Group Hospital Insurance Certificate

16) Under the Amendatory Rider for Domestic Partner /Civil Union Partner Coverage the following does not apply:

A child of a Domestic Partner/Civil Union Partner may only be eligible to be insured if: a. the child is primarily dependent on the Employee for financial support; b. the Employee has a legal obligation of support of the child; or c. the Employee is the child’s legal guardian.

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

TERM LIFE INSURANCE RIDER

Vermont residents:

1) Under the Schedule of Benefits section, the following changes are made:

a) Portability provision has been removed from this schedule and has been replaced with the Continuation for Loss of Eligibility.

The following Continuation for Loss of Eligibility benefit periods have been added:

Loss of Eligibility Maximum Benefit Period Employee

to age 100 to age 100 to age 26

Spouse

Dependent Children

2) Under the General Definitions section, the following changes are made:

a) The definition of Dependent Child is replaced with 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 provided the child is living with, and is financially dependent upon the Employee; 3. stepchild who resides with the Employee and is financially dependent upon the Employee; 4. child for whom the Employee is the court-appointed legal guardian and primarily depends on the Employee for financial support. Financial support means 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.

b) The Hospital definition is replaced with the following:

An institution that meets all of the following: 1. It is licensed as a Hospital pursuant to applicable law;

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