Group Term Life Insurance Certificate
This document is a certificate of insurance for group term life insurance with an accelerated life benefit, issued by American United Life Insurance Company.
® AmericanUnitedLifeInsuranceCompany P.O. Box 368, Indianapolis, Indiana 46206-0368 www.oneamerica.com RichmondCommunitySchoolCorporation (Hereinafter called the Group Policyholder) GroupPolicy Number:00604977-0000-000 Class: 001 ChangeEffective Date: 01/01/2023 This certificate replaces any and all certificates previously issued to You under the Group Policy indicated above. ® AmericanUnitedLifeInsuranceCompany (AUL)certifiesthat the Employee whose enrollment form is on file with the Group Policyholder as being eligible for insurance and for whom the required premium has been paid is insured under the above numbered Group Policy for group insurance benefits as designated in the Schedule of Benefits. Benefits are subject to change as described on the Schedule of Benefits page. This certificate describes the coverage provided in the Group Policy. The Group Policy determines all rights and benefits in this certificate and may be amended, cancelled or discontinued at any time by agreement between AUL and the Group Policyholder without notice to You. The Group Policy may be examined at the main office of the Group Policyholder during the regular office hours. Richard M. Ellery J. Scott Davison Secretary and General Counsel Chairman, President and Chief Executive Officer CERTIFICATEOFINSURANCE GROUPTERMLIFEINSURANCE WITHANACCELERATEDLIFEBENEFIT NOTE:RECEIPTOFTHEACCELERATEDLIFEBENEFITMAYBETAXABLE. PLEASESEEKASSISTANCEFROMAPERSONALTAXADVISOR. GC2510NN (Class 001) (Basic) (Dependent Coverage: Included) (ALB)
TABLEOFCONTENTS SECTION PROVISIONS Schedule of Benefits 1 Definitions 2 Eligibility 3 Individual Effective Date--Non-Contributory Insurance (Basic) 4 Changesin Insurance Coverage 6 Continuation of Insurance 7 WaiverofPremiumforTotalDisability 8 Individual Terminations 9 Conversion Privilege 10 Individual Reinstatements 11 Accidental Death and Dismemberment 12 Accidental Death Seat Belt Benefit 12A Accidental Death Air Bag Benefit 12B Accidental Death Repatriation Benefit 12C Accidental Death Child Higher Education Benefit 12D Accidental Death Child Care Benefit 12E Accelerated Life Benefit 13 PaymentofDeathBenefits 15 NamingofBeneficiary 16 TheDeathClaim 17 Determination of Beneficiary 18 Selection of Payment Method 19 GC2510.1 TABLEOFCONTENTS
TABLEOFCONTENTS (Continued) DependentInsurance 20 Eligibility 20A Individual Effective Date--Non-Contributory Insurance (Basic) 20B Changesin Insurance Coverage 20C WaiverofPremium 20D Individual Terminations 20E Conversion Privilege 20F PaymentofDeathBenefits 20J General Policy Provisions 21 GC2510.1 TABLEOFCONTENTS
SECTION1-SCHEDULEOFBENEFITS BASICINSURANCE CLASS001 CLASSIFICATION: Eligible Full-Time Superintendent LIFEAMOUNT: Three Times The Annual Base Salary, Then Rounded Down to the Nearest $1 With A Minimum Of $10,000 And A MaximumOf$350,000 AD&DPRINCIPALSUM: Three Times The Annual Base Salary, Then Rounded Down to the Nearest $1 With A Minimum Of $10,000 And A MaximumOf$350,000 ACCELERATEDLIFEBENEFIT(ALB):Youmayrequestpaymentof25%,50%or75%oftheLifeAmountshown above. This benefit is available on a Life Amount of $10,000 or more. The maximum payment is limited to 25%, 50% or 75% of the Life Amount shown above or $175,000, whichever is less. See Section 13. ACCIDENTALDEATHANDDISMEMBERMENTBENEFIT:Thisbenefitisincludedinthiscertificate.See Section 12. ADDITIONALACCIDENTALDEATHBENEFITS: SEATBELTBENEFIT:Thisbenefitisincludedinthiscertificate.SeeSection12A. AIRBAGBENEFIT:Thisbenefitisincludedinthiscertificate.SeeSection12B. REPATRIATIONBENEFIT:Thisbenefitisincludedinthiscertificate.SeeSection12C. CHILDHIGHEREDUCATIONEXPENSEBENEFIT:Thisbenefitisincludedinthiscertificate.SeeSection 12D. CHILDCAREBENEFIT:Thisbenefitisincludedinthiscertificate.SeeSection12E. ANNUALBASESALARY:AnnualBaseSalarywithnoCommissionsorBonuses.AnnualBaseSalaryexcludes overtime. CHANGESININSURANCECOVERAGE:Immediate.SeeSection6. CONTRIBUTIONS:Employeepremiumcontributionsarenotrequired.SeeSection4. ELIGIBILITY:First of the Month. See Section 3. FULL-TIMEEMPLOYEEREQUIREMENT:30hoursormoreperweek.SeeSection2,Definitions-Employee,and Section 3, Eligibility. GC2510.2 SECTION1-SCHEDULEOFBENEFITS
SECTION1-SCHEDULEOFBENEFITS BASICINSURANCE CLASS001 GUARANTEEDISSUEAMOUNT:$350,000.AnyamountofcoverageforwhichYourequestgreaterthanthe Guaranteed Issue Amount will only be available following written approval by AUL. Approval will be based on Evidence of Insurability and information satisfactory to AUL. If coverage for amounts greater than the Guaranteed Issue Amount is approved, coverage will begin on the date identified in writing by AUL. See Section 4, Individual Effective Date. INDIVIDUALEFFECTIVEDATE:FirstoftheMonth.SeeSection4. INDIVIDUALREINSTATEMENTS:FirstoftheMonth.SeeSection11. INDIVIDUALTERMINATIONS:EndoftheMonth.SeeSection9. TERMINATIONS:TerminationsaregovernedbytheIndividualTerminationsSection.SeeSection9. TOTALDISABILITY:ThedefinitionforTotalDisabilityandTotallyDisabledincludedin this certificateis the standard any occupation definition. See Section 2. WAITINGPERIODforPresentEmployeeshiredbeforethepolicyeffectivedate:Firstof the Month following 0 days. See Eligibility Section 3. WAITINGPERIODforNewEmployeeshiredonorafterthepolicyeffectivedate:FirstoftheMonthfollowing0 days. See Eligibility Section 3. WAIVEROFPREMIUMFORTOTALDISABILITY:Thisbenefitisincludedinthiscertificate. Reductions are not applicable to this benefit. See Section 8. GC2510.2 SECTION1-SCHEDULEOFBENEFITS
SECTION1-SCHEDULEOFBENEFITS DEPENDENTBASICINSURANCE Class Number: 001 LIFEAMOUNT Spouse under age 70 TheLesserOf$5,000Or50%Ofthe Employee’sAmount Child: Live Birth to under 6 months $1,000 6 months to 26 years TheLesserOf$2,500Or50%Ofthe Employee’sAmount CHANGESININSURANCECOVERAGE:Immediate.SeeSection20C. CONTRIBUTIONS:Employeepremiumcontributionsarenotrequired.SeeSection20B. GC2510.2 SECTION1-SCHEDULEOFBENEFITS DEPENDENTBASICINSURANCE
SECTION1-SCHEDULEOFBENEFITS DEPENDENTBASICINSURANCE Class Number: 001 GUARANTEEDISSUEAMOUNT: Basic Guaranteed Issue Amount Spouse under age 70 $5,000 Children: Live Birth to under 6 months $1,000 6 months to 26 years $2,500 AnyamountofcoverageforwhichtheDependentrequestsgreaterthan the GuaranteedIssue Amount will only be available following written approval by AUL. Approval will be based on Evidence of Insurability and information satisfactory to AUL. If coverage for amounts greater than the Guaranteed Issue Amount is approved, coverage will begin on the date identified in writing by AUL. See Section 20B, Dependent Insurance, Individual Effective Date. INDIVIDUALEFFECTIVEDATE:FirstoftheMonth.SeeSection20B. INDIVIDUALTERMINATIONS:EndoftheMonth.SeeSection20E. TERMINATIONS:TerminationsaregovernedbytheDependentInsuranceIndividualTerminations.SeeSection20E. DEPENDENTLIFEWAIVEROFPREMIUM:Thisbenefitisincludedinthiscertificate.SeeSection20D. GC2510.2 SECTION1-SCHEDULEOFBENEFITS DEPENDENTBASICINSURANCE
SECTION2–DEFINITIONS ACCIDENTALBODILYINJURYmeansaninjuryoccurring,eitherdirectlyorindirectly,asaresultofanaccident along with all other related conditions, sustained by You while insured under the policy. ACTIVEWORKandACTIVELYATWORKmeantheuseoftime,services,andenergybyYoufortheGroup Policyholder at the Group Policyholder’s regular place of business, an alternate location approved by the Group Policyholder, or an alternate location to which the Group Policyholder requires You to travel. You must be physically and mentally capable of performing each of the material and substantial duties of Your regular position with the GroupPolicyholder for at least the minimum number of hours listed in the Eligibility Section of the policy. Active Workwillincludetime off for vacation, jury duty, paid holidays, and funeral leave approved by the Group Policyholder when You could have been Actively at Work. Active Work does not include periods of time when You are not Actively at Work following an injury, Accidental Bodily Injury, Sickness, strike, lock-out, layoff, after Your employmenthasendedvoluntarily or involuntarily, or periods of time during which You are entitled or are receiving accrued employment related benefits including but not limited to vacation time. AnnualBaseSalarywithnocommissionorbonuses ANNUALBASESALARYmeansYouryearlygrosswagesreceivedfromtheGroupPolicyholderbasedona maximum40hourworkweek.AnnualBaseSalaryisbasedontheamountlastreportedinwritingtoAULbythe GroupPolicyholder and approved for coverage under the Policy by AUL before the date of death or the events shown in the AD&Dprovisions if AD&Dcoverageis included. Annual Base Salary does not include amounts received from commissions, bonuses, overtime or reimbursement for expenses. BASICLIVINGEXPENSESincludethecostoffood,shelter,clothingandanyotherbasiclivingexpensesofthe average American household. Each household member need not contribute equally or jointly to the payment of these expenses as long as each agrees both are responsible for the basic living expenses. BI-WEEKLYmeanseverytwoweeksor26timesayear. CHILDmeansanyminorrelatedbyblood,marriageorcourtorderthatcanbeclaimedasadependentforfederal incometax purposes, and may include: 1) anyofYournaturalbornchild(ren); 2) anyofYourlegallyadoptedchild(ren) from the time of placement in Your home with the intent to adopt; 3) anystepchild(ren) who live with You; 4) anychild(ren) for whom You have legal guardianship; or 5) anychild(ren) for whom coverage must be provided in accordance with state law or court order. CONTRIBUTORYINSURANCEmeansinsuranceforwhichYoupaypartorallofthepremium. GC2510.3B SECTION2-DEFINITIONS
SECTION2-DEFINITIONS Continued COVERAGEMONTHmeansthatperiodoftimebeginningonthefirstdaythattheGroupPolicyholder’scoverageis in force and ending on the day before that date of the next month. DATEOFDISABILITYmeansthefirstdayYouarenotActivelyatWorkduetoanAccidentalBodilyInjuryor Sickness and results in Total Disability. DEPENDENTmeans: 1) Yourlegalspouseunderage70; 2) YourDomesticPartnerunderage70whoserelationshipwithYouisrecognizedby andallowedunderapplicable state law provided both the Domestic Partner and You: a) share the same regular and permanent residence; b) haveaclosepersonalrelationship similar to lawful marriage; c) have agreed to be jointly responsible for Basic Living Expenses, incurred during the domestic partnership; d) are not married to anyone; e) are 18 years of age and older; f) are not so closely related by blood to be prohibited under applicable state laws; g) werementallycompetentto consent to a contract when the domestic partnership began; h) are each other’s sole domestic partner; and i) are responsible for each other’s welfare; 3) YourunmarriedChildfromlivebirth and under the age of 26, if the Child: a) is not eligible under the policy for Personal Insurance; and b) is not in the military of any country; and 4) YourunmarriedChildwhoisdisabledandincapableof self-sustainingemployment as a result of mental or physical disability. The Child must have been disabled prior to age 26. If the Child is at least age 26 on Your effective date, coverage is subject to AUL’s receiving written proof of the disability on that date including but not limited to receipt of Social Security Administration disability benefits. If the Child is not at least age 26, extension of coverage is subject to AUL’s receiving written proof of the disability not later than 120 days after the Child attains age 26. Proof of continued disability shall be required not more than once each year thereafter. If Dependent Insurance is not included in the policy, then references to Dependents and Dependent Insurance are null and void. DEPENDENTINSURANCEmeanstheinsuranceprovidedunderthepolicycoveringYourDependents,Section20, if included in the policy. ELIMINATIONPERIODseeWaiverofPremium,Section8,ifincludedinthepolicy. GC2510.3/1A SECTION2-DEFINITIONS
