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Tj ET Q q n 0 498.25 m 612 498.25 l 612 486.25 l 0 486.25 l h W n Q q n 0 486.25 m 612 486.25 l 612 474.25 l 0 474.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 185.87 476.66 Tm (Certificate of Insurance for Class 1) Tj ET Q q n 0 474.25 m 612 474.25 l 612 468.25 l 0 468.25 l h W n Q q n 0 468.25 m 612 468.25 l 612 462.25 l 0 462.25 l h W n Q q n 0 462.25 m 612 462.25 l 612 456.25 l 0 456.25 l h W n Q q n 0 456.25 m 612 456.25 l 612 444.25 l 0 444.25 l h W n Q q n 0 444.25 m 612 444.25 l 612 432.25 l 0 432.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 434.66 Tm (You) Tj ET BT /F2 12 Tf 1 0 0 1 23.75 434.66 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 41.48 434.66 Tm (entitled) Tj ET BT /F2 12 Tf 1 0 0 1 80.55 434.66 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 92.97 434.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 110.72 434.66 Tm (benefits) Tj ET BT /F2 12 Tf 1 0 0 1 151.79 434.66 Tm (described) Tj ET BT /F2 12 Tf 1 0 0 1 200.85 434.66 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 213.27 434.66 Tm (this) Tj ET BT /F2 12 Tf 1 0 0 1 233.69 434.66 Tm (Certificate) Tj ET BT /F2 12 Tf 1 0 0 1 287.41 434.66 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 297.82 434.66 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 318.9 434.66 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 336.64 434.66 Tm (eligible) Tj ET BT /F2 12 Tf 1 0 0 1 375.71 434.66 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 392.78 434.66 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 441.85 434.66 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 472.25 434.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 490 434.66 Tm (provisions) Tj ET Q q n 0 432.25 m 612 432.25 l 612 420.25 l 0 420.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 422.66 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 13.45 422.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 31.57 422.66 Tm (Policy.) Tj ET BT /F2 12 Tf 1 0 0 1 72.15 422.66 Tm (This) Tj ET BT /F2 12 Tf 1 0 0 1 96.94 422.66 Tm (Certificate) Tj ET BT /F2 12 Tf 1 0 0 1 151.03 422.66 Tm (replaces) Tj ET BT /F2 12 Tf 1 0 0 1 193.79 422.66 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 214.57 422.66 Tm (other) Tj ET BT /F2 12 Tf 1 0 0 1 242.69 422.66 Tm (certificates) Tj ET BT /F2 12 Tf 1 0 0 1 298.77 422.66 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 316.22 422.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 334.34 422.66 Tm (benefits) Tj ET BT /F2 12 Tf 1 0 0 1 375.78 422.66 Tm (described) Tj ET BT /F2 12 Tf 1 0 0 1 425.21 422.66 Tm (inside.) Tj ET BT /F2 12 Tf 1 0 0 1 463.79 422.66 Tm (As) Tj ET BT /F2 12 Tf 1 0 0 1 480.58 422.66 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 489.36 422.66 Tm (Certificate) Tj ET Q q n 0 420.25 m 612 420.25 l 612 408.25 l 0 408.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 410.66 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 13.65 410.66 Tm (Insurance,) Tj ET BT /F2 12 Tf 1 0 0 1 66.95 410.66 Tm (it) Tj ET BT /F2 12 Tf 1 0 0 1 77.27 410.66 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 88.93 410.66 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 107.92 410.66 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 116.9 410.66 Tm (contract) Tj ET BT /F2 12 Tf 1 0 0 1 159.2 410.66 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 172.86 410.66 Tm (insurance;) Tj ET BT /F2 12 Tf 1 0 0 1 225.82 410.66 Tm (it) Tj ET BT /F2 12 Tf 1 0 0 1 236.15 410.66 Tm (only) Tj ET BT /F2 12 Tf 1 0 0 1 261.14 410.66 Tm (summarizes) Tj ET BT /F2 12 Tf 1 0 0 1 322.11 410.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 340.43 410.66 Tm (provisions) Tj ET BT /F2 12 Tf 1 0 0 1 394.09 410.66 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 407.74 410.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 426.05 410.66 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 460.38 410.66 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 481.36 410.66 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 493.02 410.66 Tm (subject) Tj ET BT /F2 12 Tf 1 0 0 1 530.67 410.66 Tm (to) Tj ET Q q n 0 408.25 m 612 408.25 l 612 396.25 l 0 396.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 398.66 Tm (the Policy's terms.) Tj ET Q q n 0 396.25 m 612 396.25 l 612 384.25 l 0 384.25 l h W n Q q n 0 384.25 m 612 384.25 l 612 372.25 l 0 372.25 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 374.66 Tm (The) Tj ET BT /F4 12 Tf 1 0 0 1 23.1 374.66 Tm (Policy) Tj ET BT /F4 12 Tf 1 0 0 1 57.52 374.66 Tm (contains) Tj ET BT /F4 12 Tf 1 0 0 1 103.29 374.66 Tm (an) Tj ET BT /F4 12 Tf 1 0 0 1 119.06 374.66 Tm (Accelerated) Tj ET BT /F4 12 Tf 1 0 0 1 182.78 374.66 Tm (Death) Tj ET BT /F4 12 Tf 1 0 0 1 216.54 374.66 Tm (Benefit) Tj ET BT /F4 12 Tf 1 0 0 1 256.29 374.66 Tm (provision.) Tj ET BT /F4 12 Tf 1 0 0 1 313.49 374.66 Tm (Receipt) Tj ET BT /F4 12 Tf 1 0 0 1 355.24 374.66 Tm (of) Tj ET BT /F4 12 Tf 1 0 0 1 368.33 374.66 Tm (an) Tj ET BT /F4 12 Tf 1 0 0 1 384.1 374.66 Tm (Accelerated) Tj ET BT /F4 12 Tf 1 0 0 1 447.82 374.66 Tm (Death) Tj ET BT /F4 12 Tf 1 0 0 1 481.58 374.66 Tm (Benefit) Tj ET BT /F4 12 Tf 1 0 0 1 521.33 374.66 Tm (will) Tj ET Q q n 0 372.25 m 612 372.25 l 612 360.25 l 0 360.25 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 362.66 Tm (reduce) Tj ET BT /F4 12 Tf 1 0 0 1 39.87 362.66 Tm (benefits) Tj ET BT /F4 12 Tf 1 0 0 1 85.09 362.66 Tm (specified) Tj ET BT /F4 12 Tf 1 0 0 1 134.97 362.66 Tm (in) Tj ET BT /F4 12 Tf 1 0 0 1 150.2 362.66 Tm (the) Tj ET BT /F4 12 Tf 1 0 0 1 171.42 362.66 Tm (Policy.) Tj ET BT /F4 12 Tf 1 0 0 1 216.18 362.66 Tm (Accelerated) Tj ET BT /F4 12 Tf 1 0 0 1 282.03 362.66 Tm (Death) Tj ET BT /F4 12 Tf 1 0 0 1 317.91 362.66 Tm (Benefits) Tj ET BT /F4 12 Tf 1 0 0 1 364.46 362.66 Tm (may) Tj ET BT /F4 12 Tf 1 0 0 1 391.68 362.66 Tm (be) Tj ET BT /F4 12 Tf 1 0 0 1 408.9 362.66 Tm (taxable.) Tj ET BT /F4 12 Tf 1 0 0 1 459.67 362.66 Tm (As) Tj ET BT /F4 12 Tf 1 0 0 1 478.23 362.66 Tm (with) Tj ET BT /F4 12 Tf 1 0 0 1 506.12 362.66 Tm (all) Tj ET BT /F4 12 Tf 1 0 0 1 524 362.66 Tm (tax) Tj ET Q q n 0 360.25 m 612 360.25 l 612 348.25 l 0 348.25 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 350.66 Tm (matters,) Tj ET BT /F4 12 Tf 1 0 0 1 46.88 350.66 Tm (the) Tj ET BT /F4 12 Tf 1 0 0 1 67.45 350.66 Tm (Insured) Tj ET BT /F4 12 Tf 1 0 0 1 112.03 350.66 Tm (Person) Tj ET BT /F4 12 Tf 1 0 0 1 151.93 350.66 Tm (should) Tj ET BT /F4 12 Tf 1 0 0 1 190.53 350.66 Tm (consult) Tj ET BT /F4 12 Tf 1 0 0 1 231.77 350.66 Tm (a) Tj ET BT /F4 12 Tf 1 0 0 1 242.34 350.66 Tm (professional) Tj ET BT /F4 12 Tf 1 0 0 1 308.92 350.66 Tm (tax) Tj ET BT /F4 12 Tf 1 0 0 1 329.48 350.66 Tm (advisor) Tj ET BT /F4 12 Tf 1 0 0 1 372.06 350.66 Tm (before) Tj ET BT /F4 12 Tf 1 0 0 1 409.28 350.66 Tm (applying) Tj ET BT /F4 12 Tf 1 0 0 1 458.54 350.66 Tm (for) Tj ET BT /F4 12 Tf 1 0 0 1 478.43 350.66 Tm (this) Tj ET BT /F4 12 Tf 1 0 0 1 501.67 350.66 Tm (benefit.) Tj ET Q q n 0 348.25 m 612 348.25 l 612 336.25 l 0 336.25 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 338.66 Tm (Please read the Limitations section of the Accelerated Death Benefit included in the Policy.) Tj ET Q q n 0 336.25 m 612 336.25 l 612 324.25 l 0 324.25 l h W n Q q 1 0 0 1 326.33 283 cm q n 0 0 m 162.75 0 l 162.75 41.25 l 0 41.25 l h W n q 162.75 0 0 41.25 0 0 cm /img17796 Do Q Q Q q Q q n 0 266.9 m 612 266.9 l 612 254.9 l 0 254.9 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 142.65 257.31 Tm (CERTIFICATE OF GROUP LIFE INSURANCE) Tj ET Q Q q Q Q endstream endobj 2 0 obj <>>>>> endobj 45 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 706.85 cm q n 0 49.15 m 550.8 49.15 l 550.8 37.15 l 0 37.15 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 216.51 39.56 Tm (É«ÖÐÉ« University) Tj ET Q q n 0 37.15 m 550.8 37.15 l 550.8 25.15 l 0 25.15 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 217 27.56 Tm (000400001000-22982) Tj ET Q q n 0 25.15 m 550.8 25.15 l 550.8 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 189.99 15.56 Tm (SCHEDULE OF INSURANCE) Tj ET Q q n 0 13.15 m 550.8 13.15 l 550.8 1.15 l 0 1.15 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 270.1 25.15 l 270.1 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-SB) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 646.65 m 612 646.65 l 612 634.65 l 0 634.65 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 219.81 637.06 Tm (ELIGIBLE) Tj ET BT /F4 12 Tf 1 0 0 1 281.51 637.06 Tm (CLASS) Tj ET Q q n 0 634.65 m 612 634.65 l 612 622.65 l 0 622.65 l h W n Q q n 108 622.65 m 720 622.65 l 720 610.65 l 108 610.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 108 613.06 Tm (Class) Tj ET BT /F2 12 Tf 1 0 0 1 137 613.06 Tm (1) Tj ET BT /F2 12 Tf 1 0 0 1 171.35 613.06 Tm (All) Tj ET BT /F2 12 Tf 1 0 0 1 190.21 613.06 Tm (Full-Time) Tj ET BT /F2 12 Tf 1 0 0 1 242.4 613.06 Tm (Employees) Tj ET BT /F2 12 Tf 1 0 0 1 299.25 613.06 Tm (Working) Tj ET BT /F2 12 Tf 1 0 0 1 345.43 613.06 Tm (30) Tj ET BT /F2 12 Tf 1 0 0 1 360.96 613.06 Tm (Hours) Tj ET BT /F2 12 Tf 1 0 0 1 393.82 613.06 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 407.34 613.06 Tm (more) Tj ET Q q n 171.35 610.65 m 783.35 610.65 l 783.35 598.65 l 171.35 598.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 171.35 601.06 Tm (per week) Tj ET Q q n 0 598.65 m 550.8 598.65 l 550.8 586.65 l 0 586.65 l h W n Q q n 0 586.65 m 550.8 586.65 l 550.8 574.65 l 0 574.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 577.06 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 24.66 577.06 Tm (following) Tj ET BT /F2 12 Tf 1 0 0 1 77.33 577.06 Tm (chart) Tj ET BT /F2 12 Tf 1 0 0 1 107.32 577.06 Tm (applies) Tj ET BT /F2 12 Tf 1 0 0 1 147.32 577.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 162.66 577.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 183.33 577.06 Tm (Portability) Tj ET BT /F2 12 Tf 1 0 0 1 240 577.06 Tm (Privilege) Tj ET BT /F2 12 Tf 1 0 0 1 289.33 577.06 Tm (provision) Tj ET BT /F2 12 Tf 1 0 0 1 340.68 577.06 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 364.01 577.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 379.35 577.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 400.02 577.06 Tm (Extension) Tj ET BT /F2 12 Tf 1 0 0 1 454.02 577.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 470.02 577.06 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 504.68 577.06 Tm (Benefit) Tj ET Q q n 0 574.65 m 550.8 574.65 l 550.8 562.65 l 0 562.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 565.06 Tm (provision when benefits end upon attainment of the Social Security Normal Retirement Age:) Tj ET Q q n 0 562.65 m 275.4 562.65 l 275.4 550.65 l 0 550.65 l h W n Q q n 275.4 562.65 m 550.8 562.65 l 550.8 550.65 l 275.4 550.65 l h W n Q q n 0 550.65 m 275.4 550.65 l 275.4 538.65 l 0 538.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 100.31 541.06 Tm (Year of Birth) Tj ET 2 J 0.586 w [] 0 d 0 0 0 RG 100.6 539.46 m 163.99 539.46 l S 1 w [] 0 d Q q n 275.4 550.65 m 550.8 550.65 l 550.8 538.65 l 275.4 538.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 349.72 541.06 Tm (Normal Retirement Age) Tj ET 2 J 0.586 w [] 0 d 0 0 0 RG 350.01 539.46 m 465.39 539.46 l S 1 w [] 0 d Q q n 0 538.65 m 275.4 538.65 l 275.4 526.65 l 0 526.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 96.97 529.06 Tm (1937 and prior) Tj ET Q q n 275.4 538.65 m 550.8 538.65 l 550.8 526.65 l 275.4 526.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 401.7 529.06 Tm (65) Tj ET Q q n 0 526.65 m 275.4 526.65 l 275.4 514.65 l 0 514.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 120.3 517.06 Tm (1938) Tj ET Q q n 275.4 526.65 m 550.8 526.65 l 550.8 514.65 l 275.4 514.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 367.87 517.06 Tm (65 and 2 months) Tj ET Q q n 0 514.65 m 275.4 514.65 l 275.4 502.65 l 0 502.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 120.3 505.06 Tm (1939) Tj ET Q q n 275.4 514.65 m 550.8 514.65 l 550.8 502.65 l 275.4 502.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 367.87 505.06 Tm (65 and 4 months) Tj ET Q q n 0 502.65 m 275.4 502.65 l 275.4 490.65 l 0 490.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 120.3 493.06 Tm (1940) Tj ET Q q n 275.4 502.65 m 550.8 502.65 l 550.8 490.65 l 275.4 490.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 367.87 493.06 Tm (65 and 6 months) Tj ET Q q n 0 490.65 m 275.4 490.65 l 275.4 478.65 l 0 478.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 120.3 481.06 Tm (1941) Tj ET Q q n 275.4 490.65 m 550.8 490.65 l 550.8 478.65 l 275.4 478.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 367.87 481.06 Tm (65 and 8 months) Tj ET Q q n 0 478.65 m 275.4 478.65 l 275.4 466.65 l 0 466.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 120.3 469.06 Tm (1942) Tj ET Q q n 275.4 478.65 m 550.8 478.65 l 550.8 466.65 l 275.4 466.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 364.87 469.06 Tm (65 and 10 months) Tj ET Q q n 0 466.65 m 275.4 466.65 l 275.4 454.65 l 0 454.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 109.3 457.06 Tm (1943 - 54) Tj ET Q q n 275.4 466.65 m 550.8 466.65 l 550.8 454.65 l 275.4 454.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 401.7 457.06 Tm (66) Tj ET Q q n 0 454.65 m 275.4 454.65 l 275.4 442.65 l 0 442.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 120.3 445.06 Tm (1955) Tj ET Q q n 275.4 454.65 m 550.8 454.65 l 550.8 442.65 l 275.4 442.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 367.87 445.06 Tm (66 and 2 months) Tj ET Q q n 0 442.65 m 275.4 442.65 l 275.4 430.65 l 0 430.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 120.3 433.06 Tm (1956) Tj ET Q q n 275.4 442.65 m 550.8 442.65 l 550.8 430.65 l 275.4 430.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 367.87 433.06 Tm (66 and 4 months) Tj ET Q q n 0 430.65 m 275.4 430.65 l 275.4 418.65 l 0 418.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 120.3 421.06 Tm (1957) Tj ET Q q n 275.4 430.65 m 550.8 430.65 l 550.8 418.65 l 275.4 418.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 367.87 421.06 Tm (66 and 6 months) Tj ET Q q n 0 418.65 m 275.4 418.65 l 275.4 406.65 l 0 406.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 120.3 409.06 Tm (1958) Tj ET Q q n 275.4 418.65 m 550.8 418.65 l 550.8 406.65 l 275.4 406.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 367.87 409.06 Tm (66 and 8 months) Tj ET Q q n 0 406.65 m 275.4 406.65 l 275.4 394.65 l 0 394.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 120.3 397.06 Tm (1959) Tj ET Q q n 275.4 406.65 m 550.8 406.65 l 550.8 394.65 l 275.4 394.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 364.87 397.06 Tm (66 and 10 months) Tj ET Q q n 0 394.65 m 275.4 394.65 l 275.4 382.65 l 0 382.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 97.98 385.06 Tm (1960 and later) Tj ET Q q n 275.4 394.65 m 550.8 394.65 l 550.8 382.65 l 275.4 382.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 401.7 385.06 Tm (67) Tj ET Q q n 0 382.65 m 275.4 382.65 l 275.4 370.65 l 0 370.65 l h W n Q q n 275.4 382.65 m 550.8 382.65 l 550.8 370.65 l 275.4 370.65 l h W n Q q n 0 370.65 m 550.8 370.65 l 550.8 358.65 l 0 358.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 361.06 Tm (Note:) Tj ET BT /F2 12 Tf 1 0 0 1 32.66 361.06 Tm (Persons born on January 1 of any year should refer to the Normal Retirement Age for the previous year.) Tj ET Q q n 0 357.5 m 612 357.5 l 612 345.5 l 0 345.5 l h W n Q q n 0 345.5 m 612 345.5 l 612 333.5 l 0 333.5 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 335.91 Tm (Under) Tj ET BT /F2 12 Tf 1 0 0 1 33.43 335.91 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 51.52 335.91 Tm (Portability) Tj ET BT /F2 12 Tf 1 0 0 1 105.62 335.91 Tm (Privilege) Tj ET BT /F2 12 Tf 1 0 0 1 152.38 335.91 Tm (provision,) Tj ET BT /F2 12 Tf 1 0 0 1 204.15 335.91 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 222.25 335.91 Tm (word) Tj ET BT /F2 12 Tf 1 0 0 1 250.35 335.91 Tm ("retire") Tj ET BT /F2 12 Tf 1 0 0 1 288.89 335.91 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 302.33 335.91 Tm ("retirement") Tj ET BT /F2 12 Tf 1 0 0 1 364.87 335.91 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 398.96 335.91 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 424.39 335.91 Tm (attainment) Tj ET BT /F2 12 Tf 1 0 0 1 478.48 335.91 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 491.91 335.91 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 510.01 335.91 Tm (Social) Tj ET Q q n 0 333.5 m 612 333.5 l 612 321.5 l 0 321.5 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 323.91 Tm (Security) Tj ET BT /F2 12 Tf 1 0 0 1 44.9 323.91 Tm (Normal) Tj ET BT /F2 12 Tf 1 0 0 1 86.46 323.91 Tm (Retirement) Tj ET BT /F2 12 Tf 1 0 0 1 144.68 323.91 Tm (Age.) Tj ET BT /F2 12 Tf 1 0 0 1 172.58 323.91 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 196.14 323.91 Tm (use) Tj ET BT /F2 12 Tf 1 0 0 1 217.04 323.91 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 231.94 323.91 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 251.51 323.91 Tm (word) Tj ET BT /F2 12 Tf 1 0 0 1 281.08 323.91 Tm ("retire") Tj ET BT /F2 12 Tf 1 0 0 1 321.09 323.91 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 335.99 323.91 Tm ("retirement") Tj ET BT /F2 12 Tf 1 0 0 1 400 323.91 Tm (elsewhere) Tj ET BT /F2 12 Tf 1 0 0 1 452.88 323.91 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 467.12 323.91 Tm (this) Tj ET BT /F2 12 Tf 1 0 0 1 489.36 323.91 Tm (Certificate) Tj ET Q q n 0 321.5 m 612 321.5 l 612 309.5 l 0 309.5 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 311.91 Tm (means your retirement from employment with the Employer.) Tj ET Q q n 0 309.5 m 612 309.5 l 612 297.5 l 0 297.5 l h W n Q q n 0 297.5 m 612 297.5 l 612 285.5 l 0 285.5 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 287.91 Tm (OPEN) Tj ET BT /F4 12 Tf 1 0 0 1 36.37 287.91 Tm (ENROLLMENT) Tj ET BT /F4 12 Tf 1 0 0 1 126.08 287.91 Tm (PERIOD) Tj ET BT /F2 12 Tf 1 0 0 1 175.79 287.91 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 209.48 287.91 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 217.84 287.91 Tm (designated) Tj ET BT /F2 12 Tf 1 0 0 1 272.2 287.91 Tm (timeframe) Tj ET BT /F2 12 Tf 1 0 0 1 324.54 287.91 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 341.57 287.91 Tm (eligible) Tj ET BT /F2 12 Tf 1 0 0 1 380.59 287.91 Tm (employees) Tj ET BT /F2 12 Tf 1 0 0 1 434.95 287.91 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 447.32 287.91 Tm (elect) Tj ET BT /F2 12 Tf 1 0 0 1 473 287.91 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 519.33 287.91 Tm (who) Tj ET Q q n 0 285.5 m 612 285.5 l 612 273.5 l 0 273.5 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 275.91 Tm (did) Tj ET BT /F2 12 Tf 1 0 0 1 19.03 275.91 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 38.05 275.91 Tm (enroll) Tj ET BT /F2 12 Tf 1 0 0 1 69.74 275.91 Tm (during) Tj ET BT /F2 12 Tf 1 0 0 1 104.76 275.91 Tm (their) Tj ET BT /F2 12 Tf 1 0 0 1 130.44 275.91 Tm (initial) Tj ET BT /F2 12 Tf 1 0 0 1 162.13 275.91 Tm (eligibility) Tj ET BT /F2 12 Tf 1 0 0 1 212.49 275.91 Tm (period) Tj ET BT /F2 12 Tf 1 0 0 1 246.84 275.91 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 260.53 275.91 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 278.21 275.91 Tm (employees) Tj ET BT /F2 12 Tf 1 0 0 1 333.22 275.91 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 358.25 275.91 Tm (existing) Tj ET BT /F2 12 Tf 1 0 0 1 399.94 275.91 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 446.94 275.91 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 477.95 275.91 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 496.31 275.91 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 530.67 275.91 Tm (to) Tj ET Q q n 0 273.5 m 612 273.5 l 612 261.5 l 0 261.5 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 263.91 Tm (elect) Tj ET BT /F2 12 Tf 1 0 0 1 26.99 263.91 Tm (additional) Tj ET BT /F2 12 Tf 1 0 0 1 79.32 263.91 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 116.98 263.91 Tm (amounts.) Tj ET BT /F2 12 Tf 1 0 0 1 169.33 263.91 Tm (Evidence) Tj ET BT /F2 12 Tf 1 0 0 1 218.32 263.91 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 232.66 263.91 Tm (insurability) Tj ET BT /F2 12 Tf 1 0 0 1 291.66 263.91 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 304.01 263.91 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 323.68 263.91 Tm (required) Tj ET BT /F2 12 Tf 1 0 0 1 368.01 263.91 Tm (during) Tj ET BT /F2 12 Tf 1 0 0 1 403.68 263.91 Tm (this) Tj ET BT /F2 12 Tf 1 0 0 1 425.36 263.91 Tm (period) Tj ET BT /F2 12 Tf 1 0 0 1 460.36 263.91 Tm (provided) Tj ET BT /F2 12 Tf 1 0 0 1 507.36 263.91 Tm (certain) Tj ET Q q n 0 261.5 m 612 261.5 l 612 249.5 l 0 249.5 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 251.91 Tm (conditions) Tj ET BT /F2 12 Tf 1 0 0 1 53.44 251.91 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 71.53 251.91 Tm (met) Tj ET BT /F2 12 Tf 1 0 0 1 92.96 251.91 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 106.4 251.91 Tm (described) Tj ET BT /F2 12 Tf 1 0 0 1 155.82 251.91 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 168.59 251.91 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 186.69 251.91 Tm (Schedule) Tj ET BT /F2 12 Tf 1 0 0 1 234.12 251.91 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 247.55 251.91 Tm (Insurance.) Tj ET BT /F2 12 Tf 1 0 0 1 304.07 251.91 Tm (Participation) Tj ET BT /F2 12 Tf 1 0 0 1 368.83 251.91 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 381.61 251.91 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 396.37 251.91 Tm (Open) Tj ET BT /F2 12 Tf 1 0 0 1 425.81 251.91 Tm (Enrollment) Tj ET BT /F2 12 Tf 1 0 0 1 483.23 251.91 Tm (Period) Tj ET BT /F2 12 Tf 1 0 0 1 518 251.91 Tm (does) Tj ET Q q n 0 249.5 m 612 249.5 l 612 237.5 l 0 237.5 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 239.91 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 18.53 239.91 Tm (change) Tj ET BT /F2 12 Tf 1 0 0 1 55.7 239.91 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 73.56 239.91 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 107.42 239.91 Tm (provisions) Tj ET BT /F2 12 Tf 1 0 0 1 160.62 239.91 Tm (related) Tj ET BT /F2 12 Tf 1 0 0 1 196.46 239.91 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 208.99 239.91 Tm (Waiting) Tj ET BT /F2 12 Tf 1 0 0 1 250.84 239.91 Tm (Periods.) Tj ET BT /F2 12 Tf 1 0 0 1 296.24 239.91 Tm (Employees) Tj ET BT /F2 12 Tf 1 0 0 1 352.75 239.91 Tm (who) Tj ET BT /F2 12 Tf 1 0 0 1 376.61 239.91 Tm (have) Tj ET BT /F2 12 Tf 1 0 0 1 402.46 239.91 Tm (been) Tj ET BT /F2 12 Tf 1 0 0 1 428.31 239.91 Tm (previously) Tj ET BT /F2 12 Tf 1 0 0 1 482.17 239.91 Tm (declined) Tj ET BT /F2 12 Tf 1 0 0 1 526.01 239.91 Tm (for) Tj ET Q q n 0 237.5 m 612 237.5 l 612 225.5 l 0 225.5 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 227.91 Tm (a benefit amount or increase are not eligible to participate in the Open Enrollment.) Tj ET Q q n 0 225.5 m 612 225.5 l 612 213.5 l 0 213.5 l h W n Q q n 0 213.5 m 612 213.5 l 612 201.5 l 0 201.5 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 203.91 Tm (There) Tj ET BT /F2 12 Tf 1 0 0 1 33.43 203.91 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 57.54 203.91 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 74.32 203.91 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 91.09 203.91 Tm (Open) Tj ET BT /F2 12 Tf 1 0 0 1 122.53 203.91 Tm (Enrollment) Tj ET BT /F2 12 Tf 1 0 0 1 181.97 203.91 Tm (Period) Tj ET BT /F2 12 Tf 1 0 0 1 218.75 203.91 Tm (beginning) Tj ET BT /F2 12 Tf 1 0 0 1 272.19 203.91 Tm (November) Tj ET BT /F2 12 Tf 1 0 0 1 328.29 203.91 Tm (1) Tj ET BT /F2 7.2 Tf 1 0 0 1 334.29 207.51 Tm (st) Tj ET BT /F2 12 Tf 1 0 0 1 344.54 203.91 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 367.32 203.91 Tm (ending) Tj ET BT /F2 12 Tf 1 0 0 1 405.43 203.91 Tm (November) Tj ET BT /F2 12 Tf 1 0 0 1 461.52 203.91 Tm (30) Tj ET BT /F2 7.2 Tf 1 0 0 1 473.52 207.51 Tm (th) Tj ET BT /F2 12 Tf 1 0 0 1 484.57 203.91 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 504.01 203.91 Tm (eligible) Tj ET Q q n 0 201.5 m 612 201.5 l 612 189.5 l 0 189.5 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 191.91 Tm (Employees to enroll for or to increase their current benefit amounts.) Tj ET Q q n 0 189.5 m 612 189.5 l 612 177.5 l 0 177.5 l h W n Q q n 0 177.5 m 612 177.5 l 612 165.5 l 0 165.5 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 167.91 Tm (Coverage elected during this period will be effective:) Tj ET Q q n 18 165.5 m 630 165.5 l 630 153.5 l 18 153.5 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 155.91 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 155.91 Tm (January 1) Tj ET BT /F2 7.2 Tf 1 0 0 1 91.67 159.51 Tm (st) Tj ET BT /F2 12 Tf 1 0 0 1 96.47 155.91 Tm ( following the enrollment period, if Actively at Work on that day; or) Tj ET Q q n 18 153.5 m 630 153.5 l 630 141.5 l 18 141.5 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 143.91 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 143.91 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 68.95 143.91 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 91.22 143.91 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 110.83 143.91 Tm (Insured) Tj ET BT /F2 12 Tf 1 0 0 1 151.76 143.91 Tm (Person) Tj ET BT /F2 12 Tf 1 0 0 1 189.37 143.91 Tm (resumes) Tj ET BT /F2 12 Tf 1 0 0 1 233.64 143.91 Tm (Active) Tj ET BT /F2 12 Tf 1 0 0 1 270.57 143.91 Tm (Work,) Tj ET BT /F2 12 Tf 1 0 0 1 305.83 143.91 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 318.11 143.91 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 338.39 143.91 Tm (Actively) Tj ET BT /F2 12 Tf 1 0 0 1 384.65 143.91 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 398.25 143.91 Tm (Work) Tj ET BT /F2 12 Tf 1 0 0 1 430.52 143.91 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 447.47 143.91 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 467.07 143.91 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 489.34 143.91 Tm (the) Tj ET Q q n 45.35 141.5 m 657.35 141.5 l 657.35 129.5 l 45.35 129.5 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 131.91 Tm (elected coverage or increase would otherwise take effect.) Tj ET Q Q q Q Q endstream endobj 3 0 obj <>>>>> endobj 46 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 718.85 cm q n 0 37.15 m 550.8 37.15 l 550.8 25.15 l 0 25.15 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 216.51 27.56 Tm (É«ÖÐÉ« University) Tj ET Q q n 0 25.15 m 550.8 25.15 l 550.8 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 217 15.56 Tm (000400001000-22982) Tj ET Q q n 0 13.15 m 550.8 13.15 l 550.8 1.15 l 0 1.15 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 189.99 3.56 Tm (SCHEDULE OF INSURANCE) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 270.1 25.15 l 270.1 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-SB) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 706.85 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 646.65 m 612 646.65 l 612 634.65 l 0 634.65 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 260.67 637.06 Tm (For) Tj ET Q q n 0 634.65 m 612 634.65 l 612 622.65 l 0 622.65 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 86.68 625.06 Tm (Class) Tj ET BT /F4 12 Tf 1 0 0 1 117.02 625.06 Tm (1) Tj ET BT /F4 12 Tf 1 0 0 1 123.02 625.06 Tm ( -) Tj ET BT /F4 12 Tf 1 0 0 1 133.02 625.06 Tm (All Full-Time Employees Working 30 Hours or more per week) Tj ET Q q n 0 622.65 m 612 622.65 l 612 610.65 l 0 610.65 l h W n Q q n 0 610.65 m 612 610.65 l 612 598.65 l 0 598.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 601.06 Tm (MINIMUM HOURS:) Tj ET BT /F2 12 Tf 1 0 0 1 110.34 601.06 Tm (30 hours per week) Tj ET Q q n 0 598.65 m 612 598.65 l 612 586.65 l 0 586.65 l h W n Q q n 0 586.65 m 612 586.65 l 612 574.65 l 0 574.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 577.06 Tm (WAITING PERIOD:) Tj ET BT /F2 12 Tf 1 0 0 1 126 577.06 Tm ($For date insurance begins, refer to "Effective Dates) Tj ET BT /F2 12 Tf 1 0 0 1 379.13 577.06 Tm (of Coverages) Tj ET BT /F2 12 Tf 1 0 0 1 442.77 577.06 Tm (" section$) Tj ET Q q n 126 574.65 m 738 574.65 l 738 562.65 l 126 562.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 126 565.06 Tm (None) Tj ET Q q n 0 562.65 m 612 562.65 l 612 550.65 l 0 550.65 l h W n Q q n 0 550.65 m 612 550.65 l 612 538.65 l 0 538.65 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 541.06 Tm (Basic) Tj ET BT /F4 12 Tf 1 0 0 1 31.79 541.06 Tm (Annual) Tj ET BT /F4 12 Tf 1 0 0 1 74.26 541.06 Tm (Earnings) Tj ET BT /F2 12 Tf 1 0 0 1 125.39 541.06 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 160.5 541.06 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 186.95 541.06 Tm (annual) Tj ET BT /F2 12 Tf 1 0 0 1 223.39 541.06 Tm (base) Tj ET BT /F2 12 Tf 1 0 0 1 249.16 541.06 Tm (salary) Tj ET BT /F2 12 Tf 1 0 0 1 282.26 541.06 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 296.71 541.06 Tm (annualized) Tj ET BT /F2 12 Tf 1 0 0 1 353.14 541.06 Tm (hourly) Tj ET BT /F2 12 Tf 1 0 0 1 388.92 541.06 Tm (pay) Tj ET BT /F2 12 Tf 1 0 0 1 410.69 541.06 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 438.47 541.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 457.58 541.06 Tm (Employer) Tj ET BT /F2 12 Tf 1 0 0 1 509.36 541.06 Tm (before) Tj ET Q q n 0 538.65 m 612 538.65 l 612 526.65 l 0 526.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 529.06 Tm (taxes on the Determination Date.) Tj ET BT /F2 12 Tf 1 0 0 1 164.28 529.06 Tm (The) Tj ET BT /F4 12 Tf 1 0 0 1 185.94 529.06 Tm ("Determination Date") Tj ET BT /F2 12 Tf 1 0 0 1 300.9 529.06 Tm ( is the) Tj ET BT /F2 12 Tf 1 0 0 1 332.56 529.06 Tm (last day worked) Tj ET BT /F2 12 Tf 1 0 0 1 408.54 529.06 Tm ( just prior to the loss.) Tj ET Q q n 0 526.65 m 612 526.65 l 612 514.65 l 0 514.65 l h W n Q q n 0 514.65 m 612 514.65 l 612 502.65 l 0 502.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 505.06 Tm (It) Tj ET BT /F2 12 Tf 1 0 0 1 11.12 505.06 Tm (does) Tj ET BT /F4 12 Tf 1 0 0 1 36.91 505.06 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 57.37 505.06 Tm (include) Tj ET BT /F2 12 Tf 1 0 0 1 96.48 505.06 Tm (commissions,) Tj ET BT /F2 12 Tf 1 0 0 1 165.94 505.06 Tm (bonuses,) Tj ET BT /F2 12 Tf 1 0 0 1 211.4 505.06 Tm (overtime) Tj ET BT /F2 12 Tf 1 0 0 1 257.84 505.06 Tm (pay) Tj ET BT /F2 12 Tf 1 0 0 1 278.96 505.06 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 292.74 505.06 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 313.86 505.06 Tm (other) Tj ET BT /F2 12 Tf 1 0 0 1 342.31 505.06 Tm (extra) Tj ET BT /F2 12 Tf 1 0 0 1 370.08 505.06 Tm (compensation.) Tj ET BT /F2 12 Tf 1 0 0 1 447.31 505.06 Tm (It) Tj ET BT /F2 12 Tf 1 0 0 1 458.43 505.06 Tm (does) Tj ET BT /F4 12 Tf 1 0 0 1 484.22 505.06 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 504.68 505.06 Tm (include) Tj ET Q q n 0 502.65 m 612 502.65 l 612 490.65 l 0 490.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 493.06 Tm (income) Tj ET BT /F2 12 Tf 1 0 0 1 38.36 493.06 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 64.72 493.06 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 73.08 493.06 Tm (source) Tj ET BT /F2 12 Tf 1 0 0 1 107.43 493.06 Tm (other) Tj ET BT /F2 12 Tf 1 0 0 1 135.12 493.06 Tm (than) Tj ET BT /F2 12 Tf 1 0 0 1 158.82 493.06 Tm (the) Tj ET 0.00392 0 0 rg BT /F2 12 Tf 1 0 0 1 176.51 493.06 Tm (Employer) Tj ET 0 0 0 rg BT /F2 12 Tf 1 0 0 1 223.83 493.06 Tm (.) Tj ET BT /F2 12 Tf 1 0 0 1 232.9 493.06 Tm (It) Tj ET BT /F2 12 Tf 1 0 0 1 243.27 493.06 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 264.97 493.06 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 283.34 493.06 Tm (exceed) Tj ET BT /F2 12 Tf 1 0 0 1 319.68 493.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 337.37 493.06 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 376.4 493.06 Tm (shown) Tj ET BT /F2 12 Tf 1 0 0 1 410.77 493.06 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 423.14 493.06 Tm (the) Tj ET 0.00392 0 0 rg BT /F2 12 Tf 1 0 0 1 440.84 493.06 Tm (Employer's) Tj ET 0 0 0 rg BT /F2 12 Tf 1 0 0 1 498.02 493.06 Tm (financial) Tj ET Q q n 0 490.65 m 612 490.65 l 612 478.65 l 0 478.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 481.06 Tm (records or the amount for which premium has been paid; whichever is less.) Tj ET Q q n 0 478.65 m 612 478.65 l 612 466.65 l 0 466.65 l h W n Q q n 0 466.65 m 612 466.65 l 612 454.65 l 0 454.65 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 184.83 457.06 Tm (LIFE AND AD&D) Tj ET BT /F4 12 Tf 1 0 0 1 283.83 457.06 Tm (INSURANCE) Tj ET Q q n 0 450.35 m 273.55 450.35 l 273.55 438.35 l 0 438.35 l h W n Q q n 273.55 450.35 m 547.2 450.35 l 547.2 438.35 l 273.55 438.35 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 367.25 440.76 Tm (Benefit Amount) Tj ET Q q n 0 431.75 m 275.75 431.75 l 275.75 419.75 l 0 419.75 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 422.16 Tm (Personal Life Insurance) Tj ET Q q n 275.75 431.75 m 545.75 431.75 l 545.75 419.75 l 275.75 419.75 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.75 422.16 Tm (You) Tj ET BT /F2 12 Tf 1 0 0 1 305.41 422.16 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 335.06 422.16 Tm (elect) Tj ET BT /F2 12 Tf 1 0 0 1 366.7 422.16 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 395.68 422.16 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 451.31 422.16 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 469.63 422.16 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 495.95 422.16 Tm ($10,000) Tj ET Q q n 275.75 419.75 m 545.75 419.75 l 545.75 407.75 l 275.75 407.75 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.75 410.16 Tm (increment;) Tj ET BT /F2 12 Tf 1 0 0 1 330.38 410.16 Tm (subject) Tj ET BT /F2 12 Tf 1 0 0 1 367.7 410.16 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 380.36 410.16 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 389.01 410.16 Tm (maximum) Tj ET BT /F2 12 Tf 1 0 0 1 440.99 410.16 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 454.31 410.16 Tm (Five) Tj ET BT /F2 12 Tf 1 0 0 1 478.97 410.16 Tm (times) Tj ET BT /F2 12 Tf 1 0 0 1 508.29 410.16 Tm (Basic) Tj ET Q q n 275.75 407.75 m 545.75 407.75 l 545.75 395.75 l 275.75 395.75 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.75 398.16 Tm (Annual) Tj ET BT /F2 12 Tf 1 0 0 1 321.51 398.16 Tm (Earnings) Tj ET BT /F2 12 Tf 1 0 0 1 374.6 398.16 Tm ($rounded) Tj ET BT /F2 12 Tf 1 0 0 1 428.35 398.16 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 448.11 398.16 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 473.2 398.16 Tm (next) Tj ET BT /F2 12 Tf 1 0 0 1 504.29 398.16 Tm (higher) Tj ET Q q n 275.75 395.75 m 545.75 395.75 l 545.75 383.75 l 275.75 383.75 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.75 386.16 Tm ($10,000$.) Tj ET BT /F2 12 Tf 1 0 0 1 329.45 386.16 Tm (Coverage) Tj ET BT /F2 12 Tf 1 0 0 1 383.13 386.16 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 398.83 386.16 Tm (subject) Tj ET BT /F2 12 Tf 1 0 0 1 440.52 386.16 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 457.56 386.16 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 470.58 386.16 Tm (minimum) Tj ET BT /F2 12 Tf 1 0 0 1 524.95 386.16 Tm (of) Tj ET Q q n 275.75 383.75 m 545.75 383.75 l 545.75 371.75 l 275.75 371.75 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.75 374.16 Tm ($10,000) Tj ET BT /F2 12 Tf 1 0 0 1 317.95 374.16 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 338.47 374.16 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 353 374.16 Tm (overall) Tj ET BT /F2 12 Tf 1 0 0 1 389.51 374.16 Tm (maximum) Tj ET BT /F2 12 Tf 1 0 0 1 441.37 374.16 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 454.56 374.16 Tm ($600,000.) Tj ET BT /F2 12 Tf 1 0 0 1 505.76 374.16 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 516.95 374.16 Tm (you) Tj ET Q q n 275.75 371.75 m 545.75 371.75 l 545.75 359.75 l 275.75 359.75 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.75 362.16 Tm (initially) Tj ET BT /F2 12 Tf 1 0 0 1 318.02 362.16 Tm (become) Tj ET BT /F2 12 Tf 1 0 0 1 360.28 362.16 Tm (insured) Tj ET BT /F2 12 Tf 1 0 0 1 400.55 362.16 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 427.48 362.16 Tm (attaining) Tj ET BT /F2 12 Tf 1 0 0 1 474.41 362.16 Tm (age) Tj ET BT /F2 12 Tf 1 0 0 1 496.01 362.16 Tm (70) Tj ET BT /F2 12 Tf 1 0 0 1 512.95 362.16 Tm (your) Tj ET Q q n 275.75 359.75 m 545.75 359.75 l 545.75 347.75 l 275.75 347.75 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.75 350.16 Tm (benefit is subject to a maximum of $50,000.) Tj ET Q q n 0 346.6 m 612 346.6 l 612 334.6 l 0 334.6 l h W n Q q n 0 334.6 m 275.4 334.6 l 275.4 322.6 l 0 322.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 325.01 Tm (AD&D Insurance Principal Sum) Tj ET Q q n 275.4 334.6 m 545.4 334.6 l 545.4 322.6 l 275.4 322.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.4 325.01 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 299.66 325.01 Tm (Principal) Tj ET BT /F2 12 Tf 1 0 0 1 348.59 325.01 Tm (Sum) Tj ET BT /F2 12 Tf 1 0 0 1 376.21 325.01 Tm (equals) Tj ET BT /F2 12 Tf 1 0 0 1 412.47 325.01 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 432.73 325.01 Tm (Amount) Tj ET BT /F2 12 Tf 1 0 0 1 477.67 325.01 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 493.27 325.01 Tm (Personal) Tj ET Q q n 275.4 322.6 m 545.4 322.6 l 545.4 310.6 l 275.4 310.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.4 313.01 Tm (Life Insurance.) Tj ET Q q n 0 309.45 m 550.8 309.45 l 550.8 297.45 l 0 297.45 l h W n Q q n 0 296.3 m 612 296.3 l 612 284.3 l 0 284.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 286.71 Tm (Personal Life and AD&D Insurance will be reduced as follows:) Tj ET Q q n 0 284.3 m 612 284.3 l 612 272.3 l 0 272.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 274.71 Tm (-) Tj ET BT /F2 12 Tf 1 0 0 1 18 274.71 Tm (At age 65, benefits will reduce by 35% of the original amount;) Tj ET Q q n 0 272.3 m 612 272.3 l 612 260.3 l 0 260.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 262.71 Tm (-) Tj ET BT /F2 12 Tf 1 0 0 1 18 262.71 Tm (At age 70, benefits will reduce an additional 15% of the original amount.) Tj ET Q q n 0 260.3 m 612 260.3 l 612 248.3 l 0 248.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 250.71 Tm (Benefits will terminate when you retire.) Tj ET Q q n 0 248.3 m 612 248.3 l 612 236.3 l 0 236.3 l h W n Q q n 0 236.3 m 612 236.3 l 612 224.3 l 0 224.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 226.71 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 11.08 226.71 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 32.18 226.71 Tm (first) Tj ET BT /F2 12 Tf 1 0 0 1 54.6 226.71 Tm (enroll) Tj ET BT /F2 12 Tf 1 0 0 1 85.68 226.71 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 102.77 226.71 Tm (Personal) Tj ET BT /F2 12 Tf 1 0 0 1 147.18 226.71 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 170.26 226.71 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 190.68 226.71 Tm (AD&D) Tj ET BT /F2 12 Tf 1 0 0 1 229.1 226.71 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 278.84 226.71 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 290.59 226.71 Tm (age) Tj ET BT /F2 12 Tf 1 0 0 1 310.33 226.71 Tm (65) Tj ET BT /F2 12 Tf 1 0 0 1 325.42 226.71 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 338.51 226.71 Tm (older,) Tj ET BT /F2 12 Tf 1 0 0 1 369.26 226.71 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 387.01 226.71 Tm (above) Tj ET BT /F2 12 Tf 1 0 0 1 418.76 226.71 Tm (age) Tj ET BT /F2 12 Tf 1 0 0 1 438.5 226.71 Tm (reductions) Tj ET BT /F2 12 Tf 1 0 0 1 491.58 226.71 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 513.34 226.71 Tm (apply) Tj ET Q q n 0 224.3 m 612 224.3 l 612 212.3 l 0 212.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 214.71 Tm (to:) Tj ET Q q n 0 212.3 m 612 212.3 l 612 200.3 l 0 200.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 202.71 Tm (-) Tj ET BT /F2 12 Tf 1 0 0 1 18 202.71 Tm (Any Guarantee Issue Amount available without evidence of insurability; and) Tj ET Q q n 0 200.3 m 612 200.3 l 612 188.3 l 0 188.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 190.71 Tm (-) Tj ET BT /F2 12 Tf 1 0 0 1 18 190.71 Tm (The maximum amount of insurance for which you are eligible.) Tj ET Q q n 0 188.3 m 550.8 188.3 l 550.8 176.3 l 0 176.3 l h W n Q q n 0 175.15 m 612 175.15 l 612 163.15 l 0 163.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 165.56 Tm (Evidence of Insurability must be submitted to and approved by the Company when:) Tj ET Q q n 18 163.15 m 630 163.15 l 630 151.15 l 18 151.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 153.56 Tm (1) Tj ET BT /F2 12 Tf 1 0 0 1 24 153.56 Tm (.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 153.56 Tm (Personal) Tj ET BT /F2 12 Tf 1 0 0 1 89.69 153.56 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 112.68 153.56 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 133.02 153.56 Tm (AD&D) Tj ET BT /F2 12 Tf 1 0 0 1 171.36 153.56 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 221.01 153.56 Tm (amounts) Tj ET BT /F2 12 Tf 1 0 0 1 264.68 153.56 Tm (exceed) Tj ET BT /F2 12 Tf 1 0 0 1 301 153.56 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 318.67 153.56 Tm (guarantee) Tj ET BT /F2 12 Tf 1 0 0 1 368.31 153.56 Tm (issue) Tj ET BT /F2 12 Tf 1 0 0 1 395.32 153.56 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 434.33 153.56 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 447.33 153.56 Tm ($250,000) Tj ET BT /F2 12 Tf 1 0 0 1 495.34 153.56 Tm (at) Tj ET Q q n 45.35 151.15 m 657.35 151.15 l 657.35 139.15 l 45.35 139.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 141.56 Tm (initial enrollment;) Tj ET Q q n 18 139.15 m 630 139.15 l 630 127.15 l 18 127.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 129.56 Tm (2) Tj ET BT /F2 12 Tf 1 0 0 1 24 129.56 Tm (.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 129.56 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 67.63 129.56 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 105.91 129.56 Tm (option) Tj ET BT /F2 12 Tf 1 0 0 1 141.53 129.56 Tm (increase) Tj ET BT /F2 12 Tf 1 0 0 1 185.79 129.56 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 200.74 129.56 Tm (new) Tj ET BT /F2 12 Tf 1 0 0 1 225.69 129.56 Tm (election) Tj ET BT /F2 12 Tf 1 0 0 1 268.63 129.56 Tm (requested) Tj ET BT /F2 12 Tf 1 0 0 1 319.56 129.56 Tm (during) Tj ET BT /F2 12 Tf 1 0 0 1 355.85 129.56 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 375.47 129.56 Tm (specified) Tj ET BT /F2 12 Tf 1 0 0 1 423.73 129.56 Tm (open) Tj ET BT /F2 12 Tf 1 0 0 1 452.02 129.56 Tm (enrollment) Tj ET Q q n 45.35 127.15 m 657.35 127.15 l 657.35 115.15 l 45.35 115.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 117.56 Tm (period) Tj ET BT /F2 12 Tf 1 0 0 1 81.44 117.56 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 116.21 117.56 Tm (exceeds) Tj ET BT /F2 12 Tf 1 0 0 1 159.62 117.56 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 179.71 117.56 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 221.15 117.56 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 236.58 117.56 Tm (Personal) Tj ET BT /F2 12 Tf 1 0 0 1 283.34 117.56 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 308.76 117.56 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 331.53 117.56 Tm (AD&D) Tj ET BT /F2 12 Tf 1 0 0 1 372.3 117.56 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 424.37 117.56 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 441.81 117.56 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 471.9 117.56 Tm (than) Tj ET BT /F2 12 Tf 1 0 0 1 498 117.56 Tm (2) Tj ET Q q n 45.35 115.15 m 657.35 115.15 l 657.35 103.15 l 45.35 103.