HomeMy WebLinkAboutContract 46072-A1 V 0
YFNANCfAL- Request for Amendment COWRACTIYo. A`
ReliaStar Life Insurance Company
A member of the VoyaT""family of companies
Administrative Office: P.O. Box 20, Minneapolis, MN 55440
Group Name: City of Fort Worth
Group Number: 684121
Effective Date of Amendment: 6/1/15
Amendment:
Change the portability product from Port Choice to Port Plus. No medical questions will be required for portability coverage.
The new Portability rates will be as follows:
<25 0.12
25-29 0.14
30-34 0.2
35-39 0.25
40-44 0.39
45-49 0.61
50-54 1.11
55-59 1.9
60-64 3.16
65-69 6.99
70-74 12.97
Note:The active employee life rates will remain the same. There is no active life rate change for this amendment.
Applies to the following product(s)/coverage(s):
Basic Life Suppl Life Suppl Dep AD&D
Basic AD&D Suppl AD&D
Suppl Dep Life
Account Number: 2
Class:all
Date:
Signature:
Printed Name: ru�
Title:
Voya Internal Servicing/Sales Information:
Primary Selling Office:Dallas —
Primary Servicing Office: Dallas APPROVED AS T N AND LEGALITY:
Primary Sales Representative: Clifton Browning
Primary Client Representative: Jessica Ayala
Implementation Manager:n/a AssisMit City Attorn y t
ooa000
PLEASE DELETE THE ONE THAT DOES NOT APPLY:
(NPAMD-Amendment adding New Pr ducts)or AMD- o er endments $ o0
RECORD �'
OFFICIAL —� $ °�
AMD o°�
CITY SECRETARY
FT.WORTH, TX nald P Gonzales,AWL