UFCW Unions And Participating Employers Health And

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UFCW Unionsand Participating EmployersHealth and Welfare FundPlan Y30Summary Plan DescriptionOctober 2017Summary PlanDescriptionOctober 2017

The Administrative Manager: Receives Participating Employer/employee contributions Keeps eligibility records Processes claims Provides information about the FundThe Administrative Manager isAssociated Administrators, LLCWebsite: www.associated-admin.comParticipant Services: (800) 638-2972Fund Office911 Ridgebrook RoadSparks, MD 21152-9451(410) 683-6500Fund Office8400 Corporate Drive, Suite 430Landover, MD 20785-2361(301) 459-3020 or (800) 638-2972Hours: 8:30 a.m. to 4:30 p.m., Monday through FridayInteractive Voice Response SystemCheck the status of your medical claims 24 hours a day, 7 days a week byusing the automated phone system and calling (800) 638-2972. Press “1” atthe prompt.With respect to all uninsured benefits described herein, this SummaryPlan Description for the UFCW Unions and Participating Employers ActiveHealth and Welfare Plan functions as both the Plan Document and theSummary Plan Description for purposes of the Employee RetirementIncome Security Act of 1974 (ERISA), as amended, and the termscontained herein constitute the terms of the Plan. With respect to allfully insured benefits described herein, the terms of the Fund’s formalagreement or policy with the applicable insurer and, to the extent notinconsistent with such agreement or policy, this Summary PlanDescription, constitute the terms of the Plan.

DEAR PARTICIPANT,The United Food and Commercial Workers Unions and ParticipatingEmployers Health and Welfare Fund (referred to as “UFCW Unions andParticipating Employers Health and Welfare Fund” or the “Fund”) wasestablished as a result of collective bargaining between your Unionand your Participating Employer. The contribution rate paid by yourParticipating Employer determines the level of benefits you receive.An equal number of Trustees have been appointed by the Union andthe Participating Employers. The Trustees administer the Fund andserve without compensation. Their authority, established under theFund’s Trust Agreement, includes the right to make rules about youreligibility for benefits and the level of benefits available. The Trusteeshave the power to interpret, apply and construe the terms of the Planand make factual determinations regarding the Plan’s construction,interpretation and application. Further, the Trustees may amend therules and benefit levels at any time and may terminate the Plan. If theTrustees terminate the Plan, your rights and the distribution of assetswill be determined under the terms of the Trust and applicable law.Participants and beneficiaries have no vested rights to the benefitsdescribed in this book. Any decision made by the Trustees is bindingupon Participating Employers, employees, participants, beneficiariesand all other persons who may be involved with, or affected by, thePlan. You will be notified of any material modifications (changes) tothis Summary Plan Description (SPD) as required by federal law.The Trustees delegate authority to professionals who help themmanage the Plan: An Administrative Manager (referred to as the “Fund Office” in thisbook) receives Participating Employer contributions, keeps eligibilityrecords, pays claims, and assists Plan participants with theirbenefits. Some benefits are paid directly by the Fund; others areprovided by insurance carriers or other providers and the Fund payspremiums.1

Benefits are limited to Plan assets for all benefits provided underthe Plan. An Investment Manager invests the Fund’s assets to achieve areasonable rate of investment return. Fund Counsel provides legal advice. An independent Certified Public Accountant audits the Fund eachyear. Periodic payroll audits are also performed for eachParticipating Employer.It is important that you verify coverage with the Fund Office beforeincurring expenses under the Plan so that you can confirm that youor your dependents are covered under the Plan for the services youare seeking. Please remember that no one other than the FundOffice can verify your coverage. Do not rely upon any statementregarding coverage or benefits under the Plan made by yourParticipating Employer or Union representative.It is also extremely important that you keep the Fund Officeinformed of any change in address or desired changes independents and/or beneficiary. This is your obligation and youcould lose benefits if you fail to do so. The importance of a current,correct address on file in the Fund Office cannot be overstated. It isthe ONLY way the Trustees can keep in touch with you regardingPlan changes and other developments affecting your interestsunder the Plan.We hope you always enjoy good health. However, if the need forcoverage arises, we believe you’ll share with us the satisfaction ofknowing you have the protection of this Plan.Sincerely,BOARD OF TRUSTEES2

