2012 Annual Enrollment GuideDear Team:

One of the biggest challenges we face each year is reviewing our health plans. We are constantly working with insurance providers to bring the best coverage for the lowest cost to our Team Members. This has been challenging as health care costs continue to rise each year.

During the past few years, we have increased premiums, but the increases have been less than the national average. Our health plan claims increased tremendously in 2011. As a matter of fact, catastrophic-type claims were $2 million more than in 2010. The bottom line is this: The unexpected rise in medical claims costs, which are expected to continue to increase, and the general uncertainty surrounding health care reform and the political state of the nation means our medical plan rates will increase beginning January 1, 2012.

The increases break down like this:

•Team Members only will see a weekly increase of $1.98;

•Team Members covering a spouse will see a weekly increase of $9.75;

•Team Members covering children will increase by $8.04 per week;

•Team Members covering their family will increase by $14.90 per week.

United continues to share the cost of the insurance premium as well as any premium increases. Depending on the type of coverage you have, United Supermarkets is paying anywhere from 68 percent to 70 percent of the weekly premium cost. By comparison, the average amount Texas employers pay for family coverage of their employees is 40 percent. United also pays the first $1,000 of health claims for each Team Member ($1,250 under family coverage). We want our Team Members to be able to handle small, routine medical issues while also protecting them from financial ruin if a catastrophic health care event occurs in their lives. Please review the changes explained in the “2012 Benefit Plan Changes” section of this packet.

Also enclosed in this packet is your Annual Compensation and Benefits Summary. Listed at the bottom of the statement are the benefits United Supermarkets pays on your behalf. The company pays these benefits so you can have the comfort of knowing you have financial protection and access to care when you and your family need it most.

This is a difficult message to deliver, yet we are proud of the fact that our company is still able to offer great coverage at reasonable rates compared to our industry. We know this is an increase in cost for the company and for our Team Members, but it is a shared burden we have to work through during the continuing state of uncertainty surrounding the country’s health care industry. Despite that, we know it is you who make our company work, and it is through your efforts that Guests choose to return to our stores. Because of your commitment each and every day, we will commit to never stop fighting to give you the very best benefits package we possibly can.

Robert Taylor CEO

Annual Enrollment is November 20–December 20, 2011Just as your life changes, so do your benefit needs. Don’t miss your once-a-year opportunity to make new benefit choices for you and your family.

Your current benefit elections will roll over for the 2012 plan. However:

• If you wish to participate in the Flexible Spending Account in 2012 you must enroll.

• Vision coverage is no longer included in the medical plan. Check out the great new vision program in the benefit overview. If you want vision coverage, you must enroll in the vision plan.

If you wish to add, change or cancel benefits for the 2012 calendar year, logon to www.myunitedbenefits.com and click on “Enroll Now.” (See instructions in this packet for more information)

All passwords will be reset as of November 18, 2011 to:Username: Team Member Number Password: Last 4 Digits of Social Security Number

Did you become tobacco free prior to July 1, 2011? If so, be sure to change your plan election to a non-tobacco discounted rate.

2012 BEnEfiT PlAn ChAnGEsEffective January 1, 2012

• The medical plan includes a Health Care Account (HCA), an integral part of your health care benefit package.

– United Supermarkets will contribute $1,000 into your HCA for you, and an additional $250 if you have family enrolled in the plan.

– When you incur eligible medical expenses, payment for the services will be made from your HCA.

– You do not pay any out-of-pocket cost for eligible expenses until you use all the money in your HCA.

– It is extremely important that you use this money wisely!

• Deductible - The total calendar-year deductible for a covered Team Member is $2,300. The Family Deductible is $4,600.

– The first $1,000 ($1,250 for a family) is paid by United through your Health Care Account!

– The next $1,300 ($3,350 for a family) is paid by the Team Member.

– Once the deductible is met, the PPO coverage takes effect. This means that 80% of eligible expenses are covered, and the Team Member is responsible for the remaining 20%.

