Group Hospital Insurance Certificate

After three years from the Covered Person’s effective date of coverage, or from the effective date of increased benefits, no such statement will cause coverage or the increased benefits to be contested except for lack of eligibility for coverage.

b) The Policy Termination provision is replaced by the following:

We may terminate coverage on or after the first anniversary of the Policy Effective Date. We or the Policyholder may terminate coverage on any Premium Due Date. Written notice by certified mail must be given at least 60 days prior to such Premium Due Date. Failure by the Policyholder to pay premiums when due or within the Grace Period shall be deemed notice to Us to terminate coverage at the end of the period for which premium was paid

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

TERM LIFE INSURANCE RIDER

Maine residents:

1) Under the Schedule of Benefits, the Hospital Stay, Hospital Intensive Care Unit Stay and Newborn Nursery Care Stay Maximum Benefit Period will not be less than 31 days.

2) Under the General Definitions section, make the following changes:

a) The Dependent Child definition is replaced by the following:

An Employee’s child who meets the following requirements: 1. A child from live birth to 26 years old; 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, beginning with any waiting period pending finalization of the child’s adoption. It also means the legally adopted child of the Employee’s Spouse or Domestic Partner/Partner to a Civil Union; 3. stepchild;

4. child for whom the Employee is the court-appointed legal guardian; 5. a child of the Employee’s domestic partner /Partner to a Civil Union.

b) The Covered Accident definition is replaced with the following:

An accidental bodily injury sustained by the Covered Person that is the direct cause of the condition for which benefits are provided and that occurs while the insurance is in force.

3) The Extension of Benefits section is added:

Extension of Benefits If coverage ends while a Covered Person is confined to a Hospital as an Inpatient as the result of a Covered Accident, We will continue to pay benefits for confinement that become payable after the date coverage otherwise ends if the Covered Person meets the following requirements: 1. the confinement must be continuous after the date of termination; and 2. coverage must not have ended as a result of the Covered Person’s voluntary termination of coverage.

This Extension of Benefits terminates upon the earliest of the following: 1. the date the Covered Person is no longer confined to a Hospital as an Inpatient; 2. the date the Covered Person receives the maximum benefit for Hospital Stay; or

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