UFCW LOCAL 555 EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT - MCCAIN FOODS USA INC.
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UFCW LOCAL 555
EMPLOYERS HEALTH TRUST
2023 OPEN ENROLLMENT
McCain Foods USA Inc.
2022 – Form N
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UFCW LOCAL 555 EMPLOYERS HEALTH TRUST
Open Enrollment Packet
Table of Contents
Enrollment Letter ................................................................................................................................................ 1
Open Enrollment Election Form (return pages 3-5).............................................................................................. 2-5
Summary of Benefits for McCain Foods USA, Inc. ............................................................................................. 6-12
Participant Edge Login Instructions ..................................................................................................................13-18
Quick Reference Guide....................................................................................................................................19-20
UFCW LOCAL 555-EMPLOYERS HEALTH TRUST
Administered by Zenith American Solutions
12205 SW Tualatin Road, Suite 200
Tualatin, OR 97062
(503) 486-2102 or (866) 796-7623 Fax: (971) 239-0672
November 5, 2022
RE: Enrollment for McCain Foods USA, Inc.
Effective January 1, 2023, McCain Foods USA, Inc. employees, covered by the collective
bargaining agreement between McCain Foods USA, Inc. and UFCW Local 555, will begin
receiving health and welfare benefits through the UFCW Local 555-Employers Health Trust. This
will replace your current benefit coverage through McCain Foods USA, Inc. The attached packet
provides information about the transition, the benefits you will receive and other important
information.
In this packet you will find:
• Election of Coverage Form
• A Summary of Benefits and Coverage for your Medical and Prescription Drug
benefits
• Information about your Dental benefits
• Information about your Vision benefits
• Information about Weekly Disability benefits
• Information about your Life and AD&D benefits
• A Contact Sheet for your new Trust Office and benefit providers.
To ensure that you and your eligible dependents are covered January 1, 2023 under the
UFCW Local 555 – Employers Health Trust, you must return the election form in this packet
by December 5, 2022.
If you have questions, please contact the UFCW Local 555-Employers Health Trust Office
at 1-866-796-7623 and a representative will be happy to assist you.
1
1 UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc.
UFCW LOCAL 555-EMPLOYERS HEALTH TRUST
ADMINISTRATIVE OFFICE
c/o Zenith American Solutions
12205 SW Tualatin Rd, Suite 200, Tualatin, OR 97062
Phone: (503) 486-2102 * (866) 796-7623 * Fax: (971) 239-0672
Re: Application for Health Benefits
Please complete the enclosed application along with all requested
documents that apply to you. These documents are necessary to process
your application.
Please return your form by December 5, 2022 to ensure coverage begins
January 1, 2023.
Document Checklist:
All pages of the Application
Copy of Birth Certificates for Newborns
Copy of Birth Certificates for children with a different last name than member
Copy of Birth Certificate and Marriage Certificate for adding a Step-Child to
the plan
Copy of Marriage Certificate for new marriages
Copy of Marriage Certificate for spouses with a different last name than
member
Proof of your name change, if applicable
Your signature on Information about you
Sincerely,
Trust Office
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IMPORTANT – YOU MUST COMPLETE AND RETURN THIS FORM
TO THE TRUST BY December 5, 2022
UFCW LOCAL 555-EMPLOYERS HEALTH TRUST
Election of Coverage for McCain Foods USA, Inc.
Level 3 Coverage
Response Required by December 5, 2022
***
ELECTION FORM
Overview
Cut Here
All employees and their eligible dependents covered by the UFCW Local 555 Collective
Bargaining Agreement and McCain Foods USA, Inc. as of November 2022 and have worked a
minimum of 80 hours, will have Level 3 coverage from the UFCW Local 555-Employers Health
Trust, as of January 1, 2023.
If you want to ensure that you and your eligible dependents are covered, you must return this form.
Once eligible, your coverage will continue as long as you work at least 80 hours per month and
the necessary employer contributions are made.
1. Your Level 3 Benefits
As a Level 3 employee you will receive medical, prescription drug, dental and vision
coverage for you and your Covered Dependents; and time loss, life, and AD&D coverage
for the employee only.