CONTENTSTHE PLANCovered Employment With Participating Employers Facts about The Plan Health and Welfare Board of Trustees Summary of Benefits For Full Time Participants .Summary of Benefits For Part Time Participants .Notice – No Fund Liability Health Care Cost Containment Corporation Repaying The Fund/Overpayment of Benefits .Definitions .56891114141417ELIGIBILITYEmployee Eligibility .Special Enrollment Provisions .Loss of Eligibility .Dependent Eligibility Coverage for Full Time Students .Qualified Medical Child Support Order (“QMCSO”) Enrolling New Dependents .Loss of Dependent Eligibility .Medicaid And The Children’s Health Insur. Program (“CHIP”) 263031363739404345CONTINUATION OF COVERAGEContinuation of Coverage under The Consolidated Omnibus BudgetReconciliation Act of 1985 (“COBRA”) .Continuation of Coverage under The Family And Medical Leave Act(“FMLA”) Continuation of Coverage under The Uniformed ServicesEmployment And Re-Employment Act of 1994 (“USERRA”) .Self Payments .COST CONTAINMENTCoordination of Benefits .Subrogation Advance Benefits For Workers’ Compensation Claims Consumer Tips .Cost Awareness (“Amateur Audit”) Reward Program .3465759616368747778

YOUR BENEFITSLife Benefit .Accidental Death and Dismemberment Benefit Life Conversion (to Individual Policy) Privilege Weekly Disability Benefit .CareFirst PPO .ACA Preventive Services Benefit .Comprehensive Medical Benefits .Exclusions And Limitations Mental Health/Substance Abuse Benefit Conifer Health Solutions Mandatory Second Surgical Opinion .Home Healthcare Program . Hospice Care Services .Prescription Drug Benefit .Specialty Medications/Specialty Pharmacy .Quantity Limits/Prior Authorization Dental Benefit .Optical Benefits .Women’s Health And Cancer Rights Act (“WHCRA”) 164ADMINISTRATIVE PROCEDURESHMO Option Claims Filing And Review Procedure. Notice of Privacy Practices Your Rights under ERISA .MemberXG .Interactive Voice Response (IVR) System Participating Employers and Unions .Telephone Numbers .Addresses .165168193206209211212213214Note: Certain terms in this bookarePLANdefined under the “Definitions”THEsection on page 17. Such terms will appear in italics throughout thisbook.COVERED EMPLOYMENT WITH PARTICIPATING EMPLOYERS4

COVERED EMPLOYMENT WITH PARTICIPATING EMPLOYERSThe benefits outlined in this book apply to employees of theParticipating Employers as described below who are in Plan Y30 andare covered by a participation agreement with the Fund, or a currentCollective Bargaining Agreement with UFCW Local 27 or UFCW Local400 requiring contributions to the Fund on their behalf. Employeesmust meet the eligibility requirements in the “Employee Eligibility”section beginning on page 26 in order to be eligible for benefits underPlan Y30.Shoppers Food & PharmacyMetro/BasicsUFCW Local 27 (temporary employees)UFCW Local 400 (temporary employees)5

FACTS ABOUT THE PLANPlan NameUFCW Unions and Participating Employers Active Health andWelfare Plan, a plan of the UFCW Unions and Participating EmployersHealth and Welfare Fund.Plan SponsorBoard of Trustees of the UFCW Unions and Participating EmployersHealth and Welfare Fund, 911 Ridgebrook Road, Sparks, MD 211529451, (410) 683-6500.Employer Identification Number: 52-6044428Plan Number: 502Type of PlanThis is a welfare plan designed to provide health and welfare benefitssuch as: life, accidental death and dismemberment, hospitalization,medical, surgical, mental health, weekly disability, prescription drug,dental, and optical benefits.Type of AdministrationContract Administration - The Board of Trustees has contracted withAssociated Administrators, LLC to provide administrative managementservices.Name of Plan AdministratorBoard of Trustees of the UFCW Unions and Participating EmployersHealth and Welfare FundAgent for Service of Legal ProcessAssociated Administrators, LLC or any Trustee at this address:UFCW Unions and Participating Employers Health and Welfare Fund911 Ridgebrook RoadSparks, MD 21152-9451(410) 683-65006

Sources of ContributionSources of contributions to the Fund are Participating Employerspursuant to the terms of their Collective Bargaining Agreements orparticipation agreements and self-payments made by participantsand/or dependents.Funding MediumAll assets are held in trust by the Board of Trustees. Insurancepremiums are paid by the Fund, and insurance companies pay part ofthe benefits. Benefits are also partially paid from the accumulatedassets of the Trust. For benefits provided by insurance companies, thebenefits are guaranteed by and paid under the insurance contract andthe insurance company provides claims processing and administrativeservices related to such benefits. A current Summary Annual Report(available from the Plan Administrator) gives details of Plan funding ofbenefits. The Fund’s assets are held by PNC Bank.Plan Year and Fiscal Plan YearJanuary 1 -- December 31.7

