HomeMy WebLinkAboutExhibit 5EXHIBIT B
NOTICE AND ASSUMPTION AND NOVATION CERTIFICATION
of
Connecticut General. Life insurance Company
Dated: 2006
Policy Number(s) (the "Policy")
Policyholder Name
Address:
1. This is to certify that pursuant to the terms of the Agreement of Reinsurance and
Assumption and Novation effective as of January 1, 2007, Connecticut: General Life
Insurance Company, an insurance company with its administrative office at 900
Cottage Grove Road, Eloornfield, Ct. 06002, will reinsure and assume with a novation
all of the contractual liabilities and obligations of THE MEGA LIFE AND HEALTH
INSURANCE COMPANY, an Oklahoma life insurance company, under the above -
named Policy on the same terms and conditions asset forth In said Policy.
2. You may either accept: or reject this reinsurance. To accept, please sign where
indicated below acknowledging your acceptance of :the reinsurance and return the
executed copy of this notice to Connecticut General Life Insurance Company in the
enclosed, self-addressed return envelope. To reject this reinsurance, you must, within
sixty (60) days immediately following your receipt of this Notice and •Assumption and
Novation Certificate, notify Connecticut General Life Insurance Company at the
address set forth in the preceding paragraph, in writing of such rejection.
3.1f you do not submit such notification in accordance with the procedures set.
forth in the preceding paragraph; you will be deemed to have accepted
Connecticut General Life Insurance Company as insurer under the Polity in full
substitution for THE MEGA LIFE AND HEALTH INSURANCE COMPANY, and to
have released and discharged THE MEGA LIFE AND HEALTH INSURANCE
COMPANY from any and all liability under the Policy.
1. All terms and conditions of the Policy remain unchanged except that, from and
after your receipt of this Certificate, you should submit all claims under this Policy,
whenever incurred, and all premiums due under the Policy whenever they become due
to the respective address listed below as if Connecticut General. Life Insurance Company
had issued the Policy instead of THE MEGA LIFE AND HEALTH INSURANCE
COMPANY:
For Starbridge Products:
Mints:
Starbridge
P.O Box 55270
Phoenix, AZ 85078
Premium:
Starbridge
P.O. Box 37887
Phoenix, AZ 85069
For Fundamental Care Products:
Ci'a�rrss:
Fundamental Care
P.O. Box 30870
Phoenix, AZ 85046
Prep:d uns:
Fundamental Care
P.O. Box 37987
Phoenix, AZ 85069
IN WITNESS WHEREOF, Connecticut General Life insurance Company has caused this
Notice and Certificate of Assumption to be executed and attested as of the date first set
forth above.
Connecticut General Life Insurance Company
Attest: By:
This Certificate becomes a part of your Policy.
If you consent to the reinsurance, please indicate consent here:
Policyholder Name:
By: Date:
�1N
NOTICE AND ASSUMPTION AND NOVATION CERTIFICATION
of
Connecticut General Life Insurance Company
Dated:December 27, 2006
Policy Number: ST-0100
Policyholder Name: Wilmington Trust Company
Address: 1100 N. Market Street, Wilmington, DE 19890-1625
1. This is to certify that pursuant to the terms of the Agreement
of Reinsurance and Assumption and Novation effective as of January
1, 2007, Connecticut General Life Insurance Company, an insurance
company with its administrative office at 900 Cottage Grove Road,
Bloomfield, Ct. 06002, will reinsure and assume with a novation all
of the contractual liabilities and obligations of THE MEGA LIFE AND
HEALTH INSURANCE COMPANY, an Oklahoma life insurance company, under
the above -named Policy on the same terms and conditions as set forth
in said Policy.
2. You may either accept or reject this reinsurance. To accept,.
please sign -.where indicated below -acknowledging your acceptance of
the reinsurance and return the executed copy of this notice to
Connecticut General Life Insurance Company in the enclosed, self-
addressed return envelope. To reject this reinsurance, you must,
within sixty (60) days immediately following your receipt of this
Notice and Assumption and Novation Certificate, notify Connecticut
General Life Insurance Company at the address set forth in the
preceding paragraph, in writing of such rejection.
3.If you do not submit such notification in accordance with the
procedures set forth in the preceding paragraph, you will be
,.:••deemed to have accepted Connecticut General Life Insurance
Company as insurer under the'Policy in full substitution for THE
MEGA LIFE AND HEALTH INSURANCE• COMPANY, and to have released and
discharged THE MEGA LIFE AND HEALTH INSURANCE COMPANY from any
and all liability under the Policy.
1. All terms and conditions of the Policy remain unchanged except
that, from and after your receipt of this Certificate, you should
submit allclaims under this Policy, whenever incurred, and all
premiums due under the Policy whenever they become due to the
respective address listed below as if Connecticut General Life
Insurance Company had issued the Policy instead of THE MEGA LIFE AND
HEALTH INSURANCE •COMPANY:
For Starbridge Products:
Claims:
Starbridge
P.O Box 55270
Phoenix, AZ 85078
Premium:
Starbridge
P.O. Box 37887
Phoenix, AZ 85069
For Fundamental Care Products
Claimer
Fundamental. Care
P.O. Box 30870
Phoenix, AZ 85046
Pry;
Fundamental Care
P.Q. Box 37987
Phoenix, AZ 85069
IN WITNESS WHEREOF, Connecticut General Life Insurance Company has
caused this Notice and Certificate of Assumption to be executed and
attested as of the date first set forth above.
Connecticut General Life Insurance Company
Attest4,40 4„.„
By:
This Certificate becomes a part of your Policy.
63.1
If you consent to the reinsurance, please indicate consent here:
Policyholder Nam _1dilmington Trust Company
By Date: I 1,b1\
KE I I OLLAND
INSURANCE COMMISSIONER
STATE OF OKLA11OMA
May 15, 2007
Mr. Mark J. Lavoie
CIGNA
Routing B6LPA
900 Cottage Grove Road,
Bloomfield, CT 06152-2201
RE: First Amendment to Agreement of Reinsurance and Assumption and Novation by
and between The MEGA Life and Health Insurance Company ("MEGA") Group Policies
by Connecticut General Life Insurance Company ("CGLIC")
Dear .Mr. Lavoie:
The Oklahoma Insurance Department has approved the Amendment to the
Assumption Reinsurance and Novation agreement between MEGA and CGLIC. If you
have any questions free to contact me.
Sincerely,
Fredrica Cottrell, FLMI
Financial Analyst
fredricacoftrell@insurance.state.ok.us
Cc: John McCarter, Chief FinanciarAnalyst
al.
24D1 N. W. 33" F1ics1, s•ll,; IN I of I
I .o, Box 534O • cawhomo C iiy PX 73I33-:1 fla r (414,1)2 I.2828 a t � O MAC I401.3•92.2•007 l r Pax 005} 524-144p