2. Coverage Option – Medical and Prescription Drugs
The Trust offers you medical coverage through a self-funded plan utilizing the Regence
BlueCross BlueShield PPO network. Since Regence and your previous network provider
under the McCain Foods USA, Inc. are both Blue Cross affiliates, there should be no change
in who are network providers. The medical and prescription drug benefits provided to Level
3 Employees are summarized in the attached Summary of Benefits and Coverage.
Prescription drug benefits are provided through Optum Rx, effective January 1, 2023.
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UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc. 3
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Your dental, vision, time loss, life and accidental death and dismemberment coverage is
also summarized in the attached Summary of Benefits and Coverage.
3. Other Health Insurance
If you or any dependents have other health insurance, please complete.
Person(s) who has other insurance:
Is it through employment? Yes No
Name of Other Carrier:
4. Eligibility for Other Health Insurance Coverage—Spouse/Domestic Partner
If you enroll in the Trust a Dependent Spouse, Domestic Partner, or Same-Sex Domestic
Partner who is eligible for other coverage and declines it, the Trust will charge the Employee
$100 a month to cover his or her Spouse, Domestic Partner, or Same-Sex Domestic Partner.
If the amount is not paid, the Spouse, Domestic Partner, or Same-Sex Domestic Partner
will not be covered under the Trust.
Cut Here
Has your Spouse, Domestic Partner, or Same-Sex Domestic Partner declined other insurance coverage?
Yes No
Please note that the Trust audits to confirm that all children, Spouses, Domestic
Partners, or Same-Sex Domestic Partners meet Plan eligibility requirements. If you
have questions about what the Plan’s eligibility rules provide, please check your Plan
Booklet, or contact the Trust Office.
5. Information About You
Print Employee’s Name Social Security Number
Gender Date of Birth
Your Mailing Address City State/Zip Code
Name of Your Employer Your Phone
Date of Hire Your Email Address
Your Signature Today’s Date
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6. Information About Your Dependents
If you are covering a Spouse, Domestic Partner, Same-Sex Domestic Partner, and/or
Dependent Children, please add their names, their Social Security Numbers, and their
birth dates here. If you are adding a newborn or a child with a different last name than
yours, you will need to provide proof of birth. If adding a new spouse with a different
last name, you will need to provide a marriage certificate.
Print Name. Social Security Number, Birth Date/Gender, and Relationship to You
Print Name, Social Security Number, Birth Date/Gender, and Relationship to You
Print Name, Social Security Number, Birth Date/Gender, and Relationship to You
Print Name, Social Security Number, Birth Date/Gender, and Relationship to You
Print Name, Social Security Number, Birth Date/Gender, and Relationship to You
Cut Here
Print Name, Social Security Number, Birth Date/Gender, and Relationship to You
Print Name, Social Security Number, Birth Date/Gender, and Relationship to You
7. Select Your Dental Plan
The Trust offers two dental options. The benefits available under each option can be
reviewed in your Plan Booklet. Please select one of the options below:
Check one Trust Dental Willamette Dental
box only
If no election is made, you will automatically be placed in the Trust Dental.
8. Designate a Beneficiary for Your Life Insurance
Beneficiary’s Name Birth Date Relationship to You
Your Name (Print) Your Signature Today’s Date
9. Return This Form To:
UFCW Local 555-Employers Health Trust
c/o Zenith American Solutions
12205 SW Tualatin Rd., Suite 200
Tualatin, OR 97062
(503) 486-2102 (866) 796-7623
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UFCW LOCAL 555 -
EMPLOYERS HEALTH TRUST
SUMMARY OF LEVEL 3 BENEFITS
FOR
MCCAIN FOODS USA, INC.
Effective Date: JANUARY 1, 2023
UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc. 6SUMMARY OF BENEFITS
This is a summary of the Level 3 medical, prescription drug, dental, vision, time loss, life and accidental
death and dismemberment benefits that employees transferred from the McCain Foods USA, Inc. Plan
will receive as of January 1, 2023. A full description of the Level 3 benefits are in the Plan
Booklet/Summary Plan Description that will be mailed once enrolled.