UFCW UNIONS AND PARTICIPATING EMPLOYERSHEALTH AND WELFARE FUNDBOARD OF TRUSTEESUNION TRUSTEESEMPLOYER TRUSTEESMark Federici - ChairmanPresidentUFCW Local 4008400 Corporate Drive,Suite 200Landover, MD 20785Steven J. Loeffler, SecretaryRegional Vice President ofLabor RelationsThe Kroger Company4111 Executive ParkwayWesterville, OH 43081-3800Thomas HipkinsSecretary-TreasurerUFCW Local 2721 West Road, Second FloorTowson, MD 21204Jon BornDirector, Health and BenefitsSuperValu, Inc.11840 Valley View RoadEden Prairie, MN 55344George MurphyUFCW Local 2721 West Road, Second FloorTowson, MD 21204Donna GwinDirector, Associate Relations andLabor RelationsShoppers Food and Pharmacy16901 Melford BoulevardBowie, MD 20715Yolanda AnwarUFCW Local 4008400 Corporate DriveSuite 200Landover, MD 207858

SUMMARY OF BENEFITS FOR FULL TIME PARTICIPANTSFULL TIME GROUP A BENEFITSFull Time Group A benefits includes Hospitalization, Medical/Surgical,Prescription Drug, and Life and Accidental Death and ription DrugParticipant and Eligible Dependent(s). Room andBoard covered at 70% up to the UCR underComprehensive Benefits. You must use an innetwork CareFirst PPO provider (with theexception of (1) services provided by pathologists,anesthesiologists, and radiologists at an innetwork facility; (2) emergency admission; (3)emergency room services; and (4) emergencyAmbulance Service). Emergency room service is a 75 Co-payment, then emergency room andprovider charges are covered at 70% of Usual,Customary, and Reasonable (UCR) fees, plusbalance billing up to in-network rate if out-ofnetwork. Co-payment is waived if admitted.Participant and Eligible Dependent(s). Coveredunder Comprehensive Benefits at 70% up to theUCR. Deductible is 500 per person per year.Annual out-of-pocket maximum is 5,000/individual and 10,000/family for innetwork & out-of-network combined. Certify allInpatient Hospital stays with Conifer. Must useLabCorp or Quest lab facilities to be covered forlaboratory services.Participant and Eligible Dependent(s). Annual out-ofpocket limit for prescription drugs is 1,600 percovered person, per calendar year and 3,200 perfamily. Benefits are paid at 100% for the remainder ofthe calendar year after the out-of-pocket level isreached.5% Co-payment (with a 5 minimum) for genericdrugs; 15% Co-payment (with a 15 minimum) forbrand name drugs on the preferred formulary list;9

25% Co-payment (with a 25 minimum) for brandname drugs not on the preferred formulary list.Benefits provided through OptumRx. Generic drugsare mandatory, if available. 20,000Life InsuranceParticipant only.Accidental Death &DismembermentParticipant only. 20,000FULL TIME GROUP B BENEFITSFull Time Group B benefits includes Weekly Disability, Dental and Optical.Weekly DisabilityParticipant only.50% of gross straight time pay for first 8 weeksand 40% gross straight time pay for next 4 weeks,depending on length of employment. First dayfor accident or hospitalization, 4th day forsickness. Eligibility for all benefits is continuedduring sick pay. See page 88 for more detailedinformation regarding your Weekly Disabilitybenefits.DentalParticipant & EligibleDependent.Exams, x-rays, cleanings, amalgam fillings, andsimple extractions covered at no charge whenusing a Group Dental Service (GDS) provider.OpticalParticipant & EligibleDependent.Vision examination, eyeglass lenses and frameonce every 24 months from last date of service,through Group Vision Service (GVS).10

