouse or domestic partner is required to be enrolled in the group coverage when available.

NOTE: If your spouse or domestic partner is not working now but becomes eligible for coverage through an employer in the future, he or she must enroll in the employer’s best plan immediately upon becoming eligible. In addition, if there is a change in your spouse’s or domestic partner’s health care coverage, you must notify the Fund Office immediately.
Notice of Cobra Continuation Coverage and HIPAA Letter
Members will receive a COBRA notice with Loss of Coverage Letter if they are short hours or have terminated employment. If a member quits or terminates, coverage will remain in effect through the end of the month of termination. Members may continue coverage by completing the Cobra application and return it with payment before the deadline given.

If short hours due to a paid vacation, an Application for Reinstatement of Eligibility must be completed by All Members as each Employer does not report those hours to us. No premium payment required.

If on State Disability, Workers Comp or FMLA/CFRA, A & B Platinum + and 110 Platinum Members must submit copies of all check stubs to be credited 6 hours each day as if working with Employer Approval Letters.

Silver and Gold Members cannot use State Disability or Workers Comp to extend eligibility; only determined FMLA Employer Approval letter does. Check stubs must still be submitted to utilize as a place holder in lieu of a break in coverage.
Contact the Insurance Department for further instructions. SEE INSURANCE ELIGIBILITY GUIDELINES

Disclaimer:

This information has been written as clearly and accurately as possible.  You should be aware, however, that benefits are governed by master policies, contracts and Plan documents.  In all cases of benefit determination or differences of opinion, the legal policies, contracts or Plan documents will prevail.

You can examine the master policies, contracts and Plan documents by contacting the Fund Office.  If you prefer, you can request, in writing, copies of these documents for a reasonable fee.  The Fund Office will send you the documents within 30 days of receiving your request.

The Fund maintains the Health Care Plan for the exclusive benefit of eligible employees; however, eligibility for or participation in the Health Care Plan is not an assurance or guarantee of continued employment. 

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