Medical Benefits
All McCain Foods USA, Inc. employees being transferred to the UFCW Local 555-Employers Health
Trust effective January 1, 2023 will have Level 3 coverage.
Summary of Benefits
The Plan pays a percentage of Covered Expenses for the services listed below after the annual
deductible is met.
Preferred Provider Participating and Non-Participating
Benefit Features Provider Benefit
Benefit
Level 1 Level 2 Level 3 Level 1 Level 2 Level 3
Level 1 $400
Individual deductible per calendar year Level 2 $400
Level 3 $300
Level 1 $800
Maximum family deductible Level 2 $800
Level 3 $600
Annual out-of-pocket limit for medical Preferred and Participating Providers
expenses Level 1 $3,900 Individual/$7,800 Family
Level 2 $3,400 Individual/$6,800 Family
Level 3 $3,300 Individual/$6,600 Family
Non-Participating Providers
There is no out-of-pocket limit on benefits for services received from Non-
Participating Providers. This means that there is no limit on your potential out-of-
pocket costs.
Preventive Care Services After Deductible, Plan Pays
Preferred and Participating Providers
No Deductible, Coinsurance or
Office Visit Copay
Eligible Preventive Services under the
Affordable Care Act Non-Participating Providers
Subject to Deductible, Coinsurance
and Office Visit Copay
7 UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc.Preferred Provider Participating and Non-Participating
Benefit Features Provider Benefit
Benefit
Level 1 Level 2 Level 3 Level 1 Level 2 Level 3
Professional Services After Deductible, Plan Pays
Office exams; $10 copay applies, then 80%* 80%* 85%* 70%* 70%* 75%*
Diagnostic radiology and lab 80% 80% 85% 70% 70% 75%
Chiropractic, Naturopathic,
80%* 80%* 80%* 80%* 80%* 80%*
Acupuncture Treatment; $10 office
Surgery 80% 80% 85% 70% 70% 75%
Maternity care after the initial visit
**(except that screenings from a 80% 80% 85% 70% 70% 75%
Preferred Provider that are required to
*For Preferred and Participating Providers, copayments end when the annual out-of-pocket maximum is met.
**Prenatal visits and certain maternity screenings with a Preferred and Participating Provider will be paid at 100% in accordance with
federal regulations for all participants. Other maternity care only covered for Employees, spouses and domestic partners.
Hospital Services After Deductible, Plan Pays
Emergency services received for an
Emergency Medical Condition (copay
waived if admitted to hospital or other 80%* 80%* 85%* 80%* 80%* 85%*
facility on an inpatient basis);
otherwise $100 co- pay applies.
Inpatient stay including maternity,
80% 80% 85% 70%**** 70%**** 75%****
surgery and rehabilitation***
Outpatient services including surgery,
80% 80% 85% 70% 70% 75%
diagnostic radiology and lab
***Prenatal visits and certain maternity screenings with a Preferred and Participating Providers will be paid at 100% in accordance with
federal regulations. Maternity care only covered for employees, spouses and domestic partners. Coverage for dependent children limited
to ACA-mandated preventive care.
****Hospital Room and Board maximum for Nonparticipating Providers is $455/day. This limit does not apply to Preferred and
Participating Providers.
UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc. 8Preferred Provider Participating and Non-Participating
Benefit Features Provider Benefit
Benefit
Level 1 Level 2 Level 3 Level 1 Level 2 Level 3
Other Services After Deductible, Plan Pays
Ambulance 80% 80% 80% 80% 80% 80%
Rehabilitation including occupational,
80% 80% 85% 70% 70% 75%
speech and physical therapy
Skilled nursing facility, home health
80% 80% 85% 70% 70% 75%
and hospice care*****
Durable medical equipment and 80% 80% 85% 70% 70% 75%
Outpatient Dialysis After Deductible, Plan Pays
Outpatient dialysis treatment
(including hemodialysis, peritoneal
dialysis and hemofiltration services and 80% 80% 85% 150% of 150% of 150% of
supplies) Medicare Medicare Medicare
• First 120 days
• After 120 days and through
the end of the 34th month
• Please note, Allowed Amount
for Non-Participating
Providers is 150% of the
100%, 100%, 100%, 100%, 100%, 100%,
Medicare Allowance. If you deductible deductible deductible deductible deductible deductible
are not enrolled in Medicare waived waived waived waived waived waived
Part B, you may be required to
pay the balance of billed
charges from a Non-
Participating Provider.