SUMMARY OF BENEFITS FOR PART TIME PARTICIPANTSPART TIME GROUP A BENEFITSPart Time Group A benefits includes Hospitalization, Medical/Surgical,Prescription Drug, Life, and Accidental Death and Dismemberment.Note: Coverage for part time participants will be secondary if theparticipant has coverage under another group plan, whether as theprimary insured or as a dependent.HospitalizationParticipant only.Medical/SurgicalParticipant only.Prescription DrugParticipant only.Room and Board covered at 70% up to the UCRunder Comprehensive Benefits. You must usean in-network CareFirst PPO provider (with theexception of (1) services provided bypathologists, anesthesiologists, and radiologistsat an in-network facility; (2) emergencyadmission; (3) emergency room services; and(4) emergency Ambulance Service). Emergencyroom service is a 75 Co-payment, thenemergency room and provider charges arecovered at 70% of Usual, Customary, andReasonable (UCR) fees, plus balance billing upto in-network rate if out-of-network. Copayment is waived if admitted.Covered under Comprehensive Benefits at 70%up to the UCR. Deductible is 500 per personper year. Annual out-of-pocket maximum is 5,000/individual and 10,000/family for innetwork and out-of-network combined. Certifyall inpatient hospital stays with Conifer. Mustuse LabCorp or Quest lab facilities in order tobe covered for laboratory services.Annual out-of-pocket for prescription drugs is 1,600 per person or 3,200 per family. Afterthe out-of-pocket maximum is reached,prescriptions covered at 100% for theremainder of the calendar year.11

Life InsuranceParticipant only.Accidental Death &DismembermentParticipant only.5% co-pay (with a 5 minimum) for genericdrugs; 15% co-pay (with a 15 minimum) forbrand name drugs on the preferred formularylist; 25% co-pay (with a 25 minimum) forbrand name drugs not on the preferredformulary list. Benefits provided throughOptumRx. Generic drugs mandatory, ifavailable. 10,000. 10,000.PART TIME GROUP B BENEFITSPart Time Group B benefits include Weekly Disability, Dental andOptical benefits.Weekly DisabilityParticipant only.40% of average weekly straight time pay for first8 weeks and 30% average weekly straight timepay for next 4 weeks, depending on length ofemployment. First day for accident orhospitalization, 7th day for sickness. Eligibility forall benefits continued during sick pay. See page88 for more detailed information regarding yourWeekly Disability benefits.Exams, x-rays, cleanings, amalgam fillings, andsimple extractions covered at no charge whenusing a Group Dental Service (GDS) provider.Participant onlyVision examination, eyeglass lenses and frameonce every 24 months from last date of service,through Group Vision Service (GVS).Participant only.DentalOptical12

MAKING THE MOST OF YOUR MEDICAL BENEFITSThis book is more than a basic description of your coverage – in it,you’ll find ways to make better use of your benefits. The Fund pays alarge portion of the cost of most medical coverage for you and youreligible dependents. Many people take this for granted, not realizingthat wasteful and inefficient use of their benefits costs them time andmoney in the long run.RISING MEDICAL COSTS: WHO PAYS THE BILL?Health care costs in the United States have been rising rapidly. Why?The reasons are complicated, but the experts agree on one importantpoint: each year, vast amounts of time, money, and needless riskcould be saved through better use of medical services. Who pays thebill for rising costs and inefficiency? We all do, because insurers andproviders pass these costs on to consumers--you and the Fund.CONSUMER AWARENESSBy taking a few simple steps, you can shorten Hospital stays, lessenthe risk of unnecessary Surgery, and reduce your expenses. Forexample: Avoid weekend Hospital admissions Get second surgical opinions Take advantage of Outpatient surgery options Have admissions pre-certified Use generic drugs13

NOTICE – NO FUND LIABILITYUse of the services of any Hospital, clinic, doctor, or other providerrendering health care, whether designated by the Fund or otherwise,is the voluntary act of the participant or dependent. Some benefitsmay only be obtained from providers designated by the Fund. This isnot meant to be a recommendation or instruction to use the provider.You should select a provider or course of treatment based on allappropriate factors, only one of which is coverage by the Fund.Providers are independent contractors, not employees of the Plan.The Fund makes no representation regarding the quality of service ortreatment of any provider and is not responsible for any acts ofcommission or omission of any provider in connection with Fundcoverage. The provider is solely responsible for the services andtreatments rendered.HEALTH CARE COST CONTAINMENT CORPORATIONThe UFCW Unions and Participating Employers Health and WelfareFund, along with many other funds, participates in the Health CareCost Containment Corporation of the Mid-Atlantic Region, Inc.(HCCCC). It is designed to benefit participating funds by reducinghealth care costs for participants and their families. The HCCCC is ableto achieve significant cost savings because of increased bargainingpower in the health care marketplace.REPAYING THE FUND/OVERPAYMENT OF BENEFITSIf the Fund pays benefits in error, such as when the Fund pays you oryour dependent more benefits than you are entitled to, or if theFund advances benefits that you or your dependent are required toreimburse either because, for example, you have a compensableWorkers’ Compensation claim or have received a third partyrecovery (see “Subrogation” and “Advance Benefits for Workers’Compensation Claims”), you are required to reimburse the Fund infull and the Fund shall be entitled to recover any such benefits.14