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 105.56 Tm (increment level$s$;) Tj ET Q q n 18 103.15 m 630 103.15 l 630 91.15 l 18 91.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 93.56 Tm (3) Tj ET BT /F2 12 Tf 1 0 0 1 24 93.56 Tm (.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 93.56 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 61.56 93.56 Tm (increased) Tj ET BT /F2 12 Tf 1 0 0 1 111.75 93.56 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 152.63 93.56 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 167.5 93.56 Tm (Personal) Tj ET BT /F2 12 Tf 1 0 0 1 213.71 93.56 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 238.58 93.56 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 260.79 93.56 Tm (AD&D) Tj ET BT /F2 12 Tf 1 0 0 1 301.01 93.56 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 352.53 93.56 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 400.72 93.56 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 413.6 93.56 Tm (requested) Tj ET BT /F2 12 Tf 1 0 0 1 464.46 93.56 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 486.67 93.56 Tm (any) Tj ET Q q n 45.35 91.15 m 657.35 91.15 l 657.35 79.15 l 45.35 79.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 81.56 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 86.3 81.56 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 101.25 81.56 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 149.5 81.56 Tm (has) Tj ET BT /F2 12 Tf 1 0 0 1 170.45 81.56 Tm (been) Tj ET BT /F2 12 Tf 1 0 0 1 198.06 81.56 Tm (previously) Tj ET BT /F2 12 Tf 1 0 0 1 253.67 81.56 Tm (withdrawn) Tj ET BT /F2 12 Tf 1 0 0 1 309.95 81.56 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 324.89 81.56 Tm (declined) Tj ET BT /F2 12 Tf 1 0 0 1 370.49 81.56 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 385.44 81.56 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 398.4 81.56 Tm (pending) Tj ET BT /F2 12 Tf 1 0 0 1 442.01 81.56 Tm (underwriting) Tj ET Q q n 45.35 79.15 m 657.35 79.15 l 657.35 67.15 l 45.35 67.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 69.56 Tm (review; or) Tj ET Q q n 18 67.15 m 630 67.15 l 630 55.15 l 18 55.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 57.56 Tm (4) Tj ET BT /F2 12 Tf 1 0 0 1 24 57.56 Tm (.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 57.56 Tm (initial coverage is elected more than 31 days after first becoming eligible.) Tj ET Q q n 0 55.15 m 612 55.15 l 612 43.15 l 0 43.15 l h W n Q q n 0 43.15 m 612 43.15 l 612 31.15 l 0 31.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 33.56 Tm (If any evidence of insurability is required, it will be provided at your own expense.) Tj ET Q Q q Q Q endstream endobj 4 0 obj <>>>>> endobj 47 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 669.7 cm q n 0 86.3 m 550.8 86.3 l 550.8 74.3 l 0 74.3 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 216.51 76.71 Tm (É«ÖÐÉ« University) Tj ET Q q n 0 74.3 m 550.8 74.3 l 550.8 62.3 l 0 62.3 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 217 64.71 Tm (000400001000-22982) Tj ET Q q n 0 62.3 m 550.8 62.3 l 550.8 50.3 l 0 50.3 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 189.99 52.71 Tm (SCHEDULE OF INSURANCE) Tj ET Q q n 0 49.15 m 550.8 49.15 l 550.8 37.15 l 0 37.15 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 260.67 39.56 Tm (For) Tj ET Q q n 0 37.15 m 550.8 37.15 l 550.8 25.15 l 0 25.15 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 166.66 27.56 Tm (Class) Tj ET BT /F4 12 Tf 1 0 0 1 197 27.56 Tm (1) Tj ET BT /F4 12 Tf 1 0 0 1 203 27.56 Tm (LIFE AND AD&D) Tj ET BT /F4 12 Tf 1 0 0 1 302 27.56 Tm (INSURANCE) Tj ET Q q n 0 25.15 m 550.8 25.15 l 550.8 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 239 15.56 Tm ($Continued$) Tj ET Q q n 0 13.15 m 550.8 13.15 l 550.8 1.15 l 0 1.15 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 270.1 25.15 l 270.1 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-SB) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm 0 0 0 rg BT /F4 12 Tf 1 0 0 1 192.49 598.81 Tm (DEPENDENTS INSURANCE) Tj ET BT /F2 12 Tf 1 0 0 1 367.25 580.71 Tm (Benefit Amount) Tj ET q n 0 572.15 m 275.4 572.15 l 275.4 560.15 l 0 560.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 562.56 Tm (Spouse Life Insurance) Tj ET Q q n 275.4 572.15 m 545.4 572.15 l 545.4 560.15 l 275.4 560.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.4 562.56 Tm (You) Tj ET BT /F2 12 Tf 1 0 0 1 305.92 562.56 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 336.42 562.56 Tm (elect) Tj ET BT /F2 12 Tf 1 0 0 1 368.92 562.56 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 398.75 562.56 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 455.24 562.56 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 474.43 562.56 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 501.6 562.56 Tm ($5,000) Tj ET Q q n 275.4 560.15 m 545.4 560.15 l 545.4 548.15 l 275.4 548.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.4 550.56 Tm (increment;) Tj ET BT /F2 12 Tf 1 0 0 1 332.54 550.56 Tm (subject) Tj ET BT /F2 12 Tf 1 0 0 1 372.35 550.56 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 387.51 550.56 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 398.66 550.56 Tm (maximum) Tj ET BT /F2 12 Tf 1 0 0 1 453.14 550.56 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 468.96 550.56 Tm (50%) Tj ET BT /F2 12 Tf 1 0 0 1 496.78 550.56 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 512.6 550.56 Tm (your) Tj ET Q q n 275.4 548.15 m 545.4 548.15 l 545.4 536.15 l 275.4 536.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.4 538.56 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 300.9 538.56 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 353.06 538.56 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 393.9 538.56 Tm ($rounded) Tj ET BT /F2 12 Tf 1 0 0 1 442.74 538.56 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 457.59 538.56 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 477.77 538.56 Tm (next) Tj ET BT /F2 12 Tf 1 0 0 1 503.94 538.56 Tm (higher) Tj ET Q q n 275.4 536.15 m 545.4 536.15 l 545.4 524.15 l 275.4 524.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.4 526.56 Tm ($5,000$.) Tj ET BT /F2 12 Tf 1 0 0 1 318.76 526.56 Tm (Coverage) Tj ET BT /F2 12 Tf 1 0 0 1 368.1 526.56 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 379.47 526.56 Tm (subject) Tj ET BT /F2 12 Tf 1 0 0 1 416.82 526.56 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 429.52 526.56 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 438.21 526.56 Tm (minimum) Tj ET BT /F2 12 Tf 1 0 0 1 488.24 526.56 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 501.6 526.56 Tm ($5,000) Tj ET Q q n 275.4 524.15 m 545.4 524.15 l 545.4 512.15 l 275.4 512.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.4 514.56 Tm (and an overall maximum of $250,000.) Tj ET Q q n 0 511 m 612 511 l 612 499 l 0 499 l h W n Q q n 0 499 m 275.4 499 l 275.4 487 l 0 487 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 489.41 Tm (Spouse AD&D Insurance Principal Sum) Tj ET Q q n 275.4 499 m 545.4 499 l 545.4 487 l 275.4 487 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.4 489.41 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 297.3 489.41 Tm (Principal) Tj ET BT /F2 12 Tf 1 0 0 1 343.86 489.41 Tm (Sum) Tj ET BT /F2 12 Tf 1 0 0 1 369.1 489.41 Tm (equals) Tj ET BT /F2 12 Tf 1 0 0 1 403 489.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 420.9 489.41 Tm (Amount) Tj ET BT /F2 12 Tf 1 0 0 1 463.47 489.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 476.71 489.41 Tm (Spouse) Tj ET BT /F2 12 Tf 1 0 0 1 514.61 489.41 Tm (Life) Tj ET Q q n 275.4 487 m 545.4 487 l 545.4 475 l 275.4 475 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.4 477.41 Tm (Insurance.) Tj ET Q q n 0 473.85 m 273.55 473.85 l 273.55 461.85 l 0 461.85 l h W n Q q n 273.55 473.85 m 547.2 473.85 l 547.2 461.85 l 273.55 461.85 l h W n Q q n 0 461.85 m 273.55 461.85 l 273.55 449.85 l 0 449.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 452.26 Tm (Child Life Insurance) Tj ET Q q n 273.55 461.85 m 547.2 461.85 l 547.2 449.85 l 273.55 449.85 l h W n Q q n 0 448.7 m 275.4 448.7 l 275.4 436.7 l 0 436.7 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 6 439.11 Tm (Option 1:) Tj ET Q q n 0 433.75 m 275.4 433.75 l 275.4 421.75 l 0 421.75 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 424.16 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 76.44 424.16 Tm (Child) Tj ET BT /F2 12 Tf 1 0 0 1 109.56 424.16 Tm ($age) Tj ET BT /F2 12 Tf 1 0 0 1 136.67 424.16 Tm (14) Tj ET BT /F2 12 Tf 1 0 0 1 155.13 424.16 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 183.58 424.16 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 199.37 424.16 Tm (19) Tj ET BT /F2 12 Tf 1 0 0 1 217.83 424.16 Tm (years,) Tj ET BT /F2 12 Tf 1 0 0 1 252.6 424.16 Tm (25) Tj ET Q q n 18 421.75 m 293.4 421.75 l 293.4 409.75 l 18 409.75 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 412.16 Tm (years if a full-time student$) Tj ET Q q n 275.4 433.75 m 545.4 433.75 l 545.4 421.75 l 275.4 421.75 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 388.5 424.16 Tm ($2,500) Tj ET Q q n 0 408.6 m 612 408.6 l 612 396.6 l 0 396.6 l h W n Q q n 0 396.6 m 275.4 396.6 l 275.4 384.6 l 0 384.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 6 387.01 Tm (Option 2:) Tj ET Q q n 0 381.65 m 275.4 381.65 l 275.4 369.65 l 0 369.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 372.06 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 76.44 372.06 Tm (Child) Tj ET BT /F2 12 Tf 1 0 0 1 109.56 372.06 Tm ($age) Tj ET BT /F2 12 Tf 1 0 0 1 136.67 372.06 Tm (14) Tj ET BT /F2 12 Tf 1 0 0 1 155.13 372.06 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 183.58 372.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 199.37 372.06 Tm (19) Tj ET BT /F2 12 Tf 1 0 0 1 217.83 372.06 Tm (years,) Tj ET BT /F2 12 Tf 1 0 0 1 252.6 372.06 Tm (25) Tj ET Q q n 18 369.65 m 293.4 369.65 l 293.4 357.65 l 18 357.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 360.06 Tm (years if a full-time student$) Tj ET Q q n 275.4 381.65 m 545.4 381.65 l 545.4 369.65 l 275.4 369.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 388.5 372.06 Tm ($5,000) Tj ET Q q n 0 356.5 m 612 356.5 l 612 344.5 l 0 344.5 l h W n Q q n 0 344.5 m 275.4 344.5 l 275.4 332.5 l 0 332.5 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 6 334.91 Tm (Option 3:) Tj ET Q q n 0 329.55 m 275.4 329.55 l 275.4 317.55 l 0 317.55 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 319.96 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 76.44 319.96 Tm (Child) Tj ET BT /F2 12 Tf 1 0 0 1 109.56 319.96 Tm ($age) Tj ET BT /F2 12 Tf 1 0 0 1 136.67 319.96 Tm (14) Tj ET BT /F2 12 Tf 1 0 0 1 155.13 319.96 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 183.58 319.96 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 199.37 319.96 Tm (19) Tj ET BT /F2 12 Tf 1 0 0 1 217.83 319.96 Tm (years,) Tj ET BT /F2 12 Tf 1 0 0 1 252.6 319.96 Tm (25) Tj ET Q q n 18 317.55 m 293.4 317.55 l 293.4 305.55 l 18 305.55 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 307.96 Tm (years if a full-time student$) Tj ET Q q n 275.4 329.55 m 545.4 329.55 l 545.4 317.55 l 275.4 317.55 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 388.5 319.96 Tm ($7,500) Tj ET Q q n 0 304.4 m 612 304.4 l 612 292.4 l 0 292.4 l h W n Q q n 0 292.4 m 275.4 292.4 l 275.4 280.4 l 0 280.4 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 6 282.81 Tm (Option 4:) Tj ET Q q n 0 277.45 m 275.4 277.45 l 275.4 265.45 l 0 265.45 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 267.86 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 76.44 267.86 Tm (Child) Tj ET BT /F2 12 Tf 1 0 0 1 109.56 267.86 Tm ($age) Tj ET BT /F2 12 Tf 1 0 0 1 136.67 267.86 Tm (14) Tj ET BT /F2 12 Tf 1 0 0 1 155.13 267.86 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 183.58 267.86 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 199.37 267.86 Tm (19) Tj ET BT /F2 12 Tf 1 0 0 1 217.83 267.86 Tm (years,) Tj ET BT /F2 12 Tf 1 0 0 1 252.6 267.86 Tm (25) Tj ET Q q n 18 265.45 m 293.4 265.45 l 293.4 253.45 l 18 253.45 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 255.86 Tm (years if a full-time student$) Tj ET Q q n 275.4 277.45 m 545.4 277.45 l 545.4 265.45 l 275.4 265.45 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 385.5 267.86 Tm ($10,000) Tj ET Q q n 0 252.3 m 550.8 252.3 l 550.8 240.3 l 0 240.3 l h W n Q q n 0 239.15 m 612 239.15 l 612 227.15 l 0 227.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 229.56 Tm (Spouse Life and AD&D Insurance will be reduced as follows:) Tj ET Q q n 0 227.15 m 612 227.15 l 612 215.15 l 0 215.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 217.56 Tm (-) Tj ET BT /F2 12 Tf 1 0 0 1 18 217.56 Tm (by 35% of the original amount when your Spouse attains age 65;) Tj ET Q q n 0 215.15 m 612 215.15 l 612 203.15 l 0 203.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 205.56 Tm (-) Tj ET BT /F2 12 Tf 1 0 0 1 18 205.56 Tm (by an additional 15% of the original amount when your Spouse attains age 70.) Tj ET Q q n 0 203.15 m 612 203.15 l 612 191.15 l 0 191.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 193.56 Tm (Spouse Insurance will terminate when you retire.) Tj ET Q q n 0 191.15 m 550.8 191.15 l 550.8 179.15 l 0 179.15 l h W n Q 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 167.31 Tm (Evidence of Insurability must be submitted to and approved by the Company when:) Tj ET q n 18 164.21 m 630 164.21 l 630 152.21 l 18 152.21 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 154.61 Tm (1) Tj ET BT /F2 12 Tf 1 0 0 1 24 154.61 Tm (.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 154.61 Tm (Spouse) Tj ET BT /F2 12 Tf 1 0 0 1 84 154.61 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 107.97 154.61 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 129.28 154.61 Tm (AD&D) Tj ET BT /F2 12 Tf 1 0 0 1 168.6 154.61 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 219.22 154.61 Tm (amounts) Tj ET BT /F2 12 Tf 1 0 0 1 263.87 154.61 Tm (exceed) Tj ET BT /F2 12 Tf 1 0 0 1 301.16 154.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 319.8 154.61 Tm (guarantee) Tj ET BT /F2 12 Tf 1 0 0 1 370.42 154.61 Tm (issue) Tj ET BT /F2 12 Tf 1 0 0 1 398.4 154.61 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 438.38 154.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 452.36 154.61 Tm ($50,000) Tj ET BT /F2 12 Tf 1 0 0 1 495.34 154.61 Tm (at) Tj ET Q q n 45.35 152.21 m 657.35 152.21 l 657.35 140.21 l 45.35 140.21 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 142.61 Tm (initial enrollment;) Tj ET Q q n 18 140.21 m 630 140.21 l 630 128.21 l 18 128.21 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 130.61 Tm (2) Tj ET BT /F2 12 Tf 1 0 0 1 24 130.61 Tm (.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 130.61 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 67.63 130.61 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 105.91 130.61 Tm (option) Tj ET BT /F2 12 Tf 1 0 0 1 141.53 130.61 Tm (increase) Tj ET BT /F2 12 Tf 1 0 0 1 185.79 130.61 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 200.74 130.61 Tm (new) Tj ET BT /F2 12 Tf 1 0 0 1 225.69 130.61 Tm (election) Tj ET BT /F2 12 Tf 1 0 0 1 268.63 130.61 Tm (requested) Tj ET BT /F2 12 Tf 1 0 0 1 319.56 130.61 Tm (during) Tj ET BT /F2 12 Tf 1 0 0 1 355.85 130.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 375.47 130.61 Tm (specified) Tj ET BT /F2 12 Tf 1 0 0 1 423.73 130.61 Tm (open) Tj ET BT /F2 12 Tf 1 0 0 1 452.02 130.61 Tm (enrollment) Tj ET Q q n 45.35 128.21 m 657.35 128.21 l 657.35 116.21 l 45.35 116.21 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 118.61 Tm (period) Tj ET BT /F2 12 Tf 1 0 0 1 81.92 118.61 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 117.16 118.61 Tm (exceeds) Tj ET BT /F2 12 Tf 1 0 0 1 161.04 118.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 181.62 118.61 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 223.52 118.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 239.43 118.61 Tm (Spouse) Tj ET BT /F2 12 Tf 1 0 0 1 280.01 118.61 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 305.91 118.61 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 329.15 118.61 Tm (AD&D) Tj ET BT /F2 12 Tf 1 0 0 1 370.39 118.61 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 422.95 118.61 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 440.86 118.61 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 471.43 118.61 Tm (than) Tj ET BT /F2 12 Tf 1 0 0 1 498 118.61 Tm (2) Tj ET Q q n 45.35 116.21 m 657.35 116.21 l 657.35 104.21 l 45.35 104.21 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 106.61 Tm (increment level$s$;) Tj ET Q q n 18 104.2 m 630 104.2 l 630 92.2 l 18 92.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 94.61 Tm (3) Tj ET BT /F2 12 Tf 1 0 0 1 24 94.61 Tm (.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 94.61 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 62.07 94.61 Tm (increased) Tj ET BT /F2 12 Tf 1 0 0 1 112.77 94.61 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 154.16 94.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 169.55 94.61 Tm (Spouse) Tj ET BT /F2 12 Tf 1 0 0 1 209.62 94.61 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 235 94.61 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 257.72 94.61 Tm (AD&D) Tj ET BT /F2 12 Tf 1 0 0 1 298.45 94.61 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 350.48 94.61 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 399.18 94.61 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 412.58 94.61 Tm (requested) Tj ET BT /F2 12 Tf 1 0 0 1 463.95 94.61 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 486.67 94.61 Tm (any) Tj ET Q q n 45.35 92.2 m 657.35 92.2 l 657.35 80.2 l 45.35 80.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 82.61 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 86.3 82.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 101.25 82.61 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 149.5 82.61 Tm (has) Tj ET BT /F2 12 Tf 1 0 0 1 170.45 82.61 Tm (been) Tj ET BT /F2 12 Tf 1 0 0 1 198.06 82.61 Tm (previously) Tj ET BT /F2 12 Tf 1 0 0 1 253.67 82.61 Tm (withdrawn) Tj ET BT /F2 12 Tf 1 0 0 1 309.95 82.61 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 324.89 82.61 Tm (declined) Tj ET BT /F2 12 Tf 1 0 0 1 370.49 82.61 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 385.44 82.61 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 398.4 82.61 Tm (pending) Tj ET BT /F2 12 Tf 1 0 0 1 442.01 82.61 Tm (underwriting) Tj ET Q q n 45.35 80.2 m 657.35 80.2 l 657.35 68.2 l 45.35 68.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 70.61 Tm (review; or) Tj ET Q q n 18 68.2 m 630 68.2 l 630 56.2 l 18 56.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 58.61 Tm (4) Tj ET BT /F2 12 Tf 1 0 0 1 24 58.61 Tm (.) 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/F2 12 Tf 1 0 0 1 101.97 646.16 Tm (................................................................................................................................................) Tj ET BT /F2 12 Tf 1 0 0 1 534 646.16 Tm (3) Tj ET BT /F2 12 Tf 1 0 0 1 0 618.56 Tm (Definitions) Tj ET BT /F2 12 Tf 1 0 0 1 53.99 618.56 Tm (................................................................................................................................................................) Tj ET BT /F2 12 Tf 1 0 0 1 534 618.56 Tm (3) Tj ET BT /F2 12 Tf 1 0 0 1 0 590.96 Tm (Eligibility) Tj ET BT /F2 12 Tf 1 0 0 1 48.67 590.96 Tm (.................................................................................................................................................................) Tj ET BT /F2 12 Tf 1 0 0 1 534 590.96 Tm (4) Tj ET BT /F2 12 Tf 1 0 0 1 0 563.36 Tm (Effective Dates of Coverages) Tj ET BT /F2 12 Tf 1 0 0 1 140.94 563.36 Tm (...................................................................................................................................) 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Tj ET BT /F2 12 Tf 1 0 0 1 528 314.99 Tm (12) Tj ET BT /F2 12 Tf 1 0 0 1 0 287.39 Tm (Accidental Death and Dismemberment Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 236.57 287.39 Tm (.................................................................................................) Tj ET BT /F2 12 Tf 1 0 0 1 528 287.39 Tm (14) Tj ET BT /F2 12 Tf 1 0 0 1 0 259.79 Tm (Safe Driver Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 93.96 259.79 Tm (................................................................................................................................................) Tj ET BT /F2 12 Tf 1 0 0 1 528 259.79 Tm (16) Tj ET BT /F2 12 Tf 1 0 0 1 0 232.19 Tm (Accelerated Death Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 127.26 232.19 Tm (.....................................................................................................................................) Tj ET BT /F2 12 Tf 1 0 0 1 528 232.19 Tm (17) Tj ET BT /F2 12 Tf 1 0 0 1 0 204.59 Tm (Prior Insurance Credit Provision) Tj ET BT /F2 12 Tf 1 0 0 1 155.64 204.59 Tm (............................................................................................................................) Tj ET BT /F2 12 Tf 1 0 0 1 528 204.59 Tm (20) Tj ET BT /F2 12 Tf 1 0 0 1 0 177 Tm (Certificate Amendment) Tj ET BT /F2 12 Tf 1 0 0 1 112.96 177 Tm (..........................................................................................................................................) Tj ET BT /F2 12 Tf 1 0 0 1 528 177 Tm (21) Tj ET BT /F2 12 Tf 1 0 0 1 0 149.4 Tm (Claims Procedures Amendment) Tj ET BT /F2 12 Tf 1 0 0 1 152.64 149.4 Tm (.............................................................................................................................) Tj ET BT /F2 12 Tf 1 0 0 1 528 149.4 Tm (22) Tj ET BT /F2 12 Tf 1 0 0 1 0 121.8 Tm (Claims Procedures for Life or Accidental Death and Dismemberment Benefits) Tj ET BT /F2 12 Tf 1 0 0 1 376.21 121.8 Tm (..................................................) Tj ET BT /F2 12 Tf 1 0 0 1 528 121.8 Tm (23) Tj ET BT /F2 12 Tf 1 0 0 1 0 94.2 Tm (Notice) Tj ET BT /F2 12 Tf 1 0 0 1 31.99 94.2 Tm (.....................................................................................................................................................................) Tj ET BT /F2 12 Tf 1 0 0 1 528 94.2 Tm (26) Tj ET BT /F2 12 Tf 1 0 0 1 0 66.61 Tm (Suicide Exclusion) Tj ET BT /F2 12 Tf 1 0 0 1 86.99 66.61 Tm (...................................................................................................................................................) Tj ET BT /F2 12 Tf 1 0 0 1 528 66.61 Tm (28) Tj ET Q q Q Q endstream endobj 7 0 obj <>>>>> endobj 138 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 744 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0.00392 0 0 rg BT /F4 12 Tf 1 0 0 1 195.67 2.41 Tm (AMOUNT OF INSURANCE) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 270.1 25.15 l 270.1 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-1 VIT) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 272.9 3.56 Tm (3) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 670 m 612 670 l 612 658 l 0 658 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 660.41 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 22.23 660.41 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 61.79 660.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 75.35 660.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 100.92 660.41 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 150.47 660.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 162.04 660.41 Tm (determined) Tj ET BT /F2 12 Tf 1 0 0 1 219.58 660.41 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 235.15 660.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 253.38 660.41 Tm (Schedule) Tj ET BT /F2 12 Tf 1 0 0 1 300.94 660.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 314.5 660.41 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 364.71 660.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 377.62 660.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 395.85 660.41 Tm (Policy.) Tj ET BT /F2 12 Tf 1 0 0 1 436.65 660.41 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 458.88 660.41 Tm (initial) Tj ET BT /F2 12 Tf 1 0 0 1 490.44 660.41 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 530 660.41 Tm (of) Tj ET Q q n 0 658 m 612 658 l 612 646 l 0 646 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 648.41 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 47.02 648.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 58.74 648.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 77.12 648.41 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 116.83 648.41 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 149.87 648.41 Tm (applies) Tj ET BT /F2 12 Tf 1 0 0 1 187.58 648.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 200.63 648.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 226.34 648.41 Tm (classification) Tj ET BT /F2 12 Tf 1 0 0 1 293.37 648.41 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 309.08 648.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 327.46 648.41 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 348.51 648.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 374.22 648.41 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 421.24 648.41 Tm (becomes) Tj ET BT /F2 12 Tf 1 0 0 1 466.94 648.41 Tm (effective.) Tj ET BT /F2 12 Tf 1 0 0 1 519.33 648.41 Tm (You) Tj ET Q q n 0 646 m 612 646 l 612 634 l 0 634 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 636.41 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 24.99 636.41 Tm (become) Tj ET BT /F2 12 Tf 1 0 0 1 66.62 636.41 Tm (eligible) Tj ET BT /F2 12 Tf 1 0 0 1 106.94 636.41 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 125.25 636.41 Tm (increases) Tj ET BT /F2 12 Tf 1 0 0 1 173.55 636.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 187.21 636.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 206.2 636.41 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 246.52 636.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 260.84 636.41 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 311.14 636.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 324.8 636.41 Tm (accordance) Tj ET BT /F2 12 Tf 1 0 0 1 383.08 636.41 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 408.74 636.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 427.73 636.41 Tm (Schedule) Tj ET BT /F2 12 Tf 1 0 0 1 476.04 636.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 490.36 636.41 Tm (Insurance.) Tj ET Q q n 0 634 m 612 634 l 612 622 l 0 622 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 624.41 Tm (Any such increase will be effective on:) Tj ET Q q n 18 622 m 630 622 l 630 610 l 18 610 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 612.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 612.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 64.27 612.41 Tm (first) Tj ET BT /F2 12 Tf 1 0 0 1 87.85 612.41 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 109.43 612.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 123.68 612.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 142.6 612.41 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 193.5 612.41 Tm (Month) Tj ET BT /F2 12 Tf 1 0 0 1 229.76 612.41 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 263.34 612.41 Tm (coincides) Tj ET BT /F2 12 Tf 1 0 0 1 312.91 612.41 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 338.5 612.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 352.75 612.41 Tm (follows) Tj ET BT /F2 12 Tf 1 0 0 1 393.01 612.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 411.92 612.41 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 436.16 612.41 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 452.42 612.41 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 486 612.41 Tm (you) Tj ET Q q n 45.35 610 m 657.35 610 l 657.35 598 l 45.35 598 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 600.41 Tm (become eligible for the increase; provided you are Actively at Work on that day;) Tj ET Q q n 18 598 m 630 598 l 630 586 l 18 586 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 588.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 588.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 64.21 588.41 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 85.73 588.41 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 107.92 588.41 Tm (resume) Tj ET BT /F2 12 Tf 1 0 0 1 146.77 588.41 Tm (Active) Tj ET BT /F2 12 Tf 1 0 0 1 182.95 588.41 Tm (Work,) Tj ET BT /F2 12 Tf 1 0 0 1 217.47 588.41 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 229 588.41 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 248.53 588.41 Tm (Actively) Tj ET BT /F2 12 Tf 1 0 0 1 294.04 588.41 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 306.9 588.41 Tm (Work) Tj ET BT /F2 12 Tf 1 0 0 1 338.42 588.41 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 354.61 588.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 373.47 588.41 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 394.99 588.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 413.85 588.41 Tm (increase) Tj ET BT /F2 12 Tf 1 0 0 1 457.35 588.41 Tm (otherwise) Tj ET Q q n 45.35 586 m 657.35 586 l 657.35 574 l 45.35 574 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 576.41 Tm (would have been effective; or) Tj ET Q q n 18 574 m 630 574 l 630 562 l 18 562 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 564.41 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 564.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 63.45 564.41 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 84.21 564.41 Tm (determined) Tj ET BT /F2 12 Tf 1 0 0 1 141.63 564.41 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 157.06 564.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 175.16 564.41 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 225.26 564.41 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 250.68 564.41 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 271.45 564.41 Tm (required) Tj ET BT /F2 12 Tf 1 0 0 1 314.86 564.41 Tm (evidence) Tj ET BT /F2 12 Tf 1 0 0 1 360.94 564.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 374.37 564.41 Tm (insurability) Tj ET BT /F2 12 Tf 1 0 0 1 432.47 564.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 443.91 564.41 Tm (approved) Tj ET BT /F2 12 Tf 1 0 0 1 492 564.41 Tm (by) Tj ET Q q n 45.35 562 m 657.35 562 l 657.35 550 l 45.35 550 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 552.41 Tm (the Company.) Tj ET Q q n 0 550 m 612 550 l 612 538 l 0 538 l h W n Q q n 0 538 m 612 538 l 612 526 l 0 526 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 528.41 Tm (Any decrease will take effect on the day of the change; whether or not you are Actively at Work.) Tj ET Q q n 0 526 m 612 526 l 612 514 l 0 514 l h W n Q q n 0 514 m 612 514 l 612 502 l 0 502 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 230.32 504.41 Tm (DEFINITIONS) Tj ET Q q n 0 502 m 612 502 l 612 490 l 0 490 l h W n Q q n 0 490 m 612 490 l 612 478 l 0 478 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 480.41 Tm (ACTIVE) Tj ET BT /F2 12 Tf 1 0 0 1 48 480.41 Tm (WORK) Tj ET BT /F2 12 Tf 1 0 0 1 88.67 480.41 Tm (OR) Tj ET BT /F2 12 Tf 1 0 0 1 109.35 480.41 Tm (ACTIVELY) Tj ET BT /F2 12 Tf 1 0 0 1 173.35 480.41 Tm (AT) Tj ET BT /F2 12 Tf 1 0 0 1 193.35 480.41 Tm (WORK) Tj ET BT /F2 12 Tf 1 0 0 1 234.03 480.41 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 268.69 480.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 287.36 480.41 Tm (full-time) Tj ET BT /F2 12 Tf 1 0 0 1 333.36 480.41 Tm (performance) Tj ET BT /F2 12 Tf 1 0 0 1 397.99 480.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 412 480.41 Tm (all) Tj ET BT /F2 12 Tf 1 0 0 1 428 480.41 Tm (customary) Tj ET BT /F2 12 Tf 1 0 0 1 482 480.41 Tm (duties) Tj ET BT /F2 12 Tf 1 0 0 1 514.67 480.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 528.67 480.41 Tm (an) Tj ET Q q n 0 478 m 612 478 l 612 466 l 0 466 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 468.41 Tm (employee's) Tj ET BT /F2 12 Tf 1 0 0 1 59.89 468.41 Tm (occupation) Tj ET BT /F2 12 Tf 1 0 0 1 118.95 468.41 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 134.02 468.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 155.1 468.41 Tm (EMPLOYER'S) Tj ET BT /F2 12 Tf 1 0 0 1 235.02 468.41 Tm (place) Tj ET BT /F2 12 Tf 1 0 0 1 266.74 468.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 283.15 468.41 Tm (business) Tj ET BT /F2 12 Tf 1 0 0 1 330.23 468.41 Tm ($or) Tj ET BT /F2 12 Tf 1 0 0 1 350.64 468.41 Tm (other) Tj ET BT /F2 12 Tf 1 0 0 1 381.71 468.41 Tm (business) Tj ET BT /F2 12 Tf 1 0 0 1 428.79 468.41 Tm (location) Tj ET BT /F2 12 Tf 1 0 0 1 473.85 468.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 489.6 468.41 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 468.41 Tm (the) Tj ET Q q n 0 466 m 612 466 l 612 454 l 0 454 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 456.41 Tm (EMPLOYER requires the employee to travel.$) Tj ET Q q n 0 454 m 612 454 l 612 442 l 0 442 l h W n Q q n 0 442 m 612 442 l 612 430 l 0 430 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 432.41 Tm (COMPANY) Tj ET BT /F2 12 Tf 1 0 0 1 65.75 432.41 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 102.13 432.41 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 126.52 432.41 Tm (Lincoln) Tj ET BT /F2 12 Tf 1 0 0 1 169.58 432.41 Tm (National) Tj ET BT /F2 12 Tf 1 0 0 1 216.63 432.41 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 242.35 432.41 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 294.73 432.41 Tm (Company,) Tj ET BT /F2 12 Tf 1 0 0 1 350.12 432.41 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 367.18 432.41 Tm (Indiana) Tj ET BT /F2 12 Tf 1 0 0 1 408.9 432.41 Tm (corporation,) Tj ET BT /F2 12 Tf 1 0 0 1 472.94 432.41 Tm (whose) Tj ET BT /F2 12 Tf 1 0 0 1 509.34 432.41 Tm (Group) Tj ET Q q n 0 430 m 612 430 l 612 418 l 0 418 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 420.41 Tm (Insurance Service) Tj ET BT /F2 12 Tf 1 0 0 1 85.62 420.41 Tm ( Office address is) Tj ET BT /F2 12 Tf 1 0 0 1 172.26 420.41 Tm (8801 Indian Hills Drive, Omaha, Nebraska) Tj ET BT /F2 12 Tf 1 0 0 1 381.54 420.41 Tm (68114-4066) Tj ET BT /F2 12 Tf 1 0 0 1 439.54 420.41 Tm (.) Tj ET Q q n 0 418 m 612 418 l 612 406 l 0 406 l h W n Q q n 0 406 m 612 406 l 612 394 l 0 394 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 396.41 Tm (DAY) Tj ET BT /F2 12 Tf 1 0 0 1 29.52 396.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 43.05 396.41 Tm (DATE) Tj ET BT /F2 12 Tf 1 0 0 1 78.56 396.41 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 112.75 396.41 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 124.93 396.41 Tm (12:01) Tj ET BT /F2 12 Tf 1 0 0 1 155.79 396.41 Tm (A.M.,) Tj ET BT /F2 12 Tf 1 0 0 1 187.65 396.41 Tm (Standard) Tj ET BT /F2 12 Tf 1 0 0 1 233.84 396.41 Tm (Time,) Tj ET BT /F2 12 Tf 1 0 0 1 265.69 396.41 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 277.87 396.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 296.06 396.41 Tm (Group) Tj ET BT /F2 12 Tf 1 0 0 1 330.25 396.41 Tm (Policyholder's) Tj ET BT /F2 12 Tf 1 0 0 1 401.93 396.41 Tm (place) Tj ET BT /F2 12 Tf 1 0 0 1 430.77 396.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 444.29 396.41 Tm (business) Tj ET BT /F2 12 Tf 1 0 0 1 488.49 396.41 Tm (when) Tj ET BT /F2 12 Tf 1 0 0 1 518 396.41 Tm (used) Tj ET Q q n 0 394 m 612 394 l 612 382 l 0 382 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 384.41 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 24.75 384.41 Tm (regard) Tj ET BT /F2 12 Tf 1 0 0 1 58.81 384.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 71.56 384.41 Tm (eligibility) Tj ET BT /F2 12 Tf 1 0 0 1 121.64 384.41 Tm (dates) Tj ET BT /F2 12 Tf 1 0 0 1 149.72 384.41 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 170.46 384.41 Tm (effective) Tj ET BT /F2 12 Tf 1 0 0 1 215.84 384.41 Tm (dates.) Tj ET BT /F2 12 Tf 1 0 0 1 250.33 384.41 Tm (It) Tj ET BT /F2 12 Tf 1 0 0 1 261.07 384.41 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 295.15 384.41 Tm (12:00) Tj ET BT /F2 12 Tf 1 0 0 1 325.9 384.41 Tm (midnight,) Tj ET BT /F2 12 Tf 1 0 0 1 375.65 384.41 Tm (Standard) Tj ET BT /F2 12 Tf 1 0 0 1 421.72 384.41 Tm (Time,) Tj ET BT /F2 12 Tf 1 0 0 1 453.46 384.41 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 465.54 384.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 483.62 384.41 Tm (same) Tj ET BT /F2 12 Tf 1 0 0 1 511.69 384.41 Tm (place,) Tj ET Q q n 0 382 m 612 382 l 612 370 l 0 370 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 372.41 Tm (when used with regard to termination dates.) Tj ET Q q n 0 370 m 612 370 l 612 358 l 0 358 l h W n Q q n 0 358 m 612 358 l 612 346 l 0 346 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 348.41 Tm (EMPLOYER means the Group Policyholder or the Participating Employer named on the Face Page.) Tj ET Q q n 0 346 m 612 346 l 612 334 l 0 334 l h W n Q q n 0 334 m 612 334 l 612 322 l 0 322 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 324.41 Tm (FULL-TIME EMPLOYEE means an employee of the EMPLOYER:) Tj ET Q q n 18 322 m 630 322 l 630 310 l 18 310 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 312.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 312.41 Tm (whose employment with the EMPLOYER is the employee's principal occupation;) Tj ET Q q n 18 310 m 630 310 l 630 298 l 18 298 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 300.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 300.41 Tm (who is not a temporary or seasonal employee; and) Tj ET Q q n 18 298 m 630 298 l 630 286 l 18 286 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 288.41 Tm ($3$) Tj ET 0.00392 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 288.41 Tm (who) Tj ET BT /F2 12 Tf 1 0 0 1 69.08 288.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 80.15 288.41 Tm (regularly) Tj ET BT /F2 12 Tf 1 0 0 1 126.53 288.41 Tm (scheduled) Tj ET BT /F2 12 Tf 1 0 0 1 177.57 288.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 189.97 288.41 Tm (work) Tj ET BT /F2 12 Tf 1 0 0 1 217.7 288.41 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 229.42 288.41 Tm (such) Tj ET BT /F2 12 Tf 1 0 0 1 254.48 288.41 Tm (occupation) Tj ET BT /F2 12 Tf 1 0 0 1 310.19 288.41 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 321.92 288.41 Tm (least) Tj ET BT /F2 12 Tf 1 0 0 1 346.97 288.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 364.7 288.41 Tm (number) Tj ET BT /F2 12 Tf 1 0 0 1 404.42 288.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 417.48 288.41 Tm (hours) Tj ET BT /F2 12 Tf 1 0 0 1 447.21 288.41 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 460.27 288.41 Tm (shown) Tj ET BT /F2 12 Tf 1 0 0 1 494.67 288.41 Tm (in) Tj ET Q q n 45.35 286 m 657.35 286 l 657.35 274 l 45.35 274 l h W n 0.00392 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 276.41 Tm (the Schedule of Insurance.) Tj ET Q q n 0 274 m 612 274 l 612 262 l 0 262 l h W n Q q n 0 262 m 612 262 l 612 250 l 0 250 l h W n 0.00392 0 0 rg BT /F2 12 Tf 1 0 0 1 0 252.41 Tm (INSURANCE MONTH means:) Tj ET Q q n 18 250 m 630 250 l 630 238 l 18 238 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 240.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 240.41 Tm (that period of time beginning on the Issue Date of the Policy and extending for one month; and) Tj ET Q q n 18 238 m 630 238 l 630 226 l 18 226 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 228.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 228.41 Tm (each subsequent month beginning on the same day after that.) Tj ET Q q n 18 226 m 630 226 l 630 214 l 18 214 l h W n Q q n 0 214 m 612 214 l 612 202 l 0 202 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 204.41 Tm (POLICY) Tj ET BT /F2 12 Tf 1 0 0 1 46.92 204.41 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 81.15 204.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 99.39 204.41 Tm (Group) Tj ET BT /F2 12 Tf 1 0 0 1 133.63 204.41 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 183.85 204.41 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 218.1 204.41 Tm (issued) Tj ET BT /F2 12 Tf 1 0 0 1 251.68 204.41 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 267.26 204.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 285.5 204.41 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 335.74 204.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 348.65 204.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 366.89 204.41 Tm (Group) Tj ET BT /F2 12 Tf 1 0 0 1 401.13 204.41 Tm (Policyholder.) Tj ET BT /F2 12 Tf 1 0 0 1 472.61 204.41 Tm (A) Tj ET BT /F2 12 Tf 1 0 0 1 484.86 204.41 Tm (copy) Tj ET BT /F2 12 Tf 1 0 0 1 511.77 204.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 204.41 Tm (the) Tj ET Q q n 0 202 m 612 202 l 612 190 l 0 190 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 192.41 Tm (Policy may be examined upon request at the Group Insurance Service Office of the Group Policyholder.) Tj ET Q q n 0 190 m 612 190 l 612 178 l 0 178 l h W n Q q n 0 178 m 612 178 l 612 166 l 0 166 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 168.41 Tm (YOU) Tj ET BT /F2 12 Tf 1 0 0 1 32.89 168.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 49.77 168.41 Tm (YOUR) Tj ET BT /F2 12 Tf 1 0 0 1 90.66 168.41 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 128.21 168.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 140.42 168.41 Tm (FULL-TIME) Tj ET BT /F2 12 Tf 1 0 0 1 210.63 168.41 Tm (EMPLOYEE) Tj ET BT /F2 12 Tf 1 0 0 1 281.51 168.41 Tm (who) Tj ET BT /F2 12 Tf 1 0 0 1 309.07 168.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 323.96 168.41 Tm (covered) Tj ET BT /F2 12 Tf 1 0 0 1 368.82 168.41 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 387.71 168.41 Tm (Personal) Tj ET BT /F2 12 Tf 1 0 0 1 435.93 168.41 Tm (Insurance,) Tj ET BT /F2 12 Tf 1 0 0 1 492.45 168.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 509.34 168.41 Tm (whose) Tj ET Q q n 0 166 m 612 166 l 612 154 l 0 154 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 156.41 Tm (Dependents are covered by Dependents Insurance under the Policy.) Tj ET Q Q q Q Q endstream endobj 8 0 obj <>>>>> endobj 139 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 744 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 231.65 2.41 Tm (ELIGIBILITY) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 257.4 25.15 l 257.4 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-2 VIT) Tj ET Q q n 257.4 25.15 m 293.4 25.15 l 293.4 13.15 l 257.4 13.15 l h W n Q q n 293.4 25.15 m 540.25 25.15 l 540.25 13.15 l 293.4 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 438.93 15.56 Tm (A,$L,DEP.L,AD&D$) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 272.9 3.56 Tm (4) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 670 m 612 670 l 612 658 l 0 658 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 660.41 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 11.34 660.41 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 32.68 660.41 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 50.67 660.