Group Critical Illness Insurance Certificate

Amyotrophic Lateral Sclerosis(ALS), Advanced Stage Alzheimer's Disease, Benign Brain Tumor, Blindness, Carcinoma In Situ, Cerebral Palsy, Coma, Coronary Artery Disease, Cystic Fibrosis, End Stage Renal (Kidney) Disease, Heart Attack, Invasive Cancer, Major Organ Failure, Multiple Sclerosis, Muscular Dystrophy, Paralysis, Parkinson's Disease, Poliomyelitis, Skin Cancer, and Stroke A progressive disorder characterized by abnormal gene mutations that affects the mucus producing exocrine glands. The Date of Diagnosis is the date confirmatory IRT Testing via Sweat test is performed. The date a Physician renders the Pathological Diagnosis as defined by the Critical Illness. If a Pathological Diagnosis cannot be made, the date a Physician renders a Clinical Diagnosis. 2. A child who is 26 or more years old, primarily supported by the Employee and incapable of self-sustaining employment by reason of mental or physical handicap. A child, for purposes of this provision, includes an Employee’s: 1. natural child; 2. adopted child, from the earlier of the date the petition for adoption is filed or entry of the child in the adoptive home, or in the case of a child who is in the custody of the state, coverage shall begin at the date of entry of a final decree of adoption. It also means the legally adopted child of the Employee’s Spouse provided the child is living with, and is financially dependent upon the Employee; 3. stepchild who resides with the Employee and is financially dependent upon the Employee; 4. child for whom the Employee is the court-appointed legal guardian , as long as the child resides with the Employee and primarily depends on the Employee for financial support. Financial support means that the Employee is eligible to claim the dependent for purposes of Federal and State income tax returns The cumulative period of time during a continuous period of employment that an Employee must be in Active Service in order to be eligible for coverage under the Policy. It will be extended by the number of days the Employee is not in Active Service. For eligibility purposes, an Employee of the Employer who is in one of the Covered Classes. An Employee’s child who meets the following requirements: 1. A child from live birth to 26 years old; The Subscriber and any affiliates, subsidiaries or divisions shown in the Schedule of Affiliates and which are covered under this Policy on the date of issue or subsequently agreed to by Us. The term ''employer'' refers to an employer of a Spouse. A program established and maintained by the Employer to provide benefits to plan participants and their beneficiaries. The chronic irreversible failure of the function of both kidneys, such that regular hemodialysis or peritoneal dialysis is required to sustain life. The Date of Diagnosis is the date a Physician prescribes that the Covered Person begins dialysis. Evidence of good health that is submitted by the Eligible Person and is satisfactory to Us before the coverage subject to this requirement becomes effective. An eligible person satisfies the insurability requirement on the day We agree in writing to accept him as

Cystic Fibrosis

Date of Diagnosis

Dependent Child

Eligibility Waiting Period

Employee

Employer

Employer’s Plan

End Stage Renal(Kidney) Failure

Evidence of Insurability

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