The Fund shall have a constructive trust, lien and/or an equitable lienby agreement in favor of the Fund on any overpaid or advancedbenefits received by you, your dependent or a representative of youor your dependent (including an attorney) that is due to the Fundunder this Section, and any such amount is deemed to be held intrust by you or your dependent for the benefit of the Fund until paidto the Fund. By accepting benefits from the Fund, you and yourdependent consent and agree that a constructive trust, lien, and/orequitable lien by agreement in favor of the Fund exists with regard toany overpayment or advancement of benefits, and in accordancewith that constructive trust, lien, and/or equitable lien byagreement, you and your dependent agree to cooperate with theFund in reimbursing it for all of its costs and expenses related to thecollection of those benefits.Any refusal by you or your dependent to reimburse the Fund for anoverpaid amount will be considered a breach of your agreement withthe Fund that the Fund will provide the benefits available under thePlan and you will comply with the rules of the Fund. Further, byaccepting benefits from the Fund, you and your dependentaffirmatively waive any defenses you may have in any action by theFund to recover overpaid amounts or amounts due under any otherrule of the Plan, including but not limited to a statute of limitationsdefense or a preemption defense, to the extent permissible underapplicable law.If you or your dependent refuse to reimburse the Fund for anyoverpaid amount, the Fund has the right to recover the full amountby any and all methods which include, but are not necessarily limitedto, offsetting the amounts paid against your and/or any of yourdependents’ future benefit payments payable by the Fund under thePlan, including but not limited to benefits payable under this Plan,and the UFCW Unions and Participating Employers Retiree Healthand Welfare Plan. For example, if the overpayment or advancementwas made to you or on your behalf as the Fund participant, the Fund15

may offset the future benefits payable by the Fund to you and any ofyour dependents. If the overpayment or advancement was made toor on behalf of your dependent, the Fund may offset the futurebenefits payable by the Fund to you and any of your dependents.The Fund also may recover any overpaid or advanced benefits bypursuing legal action against the party to whom the benefits werepaid. If the Fund is required to pursue legal action against you oryour dependent to obtain repayment of the benefits advanced bythe Fund, you or your dependent or beneficiary shall pay all costsand expenses, including attorneys’ fees and costs, incurred by theFund in connection with the collection of any amounts owed theFund or the enforcement of any of the Fund’s rights toreimbursement. In the event of legal action, you or your dependentshall also be required to pay interest at the rate determined by theTrustees from time to time from the date you become obligated torepay the Fund through the date that the Fund is paid the fullamount owed. The Fund has the right to file suit against you in anystate or federal court that has jurisdiction over the Fund’s claim.RETROACTIVE TERMINATION OF COVERAGEThe Fund reserves the right to retroactively terminate your and yourdependents’ coverage under the Plan if you or any of yourdependents engage in fraud and/or intentionally misrepresent oromit a material fact relevant to your Plan coverage, or if you or yourParticipating Employer fail to timely pay any applicable premium orcontribution to the Fund relating to your benefits. Failure to followthe terms of the Plan, including but not limited to failing to notify theFund of a change in dependent status, accepting benefits in excess ofwhat is covered under the Plan, and accepting benefits after you oryour dependent are no longer eligible for coverage, will be consideredfraud and/or intentional misrepresentation. You are treated ashaving full knowledge of all the eligibility terms of this Plan.16

DEFINITIONSACCIDENTAL INJURY. Bodily injury arising out of an accident. Allinjuries sustained in connection with one accident will be consideredone injury. “Accidental Injury” does not include ptomaine poisoning,disease or infection (except pyogenic infection occurring through anaccidental cut or wound).ACTIVE WORK/ACTIVELY WORKING/ACTIVE AT WORK.Yourattendance in-person at your usual and customary place of business(outside your residence), acting in the regular performance of theduties of your occupation for wages or profit.AMBULANCE SERVICE. A licensed private professional ambulanceservice providing local ground/surface transportation by means of aspecially designed and equipped vehicle used only for transporting thesick and injured.ADMINISTRATIVE MANAGER. The company responsible for receivingParticipating Employer contributions, keeping eligibility records,paying claims, and providing information to you about the Fund. Thecompany is Associated Administrators, LLC, referred to as the “FundOffice” throughout this book.CALENDAR YEAR. A calendar year from January 1st through December31st.CARDIAC REHABILITATION.Health care specializing in therehabilitation of persons suffering from angina pectoris or personswho have recently undergone cardiac Surgery or who have suffered aheart attack.COBRA. Consolidated Omnibus Budget Reconciliation Act of 1985,and all related regulations, as amended from time to time. Providesfor continuation of benefits under certain circumstances forparticipants and their eligible dependent(s) when benefits are lost.17