This plan becomes the Secondary Payer to Medicare; the Trust will process
only the remaining amount that would not be covered by Medicare Part B
• Months 35 and following
(whether you have enrolled in Medicare Part B or not). Deductible,
coinsurance, and out-of-pocket limit do not apply.
*****Room and Board maximum for nonparticipating Skilled Nursing Facility Care is $227.50/day. This limit does not
apply to Preferred or Participating Providers.
Prescription Drug Benefits
Effective January 1, 2023, the Plan will provide benefits through a contract with Optum Rx (“Optum”)
for prescription drugs, oral, transdermal and vaginal ring contraceptives and insulin and diabetic
supplies. Discounted rates under the contract with Optum result in savings to the Participant and to
the Plan. The Plan uses a copayment structure that reduces the Participant’s out-of-pocket costs when
using generic drugs. There is no deductible under the prescription drug plan.
Participating Pharmacies
Optum maintains a network of participating retail pharmacies. Participants who fill a prescription at a
Participating Pharmacy will pay only the applicable copayment, as described below. If a
Nonparticipating Pharmacy is used, the Participant will need to pay for the prescription in full and
submit a claim for reimbursement. The Plan will pay only up to 80% of the Allowed Amount after the
copayment. The Optum network has a larger number of in-network pharmacies.
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9 UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc.A full list of the Participating Pharmacies is available from the Trust Office or at www.optumrx.com.
Copayments
When a prescription is filled at a Participating Retail Pharmacy, the Participant’s copayment will be at
one of these following tiers:
Type of Prescription In-Network Copayment Out-of-Network Copay
ACA Preventive* and $0 80% of Allowed Amount
Defined $0 Copay Drugs
Generic $10 per fill 80% of Allowed Amount after
$10 copay per fill
Preferred Brand $20 per fill 80% of Allowed Amount after
$20 copay per fill
Non-Preferred Brand $20 per fill 80% of Allowed Amount after
$20 copay per fill
*What is considered a preventive drug is updated as required to meet ACA guidelines.
A Market Priced Drug program applies to certain prescription drug classes to encourage utilization of
lower cost FDA approved alternatives. Higher costs may apply if recommended alternatives are not
utilized.
You will pay the actual cost of the prescription if the drug cost is lower than the Plan copayment. The
Plan copayment applies to the greater of a 34-day supply or 100-unit doses. The list of brand name
drugs on the Preferred Drug List can be obtained by going to www.optumx.com or contacting Optum
at 1-866-328-2005.
Prescription Drug Annual Out-of-Pocket Limit
Benefits will be paid as depicted above until you reach the annual out-of-pocket limit.
When Participating Pharmacies are used, there is both an individual and a family annual out-of-pocket
limit. After the annual out-of-pocket limit is reached, the Plan will pay 100% of Covered Expenses for
prescriptions filled by Participating Pharmacies for that person for the remainder of the calendar year.
There is no annual out-of-pocket limit when Non-Participating Pharmacies are used. The annual out-
of-pocket limits for prescription drugs are as follows:
Participating Pharmacy Non-Participating
Level Individual/Family Pharmacy
Level 3 $5,400/$10,900 No Limit
Level 2 $5,300/$10,700 No Limit
Level 1 $4,800/$9,700 No Limit
Dental Benefits Available
There are two Dental Plan options available to McCain Foods USA, Inc. employees: the Scheduled
Dental Plan which reimburses the employee for dental services received according to a schedule of
benefits, and the Willamette Dental Plan which requires the employee to use a select group of Dentists
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UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc. 10at Willamette Dental facilities and only requires a copayment from the employee at the time of service
rather than reimbursing the employee later. Employees may select a Dental Plan when first eligible for
dental benefits or during the Annual Open Enrollment period. If no election is made, the employee
will be automatically placed in the Scheduled Dental Plan. All family members must participate in the
same Dental Plan.