SECTION2-DEFINITIONS Continued EMPLOYEEmeansanyindividualwhoisafull-time,permanentEmployee(includingowner,member,partner,or shareholder) of the Group Policyholder: 1) whoislegally authorized to work and reside in the United States under applicable state and federal laws; and 2) whoseemploymentwiththeGroupPolicyholderconstituteshis principal occupation; and 3) whoregularlyworksatthat occupation at the Group Policyholder’s regular place of business a minimum of 30 hours or more per week; and 4) whoisnottemporarilyor seasonally employed by the Group Policyholder; and 5) whoisanemployee,participant, person, or any member of any employee organization, who is or may become eligible to receive a benefit of any type from the Policyholder’s employee welfare benefit plan; and 6) whoisnotanindependentcontractor. EMPLOYERseeGROUPPOLICYHOLDER.AnyreferencestoEmployerusedinthepolicyshallincludeInsured Units. EVIDENCEOFINSURABILITYmeansasignedstatementofproofacceptabletoAULofanEmployee’sor Dependent’s medical history provided at no expense to AUL, and, if requested by AUL, medical records, tests, and/or examinations at no expense to AUL. Satisfactory Evidence of Insurability must include information and documentation which can be used by AUL to determine if the individual is an acceptable underwriting risk and can be approved for coverage under AUL’s guidelines. GRANDFATHEREDRETIREE,seeEligibility,Section3A,ifincludedinthepolicy. GUARANTEEDISSUEAMOUNTmeanstheamountofcoveragethatdoesnotrequireEvidenceofInsurability. This amount is selected by the Group Policyholder on the Application and later approved in writing by AUL. GROUPPOLICYHOLDERmeanstheentitywhichappliedforandwasapprovedbyAULforcoverage.Any references to Group Policyholder used in the policy shall include Insured Units. MENTALILLNESSmeansapsychiatricorpsychologicalconditionclassifiedin the most recent version of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM), published by the American Psychiatric Association as of the date of Total Disability and has been diagnosed by a Physician. Such disorders include, but are not limited to, psychotic, emotional, behavioral disorders, or disorders related to stress or to substance abuse or dependency. If the DSM is discontinued or replaced, Mental Illness will be determined based on the diagnostic manual then published by the American Psychiatric Association on the date of Total Disability. NON-CONTRIBUTORYINSURANCEmeansinsuranceforwhichYoupaynoportionofthepremium. GC2510.3/2A SECTION2-DEFINITIONS (Probationary Elig Not Inc)
SECTION2-DEFINITIONS Continued PERMANENTANDTOTALDISABILITY/PERMANENTLYANDTOTALLYDISABLEDmeansYourinability as determined by a Physician to engage, due to Accidental Bodily Injury or Sickness in any occupation for which You are fitted by training, education or experience. Permanent and Total Disability/Permanently and Totally Disability must occur after You become insured under the Policy and it must be conclusively determined the Permanent And Total Disability will continue for Your lifetime. PERSONALINSURANCEmeanstheinsuranceprovidedunderthepolicyforYou. PHYSICIANmeansaqualified,licenseddoctorof medicineor osteopathy, and any other licensed health care provider that state law requires to be licensed prior to engaging in the practice of medicine and who is, practicing within the scope of his specialty, license, and applicable law. Physician does not include any medical provider affiliated with the Group Policyholder, or anyone related by blood, marriage, or domestic partnership to an Employee. REGULARATTENDANCEmeansthatYouorYourDependent: 1) are receiving periodic medical treatment and services from a Physician when medically required and according to standard medical protocol to effectively manage and treat Your or Your Dependent’s Disability; 2) are receiving the most appropriate treatment and care that will maximize Your medical improvement and aid in Yourreturn to work; and 3) are receiving medical care and services from a Physician whose specialty or practice is related to the Disability. RETIREEmeansanindividualwho,onhislastdayofActiveWorkpriortoretirement,wasanActivelyatWork Employeeandwhoisreceivingbenefitsunder the Group Policyholder’s retirement plan. Retiree does not include an Employeewhoisreceivingbenefits under his retirement plan solely due to being Totally Disabled and who otherwise does not meet the Group Policyholder’s retirement plan’s criteria for receipt of benefits. SICKNESSmeansillness,bodily disorder or disease, Mental Illness, normal pregnancy and complications of pregnancy. Complication of Pregnancy is defined as concurrent disease or abnormal conditions significantly affecting the usual medical management of pregnancy. TEMPORARYLAY-OFFmeansaperiodoftimeduringwhichYouarenotActivelyatWorkduetolackofworkand are not terminated from employment with the Group Policyholder. TOTALDISABILITYANDTOTALLYDISABLEDmeanthatbecauseofAccidentalBodilyInjuryorSicknessYou cannot engage in any occupation for which You are reasonably fitted by training, education, or experience. If You accept any type of employment, other than in a state-approved rehabilitation program or sheltered workshop, You will be considered fitted to that occupation. WE,OUR,US,andAULmeanAmericanUnitedLifeInsuranceCompany. YOUandYOURmeansanEmployeewhomeetstherequirementsoftheEligibilityandIndividualEffectiveDate Sections. GC2510.3/3A SECTION2-DEFINITIONS (AnyOcc)
SECTION3-ELIGIBILITY DEFINITIONS NEWEMPLOYEEmeansanEmployeewhoisemployedbytheGroupPolicyholderonoraftertheGroup Policyholder’s Effective Date. PRESENTEMPLOYEEmeansanEmployeewhoisemployedbytheGroupPolicyholderbeforetheGroup Policyholder’s Effective Date. WAITINGPERIODmeanstheperiodofdaysbeginningontheEmployee’shiredatethatanEmployeemustbe continuously Actively at Work prior to becoming eligible for Personal Insurance. Present Employees will be given credit for time insured under the Group Policyholder’s prior group life insurance contract if the policy replaces the samecoverageavailable under the prior group life insurance contract. The Waiting Period is stated in the Schedule of Benefits. Ontheeffective date of the policy, an Employee becomes eligible for Personal Insurance if: 1) the Employee has fulfilled the Waiting Period, if any, and is Actively at Work; or 2) the Employee has fulfilled the Waiting Period, if any, and is not Actively at Work due to being on an Employer-approvedleave of absence other than for injury or Sickness; or 3) the Employee has fulfilled the Waiting Period, if any, and is not Actively at Work due to being on Temporary Lay-off. After the effective date of the policy and while the policy is in force, an Actively at Work Employee becomes eligible for Personal Insurance on: 1) the date the Employee fulfills the Waiting Period, if any, if that date is the first day of the Coverage Month; or 2) the first day of the Coverage Month next following the date the Employee fulfills the Waiting Period, if any, if that date is not the first day of the Coverage Month. TOREMAINELIGIBLEFORPERSONALINSURANCEANDDEPENDENTINSURANCE,IFANY, EMPLOYEESMUSTCONTINUOUSLYMEETTHEABOVEREQUIREMENTS. GC2510.4B SECTION3-ELIGIBILITY (FOM)
Refer to Your Basic Schedule of Benefits to determine to which coverage this page applies. When applicable, the Schedule of Benefits will indicate employee premium CONTRIBUTIONSare not required and INDIVIDUAL EFFECTIVEDATEisFirstoftheMonth. SECTION4-INDIVIDUALEFFECTIVEDATE NON-CONTRIBUTORYINSURANCE Theeligible Employee, prior to receiving coverage under the policy must make written election on a form approved by AULandtheEmployermustcontributetherequiredamountofpremiumtoAULonatimelybasis. For amounts of coverage that do not exceed the Guaranteed Issue Amount shown in the Schedule of Benefits, the effective date for an eligible Employee is: 1) the first day of the Coverage Month; or 2) the first day of the next Coverage Month if the Employee applies after the first day of the Coverage Month. ToreceiveanyamountofcoverageexceedingtheGuaranteedIssueAmount,theeligibleEmployeemustmakewritten request to AUL on a form approved by AUL and undergo medical underwriting. The effective date of insurance for an eligible Employee, subject to the further provisions of this Section, will be after the Employee submits satisfactory Evidence of Insurability to AUL and on the date AUL determines the Employee is approved for coverage. Satisfactory Evidence of Insurability, at no expense to AUL, must be provided prior to receiving any amount of coverage greater than the Guaranteed Issue Amount. If an eligible Employee desires to decline coverage for which the Employer would pay 100% of the premium, the Employeemustfirst notify the Employer in writing of this decision prior to coverage being declined. Once coverage is declined, the Employer is not responsible for paying premium for that Employee, and the Employee will not be eligible for any coverage under the policy. If an eligible Employee initially declines coverage and later desires to have coverage, the Employee will be required to undergo medical underwriting and submit satisfactory Evidence of Insurability at no expense to AUL prior to receiving any coverage. No coverage shall begin until the date AUL has approved the request for coverage in writing and the required amount of premium is received from the Employer. Anyeligible Employee who converted his insurance under the policy to an individual life insurance policy and if that individual life insurance policy is still in force, the Employee is required prior to becoming insured again under the policy to undergo medical underwriting and submit satisfactory Evidence of Insurability, at no expense to AUL. If the EmployeedoesnotwishtoundergomedicalunderwritingandsubmitsatisfactoryEvidenceof Insurability, the Life Amountunderthepolicywillbereducedbytheamountofcoverageundertheindividuallifeinsurancepolicy. No coverage shall begin until the date AUL has approved the request for coverage in writing and the required amount of premiumisreceivedfrom the Employer. If an Employee is not Actively at Work on the date coverage would otherwise become effective, the effective date will be: 1) the first day of the Coverage Month, if the Eligible Employee returns to Active Work on the first day of the CoverageMonth;or 2) the first day of the Coverage Month following the date the eligible Employee returns to Active Work, if Active Workbeginsafter the first day of the Coverage Month. Contributions for Basic insurance are not required from Employees for Personal Insurance. Also see Continuity of Coverage, Section 5, if included in the policy. GC2510.5 SECTION4-INDIVIDUALEFFECTIVEDATE (First of Month) NON-CONTRIBUTORYINSURANCE
SECTION6-CHANGESININSURANCECOVERAGE TheamountofcoverageforwhichYouareeligibleisshownintheScheduleofBenefits. Achangeincoveragethatdoesnotincreasethe amount of coverage becomes effective the earlier of: 1) the date of any scheduled reduction; or 2) the date of AUL’s written approval of the change. Prior to a change in coverage that increases the amount of coverage, You must be Actively at Work and the required amountofpremiummustbepaid. Achangeincreasingthe amount of coverage equal to or less than Your Guaranteed Issue Amount takes effect the date Youbecomeeligiblefor the change in coverage. Achangeincoverageincreasingthe amount of coverage above Your Guaranteed Issue Amount is subject to: 1) satisfactory Evidence of Insurability, at no expense to AUL; and 2) uponAUL’swrittenapproval,takeseffect on the date of a request for change. If You are not Actively at Work on the approved change date, any increase in the amount of coverage takes effect on the date You return to Active Work. GC2510.8-1 SECTION6-CHANGESININSURANCECOVERAGE (Immediate)
SECTION7-CONTINUATIONOFINSURANCE CONTINUATIONOFINSURANCE Whilethe policy is in force and if You have ceased Active Work due to: 1) Sickness or injury, Personal Insurance may be continued until 9 months following cessation of Active Work; 2) TemporaryLay-off, Personal Insurance may be continued until the 90th day following cessation of Active Work; 3) anEmployer-approvedleaveof absence,Personal Insurance may be continued until the 90th day following cessation of Active Work; or 4) anEmployer-approvedleaveof absenceallowedunder the Family and Medical Leave Act (FMLA) or state law. Personal Insurance may then be continued until the end of the period allowed under FMLA or state law, whichever is longer. In all the above Continuation of Insurance situations, Personal Insurance will terminate on the earliest of the following: 1) the date You return to Active Work; 2) the date the required premium payments are not received by AUL; 3) the date You die; 4) the date You begin full or part-time employment; 5) the date the policy, or the Group Policyholder’s coverage under the policy, terminates; 6) the date You notify the Group Policyholder that You will not be returning to Active Work; 7) the date Your class is no longer offered under the policy; 8) the date You are no longer a member in an eligible class; 9) the date You make written request for termination of coverage but not prior to the date of the request; or 10) the date You enter military service for any country, except for temporary duty not scheduled for more than 30 days. If the Group Policyholder has approved more than one type of leave of absence during any one period, AUL will consider such leaves to be concurrent for the purpose of determining how long Your coverage may continue under the policy. If You do not return to Active Work, Personal Insurance terminates at the end of Continuation of Insurance period. At the end of Continuation of Insurance period, You may apply, if eligible, for Waiver of Premium for Total Disability, see Section 8, if available; or may be eligible to apply to convert the Life Amount to an individual life insurance policy pursuant to Section 10. GC2510.9 SECTION7-CONTINUATIONOFINSURANCE (Waiver: Included)