– ALL covered services, including office visits, are subject to the deductible. The only exception is prescription drugs. You will continue to have copays for prescriptions.

• Preventive Care - In addition to the HCA funded by United, the plan pays preventive care services at 100%, when billed as preventive care by an in-network provider. These expenses will NOT come out of your Health Care Account or count toward your deductible.

• Keep your BCBSTX medical and dental ID card and your ESI prescription drug card. You will only receive new cards if you add or change your coverage.

Health Care Account Overview

nEW! The individual medical plan deductible is increasing from $2,000 to $2,300—family from $4,000 to $4,600. Remember that United pays the first $1,000—$1,250 for family.

nEW! The individual annual out-of-pocket expense is increasing from $3,000 to $3,500—family from $6,000 to $7,000

nEW! The premium discounts are increasing from $5 to $6 per week for non-tobacco users and from $12 to $13 for participating in the wellness program.

nEW! The preferred brand name and the non-preferred brand name prescription plan copays are slightly increasing:

2011 2012

Generic ........................................... $5 $5 Preferred Brand Name .................. $25 $30 Non-Preferred Brand Name .......... $50 $55 Specialty ........................................ $80 $80

nEW! The vision benefits will no longer be included in the medical plan. Don’t miss this great opportunity to enroll in the vision plan administered by Ameritas.

nEW! The Term life insurance premiums are reducing. Review the “2012 Benefit Overview” for additional information.

2012 Benefit Plan Changes

Team Member PremiumsYou will be rewarded with a lower medical plan premium for making choices that reduce the risk of high claims against our medi-cal plan. If you participated in the 2011 biometric screenings and online health risk assessment, and earned the required number of wellness points, you will receive the premium discount for 2012. However, if you did not participate in the 2011 biometric screen-ings, health risk assessment AND the become wellness program, you will lose the discount effective January 1, 2012. Details for earning the 2013 premium discount and exciting, new wellness opportunities will be available to you in late December, 2011.

*A “Tobacco User” is defined as a Team Member that has used a tobacco product in the last 6 months.

These rates represent about 30% of the total premium. United Supermarkets pays about 70% of the total premium on your behalf.

Team Member Only TM & Child(ren) TM & Spouse TM & Family

Full Premium $47.33 $75.77 $81.44 $110.30

Non-Tobacco User Discount $6.00 $6.00 $6.00 $6.00

become Discount $13.00 $13.00 $13.00 $13.00

Net Premium $28.33 $56.77 $62.44 $91.30

(Up to a 30-day Supply)

Generic ................................................................................................................................................... $5 per prescription

Preferred Brand Name .........................................................................................................................$30 per prescription

Non-Preferred Brand Name .................................................................................................................$55 per prescription

Specialty ..............................................................................................................................................$80 per prescription

Prescription Drugs – Administered by Express Scripts International (ESI)

Name-Brand Prescriptions—Team Member will pay 100% of the cost of name-brand prescriptions when a generic equiva-lent is available.

Out-of-Network Pharmacy—Team Member will pay 100% of the cost when purchasing a prescription at a non-United Supermarkets pharmacy in a city where a United Pharmacy is available. The Team Member may be reimbursed for 50% of the prescription payment after the medical deductible has been met by filing a paper claim to the medical plan.

Go to www.member.express-scripts.com for a complete listing of preferred drugs.

Benefit Highlights

This is a general summary of your benefits. Please refer to your plan documents, located at www.myunitedbenefits.com, for a full description of benefits. Should there be a discrepancy between this document and the plan documents, the plan documents will prevail.

In-network providers can be located at www.bcbstx.com. Your PPO network name is “Blue Choice.”

Use your preventive care benefits. Early detection can be a life saver!

Important Note: Covered charges incurred under medical benefits for pre-existing conditions are not payable unless incurred 12 months after enrollment date. This time may be offset if the insured has creditable coverage from his/her previous plan. The pre-existing conditions exclusion does not apply to dependent children under the age of 19.

