IBEW Local 351 Welfare Fund

Stop Loss

Carrier: Amalgamated Life

Policy Period: January 1, 2021 – December 31, 2021

Policy Number: SL1113

Deductible: $500,000 with $135,000 aggregate specific corridor (following initial $150,000 reimbursement)

Contract Basis: 24/12

Policy Covers: Medical and Rx

Composite Rate: $18.26

Stop Loss Administrator Guide_2021 MC

ALSSLCF-11 specific claim form (NJ) filed

IBEW Local 351 Renewal Policy Eff. 1-1-2021

Life and AD&D

Carrier: Symetra Life Insurance Company

Policy Period: January 1, 2020 – December 31, 2021

Policy Number: 01-017210-00

Benefits: Class One – Flat $30,000 Life and AD&D.  Class Two – Flat $280,000 Life and $30,000 AD&D

Life Rate (per $1,000): Class One .10/$1,000.  Class Two .395/$1,000

AD&D Rate (per $1,000): Class One and Two .038/$1,000

E-Cert 17210 Life Class 2 NB

PH 17210 Life Contract NB

E-Cert 17210 Life Class 1 NB

Symetra Life Claim Forms