SECTION8-WAIVEROFPREMIUMFORTOTALDISABILITY This Section applies to Basic Life Insurance. DEFINITIONS ELIMINATIONPERIODmeansa9monthperiodofconsecutivedaysofTotalDisability.TheEliminationPeriod begins on the 1st day of Total Disability and ends on the last day of the 9 month period. You may not have more than three (3) days of Active Work during the Elimination Period. WAIVEROFPREMIUMBENEFITFORTOTALDISABILITY AULwillwaivefurtherpremiumpaymentsforYourLifeAmountifYou: 1) becomeTotallyDisabledbefore age 60 and while insured under the policy; 2) remaincontinuously Totally Disabled during the 9 month Elimination Period; 3) submit and AULreceivesproof of Total Disability within the three (3) months prior to the end of the Elimination Period; 4) submit and AULreceivesacceptableproof of continuous Total Disability at least annually and as requested by AUL;and 5) are under the Regular Attendance of a Physician. AULalsomayrequirethatYoubeexamined: 1) at AUL’sexpense; 2) byaPhysicianofAUL’schoice. Therequired amount of premium must continue to be received by AUL until AUL approves the request for Waiver of PremiumBenefitfor Total Disability and the Elimination Period has been fulfilled. WhileYoumeettheconditionssetforth above and are approved by AUL for the benefit, You will retain coverage without the need to make further premium payments until the first of the following occurs: 1) proof of Total Disability is not received by AUL; 2) Youbecomeemployed,orarefoundabletobeemployedinanoccupationforwhichYouarereasonablyfittedby training, education or experience; 3) Yourefusetoundergoamedicalexaminationrequestedby AUL; 4) the date You are not under the Regular Attendance of a Physician; 5) proof of continuous Total Disability is not submitted within the twelfth month of any benefit period unless it was not possible to do so; 6) Youattainage70;or 7) if You retire; 8) Yourclassterminates; or 9) YouarenolongerTotallyDisabled. GC2510.10 SECTION8-WAIVEROFPREMIUMFORTOTALDISABILITY (NoRetiree)
SECTION8-WAIVEROFPREMIUMFORTOTALDISABILITY Continued AnyAccidentalDeathandDismembermentInsurancewillcontinueuntil the earliest of the following dates: 1) the date of the final benefit determination by AUL; 2) 9monthsfollowingtheDateofDisability;or 3) the date the required amount of premium was not received by AUL. WhenYouareapprovedforbenefitsunderthisWaiverofPremiumBenefitforTotalDisability,the coverageexisting under the policy will not include any Accidental Death and Dismemberment coverage You may have had and will only include the Life Amount. GC2510.10/1 SECTION8-WAIVEROFPREMIUMFORTOTALDISABILITY (NoReduce) (AD&D:Included)
SECTION8-WAIVEROFPREMIUMFORTOTALDISABILITY Continued Life and Accidental Death and Dismemberment Insurance premiums must be paid to and received by AUL during the WaiverofPremiumBenefitforTotalDisabilityElimination Period. If the benefit request is approved, any unearned premiumbeyondtheEliminationPeriodwill be refunded. If You are not approved for this benefit, You may apply to convert Your Life Amount to an individual life insurance policy pursuant to Section 10, Conversion Privilege within 31 days from notice of the adverse benefit determination. If You did not pay premiums during the Elimination Period, You are not eligible to convert Your coverage to an individual life insurance policy upon notice of an adverse benefit determination. If You die during the Elimination Period and the required amount of premiums were not received by AUL, no benefit will be due under the policy. If coverage under the Waiver of Premium Benefit for Total Disability terminates, You are entitled to apply to convert YourLifeAmounttoanindividuallife insurance policy within 31 days of cessation of such coverage pursuant to Section 10, Conversion Privilege. If coverage under the Waiver of Premium Benefit for Total Disability terminates because You return to Active Work with the Group Policyholder and the policy is still in force, You are eligible to apply for all coverages available to Yourclass. If benefits are payable under the policy after You are approved for Waiver of Premium and You have applied and been issued an individual life insurance policy under Section 10, Conversion Privilege, any amount payable under the policy will be reduced by the amount payable under the individual life insurance policy. IN NO EVENT WILL A BENEFITBEPAYABLEUNDERBOTHTHEINDIVIDUALLIFEINSURANCEPOLICYANDTHEPOLICY GREATERTHANTHELIFEAMOUNT,NORWILLACCIDENTALDEATHANDDISMEMBERMENT BENEFITS,IFANY,BEPAYABLEBEYONDTHEWAIVEROFPREMIUMBENEFITFORTOTAL DISABILITYELIMINATIONPERIOD. GC2510.10/2 SECTION8-WAIVEROFPREMIUMFORTOTALDISABILITY (Refund) (AD&D:Included)
SECTION9-INDIVIDUALTERMINATIONS Personal Insurance terminates on the earliest of the following dates: 1) the date the policy is terminated; 2) the last day of the Coverage Month in which You request termination but not prior to the date of the request; 3) the last day of the Coverage Month for which any required premium payment was not received by AUL; 4) the last day of the Coverage Month during which You cease to be eligible, see Eligibility, Section 3 and Section 3A, if any; 5) the last day of the Coverage Month during which You become a Retiree, unless the Schedule of Benefits includes a specific classification for Retirees; 6) the last day of the Coverage Month during which You enter active military service for any country except for temporary duty of 30 days or less; 7) the last day of the Coverage Month during which You cease Active Work, except for an event listed in the policy in Continuation of Insurance, Section 7; or 8) the date of an adverse benefit determination under the Waiver of Premium provisions, if applicable. Accidental Death and Dismemberment coverage terminates when Personal Insurance terminates. Accidental Death and Dismembermentcoveragealso terminates on the earliest of the following dates: 1) the date of an adverse or positive benefit determination under the Waiver of Premium Benefit provisions; 2) the last day of the Coverage Month during which You become a Retiree, unless the Schedule of Benefits includes a specific classification for Retirees that includes AD&D Principal Sum Amounts; 3) the date Your Life Amount reduces to zero; or 4) the end of the Elimination Period. GC2510.11 SECTION9-INDIVIDUALTERMINATIONS (EOM/ALB) (AD&D:Included)
SECTION10-CONVERSIONPRIVILEGE If Your coverage, or a portion of it, terminates because You are no longer eligible for coverage under the policy, You mayapplyforanindividual life insurance conversion policy without evidence of insurability. The coverage amount of the individual life insurance conversion policy shall not exceed the amount of life insurance that ceases because of loss of eligibility for coverage under the policy minus the amount of any group life coverage for which You become eligible within 31 days of termination. If Your coverage ceases due to termination of the policy, You may apply for and receive an individual life insurance conversion policy if Your group life insurance has been in force with AUL for five (5) continuous years before the termination date. The coverage amount of the individual life insurance conversion policy may not exceed the LESSER of: 1) the amount of life insurance that ceases because of termination minus the amount of any group life coverage for whichYoubecomeeligiblewithin31daysoftermination;or 2) $10,000. Theconversion privilege is subject to the following: 1) Written application must be made and the first premium must be paid within 31 days after the date of termination of insurance. 2) Anindividual life insurance policy, other than term life insurance, offered by AUL at the time of conversion, may be selected. 3) ThepremiumontheindividualpolicymustbeatAUL’sthencustomaryrateapplicableto the form and amount of the individual policy, to the class of risk to which You or Your dependent then belong, and to the individual age attained by You or Your dependent on the effective date of the individual policy. 4) Theindividual life insurance conversion policy takes effect on the last day of the application period and is in lieu of all benefits under the Policy. If notice of the existence of the conversion right is not given at least 15 days before the expiration of the period during whichthe conversion application and payment of the first premium must be made under the terms of the policy, You have an additional period within which to exercise the conversion right. The additional conversion application period created to exercise a right of conversion expires 15 days after You are given notice of the conversion right. However, irrespective of the date on which notice is given or of the absence of any notice, the additional conversion application period may not extend beyond 60 days after the expiration date of the period within which conversion application period and payment of the first premium were to be made under the terms of the policy. For purposes of this section, notice of the right of conversion may be given to You in writing, presented to You; mailed by the Group Policyholder to Your last known address; or mailed by the insurer to Your last known address as furnished by the Group Policyholder. If death occurs during the conversion application period, AUL will pay the Life Amount available for conversion whether or not the application or the first premium payment has been made. After the 31-day period, no conversion application will be accepted unless it is proven that it was not possible for You to apply in a timely fashion. The individual life insurance conversion policy will not include Accidental Death benefits or any other benefits currently in force under the policy. PremiummustbepaidtoandreceivedbyAULforcoverageduringtheconversionapplicationperiod. IF DEATHOCCURSDURINGTHECONVERSIONAPPLICATIONPERIOD,INNOEVENTWILLBENEFITS BEPAYABLEUNDERBOTHTHEINDIVIDUALCONVERSIONPOLICYANDTHEPOLICY.ACCIDENTAL DEATHANDDISMEMBERMENTBENEFITS,IFANY,ARENOTPAYABLEBEYONDTHEDATES OUTLINEDINSECTION9,INDIVIDUALTERMINATIONS. GC2510.12 SECTION10-CONVERSIONPRIVILEGE (AD&D:Included)
SECTION11-INDIVIDUALREINSTATEMENTS If Personal Insurance and Dependent Insurance, if any, terminate due to termination of Your employment, You can apply to reinstate that coverage following return to Active Work. The following conditions apply: 1) WhenreturntoActiveWorkoccurswithin32daysoftheterminationofcoverage,coveragebecomeseffectiveon the first day of the next Coverage Month following the date of return to Active Work. Evidence of Insurability will not be required for any amount of coverage less than the Guaranteed Issue Amount. 2) WhenreturntoActiveWorkoccursaftertheperiodspecifiedin paragraph 1 above, You will be considered a new employeeandtherequirementsfound in the Eligibility and Individual Effective Date Sections will apply. 3) WhentheLifeAmounthasbeenconvertedundertheConversionPrivilege,Section10, the Life Amount available for reinstatement under the policy will be reduced by the amount of coverage under the individual life insurance policy. In no event will the amount of coverage reinstated under this Section and the amount of coverage under the individual life insurance policy be greater than the Life Amount existing on Your termination of employment. 4) Prior to applying for reinstatement, AUL must have received the required amount of premium timely. 5) Themaximumamountofcoveragereinstatedwillnotexceedthemaximumamountofcoveragewhichwould have been available had Your coverage not terminated. If reinstatement is requested for any reason other than returning to Active Work, medical underwriting and satisfactory Evidence of Insurability, at no expense to AUL, will be required prior to AUL’s approval of coverage. The effective date of reinstatement will be the date determined by AUL in writing. Dependent Insurance cannot be reinstated without reinstatement of Personal Insurance. GC2510.13 SECTION11-INDIVIDUALREINSTATEMENTS (FOM)
SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT This Section applies to Basic Accidental Death Insurance. DEFINITIONS ACCIDENTALDEATHmeansdeathduetoanaccident,directlyandindependentlyofallothercauses. ADDITIONALACCIDENTALDEATHBENEFITSmeantheSeatBeltBenefit,theAirBagBenefit,the Repatriation Benefit, the Child Higher Education Benefit and the Child Care Benefit. The total of the Additional Accidental Death Benefits payable will not exceed 100% of Your AD&D Principal Sum shown in the Schedule of Benefits. ACCIDENTALDISMEMBERMENTmeanslossofsight,speechorhearingorseveranceofabodymember,Lossof Useofalimbofthebody,orSevereBurnduetoanaccident,directlyandindependentlyof all other causes. AIRBAGmeansaninflatablerestraintdevicethat is activated in an Automobile accident and 1) wasinstalled by the Automobile manufacturer; 2) is not altered after the original installation by the Automobile manufacturer; 3) is functioning properly; and 4) complies with Federal Motor Vehicle Safety Standard Number 208 (49 C.F.R. Section 571.208) for the make, modelandyearoftheAutomobile. AUTOMOBILEmeansamotorvehicleproperlyregisteredwithlocalauthoritiesand permittedunder applicablelaws for use on highways. CHILD-seeSECTION2,DEFINITIONS. LOSSOFSIGHTmeanstotal,permanentblindness. LOSSOFSPEECHmeanstotal,permanentandirrecoverablelossofvocalcommunication. LOSSOFHEARINGmeanstotal,permanentdeafnessinbothearswhichcannotberestoredbyanymeans. LOSSOFHANDmeanscompleteseveranceofthehandthroughorabovethewrist. LOSSOFTHUMBANDINDEXFINGERmeanscompleteseveranceofboththethumbandindexfingeratorabove the metacarpophalangeal joints on the same hand. LOSSOFFOOTmeanscompleteseveranceofthefootthroughorabovetheankle. LOSSOFUSEOFUPPERANDLOWERLIMBSOFTHEBODYmeansatotal,permanentandirrecoverableloss of voluntary movement of the upper and lower limbs of the body which has continued for 12 continuous months. LOSSOFUSEOFBOTHLOWERLIMBSOFTHEBODYmeansatotal,permanentandirrecoverablelossof voluntary movement of both lower limbs of the body which has continued for 12 continuous months. LOSSOFUSEOFUPPERANDLOWERLIMBSONONESIDEOFTHEBODYmeansatotal,permanentand irrecoverable loss of voluntary movement of the upper and lower limbs on one side of the body which has continued for 12 continuous months. GC2510.14 SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT
SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT Continued LOSSOFUSEOFONELIMBOFTHEBODYmeansatotal,permanentandirrecoverablelossofvoluntary movementofonelimbofthebodywhichhascontinuedfor12continuousmonths. HEMIPLEGIAmeansthetotal,permanentandirrecoverableparalysisof the upper and lower limbs on the same side of the body which has continued for 12 continuous months. MONOPLEGIAmeansthetotal,permanentandirrecoverableparalysisof one limb of the body which has continued for 12 continuous months. PARAPLEGIAmeansthetotal,permanentandirrecoverableparalysisof both lower limbs of the body which has continued for 12 continuous months. QUADRIPLEGIAmeansthetotal,permanentandirrecoverableparalysisof both upper and lower limbs of the body whichhascontinued for 12 continuous months. SEATBELTmeansaproperlyinstalledsafetybeltmeetingthestandardsstatedin the Federal Motor Vehicle Safety Standard Number 208 (49 C.F.R. Section 571.208) for the make, model, and year of the Automobile. SEVEREBURNSmeansthird-degreeburnsonatleastfiftypercentofthebody. GC2510.14/1 SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT
SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT Continued ACCIDENTALDEATHANDDISMEMBERMENTBENEFIT If You have an accident while insured under the policy which results in a loss or condition shown below, AUL will pay the amount shown opposite the loss or condition if: 1) the loss or condition occurs within 365 days from the date of the accident; and 2) AULreceivesacceptableproof of loss or condition. FORACCIDENTALLOSSOF AMOUNTPAYABLE Life AD&DPrincipalSum Both Hands or Both Feet or Sight of Both Eyes AD&DPrincipalSum SpeechandHearing AD&DPrincipalSum OneHandandOneFoot AD&DPrincipalSum OneHandandSightofOneEye AD&DPrincipalSum OneFootandSightofOneEye AD&DPrincipalSum Sight of One Eye One-half of the AD&D Principal Sum OneHandorOneFoot One-half of the AD&D Principal Sum Speechor Hearing One-half of the AD&D Principal Sum ThumbandIndexFinger One-quarter of the AD&D Principal Sum FORCONDITIONSOF Quadriplegia or Loss of Use of Upper and Lower Limbs of the Body AD&DPrincipalSum Paraplegia or Loss of Use of Both Lower Limbs of the Body One-half of the AD&D Principal Sum Hemiplegia or Loss of Use of Upper and Lower Limbs on the Same One-half of the AD&D Principal Sum Side of the Body Monoplegiaor Loss of Use of One Limb of the Body One-quarter of the AD&D Principal Sum Severe Burns AD&DPrincipalSum TheAD&DPrincipalSumisshownintheScheduleofBenefits. AULwillonlypayabenefitforeitherparalysisor loss of a limb, but not a benefit for both. Thetotal amount payable will never exceed the AD&D Principal Sum for all losses or conditions sustained by You. Theamountpayableforlossoflife is paid according to Payment of Death Benefits, Section 15. Amounts payable for other losses are paid to You. GC2510.14/2 SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT
SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT Continued LIMITATIONS Benefits are not payable for loss due directly or indirectly to: 1) suicide or attempted suicide, whether sane or insane; 2) air travel as a crew member; 3) participation in a riot or from war or an act of war, whether declared or undeclared; 4) causedor contributed to by the insured’s commission of or attempt to commit a criminal act under relevant state law; 5) the voluntary taking of: a) a prescription drug in a manner other than as prescribed by a Physician; b) anyother federally- or state-regulated substance in an unlawful manner; c) non-prescription medicine, in a manner other than as indicated in the printed instructions; or d) poison; 6) the voluntary inhaling of gas (unless due to occupational accident); 7) Sickness other than infection occurring as a result of accidental injury; 8) voluntary use of alcohol resulting in intoxication above the legal limit; 9) voluntary use of a hallucinogen or substance causing intoxication; 10) operating a vehicle while intoxicated above the legal limit or while under the influence of hallucinogen or substance causing intoxication; 11) violation of traffic laws other than an infraction, racing, stunt-driving, or engaging in other similar activity during the accident; or 12) participation in hang-gliding, bungee jumping, skydiving, rock climbing or mountain climbing. Notice and Proof of Injury/Accidental Death: AUL’s Home Office must receive written notice of the injury/Accidental Death on which the claim is based within 31 days of the date of the accident. AUL’s Home Office must receive acceptable proof of loss within 90 days after the date of the loss. Acceptable proof of loss must be furnished as follows: 1) Acertified death certificate; 2) AcompleteandaccurateAULdeathclaimformandifavailable,acopyofthepolice,autopsy,andmedical reports related to the death; 3) AstatementbytheGroupPolicyholdercertifying the amount of coverage existing on the date of loss; and 4) AtAUL’soption,otherdocumentsorinformationasneededto investigatethe loss and determine whether or not benefits are payable under the policy. AULhastherighttoexamineYou: 1) asoften as necessary; 2) at AUL’sexpense;and 3) byamedicalprofessionalof AUL’schoice. GC2510.14/3 SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT
SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT Continued TERMINATIONOFACCIDENTALDEATHandDISMEMBERMENTBENEFIT Accidental Death and Dismemberment coverage for You will terminate as outlined in Section 9, Individual Terminations. TheGroupPolicyholdermayterminatethe insurance under this Section at the end of any Coverage Month by giving AUL31dayspriorwrittennotice. AULmayterminatetheinsuranceunderthisSectionat the end of any Coverage Month by giving 31 days prior notice to the Group Policyholder. AULWILLSTILLBELIABLEFORPAYMENTOFVALIDCLAIMSINCURREDBEFORETHE TERMINATIONDATE. THISCOVERAGEANDANYBENEFITSUNDERTHISSECTIONARENOTAVAILABLEDURINGTHE CONVERSIONAPPLICATIONPERIOD,DURINGTHEELIMINATIONPERIOD,ORWHILEELIGIBLEFOR BENEFITSUNDERTHEWAIVEROFPREMIUMPROVISIONS. GC2510.14/4 SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT
SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT EXPOSURE If You are unavoidably exposed to heat or cold as a direct result of a covered accident, and as a direct result of the exposure, You suffer a loss for which benefits would be payable under this Section, an AD&D benefit will be paid. Anylossassociatedwith exposure to heat or cold must occur within 365 days of the accident. Thetotal amount payable will never exceed the AD&D Principal Sum for all losses sustained by You. This provision is subject to the further limitations and provisions of this Section 12. DISAPPEARANCE If You are an occupant in a vessel, vehicle, or plane at the time of accidental destruction, sinking, or disappearance of the vessel, vehicle, or plane and Your body cannot be found within one year of the date of the accidental destruction, sinking, or disappearance, You will be presumed to have died. AUL will only presume Accidental Death if: 1) there is no evidence to the contrary; 2) there is a determination by the appropriate governmental authorities or court issuing a valid and legally binding determination that You have died; 3) acertified copy of the governmental authority findings or court order is provided to AUL; and 4) benefits would have been paid assuming a death certificate could have been issued if the body was recovered. If You are later determined not to have died following AUL’s payment of any benefits under the policy, the individuals and entities which received any portion of the amounts paid by AUL will immediately return all amounts received upon receiving information indicating You are alive. If You are later located after AUL has paid an Accidental Death benefit, any other benefit that may be payable under the policy will be reduced by the amount of any benefit already paid. Coverageunder the policy must exist with AUL at the time of Accidental Death. The total amount payable will not exceed the AD&DPrincipal Sum. This provision is subject to further limitations and provisions of Section 12. GC2510.14/5 SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT (Exp and Disap)
SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT SECTION12A-SEATBELTBENEFIT This Section applies to Basic Accidental Death Insurance. SEATBELTBENEFIT AULwillpayanAdditionalAccidentalDeathBenefitif You die as a result of a non-occupational Automobile accident while You are properly wearing a Seat Belt at the time of the accident. The following rules apply: 1) TheSeatBeltBenefitequalsthe lesser of: a) 10%ofYourAD&DPrincipalSumshownintheScheduleofBenefits;or b) $25,000. 2) AULmustreceivesatisfactorywritten proof that Your death resulted from an Automobile accident and that You wereproperly wearing a Seat Belt at the time of the accident. A copy of all police reports must be submitted with the claim, and must show conclusively the Seat Belt was properly worn. 3) This benefit will not be paid if You, while operating the Automobile, were legally intoxicated as defined by applicable laws, violating traffic laws other than an infraction, racing, stunt-driving, or engaging in other similar activity during the accident. In no event will the total of all Additional Accidental Death Benefits payable exceed 100% of Your AD&D Principal Sum. In addition to the above limitations, this benefit is subject to the further limitations and provisions of this Section 12. GC2510.15 SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT SECTION12A-SEATBELTBENEFIT
SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT SECTION12B-AIRBAGBENEFIT This Section applies to Basic Accidental Death Insurance. AIRBAGBENEFIT AULwillpayanAdditionalAccidentalDeathBenefitif You die as a result of a non-occupational Automobile accident while You are properly wearing a Seat Belt at the time of the accident and the Air Bag deployed properly at the time of the accident. The following rules apply: 1) TheAirBagBenefitequalsthelesserof: a) 10%ofYourAD&DPrincipalSumshownintheScheduleofBenefits;or b) $5,000. 2) AULmustreceivesatisfactorywritten proof that Your death resulted from an Automobile accident and that You wereproperly wearing a Seat Belt at the time of the accident, You were positioned in a seat that is designed to be protected by an Air Bag, and that the Air Bag deployed at the time of the accident. A copy of all police reports must be submitted with the claim, and must show conclusively the Air Bag inflated properly at the time of the accident. 3) This benefit will not be paid if You, while operating the Automobile, were legally intoxicated as defined by applicable laws, violating traffic laws other than an infraction, racing, stunt-driving, or engaging in other similar activity during the accident. In no event will the total of all Additional Accidental Death Benefits payable exceed 100% of Your AD&D Principal Sum. In addition to the above limitations, this benefit is subject to the further limitations and provisions of this Section 12. GC2510.15-1 SECTION12-ACCIDENTALDEATHANDDISMEMBEMENT SECTION12B-AIRBAGBENEFIT
SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT SECTION12C-REPATRIATIONBENEFIT This Section applies to Basic Accidental Death Insurance. DEFINITIONS REASONABLEEXPENSESmeansusualandcustomaryfeesorchargesassessedinthemarketplacefortheservices performed. REPATRIATIONBENEFIT AULwillpayanAdditionalAccidentalDeathBenefitif You die either greater than 200 miles away from Your principal place of residence or are outside of the country at the time of Accidental Death. The following rules apply: 1) TheRepatriation Benefit equals the lesser of: a) Reasonable Expenses for transportation of Your body to a funeral home or mortuary near Your principal place of residence; b) $5,000; or c) 10%ofYourAD&DPrincipalSumshownintheScheduleofBenefits. 2) AULmustreceivesatisfactorywritten proof documenting the location of Your Accidental Death. Any Repatriation Benefit will be paid following receipt that reasonable transportation expenses were paid. 3) OnlyoneRepatriationBenefit will be paid to the beneficiary who has paid the cost for any covered expenses, regardless of any additional coverages for which You may be insured with AUL. 4) Acceptablewritten proof and documentation of the reasonable transportation expenses paid must be received by AULwithin12monthsofAccidentalDeath. In no event will the total of the Additional Accidental Death Benefits payable exceed 100% of Your AD&D Principal Sum. In addition to the above limitations, this benefit is subject to the further limitations and provisions of this Section 12. GC2510.15-2 SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT SECTION12C-REPATRIATIONBENEFIT
SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT SECTION12D-CHILDHIGHEREDUCATIONBENEFIT This Section applies to Basic Accidental Death Insurance. DEFINITIONS ACADEMICYEARmeanstheannualperiodofeducationalsessionsofanaccreditedpost-secondaryeducational institution. ELIGIBLESTUDENTunderthisSectionmeansYourunmarriedChildunderage26,whoonthedateofYour Accidental Death: 1) is enrolled in and is attending an accredited post-secondary educational institution on a full-time basis; or 2) is at the 12th grade level and enrolls and attends an accredited post-secondary educational institution within 16 months from the date of Your death; and 3) is dependent upon You for principal support and is claimed as a dependent on Your federal income tax return. EDUCATIONEXPENSESmeanstuitionthatisassessedbytheaccreditedpostsecondaryeducationalinstitutionand is required to be paid in order for the Child to be classified as a full time student. CHILDHIGHEREDUCATIONBENEFIT AULwillpayanAdditionalAccidentalDeathBenefitsubjectto the following rules: 1) TheChildHigherEducationBenefitpaymentwillbenomorethan$4,000foreachEligibleStudentperAcademic Yearfor Education Expenses. The cumulative benefit payments for all eligible students will not exceed the lesser of: a) $20,000; or b) 10%ofYourAD&DPrincipalSumInsuranceshownintheScheduleofBenefits. 2) TheChildHigherEducationBenefitwill be paid: a) for Education Expenses that are incurred and paid after Your Accidental Death; b) onceannually at the conclusion of the Academic Year; c) not for more than 5 consecutive years after the date of Your Accidental Death; d) until such date that the Child no longer satisfies eligibility requirements under the policy or the accredited post-secondary educational institution; e) following AUL’s receipt of documentation showing proof of paying Education Expenses, the Child Higher Education Benefit will be paid to any named beneficiary who paid Education Expenses; and f) in direct proportion to the amount of Education Expenses paid by each named beneficiary. 3) If there is no Eligible Student, no Child Higher Education Benefit will be paid. 4) Child Higher Education Benefits will only be paid based on enrollment in one accredited post-secondary educational institution. 5) NoannualChildHigherEducationBenefitswill be paid beyond the date the policy terminates. If the policy terminates within 60 days of the end of the current Academic Year, a final Child Higher Education Benefit will be paid when eligible. In no event will the total of the Additional Accidental Death Benefits payable exceed 100% of Your AD&D Principal Sum. In addition to the above limitations, this benefit is subject to the further limitations and provisions of this Section. GC2510.15-3 SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT SECTION12D-CHILDHIGHEREDUCATIONBENEFIT
SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT SECTION12E-CHILDCAREBENEFIT This Section applies to Basic Accidental Death Insurance. DEFINITIONS CHILDCAREEXPENSESmeananyreasonableandcustomaryweeklyormonthlychild-carefeesassessedbya Child Care Facility. CHILDCAREFACILITYmeansaproperlystate-licensedchild-carecenternotownedoroperatedbyamemberof the Child’s Family. ELIGIBLECHILD(REN)meansYourChild(ren)underage13. FAMILYmeansanyparent,step-parent,grandparent,brother, sister, uncle or aunt. CHILDCAREBENEFIT AULwillpayanAdditionalAccidentalDeathBenefitsubjectto the following rules: 1) TheChildCareBenefitappliesto each Eligible Child enrolled in a Child Care Facility on the date of Your Accidental Death or subsequently enrolls in a Child Care Facility within 12 months of Your Accidental Death. 2) OnlyChildCareExpensesincurredandpaidafterYourAccidentalDeathwillbe paid. 3) Nomorethan$4,000willbepaidforeachEligibleChildpercalendaryearfor Child Careexpenses.The cumulative benefit payments for all Eligible Children will not exceed the lesser of: a) $20,000, or b) 10%ofYourAD&DPrincipalSumshownintheScheduleofBenefits. 4) TheChildCareBenefitwillbepaidonceperyearatthecompletionof the calendaryear to the earlier of the following: a) the date the Child no longer satisfies eligibility requirements; b) the date the Child attains age 13; or c) 5 consecutive years after the date of Your Accidental Death. 5) If there is no Eligible Child, no Child Care Benefit will be paid. 6) Following AUL’sreceipt of documentation showing proof of paying Child Care Expenses, the Child Care Benefit will be paid to any named beneficiary who paid Child Care Expenses, and in proportion to the amount of Child Care Expenses paid by each named beneficiary. 7) NoChildCareBenefitwillbepaidbeyondthedatethepolicyterminates.If the policy terminates within 60 days of the end of the calendar year, a final Child Care Benefit will be paid when eligible. In no event will the total of all Additional Accidental Death Benefits payable exceed 100% of Your AD&D Principal Sum. In addition to the above limitations, this benefit is subject to the further limitations and provisions of this Section 12. GC2510.15-4 SECTION12-ACCIDENTALDEATHANDDISMEMBERMENT SECTION12E-CHILDCAREBENEFIT
SECTION13-ACCELERATEDLIFEBENEFIT This Section applies to Basic Life Insurance. DEFINITION TERMINALCONDITIONmeansaninjuryorSicknessthat,despiteappropriatemedicalcare,isconclusively established to AUL will result in Your death within 12 months from the date of claim. AUL may require that You be examinedat AUL’sexpensebyAUL’schoiceofPhysician. ACCELERATEDLIFEBENEFIT If You are Permanently and Totally Disabled and are diagnosed with a Terminal Condition and are eligible for benefits under this Section, You may apply for payment of the Accelerated Life Benefit. The amount of Accelerated Life Benefit available is shown in the Schedule of Benefits, unless any portion of Your Life Amount has already been paid. The amount of Accelerated Life Benefit available will then be based on the amount remaining after payment of any portion of the Life Amount. Benefits will be paid in one lump sum to You. CONDITIONS Tobeeligible to apply for the Accelerated Life Benefit: 1) YoumusthavePersonalInsurance; 2) YoumustbedeterminedbyAULtobePermanentlyandTotallyDisabledfromanyoccupation; 3) Youmustbeunderage60; 4) YoumustbediagnosedbyaPhysicianwithaTerminalConditionwhileeligiblefor benefitsunder this Section; 5) If You are subject to laws of a community property state, you must obtain Your spouse’s written consent for paymentto YouoftheAcceleratedLife Benefit; and 6) YoucanreceiveanAcceleratedLifeBenefitonly once. PROOFREQUIREDFORTHEACCELERATEDBENEFIT Proof is a completed claim form and other information AUL requires in order to determine whether benefits are owed under this Section. AUL may require that You be examined by a Physician selected by AUL and at AUL’s expense. LIMITATIONS AnAcceleratedLife Benefit will not be paid if: 1) YouhavenamedanirrevocableBeneficiaryor madeanassignmentof YourLifeAmount; 2) all or a portion of Your Life Amount is to be paid to another person or entity pursuant to a valid court order; 3) Yourcoverageterminates;or 4) the policy terminates. GC2510.16 SECTION13-ACCELERATEDLIFEBENEFIT
SECTION13-ACCELERATEDLIFEBENEFIT Continued After payment of an Accelerated Life Benefit, Your Life Amount payable at death to Your Beneficiary equals: 1) YourLifeAmountasifanAcceleratedLifeBenefitpaymenthadnotbeenmade,minus 2) the amount of the Accelerated Life Benefit paid, minus 3) the interest charge. Theinterest charge equals the Accelerated Life Benefit amount, times the number of days from the date of paymentto Your date of death divided by 365, times the interest rate. The interest rate will be based on the current 90-day Treasury bill rate existing on the date of payment of the Accelerated Life Benefit. NOTE:YourAccidentalDeathandDismembermentInsurance,ifany,terminatedupon approvalof the Waiverof Premiumbenefit. Therequired amount of premiums must continue to be received by AUL on the original Life Amount, unless premiumshaveceasedduetocoverageundertheWaiverofPremiumbenefitofthepolicy. TheAD&DPrincipalSum,ifany,willnotbereducedbypaymentoftheAcceleratedLifeBenefit. Thefollowing information is used for illustrative purposes only: Example: Life insurance in force = $100,000* Date of receipt of proof of terminal condition = 10/31/05 Date of payment of Accelerated Life Benefit = 11/1/05 Date of death = 2/15/06 Interest rate** = 3.5% 1) AmountofAcceleratedLifeBenefit= .50 x $100,000 = $50,000 2) Interest Charge = $50,000 x (106 days / 365 days) x .035 = $508.22 3) DeathBenefitPayable= $100,000 - $50,000 - $508.22 = $49,491.78 *YourLifeInsuranceamountis shownin the Schedule of Benefits in Your insurance certificate. **Theinterest rate is equal to the 90-day Treasury bill rate on the date of the Accelerated Life Benefit payment. NOTE:TheAcceleratedLifeBenefitofferedunder the policy is intended to qualify for favorable tax treatment under the Internal Revenue Code of 1986. If the Accelerated Life Benefit qualifies for such favorable tax treatment, the benefit will be excludable from the Employee’s income and not subject to federal taxation. The laws relating to Accelerated Life Benefits are complex. Employees are advised to consult with a qualified tax advisor about circumstances under which they could receive an Accelerated Life Benefit excludable under federal law. Eligibility for Public Assistance: Receipt of an Accelerated Life Benefit may affect the Employee’s, their Dependent spouse’s, or their family’s eligibility for public assistance programs such as medical assistance (Medicaid), Aid to Families with DependentChildren (AFDC),supplementarysocial security income (SSI), and drug assistance programs. Employees are advised to consult with a qualified tax advisor and with social service agencies concerning how receipt of such a paymentwill affect the Employee’s, their Dependent spouse’s, and their family’s eligibility for public assistance. GC2510.16/1 SECTION13-ACCELERATEDLIFEBENEFIT (Waiver: Included)