Benefit Description In-Network Out-of-Network

Health Care Account (HCA) $1,000 Individual/$1,250 Family Paid by USM

Team Member Deductible $1,300 Individual/$3,350 Family $4,600 Individual/$9,200 Family

Total Calendar Year Deductible $2,300 Individual/$4,600 Family $4,600 Individual/$9,200 Family(HCA + Team Member Deductible combined)

Applies to ALL eligible services, unless indicated.

4th quarter carryover applies.

Out-of-Pocket Maximum, $3,500 Individual/$7,000 Family $7,000 Individual/$14,000 Family NOT including Deductibles

Preventive Care Including: 100% 60% after Deductible

Annual Physical

Lab and X-Ray

Well-baby Care

Immunizations

Hearing Exams

Screening Mammograms

Prostate Screening

Bone Mass Measurement

Inpatient Hospital Expenses 80% after Deductible 50% after Deductible

Medical / Surgical Expenses 80% after Deductible 50% after Deductible Including:

Office Visits

Lab and X-Ray

Other Diagnostic Procedures

All Other Outpatient Services

and Supplies

Emergency Services 80% after Deductible 80% after Deductible

Mental Health and 80% after Deductible 50% after Deductible Substance Abuse

*Your provider must bill these services as “preventive care” in order for them to be covered at 100%.

Age limitations apply.

MEDICAl PlAN

FAQ’s

Q. Do my prescription drugs apply to the HCA?

A. No. Your prescriptions will continue to be administered by ESI and be covered with a copay.

Q. How do the HCA and deductible work for families?

A. The family HCA can be used to pay for any covered services received by any family member covered under the plan. No family member has to satisfy more than the individual deductible before receiving PPO benefits, and the PPO benefits will be paid for the whole family once the family deductible is met.

Preventive Care paid 100% with no copays!

You pay $0

You pay $0

HCA Pays first $1,000 at 100%No copays!

Your HCA is funded byUnited Supermarkets.Use your funds wisely!

You pay up to $1,300

Next $1,300 is the Team Member’s portion of

the deductible.

You pay up to $3,500

After the deductible has been met, the plan pays 80% and you pay 20% up to the $3,500 out-of-

pocket maximum.

You pay $0

Remaining expenses paid by plan at 100%

Q. How much do I have to pay for my medical claim?

A. See chart below.

2012 BENEFIT OvERvIEwThis chart provides an overview of the additional benefits United Supermarkets offers. Please carefully review this information so that you can be aware of the great benefit package available to full-time Team Members! This is a general summary of your benefits. Please refer to your plan documents, located at www.myunitedbenefits.com, for a full description of benefits. Should there be a discrepancy between this document and the plan documents, the plan documents will prevail.

Benefit Plan Summary of Benefits 2012 Premiums

Tax Savings Plan Team Members can reduce their compensation by an amount equal to their contribution toward the cost of certain health benefit premiums and pay those premiums with pre-tax dollars.

Did you know that making premium contributions on a pre-tax basis reduces your taxable income and increases your take-home pay?

All eligible benefit election premiums are pre-tax unless you opt out of the plan through the online enrollment system at www.myunitedbenefits.com.

Health Care Flexible Spending Account (FSA)

Administered by Boon-Chapman.

If you participated in the Flexible Spending Account in 2011, your debit card will be reloaded

if you enroll in the 2012 plan and the card has not expired. If your debit card expires or if you are a new enrollee in the plan, a new debit card

will be issued.

Save, Save, Save Your Receipts! IRS regulations state that you must provide receipts to prove

that you have qualified medical expenses.

This account allows you to set aside pre-tax dollars each paycheck to be used for medical expenses (such as deductibles, copays, adult orthodontia treatment, laser eye surgery, etc.) that are not reimbursable under the health plan. Services paid by your medical plan’s Health Care Account are not eligible under the FSA.

See www.myunitedbenefits.com or www.mybenny.com for a list of eligible expenses and an Expense Work Sheet.

Plan Year: 12-month period beginning January 1 and ending December 31 of the same year.

