Group Critical Illness Insurance Certificate

Portability

Maximum Age of Portability

100 as of the date of porting Coverage continues to age 100 100% of inforce coverage amount

Portable Period

Amount of Portable Coverage Coverage(s) that may be ported Benefit(s) that may be ported

Employee

All Voluntary Critical Illness Coverage and Optional Benefits

CRITICAL ILLNESS BENEFITS FOR SPOUSE

SPOUSE BENEFITS Critical Illness Benefit Benefit Type

Benefit Amount

Voluntary Critical Illness Coverage Initial Benefit Amounts

50% of Employee Benefit Amount

Maximum Benefit

$10,000

New Enrollees Guaranteed Issue Amount

Initial Group Enrollment Annual Group Enrollment

$10,000 $10,000 $10,000 $10,000

Life Status Change

New Hire

Current Insureds Guaranteed Issue Amount

Initial Group Enrollment Annual Group Enrollment

$10,000 $10,000 $10,000

Life Status Change

Benefit Waiting Period:

None

Portability

Maximum Age of Portability

100 as of the date of porting Coverage continues to age 100 100% of inforce coverage amount

Portable Period

Amount of Portable Coverage Coverage(s) that may be ported Benefit(s) that may be ported

Spouse

All Voluntary Critical Illness Coverage and Optional Benefits

CRITICAL ILLNESS BENEFITS FOR DEPENDENT CHILD(REN)

DEPENDENT CHILD(REN) BENEFITS Critical Illness Benefit Benefit Type Voluntary Critical Illness Coverage Initial Benefit Amounts

Benefit Amount

50% of Employee Benefit Amount

Maximum Benefit

$10,000

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