GLDI-C200-(12/06) 1 MADISON NATIONAL LIFE INSURANCE COMPANY, INC. 1241 John Q. Hammons Drive · Madison, WI 53717 GROUP LONG TERM DISABILITY INSURANCE CERTIFICATE OF COVERAGE The Group Policy has been issued to the Policyowner. No coverage under the Group Policy is in effect until approved in writing by Madison National Life Insurance Company, Inc. The Employer must apply for group long term disability insurance coverage under the Group Policy and join the Policyowner by submitting a completed Joinder Agreement and agreeing to pay premiums. The Group Policy contains numerous optional and variable provisions. The options and variables we have approved for the Employer’s coverage under the Group Policy are contained in the Joinder Agreement and the Certificate(s) of Coverage. Only those provisions of the Group Policy which appear in the Joinder Agreement and the Certificate(s) of Coverage will apply to the Employer’s coverage under the Group Policy. All provisions on this and the following pages are part of the Certificate of Coverage. The Group Policy is on file and available for review at the main office of the Policyowner. The Certificate summarizes and explains the parts of the Group Policy that apply to you. This certificate is not an insurance policy. In the event of any conflict between the Group Policy and the Certificate, the Group Policy will control. This Certificate replaces any other Certificates previously provided to you under the Group Policy. Unless defined differently within a particular provision, the terms “you” and “your” mean the Eligible Person. “We”, “us” and “our” mean Madison National Life Insurance Company. Other defined terms appear with their initial letters capitalized. References to section headings appear in quotation marks. MADISON NATIONAL LIFE INSURANCE COMPANY, INC. By Marita Zuraitis President