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 59.34 660.41 Tm (Full-Time) Tj ET BT /F2 12 Tf 1 0 0 1 111.34 660.41 Tm (Employee) Tj ET BT /F2 12 Tf 1 0 0 1 163.34 660.41 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 184 660.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 192.67 660.41 Tm (member) Tj ET BT /F2 12 Tf 1 0 0 1 235.33 660.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 248.67 660.41 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 263.34 660.41 Tm (employee) Tj ET BT /F2 12 Tf 1 0 0 1 313.33 660.41 Tm (class) Tj ET BT /F2 12 Tf 1 0 0 1 340 660.41 Tm (shown) Tj ET BT /F2 12 Tf 1 0 0 1 374.68 660.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 387.35 660.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 405.36 660.41 Tm (Schedule) Tj ET BT /F2 12 Tf 1 0 0 1 452.68 660.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 466.02 660.41 Tm (Insurance;) Tj ET BT /F2 12 Tf 1 0 0 1 519.34 660.41 Tm (then) Tj ET Q q n 0 658 m 612 658 l 612 646 l 0 646 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 648.41 Tm (you will become eligible for the coverage provided by the Policy on the later of:) Tj ET Q q n 18 646 m 630 646 l 630 634 l 18 634 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 636.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 636.41 Tm (the Policy's date of issue; or) Tj ET Q q n 18 634 m 630 634 l 630 622 l 18 622 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 624.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 624.41 Tm (the day you complete the Waiting Period.) Tj ET Q q n 0 622 m 612 622 l 612 610 l 0 610 l h W n Q q n 0 610 m 612 610 l 612 598 l 0 598 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 600.41 Tm (WAITING PERIOD.) Tj ET BT /F2 12 Tf 1 0 0 1 107.98 600.41 Tm ($See Schedule of Insurance$.) Tj ET Q q n 0 598 m 612 598 l 612 586 l 0 586 l h W n Q q n 0 586 m 612 586 l 612 574 l 0 574 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 164.82 576.41 Tm (EFFECTIVE DATES OF COVERAGES) Tj ET Q q n 0 574 m 612 574 l 612 562 l 0 562 l h W n Q q n 0 562 m 612 562 l 612 550 l 0 550 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 552.41 Tm (Your insurance is effective on the latest of:) Tj ET Q q n 18 550 m 630 550 l 630 538 l 18 538 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 540.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 540.41 Tm (the first day of the Insurance Month following the day you become eligible for the coverage;) Tj ET Q q n 18 538 m 630 538 l 630 526 l 18 526 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 528.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 528.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 64.7 528.41 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 86.72 528.41 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 109.42 528.41 Tm (resume) Tj ET BT /F2 12 Tf 1 0 0 1 148.76 528.41 Tm (Active) Tj ET BT /F2 12 Tf 1 0 0 1 185.44 528.41 Tm (Work,) Tj ET BT /F2 12 Tf 1 0 0 1 220.46 528.41 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 232.48 528.41 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 255.18 528.41 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 274.52 528.41 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 294.54 528.41 Tm (Actively) Tj ET BT /F2 12 Tf 1 0 0 1 340.56 528.41 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 353.91 528.41 Tm (Work) Tj ET BT /F2 12 Tf 1 0 0 1 385.93 528.41 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 402.62 528.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 421.97 528.41 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 443.99 528.41 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 466.69 528.41 Tm (become) Tj ET Q q n 45.35 526 m 657.35 526 l 657.35 514 l 45.35 514 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 516.41 Tm (eligible;) Tj ET Q q n 18 514 m 630 514 l 630 502 l 18 502 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 504.41 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 504.41 Tm (the day you make written application for coverage; and sign:) Tj ET Q q n 45.35 502 m 657.35 502 l 657.35 490 l 45.35 490 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 492.41 Tm ($a$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 492.41 Tm (a payroll deduction order; or) Tj ET Q q n 45.35 490 m 657.35 490 l 657.35 478 l 45.35 478 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 480.41 Tm ($b$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 480.41 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 88 480.41 Tm (order) Tj ET BT /F2 12 Tf 1 0 0 1 117.3 480.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 130.61 480.41 Tm (pay) Tj ET BT /F2 12 Tf 1 0 0 1 151.92 480.41 Tm (premiums) Tj ET BT /F2 12 Tf 1 0 0 1 203.89 480.41 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 231.19 480.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 257.17 480.41 Tm (Flexible) Tj ET BT /F2 12 Tf 1 0 0 1 300.47 480.41 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 339.77 480.41 Tm (Plan) Tj ET BT /F2 12 Tf 1 0 0 1 365.08 480.41 Tm (account,) Tj ET BT /F2 12 Tf 1 0 0 1 409.37 480.41 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 420.68 480.41 Tm (Employer) Tj ET Q q n 72.7 478 m 684.7 478 l 684.7 466 l 72.7 466 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 72.7 468.41 Tm (contributions are paid through a Flexible Benefit Plan; or) Tj ET Q q n 18 466 m 630 466 l 630 454 l 18 454 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 456.41 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 456.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 63.57 456.41 Tm (first) Tj ET BT /F2 12 Tf 1 0 0 1 86.45 456.41 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 107.33 456.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 120.89 456.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 139.1 456.41 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 189.3 456.41 Tm (Month) Tj ET BT /F2 12 Tf 1 0 0 1 224.86 456.41 Tm (following) Tj ET BT /F2 12 Tf 1 0 0 1 275.08 456.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 293.3 456.41 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 316.84 456.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 335.05 456.41 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 385.27 456.41 Tm (approves) Tj ET BT /F2 12 Tf 1 0 0 1 432.15 456.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 457.7 456.41 Tm (coverage,) Tj ET Q q n 45.35 454 m 657.35 454 l 657.35 442 l 45.35 442 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 444.41 Tm (if evidence of insurability is required.) Tj ET Q q n 0 442 m 612 442 l 612 430 l 0 430 l h W n Q q n 0 430 m 612 430 l 612 418 l 0 418 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 420.41 Tm (Evidence of insurability is required if:) Tj ET Q q n 18 418 m 630 418 l 630 406 l 18 406 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 408.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 408.41 Tm (you apply for coverage in excess of the Guaranteed Acceptance Amount;) Tj ET Q q n 18 406 m 630 406 l 630 394 l 18 394 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 396.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 396.41 Tm (you apply to enroll for or increase coverage more than 31 days after you become eligible;) Tj ET Q q n 18 394 m 630 394 l 630 382 l 18 382 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 384.41 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 384.41 Tm (you make written application to re-enroll for coverage after you have requested:) Tj ET Q q n 45.35 382 m 657.35 382 l 657.35 370 l 45.35 370 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 372.41 Tm ($a$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 372.41 Tm (to cancel your coverage;) Tj ET Q q n 45.35 370 m 657.35 370 l 657.35 358 l 45.35 358 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 360.41 Tm ($b$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 360.41 Tm (to stop payroll deductions for the coverage; or) Tj ET Q q n 45.35 358 m 657.35 358 l 657.35 346 l 45.35 346 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 348.41 Tm ($c$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 348.41 Tm (to stop premium payments from your Flexible Benefit Plan account; or) Tj ET Q q n 18 346 m 630 346 l 630 334 l 18 334 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 336.41 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 336.41 Tm (you apply to reinstate coverage after it lapses, due to failure to pay premiums when due.) Tj ET Q q n 0 334 m 612 334 l 612 322 l 0 322 l h W n Q q n 0 322 m 612 322 l 612 310 l 0 310 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 312.41 Tm (EXCEPTION.) Tj ET BT /F2 12 Tf 1 0 0 1 80.51 312.41 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 93.92 312.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 121.34 312.41 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 170.07 312.41 Tm (terminates) Tj ET BT /F2 12 Tf 1 0 0 1 225.47 312.41 Tm (due) Tj ET BT /F2 12 Tf 1 0 0 1 248.22 312.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 262.98 312.41 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 279.73 312.41 Tm (approved) Tj ET BT /F2 12 Tf 1 0 0 1 329.8 312.41 Tm (leave) Tj ET BT /F2 12 Tf 1 0 0 1 360.54 312.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 375.96 312.41 Tm (absence) Tj ET BT /F2 12 Tf 1 0 0 1 419.35 312.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 434.77 312.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 445.52 312.41 Tm (military) Tj ET BT /F2 12 Tf 1 0 0 1 488.94 312.41 Tm (leave,) Tj ET BT /F2 12 Tf 1 0 0 1 522.67 312.41 Tm (any) Tj ET Q q n 0 310 m 612 310 l 612 298 l 0 298 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 300.41 Tm (Waiting Period or evidence of insurability requirement will be waived upon your return; provided:) Tj ET Q q n 18 298 m 630 298 l 630 286 l 18 286 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 288.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 288.41 Tm (you return within six months after the leave begins;) Tj ET Q q n 18 286 m 630 286 l 630 274 l 18 274 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 276.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 276.41 Tm (you apply or are enrolled within 31 days after resuming Active Work; and) Tj ET Q q n 18 274 m 630 274 l 630 262 l 18 262 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 264.41 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 264.41 Tm (the reinstated amount of insurance does not exceed the amount which terminated.) Tj ET Q q n 18 262 m 630 262 l 630 250 l 18 250 l h W n Q Q q Q Q endstream endobj 9 0 obj <>>>>> endobj 140 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 744 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 179.66 2.41 Tm (TERMINATION OF COVERAGE) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 257.4 25.15 l 257.4 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-2 VIT) Tj ET Q q n 257.4 25.15 m 293.4 25.15 l 293.4 13.15 l 257.4 13.15 l h W n Q q n 293.4 25.15 m 540.25 25.15 l 540.25 13.15 l 293.4 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 438.93 15.56 Tm (A,$L,DEP.L,AD&D$) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 272.9 3.56 Tm (5) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 670 m 612 670 l 612 658 l 0 658 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 660.41 Tm (Your coverage terminates on the earliest of:) Tj ET Q q n 18 658 m 630 658 l 630 646 l 18 646 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 648.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 648.41 Tm (the day the Policy terminates or your Employer ceases to be a Participating Employer;) Tj ET Q q n 18 646 m 630 646 l 630 634 l 18 634 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 636.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 636.41 Tm (the last day of the Insurance Month in which you request termination;) Tj ET Q q n 18 634 m 630 634 l 630 622 l 18 622 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 624.41 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 624.41 Tm (the last day of the period for which the premium for your insurance has been paid;) Tj ET Q q n 18 622 m 630 622 l 630 610 l 18 610 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 612.41 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 612.41 Tm (the day you cease to be a member of an employee class or die;) Tj ET Q q n 18 610 m 630 610 l 630 598 l 18 598 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 600.41 Tm ($5$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 600.41 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 70.89 600.41 Tm (respect) Tj ET BT /F2 12 Tf 1 0 0 1 109.08 600.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 122.62 600.41 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 144.16 600.41 Tm (particular) Tj ET BT /F2 12 Tf 1 0 0 1 194.34 600.41 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 244.52 600.41 Tm (benefit,) Tj ET BT /F2 12 Tf 1 0 0 1 285.05 600.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 303.92 600.41 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 325.45 600.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 344.32 600.41 Tm (part) Tj ET BT /F2 12 Tf 1 0 0 1 367.18 600.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 381.39 600.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 400.26 600.41 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 435.13 600.41 Tm (providing) Tj ET BT /F2 12 Tf 1 0 0 1 486.01 600.41 Tm (that) Tj ET Q q n 45.35 598 m 657.35 598 l 657.35 586 l 45.35 586 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 588.41 Tm (benefit terminates;) Tj ET Q q n 18 586 m 630 586 l 630 574 l 18 574 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 576.41 Tm ($6$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 576.41 Tm (the day) Tj ET BT /F2 12 Tf 1 0 0 1 80.34 576.41 Tm ( your employment with the Employer terminates; or) Tj ET Q q n 18 574 m 630 574 l 630 562 l 18 562 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 564.41 Tm ($7$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 564.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 63.54 564.41 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 84.39 564.41 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 105.92 564.41 Tm (enter) Tj ET BT /F2 12 Tf 1 0 0 1 133.43 564.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 151.61 564.41 Tm (armed) Tj ET BT /F2 12 Tf 1 0 0 1 185.12 564.41 Tm (services) Tj ET BT /F2 12 Tf 1 0 0 1 227.3 564.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 240.82 564.41 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 261.67 564.41 Tm (state) Tj ET BT /F2 12 Tf 1 0 0 1 287.19 564.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 300.71 564.41 Tm (country) Tj ET BT /F2 12 Tf 1 0 0 1 340.89 564.41 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 356.42 564.41 Tm (active) Tj ET BT /F2 12 Tf 1 0 0 1 388.59 564.41 Tm (duty;) Tj ET BT /F2 12 Tf 1 0 0 1 416.79 564.41 Tm (except) Tj ET BT /F2 12 Tf 1 0 0 1 451.63 564.41 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 469.14 564.41 Tm (duty) Tj ET BT /F2 12 Tf 1 0 0 1 494 564.41 Tm (of) Tj ET Q q n 45.35 562 m 657.35 562 l 657.35 550 l 45.35 550 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 552.41 Tm (30) Tj ET BT /F2 12 Tf 1 0 0 1 61.11 552.41 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 86.88 552.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 100.64 552.41 Tm (less) Tj ET BT /F2 12 Tf 1 0 0 1 122.4 552.41 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 140.16 552.41 Tm (training) Tj ET BT /F2 12 Tf 1 0 0 1 181.25 552.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 194.34 552.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 212.77 552.41 Tm (Reserves) Tj ET BT /F2 12 Tf 1 0 0 1 259.85 552.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 273.61 552.41 Tm (National) Tj ET BT /F2 12 Tf 1 0 0 1 318.7 552.41 Tm (Guard.) Tj ET BT /F2 12 Tf 1 0 0 1 359.21 552.41 Tm ($If) Tj ET BT /F2 12 Tf 1 0 0 1 374.97 552.41 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 396.73 552.41 Tm (send) Tj ET BT /F2 12 Tf 1 0 0 1 422.49 552.41 Tm (proof) Tj ET BT /F2 12 Tf 1 0 0 1 452.25 552.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 466.01 552.41 Tm (military) Tj ET Q q n 45.35 550 m 657.35 550 l 657.35 538 l 45.35 538 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 540.41 Tm (service, the Company will refund any unearned premium.$) Tj ET Q q n 18 538 m 630 538 l 630 526 l 18 526 l h W n Q q n 0 526 m 612 526 l 612 514 l 0 514 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 516.41 Tm (Ceasing Active Work terminates your eligibility.) Tj ET BT /F2 12 Tf 1 0 0 1 240.61 516.41 Tm (However, you may continue coverage as follows:) Tj ET Q q n 18 514 m 630 514 l 630 502 l 18 502 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 504.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 504.41 Tm (If you are disabled due to illness or injury, then coverage may be continued until the earliest of:) Tj ET Q q n 45.35 502 m 657.35 502 l 657.35 490 l 45.35 490 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 492.41 Tm ($a$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 492.41 Tm (12 Insurance Months after the disability begins;) Tj ET Q q n 45.35 490 m 657.35 490 l 657.35 478 l 45.35 478 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 480.41 Tm ($b$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 480.41 Tm (the date you are no longer disabled; or) Tj ET Q q n 45.35 478 m 657.35 478 l 657.35 466 l 45.35 466 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 468.41 Tm ($c$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 468.41 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 90.37 468.41 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 114.03 468.41 Tm (insurance,) Tj ET BT /F2 12 Tf 1 0 0 1 166.68 468.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 185.02 468.41 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 208.68 468.41 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 230.35 468.41 Tm (qualify) Tj ET BT /F2 12 Tf 1 0 0 1 268.02 468.41 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 285.68 468.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 304.02 468.41 Tm (Extension) Tj ET BT /F2 12 Tf 1 0 0 1 355.69 468.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 369.36 468.41 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 401.68 468.41 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 440.68 468.41 Tm (under) Tj ET Q q n 72.7 466 m 684.7 466 l 684.7 454 l 72.7 454 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 72.7 456.41 Tm (the Policy.) Tj ET Q q n 45.35 454 m 657.35 454 l 657.35 442 l 45.35 442 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 444.41 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 67.25 444.41 Tm (required) Tj ET BT /F2 12 Tf 1 0 0 1 110.47 444.41 Tm (premium) Tj ET BT /F2 12 Tf 1 0 0 1 157.03 444.41 Tm (payments) Tj ET BT /F2 12 Tf 1 0 0 1 206.26 444.41 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 232.84 444.41 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 247.4 444.41 Tm (received) Tj ET BT /F2 12 Tf 1 0 0 1 291.28 444.41 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 317.84 444.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 335.74 444.41 Tm (Employer) Tj ET BT /F2 12 Tf 1 0 0 1 386.3 444.41 Tm (throughout) Tj ET BT /F2 12 Tf 1 0 0 1 442.21 444.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 460.11 444.41 Tm (period) Tj ET BT /F2 12 Tf 1 0 0 1 494 444.41 Tm (of) Tj ET Q q n 45.35 442 m 657.35 442 l 657.35 430 l 45.35 430 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 432.41 Tm (continued insurance.) Tj ET Q q n 18 430 m 630 430 l 630 418 l 18 418 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 420.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 420.41 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 56.96 420.41 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 78.57 420.41 Tm (go) Tj ET BT /F2 12 Tf 1 0 0 1 94.19 420.41 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 109.81 420.41 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 124.75 420.41 Tm (approved) Tj ET BT /F2 12 Tf 1 0 0 1 173.01 420.41 Tm (Family) Tj ET BT /F2 12 Tf 1 0 0 1 210.63 420.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 224.24 420.41 Tm (Medical) Tj ET BT /F2 12 Tf 1 0 0 1 267.18 420.41 Tm (Leave) Tj ET BT /F2 12 Tf 1 0 0 1 300.1 420.41 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 321.04 420.41 Tm (are) Tj ET BT /F4 12 Tf 1 0 0 1 339.31 420.41 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 359.59 420.41 Tm (entitled) Tj ET BT /F2 12 Tf 1 0 0 1 399.2 420.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 412.15 420.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 430.42 420.41 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 458.7 420.41 Tm (favorable) Tj ET Q q n 45.35 418 m 657.35 418 l 657.35 406 l 45.35 406 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 408.41 Tm (continuation during disability, coverage may be continued until the earliest of:) Tj ET Q q n 45.35 406 m 657.35 406 l 657.35 394 l 45.35 394 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 396.41 Tm ($a$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 396.41 Tm (the end of the leave period approved by the Employer;) Tj ET Q q n 45.35 394 m 657.35 394 l 657.35 382 l 45.35 382 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 384.41 Tm ($b$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 384.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 90.87 384.41 Tm (end) Tj ET BT /F2 12 Tf 1 0 0 1 111.71 384.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 125.21 384.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 143.38 384.41 Tm (leave) Tj ET BT /F2 12 Tf 1 0 0 1 172.21 384.41 Tm (period) Tj ET BT /F2 12 Tf 1 0 0 1 206.37 384.41 Tm (required) Tj ET BT /F2 12 Tf 1 0 0 1 249.86 384.41 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 265.37 384.41 Tm (federal) Tj ET BT /F2 12 Tf 1 0 0 1 302.18 384.41 Tm (law,) Tj ET BT /F2 12 Tf 1 0 0 1 326.02 384.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 339.53 384.41 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 360.36 384.41 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 388.53 384.41 Tm (favorable) Tj ET BT /F2 12 Tf 1 0 0 1 437.34 384.41 Tm (period) Tj ET Q q n 72.7 382 m 684.7 382 l 684.7 370 l 72.7 370 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 72.7 372.41 Tm (required by a similar law;) Tj ET Q q n 45.35 370 m 657.35 370 l 657.35 358 l 45.35 358 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 360.41 Tm ($c$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 360.41 Tm (the date you notify your Employer that you will not return; or) Tj ET Q q n 45.35 358 m 657.35 358 l 657.35 346 l 45.35 346 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 348.41 Tm ($d$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 348.41 Tm (the date you begin employment with another employer.) Tj ET Q q n 45.35 346 m 657.35 346 l 657.35 334 l 45.35 334 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 336.41 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 67.25 336.41 Tm (required) Tj ET BT /F2 12 Tf 1 0 0 1 110.47 336.41 Tm (premium) Tj ET BT /F2 12 Tf 1 0 0 1 157.03 336.41 Tm (payments) Tj ET BT /F2 12 Tf 1 0 0 1 206.26 336.41 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 232.84 336.41 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 247.4 336.41 Tm (received) Tj ET BT /F2 12 Tf 1 0 0 1 291.28 336.41 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 317.84 336.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 335.74 336.41 Tm (Employer) Tj ET BT /F2 12 Tf 1 0 0 1 386.3 336.41 Tm (throughout) Tj ET BT /F2 12 Tf 1 0 0 1 442.21 336.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 460.11 336.41 Tm (period) Tj ET BT /F2 12 Tf 1 0 0 1 494 336.41 Tm (of) Tj ET Q q n 45.35 334 m 657.35 334 l 657.35 322 l 45.35 322 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 324.41 Tm (continued insurance.) Tj ET Q q n 18 322 m 630 322 l 630 310 l 18 310 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 312.41 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 312.41 Tm (If you go on a military leave, coverage may be continued for the greater of:) Tj ET Q q n 45.35 310 m 657.35 310 l 657.35 298 l 45.35 298 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 300.41 Tm ($a$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 300.41 Tm (the same period allowed for an approved Family or Medical Leave; or) Tj ET Q q n 45.35 298 m 657.35 298 l 657.35 286 l 45.35 286 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 288.41 Tm ($b$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 288.41 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 94.15 288.41 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 122.94 288.41 Tm (favorable) Tj ET BT /F2 12 Tf 1 0 0 1 172.37 288.41 Tm (leave) Tj ET BT /F2 12 Tf 1 0 0 1 201.81 288.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 215.27 288.41 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 248.73 288.41 Tm (employees) Tj ET BT /F2 12 Tf 1 0 0 1 304.17 288.41 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 329.63 288.41 Tm (similar) Tj ET BT /F2 12 Tf 1 0 0 1 367.09 288.41 Tm (seniority,) Tj ET BT /F2 12 Tf 1 0 0 1 416.21 288.41 Tm (status,) Tj ET BT /F2 12 Tf 1 0 0 1 450.67 288.41 Tm (and) Tj ET Q q n 72.7 286 m 684.7 286 l 684.7 274 l 72.7 274 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 72.7 276.41 Tm (pay who are on furlough or leave of absence are granted by the Employer.) Tj ET Q q n 45.35 274 m 657.35 274 l 657.35 262 l 45.35 262 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 264.41 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 67.25 264.41 Tm (required) Tj ET BT /F2 12 Tf 1 0 0 1 110.47 264.41 Tm (premium) Tj ET BT /F2 12 Tf 1 0 0 1 157.03 264.41 Tm (payments) Tj ET BT /F2 12 Tf 1 0 0 1 206.26 264.41 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 232.84 264.41 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 247.4 264.41 Tm (received) Tj ET BT /F2 12 Tf 1 0 0 1 291.28 264.41 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 317.84 264.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 335.74 264.41 Tm (Employer) Tj ET BT /F2 12 Tf 1 0 0 1 386.3 264.41 Tm (throughout) Tj ET BT /F2 12 Tf 1 0 0 1 442.21 264.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 460.11 264.41 Tm (period) Tj ET BT /F2 12 Tf 1 0 0 1 494 264.41 Tm (of) Tj ET Q q n 45.35 262 m 657.35 262 l 657.35 250 l 45.35 250 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 252.41 Tm (continued insurance.) Tj ET Q q n 18 250 m 630 250 l 630 238 l 18 238 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 240.41 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 240.41 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 57.48 240.41 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 79.62 240.41 Tm (cease) Tj ET BT /F2 12 Tf 1 0 0 1 109.73 240.41 Tm (work) Tj ET BT /F2 12 Tf 1 0 0 1 138.54 240.41 Tm (due) Tj ET BT /F2 12 Tf 1 0 0 1 160 240.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 173.47 240.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 182.94 240.41 Tm (temporary) Tj ET BT /F2 12 Tf 1 0 0 1 236.39 240.41 Tm (lay) Tj ET BT /F2 12 Tf 1 0 0 1 255.19 240.41 Tm (off,) Tj ET BT /F2 12 Tf 1 0 0 1 276.32 240.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 290.46 240.41 Tm (due) Tj ET BT /F2 12 Tf 1 0 0 1 311.92 240.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 325.39 240.41 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 340.86 240.41 Tm (approved) Tj ET BT /F2 12 Tf 1 0 0 1 389.65 240.41 Tm (leave) Tj ET BT /F2 12 Tf 1 0 0 1 419.1 240.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 433.23 240.41 Tm (absence) Tj ET BT /F2 12 Tf 1 0 0 1 475.35 240.41 Tm ($other) Tj ET Q q n 45.35 238 m 657.35 238 l 657.35 226 l 45.35 226 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 228.41 Tm (than) Tj ET BT /F2 12 Tf 1 0 0 1 72.28 228.41 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 89.88 228.41 Tm (approved) Tj ET BT /F2 12 Tf 1 0 0 1 140.8 228.41 Tm (Family) Tj ET BT /F2 12 Tf 1 0 0 1 181.08 228.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 197.35 228.41 Tm (Medical) Tj ET BT /F2 12 Tf 1 0 0 1 242.94 228.41 Tm (Leave) Tj ET BT /F2 12 Tf 1 0 0 1 278.52 228.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 294.79 228.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 306.39 228.41 Tm (military) Tj ET BT /F2 12 Tf 1 0 0 1 350.65 228.41 Tm (leave$,) Tj ET BT /F2 12 Tf 1 0 0 1 389.23 228.41 Tm (then) Tj ET BT /F2 12 Tf 1 0 0 1 416.17 228.41 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 465.74 228.41 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 492.67 228.41 Tm (be) Tj ET Q q n 45.35 226 m 657.35 226 l 657.35 214 l 45.35 214 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 216.41 Tm (continued) Tj ET BT /F2 12 Tf 1 0 0 1 96.21 216.41 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 113.75 216.41 Tm (three) Tj ET BT /F2 12 Tf 1 0 0 1 141.28 216.41 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 191.46 216.41 Tm (Months) Tj ET BT /F2 12 Tf 1 0 0 1 231.68 216.41 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 257.2 216.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 275.4 216.41 Tm (lay) Tj ET BT /F2 12 Tf 1 0 0 1 293.61 216.41 Tm (off) Tj ET BT /F2 12 Tf 1 0 0 1 311.14 216.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 324.68 216.41 Tm (leave) Tj ET BT /F2 12 Tf 1 0 0 1 353.54 216.41 Tm (begins.) Tj ET BT /F2 12 Tf 1 0 0 1 394.95 216.41 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 417.15 216.41 Tm (required) Tj ET BT /F2 12 Tf 1 0 0 1 460.68 216.41 Tm (premium) Tj ET Q q n 45.35 214 m 657.35 214 l 657.35 202 l 45.35 202 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 204.41 Tm (payments must be received from the Employer throughout the period of continued insurance.) Tj ET Q q n 0 202 m 612 202 l 612 190 l 0 190 l h W n Q q n 0 190 m 612 190 l 612 178 l 0 178 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 180.41 Tm (Conditions.) Tj ET BT /F2 12 Tf 1 0 0 1 66.72 180.41 Tm (In) Tj ET BT /F2 12 Tf 1 0 0 1 80.56 180.41 Tm (administering) Tj ET BT /F2 12 Tf 1 0 0 1 150.4 180.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 168.91 180.41 Tm (above) Tj ET BT /F2 12 Tf 1 0 0 1 201.41 180.41 Tm (continuations,) Tj ET BT /F2 12 Tf 1 0 0 1 272.91 180.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 291.42 180.41 Tm (Employer) Tj ET BT /F2 12 Tf 1 0 0 1 342.59 180.41 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 369.77 180.41 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 388.96 180.41 Tm (act) Tj ET BT /F2 12 Tf 1 0 0 1 406.79 180.41 Tm (so) Tj ET BT /F2 12 Tf 1 0 0 1 421.31 180.41 Tm (act) Tj ET BT /F2 12 Tf 1 0 0 1 439.14 180.41 Tm (so) Tj ET BT /F2 12 Tf 1 0 0 1 453.66 180.41 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 467.5 180.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 480.69 180.41 Tm (discriminate) Tj ET Q q n 0 178 m 612 178 l 612 166 l 0 166 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 168.41 Tm (unfairly) Tj ET BT /F2 12 Tf 1 0 0 1 41.93 168.41 Tm (among) Tj ET BT /F2 12 Tf 1 0 0 1 78.54 168.41 Tm (Insured) Tj ET BT /F2 12 Tf 1 0 0 1 118.48 168.41 Tm (Persons) Tj ET BT /F2 12 Tf 1 0 0 1 159.76 168.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 173.04 168.41 Tm (similar) Tj ET BT /F2 12 Tf 1 0 0 1 210.32 168.41 Tm (situations.) Tj ET BT /F2 12 Tf 1 0 0 1 267.21 168.41 Tm (You) Tj ET BT /F2 12 Tf 1 0 0 1 291.83 168.41 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 314.44 168.41 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 329.71 168.41 Tm (required) Tj ET BT /F2 12 Tf 1 0 0 1 373.64 168.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 386.92 168.41 Tm (pay) Tj ET BT /F2 12 Tf 1 0 0 1 408.19 168.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 426.8 168.41 Tm (Employer) Tj ET BT /F2 12 Tf 1 0 0 1 478.07 168.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 496.68 168.41 Tm (premium) Tj ET Q q n 0 166 m 612 166 l 612 154 l 0 154 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 156.41 Tm (you would have been required to pay as an Active Employee throughout the period of continued coverage.) Tj ET Q q n 0 154 m 612 154 l 612 142 l 0 142 l h W n Q q n 0 142 m 612 142 l 612 130 l 0 130 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 132.41 Tm (It) Tj ET BT /F2 12 Tf 1 0 0 1 11.15 132.41 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 35.64 132.41 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 50.78 132.41 Tm (possible) Tj ET BT /F2 12 Tf 1 0 0 1 93.94 132.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 107.1 132.41 Tm (continue) Tj ET BT /F2 12 Tf 1 0 0 1 152.24 132.41 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 202.04 132.41 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 219.86 132.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 229.01 132.41 Tm (longer) Tj ET BT /F2 12 Tf 1 0 0 1 263.48 132.41 Tm (period) Tj ET BT /F2 12 Tf 1 0 0 1 297.96 132.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 311.12 132.41 Tm (accord) Tj ET BT /F2 12 Tf 1 0 0 1 346.92 132.41 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 372.07 132.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 390.56 132.41 Tm (Portability) Tj ET BT /F2 12 Tf 1 0 0 1 445.04 132.41 Tm (Privilege) Tj ET BT /F2 12 Tf 1 0 0 1 492.19 132.41 Tm (section) Tj ET BT /F2 12 Tf 1 0 0 1 530 132.41 Tm (of) Tj ET Q q n 0 130 m 612 130 l 612 118 l 0 118 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 120.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 19.63 120.41 Tm (Certificate.) Tj ET BT /F2 12 Tf 1 0 0 1 83.19 120.41 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 106.82 120.41 Tm (Portability) Tj ET BT /F2 12 Tf 1 0 0 1 162.45 120.41 Tm (Privilege) Tj ET BT /F2 12 Tf 1 0 0 1 210.74 120.41 Tm (section) Tj ET BT /F2 12 Tf 1 0 0 1 249.7 120.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 264.66 120.41 Tm (this) Tj ET BT /F2 12 Tf 1 0 0 1 286.96 120.41 Tm (Certificate) Tj ET BT /F2 12 Tf 1 0 0 1 342.56 120.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 355.53 120.41 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 375.83 120.41 Tm (applicable) Tj ET BT /F2 12 Tf 1 0 0 1 430.11 120.41 Tm (when) Tj ET BT /F2 12 Tf 1 0 0 1 461.07 120.41 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 496.7 120.41 Tm (coverage) Tj ET Q q n 0 118 m 612 118 l 612 106 l 0 106 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 108.41 Tm (terminates) Tj ET BT /F2 12 Tf 1 0 0 1 53.03 108.41 Tm (solely) Tj ET BT /F2 12 Tf 1 0 0 1 84.74 108.41 Tm (because) Tj ET BT /F2 12 Tf 1 0 0 1 125.76 108.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 150.8 108.41 Tm (spouse) Tj ET BT /F2 12 Tf 1 0 0 1 186.52 108.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 199.56 108.41 Tm (child) Tj ET BT /F2 12 Tf 1 0 0 1 226.6 108.41 Tm (ceases) Tj ET BT /F2 12 Tf 1 0 0 1 260.29 108.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 272.68 108.41 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 287.05 108.41 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 301.42 108.41 Tm (eligible) Tj ET BT /F2 12 Tf 1 0 0 1 340.46 108.41 Tm (Dependent;) Tj ET BT /F2 12 Tf 1 0 0 1 398.82 108.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 423.86 108.41 Tm (Employer) Tj ET BT /F2 12 Tf 1 0 0 1 474.23 108.41 Tm (ceases) Tj ET BT /F2 12 Tf 1 0 0 1 507.92 108.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 520.3 108.41 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 534.67 108.41 Tm (a) Tj ET Q q n 0 106 m 612 106 l 612 94 l 0 94 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 96.41 Tm (Participating Employer; or the Policy terminates.) Tj ET Q q n 0 94 m 612 94 l 612 82 l 0 82 l h W n Q q n 0 82 m 612 82 l 612 70 l 0 70 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 72.41 Tm (If all or part of anyone's life insurance under the Policy terminates due to:) Tj ET Q q n 18 70 m 630 70 l 630 58 l 18 58 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 60.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 60.41 Tm (your Employer ceasing to be a Participating Employer;) Tj ET Q q n 18 58 m 630 58 l 630 46 l 18 46 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 48.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 48.41 Tm (your termination of membership in an eligible class; or) Tj ET Q q n 18 46 m 630 46 l 630 34 l 18 34 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 36.41 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 36.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 53.92 36.41 Tm (dependent's) Tj ET BT /F2 12 Tf 1 0 0 1 113.3 36.41 Tm (ceasing) Tj ET BT /F2 12 Tf 1 0 0 1 152.52 36.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 165.1 36.41 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 179.66 36.41 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 194.23 36.41 Tm (eligible) Tj ET BT /F2 12 Tf 1 0 0 1 233.46 36.41 Tm (family) Tj ET BT /F2 12 Tf 1 0 0 1 268.02 36.41 Tm (member) Tj ET BT /F2 12 Tf 1 0 0 1 310.58 36.41 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 323.81 36.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 332.38 36.41 Tm (result) Tj ET BT /F2 12 Tf 1 0 0 1 362.28 36.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 375.52 36.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 400.75 36.41 Tm (death) Tj ET BT /F2 12 Tf 1 0 0 1 429.98 36.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 443.22 36.41 Tm (divorce,) Tj ET BT /F2 12 Tf 1 0 0 1 485.44 36.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 498.67 36.41 Tm (a) Tj ET Q q n 45.35 34 m 657.35 34 l 657.35 22 l 45.35 22 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 24.41 Tm (child's marriage or attainment of limiting age;) Tj ET Q q n 0 22 m 612 22 l 612 10 l 0 10 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 12.41 Tm (see the Conversion Privilege section of this Certificate.) Tj ET Q Q q Q Q endstream endobj 10 0 obj <>>>>> endobj 141 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 742.85 cm q n 0 13.15 m 550.8 13.15 l 550.8 1.15 l 0 1.15 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 192.82 3.56 Tm (PORTABILITY PRIVILEGE) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 270.1 25.15 l 270.1 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-2.5) Tj ET Q q n 270.1 25.15 m 540.25 25.15 l 540.25 13.15 l 270.1 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 419.92 15.56 Tm (PORT$L,DEP.L,AD&D$) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 272.9 3.56 Tm (6) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 668.85 m 612 668.85 l 612 656.85 l 0 656.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 659.26 Tm (This) Tj ET BT /F2 12 Tf 1 0 0 1 26.78 659.26 Tm (section) Tj ET BT /F2 12 Tf 1 0 0 1 66.21 659.26 Tm (applies) Tj ET BT /F2 12 Tf 1 0 0 1 105.64 659.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 120.42 659.26 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 143.19 659.26 Tm (Personal) Tj ET BT /F2 12 Tf 1 0 0 1 189.95 659.26 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 215.38 659.26 Tm (Insurance,) Tj ET BT /F2 12 Tf 1 0 0 1 270.46 659.26 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 327.89 659.26 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 353.31 659.26 Tm (Insurance,) Tj ET BT /F2 12 Tf 1 0 0 1 408.4 659.26 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 431.17 659.26 Tm (Accidental) Tj ET BT /F2 12 Tf 1 0 0 1 488.58 659.26 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 522.67 659.26 Tm (and) Tj ET Q q n 0 656.85 m 612 656.85 l 612 644.85 l 0 644.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 647.26 Tm (Dismemberment) Tj ET BT /F2 12 Tf 1 0 0 1 83.9 647.26 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 134.46 647.26 Tm (provided) Tj ET BT /F2 12 Tf 1 0 0 1 181.04 647.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 196.96 647.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 215.54 647.26 Tm (Policy.) Tj ET BT /F2 12 Tf 1 0 0 1 257.05 647.26 Tm (Such) Tj ET BT /F2 12 Tf 1 0 0 1 284.97 647.26 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 334.87 647.26 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 359.45 647.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 374.7 647.26 Tm (continued,) Tj ET BT /F2 12 Tf 1 0 0 1 428.94 647.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 444.86 647.26 Tm (paying) Tj ET BT /F2 12 Tf 1 0 0 1 481.44 647.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 500.02 647.26 Tm (required) Tj ET Q q n 0 644.85 m 612 644.85 l 612 632.85 l 0 632.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 635.26 Tm (premiums,) Tj ET BT /F2 12 Tf 1 0 0 1 53.99 635.26 Tm (when) Tj ET BT /F2 12 Tf 1 0 0 1 79.99 635.26 Tm (:) Tj ET Q q n 18 632.85 m 630 632.85 l 630 620.85 l 18 620.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 623.26 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 623.26 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 74.48 623.26 Tm (employment) Tj ET BT /F2 12 Tf 1 0 0 1 141.6 623.26 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 170.07 623.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 191.87 623.26 Tm (Employer) Tj ET BT /F2 12 Tf 1 0 0 1 246.32 623.26 Tm (ends) Tj ET BT /F2 12 Tf 1 0 0 1 275.45 623.26 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 296.58 623.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 309.04 623.26 Tm (reason) Tj ET BT /F2 12 Tf 1 0 0 1 347.49 623.26 Tm (other) Tj ET BT /F2 12 Tf 1 0 0 1 379.28 623.26 Tm (than) Tj ET BT /F2 12 Tf 1 0 0 1 407.08 623.26 Tm (Total) Tj ET BT /F2 12 Tf 1 0 0 1 439.54 623.26 Tm (Disability) Tj ET BT /F2 12 Tf 1 0 0 1 494 623.26 Tm (or) Tj ET Q q n 45.35 620.85 m 657.35 620.85 l 657.35 608.85 l 45.35 608.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 611.26 Tm (retirement; and) Tj ET Q q n 18 608.85 m 630 608.85 l 630 596.85 l 18 596.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 599.26 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 599.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 66.42 599.26 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 118.82 599.26 Tm (has) Tj ET BT /F2 12 Tf 1 0 0 1 141.22 599.26 Tm (been) Tj ET BT /F2 12 Tf 1 0 0 1 170.29 599.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 186.04 599.26 Tm (force) Tj ET BT /F2 12 Tf 1 0 0 1 217.1 599.26 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 237.5 599.26 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 252.57 599.26 Tm (least) Tj ET BT /F2 12 Tf 1 0 0 1 280.98 599.26 Tm (12) Tj ET BT /F2 12 Tf 1 0 0 1 299.39 599.26 Tm (months) Tj ET BT /F2 12 Tf 1 0 0 1 341.14 599.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 356.89 599.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 368.63 599.26 Tm (row) Tj ET BT /F2 12 Tf 1 0 0 1 393.7 599.26 Tm (just) Tj ET BT /F2 12 Tf 1 0 0 1 417.45 599.26 Tm (prior) Tj ET BT /F2 12 Tf 1 0 0 1 447.19 599.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 462.94 599.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 484.01 599.26 Tm (date) Tj ET Q q n 45.35 596.85 m 657.35 596.85 l 657.35 584.85 l 45.35 584.