Certificate of Insurance
Life & AD&D Certificate of Insurance
| Certificate # | Eligible Class | Coverage |
|---|---|---|
| Certificate 1A | Full-Time Vice Presidents and Above with a Benefit Indicator of 518 or Above | Employer paid Basic Life, Voluntary Supplemental Life, Dependent Life, Voluntary Accidental Death & Dismemberment |
| Certificate 2 | Full-Time salaried employees of the Policyholder including hourly paid Pharmacists, Nurses, Paraprofessionals, and Team Members in Coordination or Analysis Pay Bands or with a Benefit Indicator 19 or 20, excluding Vice Presidents and above with a Benefit Indicator of 518 or above | Employer paid Basic Life, Voluntary Supplemental Life, Dependent Life, Voluntary Accidental Death & Dismemberment |
| Certificate 3 | Full-Time Hourly employees of the Policyholder excluding certain union employee and other component groups that may have differences in eligibility and/or benefits than described in this certificate, based on collective bargaining agreement provisions, and other hourly employees with coverage under a different plan | Employer paid Basic Life, Voluntary Supplemental Life, Dependent Life, Voluntary Accidental Death & Dismemberment |
| Certificate 4 | Retirees of the Policyholder who are receiving the Policyholder's standard pre-Medicare subsidized retiree medical coverage and are at least 55 but less than 65 years of age | Employer paid Basic Life |
| Certificate 5 | Named Retirees who are over age 65 and who are receiving medical coverage in accordance with the Policyholder's retirement plan | Employer paid Basic Life |
| Certificate 6 | Class 1: Full-Time Alameda Retail Clerks Local 870 employees of the Policyholder, hired prior to September 20, 1987 Class 2: Full-Time Alameda Pharmacists of the Policyholder, hired prior to October 5, 1987 | Employer paid Basic Life and Accidental Death & Dismemberment, Voluntary Supplemental Life, Dependent Life, Voluntary Accidental Death & Dismemberment |
| Certificate 7 | Class 1: Full-Time Local Union 648 employees of the Policyholder, hired before September 17, 1988 and continuously covered by the Local Union 648. Class 2: Full-Time Local Union 648 employees of the Policyholder, hired between September 18, 1988 and December 31, 2014 and continuously covered by the Local Union 648. Class 3: Full-Time Local Union 648 employees of the Policyholder, hired and/or covered by the Local Union 648. | Employer paid Basic Life and Accidental Death & Dismemberment, Voluntary Supplemental Life, Dependent Life, Voluntary Accidental Death & Dismemberment |
| Certificate 8 | Full-Time Retail, Wholesale, and Department Store Union (UFCW) Members of the Policyholder | Employer paid Basic Life and Accidental Death & Dismemberment, Voluntary Supplemental Life, Dependent Life, Voluntary Accidental Death & Dismemberment |
| Certificate 9 | Full-Time salaried employees who participate in the Policyholder's Management Plan | Employer paid Basic Accidental Death & Dismemberment |