Once the employee has made a selection, it can only be changed by written notice to the Trust Office
during the Annual Open Enrollment period or upon the occurrence of an event that creates Special
Enrollment rights.
Option 1: Scheduled Dental Plan
1. Amount of Benefits: The Scheduled Dental Plan provides up to $2,000 per Participant per year in
dental benefits (necessary basic and prosthetic pediatric dental services for children under 19 are
not subject to the $2,000 maximum). Payments are based upon a schedule of benefits which
establishes the amounts the Plan will pay for particular procedures. The scheduled amount does
not necessarily cover the full cost of the services provided.
2. Deductibles, Copayments and Exclusions: Except for orthodontic benefits, the Dental Plan does
not have any separate deductible or copayment requirements. The Plan excludes coverage for
certain types of treatment.
3. Orthodontic Benefits: The Scheduled Dental Plan offers a special orthodontic benefit.
Orthodontic benefits are paid at 70% of Covered Expenses up to a maximum of $825 for each
Participant in any five-year period.
Option 2: Willamette Dental Plan
1. About: Willamette Dental is a group practice Dental Plan which provides all dental services
through contracted Dentists practicing at specified offices. The Willamette Dental Plan option is
offered through Regence Blue Cross Blue Shield of Oregon. In addition to the Willamette Dental
contact information, Regence Customer Service is available to provide information on benefits
and Willamette Dental Locations. Except for a small visit charge and copayments for certain
procedures, Willamette Dental provides all necessary dental services without charge to the
employee.
2. Benefits Provided: Each patient pays a $15 charge for each dental appointment. Certain
procedures also require a copayment. There are no other charges. Under the Willamette Dental
Plan preventative dental services are covered at 100% and require no copayment. These services
include: dental examinations; x-rays, cleaning; fluoride treatments; sealants; oral hygiene
instruction; periodontal charting; periodontal evaluation; fillings; and simple extractions. If you
need to cancel an appointment, you must notify the dental office 24 hours in advance or a missed
appointment charge will apply.
11
11 UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc.Vision Benefits
1. Eligibility: All individuals with Level 3 benefits are eligible for vision benefits. The vision benefits
have the following frequency limitations:
• Exams: Once every 12 months
• Lenses: Once every 12 months
• Frames: Once every 24 months
• Contacts: Once every 12 months and are in lieu of lenses and frames
2. Benefits: The Plan provides vision benefits through VSP. VSP uses a network of private practice
doctors who have agreed to provide services for a negotiated amount. To find a VSP network
doctor, contact VSP at 800-877-7195 or visit VSP’s website, www.vsp.com.
Services received from non-VSP Providers may result in a lower benefit and greater out-of-pocket
expenses and will also require that a claim form be submitted.
Weekly Disability Income Benefits
If you are receiving weekly disability benefits from McCain Foods USA, Inc. Plan as of January 1, 2023,
you will continue to receive them from this Trust as long as you are eligible. Weekly disability benefits
from the McCain Foods USA, Inc. Plan will count towards the 26 week maximum under this Trust.
1. Eligibility: The Plan provides weekly disability income benefits for eligible Employees only.
Employees at Levels 1, 2 and 3 all have weekly disability benefits.
2. Benefits: Weekly disability income benefits are available for an eligible Employee only if he or
she becomes Totally Disabled while eligible. Total Disability means that he or she is unable to
perform each and every duty of his or her own occupation as a result of an illness or injury.
The weekly disability income benefit is the lesser of $200 per week or 55% of the eligible Employee’s
average straight time weekly earnings. Benefits are available as long as the eligible Employee is Totally
Disabled up to a maximum of 26 weeks. Benefits begin on the first day of Total Disability following an
accident and the eighth day if the Total Disability is the result of an illness (including pregnancy).
Life and Accidental Death and Dismemberment Benefits
Eligibility: The Plan provides Life and Accidental Death and Dismemberment benefits only to
Employees with Level 3 coverage. Level 3 Employees who have opted out of medical coverage are
eligible for Life and Accidental Death and Dismemberment benefits, which are described in a separate
Plan Document.
