Page 41 - AAACU Health & Welfare SPD rev 09012013

APPENDIX A

BENEFIT PROGRAMS OFFERED: MEDICAL/PRESCRIPTION DRUG, DENTAL, SHORT-TERM DISABILITY INSURANCE
COVERAGE, LONG-TERM DISABILITY INSURANCE COVERAGE, GROUP TERM LIFE INSURANCE, ACCIDENTAL DEATH &
DISMEMBERMENT INSURANCE COVERAGE, EMPLOYEE ASSISTANCE PROGRAM, HEALTH REIMBURSEMENT
ARRANGEMENT.
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 MEDICAL BLUE CROSS BLUE 007015689/00 and Certificates and Certificates and Certificates
INSURANCE SHIELD OF 00 of Insurance and of Insurance and of Insurance
MICHIGAN other benefit other benefit and other
benefit
materials
materials
CDHP w/ HRA provided by provided by materials
INSURER/CLAIMS Insurer. Insurer. provided by
ADMINISTRATOR
09/01/2013 Insurer.
See Plan/SPD See Plan/SPD See Plan/SPD
GROUP DENTAL DELTA DENTAL OF 0001905-2031 and Certificates and Certificates and Certificates
INSURANCE MICHIGAN of Insurance and of Insurance and of Insurance
other benefit other benefit and other

materials materials benefit
09/01/2013 INSURER/CLAIMS provided by provided by materials
ADMINISTRATOR Insurer. Insurer. provided by
Insurer.
See Plan/SPD See Plan/SPD See Plan/SPD
SHORT-TERM SUN LIFE FINANCIAL 231710-001 and Certificates and Certificates and Certificates
DISABILITY BENEFITS of Insurance and of Insurance and of Insurance
INSURER/CLAIMS other benefit other benefit and other
materials
benefit
materials
09/01/2013 ADMINISTRATOR provided by provided by materials
Insurer. Insurer. provided by
Insurer.
See Plan/SPD See Plan/SPD See Plan/SPD
LONG-TERM SUN LIFE FINANCIAL 231710-001 and Certificates and Certificates and Certificates
DISABILITY BENEFITS of Insurance and of Insurance and of Insurance
INSURER/CLAIMS other benefit other benefit and other
materials
benefit
materials
09/01/2013 ADMINISTRATOR provided by provided by materials
Insurer. Insurer. provided by
Insurer.
See Plan/SPD See Plan/SPD See Plan/SPD
GROUP TERM LIFE SUN LIFE FINANCIAL 231710-001 and Certificates and Certificates and Certificates
INSURANCE of Insurance and of Insurance and of Insurance
BENEFITS other benefit other benefit and other
INSURER/CLAIMS materials materials benefit
ADMINISTRATOR provided by provided by materials
09/01/2013 Insurer. Insurer. provided by
Insurer.

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