Page 102 - Aegion PPO SPDs
P. 102
ERISA INFORMATION AND STATEMENT OF ERISA RIGHTS
NOTE: This section is not a part of Your Benefit Booklet. The Claims Administrator is not
responsible for any statements contained herein that are not set forth in the Administrative Services
Agreement or the Benefit Booklet.
The Employee Retirement Income Security Act of 1974 (ERISA) requires that certain information be
furnished to each participant in an employee benefit Plan. This information is outlined below.
ERISA INFORMATION
Plan Name: Aegion Welfare Plan
Maintained By: Aegion
Type of Plan: Medical Plan and Dental Plan
Type of Administration: Contract Administrator
Plan Sponsor and Administrator: Aegion
17988 Edison Avenue
Chesterfield, MO 63005
Employer Identification: 45-3117900
Plan Number: 501
Agent for Services of Legal Process: Aegion
17988 Edison Avenue0
Chesterfield, MO 63005
Fiduciary: Aegion
Plan Modification and Amendment: N/A
Funding: Self-Funded- Contributions by Employer and
employee payroll deduction
End of Plan Year: December 31
Name of Claims Administrator: Healthy Alliance Life Insurance Company d.b.a.
Anthem Blue Cross Blue Shield
1831 Chestnut Street
St. Louis, MO 63103
102
NOTE: This section is not a part of Your Benefit Booklet. The Claims Administrator is not
responsible for any statements contained herein that are not set forth in the Administrative Services
Agreement or the Benefit Booklet.
The Employee Retirement Income Security Act of 1974 (ERISA) requires that certain information be
furnished to each participant in an employee benefit Plan. This information is outlined below.
ERISA INFORMATION
Plan Name: Aegion Welfare Plan
Maintained By: Aegion
Type of Plan: Medical Plan and Dental Plan
Type of Administration: Contract Administrator
Plan Sponsor and Administrator: Aegion
17988 Edison Avenue
Chesterfield, MO 63005
Employer Identification: 45-3117900
Plan Number: 501
Agent for Services of Legal Process: Aegion
17988 Edison Avenue0
Chesterfield, MO 63005
Fiduciary: Aegion
Plan Modification and Amendment: N/A
Funding: Self-Funded- Contributions by Employer and
employee payroll deduction
End of Plan Year: December 31
Name of Claims Administrator: Healthy Alliance Life Insurance Company d.b.a.
Anthem Blue Cross Blue Shield
1831 Chestnut Street
St. Louis, MO 63103
102
