63-K5 - Premium Rate Notice (5).pdf
PDF 119 KB Posted
- Attached to
- Ancillary Insurance Benefits
- Solicitation number
- RFP 2026-018
- Issued by
- Johnson County, Texas
About this file
This document is a Premium Rate Notice from Symetra Life Insurance Company for the City of Burleson, establishing insurance rates effective January 1, 2025. The notice details coverage options and monthly premium rates for Basic Life Insurance at $0.094 per $1,000, Basic Accidental Death and Dismemberment Insurance at $0.030 per $1,000, and Basic Dependent Life Insurance at $3.000 per Family Unit. Additional coverage includes Supplemental Life Insurance with age-based step-rates ranging from $0.070 per $1,000 for employees under 25 to $8.180 per $1,000 for those 75 and over, Supplemental Accidental Death and Dismemberment Insurance, Supplemental Dependent Life Insurance with spouse coverage at step rates and child coverage at $2.000 per Family Unit, Voluntary Short Term Disability Income Insurance at $0.242 per $10 of weekly benefit amount, and Long Term Disability Income Insurance at 0.210 percent of total covered payroll. Premium rate adjustments due to age changes take effect on the Policy Anniversary following the date of change.
The quoted rates are guaranteed through January 1, 2026, and will remain in effect unless there are changes in benefits, eligibility, or the addition of an Associated Company. The policyholder is instructed to use these rates beginning on the effective date and retain the Premium Rate Notice with the policy documentation. This rate notice was authorized by Margaret Meister, President of Symetra Life Insurance Company, and registered by Jake Bisuut on November 25, 2024, under Policy Number 01 017859 00.
View the file
Other files
Show 40 more
50 files listed here. See the rest on GovTribe.
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
LCG 8042 1/80 1
SYMETRA LIFE INSURANCE COMPANY
777 108th Avenue NE, Suite 1200 Bellevue, Washington 98004-5135
PREMIUM RATE NOTICE
Policy Number: 01 017859 00
Policyholder: City of Burleson
Effective Date of Premium Rates: January 1, 2025
Coverage Monthly Rate Basic Life Insurance $0.094 per $1,000 Basic Accidental Death and Dismemberment Insurance $0.030 per $1,000 Basic Dependent Life Insurance $3.000 per Family Unit Supplemental Life Insurance step-rated* Supplemental Accidental Death and Dismemberment Insurance $0.030 per $1,000 Supplemental Dependent Life Insurance
Spouse step-rated* Child $2.000 per Family Unit
Supplemental Dependent Accidental Death and Dismemberment Insurance
Spouse $0.030 per $1,000 Child $0.040 per $1,000
Voluntary Short Term Disability Income Insurance $0.242 per $10 of weekly benefit amount
Long Term Disability Income Insurance 0.210% of total covered payroll
* Supplemental Life Insurance and Supplemental Spouse Life Insurance monthly step-rates are as follows: (Premiums for Supplemental Spouse Life Insurance are calculated based on the employee’s age.)
Age Per $1,000 of Insurance Age Per $1,000 of Insurance
Under 25 $0.070 50 through 54 $0.330 25 through 29 0.070 55 through 59 0.540 30 through 34 0.080 60 through 64 0.720 35 through 39 0.100 65 through 69 1.220 40 through 44 0.140 70 through 74 2.160 45 through 49 0.220 75 and over 8.180
Symetra® is a registered service mark of Symetra Life Insurance Company.
LCG 8042 1/80 2
PREMIUM RATE NOTICE
Policy Number: 01 017859 00
Policyholder: City of Burleson
Effective Date of Premium Rates: January 1, 2025
Premium rate adjustments due to change in age are effective on the Policy Anniversary following the date of change.
Rates will be guaranteed until January 1, 2026 unless there is a change in benefits, eligibility, or an Associated Company is added.
SYMETRA LIFE INSURANCE COMPANY
By: Margaret Meister, President
Registrar: Jake Bisuut
Date: November 25, 2024
Instructions: (1) Use these rates beginning on the effective date shown above.
(2) Retain this Premium Rate Notice with your policy.
File details come from the government source that posted it. Updated .