TABLE OF CONTENTS Page SCHEDULE OF BENEFITS ...................................................................................................................................... 1.0 DEFINITIONS ............................................................................................................................................................ 2.0 CERTAIN RESPONSIBILITIES OF THE POLICYHOLDER ..................................................................................... 3.0 TRANSFER OF INSURANCE COVERAGE ............................................................................................................. 4.0 GENERAL PROVISIONS .......................................................................................................................................... 5.0 Entire Contract Changes Time Limit on Certain Defenses Records Maintained Clerical Error Misstatement of Age Not in Lieu of Workers' Compensation Conformity with State Laws Certificate of Insurance Termination of this Policy CLAIMS PROVISIONS .............................................................................................................................................. 6.0 INDIVIDUAL ELIGIBILITY, EFFECTIVE DATE AND TERMINATION ...................................................................... 7.0 General Group Eligibility Requirements Effective Date of Individual Insurance Termination of Individual Insurance Individual Reinstatement PREMIUMS ............................................................................................................................................................... 8.0 BENEFIT PROVISIONS ............................................................................................................................................ 9.0 WORKSITE MODIFICATION PROVISION ............................................................................................................. 10.0 EXCLUSIONS ......................................................................................................................................................... 11.0 LIMITATIONS .......................................................................................................................................................... 12.0 SPECIFIC INDEMNITY BENEFIT ........................................................................................................................... 13.0 SURVIVOR BENEFIT - LUMP SUM ....................................................................................................................... 14.0 WORK INCENTIVE AND CHILD CARE BENEFITS ............................................................................................... 15.0 EXTENSION OF COVERAGE UNDER THE FAMILY AND MEDICAL LEAVE ACT AND UNIFORMED SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT (USERRA) .................................................. 16.0 EXTENDED DISABILITY BENEFIT ........................................................................................................................ 17.0 REHABILITATION BENEFIT ................................................................................................................................... 18.0 LRS-6564-2 Ed. 2/83