F I D E L I T Y S E C U R I T Y L I F E ® I N S U R A N C E C O M P A N Y 3130 Broadway Kansas City, Missouri 64111-2406 Phone 800-648-8624 A STOCK COMPANY (Herein Called “the Company”) AMENDATORY RIDER REGARDING REPLACEMENT COVERAGE The Policy/Certificate to which this Amendment Rider is attached is amended as follows: The following applies when the Policy serves to replace similar coverage the Policyholder previously obtained through another plan or policy. In this provision, that other plan or policy is referred to as the prior plan. The Policyholder’s coverage under the Policy will not be considered as replacement coverage unless the Policyholder’s coverage under the Policy takes effect within 60 days after coverage under the prior plan ends. In the absence of this provision, an Insured Person who was covered by the prior plan at the date of discontinuance might not qualify for coverage under the Policy because the person is not actively at work or is confined in a Hospital. Each such person will be insured under the Policy if: 1. the person was insured under the prior plan, including coverage under the prior plan’s extension of benefits provision, on the date the Policyholder’s coverage with the prior plan ended; 2. the prior plan covered more than 15 people; and 3. the person is in a class of persons eligible for coverage under the Policy. The benefits payable for the persons described above will be the benefits of the Policy less any amount payable under the prior plan pursuant to any extension of benefits provision. The Policy, in applying any waiting periods, will give credit for the satisfaction or partial satisfaction of the same or similar provisions under the prior policy. This Rider takes effect on the effective date of the Policy/Certificate to which it is attached. This Rider terminates concurrently with the Policy/Certificate to which it is attached. It is subject to all the terms and conditions of the Policy/Certificate except as stated herein. FIDELITY SECURITY LIFE INSURANCE COMPANY President Secretary R-02264 Rev 0719
Group Vision Insurance Certificate Page 10 Page 12