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NJSFAC/BOLLINGER
NEW JERSEY STATE FIRST AID COUNCIL
ACCIDENT ONLY LONG TERM DISABILITY INSURANCE
Program Eligibility and Structure
2011/2012

LTDOVERVIEW
To enroll in the NJSFAC’s accident only disability program requires each participating squad to complete an application. This document will explain the application form, premiums, and eligibility. Please read carefully.


ELIGIBILITY and PREMIUMS

  • We will have a two month open enrollment period from May 1st to June 30th.
  • The plan effective date will be July 1, 2011.
  • The policy year is July 1st to June 30th.
  • The cost is $36.00 per member per policy year.
  • The cost is $36.00 per spouse per policy year.

  • Exclusions and Limitations

Each squad must define their own eligibility according to each squad’s bylaws. Squad members and their spouse are eligible. 100% of eligible squad members must be enrolled.

For open enrollment, the squad must (See Enrollment instruction Tab):
  1. Complete the squad application.
  2. Complete and email the covered member roster form.
  3. Submit a check payable to Bollinger for the total amount based on the instruction page of the covered member roster form.
  4. Enrollment must be received by June 15, 2011


QUESTIONS
If you have any questions, please call Bollinger at 800-952-4050 and reach Irene Walton at extension 4765.

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