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Combined Insurance Company of America


Thursday, October 4, 2012
Reference: 
CMBD-128681967

This is a new filing. Rate Sheet 7109 is new rate sheet and will not replaced any existing rate sheet. 

Rate Sheet 7109 contains the unit premiums charged and unit benefits available. 

Rate Sheet 7109 will be used in connection with our Group Accident Certificate, Form No. C14059R, previously submitted on August 28, 2012 and assigned SERFF Tracking Number CMBD-128662401. The forms are solicited on a face-to-face basis by our Insurance Producers or by direct market for telephone and mail solicitation. The application will be completed and/or transmitted either by paper or through electronic means. We certify that we will comply with your state statutes regarding privacy and electronic signatures. 

The premium will be paid by payroll deduction or other premium collection means. The forms format and type style may change for computer system reasons but type size and print will not.

Effective on Approval
Status = Assigned
HIRFAssigned
 
Attachment(s): 
AttachmentSize
CMBD-128681967.pdf39.96 KB