Grace Period: You may submit claims until March 31 after the plan year ends.

Eligibility Waiting Period: The first of the month on or after 30 days of full-time active service

Team Member Annual Contribution:You decide how much, if any, you wish to set aside in this account.

Annual Minimum - $250

Annual Maximum - $5,000

Over-the-counter drugs are no longer a qualified medical expense under the Flexible Spending Account (unless you obtain a prescription from your doctor).

H New Benefit for 2012: Vision Plan

Administered by Ameritas Group.

If you wish to participate in this plan, you must enroll on www.myunitedbenefits.com.

Vision Benefit = $350 per Calendar year per covered family member

Your $350 Benefit can be used for:

Annual Eye Exams Lenses (single vision, bifocal, trifocal, lenticular or progressive) Contacts Frames

You can use any vision provider of your choice.

Team Member Weekly Rates:

Team Member Only - $1.99 Team Member & Spouse - $4.09 Team Member & Children - $3.49 Team Member & Family - $5.59

You no longer have to be enrolled in the medical plan to have vision coverage.

Dental Plan

Administered by BlueCross and BlueShield of Texas (BCBSTX).

There are no benefit changes for 2012.

Remember: You can use any dentist. However, you may be able to save on out-of-pocket costs

by utilizing a participating DentaBlue or BlueCare dentist. A listing can be found at

www.bcbstx.com.

Calendar Year Deductible:

$75 Per Covered Person / $225 Per Family

Dental Percentage Payable:

Preventive - (Class A Services) - 100% Deductible WaivedBasic - (Class B Services) - 80% after DeductibleMajor - (Class C Services) - 50% after Deductible

– Only eligible after 12 months of coverageOrthodontia - (Class D Services) - 50% after Deductible

– Orthodontia Services are limited to dependent children under age 19

Maximum Benefit Amount:

Preventive, Basic & Major Services - $1,800 Per Covered Person, Per Calendar Year

Orthodontia - $1,800 Lifetime Maximum Per Person

Your dental rates will not increase for 2012!

Team Member Weekly Rates

Team Member Only .............................................................$3.30

Team Member & Spouse ......................................................$8.45

Team Member & Children ................................................$10.90

Team Member & Family .....................................................$14.61

Basic Term Life and AD&D

Administered by Dearborn National.

If you are applying for Basic life Coverage you must complete and sign the Evidence of Insur-ability form found on the website and return it

to the Benefits Department by January 31, 2012. Forms must be returned by the deadline for

consideration for coverage.

Age based reductions apply.

Full-Time Team Member Benefit:

Your annual compensation, rounded to the next higher $1,000, if not already a multiple thereof (minimum of $10,000, maximum of $100,000).

Spouse Benefit: $10,000

Dependent Child(ren) Benefit: $5,000

Eligibility Waiting Period: First of the month on or after 30 days of full-time active service.

Don’t forget to update your beneficiaries through the online enrollment system.

Your life insurance premiums will decrease for 2012!

Team Member Annual Premium:

.168 per $1,000 of coverage

Example (for hourly rate of $8.00):

$8.00 (per hour) x 40 (hours per week) x 52 (weeks per year)= $16,640 annual salary

$16,640 annual salary (round this to the next higher $1000)= $17,000

17 x .168 = $2.86/52 weeks = $0.06 (per pay period)

Basic Dependent Term Life Premium: Coverage for Spouse and/or child(ren)

$0.11 (per pay period)

These rates represent about 40% of the total premium. United Super-markets pays about 60% of the total premium on your behalf.

Supplemental Term Life and AD&D

Administered by Dearborn National.

If you are applying for Supplemental life Coverage or electing to increase your coverage,

you must complete and sign the Evidence of Insurability form found on the website and return

it to the Benefits Department by January 31, 2012. Forms must be returned by the

deadline for consideration for coverage.

Guaranteed issue applies only to new hires applying during their initial eligibility period.

Age based reductions apply

Note: You cannot participate in Supplemental Term Life without participating in the Basic Term Life Coverage.

