H20G Group Health – Vision

The above-captioned rates are submitted for your review and approval. The rider form is being submitted under the Corresponding Filing Tracking Number. This is a new form and does not replace any forms previously filed with your Department. The rider will be used with Group Dental Certificate Form C250A, filed by your Department on 08/11/2014. Certificate Form C250A is issued to the Delaware Group Insurance Trust, a Discretionary Group, which is sitused in the state of Delaware, to insureds residing in the District of Columbia. To the best of my knowledge, this form complies with all applicable state laws and regulations. 
 
B424 is an optional rider that will be marketed through our agency and direct response distribution channels. It will be sold at issue and as add-ons.

Status: Assigned
Percent Change: n/a

HIRFAssigned