64-K4 - Premium Rate Notice (4).pdf
PDF 141 KB Posted
- Attached to
- Ancillary Insurance Benefits
- Solicitation number
- RFP 2026-018
- Issued by
- Johnson County, Texas
About this file
This is a Premium Rate Notice from Symetra Life Insurance Company for the City of Burleson, Texas, effective January 1, 2024. The document outlines renewal rates for ancillary insurance benefits including life insurance, accidental death and dismemberment (AD&D), disability coverage, and related dependent and supplemental products. The policyholder is the City of Burleson under Policy Number 01-017859-00. Coverage types include Basic Employee Life, Basic Dependent Life, Basic Employee AD&D, Supplemental Employee Life, Supplemental Spouse Life, Supplemental Child Life, Supplemental Child AD&D, Long Term Disability, Short Term Disability, and Supplemental Spouse AD&D. The quoted rates apply to various coverage types with different calculation bases: life and AD&D rates are per $1,000 of coverage, dependent and child life rates are per family unit, long-term disability rates are per $100 of monthly covered payroll, and short-term disability rates are per $10 of weekly covered benefit.
The renewal rates establish step-rate pricing for supplemental employee and spouse life insurance based on employee age brackets ranging from under 25 to 75 and above, with rates remaining consistent between the current and renewal periods. Monthly fees include $0.094 for basic employee life, $0.030 for basic dependent life, $3.000 for dependent life, $2.000 for child life, $0.030 for basic employee AD&D, $0.040 for supplemental employee AD&D, $0.210 for supplemental spouse AD&D, and $0.210 for short-term disability. The quoted rates are guaranteed through January 1, 2026, provided there are no changes in benefits, eligibility, or associated companies. The notice was issued on April 24, 2023, by Margaret Meister, President of Symetra Life Insurance Company, which is an Iowa-domiciled insurer licensed in all states except New York.
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Text version
Policy Number: 01-017859-00
Policyholder: City of Burleson
January 1, 2024
Monthly Rate/Fee $0.094 $0.030 $3.000
Step-rates* Step-rates*
$2.000 $0.030 $0.030 $0.040 $0.210 $0.210
- Life rates are based on per $1,000
- AD&D rates are based on per $1,000
- Dependent Life rates are based on per family unit
- Child Life rates are based on per family unit
- Long Term Disability Rates based on $100 of monthly covered payroll
- Short Term Disability rates are quoted as per $10 of weekly covered benefit
SYMETRA LIFE INSURANCE COMPANY
777 108th Avenue NE, Suite 1200 Bellevue, Washington 98004-5135
PREMIUM RATE NOTICE
Effective Date of Premium Rates/Fees:
Coverage/Service Renewal
Basic Dependent Life
Basic Employee Life Basic Employee AD&D
Supplemental Employee Life Supplemental Spouse Life Supplemental Child Life
Supplemental Child AD&D Long Term Disability
Supplemental Employee AD&D Supplemental Spouse AD&D
Short Term Disability
Supplemental Employee Life Step-rates are as follows:
Current: Renewal:
Age Rate per $1,000 Rate per $1,000 < 25 $0.070 $0.070
25-29 $0.070 $0.070 30-34 $0.080 $0.080 35-39 $0.100 $0.100 40-44 $0.140 $0.140 45-49 $0.220 $0.220 50-54 $0.330 $0.330 55-59 $0.540 $0.540 60-64 $0.720 $0.720 65-69 $1.220 $1.220 70-74 $2.160 $2.160 75 + $8.180 $8.180
Supplemental Spouse Life Step-rates are as follows:
Current: Renewal:
Age Rate per $1,000 Rate per $1,000 < 25 $0.070 $0.070
25-29 $0.070 $0.070 30-34 $0.080 $0.080 35-39 $0.100 $0.100 40-44 $0.140 $0.140 45-49 $0.220 $0.220 50-54 $0.330 $0.330 55-59 $0.540 $0.540 60-64 $0.720 $0.720 65-69 $1.220 $1.220 70-74 $2.160 $2.160 75 + $8.180 $8.180
Rates/Fees will be guaranteed until January 1, 2026 unless there is a change in benefits, eligibility, or an Associated Company is added.
BY:
Date:
Instructions:
Any policy issued in the State of New York is insured and underwritten by First Symetra National Life Insurance Company of New York, a New York-licensed insurer. Any policy issued in any state other than the State of New York is insured and underwritten by Symetra Life Insurance Company, an Iowa-domiciled insurer that is licensed in all states except New York.
Margaret Meister, President
April 24, 2023
(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 .