Group Hospital Insurance Certificate

All statements made by a Covered Person are considered representations and not warranties. No statement will be used to deny or reduce benefits or be used as a defense to a claim, unless a copy of the instrument containing the statement is, or has been, furnished to the claimant.

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 fraud.

10) The Term Life Insurance Rider is modified as follows:

a) The Death Benefit provision is replaced with the following:

We will pay the benefit shown in the Schedule of Benefits if a Covered Person dies. The death benefits will include interest from the date of death to the date of payment at a rate equal to the greater of 6% or the rate applicable to proceeds left on deposit with the insurer.

b) Remove the following sentence in the Whose Insurance May Be Converted provision:

The Covered Person must be under Age 70 to be eligible for a converted policy.

11) The Critical Illness Rider is modified to remove the following exclusion:

• 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;

Washington residents:

1) If the Policy provides coverage/benefits to a Spouse, a Domestic Partner will be afforded the same coverage/benefits provided to a Spouse.

Domestic Partner means any of the following:

1. A person with whom the Employee has a registered domestic partnership under state law which imposes legal obligations on the parties substantially similar to marriage. Such person will continue to be recognized as a Domestic Partner unless and until: (1) the domestic partnership is dissolved under applicable law; or (2) either the Employee or the Domestic Partner marries another person.

All references in the policy to ''Spouse'' shall be changed to read ''Spouse and Domestic Partner'' except as follows:

1. A Domestic Partner shall be deemed eligible to be enrolled for insurance or eligible for Additional Benefits on the latest of:

a. the date of registration under Item 1 of the definition of Domestic Partner; b. the date that the Employee is eligible for insurance under the Policy; or; c. the effective date of this Rider to the Policy.

2. A child of a Domestic Partner may only be eligible to be insured or eligible for Additional Benefits 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.

2) Under the Schedule of Benefits the following changes are made:

a) A minimum benefit of $50 per day for Hospital Stay and Hospital Intensive Care Unit Stay will be available for up to 10 days.

b) Under the Hospitalization Benefits, the Hospital Intensive Care Unit Stay Additional ICU Admission benefit will not be payable, and Day 1 benefit will always pay at Day 2+ benefit levels.

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