GC 3100.2 SECTION 1 - SCHEDULE OF BENEFITS 2005 SECTION 1 - SCHEDULE OF BENEFITS CLASS NUMBER 001 ELIMINATION PERIOD 90 days. See Section 2. EMPLOYEE CONTRIBUTIONS Contributions are not required. GUARANTEED ISSUE AMOUNT $7,000. This amount is also the Maximum Monthly Benefit. See Section 2. INDIVIDUAL EFFECTIVE DATE Initial Employees New Employees First Day of a Coverage Month. See Section 3. First Day of a Coverage Month. See Section 3. MANDATORY REHABILITATION PROGRAM Not Included. MAXIMUM BENEFIT DURATION 65/5/70. See Table at end of this Section. MENTAL ILLNESS LIMITATION 24-month Lifetime Accumulation Benefit. See Section 11. MINIMUM INDEMNITY ACCIDENTAL DISMEMBERMENT & LOSS OF SIGHT This benefit is included for this class. See Section 8. MINIMUM MONTHLY BENEFIT $50. See Section 8. MONTHLY BENEFIT 66 2/3% of Basic Monthly Earnings not to exceed a Maximum Monthly Benefit of $7,000 less Other Income Benefits. See Section 8. PRE-EXISTING CONDITION EXCLUSION 3/12. See Section 9. RECURRENT DISABILITY This benefit is included for this class. See Section 8. RESIDUAL BENEFIT This benefit is included for this class. See Section 8.
Certificate of Insurance for Group Long Term Disability Income Insurance Page 3 Page 5