United Food & Commercial Workers

Unions and Employers

Midwest Health and Pension Funds

UFCW Calumet Region Insurance Fund

Summary of the Cafeteria Plan

For Employees Participating in the Health Benefits Plan

Your employer (the “Employer”) may have adopted the “Cafeteria Plan for Employees Participating in the UFCW Unions & Employers Midwest Health Benefits Plan” (the “Cafeteria Plan”) to allow tax savings for certain employees. You should confirm whether or not your Employer has adopted the Cafeteria Plan.

You may not be eligible for and/or your plan of health benefits may not include every benefit referenced in this Summary of the Cafeteria Plan (for example, dependent coverage is not provided under all plans).


Employees who are eligible to participate for health coverage under the UFCW Unions and Employers Midwest Health Benefits Plan (the “Health Benefits Plan”) are also eligible under this Cafeteria Plan to pay employee contributions for the Health Benefits Plan coverage on a pre-tax basis.

Cafeteria Plan Benefit

The Cafeteria Plan enables you to pay your required employee contributions to the Health Benefits Plan on a pre-tax basis. This allows you to reduce your taxable income and to direct your Employer to use that amount to pay the required health coverage contribution under the Health Benefits Plan. You will pay lower federal income, state income and FICA taxes due to the reduction in your taxable income.

Enrollment and Wage Reduction Contributions

By completing and timely filing the enrollment/election form to participate in the Health Benefits Plan, you automatically agree to reduce your wages in an amount equal to your required contributions for health coverage benefits and direct your Employer to use that amount to pay the employee contribution.

When You May Change Your Enrollment/Election Form

You must complete and file an enrollment/election form within 30 days of receiving the form in order to participate in the Health Benefits Plan. Your enrollment/election form will be binding for the Plan Year (January 1 through December 31). If you begin participation after the first day of a Plan Year, your enrollment/election form will be binding from the day you begin participating in the Cafeteria Plan until the end of the Plan Year. Your election remains in place unless you file a change during the annual enrollment period (generally in November and December) or due to a “Change in Election Event” as described below.

You may only file a new enrollment/election form during the Plan Year to change your coverage and contributions on account of and consistent with a “Change in Election Event” as follows:

  • Change in Employment Status–A change in employment status means your hours worked increase or decrease to a point that it changes your eligibility for single or family coverage under the Health Benefits Plan.
  • Change in Number of Dependents–You gain or lose dependents due to marriage, divorce, legal separation, annulment, death, birth, adoption and placement for adoption.
  • Change in a Dependent’s Status–Your dependent newly satisfies or ceases to satisfy eligibility requirements (for example, attaining age 19 or gaining or losing full-time student status).
  • Court-Ordered Coverage–This refers to a judgement, decree or order resulting from a divorce, legal separation, annulment or change in legal custody, including a qualified medical child support order, which requires you to enroll your dependent child in the Health Benefits Plan. You may not drop coverage unless coverage is actually provided under another individual’s plan.
  • Entitlement to Medicare or Loss of Entitlement. You or a dependent become entitled to or lose entitlement to Medicare.
  • Entitlement to Medicaid or the State Children’s Health Insurance Program (SCHIP), Loss of Entitlement, or Eligibility for Assistance for Coverage. You or a dependent become entitled to or lose entitlement to Medicaid or SCHIP or become eligible for assistance through Medicaid or SCHIP for coverage under this Health Plan.
  • Change in Cost–If there is a significant increase or decrease in the cost of a plan, a change in election may be permitted.
  • Change in Coverage–If your or a dependent’s coverage is significantly reduced or increased, a change in election may be permitted.
  • Family and Medical Leave Act–If you take a leave under the Family and Medical Leave Act, you may revoke or change your election.
  • Different Enrollment Period–Your spouse or your dependent have a plan with different enrollment periods.
  • Special Enrollment Rights Under HIPAA. Special enrollment rights are required by the Health Insurance Portability and Accountability Act (“HIPAA”). HIPAA allows individuals to enroll in a health plan in special circumstances when an individual has gained a new dependent or has gained or lost eligibility for coverage under another plan.

Changes in elections during the Plan Year must be filed within 30 days of the event except for Medicaid or SCHIP changes which may be filed within 60 days of the event.

Unpaid Leave

If you are eligible for an unpaid leave, your employer may require that your weekly contribution for health coverage during your leave be paid by you upon your return. Catch-up contributions will be taken on a pre-tax basis to the extent allowed under rules from the Internal Revenue Service. If you return from your leave in the same Plan Year in which your unpaid leave began, you will be reinstated in the Cafeteria Plan on the same terms as when the leave began.

If you are on a military leave, you can continue to contribute for health coverage. The Health Benefits Plan will provide appropriate information on USERRA coverage.

COBRA Continuation Coverage

The Health Benefits Plan will provide information about COBRA Continuation Coverage and any other health continuation requirements if you lose coverage under the Health Benefits Plan.

Payments for COBRA Continuation Coverage must be paid on an after-tax basis.

Termination of Participation

Your Cafeteria Plan coverage will automatically terminate the date that you are no longer eligible for health coverage under the Health Benefits Plan, or when the Cafeteria Plan is terminated.

Plan Document Controls

This summary explains the principal provisions of the Cafeteria Plan so that you may understand the Cafeteria Plan’s operation and its benefit to you. This summary cannot change, add to, or subtract from, the formal Cafeteria Plan document. In the event of inconsistencies between this summary and the Cafeteria Plan document, the formal Cafeteria Plan document will control.

Your Employer and the Board of Trustees of the Health Benefits Plan reserve the right to amend or terminate the Cafeteria Plan. You may inspect a copy of the Cafeteria Plan document at your employer’s office.

Please refer to the Health Benefits Plan’s summary plan description for information regarding the Health Benefits Plan’s benefits.

If you have any questions after reading this summary, please contact the Fund Office during normal business hours.


(Updated 03/18/10)