Group Accident Insurance Certificate

In the event of death or incapacity, the beneficiary or representative shall be given a copy.

Policy Termination We may terminate insurance on or after the first anniversary of the Policy Effective Date. The Subscriber may terminate insurance on any Premium Due Date. Written notice by certified mail must be given at least 31 days prior to such Premium Due Date. Failure by the Subscriber to pay premiums when due or within the Grace Period shall be deemed notice to Us to terminate insurance at the end of the period for which premium was paid.

Termination will not affect a claim for a Covered Loss that is the result, directly and independently of all other causes, of a loss that occurs while insurance was in effect.

Agency The Employer is acting as Your agent for transactions relating to insurance under the Policy. The actions of the Employer shall not be considered the actions of the Insurance Company, and the Insurance Company is not liable for any of their acts or omissions. Clerical Error A Covered Person's insurance will not be affected by error or delay in keeping records of insurance under this Policy. If such error or delay is found, We will adjust the premium fairly. Conformity with Statutes Any provisions in conflict with the requirements of any state or federal law that apply to this Policy are automatically changed to satisfy the minimum requirements of such laws.

Policy Changes We may agree with the Subscriber to modify a plan of insurance without the Covered Person's consent.

Workers' Compensation Insurance This Policy is not in place of and does not affect any requirements for insurance under any Workers' Compensation law.

Examination of the Policy This Policy will be available for inspection at the Subscriber's office during regular business hours.

Examination of Records We will be permitted to examine all of the Subscriber's records relating to this Policy. Examination may occur at any reasonable time while the Policy is in force. Examination may also occur: 1. at any time for two years after the expiration of this Policy; or, if later, 2. upon the final adjustment and settlement of all claims under this Policy.

Ownership of Records All records maintained by the Insurance Company are, and shall remain, the property of the Insurance Company.

GAI-00-CE1800.00

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