GROUP TERM LIFE INSURANCE ACCELERATED BENEFIT RIDER THIS RIDER ADDS AN ACCELERATED BENEFIT PROVISION. RECEIPT OF THIS ACCELERATED BENEFIT WILL REDUCE THE DEATH BENEFIT AND MAY BE TAXABLE. INSUREDS SHOULD SEEK ASSISTANCE FROM THEIR PERSONAL TAX ADVISOR. Attached to Group Policy Number: GL 166285 Issued to Group Policyholder: Goshen Community Schools This Rider is attached to and made a part of the Policy indicated above. Your Certificate is hereby amended, in consideration of the application for this coverage, by the addition of the following benefit. In this Rider, Reliance Standard Life Insurance Company will be referred to as “we", “us", “our". DEFINITIONS: This section gives the meaning of terms used in this Rider. The Definitions of the Policy and Certificate also apply unless they conflict with Definitions given here. "Certified" or "Certification" refers to a written statement, made by a Physician on a form provided by us, as to the Insured’s Terminal Illness. "Certificate" means the document, issued to each Insured, which explains the terms of his coverage under the Group Life Insurance Policy. "Death Benefit" means the insurance amount payable under the Certificate at death of the Insured, subject to all Certificate provisions dealing with changes in the amount of insurance and reductions or termination for age or retirement. It does not include any amount that is only payable in the event of Accidental Death. "Insured" means the primary Insured and his/her insured Dependents, if any. "Physician" means a duly licensed practitioner, acting within the scope of his license, who is recognized by the law of the state in which diagnosis is received. The Physician may not be the Insured or a member of his immediate family. "Policy" means the Group Life Insurance Policy issued to the Group Policyholder under which the Insured is covered. "Terminally Ill" or "Terminal Illness" refers to an Insured’s illness or physical condition that is Certified by a Physician to reasonably be expected to result in death in less than 12 months. "Written Request" means a request made, in writing, by the Insured to us. All pronouns include either gender unless the context indicates otherwise. DESCRIPTION OF COVERAGE: This benefit is payable to the Insured if coverage is in force and the Insured is Certified as Terminally Ill: at any time for accidental injury; or after having been covered under this Rider for at least 30 days for sickness. In order for this benefit to be paid: (1) the Insured must make a Written Request; and (2) we must receive from any assignee or irrevocable beneficiary their signed acknowledgment and agreement to payment of this benefit. We may, at our option, confirm the terminal diagnosis with a second medical exam performed at our own expense. AMOUNT OF THE ACCELERATED BENEFIT: The Accelerated Benefit will be an amount equal to 75% of the Death Benefit applicable to the Insured under the Policy on the date of the Certification of Terminal Illness, subject to a maximum benefit of $500,000. This benefit may be paid as a single lump sum or in installment payments mutually agreed to by us and the Insured. The Accelerated Benefit is payable one time only for any Insured under this Rider. LRS-8596-001-0690 F Page 14.0
Class 6 Group Life (Basic and Term) Certificate Page 18 Page 20