COLLECTIVE BARGAINING AGREEMENT.The agreement oragreements between a Participating Employer and the United Foodand Commercial Workers Unions, Local 27 or Local 400, which requirecontributions to the UFCW Unions and Participating Employers Healthand Welfare Fund.CONCURRENT CARE CLAIM. A Pre-Service Claim related to an ongoingcourse of treatment or a number of treatments over time.CO-INSURANCE OR CO-PAYMENT. The out-of-pocket amount aparticipant or dependent is responsible for paying when receivingbenefits.DEDUCTIBLE. The out-of-pocket amount a participant or dependentmust pay prior to receiving benefits from the Fund. The per-personDeductible is the first 500 of covered medical expenses Incurred in aCalendar Year for Sickness or Injury.DENTAL EMERGENCY. An unforeseen situation requiring dentaltreatment to relieve a condition necessitating immediate care.Includes accidental injuries requiring immediate treatment.DIAGNOSTIC (PROCEDURE, TEST, SERVICE, OR STUDY). A medicalprocedure, test, service, or study for determining a Sickness orcondition. Must be ordered by and performed by (or under thedirection of) a Physician and may not be Experimental in nature.DURABLE MEDICAL EQUIPMENT.Equipment which:1. can withstand use;2. is primarily and customarily used to serve a medical purpose;3. generally is not useful to a person in the absence of a Sickness orInjury; and4. is appropriate for use in the home.18

EFFECTIVE/ELIGIBILITY DATE. According to the Eligibility Rules, thedate on which coverage for a participant or dependent begins.ERISA. The Employee Retirement Income Security Act of 1974, andregulations thereunder, as amended from time to time.EXPERIMENTAL. A drug, device, medical treatment, or procedure isconsidered Experimental or investigative unless:1. The approval of the U.S. Food and Drug Administration andapproval for marketing the drug or device has been given at thetime the drug or device is furnished;2. The drug, device, medical treatment, or procedure, or the patientinformed consent document utilized with the drug, device,medical treatment, or procedure, was reviewed and approved bythe treating facility’s institutional review board or other such bodyserving a similar function, if federal law requires such review orapproval;3. Reliable evidence shows that the drug, device, medical treatment,or procedure is not the subject of on-going Phase I or Phase IIclinical trials, or the research, experimental study, orinvestigational arm of ongoing Phase III clinical trials, or is nototherwise under study to determine its maximum tolerated dose,its toxicity, its safety, its efficacy, or its efficacy as compared with astandard means of treatment or diagnosis; or4. Reliable evidence shows that the prevailing opinion amongexperts regarding the drug, device, medical treatment, orprocedure is that further studies or clinical trials are not necessaryto determine its maximum tolerated dose, its toxicity, its safety,its efficacy, or its efficacy as compared with a standard means oftreatment or diagnosis.Reliable Evidence shall mean only published reports and articles inauthoritative medical and scientific literature; the written protocolsused by the treating facility or the protocol(s) of another facilitystudying substantially the same drug, device, medical treatment, orprocedure; or the written informed consent document used by the19

treating facility or by another facility studying substantially the samedrug, device, medical treatment, or procedure.Notwithstanding the above, a drug, device, medical treatment, orprocedure that is administered as part of a clinical trial is notconsidered Experimental to the extent the Fund is required by law tocover it.EXPLANATION OF BENEFITS (“EOB”). A comprehensive statement ofhow a claim was processed.FMLA. The Family Medical Leave Act of 1993, and any regulations, asamended from time to time.FUND. The United Food and Commercial Workers Unions andParticipating Employer

UFCW Unions and Participating Employers Active Health and Welfare Plan, a plan of the UFCW Unions and Participating Employers Health and Welfare Fund. Plan Sponsor Board of Trustees of the UFCW Unions and Participating Employers Health and Welfare Fund, 91

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