MEMO to all Yardmaster and Mechanical Supervisor Members of GO-342
Dear Sisters and Brothers,
The United Transportation
Union has negotiated a Voluntary Short Term Disability (VSTD) Plan with Anthem Life Insurance Company that pays $346.00 per
week for up to 52 weeks, subject to a $693.00 per week maximum when combined with other disability plans.
The Voluntary Short Term Disability (VSTD) Plan monthly assessment will be $31.00
per month and is automatic enrollment for all UTU members. Information concerning the voluntary Short Term Disability
(VSTD) Plan will be sent to all members within the next 30 days.
The 1978 Yardmasters National Agreement provides Yardmasters with a Supplemental Sickness Plan through Trustmark
that provides benefits of $2,806 per month benefit. The maximum benefit of the voluntary Short Term Disability (VSTD)
plan is $3,000.00 per month when combining with other plans, such as Trustmark. Yardmasters desiring NOT
TO PARTICIPATE must complete, sign and mail the Wavier of Coverage Postcard which will be included in your information package
to the United Transportation Union International Office as soon as possible to avoid any deductions.
WAIVER OF COVERAGE FORM
ANTHEM LIFE
GROUP VOLUNTARY SHORT-TERM
DISABILITY (VSTD) INSURANCE
RAIL MEMBERS
ONLY
DO NOT COMPLETE THIS FORM IF YOU
WANT THE ANTHEM GROUP VSTD INSURANCE. YOU WILL BE AUTOMATICALLY ENROLLED. COMPLETE THIS FORM ONLY IF YOU
DO NOT WANT THE ANTHEM GROUP VSTD INSURANCE.
__________________________________________________________________________
I DECLINE GROUP VSTD INSURANCE THAT WAS OFFERED TO ME
By signing below, I am waiving the disability coverage that has been offered to
me by the UTU and decline to be automatically enrolled. Should I apply for waived coverage in the future, I understand that
evidence of insurability, acceptable to Anthem Life, may be required at my own expense. I further understand that should I
apply for disability benefits in the future, I may be declined coverage by the Underwriting Department at Anthem Life.
UTU Local # _________ Member Name (Printed): _______________________
Member Address: _________________________________________________
Member Signature: ________________________________ Date: ___________
__________________________________________________________________________
THIS FORM MUST BE COMPLETED FULLY AND SIGNED TO BE VALID!
Mail this completed Waiver of Coverage form to:
Attn: Updating DepartmentUnited Transportation Union14600
Detroit Avenue, Suite 200Cleveland,
OH 44107-9923