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 587.26 Tm (employment ends.) Tj ET Q q n 18 584.85 m 630 584.85 l 630 572.85 l 18 572.85 l h W n Q q n 0 572.85 m 612 572.85 l 612 560.85 l 0 560.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 563.26 Tm (To) Tj ET BT /F2 12 Tf 1 0 0 1 16.34 563.26 Tm (continue) Tj ET BT /F2 12 Tf 1 0 0 1 60.67 563.26 Tm (insurance,) Tj ET BT /F2 12 Tf 1 0 0 1 112.65 563.26 Tm (written) Tj ET BT /F2 12 Tf 1 0 0 1 149.65 563.26 Tm (application) Tj ET BT /F2 12 Tf 1 0 0 1 205.97 563.26 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 226.31 563.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 243.98 563.26 Tm (first) Tj ET BT /F2 12 Tf 1 0 0 1 266.31 563.26 Tm (premium) Tj ET BT /F2 12 Tf 1 0 0 1 312.65 563.26 Tm (payment) Tj ET BT /F2 12 Tf 1 0 0 1 356.98 563.26 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 383.32 563.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 397.66 563.26 Tm (made) Tj ET BT /F2 12 Tf 1 0 0 1 426.65 563.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 438.99 563.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 456.66 563.26 Tm (Company,) Tj ET BT /F2 12 Tf 1 0 0 1 509.33 563.26 Tm (within) Tj ET Q q n 0 560.85 m 612 560.85 l 612 548.85 l 0 548.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 551.26 Tm (31 days of the date insurance would otherwise end.) Tj ET Q q n 0 548.85 m 612 548.85 l 612 536.85 l 0 536.85 l h W n Q q n 0 536.85 m 612 536.85 l 612 524.85 l 0 524.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 527.26 Tm (AMOUNT) Tj ET BT /F2 12 Tf 1 0 0 1 56.78 527.26 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 76.23 527.26 Tm (COVERAGE.) Tj ET BT /F2 12 Tf 1 0 0 1 152.79 527.26 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 175.55 527.26 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 215.66 527.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 229.77 527.26 Tm (continued) Tj ET BT /F2 12 Tf 1 0 0 1 281.2 527.26 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 331.29 527.26 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 356.06 527.26 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 375.51 527.26 Tm (exceed) Tj ET BT /F2 12 Tf 1 0 0 1 412.93 527.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 431.7 527.26 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 471.81 527.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 485.25 527.26 Tm (force) Tj ET BT /F2 12 Tf 1 0 0 1 514.01 527.26 Tm (when) Tj ET Q q n 0 524.85 m 612 524.85 l 612 512.85 l 0 512.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 515.26 Tm (employment ends.) Tj ET BT /F2 12 Tf 1 0 0 1 93.98 515.26 Tm (During the continuation period:) Tj ET Q q n 18 512.85 m 630 512.85 l 630 500.85 l 18 500.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 503.26 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 503.26 Tm (the amount of insurance may not be increased; and) Tj ET Q q n 18 500.85 m 630 500.85 l 630 488.85 l 18 488.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 491.26 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 491.26 Tm (additional dependents may not be enrolled for Dependent Life Insurance.) Tj ET Q q n 0 488.85 m 612 488.85 l 612 476.85 l 0 476.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 479.26 Tm (Continued insurance will be subject to any reduction on account of age, as shown in the Schedule of Insurance.) Tj ET Q q n 0 476.85 m 612 476.85 l 612 464.85 l 0 464.85 l h W n Q q n 0 464.85 m 612 464.85 l 612 452.85 l 0 452.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 455.26 Tm (You) Tj ET BT /F2 12 Tf 1 0 0 1 23.81 455.26 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 47.6 455.26 Tm (decrease) Tj ET BT /F2 12 Tf 1 0 0 1 92.04 455.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 109.84 455.26 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 148.97 455.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 162.1 455.26 Tm (continued) Tj ET BT /F2 12 Tf 1 0 0 1 212.56 455.26 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 261.68 455.26 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 273.48 455.26 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 293.95 455.26 Tm (time,) Tj ET BT /F2 12 Tf 1 0 0 1 321.41 455.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 336.55 455.26 Tm (completing) Tj ET BT /F2 12 Tf 1 0 0 1 393.68 455.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 402.14 455.26 Tm (request) Tj ET BT /F2 12 Tf 1 0 0 1 439.93 455.26 Tm (form) Tj ET BT /F2 12 Tf 1 0 0 1 466.4 455.26 Tm (supplied) Tj ET BT /F2 12 Tf 1 0 0 1 510.2 455.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 455.26 Tm (the) Tj ET Q q n 0 452.85 m 612 452.85 l 612 440.85 l 0 440.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 443.26 Tm (Company.) Tj ET BT /F2 12 Tf 1 0 0 1 56.04 443.26 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 77.88 443.26 Tm (decrease) Tj ET BT /F2 12 Tf 1 0 0 1 122.36 443.26 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 144.22 443.26 Tm (take) Tj ET BT /F2 12 Tf 1 0 0 1 167.39 443.26 Tm (effect) Tj ET BT /F2 12 Tf 1 0 0 1 197.88 443.26 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 213.07 443.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 230.91 443.26 Tm (first) Tj ET BT /F2 12 Tf 1 0 0 1 253.43 443.26 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 273.94 443.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 287.12 443.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 304.97 443.26 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 354.8 443.26 Tm (Month) Tj ET BT /F2 12 Tf 1 0 0 1 389.99 443.26 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 415.15 443.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 433 443.26 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 482.85 443.26 Tm (receives) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 443.26 Tm (the) Tj ET Q q n 0 440.85 m 612 440.85 l 612 428.85 l 0 428.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 431.26 Tm (request.) Tj ET Q q n 0 428.85 m 612 428.85 l 612 416.85 l 0 416.85 l h W n Q q n 0 416.85 m 612 416.85 l 612 404.85 l 0 404.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 407.26 Tm (PAYMENT) Tj ET BT /F2 12 Tf 1 0 0 1 61.65 407.26 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 80.64 407.26 Tm (PREMIUM.) Tj ET BT /F2 12 Tf 1 0 0 1 146.94 407.26 Tm (Timely) Tj ET BT /F2 12 Tf 1 0 0 1 185.25 407.26 Tm (payment) Tj ET BT /F2 12 Tf 1 0 0 1 230.22 407.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 243.87 407.26 Tm (premium) Tj ET BT /F2 12 Tf 1 0 0 1 290.84 407.26 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 317.82 407.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 332.8 407.26 Tm (made) Tj ET BT /F2 12 Tf 1 0 0 1 362.43 407.26 Tm (directly) Tj ET BT /F2 12 Tf 1 0 0 1 402.73 407.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 415.72 407.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 434.02 407.26 Tm (Company,) Tj ET BT /F2 12 Tf 1 0 0 1 487.34 407.26 Tm (throughout) Tj ET Q q n 0 404.85 m 612 404.85 l 612 392.85 l 0 392.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 395.26 Tm (the period of continued insurance.) Tj ET BT /F2 12 Tf 1 0 0 1 169.61 395.26 Tm (The required premium will equal:) Tj ET Q q n 18 392.85 m 630 392.85 l 630 380.85 l 18 380.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 383.26 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 383.26 Tm (premium) Tj ET BT /F2 12 Tf 1 0 0 1 93.59 383.26 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 107.16 383.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 126.73 383.26 Tm (group) Tj ET BT /F2 12 Tf 1 0 0 1 159.64 383.26 Tm (rate) Tj ET BT /F2 12 Tf 1 0 0 1 182.54 383.26 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 216.77 383.26 Tm (would) Tj ET BT /F2 12 Tf 1 0 0 1 251.69 383.26 Tm (apply) Tj ET BT /F2 12 Tf 1 0 0 1 283.26 383.26 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 295.5 383.26 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 318.41 383.26 Tm (remained) Tj ET BT /F2 12 Tf 1 0 0 1 367.97 383.26 Tm (actively) Tj ET BT /F2 12 Tf 1 0 0 1 410.86 383.26 Tm (employed) Tj ET BT /F2 12 Tf 1 0 0 1 463.09 383.26 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 489.34 383.26 Tm (the) Tj ET Q q n 45.35 380.85 m 657.35 380.85 l 657.35 368.85 l 45.35 368.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 371.26 Tm (Employer; plus) Tj ET Q q n 18 368.85 m 630 368.85 l 630 356.85 l 18 356.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 359.26 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 359.26 Tm (a direct billing fee based on the premium frequency chosen.) Tj ET Q q n 0 356.85 m 612 356.85 l 612 344.85 l 0 344.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 347.26 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 22.58 347.26 Tm (premium) Tj ET BT /F2 12 Tf 1 0 0 1 69.82 347.26 Tm (frequency) Tj ET BT /F2 12 Tf 1 0 0 1 121.72 347.26 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 146.3 347.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 161.54 347.26 Tm (changed) Tj ET BT /F2 12 Tf 1 0 0 1 205.45 347.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 221.37 347.26 Tm (sending) Tj ET BT /F2 12 Tf 1 0 0 1 262.62 347.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 281.2 347.26 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 331.79 347.26 Tm (advance) Tj ET BT /F2 12 Tf 1 0 0 1 375.01 347.26 Tm (written) Tj ET BT /F2 12 Tf 1 0 0 1 412.92 347.26 Tm (request) Tj ET BT /F2 12 Tf 1 0 0 1 451.5 347.26 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 467.42 347.26 Tm (forms) Tj ET BT /F2 12 Tf 1 0 0 1 499.34 347.26 Tm (supplied) Tj ET Q q n 0 344.85 m 612 344.85 l 612 332.85 l 0 332.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 335.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 15.51 335.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 33.69 335.26 Tm (Company.) Tj ET BT /F2 12 Tf 1 0 0 1 90.38 335.26 Tm (Such) Tj ET BT /F2 12 Tf 1 0 0 1 117.89 335.26 Tm (request) Tj ET BT /F2 12 Tf 1 0 0 1 156.06 335.26 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 180.23 335.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 195.07 335.26 Tm (sent) Tj ET BT /F2 12 Tf 1 0 0 1 217.92 335.26 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 230.09 335.26 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 250.93 335.26 Tm (time) Tj ET BT /F2 12 Tf 1 0 0 1 275.77 335.26 Tm (while) Tj ET BT /F2 12 Tf 1 0 0 1 305.95 335.26 Tm (continued) Tj ET BT /F2 12 Tf 1 0 0 1 356.78 335.26 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 406.28 335.26 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 417.79 335.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 430.64 335.26 Tm (force;) Tj ET BT /F2 12 Tf 1 0 0 1 462.13 335.26 Tm (but) Tj ET BT /F2 12 Tf 1 0 0 1 480.98 335.26 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 499.83 335.26 Tm (during) Tj ET BT /F2 12 Tf 1 0 0 1 534.67 335.26 Tm (a) Tj ET Q q n 0 332.85 m 612 332.85 l 612 320.85 l 0 320.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 323.26 Tm (Grace Period.) Tj ET Q q n 0 320.85 m 612 320.85 l 612 308.85 l 0 308.85 l h W n Q q n 0 308.85 m 612 308.85 l 612 296.85 l 0 296.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 299.26 Tm (TERMINATION OF COVERAGE.) Tj ET BT /F2 12 Tf 1 0 0 1 178.99 299.26 Tm (Continued insurance will end on the earliest of:) Tj ET Q q n 18 296.85 m 630 296.85 l 630 284.85 l 18 284.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 287.26 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 287.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 63.92 287.26 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 87.81 287.26 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 137.69 287.26 Tm (has) Tj ET BT /F2 12 Tf 1 0 0 1 157.6 287.26 Tm (been) Tj ET BT /F2 12 Tf 1 0 0 1 184.16 287.26 Tm (continued) Tj ET BT /F2 12 Tf 1 0 0 1 235.38 287.26 Tm (until) Tj ET BT /F2 12 Tf 1 0 0 1 261.29 287.26 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 283.2 287.26 Tm (attain) Tj ET BT /F2 12 Tf 1 0 0 1 313.76 287.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 332.33 287.26 Tm (Social) Tj ET BT /F2 12 Tf 1 0 0 1 366.23 287.26 Tm (Security) Tj ET BT /F2 12 Tf 1 0 0 1 410.12 287.26 Tm (Normal) Tj ET BT /F2 12 Tf 1 0 0 1 450.69 287.26 Tm (Retirement) Tj ET Q q n 45.35 284.85 m 657.35 284.85 l 657.35 272.85 l 45.35 272.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 275.26 Tm (Age; or) Tj ET Q q n 18 272.85 m 630 272.85 l 630 260.85 l 18 260.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 263.26 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 263.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 64.33 263.26 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 88.63 263.26 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 138.93 263.26 Tm (would) Tj ET BT /F2 12 Tf 1 0 0 1 173.24 263.26 Tm (otherwise) Tj ET BT /F2 12 Tf 1 0 0 1 224.21 263.26 Tm (end) Tj ET BT /F2 12 Tf 1 0 0 1 245.86 263.26 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 257.5 263.26 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 279.82 263.26 Tm (remained) Tj ET BT /F2 12 Tf 1 0 0 1 328.78 263.26 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 344.42 263.26 Tm (Active) Tj ET BT /F2 12 Tf 1 0 0 1 380.73 263.26 Tm (Employee;) Tj ET BT /F2 12 Tf 1 0 0 1 437.03 263.26 Tm (but) Tj ET BT /F2 12 Tf 1 0 0 1 456.68 263.26 Tm (continued) Tj ET Q q n 45.35 260.85 m 657.35 260.85 l 657.35 248.85 l 45.35 248.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 251.26 Tm (coverage will not end when the Policy is discontinued by the Employer.) Tj ET Q q n 0 248.85 m 612 248.85 l 612 236.85 l 0 236.85 l h W n Q q n 0 236.85 m 612 236.85 l 612 224.85 l 0 224.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 227.26 Tm (When) Tj ET BT /F2 12 Tf 1 0 0 1 31.76 227.26 Tm (continued) Tj ET BT /F2 12 Tf 1 0 0 1 82.19 227.26 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 131.27 227.26 Tm (ends,) Tj ET BT /F2 12 Tf 1 0 0 1 159.38 227.26 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 180.48 227.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 193.59 227.26 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 218.69 227.26 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 273.78 227.26 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 297.54 227.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 311.98 227.26 Tm (entitled) Tj ET BT /F2 12 Tf 1 0 0 1 351.07 227.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 363.51 227.26 Tm (purchase) Tj ET BT /F2 12 Tf 1 0 0 1 409.27 227.26 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 423.7 227.26 Tm (individual) Tj ET BT /F2 12 Tf 1 0 0 1 475.47 227.26 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 494.57 227.26 Tm (policy,) Tj ET BT /F2 12 Tf 1 0 0 1 530.67 227.26 Tm (in) Tj ET Q q n 0 224.85 m 612 224.85 l 612 212.85 l 0 212.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 215.26 Tm (accord with the Conversion Privilege section of this Certificate.) Tj ET Q Q q Q Q endstream endobj 11 0 obj <>>>>> endobj 143 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 730.85 cm q n 0 25.15 m 550.8 25.15 l 550.8 13.15 l 0 13.15 l h W n 0.00392 0 0 rg BT /F4 12 Tf 1 0 0 1 220.82 15.56 Tm (DEATH BENEFIT) Tj ET Q q n 0 13.15 m 550.8 13.15 l 550.8 1.15 l 0 1.15 l h W n 0.00392 0 0 rg BT /F4 12 Tf 1 0 0 1 217.34 3.56 Tm (For Employees Only) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 225 25.15 l 225 13.15 l 0 13.15 l h W n 0.00392 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-3 VIT) Tj ET Q q n 225 25.15 m 540.25 25.15 l 540.25 13.15 l 225 13.15 l h W n 0.00392 0 0 rg BT /F2 12 Tf 1 0 0 1 450.9 15.56 Tm (SSNRA-w/o DEP.) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 272.9 3.56 Tm (7) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 656.85 m 612 656.85 l 612 644.85 l 0 644.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 647.26 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 22.06 647.26 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 61.46 647.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 74.85 647.26 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 100.25 647.26 Tm (Personal) Tj ET BT /F2 12 Tf 1 0 0 1 144.98 647.26 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 168.37 647.26 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 218.41 647.26 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 251.14 647.26 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 262.55 647.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 275.28 647.26 Tm (effect) Tj ET BT /F2 12 Tf 1 0 0 1 305.99 647.26 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 321.39 647.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 339.45 647.26 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 362.84 647.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 376.24 647.26 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 401.64 647.26 Tm (death) Tj ET BT /F2 12 Tf 1 0 0 1 431.03 647.26 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 453.1 647.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 467.83 647.26 Tm (paid) Tj ET BT /F2 12 Tf 1 0 0 1 491.89 647.26 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 505.29 647.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 514.01 647.26 Tm (death) Tj ET Q q n 0 644.85 m 612 644.85 l 612 632.85 l 0 632.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 635.26 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 36.69 635.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 49.41 635.26 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 74.78 635.26 Tm (Beneficiary.) Tj ET BT /F2 12 Tf 1 0 0 1 140.5 635.26 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 151.87 635.26 Tm (no) Tj ET BT /F2 12 Tf 1 0 0 1 167.25 635.26 Tm (named) Tj ET BT /F2 12 Tf 1 0 0 1 202.62 635.26 Tm (Beneficiary) Tj ET BT /F2 12 Tf 1 0 0 1 261.96 635.26 Tm (survives) Tj ET BT /F2 12 Tf 1 0 0 1 305.34 635.26 Tm (you,) Tj ET BT /F2 12 Tf 1 0 0 1 329.71 635.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 347.75 635.26 Tm (death) Tj ET BT /F2 12 Tf 1 0 0 1 377.12 635.26 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 413.81 635.26 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 435.86 635.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 450.56 635.26 Tm (paid) Tj ET BT /F2 12 Tf 1 0 0 1 474.6 635.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 487.31 635.26 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 512.68 635.26 Tm (estate) Tj ET Q q n 0 632.85 m 612 632.85 l 612 620.85 l 0 620.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 623.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 15.15 623.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 29.65 623.26 Tm (accord) Tj ET BT /F2 12 Tf 1 0 0 1 66.78 623.26 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 93.27 623.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 113.09 623.26 Tm (terms) Tj ET BT /F2 12 Tf 1 0 0 1 144.9 623.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 160.06 623.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 179.88 623.26 Tm (Policy.) Tj ET BT /F2 12 Tf 1 0 0 1 223.86 623.26 Tm (Arrangements) Tj ET BT /F2 12 Tf 1 0 0 1 296.99 623.26 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 322.81 623.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 339.29 623.26 Tm (made) Tj ET BT /F2 12 Tf 1 0 0 1 370.43 623.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 384.93 623.26 Tm (have) Tj ET BT /F2 12 Tf 1 0 0 1 412.74 623.26 Tm (this) Tj ET BT /F2 12 Tf 1 0 0 1 435.23 623.26 Tm (death) Tj ET BT /F2 12 Tf 1 0 0 1 466.38 623.26 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 504.85 623.26 Tm (paid) Tj ET BT /F2 12 Tf 1 0 0 1 530.67 623.26 Tm (in) Tj ET Q q n 0 620.85 m 612 620.85 l 612 608.85 l 0 608.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 611.26 Tm (installments.) Tj ET Q q n 0 608.85 m 612 608.85 l 612 596.85 l 0 596.85 l h W n Q q n 0 596.85 m 612 596.85 l 612 584.85 l 0 584.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 587.26 Tm (EXCLUSION.) Tj ET BT /F2 12 Tf 1 0 0 1 77 587.26 Tm (Benefits will not be payable if your death:) Tj ET Q q n 18 584.85 m 630 584.85 l 630 572.85 l 18 572.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 575.26 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 575.26 Tm (results from suicide while sane; and) Tj ET Q q n 18 572.85 m 630 572.85 l 630 560.85 l 18 560.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 563.26 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 563.26 Tm (occurs within two years after your Personal Life Insurance takes effect.) Tj ET Q q n 0 560.85 m 612 560.85 l 612 548.85 l 0 548.85 l h W n Q q n 0 548.85 m 612 548.85 l 612 536.85 l 0 536.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 539.26 Tm (However,) Tj ET BT /F2 12 Tf 1 0 0 1 50.58 539.26 Tm (suicide) Tj ET BT /F2 12 Tf 1 0 0 1 88.17 539.26 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 99.77 539.26 Tm (no) Tj ET BT /F2 12 Tf 1 0 0 1 115.36 539.26 Tm (defense) Tj ET BT /F2 12 Tf 1 0 0 1 155.6 539.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 168.54 539.26 Tm (payment) Tj ET BT /F2 12 Tf 1 0 0 1 213.45 539.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 227.05 539.26 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 246.63 539.26 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 296.21 539.26 Tm (benefits) Tj ET BT /F2 12 Tf 1 0 0 1 337.79 539.26 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 368.71 539.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 386.97 539.26 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 421.23 539.26 Tm (unless) Tj ET BT /F2 12 Tf 1 0 0 1 454.83 539.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 473.09 539.26 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 523.35 539.26 Tm (can) Tj ET Q q n 0 536.85 m 612 536.85 l 612 524.85 l 0 524.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 527.26 Tm (show that you intended suicide when applying for the insurance.) Tj ET Q q n 0 524.85 m 612 524.85 l 612 512.85 l 0 512.85 l h W n Q q n 0 512.85 m 612 512.85 l 612 500.85 l 0 500.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 227.99 503.26 Tm (BENEFICIARY) Tj ET Q q n 0 500.85 m 612 500.85 l 612 488.85 l 0 488.85 l h W n Q q n 0 488.85 m 612 488.85 l 612 476.85 l 0 476.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 479.26 Tm (Your) Tj ET BT /F2 12 Tf 1 0 0 1 28.56 479.26 Tm (Beneficiary) Tj ET BT /F2 12 Tf 1 0 0 1 88.42 479.26 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 110.99 479.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 126.21 479.26 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 140.1 479.26 Tm (shown) Tj ET BT /F2 12 Tf 1 0 0 1 175.33 479.26 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 191.23 479.26 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 217.12 479.26 Tm (enrollment) Tj ET BT /F2 12 Tf 1 0 0 1 273 479.26 Tm (card,) Tj ET BT /F2 12 Tf 1 0 0 1 300.55 479.26 Tm (unless) Tj ET BT /F2 12 Tf 1 0 0 1 334.44 479.26 Tm (changed.) Tj ET BT /F2 12 Tf 1 0 0 1 385.22 479.26 Tm (Only) Tj ET BT /F2 12 Tf 1 0 0 1 413.11 479.26 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 435.01 479.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 448.9 479.26 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 474.79 479.26 Tm (assignee) Tj ET BT /F2 12 Tf 1 0 0 1 519.34 479.26 Tm (may) Tj ET Q q n 0 476.85 m 612 476.85 l 612 464.85 l 0 464.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 467.26 Tm (change) Tj ET BT /F2 12 Tf 1 0 0 1 38.32 467.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 57.33 467.26 Tm (Beneficiary.) Tj ET BT /F2 12 Tf 1 0 0 1 124.98 467.26 Tm (A) Tj ET BT /F2 12 Tf 1 0 0 1 137.99 467.26 Tm (new) Tj ET BT /F2 12 Tf 1 0 0 1 162.33 467.26 Tm (Beneficiary) Tj ET BT /F2 12 Tf 1 0 0 1 222.64 467.26 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 247.64 467.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 263.31 467.26 Tm (named) Tj ET BT /F2 12 Tf 1 0 0 1 299.64 467.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 315.99 467.26 Tm (filing) Tj ET BT /F2 12 Tf 1 0 0 1 346.33 467.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 356 467.26 Tm (written) Tj ET BT /F2 12 Tf 1 0 0 1 394.33 467.26 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 428 467.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 442.34 467.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 461.34 467.26 Tm (change) Tj ET BT /F2 12 Tf 1 0 0 1 499.66 467.26 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 467.26 Tm (the) Tj ET Q q n 0 464.85 m 612 464.85 l 612 452.85 l 0 452.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 455.26 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 51.25 455.26 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 64.5 455.26 Tm (its) Tj ET BT /F2 12 Tf 1 0 0 1 80.43 455.26 Tm (Group) Tj ET BT /F2 12 Tf 1 0 0 1 115.68 455.26 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 166.91 455.26 Tm (Service) Tj ET BT /F2 12 Tf 1 0 0 1 207.48 455.26 Tm (Office.) Tj ET BT /F2 12 Tf 1 0 0 1 250.3 455.26 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 273.55 455.26 Tm (change) Tj ET BT /F2 12 Tf 1 0 0 1 312.11 455.26 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 335.37 455.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 351.28 455.26 Tm (effective) Tj ET BT /F2 12 Tf 1 0 0 1 397.84 455.26 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 412.42 455.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 427.01 455.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 446.25 455.26 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 470.83 455.26 Tm (it) Tj ET BT /F2 12 Tf 1 0 0 1 482.09 455.26 Tm (was) Tj ET BT /F2 12 Tf 1 0 0 1 505.34 455.26 Tm (signed;) Tj ET Q q n 0 452.85 m 612 452.85 l 612 440.85 l 0 440.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 443.26 Tm (subject to any action taken by the Company before it received notice of the change.) Tj ET Q q n 0 440.85 m 612 440.85 l 612 428.85 l 0 428.85 l h W n Q q n 0 428.85 m 612 428.85 l 612 416.85 l 0 416.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 151.81 419.26 Tm (EXTENSION OF DEATH BENEFIT IF YOU) Tj ET Q q n 0 416.85 m 612 416.85 l 612 404.85 l 0 404.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 180.31 407.26 Tm (BECOME TOTALLY DISABLED) Tj ET Q q n 0 404.85 m 612 404.85 l 612 392.85 l 0 392.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 217.34 395.26 Tm (For Employees Only) Tj ET Q q n 0 379.05 m 612 379.05 l 612 367.05 l 0 367.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 369.46 Tm (Any) Tj ET BT /F2 12 Tf 1 0 0 1 25.09 369.46 Tm (Personal) Tj ET BT /F2 12 Tf 1 0 0 1 70.83 369.46 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 95.24 369.46 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 146.3 369.46 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 162.72 369.46 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 189.13 369.46 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 209.54 369.46 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 232.63 369.46 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 248.37 369.46 Tm (continued,) Tj ET BT /F2 12 Tf 1 0 0 1 303.11 369.46 Tm (without) Tj ET BT /F2 12 Tf 1 0 0 1 344.2 369.46 Tm (payment) Tj ET BT /F2 12 Tf 1 0 0 1 389.94 369.46 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 404.36 369.46 Tm (premiums;) Tj ET BT /F2 12 Tf 1 0 0 1 460.1 369.46 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 471.85 369.46 Tm (while) Tj ET BT /F2 12 Tf 1 0 0 1 502.93 369.46 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 525.35 369.46 Tm (are) Tj ET Q q n 0 367.05 m 612 367.05 l 612 355.05 l 0 355.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 357.46 Tm (insured:) Tj ET Q q n 18 355.05 m 630 355.05 l 630 343.05 l 18 343.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 345.46 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 345.46 Tm (you become Totally Disabled before you reach age 60; and) Tj ET Q q n 18 343.05 m 630 343.05 l 630 331.05 l 18 331.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 333.46 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 333.46 Tm (you submit proof of your disability which is received by the Company:) Tj ET Q q n 45.35 331.05 m 657.35 331.05 l 657.35 319.05 l 45.35 319.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 321.46 Tm ($a$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 321.46 Tm (within 12 months after your Total Disability begins; or) Tj ET Q q n 45.35 319.05 m 657.35 319.05 l 657.35 307.05 l 45.35 307.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 309.46 Tm ($b$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 309.46 Tm (as soon as reasonably possible after that.) Tj ET Q q n 0 307.05 m 612 307.05 l 612 295.05 l 0 295.05 l h W n Q q n 0 295.05 m 612 295.05 l 612 283.05 l 0 283.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 285.46 Tm (Upon) Tj ET BT /F2 12 Tf 1 0 0 1 30.29 285.46 Tm (receipt) Tj ET BT /F2 12 Tf 1 0 0 1 66.55 285.46 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 80.17 285.46 Tm (such) Tj ET BT /F2 12 Tf 1 0 0 1 105.78 285.46 Tm (proof,) Tj ET BT /F2 12 Tf 1 0 0 1 138.39 285.46 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 156.67 285.46 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 206.96 285.46 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 229.25 285.46 Tm (refund) Tj ET BT /F2 12 Tf 1 0 0 1 264.19 285.46 Tm (all) Tj ET BT /F2 12 Tf 1 0 0 1 279.8 285.46 Tm (premiums) Tj ET BT /F2 12 Tf 1 0 0 1 331.41 285.46 Tm (paid) Tj ET BT /F2 12 Tf 1 0 0 1 355.69 285.46 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 373.31 285.46 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 398.92 285.46 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 445.84 285.46 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 472.79 285.46 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 491.07 285.46 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 514.68 285.46 Tm (Total) Tj ET Q q n 0 283.05 m 612 283.05 l 612 271.05 l 0 271.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 273.46 Tm (Disability began.) Tj ET Q q n 0 271.05 m 612 271.05 l 612 259.05 l 0 259.05 l h W n Q q n 0 259.05 m 612 259.05 l 612 247.05 l 0 247.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 249.46 Tm (The life insurance continued will be subject to the reductions and terminations shown in the Policy.) Tj ET Q q n 0 247.05 m 612 247.05 l 612 235.05 l 0 235.05 l h W n Q q n 0 235.05 m 612 235.05 l 612 223.05 l 0 223.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 225.46 Tm (DEFINITION OF TOTAL DISABILITY.) Tj ET BT /F2 12 Tf 1 0 0 1 207.97 225.46 Tm (For this benefit, Total Disability:) Tj ET Q q n 18 223.05 m 630 223.05 l 630 211.05 l 18 211.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 213.46 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 213.46 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 79.52 213.46 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 101.04 213.46 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 119.21 213.46 Tm (unable,) Tj ET BT /F2 12 Tf 1 0 0 1 157.71 213.46 Tm (due) Tj ET BT /F2 12 Tf 1 0 0 1 178.56 213.46 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 191.41 213.46 Tm (sickness) Tj ET BT /F2 12 Tf 1 0 0 1 234.92 213.46 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 248.44 213.46 Tm (injury,) Tj ET BT /F2 12 Tf 1 0 0 1 283.62 213.46 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 296.47 213.46 Tm (perform) Tj ET BT /F2 12 Tf 1 0 0 1 338.64 213.46 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 356.82 213.46 Tm (material) Tj ET BT /F2 12 Tf 1 0 0 1 399.65 213.46 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 420.49 213.46 Tm (substantial) Tj ET BT /F2 12 Tf 1 0 0 1 475.34 213.46 Tm (duties) Tj ET Q q n 45.35 211.05 m 657.35 211.05 l 657.35 199.05 l 45.35 199.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 201.46 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 61.74 201.46 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 85.45 201.46 Tm (employment) Tj ET BT /F2 12 Tf 1 0 0 1 151.83 201.46 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 168.22 201.46 Tm (occupation) Tj ET BT /F2 12 Tf 1 0 0 1 227.25 201.46 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 247.63 201.46 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 283.35 201.46 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 307.74 201.46 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 328.78 201.46 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 345.16 201.46 Tm (become) Tj ET BT /F2 12 Tf 1 0 0 1 388.87 201.46 Tm (qualified) Tj ET BT /F2 12 Tf 1 0 0 1 437.91 201.46 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 456.3 201.46 Tm (reason) Tj ET BT /F2 12 Tf 1 0 0 1 494 201.46 Tm (of) Tj ET Q q n 45.35 199.05 m 657.35 199.05 l 657.35 187.05 l 45.35 187.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 189.46 Tm (education, training, or experience; and) Tj ET Q q n 18 187.05 m 630 187.05 l 630 175.05 l 18 175.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 177.46 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 177.46 Tm (must continue for at least 180 days.) Tj ET Q q n 0 175.05 m 612 175.05 l 612 163.05 l 0 163.05 l h W n Q q n 0 163.05 m 612 163.05 l 612 151.05 l 0 151.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 153.46 Tm (From time to time, you must submit proof that your Total Disability is continuing.) Tj ET Q q n 0 151.05 m 612 151.05 l 612 139.05 l 0 139.05 l h W n Q q n 0 139.05 m 612 139.05 l 612 127.05 l 0 127.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 129.46 Tm (Any life insurance which has been continued under this benefit will be terminated automatically on the day:) Tj ET Q q n 18 127.05 m 630 127.05 l 630 115.05 l 18 115.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 117.46 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 117.46 Tm (you cease to be Totally Disabled;) Tj ET Q q n 18 115.05 m 630 115.05 l 630 103.05 l 18 103.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 105.46 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 105.46 Tm (you fail to take a required medical examination;) Tj ET Q q n 18 103.05 m 630 103.05 l 630 91.05 l 18 91.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 93.46 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 93.46 Tm (you fail to submit any required proofs; or) Tj ET Q q n 18 91.05 m 630 91.05 l 630 79.05 l 18 79.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 81.46 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 81.46 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 68.41 81.46 Tm (reach) Tj ET BT /F2 12 Tf 1 0 0 1 99.44 81.46 Tm (Social) Tj ET BT /F2 12 Tf 1 0 0 1 134.49 81.46 Tm (Security) Tj ET BT /F2 12 Tf 1 0 0 1 179.54 81.46 Tm (Normal) Tj ET BT /F2 12 Tf 1 0 0 1 221.25 81.46 Tm (Retirement) Tj ET BT /F2 12 Tf 1 0 0 1 279.62 81.46 Tm (Age) Tj ET BT /F2 12 Tf 1 0 0 1 304.67 81.46 Tm ($SSNRA$,) Tj ET BT /F2 12 Tf 1 0 0 1 359.41 81.46 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 374.46 81.46 Tm (shown) Tj ET BT /F2 12 Tf 1 0 0 1 410.85 81.46 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 425.24 81.46 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 444.96 81.46 Tm (Schedule) Tj ET BT /F2 12 Tf 1 0 0 1 494 81.46 Tm (of) Tj ET Q q n 45.35 79.05 m 657.35 79.05 l 657.35 67.05 l 45.35 67.05 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 69.46 Tm (Insurance.) Tj ET Q Q q Q Q endstream endobj 12 0 obj <>>>>> endobj 144 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 742.85 cm q n 0 13.15 m 550.8 13.15 l 550.8 1.15 l 0 1.15 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 226.32 3.56 Tm (ASSIGNMENTS) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 270.1 25.15 l 270.1 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-3.0C 01) Tj ET Q q n 270.1 25.15 m 540.25 25.15 l 540.25 13.15 l 270.1 13.15 l h W n Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 272.9 3.56 Tm (8) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 682.65 m 612 682.65 l 612 670.65 l 0 670.65 l h W n Q q n 0 670.65 m 612 670.65 l 612 658.65 l 0 658.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 661.06 Tm (Personal) Tj ET BT /F2 12 Tf 1 0 0 1 44.92 661.06 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 68.49 661.06 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 118.72 661.06 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 139.64 661.06 Tm (Accidental) Tj ET BT /F2 12 Tf 1 0 0 1 195.2 661.06 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 227.45 661.06 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 277.68 661.06 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 301.93 661.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 316.84 661.06 Tm (assigned.) Tj ET BT /F2 12 Tf 1 0 0 1 368.35 661.06 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 390.6 661.06 Tm (assignments) Tj ET BT /F2 12 Tf 1 0 0 1 452.85 661.06 Tm (allowed) Tj ET BT /F2 12 Tf 1 0 0 1 494.43 661.06 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 661.06 Tm (the) Tj ET Q q n 0 658.65 m 612 658.65 l 612 646.65 l 0 646.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 649.06 Tm (Policy are absolute assignments and funeral assignments as described below.) Tj ET Q q n 0 646.65 m 612 646.65 l 612 634.65 l 0 634.65 l h W n Q q n 0 634.65 m 612 634.65 l 612 622.65 l 0 622.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 625.06 Tm (No assignment will be binding on the Company unless and until:) Tj ET Q q n 18 622.65 m 630 622.65 l 630 610.65 l 18 610.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 613.06 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 613.06 Tm (it is made on a form furnished by the Company;) Tj ET Q q n 18 610.65 m 630 610.65 l 630 598.65 l 18 598.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 601.06 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 601.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 64.26 601.06 Tm (original) Tj ET BT /F2 12 Tf 1 0 0 1 105.83 601.06 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 118.08 601.06 Tm (completed) Tj ET BT /F2 12 Tf 1 0 0 1 172.3 601.06 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 193.88 601.06 Tm (filed) Tj ET BT /F2 12 Tf 1 0 0 1 220.11 601.06 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 245.69 601.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 264.6 601.06 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 315.51 601.06 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 328.41 601.06 Tm (its) Tj ET BT /F2 12 Tf 1 0 0 1 344 601.06 Tm (Group) Tj ET BT /F2 12 Tf 1 0 0 1 378.91 601.06 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 429.79 601.06 Tm (Service) Tj ET BT /F2 12 Tf 1 0 0 1 470.02 601.06 Tm (Office;) Tj ET Q q n 45.35 598.65 m 657.35 598.65 l 657.35 586.65 l 45.35 586.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 589.06 Tm (and) Tj ET Q q n 18 586.65 m 630 586.65 l 630 574.65 l 18 574.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 577.06 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 577.06 Tm (it is approved by the Company.) Tj ET Q q n 0 574.65 m 612 574.65 l 612 562.65 l 0 562.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 565.06 Tm (The Company and the Employer do not assume responsibility for the validity or effect of an assignment.) Tj ET Q q n 0 562.65 m 612 562.65 l 612 550.65 l 0 550.65 l h W n Q q n 0 550.65 m 612 550.65 l 612 538.65 l 0 538.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 541.06 Tm (ABSOLUTE) Tj ET BT /F2 12 Tf 1 0 0 1 65.98 541.06 Tm (ASSIGNMENTS.) Tj ET BT /F2 12 Tf 1 0 0 1 159.63 541.06 Tm (You) Tj ET BT /F2 12 Tf 1 0 0 1 183.62 541.06 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 207.59 541.06 Tm (make) Tj ET BT /F2 12 Tf 1 0 0 1 236.9 541.06 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 251.54 541.06 Tm (irrevocable) Tj ET BT /F2 12 Tf 1 0 0 1 308.83 541.06 Tm (assignment) Tj ET BT /F2 12 Tf 1 0 0 1 366.14 541.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 379.45 541.06 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 404.77 541.06 Tm (Personal) Tj ET BT /F2 12 Tf 1 0 0 1 449.41 541.06 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 472.72 541.06 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 522.67 541.06 Tm (and) Tj ET Q q n 0 538.65 m 612 538.65 l 612 526.65 l 0 526.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 529.06 Tm (Accidental) Tj ET BT /F2 12 Tf 1 0 0 1 56.63 529.06 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 89.94 529.06 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 141.24 529.06 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 155.89 529.06 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 165.88 529.06 Tm (gift) Tj ET BT /F2 12 Tf 1 0 0 1 187.2 529.06 Tm ($with) Tj ET BT /F2 12 Tf 1 0 0 1 217.18 529.06 Tm (no) Tj ET BT /F2 12 Tf 1 0 0 1 233.84 529.06 Tm (consideration$,) Tj ET BT /F2 12 Tf 1 0 0 1 310.14 529.06 Tm (providing) Tj ET BT /F2 12 Tf 1 0 0 1 361.46 529.06 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 384.12 529.06 Tm (have) Tj ET BT /F2 12 Tf 1 0 0 1 411.43 529.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 430.75 529.06 Tm (legal) Tj ET BT /F2 12 Tf 1 0 0 1 458.73 529.06 Tm (capacity) Tj ET BT /F2 12 Tf 1 0 0 1 503.36 529.06 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 529.06 Tm (the) Tj ET Q q n 0 526.65 m 612 526.65 l 612 514.65 l 0 514.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 517.06 Tm (mental) Tj ET BT /F2 12 Tf 1 0 0 1 36.75 517.06 Tm (capacity) Tj ET BT /F2 12 Tf 1 0 0 1 80.83 517.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 94.26 517.06 Tm (do) Tj ET BT /F2 12 Tf 1 0 0 1 110.36 517.06 Tm (so.) Tj ET BT /F2 12 Tf 1 0 0 1 132.23 517.06 Tm (It) Tj ET BT /F2 12 Tf 1 0 0 1 143.66 517.06 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 168.42 517.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 183.84 517.06 Tm (made) Tj ET BT /F2 12 Tf 1 0 0 1 213.93 517.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 227.36 517.06 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 236.79 517.06 Tm (trust) Tj ET BT /F2 12 Tf 1 0 0 1 262.22 517.06 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 276.32 517.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 289.75 517.06 Tm (one) Tj ET BT /F2 12 Tf 1 0 0 1 311.18 517.06 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 325.27 517.06 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 354.03 517.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 368.13 517.06 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 394.22 517.06 Tm (relatives,) Tj ET BT /F2 12 Tf 1 0 0 1 441.97 517.06 Tm (their) Tj ET BT /F2 12 Tf 1 0 0 1 468.06 517.06 Tm (estates,) Tj ET BT /F2 12 Tf 1 0 0 1 507.14 517.06 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 521.24 517.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 534.67 517.06 Tm (a) Tj ET Q q n 0 514.65 m 612 514.65 l 612 502.65 l 0 502.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 505.06 Tm (trustee of a trust under which one of the relatives is a beneficiary.) Tj ET Q q n 0 502.65 m 612 502.65 l 612 490.65 l 0 490.65 l h W n Q q n 0 490.65 m 612 490.65 l 612 478.65 l 0 478.