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I
ri Zimmerman
Account Manager
MN Insurance License # 20838736)
EMPLOYEE BENEFITS
Phone (6] 2) 342-3 ]62
Fax (6] 2) 342-3646
Internet Address: terri.zirnmemlan(l"iJUs.ing.com
September 14, 2005
Linda Magee
Anoka Coun(v Instrumentalities
Ci(v of Columbia Heights
590 40th Avenue NE
Columbia Heights, MN 55421
RE: Premium Rate Notification
Group Policy Number 31188-0, Account 8
Dear Linda:
Enclosed, please find the Premium Rate Notification (PRN) from ReliaStar Life Insurance
Company, which confirms your Life and Accidental Death & Dismemberment insurance
rates effective September 1, 2005. Please file this notice in your master contract.
We appreciate your continued business. If you have questions regarding this information or
any other aspect of your policy with ReliaStar, please feel free to call me.
Sincerely,
~JV'V
Account Manager
Enclosure
Cc: Britt Osterhues, Johnson McCann Benefits, Inc.
100
(; 12.3 72.5322
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Fax: 6!2.342.3Mh
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ING
GROUP POLICY
EMPlOVEE BENEFITS
20 Washington Avenue South
Minneapolis, MN 5540-1
Anoka County Instrumentalities
Group Benefit Plan: 0031188-0
Anoka County - City of Columbia Heights - Acct. 8
PREMIUM RATE NOTIFICATION
MO
F PAYMENT
The premium rates contained in the Group Policy are amended as outlined below.
PREMIUM RATES EFF
Monthly
E
Life Basic Employee, per $1,000
Accidental Death & Dismemberment Basic Employee, per $1,000
Life Supplemental Employee, per $1,000
Under 25
25 - 29
30 - 34
35 - 39
40 - 44
45 - 49
50 - 54
55 - 59
60 - 64
65 - 69
70 +
Accidental Death & Dismemberment Supplemental Employee, per $1,000
Life Supplemental Dependent Spouse, per $1,000
Under 25
25 - 29
30 - 34
35 - 39
40 - 44
45 - 49
50 - 54
55 - 59
60 - 64
65 - 69
70 +
Accidental Death & Dismemberment Supplemental Dependent Spouse, per
$1,000
Life Basic Dependent Family - Grandfathered Coverage
Life Supplemental Dependent Children
5,000
10,000
* Premium Rate Notification due to policy renewal.
Minneapolis Office/9
Produced on: 08/18/2005
Page 1 of 1
All products and services provided by ReliaStar Life Insurance Company or ReliaStar Life Insurance Company of New York.
09/01/2005 *
CURRENT
PREMIUM RATES
$ 0.16 $ 0.16
0.03 0.03
0.05 0.05
0.06 0.06
0.10 0.10
0.12 0.12
0.19 0.19
0.31 0.31
0.52 0.52
0.82 0.82
1.29 1.29
2.10 2.10
3.95 3.95
0.04 0.04
0.05 0.05
0.06 0.06
0.10 0.10
0.12 0.12
0.19 0.19
0.31 0.31
0.52 0.52
0.82 0.82
1.29 1.29
2.10 2.10
3.95 3.95
0.04 0.04
0.60 0.60
1.00 1.00
2.00 2.00