Page 42 - 2013 Adv1FCU Health and Welfare SPD

BENEFIT PROGRAM/ NAME OF INSURER/ POLICY OR CLAIMS
BENEFITS
EFFECTIVE DATE CLAIMS CONTRACT PROVIDED ELIGIBILITY PROCEDURE
OF COVERAGE ADMINISTRATOR NUMBER(S) & BENEFITS
See Plan/SPD See Plan/SPD See Plan/SPD
GROUP TERM LIFE MET LIFE - SMALL TM- and Certificates and Certificates and Certificates
INSURANCE BUSINESS CENTER 05989325-G of Insurance and of Insurance and of Insurance
BENEFITS other benefit other benefit and other
materials
materials
benefit
INSURER/Claims provided by provided by materials
01/01/2013 Administrator Insurer. Insurer. provided by
Insurer.
See Plan/SPD See Plan/SPD See Plan/SPD
ACCIDENTAL DEATH MET LIFE - SMALL TM- and Certificates and Certificates and Certificates
AND BUSINESS CENTER 05989325-G of Insurance and of Insurance and of Insurance
DISMEMBERMENT other benefit other benefit and other
INSURANCE INSURER/Claims materials materials benefit
COVERAGE provided by provided by materials
Administrator Insurer. Insurer. provided by

Insurer.
01/01/2013

42