Benefits: The Plan provides Accidental Death and Dismemberment benefits for eligible Employees
only. The Life Insurance Benefit is $2,000. The maximum Accidental Death and Dismemberment benefit
is $2,000. The amount payable for Accidental Death and Dismemberment benefits depends on the
nature of the bodily injury that the eligible Employee suffers. The eligible Employee may name a
beneficiary for these benefits.
12
UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc. 12UFCW Local 555-Employers Health Trust
Administered by Zenith American
Solutions-Trust Office
12205 SW Tualatin Rd, Suite 200
Tualatin, OR 97062
1.866.796.7623
Dear Members:
We are pleased to inform you that your Participant website called “Participant Edge” has enhanced
capabilities for UFCW Local 555 –Employers Health Trust Participants.
Participant Edge is the Trust’s individualized Participant portal. On this new site, you will be able to view
the following:
• Eligibility Information (after January 1, 2023)
• Work History (after January 1, 2023)
• Medical and Dental Claims Information and EOBs (after January 1, 2023)
• Disability Payment Information (after January 1, 2023)
• Plan Documentation and Important Plan Links
• Online Fillable Forms
And More!
The portal’s website address is https://edge.zenith-american.com. You can also access
Participant Edge via the mobile application, available on the App Store and Google Play.
The Trust encourages all Participants to take advantage of this exciting new tool. Please contact the
Trust Office at 1.866.796.7623 or via email at 555eligibility@Zenith-American.com
with any questions.
This packet provides additional details and instructions for you:
1. Create an account on Participant Edge to begin using your website
2. Participant Edge Frequently Asked Questions (FAQ)
3. Document Upload feature and fillable form submission instructions
UFCW Local 555-Employers Health Trust
Go to the Website:
edge.zenith-american.com
We strongly urge you to complete and return the forms to the
Trust Office to ensure that our records accurately reflect your Select "LOGIN"
information. Select "Participant Edge"
ZENITH-AMERICAN.COM | 866.796.7623
12205 SW TUALATIN RD, SUITE 200 | Tualatin, OR 97062
13 UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc.It’s not always possible for Participants to come into the office or call during
business hours. With Participant Edge, Participants can view benefit plan details,
including eligibility and work history by year, 401k, pension access, links to
1.866.796.7623 vendors, and more – available in English or Spanish.
Participant Edge improves service resolution and reduces customer service calls by
giving participants the ability to securely access information and plan documents.
Participant Edge designed by
industry experts combines
the latest technology and
innovative practices to
dramatically improve both
participant service and fund Work History Mobile Application
office efficiency, including: The Work History menu option allows Participants can access the site
you to see your work history for any of 24/7/365 online using a computer,
Zenith American Solutions is your funds. Your work history appears tablet or smartphone, or via the
the largest Taft-Hartley third- sorted by work year. Participant Edge™ mobile application.
party administrator in the
United States and operates
numerous offices Check Eligibility Forms and Documents
nationwide, each one The Eligibility menu option displays Securely display specific documents,
focused on serving clients your health and work eligibility. When including medical and dental EOBs, to
and participants locally viewing your eligibility confirm that you view, download and print on demand.
through an unrivaled depth are viewing the correct trust.
of resources and wealth of
professional expertise.
Contact your Customer Care
Advocacy Department for help
edge.zenith-american.com
14
UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc. 14ONE-STOP-SHOP FOR PARTICIPANTS
© Zenith American Solutions, Inc. 2022. All rights reserved. Member Communication
15 UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc.Features Value and Benefits
Self-Service Accessibility
• Side menu for quick navigation between pages.
• Designated Participant Edge™ Administrators can modify Fund,
benefit plan and other selections as requested.
Navigation tools make the site
• Detail filters to view specific information, such as a work history by a easy and intuitive. Filters allow
specific year. participants to quickly locate
exactly what they need.
Security Best Practices
Participant Edge incorporates the latest in web authentication best practices,
including:
• Account setup authentication ensures only permitted individuals can
access the server.
• Two ways to verify identity during account setup requires a second form Secure internet access to the
of identification such as social security number. information your participants
need with assured privacy.
Flexible Configuration and Custom Branding
Participant Edge administrator can control the look of the site:
• Use your brand color scheme, custom image/logo in page banner,
and provide your own Welcome Message text.
