ICC18 LR14GP-WOP-2 4 WOP-12995 (11/25) PROOF OF CONTINUED TOTAL DISABILITY After your claim is approved, we may periodically request additional proof of your continuing Total Disability, but not more frequently than once every six months. TERMINATION OF WAIVER OF PREMIUM We will stop waiving Premiums on the earliest of the following dates:  The date you are no longer Totally Disabled.  The date you do not give us proof of Total Disability as requested.  Your 65th birthday. If Premiums are no longer waived, insurance under the Policy will stay in force only if all of the following conditions are met:  Life insurance is in force for Active Employees under the Policy, and  You are in an eligible class for coverage under the Policy, and  Your Premium payments are resumed. The amount of insurance will be subject to the Certificate and riders in effect on the date your Premium payments are resumed. You will not be eligible for portability under any Portability Rider on the date we stop waiving your Premiums. CONVERSION AFTER TERMINATION OF WAIVER OF PREMIUM When Waiver of Premium under this rider ends, and if you are not otherwise eligible for insurance under the Policy, then conversion will be available as described in the CONVERSION provision of the Certificate and riders. DENIALS AND APPEALS FOR PLANS SUBJECT TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA) If we deny a claim in whole or in part (an “adverse benefit determination”), we will provide written notice of the adverse benefit determination to you as soon as possible, but no more than 45 days after receipt of the claim unless an extension is needed. An extension of 30 days will be allowed for processing the claim for matters beyond our control. You will be given notice of any such extension before the end of the initial 45-day period. If, before the end of the 30- day extension period, we are still unable to render a decision on the claim for matters beyond our control, a second extension of 30 days will be allowed for processing the claim. You will be given notice of any such second extension before the end of the first 30-day extension period. The notice(s) will state the circumstances requiring the extension and the date a decision is expected. The notice(s) will also specifically explain the standards on which entitlement to a benefit is based, the unresolved issues that prevent a decision on the claim and the additional information needed to resolve those issues. If additional information is needed, you will have 45 days to provide the specified information. If an extension is needed due to your failure to submit information necessary to decide a claim, the extension period will be tolled from the date on which notification of the extension is sent to you until the date on which you respond to the request for additional information. A notice of an adverse benefit determination will be written in an understandable manner and include the following:  The specific reason(s) for the adverse benefit determination.  Reference to the specific provision on which the determination is based.  A description of additional information, if any, which would enable you to receive the benefits sought and an explanation of why it is needed.  A description and a copy of relevant claim review procedure and the time limits applicable to such procedures, including a statement of your right to bring a civil action following an adverse benefit determination on review.  A statement that if an internal rule, guideline, protocol or other similar criterion was relied upon in making the adverse benefit determination, a copy of such rule, guideline, protocol or other criterion will be provided free of charge to you upon request. You may request a review of an adverse benefit determination (an “appeal”) at any time during the 180 day period following receipt of the notice of the determination. We will consider an appeal upon written application of you or your duly authorized representative. As part of the appeal you also have the right, upon request and free of charge, to reasonable access to and copies of all documents, records and other information relevant to your claim. This includes