Club Eligibility & Participation Requirements Any duly authorized Boys & Girls Club in good standing with the Boys & Girls Clubs of America is eligible to participate in these Plans. The Club Participation Agreement specifies which Plans your Club wishes to make available to its employees, and serves as authorization to set up your group coverage. It also requires that you choose either a 30-day or a 90-day waiting period. This is the waiting period newly hired employees must meet before they are eligible for coverage. If you need a Club Participation Agreement, you can download one in the Online Forms Section or call our enrollment department at 1-800-245-8813. Enrolling An Employee (or Making Changes to an Employee’s Coverage) Employee Eligibility An employee must work at least 30 hours a week to be eligible for coverage. An employee signing up for coverage must fill out an Employee Application & Coverage Change Form. The Application form is also used for the following: Reporting Address Changes Reporting Name Changes & Changes in Marital Status Adding Dependents to the Coverage Removing Dependents from the Coverage Changing Beneficiary Increasing Life Insurance Coverage Click here to download an Employee Application & Coverage Change Form. If you need a quantity of Employee Application & Coverage Change Forms, feel free to call us at 1-800-245-8813.

Report All Employee Terminations Immediately Terminated employees are entitled to continue certain coverages if they so desire. Timely notification of this right is very important. Terminations can be reported in the following ways: (Preferred Method) By downloading, completing, and submitting an Employee Termination Notice. Click here to download this form. (You will need the latest version of Adobe® Acrobat Reader® to view this form. Click here for Adobe Acrobat Reader.) By mail, on Club letterhead to: CTI Administrators at 100 Court Ave., Suite 306, Des Moines, IA 50309-2295. Be sure to include employee name and last day worked; and the signature of the person authorizing the termination. By fax, on Club letterhead to: CTI Administrators at 1-515-244-8650. Be sure to include employee name, last day worked, and the signature of the person authorizing the termination. By crossing out the employee’s name on your Club’s Monthly Premium Bill when you return it to CTI Administrators with your premium payment. Be sure to include employee’s last day worked; and initial the change on the bill.

Your Club’s Monthly Premium Bill lists your employees individually, and shows the benefit coverages they are signed up for. This helps you make sure everyone is receiving the appropriate level of benefits. Monthly Premium Bills are mailed the 10th of each month showing your Club’s premium due for the coming month. (For example: statements that go out May 10 are for your benefits coverage for the month of June.) In the above example, payment is due June 1. Reviewing Your Statement Make sure the Club’s name, address, and contact person are correct. Verify that the coverages being billed are those authorized by your Club & selected by the employee, and that all eligible employees are receiving all the benefits they are entitled to. Make sure that those listed on the bill are active employees working at least 30 hours a week, and that their ages are correct. If someone is no longer employed by your Club, draw a line through his/her name and write in the last date he/she worked and initial the bill. Please pay the amount due exactly as it is shown on the statement (any adjustments will be applied to the next month’s bill.) Mail your Club’s payment - along with the statement - in the envelope provided. 2006 Summary Annual Report