SUMMARY ANNUAL REPORT ERISA STATEMENT
For Wesleyan University Group Insurance Program
This is a summary of the annual report of the Wesleyan University Group Insurance Program, EIN 06-0646959, Plan No. 511, for the period January 1, 2012 through December 31, 2012. The annual report has been filed with the Employee Benefits Security Administration, U.S. Department of Labor, as required under the Employee Retirement Income Security Act of 1974 (ERISA).
Wesleyan University has committed itself to pay all Medical, Dental and Short-Term Disability claims incurred under the terms of the plan. Fees for Medical, Dental and Short Term Disability and claims for Medical, Prescription and Dental paid in this period equaled $11,576,641.
The plan has contracts with Hartford Life and Accident, CIGNA Health and Life Insurance Company and Affiliates (“Cigna”), and Combined Insurance Company of America (EyeMed Vision Care) to pay Stop Loss, Life Insurance, Long-Term Disability and Vision claims incurred under the terms of the plan. The total premiums paid for the plan year ending December 31, 2012 were $1,129,398.
Your Rights To Additional Information
You have the right to receive a copy of the full annual report, or any part thereof, on request.
The items listed below are included in that report:
- Insurance information, including sales commissions paid by insurance carriers
To obtain a copy of the full annual report, or any part thereof, write or call the office of Wesleyan University, 212 College Street, Middletown, CT 06459, or by telephone at (860) 685-2100.
You also have the right to receive from the plan administrator, on request and at no charge, a statement of the assets and liabilities of the plan and accompanying notes, or a statement of income and expenses of the plan and accompanying notes, or both. If you request a copy of the full annual report from the plan administrator, these two statements and accompanying notes will be included as part of that report.
You also have the legally protected right to examine the annual report at the main office of the plan (Wesleyan University, 212 College Street, Middletown, CT 06459) and at the U.S. Department of Labor in Washington, D.C., or to obtain a copy from the U.S. Department of Labor upon payment of copying costs. Requests to the Department should be addressed to:
Public Disclosure Room, Room N1513,
Employee Benefits Security Administration, U.S.
Department of Labor, 200 Constitution Avenue,N.W.,
Washington, D.C. 20210.