15 2. We will refund all premiums paid for any coverage under which benefits are excluded from payment under this provision. 3. If You were covered under the Prior Plan on the day before the Effective Date under the Group Policy, credit will be given for the time You were insured under the Prior Plan. 4. This exclusion does not apply to insurance coverage which is 100% paid for by the Employer or Employee Basic Life Insurance. GTL-C1200-0608 VIII. LIFE INSURANCE CONVERSION BENEFIT A. When Coverage Ends. 1. If an Insured Person’s coverage under the Policy ends, the Insured Person may, as described below, apply for Our individual life insurance policy without submitting Evidence of Insurability. a. The Insured Person must complete an application, pay the first premium, and send them to Us within the 31-day period immediately following the date coverage ends under the Policy (the Conversion Period). b. The individual policy will become effective on the first day following the date coverage under the Policy ends. c. The Insured Person may convert all or part of the amount of life insurance benefit, as shown in the “Schedule of Benefits”. 2. If an Insured Person has been insured under the Policy for at least five years and is no longer eligible due to cancellation of the Policy or cancellation of the class of insureds in which the Employee belonged, an Insured Person may convert the lesser of: (1) $10,000 or (2) all or part of the amount for which the Insured Person is no longer eligible for under the Policy. B. Premiums. 1. Premiums for such individual life policy will be based on: (1) Our usual rate for the amount and type of individual policy; (2) the Insured Person’s class of risk; and (3) the Insured Person’s attained age. 2. If an Insured Person dies during the Conversion Period, the maximum amount of life insurance to which he or she would have been entitled to under such individual policy shall be payable as a claim under the Group Policy, whether or not application for the individual policy or the payment of the first premium has been made. 3. The rights or benefits granted under this provision are in lieu of any other rights or benefits granted under the Group Policy. GTL-C1300-0608 IX. ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE A. If an Insured Person has an Accident while insured for Accidental Death and Dismemberment (AD&D) Insurance and the Accident results in a Loss (as defined below), We will pay benefits according to the terms of the Group Policy after We receive Proof of Loss. B. Eligibility. An Insured Person must be a member of a class that is eligible for AD&D coverage under the Group Policy as specified in the “Schedule of Benefits”. C. Definitions for AD&D Insurance 1. Loss means Loss of one or more of the body parts or bodily functions listed under “AD&D Benefit” below, or as otherwise provided for under this “Accidental Death and Dismemberment Insurance” section, which: a. is caused solely and directly by an Accident; b. occurs independently of all other causes; c. occurs within 365 days after the Accident; and d. while the Insured Person is covered under the Group Policy.
Life Certificate - All Other Employees Page 15 Page 17