SECTION 1 - SCHEDULE OF BENEFITS CLASS NUMBER 001 ELIMINATION PERIOD 90 days. See Section 2. EMPLOYEE CONTRIBUTIONS Contributions are not required. GUARANTEED ISSUE AMOUNT $7,000. This amount is also the Maximum Monthly Benefit. See Section 2. INDIVIDUAL EFFECTIVE DATE Initial Employees First Day of a Coverage Month. See Section 3. New Employees First Day of a Coverage Month. See Section 3. MANDATORY REHABILITATION PROGRAM Not Included. MAXIMUM BENEFIT DURATION 65/5/70. See Table at end of this Section. MENTAL ILLNESS LIMITATION 24-month Lifetime Accumulation Benefit. See Section 11. MINIMUM INDEMNITY ACCIDENTAL This benefit is included for this class. See Section 8. DISMEMBERMENT & LOSS OF SIGHT MINIMUM MONTHLY BENEFIT $50. See Section 8. MONTHLY BENEFIT 66 2/3% of Basic Monthly Earnings not to exceed a Maximum Monthly Benefit of $7,000 less Other Income Benefits. See Section 8. PRE-EXISTING CONDITION EXCLUSION 3/12. See Section 9. RECURRENT DISABILITY This benefit is included for this class. See Section 8. RESIDUAL BENEFIT This benefit is included for this class. See Section 8. GC 3100.2 SECTION 1 - SCHEDULE OF BENEFITS 2005
Certificate of Insurance: Group Long Term Disability Income Insurance Page 3 Page 5