Group Accident Insurance Certificate

and incapable of self-sustaining employment by reason of mental or physical handicap or ceases to quality as a Dependent Child; • the date the Spouse or Dependent no longer meets the definition of Spouse or Dependent Child; • the date the Covered Person is considered to reside outside the United States. The Covered Person will be considered to reside outside the United States when the Covered Person has been outside the United States for a total period of 4 months during any 4 consecutive months.

8) The Common Exclusions section has been modified to include only the following exclusions:

1. intentionally self-inflicted Injury, suicide or any attempt thereat while sane or insane; 2. commission of or active participation in a felony, riot or insurrection; 3. declared or undeclared war or act of war;

4. a Covered Loss that occurs while on active duty service in the military, naval or air force of any country or international organization. Upon Our receipt of proof of service, We will refund any premium paid for this time. Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days; 5. mental or emotional disorders, alcoholism and drug addiction; 6. Injuries that occur in the workplace or during the course of any employment for pay, benefit, or profit.

9) Under the Claim Provisions section, the second paragraph of the Payment of Claims provision has been modified as follows:

If We are to pay benefits to the estate or to a person who is incapable of giving a valid release, We may pay up to an amount not exceeding $1,000 to a relative by blood or marriage whom We believe is equitably entitled.

10) Under the Administrative Provisions section , the following is added:

Refund of Unearned Premium If the Policyholder cancels this Policy for any reason, We shall refund the pro rata portion of the Unused Collected Premium to the beginning of the next monthly billing cycle. “Unused Collected Premium” as used herein means that portion of any premium collected which is not used, on a pro rata basis to the beginning of the next monthly billing cycle at the time of cancellation, by Us to insure against loss as there is no risk of loss from Covered Persons, or that portion of any collected premium which would have not been collected had the premium been paid monthly.

11) Under the General Provisions section, the following is added :

Contact Information for the Idaho Department of Insurance: Idaho Department of Insurance Consumer Affairs 700 W. State Street, 3rd floor P.O. Box 83720 Boise, ID 83720-0043 1-800-721-3272 or www.DOI.Idaho.gov

12) The following Rider form(s) is/are not available:

WELLNESS TREATMENT, HEALTH SCREENING TEST AND PREVENTIVE CARE BENEFIT RIDER SICKNESS BENEFITS RIDER ACCIDENT DISABILITY INCOME RIDER

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