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 481.06 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 22.54 481.06 Tm (term) Tj ET BT /F2 12 Tf 1 0 0 1 48.42 481.06 Tm ("relatives") Tj ET BT /F2 12 Tf 1 0 0 1 102.75 481.06 Tm (includes,) Tj ET BT /F2 12 Tf 1 0 0 1 149.63 481.06 Tm (but) Tj ET BT /F2 12 Tf 1 0 0 1 168.85 481.06 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 180.74 481.06 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 199.96 481.06 Tm (limited) Tj ET BT /F2 12 Tf 1 0 0 1 237.84 481.06 Tm (to,) Tj ET BT /F2 12 Tf 1 0 0 1 254.06 481.06 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 279.95 481.06 Tm (spouse,) Tj ET BT /F2 12 Tf 1 0 0 1 319.5 481.06 Tm (parents,) Tj ET BT /F2 12 Tf 1 0 0 1 361.04 481.06 Tm (grandparents,) Tj ET BT /F2 12 Tf 1 0 0 1 429.9 481.06 Tm (aunts,) Tj ET BT /F2 12 Tf 1 0 0 1 462.12 481.06 Tm (uncles,) Tj ET BT /F2 12 Tf 1 0 0 1 499.66 481.06 Tm (siblings,) Tj ET Q q n 0 478.65 m 612 478.65 l 612 466.65 l 0 466.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 469.06 Tm (children, adopted children, stepchildren, and grandchildren.) Tj ET Q q n 0 466.65 m 612 466.65 l 612 454.65 l 0 454.65 l h W n Q q n 0 454.65 m 612 454.65 l 612 442.65 l 0 442.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 445.06 Tm (In) Tj ET BT /F2 12 Tf 1 0 0 1 13.67 445.06 Tm (some) Tj ET BT /F2 12 Tf 1 0 0 1 42.67 445.06 Tm (states,) Tj ET BT /F2 12 Tf 1 0 0 1 76.01 445.06 Tm (community) Tj ET BT /F2 12 Tf 1 0 0 1 134.34 445.06 Tm (property) Tj ET BT /F2 12 Tf 1 0 0 1 178.67 445.06 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 190.34 445.06 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 205.34 445.06 Tm (established) Tj ET BT /F2 12 Tf 1 0 0 1 262.34 445.06 Tm (form) Tj ET BT /F2 12 Tf 1 0 0 1 289.34 445.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 303.01 445.06 Tm (ownership) Tj ET BT /F2 12 Tf 1 0 0 1 356.67 445.06 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 378.34 445.06 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 405.35 445.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 420.35 445.06 Tm (considered) Tj ET BT /F2 12 Tf 1 0 0 1 476 445.06 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 489.01 445.06 Tm (making) Tj ET BT /F2 12 Tf 1 0 0 1 528.67 445.06 Tm (an) Tj ET Q q n 0 442.65 m 612 442.65 l 612 430.65 l 0 430.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 433.06 Tm (assignment.) Tj ET BT /F2 12 Tf 1 0 0 1 63.82 433.06 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 75.23 433.06 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 96.64 433.06 Tm (make) Tj ET BT /F2 12 Tf 1 0 0 1 126.04 433.06 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 140.78 433.06 Tm (absolute) Tj ET BT /F2 12 Tf 1 0 0 1 184.18 433.06 Tm (assignment) Tj ET BT /F2 12 Tf 1 0 0 1 241.59 433.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 254.34 433.06 Tm (two) Tj ET BT /F2 12 Tf 1 0 0 1 275.75 433.06 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 289.16 433.06 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 317.23 433.06 Tm (assignees,) Tj ET BT /F2 12 Tf 1 0 0 1 368.96 433.06 Tm (such) Tj ET BT /F2 12 Tf 1 0 0 1 394.37 433.06 Tm (assignees) Tj ET BT /F2 12 Tf 1 0 0 1 443.11 433.06 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 465.19 433.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 479.93 433.06 Tm (joint) Tj ET BT /F2 12 Tf 1 0 0 1 505.34 433.06 Tm (owners) Tj ET Q q n 0 430.65 m 612 430.65 l 612 418.65 l 0 418.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 421.06 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 24.47 421.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 42.26 421.06 Tm (right) Tj ET BT /F2 12 Tf 1 0 0 1 68.06 421.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 81.19 421.06 Tm (survivorship) Tj ET BT /F2 12 Tf 1 0 0 1 144.33 421.06 Tm (between) Tj ET BT /F2 12 Tf 1 0 0 1 187.44 421.06 Tm (them.) Tj ET BT /F2 12 Tf 1 0 0 1 220.71 421.06 Tm (You) Tj ET BT /F2 12 Tf 1 0 0 1 244.51 421.06 Tm (should) Tj ET BT /F2 12 Tf 1 0 0 1 279.65 421.06 Tm (consult) Tj ET BT /F2 12 Tf 1 0 0 1 317.45 421.06 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 341.92 421.06 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 367.05 421.06 Tm (own) Tj ET BT /F2 12 Tf 1 0 0 1 390.85 421.06 Tm (legal) Tj ET BT /F2 12 Tf 1 0 0 1 417.3 421.06 Tm (advisor) Tj ET BT /F2 12 Tf 1 0 0 1 455.77 421.06 Tm (before) Tj ET BT /F2 12 Tf 1 0 0 1 489.55 421.06 Tm (making) Tj ET BT /F2 12 Tf 1 0 0 1 528.67 421.06 Tm (an) Tj ET Q q n 0 418.65 m 612 418.65 l 612 406.65 l 0 406.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 409.06 Tm (assignment.) Tj ET Q q n 0 406.65 m 612 406.65 l 612 394.65 l 0 394.65 l h W n Q q n 0 394.65 m 612 394.65 l 612 382.65 l 0 382.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 385.06 Tm (Once) Tj ET BT /F2 12 Tf 1 0 0 1 28.84 385.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 47.02 385.06 Tm (assignment) Tj ET BT /F2 12 Tf 1 0 0 1 104.54 385.06 Tm (has) Tj ET BT /F2 12 Tf 1 0 0 1 124.05 385.06 Tm (been) Tj ET BT /F2 12 Tf 1 0 0 1 150.23 385.06 Tm (recorded) Tj ET BT /F2 12 Tf 1 0 0 1 195.72 385.06 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 211.24 385.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 229.42 385.06 Tm (Company,) Tj ET BT /F2 12 Tf 1 0 0 1 282.61 385.06 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 304.13 385.06 Tm (can) Tj ET BT /F2 12 Tf 1 0 0 1 324.3 385.06 Tm (no) Tj ET BT /F2 12 Tf 1 0 0 1 339.82 385.06 Tm (longer) Tj ET BT /F2 12 Tf 1 0 0 1 374 385.06 Tm (change) Tj ET BT /F2 12 Tf 1 0 0 1 411.5 385.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 429.68 385.06 Tm (beneficiary) Tj ET BT /F2 12 Tf 1 0 0 1 487.17 385.06 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 508.01 385.06 Tm (cannot) Tj ET Q q n 0 382.65 m 612 382.65 l 612 370.65 l 0 370.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 373.06 Tm (apply) Tj ET BT /F2 12 Tf 1 0 0 1 30.61 373.06 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 48.55 373.06 Tm (conversion.) Tj ET BT /F2 12 Tf 1 0 0 1 112.09 373.06 Tm (Only) Tj ET BT /F2 12 Tf 1 0 0 1 140.04 373.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 158.65 373.06 Tm (assignee) Tj ET BT /F2 12 Tf 1 0 0 1 203.25 373.06 Tm (can) Tj ET BT /F2 12 Tf 1 0 0 1 223.85 373.06 Tm (change) Tj ET BT /F2 12 Tf 1 0 0 1 261.77 373.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 280.38 373.06 Tm (beneficiary) Tj ET BT /F2 12 Tf 1 0 0 1 338.29 373.06 Tm (designation) Tj ET BT /F2 12 Tf 1 0 0 1 397.57 373.06 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 408.84 373.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 427.45 373.06 Tm (previous) Tj ET BT /F2 12 Tf 1 0 0 1 472.72 373.06 Tm (designation) Tj ET BT /F2 12 Tf 1 0 0 1 532 373.06 Tm (is) Tj ET Q q n 0 370.65 m 612 370.65 l 612 358.65 l 0 358.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 361.06 Tm (revocable.) Tj ET BT /F2 12 Tf 1 0 0 1 56.09 361.06 Tm (An) Tj ET BT /F2 12 Tf 1 0 0 1 73.98 361.06 Tm (assignment) Tj ET BT /F2 12 Tf 1 0 0 1 131.2 361.06 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 153.1 361.06 Tm (have) Tj ET BT /F2 12 Tf 1 0 0 1 178.98 361.06 Tm (no) Tj ET BT /F2 12 Tf 1 0 0 1 194.21 361.06 Tm (effect) Tj ET BT /F2 12 Tf 1 0 0 1 224.74 361.06 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 239.96 361.06 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 248.52 361.06 Tm (prior) Tj ET BT /F2 12 Tf 1 0 0 1 275.07 361.06 Tm (irrevocable) Tj ET BT /F2 12 Tf 1 0 0 1 332.26 361.06 Tm (beneficiary) Tj ET BT /F2 12 Tf 1 0 0 1 389.46 361.06 Tm (designation.) Tj ET BT /F2 12 Tf 1 0 0 1 454.23 361.06 Tm (Only) Tj ET BT /F2 12 Tf 1 0 0 1 481.46 361.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 499.35 361.06 Tm (assignee) Tj ET Q q n 0 358.65 m 612 358.65 l 612 346.65 l 0 346.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 349.06 Tm (can) Tj ET BT /F2 12 Tf 1 0 0 1 19.8 349.06 Tm (apply) Tj ET BT /F2 12 Tf 1 0 0 1 49.6 349.06 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 66.74 349.06 Tm (conversion) Tj ET BT /F2 12 Tf 1 0 0 1 122.54 349.06 Tm (but) Tj ET BT /F2 12 Tf 1 0 0 1 141.01 349.06 Tm (only) Tj ET BT /F2 12 Tf 1 0 0 1 165.49 349.06 Tm (when) Tj ET BT /F2 12 Tf 1 0 0 1 194.63 349.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 212.43 349.06 Tm (Conversion) Tj ET BT /F2 12 Tf 1 0 0 1 270.91 349.06 Tm (Privilege) Tj ET BT /F2 12 Tf 1 0 0 1 317.38 349.06 Tm (provision) Tj ET BT /F2 12 Tf 1 0 0 1 365.85 349.06 Tm (would) Tj ET BT /F2 12 Tf 1 0 0 1 399 349.06 Tm (have) Tj ET BT /F2 12 Tf 1 0 0 1 424.8 349.06 Tm (been) Tj ET BT /F2 12 Tf 1 0 0 1 450.59 349.06 Tm (available) Tj ET BT /F2 12 Tf 1 0 0 1 497.04 349.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 509.52 349.06 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 530.67 349.06 Tm (in) Tj ET Q q n 0 346.65 m 612 346.65 l 612 334.65 l 0 334.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 337.06 Tm (the absence of the assignment under the Policy.) Tj ET Q q n 0 334.65 m 612 334.65 l 612 322.65 l 0 322.65 l h W n Q q n 0 322.65 m 612 322.65 l 612 310.65 l 0 310.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 313.06 Tm (An absolute assignment cannot be used as a collateral assignment.) Tj ET Q q n 0 310.65 m 612 310.65 l 612 298.65 l 0 298.65 l h W n Q q n 0 298.65 m 612 298.65 l 612 286.65 l 0 286.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 289.06 Tm (FUNERAL) Tj ET BT /F2 12 Tf 1 0 0 1 58.54 289.06 Tm (ASSIGNMENTS.) Tj ET BT /F2 12 Tf 1 0 0 1 151.94 289.06 Tm (Upon) Tj ET BT /F2 12 Tf 1 0 0 1 181.81 289.06 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 207.01 289.06 Tm (death,) Tj ET BT /F2 12 Tf 1 0 0 1 239.19 289.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 257.05 289.06 Tm (beneficiary) Tj ET BT /F2 12 Tf 1 0 0 1 314.21 289.06 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 338.07 289.06 Tm (assign) Tj ET BT /F2 12 Tf 1 0 0 1 371.27 289.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 389.13 289.06 Tm (Personal) Tj ET BT /F2 12 Tf 1 0 0 1 433.66 289.06 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 456.84 289.06 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 506.68 289.06 Tm (benefit) Tj ET Q q n 0 286.65 m 612 286.65 l 612 274.65 l 0 274.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 277.06 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 21.12 277.06 Tm (Accidental) Tj ET BT /F2 12 Tf 1 0 0 1 76.89 277.06 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 109.34 277.06 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 159.78 277.06 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 196.89 277.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 210.02 277.06 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 219.14 277.06 Tm (funeral) Tj ET BT /F2 12 Tf 1 0 0 1 256.92 277.06 Tm (home) Tj ET BT /F2 12 Tf 1 0 0 1 287.38 277.06 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 305.17 277.06 Tm (payment) Tj ET BT /F2 12 Tf 1 0 0 1 350.28 277.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 364.07 277.06 Tm (burial) Tj ET BT /F2 12 Tf 1 0 0 1 395.86 277.06 Tm (expenses.) Tj ET BT /F2 12 Tf 1 0 0 1 449.77 277.06 Tm (After) Tj ET BT /F2 12 Tf 1 0 0 1 478.89 277.06 Tm (payment) Tj ET BT /F2 12 Tf 1 0 0 1 524 277.06 Tm (has) Tj ET Q q n 0 274.65 m 612 274.65 l 612 262.65 l 0 262.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 265.06 Tm (been) Tj ET BT /F2 12 Tf 1 0 0 1 27.16 265.06 Tm (made) Tj ET BT /F2 12 Tf 1 0 0 1 57.66 265.06 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 76.16 265.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 95.33 265.06 Tm (burial) Tj ET BT /F2 12 Tf 1 0 0 1 127.83 265.06 Tm (expenses) Tj ET BT /F2 12 Tf 1 0 0 1 175.66 265.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 189.5 265.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 208.67 265.06 Tm (assigned) Tj ET BT /F2 12 Tf 1 0 0 1 254.51 265.06 Tm (funeral) Tj ET BT /F2 12 Tf 1 0 0 1 292.99 265.06 Tm (home,) Tj ET BT /F2 12 Tf 1 0 0 1 327.16 265.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 346.33 265.06 Tm (remaining) Tj ET BT /F2 12 Tf 1 0 0 1 399.49 265.06 Tm (death) Tj ET BT /F2 12 Tf 1 0 0 1 429.99 265.06 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 467.81 265.06 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 480.33 265.06 Tm (then) Tj ET BT /F2 12 Tf 1 0 0 1 505.5 265.06 Tm (paid) Tj ET BT /F2 12 Tf 1 0 0 1 530.67 265.06 Tm (in) Tj ET Q q n 0 262.65 m 612 262.65 l 612 250.65 l 0 250.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 253.06 Tm (accord with the Beneficiary and Settlement Options sections of the Policy.) Tj ET Q Q q Q Q endstream endobj 13 0 obj <>>>>> endobj 145 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 742.85 cm q n 0 13.15 m 550.8 13.15 l 550.8 1.15 l 0 1.15 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 194.15 3.56 Tm (CONVERSION PRIVILEGE) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n -0.05 38.6 m 540.15 38.6 l 540.15 26.6 l -0.05 26.6 l h W n Q q n -0.05 25.15 m 270 25.15 l 270 13.15 l -0.05 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 -0.05 15.56 Tm (GL1102-4 MO) Tj ET Q q n 270 25.15 m 540.15 25.15 l 540.15 13.15 l 270 13.15 l h W n Q q n -0.05 13.15 m 257.3 13.15 l 257.3 1.15 l -0.05 1.15 l h W n Q q n 257.3 13.15 m 293.3 13.15 l 293.3 1.15 l 257.3 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 272.8 3.56 Tm (9) Tj ET Q q n 293.3 13.15 m 540.15 13.15 l 540.15 1.15 l 293.3 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.59 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 682.65 m 612 682.65 l 612 670.65 l 0 670.65 l h W n Q q n 0 670.65 m 612 670.65 l 612 658.65 l 0 658.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 661.06 Tm (GENERAL CONVERSION PRIVILEGE.) Tj ET BT /F2 12 Tf 1 0 0 1 210.32 661.06 Tm (If your insurance or insurance on a Dependent terminates due to:) Tj ET Q q n 18 658.65 m 630 658.65 l 630 646.65 l 18 646.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 649.06 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 649.06 Tm (termination of your employment or membership in an eligible class; or) Tj ET Q q n 18 646.65 m 630 646.65 l 630 634.65 l 18 634.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 637.06 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 637.06 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 53.78 637.06 Tm (dependent's) Tj ET BT /F2 12 Tf 1 0 0 1 113.03 637.06 Tm (ceasing) Tj ET BT /F2 12 Tf 1 0 0 1 152.12 637.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 164.56 637.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 179 637.06 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 193.43 637.06 Tm (eligible) Tj ET BT /F2 12 Tf 1 0 0 1 232.52 637.06 Tm (family) Tj ET BT /F2 12 Tf 1 0 0 1 266.95 637.06 Tm (member) Tj ET BT /F2 12 Tf 1 0 0 1 309.38 637.06 Tm (due) Tj ET BT /F2 12 Tf 1 0 0 1 329.81 637.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 342.25 637.06 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 367.35 637.06 Tm (death) Tj ET BT /F2 12 Tf 1 0 0 1 396.45 637.06 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 409.55 637.06 Tm (divorce,) Tj ET BT /F2 12 Tf 1 0 0 1 451.64 637.06 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 464.74 637.06 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 473.17 637.06 Tm (child's) Tj ET Q q n 45.35 634.65 m 657.35 634.65 l 657.35 622.65 l 45.35 622.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 625.06 Tm (marriage or attainment of the limiting age;) Tj ET Q q n 0 622.65 m 612 622.65 l 612 610.65 l 0 610.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 613.06 Tm (then an individual life policy, known as a conversion policy, may be purchased without evidence of insurability.) Tj ET Q q n 0 610.65 m 612 610.65 l 612 598.65 l 0 598.65 l h W n Q q n 0 598.65 m 612 598.65 l 612 586.65 l 0 586.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 589.06 Tm (To) Tj ET BT /F2 12 Tf 1 0 0 1 17.36 589.06 Tm (purchase) Tj ET BT /F2 12 Tf 1 0 0 1 64.03 589.06 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 73.38 589.06 Tm (conversion) Tj ET BT /F2 12 Tf 1 0 0 1 130.06 589.06 Tm (policy,) Tj ET BT /F2 12 Tf 1 0 0 1 167.09 589.06 Tm (application) Tj ET BT /F2 12 Tf 1 0 0 1 224.43 589.06 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 245.78 589.06 Tm (payment) Tj ET BT /F2 12 Tf 1 0 0 1 291.13 589.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 305.15 589.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 323.84 589.06 Tm (first) Tj ET BT /F2 12 Tf 1 0 0 1 347.2 589.06 Tm (premium) Tj ET BT /F2 12 Tf 1 0 0 1 394.55 589.06 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 421.91 589.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 437.27 589.06 Tm (made) Tj ET BT /F2 12 Tf 1 0 0 1 467.28 589.06 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 501.98 589.06 Tm (31) Tj ET BT /F2 12 Tf 1 0 0 1 518 589.06 Tm (days) Tj ET Q q n 0 586.65 m 612 586.65 l 612 574.65 l 0 574.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 577.06 Tm (after the life insurance is terminated.) Tj ET Q q n 0 574.65 m 612 574.65 l 612 562.65 l 0 562.65 l h W n Q q n 0 562.65 m 612 562.65 l 612 550.65 l 0 550.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 553.06 Tm (The conversion policy issued under this General Conversion Privilege will:) Tj ET Q q n 18 550.65 m 630 550.65 l 630 538.65 l 18 538.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 541.06 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 541.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 61.35 541.06 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 75.36 541.06 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 91.36 541.06 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 132.03 541.06 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 152.04 541.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 166.04 541.06 Tm (exceed) Tj ET BT /F2 12 Tf 1 0 0 1 204.02 541.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 223.36 541.06 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 264.02 541.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 278.69 541.06 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 299.36 541.06 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 350.01 541.06 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 384.01 541.06 Tm (was) Tj ET BT /F2 12 Tf 1 0 0 1 407.35 541.06 Tm (terminated;) Tj ET BT /F2 12 Tf 1 0 0 1 466.67 541.06 Tm (less) Tj ET BT /F2 12 Tf 1 0 0 1 489.34 541.06 Tm (the) Tj ET Q q n 45.35 538.65 m 657.35 538.65 l 657.35 526.65 l 45.35 526.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 529.06 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 84.73 529.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 98.11 529.06 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 118.82 529.06 Tm (group) Tj ET BT /F2 12 Tf 1 0 0 1 150.21 529.06 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 169.58 529.06 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 218.95 529.06 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 236.32 529.06 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 269.04 529.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 287.08 529.06 Tm (person) Tj ET BT /F2 12 Tf 1 0 0 1 322.46 529.06 Tm (becomes) Tj ET BT /F2 12 Tf 1 0 0 1 367.83 529.06 Tm (eligible) Tj ET BT /F2 12 Tf 1 0 0 1 407.2 529.06 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 441.25 529.06 Tm (31) Tj ET BT /F2 12 Tf 1 0 0 1 456.64 529.06 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 482.02 529.06 Tm (after) Tj ET Q q n 45.35 526.65 m 657.35 526.65 l 657.35 514.65 l 45.35 514.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 517.06 Tm (insurance terminates;) Tj ET Q q n 18 514.65 m 630 514.65 l 630 502.65 l 18 502.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 505.06 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 505.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 60.96 505.06 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 77.24 505.06 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 98.85 505.06 Tm (form) Tj ET BT /F2 12 Tf 1 0 0 1 126.45 505.06 Tm ($except) Tj ET BT /F2 12 Tf 1 0 0 1 166.04 505.06 Tm (term$) Tj ET BT /F2 12 Tf 1 0 0 1 196.31 505.06 Tm (then) Tj ET BT /F2 12 Tf 1 0 0 1 221.25 505.06 Tm (issued) Tj ET BT /F2 12 Tf 1 0 0 1 255.53 505.06 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 271.82 505.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 290.76 505.06 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 341.7 505.06 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 354.64 505.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 373.58 505.06 Tm (age) Tj ET BT /F2 12 Tf 1 0 0 1 394.52 505.06 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 416.13 505.06 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 456.4 505.06 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 474.67 505.06 Tm (which) Tj ET Q q n 45.35 502.65 m 657.35 502.65 l 657.35 490.65 l 45.35 490.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 493.06 Tm (application is made;) Tj ET Q q n 18 490.65 m 630 490.65 l 630 478.65 l 18 478.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 481.06 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 481.06 Tm (be issued at the person's age at nearest birthday;) Tj ET Q q n 18 478.65 m 630 478.65 l 630 466.65 l 18 466.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 469.06 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 469.06 Tm (be issued without disability or other supplemental benefits; and) Tj ET Q q n 18 466.65 m 630 466.65 l 630 454.65 l 18 454.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 457.06 Tm ($5$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 457.06 Tm (require premiums based on the class of risk to which the person then belongs.) Tj ET Q q n 0 454.65 m 612 454.65 l 612 442.65 l 0 442.65 l h W n Q q n 0 442.65 m 612 442.65 l 612 430.65 l 0 430.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 433.06 Tm (CONVERSION) Tj ET BT /F2 12 Tf 1 0 0 1 82.59 433.06 Tm (UPON) Tj ET BT /F2 12 Tf 1 0 0 1 120.52 433.06 Tm (POLICY) Tj ET BT /F2 12 Tf 1 0 0 1 169.11 433.06 Tm (TERMINATION) Tj ET BT /F2 12 Tf 1 0 0 1 257.68 433.06 Tm (OR) Tj ET BT /F2 12 Tf 1 0 0 1 279.6 433.06 Tm (AMENDMENT.) Tj ET BT /F2 12 Tf 1 0 0 1 371.1 433.06 Tm (A) Tj ET BT /F2 12 Tf 1 0 0 1 385.02 433.06 Tm (conversion) Tj ET BT /F2 12 Tf 1 0 0 1 442.93 433.06 Tm (policy) Tj ET BT /F2 12 Tf 1 0 0 1 478.18 433.06 Tm (also) Tj ET BT /F2 12 Tf 1 0 0 1 502.76 433.06 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 528.67 433.06 Tm (be) Tj ET Q q n 0 430.65 m 612 430.65 l 612 418.65 l 0 418.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 421.06 Tm (purchased if:) Tj ET Q q n 18 418.65 m 630 418.65 l 630 406.65 l 18 406.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 409.06 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 409.06 Tm (all) Tj ET BT /F2 12 Tf 1 0 0 1 62.15 409.06 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 76.96 409.06 Tm (part) Tj ET BT /F2 12 Tf 1 0 0 1 100.42 409.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 115.23 409.06 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 142.03 409.06 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 192.82 409.06 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 207.63 409.06 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 258.42 409.06 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 275.22 409.06 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 285.36 409.06 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 342.15 409.06 Tm (terminates) Tj ET BT /F2 12 Tf 1 0 0 1 396.94 409.06 Tm (due) Tj ET BT /F2 12 Tf 1 0 0 1 419.07 409.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 433.21 409.06 Tm (amendment) Tj ET BT /F2 12 Tf 1 0 0 1 494 409.06 Tm (or) Tj ET Q q n 45.35 406.65 m 657.35 406.65 l 657.35 394.65 l 45.35 394.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 397.06 Tm (termination of the Policy; and) Tj ET Q q n 18 394.65 m 630 394.65 l 630 382.65 l 18 382.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 385.06 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 385.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 63.61 385.06 Tm (person) Tj ET BT /F2 12 Tf 1 0 0 1 99.2 385.06 Tm (applying) Tj ET BT /F2 12 Tf 1 0 0 1 144.79 385.06 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 162.38 385.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 180.63 385.06 Tm (conversion) Tj ET BT /F2 12 Tf 1 0 0 1 236.88 385.06 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 271.15 385.06 Tm (has) Tj ET BT /F2 12 Tf 1 0 0 1 290.74 385.06 Tm (been) Tj ET BT /F2 12 Tf 1 0 0 1 316.99 385.06 Tm (covered) Tj ET BT /F2 12 Tf 1 0 0 1 358.56 385.06 Tm (continuously) Tj ET BT /F2 12 Tf 1 0 0 1 424.16 385.06 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 455.08 385.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 473.33 385.06 Tm (Policy) Tj ET Q q n 45.35 382.65 m 657.35 382.65 l 657.35 370.65 l 45.35 370.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 373.06 Tm (for at least 5 years.) Tj ET Q q n 0 370.65 m 612 370.65 l 612 358.65 l 0 358.65 l h W n Q q n 0 358.65 m 612 358.65 l 612 346.65 l 0 346.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 349.06 Tm (A) Tj ET BT /F2 12 Tf 1 0 0 1 12.12 349.06 Tm (conversion) Tj ET BT /F2 12 Tf 1 0 0 1 68.22 349.06 Tm (policy) Tj ET BT /F2 12 Tf 1 0 0 1 101.66 349.06 Tm (issued) Tj ET BT /F2 12 Tf 1 0 0 1 135.12 349.06 Tm (due) Tj ET BT /F2 12 Tf 1 0 0 1 155.89 349.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 168.68 349.06 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 202.79 349.06 Tm (termination) Tj ET BT /F2 12 Tf 1 0 0 1 261.56 349.06 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 275.01 349.06 Tm (amendment) Tj ET BT /F2 12 Tf 1 0 0 1 334.44 349.06 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 356.56 349.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 371.34 349.06 Tm (subject) Tj ET BT /F2 12 Tf 1 0 0 1 408.78 349.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 421.56 349.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 439.67 349.06 Tm (same) Tj ET BT /F2 12 Tf 1 0 0 1 467.78 349.06 Tm (conditions) Tj ET BT /F2 12 Tf 1 0 0 1 521.23 349.06 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 534.67 349.06 Tm (a) Tj ET Q q n 0 346.65 m 612 346.65 l 612 334.65 l 0 334.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 337.06 Tm (policy issued under the General Conversion Privilege; except its amount may not exceed the lesser of:) Tj ET Q q n 18 334.65 m 630 334.65 l 630 322.65 l 18 322.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 325.06 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 325.06 Tm ($10,000; or) Tj ET Q q n 18 322.65 m 630 322.65 l 630 310.65 l 18 310.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 313.06 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 313.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 63.6 313.06 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 103.18 313.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 116.76 313.06 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 136.34 313.06 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 185.9 313.06 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 218.81 313.06 Tm (terminates,) Tj ET BT /F2 12 Tf 1 0 0 1 275.38 313.06 Tm (less) Tj ET BT /F2 12 Tf 1 0 0 1 296.96 313.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 315.21 313.06 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 354.79 313.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 368.37 313.06 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 389.29 313.06 Tm (group) Tj ET BT /F2 12 Tf 1 0 0 1 420.87 313.06 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 440.44 313.06 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 490.01 313.06 Tm (for) Tj ET Q q n 45.35 310.65 m 657.35 310.65 l 657.35 298.65 l 45.35 298.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 301.06 Tm (which the person becomes eligible within 31 days after the termination.) Tj ET Q q n 0 298.65 m 612 298.65 l 612 286.65 l 0 286.65 l h W n Q q n 0 286.65 m 612 286.65 l 612 274.65 l 0 274.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 277.06 Tm (The conversion policy will take effect on the later of:) Tj ET Q q n 18 274.65 m 630 274.65 l 630 262.65 l 18 262.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 265.06 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 265.06 Tm (its date of issue; or) Tj ET Q q n 18 262.65 m 630 262.65 l 630 250.65 l 18 250.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 253.06 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 253.06 Tm (31 days after the date the insurance terminated.) Tj ET Q q n 0 250.65 m 612 250.65 l 612 238.65 l 0 238.65 l h W n Q q n 0 238.65 m 612 238.65 l 612 226.65 l 0 226.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 229.06 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 11.35 229.06 Tm (death) Tj ET BT /F2 12 Tf 1 0 0 1 40.7 229.06 Tm (occurs) Tj ET BT /F2 12 Tf 1 0 0 1 75.38 229.06 Tm (during) Tj ET BT /F2 12 Tf 1 0 0 1 110.07 229.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 128.09 229.06 Tm (31) Tj ET BT /F2 12 Tf 1 0 0 1 143.45 229.06 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 164.14 229.06 Tm (conversion) Tj ET BT /F2 12 Tf 1 0 0 1 220.15 229.06 Tm (period,) Tj ET BT /F2 12 Tf 1 0 0 1 257.17 229.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 275.19 229.06 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 325.21 229.06 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 347.24 229.06 Tm (pay) Tj ET BT /F2 12 Tf 1 0 0 1 367.93 229.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 385.95 229.06 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 405.3 229.06 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 454.64 229.06 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 487.33 229.06 Tm (could) Tj ET BT /F2 12 Tf 1 0 0 1 517.35 229.06 Tm (have) Tj ET Q q n 0 226.65 m 612 226.65 l 612 214.65 l 0 214.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 217.06 Tm (been converted even if no one applied for the conversion policy.) Tj ET Q q n 0 214.65 m 612 214.65 l 612 202.65 l 0 202.65 l h W n Q q n 0 202.65 m 612 202.65 l 612 190.65 l 0 190.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 193.06 Tm (NOTICE.) Tj ET BT /F2 12 Tf 1 0 0 1 55.95 193.06 Tm (When) Tj ET BT /F2 12 Tf 1 0 0 1 89.09 193.06 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 115.56 193.06 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 166.02 193.06 Tm (terminates,) Tj ET BT /F2 12 Tf 1 0 0 1 223.49 193.06 Tm (written) Tj ET BT /F2 12 Tf 1 0 0 1 261.96 193.06 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 295.76 193.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 310.23 193.06 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 336.71 193.06 Tm (right) Tj ET BT /F2 12 Tf 1 0 0 1 363.86 193.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 377.67 193.06 Tm (convert) Tj ET BT /F2 12 Tf 1 0 0 1 418.13 193.06 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 441.28 193.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 457.09 193.06 Tm (given) Tj ET BT /F2 12 Tf 1 0 0 1 488.23 193.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 502.05 193.06 Tm (you.) Tj ET BT /F2 12 Tf 1 0 0 1 532.01 193.06 Tm (If) Tj ET Q q n 0 190.65 m 612 190.65 l 612 178.65 l 0 178.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 181.06 Tm (written) Tj ET BT /F2 12 Tf 1 0 0 1 37.44 181.06 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 70.21 181.06 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 81.67 181.06 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 100.45 181.06 Tm (given) Tj ET BT /F2 12 Tf 1 0 0 1 130.56 181.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 143.35 181.06 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 164.8 181.06 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 176.91 181.06 Tm (least) Tj ET BT /F2 12 Tf 1 0 0 1 202.35 181.06 Tm (15) Tj ET BT /F2 12 Tf 1 0 0 1 217.81 181.06 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 243.25 181.06 Tm (before) Tj ET BT /F2 12 Tf 1 0 0 1 277.35 181.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 295.46 181.06 Tm (end) Tj ET BT /F2 12 Tf 1 0 0 1 316.24 181.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 329.68 181.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 347.8 181.06 Tm (31) Tj ET BT /F2 12 Tf 1 0 0 1 363.25 181.06 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 384.02 181.06 Tm (conversion) Tj ET BT /F2 12 Tf 1 0 0 1 440.13 181.06 Tm (period,) Tj ET BT /F2 12 Tf 1 0 0 1 477.23 181.06 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 492.01 181.06 Tm (additional) Tj ET Q q n 0 178.65 m 612 178.65 l 612 166.65 l 0 166.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 169.06 Tm (period) Tj ET BT /F2 12 Tf 1 0 0 1 35.1 169.06 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 48.88 169.06 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 82.65 169.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 96.43 169.06 Tm (convert) Tj ET BT /F2 12 Tf 1 0 0 1 136.86 169.06 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 159.97 169.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 175.75 169.06 Tm (granted.) Tj ET BT /F2 12 Tf 1 0 0 1 223.62 169.06 Tm (Any) Tj ET BT /F2 12 Tf 1 0 0 1 248.73 169.06 Tm (such) Tj ET BT /F2 12 Tf 1 0 0 1 275.17 169.06 Tm (extension) Tj ET BT /F2 12 Tf 1 0 0 1 325.61 169.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 340.05 169.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 359.15 169.06 Tm (conversion) Tj ET BT /F2 12 Tf 1 0 0 1 416.25 169.06 Tm (period) Tj ET BT /F2 12 Tf 1 0 0 1 451.35 169.06 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 474.47 169.06 Tm (expire) Tj ET BT /F2 12 Tf 1 0 0 1 508.89 169.06 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 169.06 Tm (the) Tj ET Q q n 0 166.65 m 612 166.65 l 612 154.65 l 0 154.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 157.06 Tm (earliest of:) Tj ET Q q n 18 154.65 m 630 154.65 l 630 142.65 l 18 142.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 145.06 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 145.06 Tm (15 days after you are given the written notice; or) Tj ET Q q n 18 142.65 m 630 142.65 l 630 130.65 l 18 130.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 133.06 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 133.06 Tm (60 days after the end of the 31 day conversion period, even if you are never given such notice.) Tj ET Q q n 0 130.65 m 612 130.65 l 612 118.65 l 0 118.65 l h W n Q q n 0 118.65 m 612 118.65 l 612 106.65 l 0 106.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 109.06 Tm (No) Tj ET BT /F2 12 Tf 1 0 0 1 18.49 109.06 Tm (death) Tj ET BT /F2 12 Tf 1 0 0 1 48.3 109.06 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 85.44 109.06 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 107.93 109.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 123.08 109.06 Tm (payable) Tj ET BT /F2 12 Tf 1 0 0 1 164.22 109.06 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 195.37 109.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 213.85 109.06 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 248.34 109.06 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 274.15 109.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 292.63 109.06 Tm (31) Tj ET BT /F2 12 Tf 1 0 0 1 308.45 109.06 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 329.61 109.06 Tm (conversion) Tj ET BT /F2 12 Tf 1 0 0 1 386.08 109.06 Tm (period) Tj ET BT /F2 12 Tf 1 0 0 1 420.56 109.06 Tm (has) Tj ET BT /F2 12 Tf 1 0 0 1 440.38 109.06 Tm (expired) Tj ET BT /F2 12 Tf 1 0 0 1 480.19 109.06 Tm (even) Tj ET BT /F2 12 Tf 1 0 0 1 506.67 109.06 Tm (though) Tj ET Q q n 0 106.65 m 612 106.65 l 612 94.65 l 0 94.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 97.06 Tm (the right to convert may be extended.) Tj ET Q Q q Q Q endstream endobj 14 0 obj <>>>>> endobj 146 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 744 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 176.98 2.41 Tm (DEPENDENTS LIFE INSURANCE) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n -5.75 38.6 m 534.5 38.6 l 534.5 26.6 l -5.75 26.6 l h W n Q q n 0 25.15 m 279 25.15 l 279 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-5 VIT) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 270.4 3.56 Tm (10) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 670 m 612 670 l 612 658 l 0 658 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 660.41 Tm (DEATH) Tj ET BT /F2 12 Tf 1 0 0 1 44.27 660.41 Tm (BENEFIT.) Tj ET BT /F2 12 Tf 1 0 0 1 103.83 660.41 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 115.44 660.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 141.04 660.41 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 196.64 660.41 Tm (spouse) Tj ET BT /F2 12 Tf 1 0 0 1 232.92 660.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 246.53 660.41 Tm (child) Tj ET BT /F2 12 Tf 1 0 0 1 274.13 660.41 Tm (dies) Tj ET BT /F2 12 Tf 1 0 0 1 297.08 660.41 Tm (while) Tj ET BT /F2 12 Tf 1 0 0 1 327.35 660.41 Tm (insured) Tj ET BT /F2 12 Tf 1 0 0 1 366.29 660.41 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 397.23 660.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 415.5 660.41 Tm (Policy,) Tj ET BT /F2 12 Tf 1 0 0 1 452.78 660.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 471.05 660.41 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 521.33 660.41 Tm (will) Tj ET Q q n 0 658 m 612 658 l 612 646 l 0 646 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 648.41 Tm (pay) Tj ET BT /F2 12 Tf 1 0 0 1 21.19 648.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 39.72 648.41 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 79.57 648.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 93.44 648.41 Tm (Dependents) Tj ET BT /F2 12 Tf 1 0 0 1 153.95 648.41 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 177.8 648.41 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 228.31 648.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 241.5 648.41 Tm (effect) Tj ET BT /F2 12 Tf 1 0 0 1 272.67 648.41 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 288.54 648.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 307.06 648.41 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 330.91 648.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 344.77 648.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 363.3 648.41 Tm (death.) Tj ET BT /F2 12 Tf 1 0 0 1 400.02 648.41 Tm (This) Tj ET BT /F2 12 Tf 1 0 0 1 425.21 648.41 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 465.07 648.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 476.94 648.41 Tm (shown) Tj ET BT /F2 12 Tf 1 0 0 1 512.14 648.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 648.41 Tm (the) Tj ET Q q n 0 646 m 612 646 l 612 634 l 0 634 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 636.41 Tm (Schedule) Tj ET BT /F2 12 Tf 1 0 0 1 47.38 636.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 60.76 636.41 Tm (Insurance.) Tj ET BT /F2 12 Tf 1 0 0 1 117.18 636.41 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 139.22 636.41 Tm (death) Tj ET BT /F2 12 Tf 1 0 0 1 168.6 636.41 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 205.3 636.41 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 227.36 636.41 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 242.07 636.41 Tm (paid) Tj ET BT /F2 12 Tf 1 0 0 1 266.12 636.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 278.84 636.41 Tm (you.) Tj ET BT /F2 12 Tf 1 0 0 1 306.62 636.41 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 318 636.41 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 339.39 636.41 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 357.43 636.41 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 376.15 636.41 Tm (living) Tj ET BT /F2 12 Tf 1 0 0 1 407.54 636.41 Tm (when) Tj ET BT /F2 12 Tf 1 0 0 1 436.92 636.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 462.3 636.41 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 517.67 636.41 Tm (dies,) Tj ET Q q n 0 634 m 612 634 l 612 622 l 0 622 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 624.41 Tm (the death benefit will be paid to your beneficiary or in accord with the Facility of Payment section of the Policy.) Tj ET Q q n 0 622 m 612 622 l 612 610 l 0 610 l h W n Q q n 0 610 m 612 610 l 612 598 l 0 598 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 600.41 Tm (EXCLUSION.) Tj ET BT /F2 12 Tf 1 0 0 1 77 600.41 Tm (Benefits will not be payable if your Dependent's death:) Tj ET Q q n 18 598 m 630 598 l 630 586 l 18 586 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 588.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 588.41 Tm (results from suicide, while sane; and) Tj ET Q q n 18 586 m 630 586 l 630 574 l 18 574 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 576.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 576.41 Tm (occurs within two years after insurance for that Dependent takes effect.) Tj ET Q q n 0 574 m 612 574 l 612 562 l 0 562 l h W n Q q n 0 562 m 612 562 l 612 550 l 0 550 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 552.41 Tm (However,) Tj ET BT /F2 12 Tf 1 0 0 1 50.58 552.41 Tm (suicide) Tj ET BT /F2 12 Tf 1 0 0 1 88.17 552.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 99.77 552.41 Tm (no) Tj ET BT /F2 12 Tf 1 0 0 1 115.36 552.41 Tm (defense) Tj ET BT /F2 12 Tf 1 0 0 1 155.6 552.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 168.54 552.41 Tm (payment) Tj ET BT /F2 12 Tf 1 0 0 1 213.45 552.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 227.05 552.41 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 246.63 552.41 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 296.21 552.41 Tm (benefits) Tj ET BT /F2 12 Tf 1 0 0 1 337.79 552.41 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 368.71 552.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 386.97 552.41 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 421.23 552.41 Tm (unless) Tj ET BT /F2 12 Tf 1 0 0 1 454.83 552.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 473.09 552.41 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 523.35 552.41 Tm (can) Tj ET Q q n 0 550 m 612 550 l 612 538 l 0 538 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 540.41 Tm (show that your Dependent intended suicide when applying for the insurance.) Tj ET Q q n 0 538 m 612 538 l 612 526 l 0 526 l h W n Q q n 0 526 m 612 526 l 612 514 l 0 514 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 516.41 Tm (DEPENDENT.) Tj ET BT /F2 12 Tf 1 0 0 1 83.6 516.41 Tm (A) Tj ET BT /F2 12 Tf 1 0 0 1 97.23 516.41 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 154.18 516.41 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 189.8 516.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 200.1 516.41 Tm (person) Tj ET BT /F2 12 Tf 1 0 0 1 237.06 516.41 Tm (who) Tj ET BT /F2 12 Tf 1 0 0 1 262.69 516.41 Tm (meets) Tj ET BT /F2 12 Tf 1 0 0 1 295.65 516.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 315.28 516.41 Tm (definition) Tj ET BT /F2 12 Tf 1 0 0 1 366.91 516.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 381.87 516.