TABLE OF CONTENTS Page SCHEDULE OF BENEFITS .......................................................................................................................................1.0 DEFINITIONS .............................................................................................................................................................2.0 CERTAIN RESPONSIBILITIES OF THE POLICYHOLDER ......................................................................................3.0 GENERAL PROVISIONS ...........................................................................................................................................4.0 Entire Contract Changes Incontestability Records Maintained Clerical Error Misstatement of Age Not in Lieu of Workers' Compensation Conformity With State Laws Certificate of Insurance Termination of the Policy CLAIMS PROVISIONS ...............................................................................................................................................5.0 Notice of Claim Claim Forms Written Proof of Loss Payment of Claims Time Payment of Claims Physical Examination Legal Actions INDIVIDUAL ELIGIBILITY, EFFECTIVE DATE AND TERMINATION .......................................................................6.0 General Group Eligible Classes Effective Date of Individual Insurance Termination of Individual Insurance Individual Reinstatement WEEKLY INCOME INSURANCE ...............................................................................................................................7.0 Benefits Payable Period of Disability Exclusions PARTIAL DISABILITY BENEFIT ................................................................................................................................8.0 TRANSFER OF INSURANCE COVERAGE ..............................................................................................................9.0 PREMIUMS ..............................................................................................................................................................10.0 Premium Payment Premium Rate Grace Period LIMITATION .............................................................................................................................................................11.0 EXTENSION OF COVERAGE UNDER THE FAMILY AND MEDICAL LEAVE ACT AND UNIFORMED SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT (USERRA) ...................................................12.0 LRS-6451-1 Ed. 4/82