Group Critical Illness Insurance Certificate

that the Employee is eligible to claim the dependent for purposes of Federal and State income tax returns. 5. a child of the Employee’s domestic partner /Partner to a Civil Union, provided the child is living with, and is financially dependent upon the Employee c) The definition of Physical Activities of Daily Living revised as follows: Activities used in measuring levels of personal functioning capacity. These activities are normally performed without assistance, allowing personal independence in everyday living. These activities include the following: 1. Transfer - The ability to move into or out of a bed, chair or wheelchair with or without the assistance of equipment; 2. Mobility – The ability to move from place to place, either via walking, a wheelchair, cane, crutches, walker or other equipment; 3. Continence - The ability to maintain control of bowel and bladder function; or, when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene (including caring for catheter, urostomy, or colostomy bag); 4. Dressing - Putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs; 5. Toileting - Getting to and from the toilet, transferring on and off the toilet and performing associated personal hygiene; 6. Eating - Feeding oneself by consuming food or fluids manually from a receptacle (such as a plate, cup or table); or 7. Bathing - Washing oneself by sponge bath; or in either a tub or a shower, including the task of getting into or out of the tub or shower. d) The definition of Spouse is revised as follows: The Employee’s current lawful Spouse. Except for purposes of determining initial eligibility, the term includes a Spouse who is widowed or divorced or legally separated from an Employee. The term includes a common-law Spouse who is recognized as a common-law Spouse under the laws of the jurisdiction where the common-law marriage was formed. 3) Under the Continuation of Coverage Provisions section, in the Continuation for Disability for Employees age 60 and Over the definition of Disability/Disabled is revised as follows: “Disability”/“Disabled” means because of Injury or Sickness the Employee is unable to perform the material duties of His Regular Occupation, as defined below. 4) Under the Extension of Benefits and Waiver of Premium Provision section, in the Extension of Benefits provision the definition of Disability/Disabled is revised as follows: “Disability”/”Disabled” means because of Injury or illness the Employee is continuously unable to perform the material duties of his or her Regular Occupation. 5) Under the Exclusions and Limitation section the following changes are made: a) The felony exclusion is revised to:  commission of a felony; b) The Pre-Existing Condition Limitation is revised as follows: We will not pay benefits for a Covered Loss caused or contributed to by, or resulting from, a Pre-existing Condition, except for Childhood Conditions listed in the Schedule of Benefits for a Dependent Child covered from birth. The term “Pre-existing Condition” means a condition for which medical advice, diagnosis, care or treatment was recommended by or received from a Physician within the 6-month period preceding the Covered Person’s

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