Plan Documents
Here you’ll find the UFCW documents and forms you need in Adobe PDF format. Don’t have Adobe Reader? Get it here
UFCW Health Plan Documents
Plan Documents (Plan One)
Download PDF
|
Summary of Benefits & Coverage (SBC) Plan One
Download PDF
|
Plan Documents (Plan Two)
Download PDF
|
Summary of Benefits & Coverage (SBC) Plan Two
Download PDF
|
Plan Documents (Plan Three)
Download PDF
|
Summary of Benefits & Coverage (SBC) Plan Three
Download PDF
|
Plan Documents (Retirees)
Download PDF
|
SBC Glossary
Download PDF
|
Prior Authorization List
|
Provider Listing
HMN Directory
|
Helpful Documents and Forms
HIPAA Authorized Representative Form
|
Urgent Care Listings
Download PDF
|
Coordination of Benefits (COB) Questionnaire
|
Akamai Way Flier
|
Frequently Asked Questions (FAQ’s)
|
|