Full-Time Team Member Benefit:1, 2, 3, 4 or 5 times your annual salary rounded to the next higher $1,000, if not already a multiple thereof, up to a maximum of $500,000.

Team Member Guaranteed Issue:The lesser of 5 times salary or $300,000 (no guaranteed issue for age 70 or over).

Spouse Benefit:Option of $10,000, $25,000 or $50,000 not to exceed the insured Team Member’s Supplemental Term Life Insurance benefit.

Spouse Guaranteed Issue:$50,000 for spouses of Team Members under age 70. No guaranteed issue for spouses of Team Members 70 or over.

Dependent Child Benefit:$5,000

Eligibility waiting Period:First of the month on or after 30 days of full-time active service.

Don’t forget to update your beneficiaries through the online enrollment system.

Your life insurance premiums will not increase for 2012 (unless you change age brackets)!

Team Member Annual Premium (by age):Age Annual Rate per Age Annual Rate per $1,000 of coverage $1,000 of coverage

Example: A Team Member age 36 earning $8.00 per hour, who has elected 2 times his annual salary, would calculate his premium accord-ing to the following formula:

$8.00 (per hour) x 40 (hours per week) x 52 (weeks per year) = $16,640 annual salary

$16,640 x 2 (two times annual salary in life insurance)

$33,280 (round this number up to the next $1,000) = $34,000 (amount of life coverage)

34 x $1.56 = $53.04 annually / 52 weeks = $1.02 (per paycheck for Supplemental Term Life)

Spouse Annual Premium (based on Team Member Age)

Child(ren) Premium: $0.23 per pay period

< 35 $1.08 35-39 $1.56 40-44 $2.5245-49 $3.9650-54 $5.64

55-59 $9.24 60-64 $13.6865-69 $19.5670-74 $23.0475+ $35.04

Team Member’s Age< 35

35–3940–4445–4950–5455–5960–6465–69

Spouse Rate(annual) $10,000

$11.88$18.24$27.36$42.24$59.04$96.24$114.48$141.72

Spouse Rate(annual) $25,000

$29.70$45.60$68.40$105.60$147.60$240.60$286.20$354.30

Spouse Rate(annual) $50,000

$59.40$91.20$136.80$211.20$295.20$481.20$572.40$708.60

Overwhelmed by all these numbers? Don’t worry! The online enrollment system calculates these premiums for you!

Team-Member Assistance Program

Administered by Health Management Systems of America through Reliance Standard

Life Insurance Company (RSLI).

The assistance program is a professional counseling and referral service designed to help you with your personal, job or family problems. The assistance program addresses substance abuse, family problems, marital counseling, work-related conflicts, financial problems and emotional and mental health issues.

It is free, voluntary and strictly confidential.

For confidential, personal assistance, please call the toll-free number for counseling 24 hours a day, 7 days a week — (800) 767-5320.

United Supermarkets provides the Team-Member Assistance Program for all full-time Team Members at no cost to you!

Universal Life Insurance

Permanent Universal Life Insurance Policy, provided by Transamerica Life Insurance Company, designed to complement your

existing group benefits.

You can choose to cover your spouse and eligible children or grandchildren even if you do not participate. You can choose the benefit and premium amount that best fits your lifestyle. Universal Life Insurance is permanent – take your benefits with you whether you retire or leave United Supermarkets. This plan includes a Long-Term Care Benefit!

Important: To enroll call Total Benefits Solutions at (888) 783-9653 (toll-free), 8:30 am to 5:00 pm, Monday-Thursday and 8:30 am to 4:00 pm Friday.

Universal Life is an individual policy and you can retain coverage if you leave United Supermarkets.

Critical Illness Insurance

Pays a lump-sum benefit directly to you to use for any purpose!

Provided through HighMark / Continental American Insurance Company

Critical Illness coverage pays a lump-sum benefit following the diagnosis of cancer, carcinoma in situ, heart attack, coronary artery bypass surgery, stroke, major organ transplant and end-stage renal failure. Family coverage is available and children are automatically covered at 10% of the Team Member benefit at no extra cost up to a maximum of $5,000.

