Group Hospital Insurance Certificate

A covered Spouse who applies and agrees to pay required premiums within 60 days of the loss of eligibility of coverage may remain covered under a Certificate issued to Him while this Policy remains in force for the Portable Period shown in the Schedule of Benefits . Any Dependent Child coverage provided under the Spouse’s Certificate is portable when the Spouse ports His coverage. A covered Dependent Child who: 1. has been covered under the Employee’s or Spouse’s Certificate that remains in force; and 2. applies and agrees to pay required premiums within 60 days of the loss of eligibility of coverage, may remain covered under a Certificate issued to Him while this Policy remains in force for the Portable Period shown in the Schedule of Benefits . A Policyholder must provide an Employee who is (a) current on His premium payment for ported insurance, or (b) eligible to elect portable insurance during the Grace Period, the opportunity to make changes to their ported coverage benefits, subject to the options made available by the Policyholder, if such opportunity is available to regular Employees during an Annual Enrollment Period. Ported Insurance Premium The premium for portable insurance may not exceed 102% of the group rate in effect for a group member, including a Policyholder’s contribution, if any, for a group insurance policy. We may not charge an Employee an additional fee, an additional premium, interest, or any similar charge for electing portable insurance. Amount of Portable Insurance The amount of portable coverage is shown in the Schedule of Benefits and will be subject to the provisions of the Policy that reduce the coverage amount because of age, retirement, or a change in class. Effective Date of Ported Insurance Ported insurance will become effective under this section on the date the Covered Person’s coverage under the Policy would otherwise have terminated, as described above, if the Covered Person has applied and agreed to pay required premiums within 60 days of the date He would otherwise have ceased to be eligible. The Covered Person need not show Us that He is insurable.

Termination of Ported Insurance Coverage will end on the earliest of the following dates: 1. the day after the end of the last period for which premiums are paid; 2. the end of the Portable Period; 3. the date the Employee’s ported coverage terminates;

4. for a Dependent Child, the first day of the month following the date the Dependent Child reaches age 26 unless primarily supported by the Employee and incapable of self-sustaining employment by reason of mental

or physical impairment or ceases to quality as a Dependent Child; 5. the date the Spouse no longer meets the definition of Spouse;

6. the date the Covered Person is considered to reside outside the United States. The Covered Person will be considered to reside outside the United States when the Covered Person has been outside the United States for a total period of 4 months during any 4 consecutive months.

9) Under the Common Exclusions and Limitations section the following changes are made:

a) The following exclusions are removed:

• voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage; • operating any type of vehicle while under the influence of alcohol or any drug, narcotic or other intoxicant including any prescribed drug for which the Covered Person has been provided a written warning against operating a vehicle while taking it. ''Under the influence of alcohol'', for purposes of this

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