SECTION15-PAYMENTOFDEATHBENEFITS If You die while insured under the policy, AUL will pay the benefits owed under the policy to the Beneficiary: 1) upontimelyreceipt of acceptable proof of death; and 2) subject to all other provisions of the policy and to Your dated and signed designation. Thefollowing Sections describe the manner in which death benefits are paid. SECTION16-NAMINGOFBENEFICIARY BENEFICIARYmeanstheindividual,individualsor entity named by You to receive Your Life Amount. Unless the policy provides otherwise, AUL will pay benefits according to Your Beneficiary designation. WhenYouapplyforcoverageonanAUL-approvedform,Youshould: 1) designate the name of one or more Beneficiaries; 2) classify the Beneficiaries by order of preference, either primary or contingent; and 3) indicate distribution of the proceeds among members of the class of Beneficiaries. If more than one primary Beneficiary is listed and no distributive share is indicated, then all primary Beneficiaries will share equally. If no primary Beneficiaries outlive You and there is no distributive share indicated among the contingent Beneficiaries, then all contingent Beneficiaries will share equally. If the policy replaces insurance coverage of another carrier, AUL may, upon written request of the Group Policyholder, recognize Beneficiary designations in effect under the prior coverage as effective until a new designation is made with AUL, provided that prior designations are in a form acceptable to AUL and the Group Policyholder receives AUL’s written approval of the form. CHANGINGABENEFICIARY YoumaychangeaBeneficiaryatanytimebywrittenrequest.Therequestmustbecompleted,signed,datedand filed through the Group Policyholder. AULmayrecognizeabeneficiarychangeasofthedatetheformwassignedbyYouevenifYouarenotalivewhen AULreceivesit. However, AULis not liable if benefits are paid according to the previous designation before AUL receives the change. If You apply for an individual life insurance conversion policy under Section 10, Conversion Privilege and name a new Beneficiary, AUL will use any beneficiary designated in that application when determining whichbeneficiary to pay. AULreservestheright to require that any Beneficiary designation be acceptable to it and be made pursuant to applicable laws. GC2510.18 SECTION15-PAYMENTOFDEATHBENEFIT SECTION16-NAMINGOFBENEFICIARY
SECTION17-THEDEATHCLAIM If You die while insured under the policy, proof of death should be furnished as soon as possible. The claim must be submitted within 12 months of the date of death. The claim may still be considered if it can be shown that timely submission of the claim was not possible due to events beyond the control of the beneficiary, but will not be considered after the applicable statute of limitations has passed. Proof of death must include: 1) acertified death certificate; and 2) acompletedclaimform. AUL,atitsoption, may also require: 1) return of Your insurance certificate; 2) submission of pertinent medical records, including an autopsy report; 3) police reports; or 4) anyother documents AULmaydeemreasonablynecessaryto determinewhatbenefitsand to whom benefits are owed. If the cause of death cannot be clearly established by other means, AUL reserves the right to have a medical examination performed. The examination will be performed: 1) at AUL’sexpense;and 2) byaPhysicianofAUL’schoice. If the policy is no longer in force, proof furnished more than two (2) years from the date of loss must also include: 1) proof of employment at death; and 2) proof of coverage under the policy at death. GC2510.19 SECTION17-THEDEATHCLAIM
SECTION18-DETERMINATIONOFBENEFICIARY Onceacceptableproof of death is received, AUL will determine the Beneficiaries or payees in the following order: 1) If more than one primary Beneficiary is listed and no distributive share is indicated, then all primary Beneficiaries will share equally. 2) If no primary Beneficiaries outlive You and there is no distributive share indicated among contingent Beneficiaries, then all contingent Beneficiaries will share equally. 3) If no named Beneficiaries outlive You or none were named, then at AUL’s option, a surviving relative. Relatives will be considered in descending order of preference as follows: a) spouse; b) natural and legally adopted child(ren); c) parent(s); or d) brother(s) and sister(s). 4) If Your estate is not substantial and there are no statutory requirements to the contrary, at AUL’s option, benefits maybepaidtotheclosestsurviving heir(s) under applicable small estate laws. 5) If no named Beneficiaries outlive You or none were named, then at AUL’s option, Your estate. AULmay,atitsoption,paytheproceedsinanamountupto$2,000toanyindividualappearingtoAULtobelegally entitled to payment by reason of having paid funeral or other burial expenses related to Your death. In the event You and Your Dependents should die simultaneously or if there is no clear evidence as to which individual died first, it shall be presumed that the Dependents should have predeceased You. If any Beneficiary dies within 15 days after Your death, the Beneficiary will be treated as having died before You. This provision does not apply to any payment mailed to such Beneficiary during the 15 days following Your death, and any payment made in good faith shall fully discharge AUL. SECTION19-SELECTIONOFPAYMENTMETHOD Theproceedswill be paid in a lump sum unless another payment method is selected or changed by giving written notice to AUL prior to Your death. If no payment method is in effect at death, the payee may select a payment method. For information concerning payment method options, You or payee should contact AUL. Benefits will be paid only if AUL decides in its discretion the person is entitled to them and after AUL approves the paymentmethod.Anypersonwhobecomesentitledtoreceiveanyportionof the proceedsunder the policy shall be entitled to receive payment of interest if any payment is not received by such person within 30 days after the event giving rise to the obligation and after all requested information is received by AUL. Interest payable shall be calculated at an annual rate after all requested information is received by AUL. The rate of interest payable shall be the lesser of 3% or that rate, as determined from time to time by AUL, applicable to proceeds of life insurance left on deposit with AUL and subject to withdrawal on demand. For the purposes of this section, payment shall be deemed to have been received by the person when deposited by AUL in United States mail, postage prepaid, and directed to the person’s last known address or the Group Policyholder’s address shown in AUL’s records. Other than lump sum payment, AUL reserves the right to specify the minimum periodic payment when a method is to becomeeffective. GC2510.20A SECTION18-DETERMINATIONOFBENEFICIARY SECTION19-SELECTIONOFPAYMENTMETHOD
SECTION20-DEPENDENTINSURANCE SECTION20A-ELIGIBILITY ELIGIBILITY All Dependents must be legally authorized to reside in the United States under applicable state and federal laws. Anindividual who is Your Dependent on the effective date of the policy becomes eligible for Dependent Insurance on the later of the following dates: 1) the effective date of the policy; 2) the date You become eligible for Personal Insurance; or 3) the effective date that Dependent coverage under Section 20, Dependent Insurance, is added to the policy. Anindividual who becomes Your Dependent after the effective date of the policy becomes eligible for Dependent Insurance on the later of the following dates: 1) the date You become eligible for Personal Insurance; 2) the date the individual becomes Your Dependent; or 3) the effective date that Dependent coverage under Section 20, Dependent Insurance, is added to the Group Policyholder’s coverage. You,asacondition of insuring Your Dependent(s), must make written election to AUL on a form approved by AUL and, for Contributory Insurance, must contribute the required amount of premium to AUL on a timely basis. GC2510.21 SECTION20-DEPENDENTINSURANCE SECTION20A-ELIGIBILITY
Refer to Your Basic Dependent Schedule of Benefits to determine to which coverage this page applies. When applicable, the Dependent Schedule of Benefits will indicate employee premium CONTRIBUTIONS are not required and INDIVIDUALEFFECTIVEDATEisFirstoftheMonth. SECTION20-DEPENDENTINSURANCE SECTION20B-INDIVIDUALEFFECTIVEDATE INDIVIDUALEFFECTIVEDATE--NON-CONTRIBUTORYINSURANCE For amounts of coverage that do not exceed the Guaranteed Issue Amount shown in the Dependent Insurance Schedule of Benefits, the effective date of Dependent Insurance for each Dependent will be: 1) the first day of the Coverage Month; or 2) the first day of the next Coverage Month if You apply for Dependent coverage after the first day of the Coverage Month. ToreceiveanyamountofcoverageexceedingtheGuaranteedIssueAmount,Youmustmakeawrittenrequestto AULonaformapprovedbyAULandtheDependentmustundergomedicalunderwriting.Theeffectivedateof DependentInsurance for an eligible Dependent, subject to the further provisions of this Section, will be after the Dependentsubmits satisfactory Evidence of Insurability to AUL and the date AUL determines the Dependent is approved for coverage. Satisfactory Evidence of Insurability, at no expense to AUL, must be provided prior to receiving any amount of coverage greater than the Guaranteed Issue Amount. If You have at least one Dependent insured under the policy, insurance amounts for any new Dependent that do not exceed the Guaranteed Issue Amount shown in the Dependent Insurance Schedule of Benefits become effective on the date that Dependent is acquired. Contributions for Dependent Insurance are not required from You. AnyDependentwhoconvertedhisinsuranceunderthepolicyto an individual life insurance policy and if that individual life insurance policy is still in force, the Dependent is required prior to becoming insured again under the policy, to undergo medical underwriting and submit satisfactory Evidence of Insurability, at no expense to AUL. If the Dependentdoesnot wish to undergo medical underwriting and submit satisfactory Evidence of Insurability, the Life Amountunderthepolicywillbereducedbytheamountofcoverageundertheindividuallifeinsurancepolicy. No coverage shall begin until the date AUL has approved the request for coverage in writing and the required amount of premiumisreceivedfrom the Employer. If a Dependent is confined in any medical facility, rehabilitation center, convalescent care facility, nursing home, or correctional facility on the date Dependent Insurance would otherwise become effective for that Dependent, the effective date for that Dependent is the date following the Dependent’s final discharge from the medical facility, rehabilitation center, convalescent care facility, nursing home, or correctional facility and the resumption of the usual and customary duties or activities of an individual in good health and of the same age and sex. For the purposes of the policy, a Dependent will not cease to be confined if one confinement is followed by another confinement, within 72 hours, for the same or a related injury or Sickness. Also see Continuity of Coverage, Section 5, if included in the policy. DependentInsurance will not become effective for a Dependent unless You are insured for Personal Insurance. GC2510.22 SECTION20-DEPENDENTINSURANCE (FOM/Non-Contrib) SECTION20B-INDIVIDUALEFFECTIVEDATE