Allows for continuity between
• Choose which pages and information to include on your site. your Fund site and Participant
Edge™. Select which benefit
pages display to your needs.
Participant Edge is a proprietary interactive website that works for you.
The site is customized around your Fund(s) and not only reduces your
costs but ensures that your participants get the best service at every turn.
edge.zenith-american.com
16
Member Communication
UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc. 16You have online resources for the UFCW
Local 555-Employers Health Trust.
Create an account on
Participant Edge to begin
using your new website!
Participant Edge allows you to access and update your information quickly, easily, and securely. If you haven't
already, you'll need to set up an account on the site to see all the new features.
Use the following URL to access the Edge Hub, where you can create an account: edge.zenith-american.com.
If you are new or you have not set up an account:
Visit the Edge Hub website to get started
From your computer, use one of the following browsers:
Firefox, Chrome, or Safari
edge.zenith-american.com
Access the Edge Hub website:
Note: Dependents may not register for online access.
Register for an account by creating a Username and Password
The Username you choose must contain 4 to 15 characters. It may consist of
any combination of letters (A-Z) or numbers (0-9).
The Password must contain 8 to 12 characters. It may consist of any
combination of letters (A-Z) or numbers (0-9).
Note: Spaces, punctuation and special characters are not valid characters.
If you already created an account: 24/7/365 access:
Login to access your resources as well Download the Participant Edge Mobile
as optional self-service capabilities Application
Some of which include: Access the site using a computer, tablet, or
smartphone, or via the mobile application.
• Download Documents
• Check Application Statuses
• View Eligibility
• View Pension Information
• View Claim Information Support Help Page
• View 1095 Forms If you need assistance, select
edge.zenith-american.com
17
17 UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc.PARTICIPANT EDGE FREQUENTLY ASKED QUESTIONS
I'm using a supported web browser and the
webpage still won't load. What do I do?
CHROME
1. From the Browsing history menu, select "Clear browsing data".
2. Click advanced, select "Download history".
3. Select "Cookies and other site data" for cached files.
4. Click "Clear Data".
5. Exit/quit all browser windows and reopen the browser.
FIREFOX What do I do if I forgot my Username or
1. From the History menu, select "Clear Recent History". Password?
2. From the range from Time range drop-down. If you forgot your Username or Password, click
3. Click the down arrow to choose which elements to clear. on the "Forgot your password?' link and fill in
4. To clear your entire cache, select all items. the requested information.
SAFARI
1. On the upper left-hand side of your screen, click "Preferences".
How do I change the language settings?
2. In the window that appears, click the Privacy tab. Toggle between English and Spanish
3. Click the button "Remove All Website Data". depending on your language preference. Select
4. Click "Remove Now" from the pop-up window that appears. the drop down in the upper corner.
If clearing your browser history doesn’t work, try restarting
your computer. If you have tried all troubleshooting tips and
are still experiencing difficulties, please contact your Plan
What if I belong to multiple Trust Funds?
Benefits Administrator’s Customer Service department. Select your Trust from the menu in the upper
right-hand corner, then you can select the
applicable fund from the drop-down list (if you
How do I view more information in addition to what's belong to multiple).
displayed to me on my Dashboard?
The Dashboard is the first option on the navigation menu
allowing you to view your benefit plan information at-a-
glance. To see each section in more detail, click the view
links.
You will see:
• General Information
• Eligibility
• Work History on the Dashboard
How do I access Documents and Forms?
The Documents menu option allows you to view and
download plan documents related to you and the Fund.
Contact your Customer Care
Advocacy Department for help
Click or tap a document file link to open it.
edge.zenith-american.com
© Zenith American Solutions, Inc. 2022. All rights reserved.
UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc. 18Use this sheet to find the assistance you need
QUICK REFERENCE CHART
Information Needed Whom to Contact
ELIGIBILITY QUESTIONS:
TRUST OFFICE
- Eligibility for Coverage
- Enrollment for Coverage Zenith American Solutions, Inc.