Important: To enroll call Total Benefits Solutions at (888) 783-9653 (toll-free), 8:30 am to 5:00 pm, Monday- Thursday and 8:30 am to 4:00 pm Friday.

You can take coverage with you if you leave or retire from United Supermarkets (with certain stipulations).

Accident Insurance

Provided through UnumProvident Corporation.

Accident Insurance is designed to help pay for high costs that may not be covered by traditional health insurance due to injuries that occur either on or off the job.

Coverage is available for you, as well as your family. You may cover one person or your entire family.

Important: To enroll call Total Benefits Solutions at (888) 783-9653 (toll-free), 8:30 am to 5:00 pm, Monday—Thursday and 8:30 am to 4:00 pm Friday.

You own your policy and can take it with you if you leave the company and premiums are paid on time!

Life Lock Identity Theft Protection

United Supermarkets has partnered with life lock to help protect your identity!

Technology has ushered in an information on-demand society, one in which the sensitive data of millions of individuals can be easily accessed and shared in seconds. LifeLock, the leader in proactive identity theft protection, uses the industry’s most innovative tool to help consumers from this growing threat before it happens.

LifeLock helps protect your identity – even if your information falls into the wrong hands. As a LifeLock member, if you become a victim of identity theft because of a failure in LifeLock’s service, they’ll help fix it at their expense, up to $1,000,000. (Other restrictions apply. See lifelock.com for details.)

HOW TO ENROLL:

1. Visit www.lifelock.com or call (800) LIFELOCK (543-3562).

2. Use promocode ‘UNITEDTM’.

3. Complete enrollment by providing your required information.

Coverage Categories Monthly Cost Annual Cost

Team Member Only $6.00 each $66.00 each

Spouse or Adult over 17 $6.00 each $66.00 each

Children under 18 $1.50 each $15.00 each

This plan is on a direct-pay basis and cannot be payroll deducted.

MetLife Auto & Home Insurance

Group discounts for automatic payroll deduction. Many policies available, including renters

insurance, condo, motorcycle and RV coverage, just to name a few.

Full-time Team Members with at least one year of full-time service can enjoy special savings and get special group discounts on auto and home insurance through payroll deduction. You can save with a discount for years of service with our company, being a good driver and if you have multiple policies.

MetLife provides excellent benefits like replacement price if your new car is totaled within the first year or up to 15,000 miles (whichever comes first). If your tires, battery or shocks are damaged in an accident, you get brand-new parts, with no deduction for depreciation.

Get a free price quote by calling (800) GET-MET 8 (800-438-6388).

Purchasing Power

A premium purchasing program through the ease of payroll deduction.

Use the Group Code: ‘USM2237‘ to purchase brand-name computers, electronics, home appliances, lawn equipment, exercise equipment and furniture.

Full-time Team Members with at least one year of full-time service, at least 18 years of age, earning at least $15,000 a year and have a bank account or credit card (to be used in case of non-payment via payroll deduction) can start shopping!

Get started today! Go to www.myunitedbenefits.com and click on the Purchasing Power logo or call, toll-free (866) 768-2988.

Delivered straight to your home.

Remember, if you wish to participate in the 2012 Flexible Spending Account, you must enroll online!

2012 Voluntary Plan OverviewNot included on the online enrollment system—refer to the contact information listed below.

Long-Term Disability

Administered by Reliance Standard Life Insurance Company (RSLI).

Did you know that long-Term Disability replaces a portion of your income should you have

an extended disability?

Benefit Percentage: 60% of your covered earnings

Waiting Period Before Benefits are paid: 180 Days

Maximum Benefit:$5,000 or $10,000 per month, dependent upon earnings

Maximum Benefit Period:To age 65 or Social Security normal retirement age

Eligibility Waiting Period:First of the month on or after 12 months of full-time active service

Important: This plan contains a Pre-existing Condition limitation. “Pre-existing Condition” means any Sickness or Injury for which the Insured received medi-cal treatment, consultation, care or services, including diagnostic procedures, or took prescribed drugs or medicines, during the 3 months immediately prior to the Insured’s effective date of insurance.

