SENTRY STUDENT SECURITY PLAN

Ohio (2009-2010)

ENROLLMENT INSTRUCTIONS Read the brochure carefully. Type responses into, print, then sign the Enrollment Form (click here). Complete application for only the initial period in which you enroll for the school year.  Students attending classes only On-Line must complete the application enrollment form applicable to their state of residence.  For On-Line Students, coverage will be issued  based on your state of residence. The premiums for the Student Security Plan are based on the Student’s age. There are two categories of premium based on the Student’s age group. In applying for coverage, be sure to choose the premium for your correct age group. Students who also apply for spouse coverage will still pay rates based on the Student’s age and not the spouse’s age. Determine the amount of monthly premium due from the chart above and multiply by the number of months requested (four month minimum). For coverage beginning after April 1, 2010, please call our office for the pro-rata amount of premium.  You will be billed for subsequent periods. However, you may pay for more than the four month minimum or up to the Master Policy termination date of 8-1-2010.    NOTE:  Nevada residents - four month maximum payment. Make your check or money order payable to: SENTRY LIFE INSURANCE CO. (U.S. Funds Only) Mail the Enrollment Form and your check or money order to: E.J. Smith & Associates, Inc. 899 Skokie Boulevard Northbrook, Illinois 60062-4029 (847) 564-3660 POLICIES AND IDENTIFICATION CARDS You will receive an evidence of insurance coverage which includes all policy provisions, an identification card and a claim form. VERIFICATION OF COVERAGE Coverage may be verified by either calling the Plan Administrator or the Insurance Company.