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 392.17 516.41 Tm (dependent) Tj ET BT /F2 12 Tf 1 0 0 1 446.45 516.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 461.41 516.41 Tm (yours) Tj ET BT /F2 12 Tf 1 0 0 1 493.05 516.41 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 516.41 Tm (the) Tj ET Q q n 0 514 m 612 514 l 612 502 l 0 502 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 504.41 Tm (provision of the U.S. Internal Revenue Code; and is your:) Tj ET Q q n 18 502 m 630 502 l 630 490 l 18 490 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 492.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 492.41 Tm (spouse who is not legally separated from you;) Tj ET Q q n 18 490 m 630 490 l 630 478 l 18 478 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 480.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 480.41 Tm (unmarried child at least) Tj ET BT /F2 12 Tf 1 0 0 1 161.31 480.41 Tm (14 days but less than 19 years of age;) Tj ET Q q n 18 478 m 630 478 l 630 466 l 18 466 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 468.41 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 468.41 Tm (unmarried) Tj ET BT /F2 12 Tf 1 0 0 1 99.01 468.41 Tm (child) Tj ET BT /F2 12 Tf 1 0 0 1 127.34 468.41 Tm (less) Tj ET BT /F2 12 Tf 1 0 0 1 149.69 468.41 Tm (than) Tj ET BT /F2 12 Tf 1 0 0 1 174.69 468.41 Tm (25) Tj ET BT /F2 12 Tf 1 0 0 1 191.03 468.41 Tm (years) Tj ET BT /F2 12 Tf 1 0 0 1 220.69 468.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 235.03 468.41 Tm (age) Tj ET BT /F2 12 Tf 1 0 0 1 256.03 468.41 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 277.7 468.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 287.37 468.41 Tm (full-time) Tj ET BT /F2 12 Tf 1 0 0 1 333.7 468.41 Tm (student) Tj ET BT /F2 12 Tf 1 0 0 1 372.7 468.41 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 385.71 468.41 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 401.38 468.41 Tm (accredited) Tj ET BT /F2 12 Tf 1 0 0 1 455.01 468.41 Tm (college) Tj ET BT /F2 12 Tf 1 0 0 1 494 468.41 Tm (or) Tj ET Q q n 45.35 466 m 657.35 466 l 657.35 454 l 45.35 454 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 456.41 Tm (university; or) Tj ET Q q n 18 454 m 630 454 l 630 442 l 18 442 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 444.41 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 444.41 Tm (unmarried) Tj ET BT /F2 12 Tf 1 0 0 1 98.29 444.41 Tm (child) Tj ET BT /F2 12 Tf 1 0 0 1 125.91 444.41 Tm (who) Tj ET BT /F2 12 Tf 1 0 0 1 150.2 444.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 161.83 444.41 Tm (totally) Tj ET BT /F2 12 Tf 1 0 0 1 196.12 444.41 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 217.07 444.41 Tm (permanently) Tj ET BT /F2 12 Tf 1 0 0 1 280.68 444.41 Tm (disabled) Tj ET BT /F2 12 Tf 1 0 0 1 324.29 444.41 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 345.24 444.41 Tm (who) Tj ET BT /F2 12 Tf 1 0 0 1 369.54 444.41 Tm (became) Tj ET BT /F2 12 Tf 1 0 0 1 409.8 444.41 Tm (so) Tj ET BT /F2 12 Tf 1 0 0 1 424.1 444.41 Tm (disabled) Tj ET BT /F2 12 Tf 1 0 0 1 467.71 444.41 Tm (prior) Tj ET BT /F2 12 Tf 1 0 0 1 494.67 444.41 Tm (to) Tj ET Q q n 45.35 442 m 657.35 442 l 657.35 430 l 45.35 430 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 432.41 Tm (reaching 19 years) Tj ET BT /F2 12 Tf 1 0 0 1 132.98 432.41 Tm (of age) Tj ET BT /F2 12 Tf 1 0 0 1 162.63 432.41 Tm (.) Tj ET Q q n 0 430 m 612 430 l 612 418 l 0 418 l h W n Q q n 0 418 m 612 418 l 612 406 l 0 406 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 408.41 Tm (A) Tj ET BT /F2 12 Tf 1 0 0 1 14.01 408.41 Tm (legally) Tj ET BT /F2 12 Tf 1 0 0 1 52.01 408.41 Tm (adopted) Tj ET BT /F2 12 Tf 1 0 0 1 95.33 408.41 Tm (child) Tj ET BT /F2 12 Tf 1 0 0 1 124.67 408.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 138.02 408.41 Tm (considered) Tj ET BT /F2 12 Tf 1 0 0 1 195.34 408.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 222.68 408.41 Tm (child) Tj ET BT /F2 12 Tf 1 0 0 1 252.01 408.41 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 280.68 408.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 300.68 408.41 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 326.01 408.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 341.35 408.41 Tm (placement) Tj ET BT /F2 12 Tf 1 0 0 1 396 408.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 410.68 408.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 438.02 408.41 Tm (home) Tj ET BT /F2 12 Tf 1 0 0 1 470.02 408.41 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 489.35 408.41 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 506.02 408.41 Tm (agency) Tj ET Q q n 0 406 m 612 406 l 612 394 l 0 394 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 396.41 Tm (adoption;) Tj ET BT /F2 12 Tf 1 0 0 1 48.82 396.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 62.31 396.41 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 89.12 396.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 107.27 396.41 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 130.75 396.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 148.9 396.41 Tm (adoption) Tj ET BT /F2 12 Tf 1 0 0 1 194.38 396.41 Tm (petition) Tj ET BT /F2 12 Tf 1 0 0 1 234.54 396.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 246.03 396.41 Tm (filed,) Tj ET BT /F2 12 Tf 1 0 0 1 274.51 396.41 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 285.33 396.41 Tm (later,) Tj ET BT /F2 12 Tf 1 0 0 1 313.14 396.41 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 330.62 396.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 339.44 396.41 Tm (private) Tj ET BT /F2 12 Tf 1 0 0 1 376.25 396.41 Tm (adoption.) Tj ET BT /F2 12 Tf 1 0 0 1 428.22 396.41 Tm (In) Tj ET BT /F2 12 Tf 1 0 0 1 441.71 396.41 Tm (addition) Tj ET BT /F2 12 Tf 1 0 0 1 484.53 396.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 497.35 396.41 Tm (naturally) Tj ET Q q n 0 394 m 612 394 l 612 382 l 0 382 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 384.41 Tm (born) Tj ET BT /F2 12 Tf 1 0 0 1 25.95 384.41 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 47.24 384.41 Tm (legally) Tj ET BT /F2 12 Tf 1 0 0 1 83.85 384.41 Tm (adopted) Tj ET BT /F2 12 Tf 1 0 0 1 125.8 384.41 Tm (children,) Tj ET BT /F2 12 Tf 1 0 0 1 172.07 384.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 190.69 384.41 Tm (word) Tj ET BT /F2 12 Tf 1 0 0 1 219.31 384.41 Tm ("child") Tj ET BT /F2 12 Tf 1 0 0 1 257.06 384.41 Tm (includes) Tj ET BT /F2 12 Tf 1 0 0 1 301.01 384.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 326.97 384.41 Tm (stepchild) Tj ET BT /F2 12 Tf 1 0 0 1 374.25 384.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 388.2 384.41 Tm (foster) Tj ET BT /F2 12 Tf 1 0 0 1 419.49 384.41 Tm (child;) Tj ET BT /F2 12 Tf 1 0 0 1 450.77 384.41 Tm (provided) Tj ET BT /F2 12 Tf 1 0 0 1 497.39 384.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 516.01 384.41 Tm (child) Tj ET Q q n 0 382 m 612 382 l 612 370 l 0 370 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 372.41 Tm (resides) Tj ET BT /F2 12 Tf 1 0 0 1 37.04 372.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 50.09 372.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 75.8 372.41 Tm (household) Tj ET BT /F2 12 Tf 1 0 0 1 128.84 372.41 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 149.88 372.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 161.6 372.41 Tm (dependent) Tj ET BT /F2 12 Tf 1 0 0 1 214.63 372.41 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 230.34 372.41 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 252.06 372.41 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 269.77 372.41 Tm (principal) Tj ET BT /F2 12 Tf 1 0 0 1 316.13 372.41 Tm (support.) Tj ET BT /F2 12 Tf 1 0 0 1 362.56 372.41 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 374.27 372.41 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 402.64 372.41 Tm (than) Tj ET BT /F2 12 Tf 1 0 0 1 427.01 372.41 Tm (one) Tj ET BT /F2 12 Tf 1 0 0 1 448.06 372.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 461.77 372.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 470.81 372.41 Tm (child's) Tj ET BT /F2 12 Tf 1 0 0 1 505.35 372.41 Tm (parents) Tj ET Q q n 0 370 m 612 370 l 612 358 l 0 358 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 360.41 Tm (are insured under the Policy, that child may be insured under only one Certificate.) Tj ET Q q n 0 358 m 612 358 l 612 346 l 0 346 l h W n Q q n 0 346 m 612 346 l 612 334 l 0 334 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 336.41 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 22.3 336.41 Tm (term) Tj ET BT /F2 12 Tf 1 0 0 1 47.93 336.41 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 103.55 336.41 Tm (does) Tj ET BT /F2 12 Tf 1 0 0 1 129.18 336.41 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 148.16 336.41 Tm (include) Tj ET BT /F2 12 Tf 1 0 0 1 187.12 336.41 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 202.09 336.41 Tm (Insured) Tj ET BT /F2 12 Tf 1 0 0 1 241.71 336.41 Tm (Person,) Tj ET BT /F2 12 Tf 1 0 0 1 281.02 336.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 294.66 336.41 Tm (anyone) Tj ET BT /F2 12 Tf 1 0 0 1 332.95 336.41 Tm (serving) Tj ET BT /F2 12 Tf 1 0 0 1 371.92 336.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 384.89 336.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 403.19 336.41 Tm (armed) Tj ET BT /F2 12 Tf 1 0 0 1 436.82 336.41 Tm (forces) Tj ET BT /F2 12 Tf 1 0 0 1 469.77 336.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 483.41 336.41 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 504.37 336.41 Tm (state) Tj ET BT /F2 12 Tf 1 0 0 1 530 336.41 Tm (or) Tj ET Q q n 0 334 m 612 334 l 612 322 l 0 322 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 324.41 Tm (country.) Tj ET Q q n 0 322 m 612 322 l 612 310 l 0 310 l h W n Q q n 0 310 m 612 310 l 612 298 l 0 298 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 300.41 Tm (ELIGIBILITY.) Tj ET BT /F2 12 Tf 1 0 0 1 79.64 300.41 Tm (You become eligible for Dependents Life Insurance on the later of:) Tj ET Q q n 18 298 m 630 298 l 630 286 l 18 286 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 288.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 288.41 Tm (the date you become eligible for other coverages provided by the Policy;) Tj ET Q q n 18 286 m 630 286 l 630 274 l 18 274 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 276.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 276.41 Tm (the effective date of this section; or) Tj ET Q q n 18 274 m 630 274 l 630 262 l 18 262 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 264.41 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 264.41 Tm (the date you first acquire a Dependent $as defined by the Policy$.) Tj ET Q q n 0 262 m 612 262 l 612 250 l 0 250 l h W n Q q n 0 250 m 612 250 l 612 238 l 0 238 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 240.41 Tm (EFFECTIVE DATE.) Tj ET BT /F2 12 Tf 1 0 0 1 107.33 240.41 Tm (Your Dependents Life Insurance will become effective on the later of:) Tj ET Q q n 18 238 m 630 238 l 630 226 l 18 226 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 228.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 228.41 Tm (the date you become eligible for Dependents Life Insurance;) Tj ET Q q n 18 226 m 630 226 l 630 214 l 18 214 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 216.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 216.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 63.75 216.41 Tm (first) Tj ET BT /F2 12 Tf 1 0 0 1 86.82 216.41 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 107.89 216.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 121.62 216.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 140.02 216.41 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 190.4 216.41 Tm (Month) Tj ET BT /F2 12 Tf 1 0 0 1 226.14 216.41 Tm (following) Tj ET BT /F2 12 Tf 1 0 0 1 276.55 216.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 294.95 216.41 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 318.67 216.41 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 340.41 216.41 Tm (sign) Tj ET BT /F2 12 Tf 1 0 0 1 364.16 216.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 389.89 216.41 Tm (payroll) Tj ET BT /F2 12 Tf 1 0 0 1 427.62 216.41 Tm (deduction) Tj ET BT /F2 12 Tf 1 0 0 1 478.68 216.41 Tm (order) Tj ET Q q n 45.35 214 m 657.35 214 l 657.35 202 l 45.35 202 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 204.41 Tm (and apply for the coverage; or) Tj ET Q q n 18 202 m 630 202 l 630 190 l 18 190 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 192.41 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 192.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 64.35 192.41 Tm (first) Tj ET BT /F2 12 Tf 1 0 0 1 88.02 192.41 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 109.69 192.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 124.03 192.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 143.03 192.41 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 194.01 192.41 Tm (Month) Tj ET BT /F2 12 Tf 1 0 0 1 230.36 192.41 Tm (following) Tj ET BT /F2 12 Tf 1 0 0 1 281.36 192.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 300.36 192.41 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 324.69 192.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 343.69 192.41 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 394.7 192.41 Tm (approves) Tj ET BT /F2 12 Tf 1 0 0 1 442.35 192.41 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 464.02 192.41 Tm (required) Tj ET Q q n 45.35 190 m 657.35 190 l 657.35 178 l 45.35 178 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 180.41 Tm (evidence of insurability on all your Dependents.) Tj ET Q q n 0 178 m 612 178 l 612 166 l 0 166 l h W n Q q n 0 166 m 612 166 l 612 154 l 0 154 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 156.41 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 12.18 156.41 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 34.37 156.41 Tm (acquire) Tj ET BT /F2 12 Tf 1 0 0 1 73.86 156.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 83.38 156.41 Tm (new) Tj ET BT /F2 12 Tf 1 0 0 1 107.56 156.41 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 163.72 156.41 Tm (child) Tj ET BT /F2 12 Tf 1 0 0 1 191.9 156.41 Tm (while) Tj ET BT /F2 12 Tf 1 0 0 1 222.75 156.41 Tm (insured) Tj ET BT /F2 12 Tf 1 0 0 1 262.27 156.41 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 280.44 156.41 Tm (Dependents) Tj ET BT /F2 12 Tf 1 0 0 1 341.28 156.41 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 365.45 156.41 Tm (Insurance,) Tj ET BT /F2 12 Tf 1 0 0 1 419.28 156.41 Tm (his) Tj ET BT /F2 12 Tf 1 0 0 1 437.47 156.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 451.66 156.41 Tm (her) Tj ET BT /F2 12 Tf 1 0 0 1 471.17 156.41 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 521.33 156.41 Tm (will) Tj ET Q q n 0 154 m 612 154 l 612 142 l 0 142 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 144.41 Tm (become effective on the date the Dependent is acquired.) Tj ET Q q n 0 142 m 612 142 l 612 130 l 0 130 l h W n Q q n 0 130 m 612 130 l 612 118 l 0 118 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 120.41 Tm (DELAYED) Tj ET BT /F2 12 Tf 1 0 0 1 61.66 120.41 Tm (EFFECTIVE) Tj ET BT /F2 12 Tf 1 0 0 1 130 120.41 Tm (DATE.) Tj ET BT /F2 12 Tf 1 0 0 1 175 120.41 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 188 120.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 198.33 120.41 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 255.32 120.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 268.33 120.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 282.66 120.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 293 120.41 Tm (Period) Tj ET BT /F2 12 Tf 1 0 0 1 329.33 120.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 344.33 120.41 Tm (Limited) Tj ET BT /F2 12 Tf 1 0 0 1 387.33 120.41 Tm (Activity) Tj ET BT /F2 12 Tf 1 0 0 1 431.66 120.41 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 448.67 120.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 468.34 120.41 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 490.67 120.41 Tm (his) Tj ET BT /F2 12 Tf 1 0 0 1 509.68 120.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 524.68 120.41 Tm (her) Tj ET Q q n 0 118 m 612 118 l 612 106 l 0 106 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 108.41 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 56.13 108.41 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 80.26 108.41 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 131.05 108.41 Tm (would) Tj ET BT /F2 12 Tf 1 0 0 1 165.2 108.41 Tm (otherwise) Tj ET BT /F2 12 Tf 1 0 0 1 216 108.41 Tm (take) Tj ET BT /F2 12 Tf 1 0 0 1 240.13 108.41 Tm (effect;) Tj ET BT /F2 12 Tf 1 0 0 1 274.92 108.41 Tm (then) Tj ET BT /F2 12 Tf 1 0 0 1 299.73 108.41 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 349.85 108.41 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 367.99 108.41 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 390.14 108.41 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 446.26 108.41 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 469.08 108.41 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 488.56 108.41 Tm (take) Tj ET BT /F2 12 Tf 1 0 0 1 512.7 108.41 Tm (effect) Tj ET Q q n 0 106 m 612 106 l 612 94 l 0 94 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 96.41 Tm (until the day after:) Tj ET Q q n 18 94 m 630 94 l 630 82 l 18 82 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 84.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 84.41 Tm (his or her final discharge from the health care facility; or) Tj ET Q q n 18 82 m 630 82 l 630 70 l 18 70 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 72.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 72.41 Tm (resuming the normal activities of a healthy person of the same age and sex.) Tj ET Q q n 18 70 m 630 70 l 630 58 l 18 58 l h W n Q q n 0 58 m 612 58 l 612 46 l 0 46 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 48.41 Tm ("Period) Tj ET BT /F2 12 Tf 1 0 0 1 40.58 48.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 54.93 48.41 Tm (Limited) Tj ET BT /F2 12 Tf 1 0 0 1 97.27 48.41 Tm (Activity") Tj ET BT /F2 12 Tf 1 0 0 1 145.85 48.41 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 180.86 48.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 190.54 48.41 Tm (period) Tj ET BT /F2 12 Tf 1 0 0 1 225.55 48.41 Tm (when) Tj ET BT /F2 12 Tf 1 0 0 1 255.89 48.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 265.57 48.41 Tm (spouse) Tj ET BT /F2 12 Tf 1 0 0 1 302.59 48.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 316.93 48.41 Tm (child) Tj ET BT /F2 12 Tf 1 0 0 1 345.28 48.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 357.64 48.41 Tm (confined) Tj ET BT /F2 12 Tf 1 0 0 1 403.97 48.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 417.66 48.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 427.34 48.41 Tm (health) Tj ET BT /F2 12 Tf 1 0 0 1 461.01 48.41 Tm (care) Tj ET BT /F2 12 Tf 1 0 0 1 485.33 48.41 Tm (facility;) Tj ET BT /F2 12 Tf 1 0 0 1 527 48.41 Tm (or,) Tj ET Q q n 0 46 m 612 46 l 612 34 l 0 34 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 36.41 Tm (whether) Tj ET BT /F2 12 Tf 1 0 0 1 42.68 36.41 Tm (confined) Tj ET BT /F2 12 Tf 1 0 0 1 88.68 36.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 102.71 36.41 Tm (not,) Tj ET BT /F2 12 Tf 1 0 0 1 125.07 36.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 137.1 36.41 Tm (unable) Tj ET BT /F2 12 Tf 1 0 0 1 173.11 36.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 186.47 36.41 Tm (perform) Tj ET BT /F2 12 Tf 1 0 0 1 229.15 36.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 247.83 36.41 Tm (regular) Tj ET BT /F2 12 Tf 1 0 0 1 285.84 36.41 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 307.19 36.41 Tm (usual) Tj ET BT /F2 12 Tf 1 0 0 1 336.55 36.41 Tm (activities) Tj ET BT /F2 12 Tf 1 0 0 1 383.89 36.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 397.92 36.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 407.27 36.41 Tm (healthy) Tj ET BT /F2 12 Tf 1 0 0 1 446.62 36.41 Tm (person) Tj ET BT /F2 12 Tf 1 0 0 1 482.63 36.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 496.66 36.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 515.34 36.41 Tm (same) Tj ET Q q n 0 34 m 612 34 l 612 22 l 0 22 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 24.41 Tm (age and sex.) Tj ET Q q n 0 22 m 612 22 l 612 10 l 0 10 l h W n Q Q q Q Q endstream endobj 15 0 obj <>>>>> endobj 147 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 720 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 176.98 26.41 Tm (DEPENDENTS LIFE INSURANCE) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 239 14.41 Tm ($Continued$) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n -5.75 38.6 m 534.5 38.6 l 534.5 26.6 l -5.75 26.6 l h W n Q q n 0 25.15 m 279 25.15 l 279 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-5 VIT) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 270.4 3.56 Tm (11) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 659.8 m 612 659.8 l 612 647.8 l 0 647.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 650.21 Tm (EVIDENCE) Tj ET BT /F2 12 Tf 1 0 0 1 63.56 650.21 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 82.47 650.21 Tm (INSURABILITY.) Tj ET BT /F2 12 Tf 1 0 0 1 176.61 650.21 Tm (Each) Tj ET BT /F2 12 Tf 1 0 0 1 204.17 650.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 217.73 650.21 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 243.3 650.21 Tm (Dependents) Tj ET BT /F2 12 Tf 1 0 0 1 303.52 650.21 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 330.43 650.21 Tm (submit) Tj ET BT /F2 12 Tf 1 0 0 1 366.68 650.21 Tm (evidence) Tj ET BT /F2 12 Tf 1 0 0 1 412.89 650.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 426.45 650.21 Tm (insurability) Tj ET BT /F2 12 Tf 1 0 0 1 484.69 650.21 Tm (satisfactory) Tj ET Q q n 0 647.8 m 612 647.8 l 612 635.8 l 0 635.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 638.21 Tm (to the Company, if you:) Tj ET Q q n 18 635.8 m 630 635.8 l 630 623.8 l 18 623.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 626.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 626.21 Tm (apply for Spouse Life Insurance in excess of the Guaranteed Acceptance Amount;) Tj ET Q q n 18 623.8 m 630 623.8 l 630 611.8 l 18 611.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 614.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 614.21 Tm (apply to enroll for or increase Spouse Life Insurance more than 31 days after:) Tj ET Q q n 45.35 611.8 m 657.35 611.8 l 657.35 599.8 l 45.35 599.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 602.21 Tm ($a$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 602.21 Tm (first becoming eligible for Dependent Life Insurance; or) Tj ET Q q n 45.35 599.8 m 657.35 599.8 l 657.35 587.8 l 45.35 587.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 590.21 Tm ($b$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 590.21 Tm (first acquiring an eligible spouse;) Tj ET Q q n 18 587.8 m 630 587.8 l 630 575.8 l 18 575.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 578.21 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 578.21 Tm (apply to enroll for or increase Children's Life Insurance more than 31 days after:) Tj ET Q q n 45.35 575.8 m 657.35 575.8 l 657.35 563.8 l 45.35 563.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 566.21 Tm ($a$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 566.21 Tm (first becoming eligible for Dependent Life Insurance; or) Tj ET Q q n 45.35 563.8 m 657.35 563.8 l 657.35 551.8 l 45.35 551.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 554.21 Tm ($b$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 554.21 Tm (first acquiring an eligible child;) Tj ET Q q n 18 551.8 m 630 551.8 l 630 539.8 l 18 539.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 542.21 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 542.21 Tm (apply for Dependents Life Insurance after requesting:) Tj ET Q q n 45.35 539.8 m 657.35 539.8 l 657.35 527.8 l 45.35 527.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 530.21 Tm ($a$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 530.21 Tm (to terminate the Dependents Insurance; or) Tj ET Q q n 45.35 527.8 m 657.35 527.8 l 657.35 515.8 l 45.35 515.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 518.21 Tm ($b$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 518.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 85.74 518.21 Tm (cancel) Tj ET BT /F2 12 Tf 1 0 0 1 120.08 518.21 Tm (premium) Tj ET BT /F2 12 Tf 1 0 0 1 167.11 518.21 Tm (payments) Tj ET BT /F2 12 Tf 1 0 0 1 216.8 518.21 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 232.5 518.21 Tm (payroll) Tj ET BT /F2 12 Tf 1 0 0 1 270.2 518.21 Tm (deduction) Tj ET BT /F2 12 Tf 1 0 0 1 321.22 518.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 334.92 518.21 Tm (through) Tj ET BT /F2 12 Tf 1 0 0 1 375.95 518.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 384.98 518.21 Tm (Flexible) Tj ET BT /F2 12 Tf 1 0 0 1 428.01 518.21 Tm (Benefits) Tj ET Q q n 72.7 515.8 m 684.7 515.8 l 684.7 503.8 l 72.7 503.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 72.7 506.21 Tm (Plan account; or) Tj ET Q q n 18 503.8 m 630 503.8 l 630 491.8 l 18 491.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 494.21 Tm ($5$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 494.21 Tm (apply) Tj ET BT /F2 12 Tf 1 0 0 1 76.92 494.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 91.17 494.21 Tm (reinstate) Tj ET BT /F2 12 Tf 1 0 0 1 136.74 494.21 Tm (continued) Tj ET BT /F2 12 Tf 1 0 0 1 188.97 494.21 Tm (Dependents) Tj ET BT /F2 12 Tf 1 0 0 1 250.53 494.21 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 275.44 494.21 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 326.99 494.21 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 353.88 494.21 Tm (it) Tj ET BT /F2 12 Tf 1 0 0 1 365.47 494.21 Tm (lapses) Tj ET BT /F2 12 Tf 1 0 0 1 399.71 494.21 Tm (due) Tj ET BT /F2 12 Tf 1 0 0 1 421.95 494.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 436.2 494.21 Tm (failure) Tj ET BT /F2 12 Tf 1 0 0 1 472.43 494.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 486.67 494.21 Tm (pay) Tj ET Q q n 45.35 491.8 m 657.35 491.8 l 657.35 479.8 l 45.35 479.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 482.21 Tm (premium when due.) Tj ET Q q n 0 479.8 m 612 479.8 l 612 467.8 l 0 467.8 l h W n Q q n 0 467.8 m 612 467.8 l 612 455.8 l 0 455.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 458.21 Tm (TERMINATION) Tj ET BT /F2 12 Tf 1 0 0 1 86.99 458.21 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 106.01 458.21 Tm (DEPENDENTS) Tj ET BT /F2 12 Tf 1 0 0 1 187.01 458.21 Tm (INSURANCE.) Tj ET BT /F2 12 Tf 1 0 0 1 266.03 458.21 Tm (Your) Tj ET BT /F2 12 Tf 1 0 0 1 294.36 458.21 Tm (Dependents) Tj ET BT /F2 12 Tf 1 0 0 1 354.68 458.21 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 405 458.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 422.66 458.21 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 443.66 458.21 Tm (spouse) Tj ET BT /F2 12 Tf 1 0 0 1 480 458.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 493.67 458.21 Tm (child) Tj ET BT /F2 12 Tf 1 0 0 1 521.33 458.21 Tm (will) Tj ET Q q n 0 455.8 m 612 455.8 l 612 443.8 l 0 443.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 446.21 Tm (cease on the earliest of:) Tj ET Q q n 18 443.8 m 630 443.8 l 630 431.8 l 18 431.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 434.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 434.21 Tm (the date the Policy terminates or your Employer ceases to be a Participating Employer;) Tj ET Q q n 18 431.8 m 630 431.8 l 630 419.8 l 18 419.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 422.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 422.21 Tm (the date Dependent Insurance is discontinued under the Policy;) Tj ET Q q n 18 419.8 m 630 419.8 l 630 407.8 l 18 407.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 410.21 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 410.21 Tm (the last day of the Insurance Month in which termination is requested;) Tj ET Q q n 18 407.8 m 630 407.8 l 630 395.8 l 18 395.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 398.21 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 398.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 63.48 398.21 Tm (last) Tj ET BT /F2 12 Tf 1 0 0 1 83.62 398.21 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 104.42 398.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 117.89 398.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 136.03 398.21 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 186.14 398.21 Tm (Month) Tj ET BT /F2 12 Tf 1 0 0 1 221.62 398.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 239.09 398.21 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 271.89 398.21 Tm (premium) Tj ET BT /F2 12 Tf 1 0 0 1 318.68 398.21 Tm (payment) Tj ET BT /F2 12 Tf 1 0 0 1 363.48 398.21 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 374.96 398.21 Tm (made) Tj ET BT /F2 12 Tf 1 0 0 1 404.42 398.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 421.88 398.21 Tm (such) Tj ET BT /F2 12 Tf 1 0 0 1 447.35 398.21 Tm (Dependents) Tj ET Q q n 45.35 395.8 m 657.35 395.8 l 657.35 383.8 l 45.35 383.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 386.21 Tm (Insurance;) Tj ET Q q n 18 383.8 m 630 383.8 l 630 371.8 l 18 371.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 374.21 Tm ($5$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 374.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 63.51 374.21 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 86.99 374.21 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 108.49 374.21 Tm (cease) Tj ET BT /F2 12 Tf 1 0 0 1 137.97 374.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 150.8 374.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 165.62 374.21 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 178.46 374.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 187.28 374.21 Tm (class) Tj ET BT /F2 12 Tf 1 0 0 1 214.1 374.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 227.6 374.21 Tm (employees) Tj ET BT /F2 12 Tf 1 0 0 1 282.41 374.21 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 315.24 374.21 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 326.74 374.21 Tm (eligible) Tj ET BT /F2 12 Tf 1 0 0 1 366.23 374.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 383.72 374.21 Tm (Dependents) Tj ET BT /F2 12 Tf 1 0 0 1 443.87 374.21 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 494 374.21 Tm (or) Tj ET Q q n 45.35 371.8 m 657.35 371.8 l 657.35 359.8 l 45.35 359.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 362.21 Tm (die;) Tj ET Q q n 18 359.8 m 630 359.8 l 630 347.8 l 18 347.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 350.21 Tm ($6$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 350.21 Tm (the date your spouse or child ceases to be an eligible Dependent, as defined by this section;) Tj ET Q q n 18 347.8 m 630 347.8 l 630 335.8 l 18 335.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 338.21 Tm ($7$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 338.21 Tm (the date your employment with the Participating Employer ends) Tj ET BT /F2 12 Tf 1 0 0 1 352.61 338.21 Tm (; or) Tj ET Q q n 18 335.8 m 630 335.8 l 630 323.8 l 18 323.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 326.21 Tm ($8$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 326.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 64.1 326.21 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 88.18 326.21 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 110.28 326.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 124.36 326.21 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 150.45 326.21 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 206.52 326.21 Tm (enters) Tj ET BT /F2 12 Tf 1 0 0 1 239.27 326.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 258.02 326.21 Tm (armed) Tj ET BT /F2 12 Tf 1 0 0 1 292.1 326.21 Tm (services) Tj ET BT /F2 12 Tf 1 0 0 1 334.84 326.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 348.93 326.21 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 370.35 326.21 Tm (state) Tj ET BT /F2 12 Tf 1 0 0 1 396.43 326.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 410.52 326.21 Tm (country;) Tj ET BT /F2 12 Tf 1 0 0 1 454.6 326.21 Tm (except) Tj ET BT /F2 12 Tf 1 0 0 1 490.01 326.21 Tm (for) Tj ET Q q n 45.35 323.8 m 657.35 323.8 l 657.35 311.8 l 45.35 311.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 314.21 Tm (duty) Tj ET BT /F2 12 Tf 1 0 0 1 71.56 314.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 86.43 314.21 Tm (30) Tj ET BT /F2 12 Tf 1 0 0 1 103.3 314.21 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 130.18 314.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 145.05 314.21 Tm (less) Tj ET BT /F2 12 Tf 1 0 0 1 167.92 314.21 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 182.13 314.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 201.66 314.21 Tm (Reserves) Tj ET BT /F2 12 Tf 1 0 0 1 249.86 314.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 264.73 314.21 Tm (National) Tj ET BT /F2 12 Tf 1 0 0 1 310.92 314.21 Tm (Guard.) Tj ET BT /F2 12 Tf 1 0 0 1 353.66 314.21 Tm ($If) Tj ET BT /F2 12 Tf 1 0 0 1 370.52 314.21 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 393.4 314.21 Tm (send) Tj ET BT /F2 12 Tf 1 0 0 1 420.27 314.21 Tm (proof) Tj ET BT /F2 12 Tf 1 0 0 1 451.14 314.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 466.01 314.21 Tm (military) Tj ET Q q n 45.35 311.8 m 657.35 311.8 l 657.35 299.8 l 45.35 299.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 302.21 Tm (service, the Company will refund any unearned premium.$) Tj ET Q q n 0 299.8 m 612 299.8 l 612 287.8 l 0 287.8 l h W n Q q n 0 287.8 m 612 287.8 l 612 275.8 l 0 275.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 278.21 Tm (Dependents Insurance for your Dependent children will also cease on:) Tj ET Q q n 18 275.8 m 630 275.8 l 630 263.8 l 18 263.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 266.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 266.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 64.17 266.21 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 88.33 266.21 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 114.49 266.21 Tm (Personal) Tj ET BT /F2 12 Tf 1 0 0 1 159.98 266.21 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 184.13 266.21 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 234.94 266.21 Tm (ceases,) Tj ET BT /F2 12 Tf 1 0 0 1 272.75 266.21 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 284.24 266.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 303.07 266.21 Tm (child) Tj ET BT /F2 12 Tf 1 0 0 1 331.23 266.21 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 343.4 266.21 Tm (enrolled) Tj ET BT /F2 12 Tf 1 0 0 1 386.88 266.21 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 418.37 266.21 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 433.86 266.21 Tm (Employee) Tj ET BT /F2 12 Tf 1 0 0 1 486.67 266.21 Tm (and) Tj ET Q q n 45.35 263.8 m 657.35 263.8 l 657.35 251.8 l 45.35 251.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 254.21 Tm (Children's Plan; or) Tj ET Q q n 18 251.8 m 630 251.8 l 630 239.8 l 18 239.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 242.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 242.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 63.91 242.21 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 87.8 242.21 Tm (Spouse) Tj ET BT /F2 12 Tf 1 0 0 1 126.38 242.21 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 176.92 242.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 194.81 242.21 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 220.71 242.21 Tm (spouse) Tj ET BT /F2 12 Tf 1 0 0 1 257.28 242.21 Tm (ceases,) Tj ET BT /F2 12 Tf 1 0 0 1 294.83 242.21 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 306.06 242.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 324.62 242.21 Tm (child) Tj ET BT /F2 12 Tf 1 0 0 1 352.52 242.21 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 364.43 242.21 Tm (enrolled) Tj ET BT /F2 12 Tf 1 0 0 1 407.65 242.21 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 438.87 242.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 448.1 242.21 Tm (Spouse) Tj ET BT /F2 12 Tf 1 0 0 1 486.67 242.21 Tm (and) Tj ET Q q n 45.35 239.8 m 657.35 239.8 l 657.35 227.8 l 45.35 227.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 230.21 Tm (Children's Plan.) Tj ET Q q n 0 227.8 m 612 227.8 l 612 215.8 l 0 215.8 l h W n Q q n 0 215.8 m 612 215.8 l 612 203.8 l 0 203.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 206.21 Tm (When) Tj ET BT /F2 12 Tf 1 0 0 1 32.06 206.21 Tm (Dependents) Tj ET BT /F2 12 Tf 1 0 0 1 92.13 206.21 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 142.18 206.21 Tm (ceases) Tj ET BT /F2 12 Tf 1 0 0 1 176.23 206.21 Tm (because) Tj ET BT /F2 12 Tf 1 0 0 1 217.62 206.21 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 243.03 206.21 Tm (employment) Tj ET BT /F2 12 Tf 1 0 0 1 306.43 206.21 Tm (ends,) Tj ET BT /F2 12 Tf 1 0 0 1 334.84 206.21 Tm (it) Tj ET BT /F2 12 Tf 1 0 0 1 344.92 206.21 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 368.99 206.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 383.73 206.21 Tm (possible) Tj ET BT /F2 12 Tf 1 0 0 1 426.48 206.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 439.22 206.21 Tm (continue) Tj ET BT /F2 12 Tf 1 0 0 1 483.95 206.21 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 530.67 206.21 Tm (in) Tj ET Q q n 0 203.8 m 612 203.8 l 612 191.8 l 0 191.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 194.21 Tm (accord) Tj ET BT /F2 12 Tf 1 0 0 1 36.59 194.21 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 62.53 194.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 81.8 194.21 Tm (Portability) Tj ET BT /F2 12 Tf 1 0 0 1 137.08 194.21 Tm (Privilege) Tj ET BT /F2 12 Tf 1 0 0 1 185.02 194.21 Tm (section) Tj ET BT /F2 12 Tf 1 0 0 1 223.62 194.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 238.23 194.21 Tm (this) Tj ET BT /F2 12 Tf 1 0 0 1 260.18 194.21 Tm (Certificate.) Tj ET BT /F2 12 Tf 1 0 0 1 323.04 194.21 Tm (When) Tj ET BT /F2 12 Tf 1 0 0 1 356.3 194.21 Tm (Dependents) Tj ET BT /F2 12 Tf 1 0 0 1 417.56 194.21 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 468.81 194.21 Tm (ceases) Tj ET BT /F2 12 Tf 1 0 0 1 504.07 194.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 522.67 194.21 Tm (any) Tj ET Q q n 0 191.8 m 612 191.8 l 612 179.8 l 0 179.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 182.21 Tm (reason) Tj ET BT /F2 12 Tf 1 0 0 1 35.03 182.21 Tm (except) Tj ET BT /F2 12 Tf 1 0 0 1 70.06 182.21 Tm (nonpayment) Tj ET BT /F2 12 Tf 1 0 0 1 133.1 182.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 146.81 182.21 Tm (premium,) Tj ET BT /F2 12 Tf 1 0 0 1 196.84 182.21 Tm (it) Tj ET BT /F2 12 Tf 1 0 0 1 207.23 182.21 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 231.6 182.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 246.64 182.21 Tm (possible) Tj ET BT /F2 12 Tf 1 0 0 1 289.69 182.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 302.74 182.21 Tm (purchase) Tj ET BT /F2 12 Tf 1 0 0 1 349.1 182.21 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 364.14 182.21 Tm (individual) Tj ET BT /F2 12 Tf 1 0 0 1 416.52 182.21 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 436.22 182.21 Tm (policy) Tj ET BT /F2 12 Tf 1 0 0 1 469.93 182.21 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 482.98 182.21 Tm (accord) Tj ET BT /F2 12 Tf 1 0 0 1 518.67 182.21 Tm (with) Tj ET Q q n 0 179.8 m 612 179.8 l 612 167.8 l 0 167.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 170.21 Tm (the Conversion Privilege section of this Certificate.) Tj ET Q q n 0 167.8 m 612 167.8 l 612 155.8 l 0 155.8 l h W n Q q n 0 155.8 m 612 155.8 l 612 143.8 l 0 143.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 146.21 Tm (MISSTATEMENT) Tj ET BT /F2 12 Tf 1 0 0 1 97.01 146.21 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 116.69 146.21 Tm (AGE.) Tj ET BT /F2 12 Tf 1 0 0 1 153.03 146.21 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 165.36 146.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 184.36 146.21 Tm (age) Tj ET BT /F2 12 Tf 1 0 0 1 205.35 146.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 219.69 146.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 229.35 146.21 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 285.67 146.21 Tm (has) Tj ET BT /F2 12 Tf 1 0 0 1 306 146.21 Tm (been) Tj ET BT /F2 12 Tf 1 0 0 1 333 146.21 Tm (misstated,) Tj ET BT /F2 12 Tf 1 0 0 1 385.66 146.21 Tm (premiums) Tj ET BT /F2 12 Tf 1 0 0 1 438 146.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 461.01 146.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 476.67 146.21 Tm (subject) Tj ET BT /F2 12 Tf 1 0 0 1 515 146.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 528.67 146.21 Tm (an) Tj ET Q q n 0 143.8 m 612 143.8 l 612 131.8 l 0 131.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 134.21 Tm (equitable) Tj ET BT /F2 12 Tf 1 0 0 1 47.11 134.21 Tm (adjustment.) Tj ET BT /F2 12 Tf 1 0 0 1 109.03 134.21 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 120.16 134.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 137.95 134.21 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 177.07 134.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 190.2 134.21 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 226.65 134.21 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 237.78 134.21 Tm (dependent) Tj ET BT /F2 12 Tf 1 0 0 1 290.23 134.21 Tm (upon) Tj ET BT /F2 12 Tf 1 0 0 1 317.36 134.21 Tm (age,) Tj ET BT /F2 12 Tf 1 0 0 1 340.14 134.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 357.93 134.21 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 394.38 134.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 416.18 134.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 430.63 134.21 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 451.76 134.21 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 484.22 134.21 Tm (would) Tj ET BT /F2 12 Tf 1 0 0 1 517.35 134.21 Tm (have) Tj ET Q q n 0 131.8 m 612 131.8 l 612 119.8 l 0 119.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 122.21 Tm (been payable based upon the Dependent's correct age.) Tj ET Q q n 0 119.8 m 612 119.8 l 612 107.8 l 0 107.8 l h W n Q q n 0 107.8 m 612 107.8 l 612 95.8 l 0 95.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 98.21 Tm (ASSIGNMENT.) Tj ET BT /F2 12 Tf 1 0 0 1 86.34 98.21 Tm (Dependents Insurance may not be assigned.) Tj ET Q q n 0 95.8 m 612 95.8 l 612 83.8 l 0 83.8 l h W n Q q n 0 83.8 m 612 83.8 l 612 71.8 l 0 71.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 74.2 Tm (INCONTESTABILITY.) Tj ET BT /F2 12 Tf 1 0 0 1 123.98 74.2 Tm (Except) Tj ET BT /F2 12 Tf 1 0 0 1 160.46 74.2 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 177.61 74.2 Tm (nonpayment) Tj ET BT /F2 12 Tf 1 0 0 1 240.09 74.2 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 253.25 74.2 Tm (premiums,) Tj ET BT /F2 12 Tf 1 0 0 1 307.41 74.2 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 325.23 74.2 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 375.06 74.2 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 398.88 74.2 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 417.38 74.2 Tm (contest) Tj ET BT /F2 12 Tf 1 0 0 1 454.53 74.2 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 472.36 74.2 Tm (validity) Tj ET BT /F2 12 Tf 1 0 0 1 512.18 74.2 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 74.2 Tm (the) Tj ET Q q n 0 71.8 m 612 71.8 l 612 59.8 l 0 59.