Group Hospital Insurance Certificate

coverage ended due to an approved unpaid leave of absence or Temporary Layoff, credit will be given for any time that was satisfied.

10) Under the General Provisions section, the following changes are made:

a) The Misstatement of Age or Sex provision is replaced by the following:

Misstatement of Age or Sex If the Covered Person’s age or sex has been misstated, We will adjust all benefits to the amounts that would have been purchased for the correct age or sex.

b) The 30 Day Right to Examine Certificate provisions is replaced by the following:

10 Day Right To Examine Certificate If a Covered Person does not like the Certificate for any reason, it may be returned to Us within 10 days after receipt. We will return any premium that has been paid and the Certificate will be void as if it had never been issued.

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

ACCIDENTAL DEATH AND DISMEMBERMENT RIDER DISABILITY INCOME RIDER TERM LIFE INSURANCE RIDER

Oregon residents:

NOTICE: MUST PROVIDE DOMESTIC PARTNER COVERAGE FOR OREGON RESIDENTS

1) Under the Schedule of Benefits section, Tier 1 benefits are not available. Tier 2 benefits will always be paid.

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

ACCIDENTAL DEATH AND DISMEMBERMENT RIDER CRITICAL ILLNESS INSURANCE RIDER DISABILITY INCOME RIDER

3) When the Wellness Treatment, Health Screening Test and Preventive Care Benefit Rider is included under your plan, the following changes are not available:

Remove Preventive Care benefits from this title and remove the preventive care coverage section and any reference to Preventive Care in this Rider.

South Carolina residents:

1) Under the General Definitions section, item 2 of the second paragraph of the Dependent Child definition includes adopted child as follows:

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 provided the child is living with, and is financially dependent upon the Employee;

2) Under the Claim Provisions section, make the following changes:

a) The Physical Examination and Autopsy provision is replaced with the following:

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