SECTION20-DEPENDENTINSURANCE SECTION20C-CHANGESININSURANCECOVERAGE CHANGESININSURANCECOVERAGE TheamountofcoverageforwhichaDependentiseligibleis shownin the Scheduleof Benefits. Achangeincoveragethatdoesnotincreasethe amount of coverage becomes effective the earlier of: 1) the date of any scheduled reduction; or 2) the date of AUL’s approval of the change. Prior to a change in coverage that increases the amount of coverage, the Dependent must not be confined in any medical facility, rehabilitation center, convalescent care facility, nursing home, or correctional facility and You must be Actively at Work and the required amount of premium must be paid. Achangeincoverageincreasingthe amount of coverage equal to or less than the Dependent’s Guaranteed Issue Amounttakeseffecton the date the Dependent becomes eligible for the change. Achangeincoverageincreasingthe amount of coverage above the Dependent’s Guaranteed Issue Amount is subject to: 1) satisfactory Evidence of Insurability, at no expense to AUL; and 2) uponAUL’swrittenapproval,takeseffect on the date of the request for change. If a Dependent is confined in any medical facility, rehabilitation center, convalescent care facility, nursing home, or correctional facility on the approved change date, any increase in the amount of coverage for that Dependent takes effect on the date of the Dependent’s final discharge from the medical facility, rehabilitation center, convalescent care facility, nursing home, or correctional facility and the resumption of the usual and customary duties or activities of an individual in good health and of the same age and sex. For the purposes of the policy, a Dependent will not cease to be confined if one confinement is followed by another confinement, within 72 hours, for the same or a related injury or Sickness. GC2510.24-1 SECTION20-DEPENDENTINSURANCE (Immediate) SECTION20C-CHANGESININSURANCE
SECTION20-DEPENDENTINSURANCE SECTION20D-WAIVEROFPREMIUM This Provision applies to Basic Life Insurance. DEFINITIONS ELIMINATIONPERIODmeansa9monthperiodofconsecutivedaysofTotalDisability.TheEliminationPeriod begins on the 1st day of Total Disability and ends on the last day of the 9 month period. You may not have more than three (3) days of Active Work during the Elimination Period. WAIVEROFPREMIUMBENEFITFORTOTALDISABILITY If You have been approved by AUL for Waiver of Premium Benefit for Total Disability under the policy and remain Totally Disabled, AUL will waive further premium payments for Your Dependent Life Insurance until the first of the following occurs: 1) YourcoverageunderWaiverofPremiumprovisionsterminatesfor any reason; 2) the Dependent attains the maximum age; or 3) in the case of a Dependent legal spouse, divorce. If You are not approved for the Waiver of Premium for Total Disability Benefit, You may apply to convert Your DependentLife Amount to an individual life insurance policy pursuant to Section 20F, Conversion Privilege, within 31 days from notice of the adverse benefit determination. If You did not pay premiums during the Elimination Period, Youarenoteligible to convert Your coverage to an individual life insurance policy upon notice of an adverse benefit determination. If coverage under the Waiver of Premium Benefit for Total Disability terminates, You are entitled to apply to convert YourDependentLifeAmounttoanindividuallifeinsurancepolicy within 31 days of cessation of such coverage pursuant to Section 20F, Conversion Privilege. DEPENDENTACCIDENTALDEATHANDDISMEMBERMENTBENEFITS,IFANY,ARENOTPAYABLE AFTERYOURELIMINATIONPERIOD. GC2510.25 SECTION20-DEPENDENTINSURANCE SECTION20D-WAIVEROFPREMIUM
SECTION20-DEPENDENTINSURANCE SECTION20E-INDIVIDUALTERMINATIONS INDIVIDUALTERMINATIONS ADependent’sinsuranceterminates on the earliest of the following dates: 1) the date the policy or this Section is terminated; 2) the last day of the Coverage Month in which You request termination, but not prior to the date AUL receives the request; 3) the last day of the Coverage Month for which any required premium payment was not received by AUL; 4) the last day of the Coverage Month during which the Dependent ceases to be eligible; 5) the date Personal Insurance terminates; 6) the last day of the Coverage Month after You have not been Actively at Work for 9 months due to Sickness or injury or 7) the date of an adverse or positive benefit determination under the Waiver of Premium provision. GC2510.26 SECTION20-DEPENDENTINSURANCE (NoADD/NoALB) SECTION20E-INDIVIDUALTERMINATIONS (WPD/NoRET)
SECTION20-DEPENDENTINSURANCE SECTION20F-CONVERSIONPRIVILEGE CONVERSIONPRIVILEGE If a Dependent’s coverage, or a portion of it, terminates because the Dependent is no longer eligible for coverage under the policy, the Dependent may apply for an individual life insurance conversion policy without evidence of insurability. The coverage amount of the individual life insurance conversion policy shall not exceed the amount of life insurance that ceases because of loss of eligibility for coverage under the policy minus the amount of any group life coverage for which the Dependent becomes eligible within 31 days of termination. If the Dependent’s coverage ceases due to termination of the Policy, the Dependent may apply for and receive an individual life insurance conversion policy if the Dependent’s group life insurance has been in force with AUL for five (5) continuous years before the termination date. The coverage amount of the individual life insurance conversion policy may not exceed the LESSER of: 1) the amount of life insurance that ceases because of termination minus the amount of any group life coverage for whichthe Dependent becomes eligible within 31 days of termination; or 2) $10,000. Theconversion privilege is subject to the following: 1) Written application must be made and the first premium must be paid within 31 days after the date of termination of insurance. 2) Anindividual life insurance policy, other than term life insurance, offered by AUL at the time of conversion, may be selected. 3) ThepremiumontheindividualpolicymustbeatAUL’sthencustomaryrateapplicableto the form and amount of the individual policy, to the class of risk to which You or dependent then belongs, and to the individual age attained by You or your dependent on the effective date of the individual policy. 4) Theindividual life insurance conversion policy takes effect on the last day of the application period and is in lieu of all benefits under the Policy. If notice of the existence of the conversion right is not given at least 15 days before the expiration of the period during whichthe conversion application and payment of the first premium must be made under the terms of the policy, the Dependenthasanadditional period within which to exercise the conversion right. The additional conversion application period created to exercise a right of conversion expires 15 days after the Dependent is given notice of the conversion right. However, irrespective of the date on which notice is given or of the absence of any notice, the additional conversion application period may not extend beyond 60 days after the expiration date of the period within whichconversion application and payment of the first premium were to be made under the terms of the policy. For purposes of this section, notice of the right of conversion may be given to the Dependent in writing presented to You; mailed by the Group Policyholder to the last known address of the Dependent; or mailed by the insurer to the last knownaddressoftheDependentasfurnishedby the Group Policyholder. GC2510.27 SECTION20-DEPENDENTINSURANCE SECTION20F-CONVERSIONPRIVILEGE
SECTION20-DEPENDENTINSURANCE SECTION20F-CONVERSIONPRIVILEGE Continued If death occurs during the conversion application period, AUL will pay the Dependent Life Amount available for conversion whether or not the application or the first premium payment has been made. After the 31-day period, no conversion application will be accepted unless it is proven that it was not possible for the Dependent to apply in a timely fashion. The individual life insurance conversion policy will not include Accidental Death benefits or any other benefits currently in force under the policy. PremiummustbepaidtoandreceivedbyAULforcoverageduringtheconversionapplicationperiod. IF DEATHOCCURSDURINGTHECONVERSIONAPPLICATIONPERIOD,INNOEVENTWILLBENEFITS BEPAYABLEUNDERBOTHTHEINDIVIDUALCONVERSIONPOLICYANDTHEPOLICY. See INDIVIDUALREINSTATEMENTS,Section11. GC2510.27/1 SECTION20-DEPENDENTINSURANCE SECTION20F-CONVERSIONPRIVILEGE
SECTION20-DEPENDENTINSURANCE SECTION20J-PAYMENTOFDEATHBENEFITS PAYMENTOFDEATHBENEFITS UponthedeathofaninsuredDependent,benefitswill be paid in the same manner as in Section 15. Benefits will be paid in a lump sum: 1) to You; 2) to Your Beneficiary, if You are not living; or 3) asprovided in Section 18. GC2510.32 SECTION20-DEPENDENTINSURANCE SECTION20J-PAYMENTOFDEATHBENEFITS
SECTION21-GENERALPOLICYPROVISIONS ENTIRECONTRACT:Thepolicy,theenrollmentformsoftheindividuals,theapplicationof the Group Policyholder, and any amendmentsmadefromtimetotimeconstitutethe entire contract between the parties. AMENDMENTandCHANGES:ThepolicymaybeamendedbymutualagreementbetweentheGroupPolicyholderand AULbutwithoutprejudiceto any valid claim incurred prior to the effective date of the amendment. The policy may be changed or corrected by AUL at any time. However, no change in the policy will be valid unless written notice is provided by AULcontainingthesignature of its Chief Executive Officer or Secretary. No other person can alter or waive the conditions of the policy or make any agreement that shall be binding upon AUL. No agent may or has the authority to waive, alter or change any terms and conditions of the policy or coverage. INCONTESTABILITY:Thevalidityofanycoverageunderthepolicymaynotbecontested,exceptfornonpaymentof premiums, after the policy has been in force for two years after its date of issue, and other than a misrepresentation of a material fact, no statement made by Group Policyholder or You or Your Dependent relating to Your insurability may be used in contesting the validity of the insurance with respect to which the statement was made, unless: (1) the insurance has not been in force for a period of two years or longer; or (2) the statement is contained in a written instrument signed by the Group Policyholder or You or Your Dependent. However, AUL is not precluded from asserting at any time any defenses based upon provisions in the policy relating to eligibility for coverage. All statements made by the Group Policyholder or by the EmployeesorDependentsinsuredareto be deemedrepresentationsand not warranties, and that other than a misrepresentation of a material fact no statement made by any person insured may be used in any contest unless a copy of the instrument containing the statement is or has been furnished to the Employees or Dependents or, in the event of death or incapacity of the EmployeeorDependent,totheEmployee’sorDependent’sbeneficiaryor personal representative. INSURANCEFRAUD:AULwantstoensurethatitscustomersdonotincuradditionalinsurancecostsasaresultoftheactof insurance fraud. AUL promises to focus on all means necessary to support fraud detection, investigation and prosecution. Anypersonwhoknowinglypresentsafalseorfraudulentclaimfor payment of a loss or benefit or knowingly presents false information in an application for insurance may be guilty of a crime and may be subject to fines and confinement in prison. RELATIONSHIP:AULandtheGroupPolicyholderare,andwillremain,independentcontractors.Nothingin the policy shall be construed as making the parties joint ventures or as creating a relationship of employer and employee, master and servant, or principal and agent. Neither party has any power, right or authority to bind the other or to assume or create any obligation or responsibility on behalf of the other. AUL and the Group Policyholder each retain exclusive control of their time and methods to perform their respective duties. AUL and the Group Policyholder will employ, pay and supervise their own employeesandpaytheir own expensesduring the term of the policy. DISCRETIONARYAUTHORITY:BenefitsunderthepolicywillbepaidonlyifAULdecidesinitsdiscretionthatthe applicant is entitled to them. Except for the functions the policy explicitly reserves to a Group Policyholder, AUL reserves the right to: 1) managethepolicy and administer claims under it; and 2) interpret the provisions and resolve questions arising under it. AUL’sauthority includes, but is not limited to, the right to: 1) establish and enforce procedures for administering the policy and claims under it; 2) determine applicant’s eligibility for insurance and entitlement to benefits; 3) determine what information AUL reasonably requires to make such decisions; and 4) resolve all matters when a claim review is requested. Anydecisionthat AULmakes,in the exercise of its authority, will be conclusive; subject to Your or Your beneficiary’s right to request reviews allowed under applicable laws. GC2510.33 SECTION21-GENERALPOLICYPROVISIONS