- Demographic Changes (Names/Addresses etc.) Contributions Accounting Department
- Obtaining ID Cards 12205 SW Tualatin Rd. Suite 200
- Medical/Dental/Claims Appeals that were initially Tualatin, OR 97062
denied by Carrier.
Phone: 503-486-2102
- Proof of Insurance & Medicare D Notice.
- COBRA Information and Premium Payments Fax: 971-239-0672
- Accident and Disability Weekly Benefits and 555eligibility@Zenith-American.com
Claims
- Death and AD&D Benefits and Claims
- Retirement Information & Premium Payments
BENEFIT AND CLAIMS QUESTIONS: TRUST OFFICE
Zenith American Solutions, Inc.
FOR TRUST INDEMNITY PLAN: Benefits & Claims Department
- Explanation of Benefits (EOBs) 12205 SW Tualatin Rd. Suite 200
- Medical Benefits Tualatin, OR 97062
- Medical Claims Submission Phone: 503-486-2102
- Medical Claims Status Fax: 971-239-0671
- Medical Claims Appeal
- ID Cards
www.zenith-american.com
DENTAL BENEFITS: TRUST OFFICE
Trust Self-Funded Dental Plan
-Dental Benefits 12205 SW Tualatin Rd. Suite 200
-Dental Claims Submission Tualatin, OR 97062
-Initial Dental Claims Appeals
Phone: 503-486-2102
-ID Cards
*Note, Dental Benefits are only available once
Fax: 971-239-0671
you attain Level 2 coverage and above www.zenith-american.com
------------------------------------------------------- -------------------------------------------------------
-Benefit Office Locations and Appointments Willamette Dental
-ID Cards Phone: (855) 433-6825
www.willamettedental.com
CLAIMS ADMINISTRATOR FOR
PRESCRIPTION DRUGS :
Optum RX
TRUST INDEMNITY PLAN PO Box 650334
-Information on Benefits Dallas, TX 85034-0334
-Participating Pharmacies
-Claims Submissions for Prescriptions
www.optumrx.com
-ID Cards (866) 328-2005
-Mail Order Pharmacy
-Market Place RX Program
-Specialty Drug Benefits (Precert. and Ordering)
19 UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc.VISION BENEFITS: Vision Service Plan (VSP)
-Benefits/Vision Network Providers P.O. Box 997105
-Claims Submission Sacramento, CA 95899
-Claims Appeal for Vision Benefits www.vsp.com
*Note: Vision Benefits are only available once (800) 877-7195
you attain Level 3 coverage
TRUST OFFICE
Zenith American Solutions, Inc.
WEEKLY DISABILITY INCOME: 12205 SW Tualatin Rd. Suite 200
-Apply for Weekly Disability Benefits Tualatin, OR 97062
-Check Status of Disability Payment Phone: 503-486-2102
Fax: 971-239-0671
www.zenith-american.com
LEVEL II CLAIMS APPEALS TRUST OFFICE
If you are unsuccessful appealing your claim, Level The Board of Trustees
2 Claim Appeals for Medical, Prescription Drug, UFCW Local 555 Trust Funds
Dental, Vision, Death, Accidental Death and 12205 SW Tualatin Rd. Suite 200
Dismemberment (AD&D) and Weekly Disability Tualatin, OR 97062
Benefit can be heard by the Board of Trustees. Phone: 503-486-2102
MEDICARE Medicare
1-800-633-4227
-Contact Medicare with questions regarding www.medicare.gov
Medicare Part A, B, and/or D coverage.
HIPAA PRIVACY & SECURITY OFFICERS TRUST OFFICE
Zenith American Solutions, Inc.
-HIPAA Notice of Privacy Practice 12205 SW Tualatin Rd. Suite 200
Tualatin, OR 97062
Phone: 503-486-2102
www.zenith-american.com
UFCW LOCAL 555 - EMPLOYERS HEALTH TRUST 2023 OPEN ENROLLMENT McCain Foods USA Inc. 20PRESRT STD
UFCW LOCAL 555-EMPLOYERS HEALTH TRUST US POSTAGE
PAID
12205 SW Tualatin Rd., Suite 200 PERMIT 243
Tualatin, OR 97062 PORTLAND OR
2023 – OPEN ENROLLMENTYou can also read