United Supermarkets provides Long-Term Disability coverage for all full-time Team Members at no cost to you!

Short-Term Income Replacement Plan (Short-Term Disability)

Administered by Reliance Standard Life Insurance Company (RSLI).

Is your paycheck insured? This plan replaces a portion of your income when you are unable to work due to a covered illness or injury such as

maternity leave and surgeries that result in a short absence from work.

To report a claim call Matrix Absence Management at

(866) 533-3438.

Benefit Percentage: 60% of your gross covered earnings (Benefits are not taxable, so your take home pay is not significantly reduced!)

waiting Period Before Benefits are paid:

Accident – 0 days

Sickness – 7 days

Maximum Benefit: $1,731 per week

Maximum Benefit Period: 26 weeks

Eligibility waiting Period: First of the month on, or after, 12 months of full-time active service.

Important: This plan contains a Pre-Existing Condition limitation unless you enroll in the plan during the first 12 months of full-time active service. “Pre-Existing Condition” means any sickness or injury for which the Insured received medical treatment, consultation, care or services, including diagnostic procedures, or took prescribed drugs or medicines, during the 3 months immediately prior to the Insured’s effective date of insurance.

Your Short-Term Income replacement plan insurance premiums will not increase for 2012!

Team Member Annual Premium:

$4.62 per $1,000 of your disability benefit (60% of total annual salary)

Example:

$20,000 (annual income) x .60 (60%) = $12,000 (disability benefit)

$12,000 / $1,000 = $12 (disability benefit $1,000)

$12.00 x $4.62 = $55.44 (annual premium)

$55.44 / 52 = $1.07 (per paycheck for Short-Term Disability)

This benefit is not taxable. You do not pay federal income tax or Social Security tax on income from this plan.

United Supermarkets pays about 53% of the Short-Term Disability Premium on your behalf.

Benefit Plan Summary of Benefits 2012 Premiums

Benefit Plan Summary of Benefits 2012 Premiums

Are you ready to enroll or make changes? Log on!Read this guide and review the benefits informa-tion on www.myunitedbenefits.com - it’s the best way to learn about your benefits so you can make good choices during enrollment.

• When you are ready to enroll, click the “Enroll Now Login” button.

• To log in, you will need your: Username–Team Member Number Password–Last 4 digits of your Social Security Number

• You will be asked to change your password after the first time you log in.

• If you are making changes only, follow the online instructions.

• If you are enrolling for the first time, follow Steps 1–4 below.

ONlINE ENROllMENTNote: Your 2011 elections roll over to 2012 except for the Flexible Spending Account Elections and the new vision program. No changes are required if keeping current benefits.

Did you begin using tobacco products in the past 6 months? Be sure to change your medical election to tobacco user!

If you are dropping benefits during annual

enrollment due to a qualifying event (marriage, divorce,

over age dependent, other coverage, etc.)

you must contact the Team Member

Benefits Department.

Step 3: Confirm your ElectionsReview your selections carefully, and if you decide to waive or change plans, select

“View/Change Plan/Waive.” If you need to change the covered family members, select “Cover/Waive Family Members.” The review screen will also illustrate your cost and the

contribution made by United Supermarkets.

Step 1: Enter Your Personal InfoAfter logging in, select “Enroll Now” to begin en-tering your personal information, making sure to complete the required fields marked with an aster-isk. Upon completing your personal information, select “SAVE” and begin adding family members. Be sure to enter all family members that would be eligible for coverage on any plan. You will choose later whom to cover on each benefit. Select “Save & Add Another” to continue adding family mem-bers and “Save” when finished. Select “Continue” when all family members have been added.

