UFCW Unions & Participating Employers Health and Welfare Fund

NETime Benefit system

Want to check eligibility or the status of your claim? Log on to NETime and check your
information online, available 24 hours a day, seven days a week.

 

Summary Plan Description (“SPD”) Booklets

Plan JS SPD
SMMs (Benefit Changes) for Plan JS SPD
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) to Plan Y20 SPD
Shoppers Plans Y20, Y30 and Y40 Summary of Material Modifications
Plan T SPD
SMMs (Benefit Changes) to Plan T SPD
Plan Z SPD

 

Summary of Benefits and Coverage (“SBC”)

2017 SBC for Plan JS
2017 SBC for Plan JSS2
2017 SBC for Plan Y
2017 SBC for Plan Y20
2017 SBC for Plan Y30

Shoppers Open Enrollment

Shoppers 1st Req Re-Enroll Full Time JSS2
Shoppers 1st Req Re-Enroll Part Time JSS2
Shoppers 1st Req Re-Enroll Plan Y and Y20 FT
Shoppers 1st Req Re-Enroll Plan Y Y20 FT NE
Shoppers 1st Req Re-Enroll Plan Y20 FT
Shoppers 1st Req Re-Enroll Plan YFT
Shoppers 1st Req Re-Enroll Plan YPT IND
Shoppers 1st Req Re-Enroll PT Y20 NE

Payroll Deduct Plans Y and Y20 PT IND 6-2015
Payroll Deduction Shoppers JSS2 6-2015
Payroll Deduction Shoppers Y and Y20 FT

Shoppers 1st Req Re-Enroll Plan Y PT FAM Spousal Surcharge
Shoppers 1st Req Re-Enroll Plan Y20 FT FAM Spousal Surcharge
Spousal Surcharge Authorization Form 6-2015

UW FT T Z Y Enrollment Form
UW JS JSS S Enrollment Form
UW PT FAM T Z Y Enrollment Form

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
Preventive Services Benefits for Plans Y, Y20 and JSS2
Prescription Drug/Medicare Notice of Creditable Coverage
QDRO

Retiree Information

Non-Discrimination Notice

Useful Links

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

Useful Numbers

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

For Your Benefit Newsletters

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.