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 62.21 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 34.07 62.21 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 47.47 62.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 60.21 62.21 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 80.94 62.21 Tm (Dependent,) Tj ET BT /F2 12 Tf 1 0 0 1 139.33 62.21 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 164.71 62.21 Tm (it) Tj ET BT /F2 12 Tf 1 0 0 1 174.78 62.21 Tm (has) Tj ET BT /F2 12 Tf 1 0 0 1 194.18 62.21 Tm (been) Tj ET BT /F2 12 Tf 1 0 0 1 220.24 62.21 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 232.98 62.21 Tm (force) Tj ET BT /F2 12 Tf 1 0 0 1 261.03 62.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 278.43 62.21 Tm (two) Tj ET BT /F2 12 Tf 1 0 0 1 299.83 62.21 Tm (years) Tj ET BT /F2 12 Tf 1 0 0 1 328.56 62.21 Tm (during) Tj ET BT /F2 12 Tf 1 0 0 1 363.29 62.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 381.36 62.21 Tm (lifetime) Tj ET BT /F2 12 Tf 1 0 0 1 422.08 62.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 435.48 62.21 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 456.88 62.21 Tm (Dependent.) Tj ET BT /F2 12 Tf 1 0 0 1 518.67 62.21 Tm (This) Tj ET Q q n 0 59.8 m 612 59.8 l 612 47.8 l 0 47.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 50.21 Tm (clause) Tj ET BT /F2 12 Tf 1 0 0 1 35.41 50.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 59.5 50.21 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 80.25 50.21 Tm (affect) Tj ET BT /F2 12 Tf 1 0 0 1 112.98 50.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 133.06 50.21 Tm (Company's) Tj ET BT /F2 12 Tf 1 0 0 1 191.98 50.21 Tm (right) Tj ET BT /F2 12 Tf 1 0 0 1 220.07 50.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 234.82 50.21 Tm (contest) Tj ET BT /F2 12 Tf 1 0 0 1 274.23 50.21 Tm (claims) Tj ET BT /F2 12 Tf 1 0 0 1 310.98 50.21 Tm (made) Tj ET BT /F2 12 Tf 1 0 0 1 342.39 50.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 361.8 50.21 Tm (accidental) Tj ET BT /F2 12 Tf 1 0 0 1 415.86 50.21 Tm (death) Tj ET BT /F2 12 Tf 1 0 0 1 447.27 50.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 462.69 50.21 Tm (dismemberment) Tj ET Q q n 0 47.8 m 612 47.8 l 612 35.8 l 0 35.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 38.21 Tm (benefits.) Tj ET Q Q q Q Q endstream endobj 16 0 obj <>>>>> endobj 148 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 744 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 97.98 2.41 Tm (ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 257.4 25.15 l 257.4 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-6.3A 01 MO) Tj ET Q q n 257.4 25.15 m 293.4 25.15 l 293.4 13.15 l 257.4 13.15 l h W n Q q n 293.4 25.15 m 540.25 25.15 l 540.25 13.15 l 293.4 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 429.9 15.56 Tm (COMMON CARRIER) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 270.4 3.56 Tm (12) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 670 m 612 670 l 612 658 l 0 658 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 660.41 Tm (DEATH) Tj ET BT /F4 12 Tf 1 0 0 1 46.6 660.41 Tm (OR) Tj ET BT /F4 12 Tf 1 0 0 1 68.52 660.41 Tm (DISMEMBERMENT) Tj ET BT /F4 12 Tf 1 0 0 1 183.78 660.41 Tm (BENEFIT) Tj ET BT /F4 12 Tf 1 0 0 1 240.38 660.41 Tm (FOR) Tj ET BT /F4 12 Tf 1 0 0 1 269.63 660.41 Tm (AN) Tj ET BT /F4 12 Tf 1 0 0 1 290.89 660.41 Tm (INSURED) Tj ET BT /F4 12 Tf 1 0 0 1 348.82 660.41 Tm (PERSON.) Tj ET BT /F2 12 Tf 1 0 0 1 408.34 660.41 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 430.92 660.41 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 481.5 660.41 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 504.09 660.41 Tm (pay) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 660.41 Tm (the) Tj ET Q q n 0 658 m 612 658 l 612 646 l 0 646 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 648.41 Tm (benefit listed below, if:) Tj ET Q q n 18 646 m 630 646 l 630 634 l 18 634 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 636.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 636.41 Tm (you sustain an accidental bodily injury while insured under this provision; and) Tj ET Q q n 18 634 m 630 634 l 630 622 l 18 622 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 624.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 624.41 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 68.02 624.41 Tm (injury) Tj ET BT /F2 12 Tf 1 0 0 1 101.35 624.41 Tm (directly) Tj ET BT /F2 12 Tf 1 0 0 1 142.68 624.41 Tm (causes) Tj ET BT /F2 12 Tf 1 0 0 1 178.67 624.41 Tm (one) Tj ET BT /F2 12 Tf 1 0 0 1 200.67 624.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 215.34 624.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 234.67 624.41 Tm (following) Tj ET BT /F2 12 Tf 1 0 0 1 286 624.41 Tm (losses) Tj ET BT /F2 12 Tf 1 0 0 1 319.35 624.41 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 354.69 624.41 Tm (365) Tj ET BT /F2 12 Tf 1 0 0 1 377.36 624.41 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 404.03 624.41 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 430.68 624.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 450.01 624.41 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 474.67 624.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 489.34 624.41 Tm (the) Tj ET Q q n 45.35 622 m 657.35 622 l 657.35 610 l 45.35 610 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 612.41 Tm (accident.) Tj ET Q q n 0 610 m 612 610 l 612 598 l 0 598 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 600.41 Tm (The loss must result directly from the injury and from no other causes.) Tj ET Q q n 0 598 m 612 598 l 612 586 l 0 586 l h W n Q q n 0 586 m 275.4 586 l 275.4 574 l 0 574 l h W n Q q n 0 574 m 275.4 574 l 275.4 562 l 0 562 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 116.96 564.41 Tm (LOSS) Tj ET Q q n 275.4 586 m 428.4 586 l 428.4 574 l 275.4 574 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 275.4 576.41 Tm (BENEFIT FOR) Tj ET Q q n 275.4 574 m 428.4 574 l 428.4 562 l 275.4 562 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 275.4 564.41 Tm (COMMON CARRIER) Tj ET Q q n 275.4 562 m 428.4 562 l 428.4 550 l 275.4 550 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 275.4 552.41 Tm (ACCIDENT) Tj ET Q q n 428.4 586 m 558.9 586 l 558.9 574 l 428.4 574 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 428.4 576.41 Tm (BENEFIT FOR) Tj ET Q q n 428.4 574 m 558.9 574 l 558.9 562 l 428.4 562 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 428.4 564.41 Tm (OTHER COVERED) Tj ET Q q n 428.4 562 m 558.9 562 l 558.9 550 l 428.4 550 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 428.4 552.41 Tm (ACCIDENT) Tj ET Q q n 0 550 m 275.4 550 l 275.4 538 l 0 538 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 540.41 Tm (Loss of Life) Tj ET Q q n 275.4 550 m 428.4 550 l 428.4 538 l 275.4 538 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.4 540.41 Tm (2 Times Principal Sum) Tj ET Q q n 428.4 550 m 558.9 550 l 558.9 538 l 428.4 538 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 428.4 540.41 Tm (Principal Sum) Tj ET Q q n 0 538 m 275.4 538 l 275.4 526 l 0 526 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 528.41 Tm (Loss of One Member $Hand, Foot or Eye$) Tj ET Q q n 275.4 538 m 428.4 538 l 428.4 526 l 275.4 526 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.4 528.41 Tm (Principal Sum) Tj ET Q q n 428.4 538 m 558.9 538 l 558.9 526 l 428.4 526 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 428.4 528.41 Tm (1/2 Principal Sum) Tj ET Q q n 0 526 m 275.4 526 l 275.4 514 l 0 514 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 516.41 Tm (Loss of Two or More Members) Tj ET Q q n 275.4 526 m 428.4 526 l 428.4 514 l 275.4 514 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 275.4 516.41 Tm (2 Times Principal Sum) Tj ET Q q n 428.4 526 m 558.9 526 l 558.9 514 l 428.4 514 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 428.4 516.41 Tm (Principal Sum) Tj ET Q q n 0 514 m 275.4 514 l 275.4 502 l 0 502 l h W n Q q n 275.4 514 m 428.4 514 l 428.4 502 l 275.4 502 l h W n Q q n 428.4 514 m 554.4 514 l 554.4 502 l 428.4 502 l h W n Q q n 0 500.85 m 612 500.85 l 612 488.85 l 0 488.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 491.26 Tm (The Principal Sum for your class is shown in the Schedule of Insurance.) Tj ET Q q n 0 488.85 m 612 488.85 l 612 476.85 l 0 476.85 l h W n Q q n 0 476.85 m 612 476.85 l 612 464.85 l 0 464.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 467.26 Tm (MAXIMUM PER PERSON.) Tj ET BT /F2 12 Tf 1 0 0 1 152.32 467.26 Tm (If you sustain more than one loss resulting from the same accident, the benefit:) Tj ET Q q n 18 464.85 m 630 464.85 l 630 452.85 l 18 452.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 455.26 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 455.26 Tm (will be the one largest amount listed;) Tj ET Q q n 18 452.85 m 630 452.85 l 630 440.85 l 18 440.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 443.26 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 443.26 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 67.94 443.26 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 87.19 443.26 Tm (exceed) Tj ET BT /F2 12 Tf 1 0 0 1 124.42 443.26 Tm (two) Tj ET BT /F2 12 Tf 1 0 0 1 146.34 443.26 Tm (times) Tj ET BT /F2 12 Tf 1 0 0 1 176.26 443.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 194.84 443.26 Tm (Principal) Tj ET BT /F2 12 Tf 1 0 0 1 242.09 443.26 Tm (Sum) Tj ET BT /F2 12 Tf 1 0 0 1 268.02 443.26 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 285.93 443.26 Tm (all) Tj ET BT /F2 12 Tf 1 0 0 1 301.84 443.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 315.76 443.26 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 341.68 443.26 Tm (combined) Tj ET BT /F2 12 Tf 1 0 0 1 392.92 443.26 Tm (losses) Tj ET BT /F2 12 Tf 1 0 0 1 425.51 443.26 Tm (resulting) Tj ET BT /F2 12 Tf 1 0 0 1 471.43 443.26 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 498.67 443.26 Tm (a) Tj ET Q q n 45.35 440.85 m 657.35 440.85 l 657.35 428.85 l 45.35 428.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 431.26 Tm (Common Carrier Accident; and) Tj ET Q q n 18 428.85 m 630 428.85 l 630 416.85 l 18 416.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 419.26 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 419.26 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 68.69 419.26 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 88.7 419.26 Tm (exceed) Tj ET BT /F2 12 Tf 1 0 0 1 126.67 419.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 146.01 419.26 Tm (Principal) Tj ET BT /F2 12 Tf 1 0 0 1 194 419.26 Tm (Sum) Tj ET BT /F2 12 Tf 1 0 0 1 220.68 419.26 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 239.35 419.26 Tm (all) Tj ET BT /F2 12 Tf 1 0 0 1 256.01 419.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 270.68 419.26 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 297.35 419.26 Tm (combined) Tj ET BT /F2 12 Tf 1 0 0 1 349.34 419.26 Tm (losses) Tj ET BT /F2 12 Tf 1 0 0 1 382.68 419.26 Tm (resulting) Tj ET BT /F2 12 Tf 1 0 0 1 429.35 419.26 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 457.35 419.26 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 479.34 419.26 Tm (other) Tj ET Q q n 45.35 416.85 m 657.35 416.85 l 657.35 404.85 l 45.35 404.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 407.26 Tm (covered accident.) Tj ET Q q n 0 404.85 m 612 404.85 l 612 392.85 l 0 392.85 l h W n Q q n 0 392.85 m 612 392.85 l 612 380.85 l 0 380.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 383.26 Tm (TO) Tj ET BT /F4 12 Tf 1 0 0 1 20.51 383.26 Tm (WHOM) Tj ET BT /F4 12 Tf 1 0 0 1 65.68 383.26 Tm (PAYABLE.) Tj ET BT /F2 12 Tf 1 0 0 1 132.36 383.26 Tm (Benefits) Tj ET BT /F2 12 Tf 1 0 0 1 175.52 383.26 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 192.69 383.26 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 217.85 383.26 Tm (loss) Tj ET BT /F2 12 Tf 1 0 0 1 239.7 383.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 252.87 383.26 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 272.03 383.26 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 293.87 383.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 308.37 383.26 Tm (paid) Tj ET BT /F2 12 Tf 1 0 0 1 332.2 383.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 344.71 383.26 Tm (accord) Tj ET BT /F2 12 Tf 1 0 0 1 379.85 383.26 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 404.36 383.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 422.19 383.26 Tm (Beneficiary) Tj ET BT /F2 12 Tf 1 0 0 1 481.33 383.26 Tm (section.) Tj ET BT /F2 12 Tf 1 0 0 1 524.67 383.26 Tm (All) Tj ET Q q n 0 380.85 m 612 380.85 l 612 368.85 l 0 368.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 371.26 Tm (other benefits will be paid to you.) Tj ET Q q n 0 368.85 m 612 368.85 l 612 356.85 l 0 356.85 l h W n Q q n 0 356.85 m 612 356.85 l 612 344.85 l 0 344.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 347.26 Tm (LIMITATIONS.) Tj ET BT /F2 12 Tf 1 0 0 1 91.69 347.26 Tm (Benefits are not payable for any loss to which a contributing cause is:) Tj ET Q q n 18 344.85 m 630 344.85 l 630 332.85 l 18 332.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 335.26 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 335.26 Tm (intentional self-inflicted injury or self-destruction, while sane;) Tj ET Q q n 18 332.85 m 630 332.85 l 630 320.85 l 18 320.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 323.26 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 323.26 Tm (disease, bodily or mental infirmity, or medical or surgical treatment of these; except for) Tj ET Q q n 45.35 320.85 m 657.35 320.85 l 657.35 308.85 l 45.35 308.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 311.26 Tm ($a$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 311.26 Tm (pyogenic infections resulting from an accidental bodily injury; or) Tj ET Q q n 45.35 308.85 m 657.35 308.85 l 657.35 296.85 l 45.35 296.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 299.26 Tm ($b$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 299.26 Tm (the accidental ingestion of contaminated substances;) Tj ET Q q n 18 296.85 m 630 296.85 l 630 284.85 l 18 284.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 287.26 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 287.26 Tm (participation in a riot;) Tj ET Q q n 18 284.85 m 630 284.85 l 630 272.85 l 18 272.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 275.26 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 275.26 Tm (duty as a member of any military, naval or air force;) Tj ET Q q n 18 272.85 m 630 272.85 l 630 260.85 l 18 260.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 263.26 Tm ($5$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 263.26 Tm (war or any act of war, declared or undeclared;) Tj ET Q q n 18 260.85 m 630 260.85 l 630 248.85 l 18 248.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 251.26 Tm ($6$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 251.26 Tm (participation in the commission of a felony;) Tj ET Q q n 18 248.85 m 630 248.85 l 630 236.85 l 18 236.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 239.26 Tm ($7$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 239.26 Tm (voluntary use of drugs; except when prescribed by a Physician;) Tj ET Q q n 18 236.85 m 630 236.85 l 630 224.85 l 18 224.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 227.26 Tm ($8$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 227.26 Tm (voluntary inhalation of gas, including carbon monoxide, while sane;) Tj ET Q q n 18 224.85 m 630 224.85 l 630 212.85 l 18 212.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 215.26 Tm ($9$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 215.26 Tm (travel) Tj ET BT /F2 12 Tf 1 0 0 1 75.77 215.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 88.86 215.26 Tm (flight) Tj ET BT /F2 12 Tf 1 0 0 1 117.96 215.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 130.39 215.26 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 150.81 215.26 Tm (aircraft,) Tj ET BT /F2 12 Tf 1 0 0 1 191.55 215.26 Tm (including) Tj ET BT /F2 12 Tf 1 0 0 1 239.97 215.26 Tm (balloons) Tj ET BT /F2 12 Tf 1 0 0 1 283.74 215.26 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 304.16 215.26 Tm (gliders;) Tj ET BT /F2 12 Tf 1 0 0 1 343.25 215.26 Tm (except) Tj ET BT /F2 12 Tf 1 0 0 1 377.66 215.26 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 390.76 215.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 399.18 215.26 Tm (fare) Tj ET BT /F2 12 Tf 1 0 0 1 420.93 215.26 Tm (paying) Tj ET BT /F2 12 Tf 1 0 0 1 456.69 215.26 Tm (passenger) Tj ET Q q n 45.35 212.85 m 657.35 212.85 l 657.35 200.85 l 45.35 200.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 203.26 Tm (on a regularly scheduled flight; or) Tj ET Q q n 18 200.85 m 630 200.85 l 630 188.85 l 18 188.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 191.26 Tm ($10$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 191.26 Tm (driving a vehicle while intoxicated.) Tj ET Q q n 0 188.85 m 612 188.85 l 612 176.85 l 0 176.85 l h W n Q q n 0 176.85 m 612 176.85 l 612 164.85 l 0 164.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 167.26 Tm (DEFINITIONS.) Tj ET Q q n 0 164.85 m 612 164.85 l 612 152.85 l 0 152.85 l h W n Q q n 0 152.85 m 612 152.85 l 612 140.85 l 0 140.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 143.26 Tm ("Beneficiary") Tj ET BT /F2 12 Tf 1 0 0 1 69.27 143.26 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 103.43 143.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 121.59 143.26 Tm (person$s$) Tj ET BT /F2 12 Tf 1 0 0 1 169.75 143.26 Tm (named) Tj ET BT /F2 12 Tf 1 0 0 1 205.24 143.26 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 220.74 143.26 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 246.24 143.26 Tm (enrollment) Tj ET BT /F2 12 Tf 1 0 0 1 301.72 143.26 Tm (form.) Tj ET BT /F2 12 Tf 1 0 0 1 335.05 143.26 Tm (You) Tj ET BT /F2 12 Tf 1 0 0 1 359.22 143.26 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 383.39 143.26 Tm (change) Tj ET BT /F2 12 Tf 1 0 0 1 420.87 143.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 439.03 143.26 Tm (Beneficiary) Tj ET BT /F2 12 Tf 1 0 0 1 498.5 143.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 514 143.26 Tm (filing) Tj ET Q q n 0 140.85 m 612 140.85 l 612 128.85 l 0 128.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 131.26 Tm (a written notice of the change with the Company at its Group Insurance Service Office.) Tj ET Q q n 0 128.85 m 612 128.85 l 612 116.85 l 0 116.85 l h W n Q q n 0 116.85 m 612 116.85 l 612 104.85 l 0 104.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 107.26 Tm ("Common) Tj ET BT /F2 12 Tf 1 0 0 1 52.82 107.26 Tm (Carrier) Tj ET BT /F2 12 Tf 1 0 0 1 90.05 107.26 Tm (Accident") Tj ET BT /F2 12 Tf 1 0 0 1 141.52 107.26 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 175.43 107.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 184 107.26 Tm (covered) Tj ET BT /F2 12 Tf 1 0 0 1 225.23 107.26 Tm (accidental) Tj ET BT /F2 12 Tf 1 0 0 1 277.12 107.26 Tm (bodily) Tj ET BT /F2 12 Tf 1 0 0 1 311.04 107.26 Tm (injury,) Tj ET BT /F2 12 Tf 1 0 0 1 345.95 107.26 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 378.53 107.26 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 389.79 107.26 Tm (sustained) Tj ET BT /F2 12 Tf 1 0 0 1 437.7 107.26 Tm (while) Tj ET BT /F2 12 Tf 1 0 0 1 467.61 107.26 Tm (riding) Tj ET BT /F2 12 Tf 1 0 0 1 499.53 107.26 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 512.78 107.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 521.36 107.26 Tm (fare) Tj ET Q q n 0 104.85 m 612 104.85 l 612 92.85 l 0 92.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 95.26 Tm (paying) Tj ET BT /F2 12 Tf 1 0 0 1 37.45 95.26 Tm (passenger) Tj ET BT /F2 12 Tf 1 0 0 1 89.55 95.26 Tm ($not) Tj ET BT /F2 12 Tf 1 0 0 1 113.66 95.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 123.77 95.26 Tm (pilot,) Tj ET BT /F2 12 Tf 1 0 0 1 153.56 95.26 Tm (operator) Tj ET BT /F2 12 Tf 1 0 0 1 198.32 95.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 213.11 95.26 Tm (crew) Tj ET BT /F2 12 Tf 1 0 0 1 241.21 95.26 Tm (member$) Tj ET BT /F2 12 Tf 1 0 0 1 289.3 95.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 303.42 95.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 318.2 95.26 Tm (on,) Tj ET BT /F2 12 Tf 1 0 0 1 337.99 95.26 Tm (boarding) Tj ET BT /F2 12 Tf 1 0 0 1 385.43 95.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 400.21 95.26 Tm (getting) Tj ET BT /F2 12 Tf 1 0 0 1 438.33 95.26 Tm (off) Tj ET BT /F2 12 Tf 1 0 0 1 457.11 95.26 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 485.22 95.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 495.33 95.26 Tm (Common) Tj ET Q q n 0 92.85 m 612 92.85 l 612 80.85 l 0 80.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 83.26 Tm (Carrier.) Tj ET Q q n 0 80.85 m 612 80.85 l 612 68.85 l 0 68.85 l h W n Q q n 0 68.85 m 612 68.85 l 612 56.85 l 0 56.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 59.26 Tm ("Common) Tj ET BT /F2 12 Tf 1 0 0 1 52.62 59.26 Tm (Carrier") Tj ET BT /F2 12 Tf 1 0 0 1 94.54 59.26 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 128.24 59.26 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 148.61 59.26 Tm (land,) Tj ET BT /F2 12 Tf 1 0 0 1 175.32 59.26 Tm (air) Tj ET BT /F2 12 Tf 1 0 0 1 191.02 59.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 204.07 59.26 Tm (water) Tj ET BT /F2 12 Tf 1 0 0 1 233.76 59.26 Tm (conveyance) Tj ET BT /F2 12 Tf 1 0 0 1 293.44 59.26 Tm (operated) Tj ET BT /F2 12 Tf 1 0 0 1 337.79 59.26 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 368.16 59.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 376.53 59.26 Tm (license) Tj ET BT /F2 12 Tf 1 0 0 1 412.9 59.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 425.28 59.26 Tm (transport) Tj ET BT /F2 12 Tf 1 0 0 1 470.98 59.26 Tm (passengers) Tj ET BT /F2 12 Tf 1 0 0 1 526.01 59.26 Tm (for) Tj ET Q q n 0 56.85 m 612 56.85 l 612 44.85 l 0 44.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 47.26 Tm (hire.) Tj ET Q q n 0 44.85 m 612 44.85 l 612 32.85 l 0 32.85 l h W n Q q n 0 32.85 m 612 32.85 l 612 20.85 l 0 20.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 23.26 Tm ("Intoxicated") Tj ET BT /F2 12 Tf 1 0 0 1 67.4 23.26 Tm (shall) Tj ET BT /F2 12 Tf 1 0 0 1 93.69 23.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 108.65 23.26 Tm (defined) Tj ET BT /F2 12 Tf 1 0 0 1 148.26 23.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 163.89 23.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 182.17 23.26 Tm (jurisdiction) Tj ET BT /F2 12 Tf 1 0 0 1 240.46 23.26 Tm (where) Tj ET BT /F2 12 Tf 1 0 0 1 273.4 23.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 291.69 23.26 Tm (accident) Tj ET BT /F2 12 Tf 1 0 0 1 335.29 23.26 Tm (occurs.) Tj ET BT /F2 12 Tf 1 0 0 1 376.87 23.26 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 399.15 23.26 Tm (exclusion) Tj ET BT /F2 12 Tf 1 0 0 1 448.77 23.26 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 471.06 23.26 Tm (apply) Tj ET BT /F2 12 Tf 1 0 0 1 501.35 23.26 Tm (whether) Tj ET Q q n 0 20.85 m 612 20.85 l 612 8.85 l 0 8.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 11.26 Tm (or not the driver is convicted.) Tj ET Q Q q Q Q endstream endobj 17 0 obj <>>>>> endobj 149 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 720 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 97.98 26.41 Tm (ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 239 14.41 Tm ($Continued$) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 257.4 25.15 l 257.4 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-6.3A 01 MO) Tj ET Q q n 257.4 25.15 m 293.4 25.15 l 293.4 13.15 l 257.4 13.15 l h W n Q q n 293.4 25.15 m 540.25 25.15 l 540.25 13.15 l 293.4 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 429.9 15.56 Tm (COMMON CARRIER) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 270.4 3.56 Tm (13) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 659.8 m 612 659.8 l 612 647.8 l 0 647.8 l h W n Q q n 0 647.8 m 612 647.8 l 612 635.8 l 0 635.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 638.21 Tm ("Loss of a Member" includes the following:) Tj ET Q q n 18 635.8 m 630 635.8 l 630 623.8 l 18 623.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 626.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 626.21 Tm ("Loss of Hand or Foot," means complete severance through or above the wrist or ankle joint.) Tj ET Q q n 18 623.8 m 630 623.8 l 630 611.8 l 18 611.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 614.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 614.21 Tm ("Loss of an Eye," means total and irrevocable loss of sight in that eye.) Tj ET Q q n 0 611.8 m 612 611.8 l 612 599.8 l 0 599.8 l h W n Q Q q Q Q endstream endobj 18 0 obj <>>>>> endobj 150 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 744 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 97.98 2.41 Tm (ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 257.4 25.15 l 257.4 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-6.3B 01 MO) Tj ET Q q n 257.4 25.15 m 293.4 25.15 l 293.4 13.15 l 257.4 13.15 l h W n Q q n 293.4 25.15 m 540.25 25.15 l 540.25 13.15 l 293.4 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 413.55 15.56 Tm (COMMON CARRIER SP) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 270.4 3.56 Tm (14) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 670 m 612 670 l 612 658 l 0 658 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 660.41 Tm (DEATH) Tj ET BT /F4 12 Tf 1 0 0 1 45.88 660.41 Tm (OR) Tj ET BT /F4 12 Tf 1 0 0 1 67.08 660.41 Tm (DISMEMBERMENT) Tj ET BT /F4 12 Tf 1 0 0 1 181.62 660.41 Tm (BENEFIT) Tj ET BT /F4 12 Tf 1 0 0 1 237.51 660.41 Tm (FOR) Tj ET BT /F4 12 Tf 1 0 0 1 266.04 660.41 Tm (A) Tj ET BT /F4 12 Tf 1 0 0 1 277.91 660.41 Tm (DEPENDENT) Tj ET BT /F4 12 Tf 1 0 0 1 355.12 660.41 Tm (SPOUSE.) Tj ET BT /F2 12 Tf 1 0 0 1 411.21 660.41 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 433.07 660.41 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 482.94 660.41 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 504.81 660.41 Tm (pay) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 660.41 Tm (the) Tj ET Q q n 0 658 m 612 658 l 612 646 l 0 646 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 648.41 Tm (benefit listed below, if:) Tj ET Q q n 18 646 m 630 646 l 630 634 l 18 634 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 636.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 636.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 70.46 636.41 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 125.56 636.41 Tm (Spouse) Tj ET BT /F2 12 Tf 1 0 0 1 163.34 636.41 Tm (sustains) Tj ET BT /F2 12 Tf 1 0 0 1 204.46 636.41 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 218.91 636.41 Tm (accidental) Tj ET BT /F2 12 Tf 1 0 0 1 270.65 636.41 Tm (bodily) Tj ET BT /F2 12 Tf 1 0 0 1 304.44 636.41 Tm (injury) Tj ET BT /F2 12 Tf 1 0 0 1 336.22 636.41 Tm (while) Tj ET BT /F2 12 Tf 1 0 0 1 366 636.41 Tm (insured) Tj ET BT /F2 12 Tf 1 0 0 1 404.44 636.41 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 434.88 636.41 Tm (this) Tj ET BT /F2 12 Tf 1 0 0 1 455.33 636.41 Tm (provision;) Tj ET Q q n 45.35 634 m 657.35 634 l 657.35 622 l 45.35 622 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 624.41 Tm (and) Tj ET Q q n 18 622 m 630 622 l 630 610 l 18 610 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 612.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 612.41 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 68.02 612.41 Tm (injury) Tj ET BT /F2 12 Tf 1 0 0 1 101.35 612.41 Tm (directly) Tj ET BT /F2 12 Tf 1 0 0 1 142.68 612.41 Tm (causes) Tj ET BT /F2 12 Tf 1 0 0 1 178.67 612.41 Tm (one) Tj ET BT /F2 12 Tf 1 0 0 1 200.67 612.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 215.34 612.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 234.67 612.41 Tm (following) Tj ET BT /F2 12 Tf 1 0 0 1 286 612.41 Tm (losses) Tj ET BT /F2 12 Tf 1 0 0 1 319.35 612.41 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 354.69 612.41 Tm (365) Tj ET BT /F2 12 Tf 1 0 0 1 377.36 612.41 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 404.03 612.41 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 430.68 612.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 450.01 612.41 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 474.67 612.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 489.34 612.41 Tm (the) Tj ET Q q n 45.35 610 m 657.35 610 l 657.35 598 l 45.35 598 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 600.41 Tm (accident.) Tj ET Q q n 0 598 m 612 598 l 612 586 l 0 586 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 588.41 Tm (The loss must result directly from the injury and from no other causes.) Tj ET Q q n 0 586 m 612 586 l 612 574 l 0 574 l h W n Q q n 0 574 m 612 574 l 612 562 l 0 562 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 564.41 Tm (Your Dependent Spouse is eligible for the Accidental Death and Dismemberment Insurance if your Spouse:) Tj ET Q q n 18 562 m 630 562 l 630 550 l 18 550 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 552.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 552.41 Tm (is insured by this provision on the date of the accident;) Tj ET Q q n 18 550 m 630 550 l 630 538 l 18 538 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 540.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 540.41 Tm (is not legally separated from you; and) Tj ET Q q n 18 538 m 630 538 l 630 526 l 18 526 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 528.41 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 528.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 57.04 528.41 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 76.07 528.41 Tm (serving) Tj ET BT /F2 12 Tf 1 0 0 1 115.08 528.41 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 130.78 528.41 Tm (active) Tj ET BT /F2 12 Tf 1 0 0 1 163.11 528.41 Tm (duty) Tj ET BT /F2 12 Tf 1 0 0 1 188.14 528.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 201.16 528.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 219.51 528.41 Tm (armed) Tj ET BT /F2 12 Tf 1 0 0 1 253.18 528.41 Tm (forces) Tj ET BT /F2 12 Tf 1 0 0 1 286.19 528.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 299.87 528.41 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 320.89 528.41 Tm (state) Tj ET BT /F2 12 Tf 1 0 0 1 346.57 528.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 360.26 528.41 Tm (country) Tj ET BT /F2 12 Tf 1 0 0 1 400.6 528.41 Tm (except) Tj ET BT /F2 12 Tf 1 0 0 1 435.61 528.41 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 453.29 528.41 Tm (duty) Tj ET BT /F2 12 Tf 1 0 0 1 478.31 528.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 492 528.41 Tm (30) Tj ET Q q n 45.35 526 m 657.35 526 l 657.35 514 l 45.35 514 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 516.41 Tm (days or less for training in the Reserves or National Guard.) Tj ET Q q n 0 514 m 612 514 l 612 502 l 0 502 l h W n Q q n 0 502 m 243.9 502 l 243.9 490 l 0 490 l h W n Q q n 0 490 m 243.9 490 l 243.9 478 l 0 478 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 101.21 480.41 Tm (LOSS) Tj ET Q q n 243.9 502 m 401.4 502 l 401.4 490 l 243.9 490 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 243.9 492.41 Tm (BENEFIT FOR COMMON) Tj ET Q q n 243.9 490 m 401.4 490 l 401.4 478 l 243.9 478 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 243.9 480.41 Tm (CARRIER ACCIDENT) Tj ET Q q n 401.4 502 m 545.4 502 l 545.4 490 l 401.4 490 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 401.4 492.41 Tm (BENEFIT) Tj ET BT /F4 12 Tf 1 0 0 1 460.01 492.41 Tm (FOR) Tj ET BT /F4 12 Tf 1 0 0 1 491.26 492.41 Tm (OTHER) Tj ET Q q n 401.4 490 m 545.4 490 l 545.4 478 l 401.4 478 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 401.4 480.41 Tm (COVERED ACCIDENT) Tj ET Q q n 401.4 478 m 545.4 478 l 545.4 466 l 401.4 466 l h W n Q q n 0 466 m 243.9 466 l 243.9 454 l 0 454 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 456.41 Tm (Loss of Life) Tj ET Q q n 243.9 466 m 401.4 466 l 401.4 454 l 243.9 454 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 243.9 456.41 Tm (2 Times Principal Sum) Tj ET Q q n 401.4 466 m 545.4 466 l 545.4 454 l 401.4 454 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 401.4 456.41 Tm (Principal Sum) Tj ET Q q n 0 454 m 243.9 454 l 243.9 442 l 0 442 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 444.41 Tm (Loss of One Member $Hand, Foot or Eye$) Tj ET Q q n 243.9 454 m 401.4 454 l 401.4 442 l 243.9 442 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 243.9 444.41 Tm (Principal Sum) Tj ET Q q n 401.4 454 m 545.4 454 l 545.4 442 l 401.4 442 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 401.4 444.41 Tm (1/2 Principal Sum) Tj ET Q q n 0 442 m 243.9 442 l 243.9 430 l 0 430 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 432.41 Tm (Loss of Two or More Members) Tj ET Q q n 243.9 442 m 401.4 442 l 401.4 430 l 243.9 430 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 243.9 432.41 Tm (2 Times Principal Sum) Tj ET Q q n 401.4 442 m 545.4 442 l 545.4 430 l 401.4 430 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 401.4 432.41 Tm (Principal Sum) Tj ET Q q n 0 430 m 612 430 l 612 418 l 0 418 l h W n Q q n 0 418 m 612 418 l 612 406 l 0 406 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 408.41 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 18.66 408.41 Tm ( Principal Sum which applies to your Dependent Spouse is shown in the Schedule of Insurance.) Tj ET Q q n 0 406 m 612 406 l 612 394 l 0 394 l h W n Q q n 0 394 m 612 394 l 612 382 l 0 382 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 384.41 Tm (MAXIMUM) Tj ET BT /F4 12 Tf 1 0 0 1 68.34 384.41 Tm (PER) Tj ET BT /F4 12 Tf 1 0 0 1 96.03 384.41 Tm (PERSON.) Tj ET BT /F2 12 Tf 1 0 0 1 155.09 384.41 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 166.78 384.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 192.47 384.41 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 248.14 384.41 Tm (Spouse) Tj ET BT /F2 12 Tf 1 0 0 1 286.5 384.41 Tm (sustains) Tj ET BT /F2 12 Tf 1 0 0 1 328.2 384.41 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 356.55 384.41 Tm (than) Tj ET BT /F2 12 Tf 1 0 0 1 380.9 384.41 Tm (one) Tj ET BT /F2 12 Tf 1 0 0 1 401.92 384.41 Tm (loss) Tj ET BT /F2 12 Tf 1 0 0 1 424.29 384.41 Tm (resulting) Tj ET BT /F2 12 Tf 1 0 0 1 469.97 384.41 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 496.99 384.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 515.34 384.41 Tm (same) Tj ET Q q n 0 382 m 612 382 l 612 370 l 0 370 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 372.41 Tm (accident, the benefit:) Tj ET Q q n 18 370 m 630 370 l 630 358 l 18 358 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 360.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 360.41 Tm (will be the one largest amount listed;) Tj ET Q q n 18 358 m 630 358 l 630 346 l 18 346 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 348.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 348.41 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 67.79 348.41 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 86.89 348.41 Tm (exceed) Tj ET BT /F2 12 Tf 1 0 0 1 123.97 348.41 Tm (two) Tj ET BT /F2 12 Tf 1 0 0 1 145.74 348.41 Tm (times) Tj ET BT /F2 12 Tf 1 0 0 1 175.51 348.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 193.94 348.41 Tm (Principal) Tj ET BT /F2 12 Tf 1 0 0 1 241.04 348.41 Tm (Sum) Tj ET BT /F2 12 Tf 1 0 0 1 266.82 348.41 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 284.58 348.41 Tm (all) Tj ET BT /F2 12 Tf 1 0 0 1 300.35 348.41 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 314.11 348.41 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 335.88 348.41 Tm (person's) Tj ET BT /F2 12 Tf 1 0 0 1 378.47 348.41 Tm (combined) Tj ET BT /F2 12 Tf 1 0 0 1 429.57 348.41 Tm (losses) Tj ET BT /F2 12 Tf 1 0 0 1 462.01 348.41 Tm (resulting) Tj ET Q q n 45.35 346 m 657.35 346 l 657.35 334 l 45.35 334 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 336.41 Tm (from a Common Carrier Accident; and) Tj ET Q q n 18 334 m 630 334 l 630 322 l 18 322 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 324.41 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 324.41 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 67.03 324.41 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 85.39 324.41 Tm (exceed) Tj ET BT /F2 12 Tf 1 0 0 1 121.71 324.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 139.38 324.41 Tm (Principal) Tj ET BT /F2 12 Tf 1 0 0 1 185.73 324.41 Tm (Sum) Tj ET BT /F2 12 Tf 1 0 0 1 210.75 324.41 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 227.76 324.41 Tm (all) Tj ET BT /F2 12 Tf 1 0 0 1 242.77 324.41 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 263.78 324.41 Tm (person's) Tj ET BT /F2 12 Tf 1 0 0 1 305.62 324.41 Tm (combined) Tj ET BT /F2 12 Tf 1 0 0 1 355.96 324.41 Tm (losses) Tj ET BT /F2 12 Tf 1 0 0 1 387.65 324.41 Tm (resulting) Tj ET BT /F2 12 Tf 1 0 0 1 432.66 324.41 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 459 324.41 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 479.34 324.41 Tm (other) Tj ET Q q n 45.35 322 m 657.35 322 l 657.35 310 l 45.35 310 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 312.41 Tm (covered accident.) Tj ET Q q n 18 310 m 630 310 l 630 298 l 18 298 l h W n Q q n 0 298 m 612 298 l 612 286 l 0 286 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 288.41 Tm (TO WHOM PAYABLE.) Tj ET BT /F2 12 Tf 1 0 0 1 131.67 288.41 Tm (Benefits for a Dependent Spouse's loss will be payable:) Tj ET Q q n 18 286 m 630 286 l 630 274 l 18 274 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 276.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 276.41 Tm (to you; or) Tj ET Q q n 18 274 m 630 274 l 630 262 l 18 262 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 264.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 264.41 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 55.79 264.41 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 76.9 264.41 Tm (fail) Tj ET BT /F2 12 Tf 1 0 0 1 96 264.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 108.45 264.41 Tm (survive) Tj ET BT /F2 12 Tf 1 0 0 1 146.88 264.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 171.99 264.41 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 227.08 264.41 Tm (Spouse,) Tj ET BT /F2 12 Tf 1 0 0 1 267.86 264.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 280.3 264.41 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 305.41 264.41 Tm (Beneficiary) Tj ET BT /F2 12 Tf 1 0 0 1 364.49 264.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 377.59 264.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 390.04 264.41 Tm (accord) Tj ET BT /F2 12 Tf 1 0 0 1 425.12 264.41 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 449.57 264.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 467.34 264.41 Tm (Facility) Tj ET Q q n 45.35 262 m 657.35 262 l 657.35 250 l 45.35 250 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 252.41 Tm (of Payment section of the Policy.) Tj ET Q q n 0 250 m 612 250 l 612 238 l 0 238 l h W n Q q n 0 238 m 612 238 l 612 226 l 0 226 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 228.41 Tm (LIMITATIONS.) Tj ET BT /F2 12 Tf 1 0 0 1 91.69 228.41 Tm (Benefits are not payable for any loss to which a contributing cause is:) Tj ET Q q n 18 226 m 630 226 l 630 214 l 18 214 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 216.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 216.41 Tm (intentional self-inflicted injury or self-destruction, while sane;) Tj ET Q q n 18 214 m 630 214 l 630 202 l 18 202 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 204.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 204.41 Tm (disease, bodily or mental infirmity, or medical or surgical treatment of these, except for;) Tj ET Q q n 45.35 202 m 657.35 202 l 657.35 190 l 45.35 190 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 192.41 Tm ($a$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 192.41 Tm (pyogenic infections resulting from an accidental bodily injury; or) Tj ET Q q n 45.35 190 m 657.35 190 l 657.35 178 l 45.35 178 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 180.41 Tm ($b$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 180.41 Tm (the accidental ingestion of contaminated substances;) Tj ET Q q n 18 178 m 630 178 l 630 166 l 18 166 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 168.41 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 168.41 Tm (participation in a riot;) Tj ET Q q n 18 166 m 630 166 l 630 154 l 18 154 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 156.41 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 156.41 Tm (duty as a member of any military, naval or air force;) Tj ET Q q n 18 154 m 630 154 l 630 142 l 18 142 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 144.41 Tm ($5$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 144.41 Tm (war or any act of war, declared or undeclared;) Tj ET Q q n 18 142 m 630 142 l 630 130 l 18 130 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 132.41 Tm ($6$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 132.41 Tm (participation in the commission of a felony;) Tj ET Q q n 18 130 m 630 130 l 630 118 l 18 118 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 120.41 Tm ($7$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 120.41 Tm (voluntary use of drugs; except when prescribed by a Physician;) Tj ET Q q n 18 118 m 630 118 l 630 106 l 18 106 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 108.41 Tm ($8$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 108.41 Tm (voluntary inhalation of gas, including carbon monoxide, while sane;) Tj ET Q q n 18 106 m 630 106 l 630 94 l 18 94 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 96.41 Tm ($9$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 96.41 Tm (travel) Tj ET BT /F2 12 Tf 1 0 0 1 75.77 96.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 88.86 96.41 Tm (flight) Tj ET BT /F2 12 Tf 1 0 0 1 117.96 96.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 130.39 96.41 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 150.81 96.41 Tm (aircraft,) Tj ET BT /F2 12 Tf 1 0 0 1 191.55 96.41 Tm (including) Tj ET BT /F2 12 Tf 1 0 0 1 239.97 96.41 Tm (balloons) Tj ET BT /F2 12 Tf 1 0 0 1 283.74 96.41 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 304.16 96.41 Tm (gliders;) Tj ET BT /F2 12 Tf 1 0 0 1 343.25 96.41 Tm (except) Tj ET BT /F2 12 Tf 1 0 0 1 377.66 96.41 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 390.76 96.