Step 2: Choose Your Benefits! Now is the fun part, where you choose the ben-efits and coverage levels you want. The system will walk you through each benefit, step by step, giving you the option of waiving or electing cov-erage. For each benefit you elect, you will have the opportunity to select which family members you want to cover. After making each of your benefit selections, select “Continue” and the rates will be illustrated for each tier of coverage. The final step for enrolling in each benefit requires you to agree to the Participation Agreement and select “Enroll Now.” Be sure to complete the “Beneficiary Assignment” on any life insurance you elect. It is very important that you designate or add additional beneficiaries for each life insur-ance policy you select.

Step 4: Checkout! Upon completing the enrollment process, you will be able to review a confirmation screen stat-ing “Enrollment Complete.”

Print your confirmation.

If you wish to participate in the Flexible Spending Account in 2012, you must enroll!

Vision benefits are no longer included in the medical plan. If you would like to have vision insurance for you or you and your family, you must enroll in the new vision plan.

The deadline for annual enrollment is December 20, 2011. If you wish to add, change or cancel benefits for the 2012 calendar year, logon to www.myunitedbenefits.com and click on “Enroll Now”. All passwords will be reset to: last 4 digits of your Social Security Number.Username: Team Member Number

United Supermarkets7830 Orlando Ave. | Lubbock, TX 79423 | (806) 791-0220

www.myunitedbenefits.com

CONTACTS

Medical & Dental Insurance ............................................................................................................... BlueCross BlueShield of Texas

Eligibility Verification, Benefits, Claim Status or Participating Providers: toll-free: (800) 521-2227

In order to receive the highest level of benefits, use in-network providers. www.bcbstx.com

For a listing of in-network providers, go to www.bcbstx.com and search BlueChoice PPO providers.

Vision Plan ............................................................................................................................................................... Ameritas Group

(800) 487.5553

www.ameritasgroup.com

Prescription Plan ....................................................................................................................................................... Express Scripts

Participating Pharmacies: United Supermarkets – Market Street – Amigos United. toll-free: (800) 451-6245

In areas with stores that do not have a United pharmacy, go to the Express Scripts website. www.member.express-scripts.com

Life Insurance .....................................................Team Member Benefits Department, United Supermarkets Store Support Center

toll-free: (888) 791-0220

Disability Insurance .............................................................................................................................Matrix Absence Management

To Report a Short-Term Disability Claim. toll-free: (866) 533-3438

Flexible Spending Accounts (FSA) ................................................................................Boon-Chapman Benefit Administrators, Inc.

(800) 252-9653 (Option 6)

www.mybenny.com

Team Member Assistance Program .................................................................................. Health Management Systems of America

through Reliance Standard Life Insurance Company

toll-free: (800) 767-5320

For work/life Resources visit: www.my-life-resource.com

user name: hmsa password: myresource

Voluntary Insurance Products ....................................................................................................................... Total Benefits Solutions

Universal Life Insurance, Critical Illness, and Accident Insurance (806) 783-9653

toll-free: (888) 783-9653

LifeLock Identity Theft Protection ............................................................................................... To enroll visit www.lifelock.com or

call (800) LIFELOCK (543-3562) - Use promo code ‘UNITEDTM’

MetLife Auto & Home Insurance ......................................................................................... Get a free price quote: (800) 438–6388

Purchasing Power ......................................................................................... To make a purchase, visit www.myunitedbenefits.com

or call toll-free 866-768-2988

401(k) .......................................................................................................................................................................... New York Life

To Check Account Balance, Change Contribution or Fund Choices, (800) 294-3575

Request a Loan Withdrawal or Request a Rollover. spanish: (888) 440-0022

www.mylife.newyorklife.com

Assistance and Information ................................Team Member Benefits Department, United Supermarkets Store Support Center

(806) 791-0220

toll-free: (888) 791-0220

Insurance Associates

(806) 765-7264

toll-free: (866) 765-7264

DFW area: (972) 740-5906

DID YOU kNOW…?

The Women’s Health and Cancer Rights Act of 1998 provides benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prosthesis and complications resulting from a mastectomy, including lymphedema.