IMPORTANT: The monthly cost for coverage is based on your age at the start of the coverage and will increase on the policy anniversary date after you move into a new age bracket.

Participation in this program is voluntary, and the decision to enroll rests solely with the Members. Members are responsible for bearing all associated costs. A $3 technology fee is included in all listed monthly costs for the following coverages: Short-Term Disability and Long-Term Disability. A $2 technology fee is included in all listed monthly costs for the following coverages: Member Life and Spouse Life.

This voluntary benefit plan is classified as a Safe Harbor plan and, as such, is not subject to the Employee Retirement Income Security Act of 1974 (ERISA). The BLET does not contribute to the premiums for this plan on behalf of its Members, does not endorse the plan, and does not require Members to enroll in the plan.

IMPORTANT: If you leave the union or retire, it is your responsibility to contact our office immediately at (224) 770-5307. Failure to do so within 90 days will forfeit your ability to keep coverage and receive any refunds.

We encourage Members to thoroughly review the complete policy booklet. Email info@unionone.com to request a copy.

This program is administered by Union One Benefits Administration.

FOR AD&D, STD & LTD: THIS IS AN EXCEPTED BENEFITS POLICY. IT PROVIDES COVERAGE ONLY FOR THE LIMITED BENEFITS OR SERVICES SPECIFIED IN THE POLICY.

For STD & LTD: These policies provide disability income insurance only and do NOT provide basic hospital, basic medical, or major medical insurance as defined by the New York State Department of Financial Services.

For Life: You have 31 days to notify Union One of your retirement if you wish to port or convert your Life Insurance.

North Carolina Residents: THIS IS NOT A MEDICARE SUPPLEMENT PLAN. If you are eligible for Medicare, review the Guide to Health Insurance for People with Medicare, which is available from the company.

Group Insurance coverages are issued by The Prudential Insurance Company of America, a Prudential Financial company, Newark, NJ. The Booklet-Certificate contains all details, including any policy exclusions, limitations, and restrictions, which may apply. Contract Series: 83500.

Prudential, the Prudential logo, and the Rock symbol are service marks of Prudential Financial, Inc. and its related entities, registered in many jurisdictions worldwide.