SECTION21-GENERALPOLICYPROVISIONS Continued GRACEPERIOD:PremiumsareduemonthlyandmustbereceivedbyAULwithintherequiredtimeframefor coverage to remain in force. You are entitled to a grace period of 31 calendar days for the payment of any premium due except the first. During the grace period, the insurance coverage shall continue in force, unless AUL has received written notice of termination in advance of date of termination and in accordance with the terms of the policy. Group Policyholder is liable to AUL for the payment of a pro rata premium for the time the policy was in force during the grace period. If the required amount of premium is not received by the end of the grace period, the insurance will terminate as of the last day of coverage for which premium was paid. LEGALACTION:Nolegalactionmaybebroughttoobtainbenefitsunderthepolicy: 1) for at least 60 days after proof of loss has been furnished and before arbitration is held pursuant to the arbitration provisions in the policy; or 2) after three (3) years from the time written proof of loss is required to have been furnished to AUL. CONFORMITYWITHSTATELAWS:Anyprovisionofthepolicyinconflictwiththelawsofthestateinwhichitis delivered is amended to conform to the minimum requirements of those laws. DATAANDRECORDS:TheGroupPolicyholdermustfurnishinformationwhichAULreasonablyrequires.The GroupPolicyholder’s documents which may have a bearing on the insurance shall be open for inspection by AUL at all reasonable times. GENDERPRONOUNS:Wheneverthemalepronounisused,itshallalsomeanthefemale. CERTIFICATES:Ifthereisanydiscrepancybetweentheprovisionsof any certificateand the provisions of the policy, the provisions of the policy will govern. ASSIGNMENT:YoumaymakeanabsoluteassignmentofallbenefitsandrightsofYourcoverage.Anycoverageis assignable to the extent permitted by law except that no collateral assignment is permitted. No assignment is binding unless filed with AUL in a form acceptable to it. AUL assumes no responsibility for the validity or effect of any assignment. CLAIMSOFCREDITORS:Thebenefitspaidunderthepolicywillbeexemptfromtheclaimsofcreditorstothe maximumextentpermittedbylaw. CLERICALERROR:ClericalerroronthepartoftheGroupPolicyholderorAULwillnotinvalidateinsurance otherwise in force or continue insurance otherwise validly terminated. Upon discovery of an error, an equitable adjustment will be made in the premiums and/or benefits, if appropriate. MISSTATEMENTOFAGE:IfYourageorYourDependenthasbeenmisstated,thebenefitswillbepayablebased on the true facts. Premium adjustment will be made so that AUL will receive the actual premium required based on the true facts. Any adjustment of benefits due to the correction of age will also be made. GC2510.33/1 SECTION21-GENERALPOLICYPROVISIONS
SECTION21-GENERALPOLICYPROVISIONS Continued ARBITRATION:Anycontroversyorclaimarisingoutoforrelatingtothepolicy,the saleor solicitation of the policy, or its breach thereof whether in tort, contract, breach of duty (including but not limited to) any alleged fiduciary, good faith and fair dealing duties, shall be decided by arbitration in accordance with the Federal Arbitration Act, the procedures of the commercial arbitration rules of the American Arbitration Association, and this agreement. TheCourtofArbitrators, which is to be held in the county seat where the Policyholder resides, shall consist of three (3) arbitrators familiar with group insurance and employee welfare benefit plans. The selection of the arbitrators shall be conducted within thirty (30) days after proper service of a demand for arbitration. One of the arbitrators shall be appointed by AUL, one by the insured, and the third shall be selected by the first two appointees prior to the beginning of arbitration. Should the two arbitrators be unable to agree upon the choice of a third, the appointment shall be left to the President or any Vice President of the American Arbitration Association. The arbitrators shall decide by a majority of votes, the award shall be in writing, the decision shall be signed by a majority of the arbitrators, and they shall include a statement regarding the reasons for the disposition of any claim. Judgment on the award rendered by the arbitrators may be entered by any court having jurisdiction thereof. The parties are not precluded from challenging the decision under the Federal Arbitration Act or applicable law. Unless not allowed under applicable law, each party shall bear the expense of its own attorney and arbitrator, and shall share equally with the other party the expenses of the third arbitrator and of the arbitration. Theparties agree that AUL is engaged in interstate commerce, and the transaction is governed by the Federal Arbitration Act, 9 U.S.C. Sections 1-16. Consistent with the expedited nature of arbitration, each party will, upon the written request of the other party, promptly provide the other with copies of documents relevant to the issues raised by any claim or counterclaim on whichthe producing party may rely in support of or in opposition to any claim or defense. Any dispute regarding discovery, or the relevance or scope thereof, shall be determined by the arbitrator(s), which determination shall be conclusive. All discovery shall be completed within 60 days following the appointment of the arbitrator(s) or longer following mutual agreement by the parties. ERISAAPPEALGUIDELINESWHENPOLICYISGOVERNEDBYERISA:IfaclaimantwishestoappealAUL’s decision, claimants are allowed 60 days following receipt of a notification of an adverse benefit determination within whichto appeal the determination. Claimants are allowed the opportunity to submit written comments, documents, records, and other information relating to the claim for benefits. The claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claimant’s claim for benefits. Whether a document, record, or other information is relevant to a claim for benefits shall be determined by reference to paragraph (m)(8) of 29 C.F.R. Section 2560.503-1. AUL’s review will take into account all comments, documents, records, and other information submitted by the claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination. A claimant has a right to obtain the information about any voluntary appeal procedures offered by the plan described in paragraph (c)(3)(iv) of 29 C.F.R. Section 2560.503-1 and has a right to bring an action under section 502(a) of ERISA. A final determination will be provided pursuant to 29 C.F.R. Section 2560.503-1. GC2510.33/2 SECTION21-GENERALPOLICYPROVISIONS
NOTICETOINDIANAPOLICYHOLDERS Questions regarding your policy or coverage should be directed to: AmericanUnitedLifeInsuranceCompany® a OneAmerica®Company OneAmericanSquare P.O. Box 368 Indianapolis, IN 46206-0368 Telephone1-800-553-5318 If you (a) need the assistance of the governmental agency that regulates insurance; or (b) have a complaint you have been unable to resolve with your insurer you may contact the Department of Insurance by mail, telephone or email: State of Indiana Department of Insurance ConsumerServicesDivision 311 West Washington Street, Suite 300 Indianapolis, Indiana 46204 ConsumerHotline:(800) 622-4461; (317) 232-2395 Complaints can be filed electronically at www.in.gov/idoi.
NOTICEOFPROTECTIONPROVIDEDBYTHE INDIANALIFEANDHEALTHINSURANCEGUARANTYASSOCIATION This Notice provides a brief summary of the Indiana Life and Health Insurance Guaranty Association (“ILHIGA”) and the protection it provides for policyholders. This safety net was created under Indiana law, which determines who and what is covered and the amounts of coverage. ILHIGA was established to provide protection to policyholders in the unlikely event that your life, annuity or health insurance company becomes financially unable to meet its obligations and is taken over by its insurance department. If this should happen, ILHIGA will typically arrange to continue coverage and pay claims, in accordance with Indiana law, with funding from assessments paid by other insurance companies. (For the purpose of the Notice, the terms “insurance company” and “insurer” mean and include health maintenance organizations (“HMOs”).) Basic Protections Currently Provided by ILHIGA Generally, an individual is covered by ILHIGA if the insurer was a member of ILHIGA and the individual lives in Indiana at the time the insurer is ordered into liquidation with a finding of insolvency. The coverage limits below apply only to companies placed in rehabilitation or liquidation on or after July 1, 2018. The benefits that ILHIGA is obligated to cover are not to exceed the lesser of (a) the contractual obligations for which the member insurer is liable or would have been liable if the member insurer were not an insolvent insurer, or (b) the limits indicated below: Life Insurance • $300,000 in death benefits • $100,000 in net cash surrender or net cash withdrawal values Health Insurance • $500,000 for health plans benefits (see definition below) • $300,000 in disability income and long-term care insurance benefits • $100,000 in other types of health insurance benefits Annuities • $250,000 in present value of annuity benefits (including net cash surrender and net cash withdrawal values) The maximum amount of protection for each individual, regardless of the number of policies or contracts, is $300,000. Special rules may apply with regard to health benefit plans and covered unallocated annuities. “Health benefit plan” is defined in IC 27-8-8-2(o) and generally includes hospital or medical expense policies, certificates, HMO subscriber contracts or certificates or other similar health contracts that provide comprehensive forms of coverage for hospitalization or medical services, but exclude policies that provide coverages for limited benefits (such as accident-only, credit, dental-only or vision-only insurance), Medicare Supplement insurance, disability income insurance and long-term care insurance. The protections listed above apply only to the extent that benefits are payable under covered policy(s). In no event will the ILHIGA provide benefits greater than the contractual obligations in the life, annuity, or health insurance policy or contract. The statutory limits on ILHIGA coverage have changed over the years and coverage in prior years may not be the same as that set forth in this Notice. G-IN Rev. 07-19
Note: Certain policies and contracts may not be covered or fully covered. For example, coverage does not extend to any portion(s) of a policy or contract that the insurer does not guarantee, such as certain investment additions to the account value of a variable life insurance policy or variable annuity contract. Benefits provided by a long-term care (LTC) rider to a life insurance policy or annuity contract shall be considered the same type of benefits as the base life insurance policy or annuity to which it relates. To learn more about the protections provided by ILHIGA, please visit the ILHIGA website at www.inlifega.org or contact: Indiana Life & Health Insurance Indiana Department of Insurance Guaranty Association 311 West Washington Street, Suite 103 3502 Woodview Trace, Suite 100 Indianapolis, IN 46204 Indianapolis, IN 46268 317-232-2385 317-636-8204 The policy or contract that this notice accompanies might not be fully covered by ILHIGA and even if coverage is currently provided, coverage is (a) subject to substantial limitations and exclusions (some of which are described above), (b) generally conditioned on continued residence in Indiana, and (c) subject to possible change as a result of future amendments to Indiana law and court decisions. Complaints to allege a violation of any provision of the Indiana Life and Health Insurance Guaranty Association Act must be filed with the Indiana Department of Insurance, 311 W. Washington Street, Suite 103, Indianapolis, IN 46204; (telephone) 317-232-2385. Insurance companies and agents are not allowed by Indiana law to use the existence of ILHIGA or its coverage to encourage you to purchase any form of insurance. (IC 27-8-8-18(a)). When selecting an insurance company, you should not rely on ILHIGA coverage. If there is any inconsistency between this notice and Indiana law, Indiana law will control. Questions regarding the financial condition of a company or your life, health insurance policy or annuity should be directed to your insurance company or agent. G-IN Rev. 07-19