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 399.18 96.41 Tm (fare) Tj ET BT /F2 12 Tf 1 0 0 1 420.93 96.41 Tm (paying) Tj ET BT /F2 12 Tf 1 0 0 1 456.69 96.41 Tm (passenger) Tj ET Q q n 45.35 94 m 657.35 94 l 657.35 82 l 45.35 82 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 84.41 Tm (on a regularly scheduled flight; or) Tj ET Q q n 18 82 m 630 82 l 630 70 l 18 70 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 72.41 Tm ($10$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 72.41 Tm (driving a vehicle while intoxicated.) Tj ET Q Q q Q Q endstream endobj 19 0 obj <>>>>> endobj 151 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 720 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 97.98 26.41 Tm (ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 239 14.41 Tm ($Continued$) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 257.4 25.15 l 257.4 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-6.3B 01 MO) Tj ET Q q n 257.4 25.15 m 293.4 25.15 l 293.4 13.15 l 257.4 13.15 l h W n Q q n 293.4 25.15 m 540.25 25.15 l 540.25 13.15 l 293.4 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 413.55 15.56 Tm (COMMON CARRIER SP) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 270.4 3.56 Tm (15) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 646 m 612 646 l 612 634 l 0 634 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 636.41 Tm (DEFINITIONS.) Tj ET Q q n 0 634 m 612 634 l 612 622 l 0 622 l h W n Q q n 0 622 m 612 622 l 612 610 l 0 610 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 612.41 Tm ("Common) Tj ET BT /F2 12 Tf 1 0 0 1 52.82 612.41 Tm (Carrier) Tj ET BT /F2 12 Tf 1 0 0 1 90.05 612.41 Tm (Accident") Tj ET BT /F2 12 Tf 1 0 0 1 141.52 612.41 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 175.43 612.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 184 612.41 Tm (covered) Tj ET BT /F2 12 Tf 1 0 0 1 225.23 612.41 Tm (accidental) Tj ET BT /F2 12 Tf 1 0 0 1 277.12 612.41 Tm (bodily) Tj ET BT /F2 12 Tf 1 0 0 1 311.04 612.41 Tm (injury,) Tj ET BT /F2 12 Tf 1 0 0 1 345.95 612.41 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 378.53 612.41 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 389.79 612.41 Tm (sustained) Tj ET BT /F2 12 Tf 1 0 0 1 437.7 612.41 Tm (while) Tj ET BT /F2 12 Tf 1 0 0 1 467.61 612.41 Tm (riding) Tj ET BT /F2 12 Tf 1 0 0 1 499.53 612.41 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 512.78 612.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 521.36 612.41 Tm (fare) Tj ET Q q n 0 610 m 612 610 l 612 598 l 0 598 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 600.41 Tm (paying) Tj ET BT /F2 12 Tf 1 0 0 1 37.45 600.41 Tm (passenger) Tj ET BT /F2 12 Tf 1 0 0 1 89.55 600.41 Tm ($not) Tj ET BT /F2 12 Tf 1 0 0 1 113.66 600.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 123.77 600.41 Tm (pilot,) Tj ET BT /F2 12 Tf 1 0 0 1 153.56 600.41 Tm (operator) Tj ET BT /F2 12 Tf 1 0 0 1 198.32 600.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 213.11 600.41 Tm (crew) Tj ET BT /F2 12 Tf 1 0 0 1 241.21 600.41 Tm (member$) Tj ET BT /F2 12 Tf 1 0 0 1 289.3 600.41 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 303.42 600.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 318.2 600.41 Tm (on,) Tj ET BT /F2 12 Tf 1 0 0 1 337.99 600.41 Tm (boarding) Tj ET BT /F2 12 Tf 1 0 0 1 385.43 600.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 400.21 600.41 Tm (getting) Tj ET BT /F2 12 Tf 1 0 0 1 438.33 600.41 Tm (off) Tj ET BT /F2 12 Tf 1 0 0 1 457.11 600.41 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 485.22 600.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 495.33 600.41 Tm (Common) Tj ET Q q n 0 598 m 612 598 l 612 586 l 0 586 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 588.41 Tm (Carrier.) Tj ET Q q n 0 586 m 612 586 l 612 574 l 0 574 l h W n Q q n 0 574 m 612 574 l 612 562 l 0 562 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 564.41 Tm ("Common) Tj ET BT /F2 12 Tf 1 0 0 1 52.62 564.41 Tm (Carrier") Tj ET BT /F2 12 Tf 1 0 0 1 94.54 564.41 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 128.24 564.41 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 148.61 564.41 Tm (land,) Tj ET BT /F2 12 Tf 1 0 0 1 175.32 564.41 Tm (air) Tj ET BT /F2 12 Tf 1 0 0 1 191.02 564.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 204.07 564.41 Tm (water) Tj ET BT /F2 12 Tf 1 0 0 1 233.76 564.41 Tm (conveyance) Tj ET BT /F2 12 Tf 1 0 0 1 293.44 564.41 Tm (operated) Tj ET BT /F2 12 Tf 1 0 0 1 337.79 564.41 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 368.16 564.41 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 376.53 564.41 Tm (license) Tj ET BT /F2 12 Tf 1 0 0 1 412.9 564.41 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 425.28 564.41 Tm (transport) Tj ET BT /F2 12 Tf 1 0 0 1 470.98 564.41 Tm (passengers) Tj ET BT /F2 12 Tf 1 0 0 1 526.01 564.41 Tm (for) Tj ET Q q n 0 562 m 612 562 l 612 550 l 0 550 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 552.41 Tm (hire.) Tj ET Q q n 0 550 m 612 550 l 612 538 l 0 538 l h W n Q q n 0 538 m 612 538 l 612 526 l 0 526 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 528.41 Tm ("Intoxicated") Tj ET BT /F2 12 Tf 1 0 0 1 67.4 528.41 Tm (shall) Tj ET BT /F2 12 Tf 1 0 0 1 93.69 528.41 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 108.65 528.41 Tm (defined) Tj ET BT /F2 12 Tf 1 0 0 1 148.26 528.41 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 163.89 528.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 182.17 528.41 Tm (jurisdiction) Tj ET BT /F2 12 Tf 1 0 0 1 240.46 528.41 Tm (where) Tj ET BT /F2 12 Tf 1 0 0 1 273.4 528.41 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 291.69 528.41 Tm (accident) Tj ET BT /F2 12 Tf 1 0 0 1 335.29 528.41 Tm (occurs.) Tj ET BT /F2 12 Tf 1 0 0 1 376.87 528.41 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 399.15 528.41 Tm (exclusion) Tj ET BT /F2 12 Tf 1 0 0 1 448.77 528.41 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 471.06 528.41 Tm (apply) Tj ET BT /F2 12 Tf 1 0 0 1 501.35 528.41 Tm (whether) Tj ET Q q n 0 526 m 612 526 l 612 514 l 0 514 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 516.41 Tm (or not the driver is convicted.) Tj ET Q q n 0 514 m 612 514 l 612 502 l 0 502 l h W n Q q n 0 502 m 612 502 l 612 490 l 0 490 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 492.41 Tm ("Loss of a Member" includes the following:) Tj ET Q q n 18 490 m 630 490 l 630 478 l 18 478 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 480.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 480.41 Tm ("Loss of Hand or Foot," means complete severance through or above the wrist or ankle joint.) Tj ET Q q n 18 478 m 630 478 l 630 466 l 18 466 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 468.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 468.41 Tm ("Loss of an Eye," means total and irrevocable loss of sight in that eye.) Tj ET Q q n 0 466 m 612 466 l 612 454 l 0 454 l h W n Q q n 0 454 m 612 454 l 612 442 l 0 442 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 444.41 Tm (INDIVIDUAL) Tj ET BT /F4 12 Tf 1 0 0 1 77.07 444.41 Tm (TERMINATION) Tj ET BT /F4 12 Tf 1 0 0 1 168.81 444.41 Tm (OF) Tj ET BT /F4 12 Tf 1 0 0 1 188.53 444.41 Tm (INSURANCE) Tj ET BT /F4 12 Tf 1 0 0 1 262.94 444.41 Tm (FOR) Tj ET BT /F4 12 Tf 1 0 0 1 291.33 444.41 Tm (A) Tj ET BT /F4 12 Tf 1 0 0 1 303.05 444.41 Tm (DEPENDENT) Tj ET BT /F4 12 Tf 1 0 0 1 380.12 444.41 Tm (SPOUSE.) Tj ET BT /F2 12 Tf 1 0 0 1 435.93 444.41 Tm (Accidental) Tj ET BT /F2 12 Tf 1 0 0 1 490.96 444.41 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 522.67 444.41 Tm (and) Tj ET Q q n 0 442 m 612 442 l 612 430 l 0 430 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 432.41 Tm (Dismemberment Insurance for your Dependent Spouse will cease on the earlier of:) Tj ET Q q n 18 430 m 630 430 l 630 418 l 18 418 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 420.41 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 420.41 Tm (the date he or she is no longer an eligible spouse; or) Tj ET Q q n 18 418 m 630 418 l 630 406 l 18 406 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 408.41 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 408.41 Tm (the date you are no longer eligible for coverage under the Policy.) Tj ET Q Q q Q Q endstream endobj 20 0 obj <>>>>> endobj 152 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 742.85 cm q n 0 13.15 m 550.8 13.15 l 550.8 1.15 l 0 1.15 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 201.65 3.56 Tm (SAFE DRIVER BENEFIT) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 270.1 25.15 l 270.1 13.15 l 0 13.15 l h W n 0.00392 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-6.15A) Tj ET Q q n 270.1 25.15 m 540.25 25.15 l 540.25 13.15 l 270.1 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 442.93 15.56 Tm (Seat Belt & Air Bag) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 270.4 3.56 Tm (16) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 668.85 m 612 668.85 l 612 656.85 l 0 656.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 659.26 Tm (BENEFIT.) Tj ET BT /F2 12 Tf 1 0 0 1 65.61 659.26 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 80.24 659.26 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 104.88 659.26 Tm (die) Tj ET BT /F2 12 Tf 1 0 0 1 126.18 659.26 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 142.82 659.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 154.79 659.26 Tm (direct) Tj ET BT /F2 12 Tf 1 0 0 1 188.74 659.26 Tm (result) Tj ET BT /F2 12 Tf 1 0 0 1 222.04 659.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 238.68 659.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 250.64 659.26 Tm (covered) Tj ET BT /F2 12 Tf 1 0 0 1 295.26 659.26 Tm (auto) Tj ET BT /F2 12 Tf 1 0 0 1 322.56 659.26 Tm (accident,) Tj ET BT /F2 12 Tf 1 0 0 1 372.17 659.26 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 392.8 659.26 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 428.77 659.26 Tm (Accidental) Tj ET BT /F2 12 Tf 1 0 0 1 487.38 659.26 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 522.67 659.26 Tm (and) Tj ET Q q n 0 656.85 m 612 656.85 l 612 644.85 l 0 644.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 647.26 Tm (Dismemberment Benefits are payable; then:) Tj ET Q q n 18 644.85 m 630 644.85 l 630 632.85 l 18 632.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 635.26 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 635.26 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 60.75 635.26 Tm (additional) Tj ET BT /F2 12 Tf 1 0 0 1 112.82 635.26 Tm (Seat) Tj ET BT /F2 12 Tf 1 0 0 1 137.55 635.26 Tm (Belt) Tj ET BT /F2 12 Tf 1 0 0 1 161.63 635.26 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 201.02 635.26 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 223.77 635.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 239.17 635.26 Tm (payable,) Tj ET BT /F2 12 Tf 1 0 0 1 283.56 635.26 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 294.97 635.26 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 317.04 635.26 Tm (were) Tj ET BT /F2 12 Tf 1 0 0 1 344.43 635.26 Tm (wearing) Tj ET BT /F2 12 Tf 1 0 0 1 387.16 635.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 396.56 635.26 Tm (properly) Tj ET BT /F2 12 Tf 1 0 0 1 441.29 635.26 Tm (fastened) Tj ET BT /F2 12 Tf 1 0 0 1 485.34 635.26 Tm (seat) Tj ET Q q n 45.35 632.85 m 657.35 632.85 l 657.35 620.85 l 45.35 620.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 623.26 Tm (belt at the time of the accident; and) Tj ET Q q n 18 620.85 m 630 620.85 l 630 608.85 l 18 608.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 611.26 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 611.26 Tm (an additional Air Bag Benefit will be payable, if the auto was equipped with air bag$s$.) Tj ET Q q n 0 608.85 m 612 608.85 l 612 596.85 l 0 596.85 l h W n Q q n 0 596.85 m 612 596.85 l 612 584.85 l 0 584.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 587.26 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 22.28 587.26 Tm (Seat) Tj ET BT /F2 12 Tf 1 0 0 1 46.56 587.26 Tm (Belt) Tj ET BT /F2 12 Tf 1 0 0 1 70.17 587.26 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 109.11 587.26 Tm (equals) Tj ET BT /F2 12 Tf 1 0 0 1 143.39 587.26 Tm ($10,000) Tj ET BT /F2 12 Tf 1 0 0 1 186.01 587.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 199.63 587.26 Tm (10%) Tj ET BT /F2 12 Tf 1 0 0 1 225.25 587.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 238.86 587.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 257.14 587.26 Tm (Principal) Tj ET BT /F2 12 Tf 1 0 0 1 304.09 587.26 Tm (Sum,) Tj ET BT /F2 12 Tf 1 0 0 1 332.71 587.26 Tm (whichever) Tj ET BT /F2 12 Tf 1 0 0 1 386.31 587.26 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 397.93 587.26 Tm (less;) Tj ET BT /F2 12 Tf 1 0 0 1 422.89 587.26 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 443.83 587.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 462.11 587.26 Tm (Air) Tj ET BT /F2 12 Tf 1 0 0 1 481.73 587.26 Tm (Bag) Tj ET BT /F2 12 Tf 1 0 0 1 504.68 587.26 Tm (Benefit) Tj ET Q q n 0 584.85 m 612 584.85 l 612 572.85 l 0 572.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 575.26 Tm (equals) Tj ET BT /F2 12 Tf 1 0 0 1 34.11 575.26 Tm ($10,000) Tj ET BT /F2 12 Tf 1 0 0 1 76.57 575.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 90.02 575.26 Tm (10%) Tj ET BT /F2 12 Tf 1 0 0 1 115.47 575.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 128.92 575.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 147.04 575.26 Tm (Principal) Tj ET BT /F2 12 Tf 1 0 0 1 193.82 575.26 Tm (Sum,) Tj ET BT /F2 12 Tf 1 0 0 1 222.28 575.26 Tm (whichever) Tj ET BT /F2 12 Tf 1 0 0 1 275.71 575.26 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 287.17 575.26 Tm (less.) Tj ET BT /F2 12 Tf 1 0 0 1 315.09 575.26 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 337.2 575.26 Tm (Seat) Tj ET BT /F2 12 Tf 1 0 0 1 361.31 575.26 Tm (Belt) Tj ET BT /F2 12 Tf 1 0 0 1 384.77 575.26 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 423.54 575.26 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 444.33 575.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 462.44 575.26 Tm (Air) Tj ET BT /F2 12 Tf 1 0 0 1 481.89 575.26 Tm (Bag) Tj ET BT /F2 12 Tf 1 0 0 1 504.68 575.26 Tm (Benefit) Tj ET Q q n 0 572.85 m 612 572.85 l 612 560.85 l 0 560.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 563.26 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 24.33 563.26 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 45.33 563.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 62.32 563.26 Tm (less) Tj ET BT /F2 12 Tf 1 0 0 1 85.98 563.26 Tm (than) Tj ET BT /F2 12 Tf 1 0 0 1 112.3 563.26 Tm ($1,000.) Tj ET BT /F2 12 Tf 1 0 0 1 159.63 563.26 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 183.95 563.26 Tm (Principal) Tj ET BT /F2 12 Tf 1 0 0 1 232.94 563.26 Tm (Sum) Tj ET BT /F2 12 Tf 1 0 0 1 260.61 563.26 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 274.27 563.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 294.6 563.26 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 336.26 563.26 Tm (payable) Tj ET BT /F2 12 Tf 1 0 0 1 379.23 563.26 Tm (because) Tj ET BT /F2 12 Tf 1 0 0 1 422.87 563.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 438.53 563.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 458.85 563.26 Tm (Insured) Tj ET BT /F2 12 Tf 1 0 0 1 500.5 563.26 Tm (Person's) Tj ET Q q n 0 560.85 m 612 560.85 l 612 548.85 l 0 548.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 551.26 Tm (accidental death.) Tj ET Q q n 0 548.85 m 612 548.85 l 612 536.85 l 0 536.85 l h W n Q q n 0 536.85 m 612 536.85 l 612 524.85 l 0 524.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 527.26 Tm (A) Tj ET BT /F2 12 Tf 1 0 0 1 11.85 527.26 Tm (copy) Tj ET BT /F2 12 Tf 1 0 0 1 38.35 527.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 51.53 527.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 69.37 527.26 Tm (police) Tj ET BT /F2 12 Tf 1 0 0 1 101.87 527.26 Tm (report) Tj ET BT /F2 12 Tf 1 0 0 1 133.71 527.26 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 160.22 527.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 174.73 527.26 Tm (submitted) Tj ET BT /F2 12 Tf 1 0 0 1 225.24 527.26 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 249.76 527.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 267.6 527.26 Tm (claim.) Tj ET BT /F2 12 Tf 1 0 0 1 303.61 527.26 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 325.45 527.26 Tm (position) Tj ET BT /F2 12 Tf 1 0 0 1 367.3 527.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 380.48 527.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 398.32 527.26 Tm (seat) Tj ET BT /F2 12 Tf 1 0 0 1 420.16 527.26 Tm (belt) Tj ET BT /F2 12 Tf 1 0 0 1 441.33 527.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 454.51 527.26 Tm (presence) Tj ET BT /F2 12 Tf 1 0 0 1 499.66 527.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 512.84 527.26 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 527.34 527.26 Tm (air) Tj ET Q q n 0 524.85 m 612 524.85 l 612 512.85 l 0 512.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 515.26 Tm (bag must be certified by:) Tj ET Q q n 18 512.85 m 630 512.85 l 630 500.85 l 18 500.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 503.26 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 503.26 Tm (the official accident report; or) Tj ET Q q n 18 500.85 m 630 500.85 l 630 488.85 l 18 488.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 491.26 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 491.26 Tm (the coroner, traffic officer or other investigating officer.) Tj ET Q q n 0 488.85 m 612 488.85 l 612 476.85 l 0 476.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 479.26 Tm (Upon) Tj ET BT /F2 12 Tf 1 0 0 1 31.2 479.26 Tm (receipt) Tj ET BT /F2 12 Tf 1 0 0 1 68.37 479.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 82.9 479.26 Tm (satisfactory) Tj ET BT /F2 12 Tf 1 0 0 1 142.75 479.26 Tm (written) Tj ET BT /F2 12 Tf 1 0 0 1 181.27 479.26 Tm (proof,) Tj ET BT /F2 12 Tf 1 0 0 1 214.79 479.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 233.98 479.26 Tm (additional) Tj ET BT /F2 12 Tf 1 0 0 1 286.5 479.26 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 324.35 479.26 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 347.55 479.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 363.41 479.26 Tm (paid) Tj ET BT /F2 12 Tf 1 0 0 1 388.6 479.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 402.47 479.26 Tm (accord) Tj ET BT /F2 12 Tf 1 0 0 1 438.97 479.26 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 464.84 479.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 484.03 479.26 Tm (Beneficiary) Tj ET Q q n 0 476.85 m 612 476.85 l 612 464.85 l 0 464.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 467.26 Tm (section.) Tj ET Q q n 0 464.85 m 612 464.85 l 612 452.85 l 0 452.85 l h W n Q q n 0 452.85 m 612 452.85 l 612 440.85 l 0 440.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 443.26 Tm (DEFINITIONS.) Tj ET BT /F2 12 Tf 1 0 0 1 83.66 443.26 Tm (As used in this provision:) Tj ET Q q n 0 440.85 m 612 440.85 l 612 428.85 l 0 428.85 l h W n Q q n 0 428.85 m 612 428.85 l 612 416.85 l 0 416.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 419.26 Tm ("Auto") Tj ET BT /F2 12 Tf 1 0 0 1 37.37 419.26 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 71.61 419.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 80.51 419.26 Tm (4-wheel) Tj ET BT /F2 12 Tf 1 0 0 1 122.74 419.26 Tm (passenger) Tj ET BT /F2 12 Tf 1 0 0 1 173.63 419.26 Tm (car,) Tj ET BT /F2 12 Tf 1 0 0 1 194.85 419.26 Tm (station) Tj ET BT /F2 12 Tf 1 0 0 1 230.43 419.26 Tm (wagon,) Tj ET BT /F2 12 Tf 1 0 0 1 269 419.26 Tm (jeep,) Tj ET BT /F2 12 Tf 1 0 0 1 295.56 419.26 Tm (pick-up) Tj ET BT /F2 12 Tf 1 0 0 1 335.79 419.26 Tm (truck) Tj ET BT /F2 12 Tf 1 0 0 1 364.03 419.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 377.6 419.26 Tm (van-type) Tj ET BT /F2 12 Tf 1 0 0 1 423.16 419.26 Tm (car.) Tj ET BT /F2 12 Tf 1 0 0 1 447.96 419.26 Tm (It) Tj ET BT /F2 12 Tf 1 0 0 1 458.87 419.26 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 485.78 419.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 500.68 419.26 Tm (licensed) Tj ET Q q n 0 416.85 m 612 416.85 l 612 404.85 l 0 404.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 407.26 Tm (for use on public highways.) Tj ET BT /F2 12 Tf 1 0 0 1 138.98 407.26 Tm (It includes a car owned or leased by the Employer.) Tj ET Q q n 0 404.85 m 612 404.85 l 612 392.85 l 0 392.85 l h W n Q q n 0 392.85 m 612 392.85 l 612 380.85 l 0 380.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 383.26 Tm ("Intoxicated,") Tj ET BT /F2 12 Tf 1 0 0 1 70.7 383.26 Tm ("Impaired,") Tj ET BT /F2 12 Tf 1 0 0 1 130.73 383.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 144.65 383.26 Tm ("Under) Tj ET BT /F2 12 Tf 1 0 0 1 183.46 383.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 202.04 383.26 Tm (Influence) Tj ET BT /F2 12 Tf 1 0 0 1 251.27 383.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 265.19 383.26 Tm (Drugs") Tj ET BT /F2 12 Tf 1 0 0 1 303.35 383.26 Tm (shall) Tj ET BT /F2 12 Tf 1 0 0 1 329.93 383.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 345.18 383.26 Tm (defined) Tj ET BT /F2 12 Tf 1 0 0 1 385.09 383.26 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 399.01 383.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 414.93 383.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 433.52 383.26 Tm (jurisdiction) Tj ET BT /F2 12 Tf 1 0 0 1 492.1 383.26 Tm (where) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 383.26 Tm (the) Tj ET Q q n 0 380.85 m 612 380.85 l 612 368.85 l 0 368.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 371.26 Tm (accident occurs.) Tj ET Q q n 0 368.85 m 612 368.85 l 612 356.85 l 0 356.85 l h W n Q q n 0 356.85 m 612 356.85 l 612 344.85 l 0 344.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 347.26 Tm ("Seat Belt" means a properly installed:) Tj ET Q q n 18 344.85 m 630 344.85 l 630 332.85 l 18 332.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 335.26 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 335.26 Tm (seat belt or lap and shoulder restraint; or) Tj ET Q q n 18 332.85 m 630 332.85 l 630 320.85 l 18 320.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 323.26 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 323.26 Tm (other restraint approved by the National Highway Traffic Safety Administration.) Tj ET Q q n 0 320.85 m 612 320.85 l 612 308.85 l 0 308.85 l h W n Q q n 0 308.85 m 612 308.85 l 612 296.85 l 0 296.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 299.26 Tm (LIMITATIONS.) Tj ET BT /F2 12 Tf 1 0 0 1 86.32 299.26 Tm (Safe Driver Benefits will not be paid if:) Tj ET Q q n 18 296.85 m 630 296.85 l 630 284.85 l 18 284.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 287.26 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 287.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 63.16 287.26 Tm (Accidental) Tj ET BT /F2 12 Tf 1 0 0 1 118.28 287.26 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 150.09 287.26 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 170.56 287.26 Tm (Dismemberment) Tj ET BT /F2 12 Tf 1 0 0 1 253.7 287.26 Tm (Benefits) Tj ET BT /F2 12 Tf 1 0 0 1 296.84 287.26 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 307.99 287.26 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 326.48 287.26 Tm (paid) Tj ET BT /F2 12 Tf 1 0 0 1 350.29 287.26 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 380.76 287.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 398.57 287.26 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 432.39 287.26 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 449.53 287.26 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 474.68 287.26 Tm (death;) Tj ET Q q n 45.35 284.85 m 657.35 284.85 l 657.35 272.85 l 45.35 272.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 275.26 Tm (or) Tj ET Q q n 18 272.85 m 630 272.85 l 630 260.85 l 18 260.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 263.26 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 263.26 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 58.37 263.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 77.39 263.26 Tm (time) Tj ET BT /F2 12 Tf 1 0 0 1 103.07 263.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 117.42 263.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 136.44 263.26 Tm (accident,) Tj ET BT /F2 12 Tf 1 0 0 1 183.77 263.26 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 206.13 263.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 220.48 263.26 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 242.16 263.26 Tm (other) Tj ET BT /F2 12 Tf 1 0 0 1 271.18 263.26 Tm (person) Tj ET BT /F2 12 Tf 1 0 0 1 307.53 263.26 Tm (who) Tj ET BT /F2 12 Tf 1 0 0 1 332.55 263.26 Tm (was) Tj ET BT /F2 12 Tf 1 0 0 1 355.57 263.26 Tm (driving) Tj ET BT /F2 12 Tf 1 0 0 1 394.59 263.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 413.61 263.26 Tm (auto) Tj ET BT /F2 12 Tf 1 0 0 1 438.63 263.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 452.32 263.26 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 486 263.26 Tm (you) Tj ET Q q n 45.35 260.85 m 657.35 260.85 l 657.35 248.85 l 45.35 248.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 251.26 Tm (were traveling:) Tj ET Q q n 45.35 248.85 m 657.35 248.85 l 657.35 236.85 l 45.35 236.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 239.26 Tm ($a$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 239.26 Tm (was driving without a valid drivers' license;) Tj ET Q q n 45.35 236.85 m 657.35 236.85 l 657.35 224.85 l 45.35 224.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 227.26 Tm ($b$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 227.26 Tm (was driving in excess of the legal speed limit; or) Tj ET Q q n 45.35 224.85 m 657.35 224.85 l 657.35 212.85 l 45.35 212.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 215.26 Tm ($c$) Tj ET BT /F2 12 Tf 1 0 0 1 72.7 215.26 Tm (was) Tj ET BT /F2 12 Tf 1 0 0 1 95.43 215.26 Tm (driving) Tj ET BT /F2 12 Tf 1 0 0 1 134.16 215.26 Tm (while) Tj ET BT /F2 12 Tf 1 0 0 1 164.89 215.26 Tm (intoxicated,) Tj ET BT /F2 12 Tf 1 0 0 1 225.28 215.26 Tm (impaired,) Tj ET BT /F2 12 Tf 1 0 0 1 275 215.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 289.06 215.26 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 320.45 215.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 339.18 215.26 Tm (influence) Tj ET BT /F2 12 Tf 1 0 0 1 387.89 215.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 401.96 215.26 Tm (drugs) Tj ET BT /F2 12 Tf 1 0 0 1 432.69 215.26 Tm ($except) Tj ET Q q n 72.7 212.85 m 684.7 212.85 l 684.7 200.85 l 72.7 200.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 72.7 203.26 Tm (for drugs taken as prescribed by a Physician for the driver's use$.) Tj ET Q q n 45.35 200.85 m 657.35 200.85 l 657.35 188.85 l 45.35 188.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 191.26 Tm (The above limitations will apply, whether or not the driver is convicted.) Tj ET Q Q q Q Q endstream endobj 21 0 obj <>>>>> endobj 154 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 636.5 cm q n 0 119.5 m 612 119.5 l 612 107.5 l 0 107.5 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 186.16 109.91 Tm (CERTIFICATE AMENDMENT) Tj ET Q q n 0 107.5 m 612 107.5 l 612 95.5 l 0 95.5 l h W n Q q n 0 95.5 m 612 95.5 l 612 83.5 l 0 83.5 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 85.91 Tm (TO BE ATTACHED TO THE CERTIFICATE FOR GROUP POLICY NO 000400001000-22982) Tj ET Q q n 0 83.5 m 612 83.5 l 612 71.5 l 0 71.5 l h W n Q q n 0 71.5 m 612 71.5 l 612 59.5 l 0 59.5 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 61.91 Tm (ISSUED TO:) Tj ET BT /F4 12 Tf 1 0 0 1 73.69 61.91 Tm (É«ÖÐÉ« University) Tj ET Q q n 0 59.5 m 612 59.5 l 612 47.5 l 0 47.5 l h W n Q q n 0 47.5 m 612 47.5 l 612 35.5 l 0 35.5 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 89.17 37.91 Tm (Your Certificate is amended by the addition of the following provision.) Tj ET Q q n 0 35.5 m 612 35.5 l 612 23.5 l 0 23.5 l h W n Q q n 0 23.5 m 612 23.5 l 612 11.5 l 0 11.5 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 173.31 13.91 Tm (ACCELERATED DEATH BENEFIT) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 270.1 25.15 l 270.1 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-3.8-AMEND.01 MO) Tj ET Q q n 270.1 25.15 m 540.25 25.15 l 540.25 13.15 l 270.1 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 485.25 15.56 Tm (ADB-DEP.) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 270.4 3.56 Tm (17) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 576.3 m 612 576.3 l 612 564.3 l 0 564.3 l h W n Q q n 0 564.3 m 612 564.3 l 612 552.3 l 0 552.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 554.71 Tm (BENEFIT.) Tj ET BT /F2 12 Tf 1 0 0 1 60.47 554.71 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 83.2 554.71 Tm (Accelerated) Tj ET BT /F2 12 Tf 1 0 0 1 144.56 554.71 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 177.28 554.71 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 216.67 554.71 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 228.75 554.71 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 244.14 554.71 Tm (advance) Tj ET BT /F2 12 Tf 1 0 0 1 287.52 554.71 Tm (payment) Tj ET BT /F2 12 Tf 1 0 0 1 332.91 554.71 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 346.98 554.71 Tm (part) Tj ET BT /F2 12 Tf 1 0 0 1 369.7 554.71 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 383.77 554.71 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 409.84 554.71 Tm (Personal) Tj ET BT /F2 12 Tf 1 0 0 1 455.24 554.71 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 479.29 554.71 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 530 554.71 Tm (or) Tj ET Q q n 0 552.3 m 612 552.3 l 612 540.3 l 0 540.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 542.71 Tm (Spouse Life Insurance.) Tj ET BT /F2 12 Tf 1 0 0 1 116.3 542.71 Tm (It may be paid to you, in a lump sum, once during your lifetime.) Tj ET Q q n 0 540.3 m 612 540.3 l 612 528.3 l 0 528.3 l h W n Q q n 0 528.3 m 612 528.3 l 612 516.3 l 0 516.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 518.71 Tm (To qualify, you must:) Tj ET Q q n 18 516.3 m 630 516.3 l 630 504.3 l 18 504.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 506.71 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 506.71 Tm (have satisfied the Active Work requirement under the Policy;) Tj ET Q q n 18 504.3 m 630 504.3 l 630 492.3 l 18 492.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 494.71 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 494.71 Tm (have been insured under the Policy for at least 12 months; and) Tj ET Q q n 18 492.3 m 630 492.3 l 630 480.3 l 18 480.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 482.71 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 482.71 Tm (have) Tj ET BT /F2 12 Tf 1 0 0 1 74.17 482.71 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 88.99 482.71 Tm (least) Tj ET BT /F2 12 Tf 1 0 0 1 117.14 482.71 Tm ($2,000) Tj ET BT /F2 12 Tf 1 0 0 1 156.31 482.71 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 172.47 482.71 Tm (Personal) Tj ET BT /F2 12 Tf 1 0 0 1 219.96 482.71 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 246.11 482.71 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 298.91 482.71 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 332.4 482.71 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 353.22 482.71 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 390.05 482.71 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 408.22 482.71 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 429.04 482.71 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 452.53 482.71 Tm (before) Tj ET BT /F2 12 Tf 1 0 0 1 489.34 482.71 Tm (the) Tj ET Q q n 45.35 480.3 m 657.35 480.3 l 657.35 468.3 l 45.35 468.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 470.71 Tm (Accelerated Death Benefit is paid.) Tj ET Q q n 0 468.3 m 612 468.3 l 612 456.3 l 0 456.3 l h W n Q q n 0 456.3 m 612 456.3 l 612 444.3 l 0 444.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 446.71 Tm (To qualify, your Terminal Dependent spouse must:) Tj ET Q q n 18 444.3 m 630 444.3 l 630 432.3 l 18 432.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 434.71 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 434.71 Tm (have satisfied the Nonconfinement or Period of Limited Activity requirement under the Policy;) Tj ET Q q n 18 432.3 m 630 432.3 l 630 420.3 l 18 420.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 422.71 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 422.71 Tm (have been insured under the Policy for at least 12 months; and) Tj ET Q q n 18 420.3 m 630 420.3 l 630 408.3 l 18 408.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 410.71 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 410.71 Tm (have) Tj ET BT /F2 12 Tf 1 0 0 1 74.61 410.71 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 89.88 410.71 Tm (least) Tj ET BT /F2 12 Tf 1 0 0 1 118.47 410.71 Tm ($2,000) Tj ET BT /F2 12 Tf 1 0 0 1 158.08 410.71 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 174.69 410.71 Tm (Spouse) Tj ET BT /F2 12 Tf 1 0 0 1 215.96 410.71 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 242.56 410.71 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 295.81 410.71 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 329.74 410.71 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 351 410.71 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 388.28 410.71 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 406.89 410.71 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 428.15 410.71 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 452.09 410.71 Tm (before) Tj ET BT /F2 12 Tf 1 0 0 1 489.34 410.71 Tm (the) Tj ET Q q n 45.35 408.3 m 657.35 408.3 l 657.35 396.3 l 45.35 396.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 398.71 Tm (Accelerated Death Benefit is paid.) Tj ET Q q n 0 396.3 m 612 396.3 l 612 384.3 l 0 384.3 l h W n Q q n 0 384.3 m 612 384.3 l 612 372.3 l 0 372.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 374.71 Tm (Receiving) Tj ET BT /F2 12 Tf 1 0 0 1 54 374.71 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 74.01 374.71 Tm (Accelerated) Tj ET BT /F2 12 Tf 1 0 0 1 136.64 374.71 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 170.65 374.71 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 211.31 374.71 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 235.33 374.71 Tm (reduce) Tj ET BT /F2 12 Tf 1 0 0 1 272.65 374.71 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 292.66 374.71 Tm (Remaining) Tj ET BT /F2 12 Tf 1 0 0 1 350.67 374.71 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 376.01 374.71 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 428 374.71 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 450.67 374.71 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 470.68 374.71 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 504.68 374.71 Tm (Benefit) Tj ET Q q n 0 372.3 m 612 372.3 l 612 360.3 l 0 360.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 362.71 Tm (payable at death, as shown on the next page.) Tj ET Q q n 0 360.3 m 612 360.3 l 612 348.3 l 0 348.3 l h W n Q q n 0 348.3 m 612 348.3 l 612 336.3 l 0 336.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 338.71 Tm ("Claimant,") Tj ET BT /F2 12 Tf 1 0 0 1 61.92 338.71 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 77.05 338.71 Tm (used) Tj ET BT /F2 12 Tf 1 0 0 1 104.18 338.71 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 118.65 338.71 Tm (this) Tj ET BT /F2 12 Tf 1 0 0 1 141.12 338.71 Tm (section,) Tj ET BT /F2 12 Tf 1 0 0 1 183.24 338.71 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 219.03 338.71 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 238.82 338.71 Tm (Terminal) Tj ET BT /F2 12 Tf 1 0 0 1 287.94 338.71 Tm (Insured) Tj ET BT /F2 12 Tf 1 0 0 1 329.06 338.71 Tm (Person) Tj ET BT /F2 12 Tf 1 0 0 1 366.86 338.71 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 381.98 338.71 Tm (Terminal) Tj ET BT /F2 12 Tf 1 0 0 1 431.1 338.71 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 488.21 338.71 Tm (spouse) Tj ET BT /F2 12 Tf 1 0 0 1 526.01 338.71 Tm (for) Tj ET Q q n 0 336.3 m 612 336.3 l 612 324.3 l 0 324.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 326.71 Tm (whom the Accelerated Death Benefit is requested.) Tj ET Q q n 0 324.3 m 612 324.3 l 612 312.3 l 0 312.3 l h W n Q q n 0 312.3 m 612 312.3 l 612 300.3 l 0 300.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 302.71 Tm ("Terminal") Tj ET BT /F2 12 Tf 1 0 0 1 57.6 302.71 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 92.08 302.71 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 113.91 302.71 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 127.73 302.71 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 153.55 302.71 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 209.35 302.71 Tm (spouse) Tj ET BT /F2 12 Tf 1 0 0 1 245.84 302.71 Tm (has) Tj ET BT /F2 12 Tf 1 0 0 1 265.66 302.71 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 274.81 302.71 Tm (medical) Tj ET BT /F2 12 Tf 1 0 0 1 316.62 302.71 Tm (condition) Tj ET BT /F2 12 Tf 1 0 0 1 365.77 302.71 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 398.92 302.71 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 410.75 302.71 Tm (expected) Tj ET BT /F2 12 Tf 1 0 0 1 457.21 302.71 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 470.37 302.71 Tm (result) Tj ET BT /F2 12 Tf 1 0 0 1 500.86 302.71 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 514.01 302.71 Tm (death) Tj ET Q q n 0 300.3 m 612 300.3 l 612 288.3 l 0 288.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 290.71 Tm (within 12 months, despite appropriate medical treatment.) Tj ET Q q n 0 288.3 m 612 288.3 l 612 276.3 l 0 276.3 l h W n Q q n 0 276.3 m 612 276.3 l 612 264.3 l 0 264.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 266.71 Tm (APPLYING) Tj ET BT /F2 12 Tf 1 0 0 1 66.97 266.71 Tm (FOR) Tj ET BT /F2 12 Tf 1 0 0 1 97.94 266.71 Tm (THE) Tj ET BT /F2 12 Tf 1 0 0 1 128.89 266.71 Tm (BENEFIT.) Tj ET BT /F2 12 Tf 1 0 0 1 196.47 266.71 Tm (To) Tj ET BT /F2 12 Tf 1 0 0 1 217.43 266.71 Tm (withdraw) Tj ET BT /F2 12 Tf 1 0 0 1 270.38 266.71 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 292.67 266.71 Tm (Accelerated) Tj ET BT /F2 12 Tf 1 0 0 1 357.58 266.71 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 393.86 266.71 Tm (Benefit,) Tj ET BT /F2 12 Tf 1 0 0 1 439.81 266.71 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 465.44 266.71 Tm ($or) Tj ET BT /F2 12 Tf 1 0 0 1 487.06 266.71 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 516.68 266.71 Tm (legal) Tj ET Q q n 0 264.3 m 612 264.3 l 612 252.3 l 0 252.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 254.71 Tm (representative$ must send the Company:) Tj ET Q q n 18 252.3 m 630 252.3 l 630 240.3 l 18 240.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 242.71 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 242.71 Tm (written election of the Accelerated Death Benefit, on forms supplied by the Company; and) Tj ET Q q n 18 240.3 m 630 240.3 l 630 228.3 l 18 228.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 230.71 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 230.71 Tm (satisfactory proof that the Claimant is Terminal, including a Physician's written statement.) Tj ET Q q n 0 228.3 m 612 228.3 l 612 216.3 l 0 216.3 l h W n Q q n 0 216.3 m 612 216.3 l 612 204.3 l 0 204.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 206.71 Tm (The Company reserves the right to decide whether such proof is satisfactory.) Tj ET Q q n 0 204.3 m 612 204.3 l 612 192.3 l 0 192.3 l h W n Q q n 0 192.3 m 612 192.3 l 612 180.3 l 0 180.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 182.71 Tm (Before) Tj ET BT /F2 12 Tf 1 0 0 1 38.51 182.71 Tm (paying) Tj ET BT /F2 12 Tf 1 0 0 1 77.02 182.71 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 94.21 182.71 Tm (Accelerated) Tj ET BT /F2 12 Tf 1 0 0 1 157.35 182.71 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 191.86 182.71 Tm (Benefit,) Tj ET BT /F2 12 Tf 1 0 0 1 236.03 182.71 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 256.55 182.71 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 309.07 182.71 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 338.27 182.71 Tm (also) Tj ET BT /F2 12 Tf 1 0 0 1 363.45 182.71 Tm (receive) Tj ET BT /F2 12 Tf 1 0 0 1 403.95 182.71 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 424.46 182.71 Tm (written) Tj ET BT /F2 12 Tf 1 0 0 1 464.31 182.71 Tm (consent) Tj ET BT /F2 12 Tf 1 0 0 1 506.82 182.71 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 522.67 182.71 Tm (any) Tj ET Q q n 0 180.3 m 612 180.3 l 612 168.3 l 0 168.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 170.71 Tm (irrevocable) Tj ET BT /F2 12 Tf 1 0 0 1 60.29 170.71 Tm (beneficiary,) Tj ET BT /F2 12 Tf 1 0 0 1 123.58 170.71 Tm (assignee) Tj ET BT /F2 12 Tf 1 0 0 1 170.55 170.71 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 186.87 170.71 Tm (bankruptcy) Tj ET BT /F2 12 Tf 1 0 0 1 247.18 170.71 Tm (court) Tj ET BT /F2 12 Tf 1 0 0 1 278.16 170.71 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 305.82 170.71 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 323.47 170.71 Tm (interest) Tj ET BT /F2 12 Tf 1 0 0 1 365.11 170.71 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 380.77 170.71 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 401.75 170.71 Tm (benefit.) Tj ET BT /F2 12 Tf 1 0 0 1 450.72 170.71 Tm (Before) Tj ET BT /F2 12 Tf 1 0 0 1 489.69 170.71 Tm (paying) Tj ET BT /F2 12 Tf 1 0 0 1 528.67 170.71 Tm (an) Tj ET Q q n 0 168.3 m 612 168.3 l 612 156.3 l 0 156.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 158.71 Tm (Accelerated) Tj ET BT /F2 12 Tf 1 0 0 1 61.63 158.71 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 94.63 158.71 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 134.3 158.71 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 152.63 158.71 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 178.98 158.71 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 235.3 158.71 Tm (spouse,) Tj ET BT /F2 12 Tf 1 0 0 1 275.31 158.71 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 294.32 158.71 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 345.33 158.71 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 373.01 158.71 Tm (also) Tj ET BT /F2 12 Tf 1 0 0 1 396.69 158.71 Tm (receive) Tj ET BT /F2 12 Tf 1 0 0 1 435.67 158.71 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 462.01 158.71 Tm (written) Tj ET BT /F2 12 Tf 1 0 0 1 500.34 158.71 Tm (consent.) Tj ET Q q n 0 156.3 m 612 156.3 l 612 144.3 l 0 144.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 146.71 Tm ($See Limitations 3, 4, 5, and 6.$) Tj ET Q q n 0 144.3 m 612 144.3 l 612 132.3 l 0 132.3 l h W n Q q n 0 132.3 m 612 132.3 l 612 120.3 l 0 120.3 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 122.71 Tm (NOTE:) Tj ET BT /F4 12 Tf 1 0 0 1 51.05 122.71 Tm (THIS) Tj ET BT /F4 12 Tf 1 0 0 1 86.25 122.71 Tm (IS) Tj ET BT /F4 12 Tf 1 0 0 1 104.11 122.71 Tm (NOT) Tj ET BT /F4 12 Tf 1 0 0 1 136.64 122.71 Tm (A) Tj ET BT /F4 12 Tf 1 0 0 1 151.82 122.71 Tm (LONG-TERM) Tj ET BT /F4 12 Tf 1 0 0 1 233.68 122.71 Tm (CARE) Tj ET BT /F4 12 Tf 1 0 0 1 274.2 122.71 Tm (POLICY.) Tj ET BT /F4 12 Tf 1 0 0 1 336.92 122.71 Tm (RECEIVING) Tj ET BT /F4 12 Tf 1 0 0 1 412.78 122.71 Tm (THIS) Tj ET BT /F4 12 Tf 1 0 0 1 447.98 122.71 Tm (ACCELERATED) Tj ET Q q n 0 120.3 m 612 120.3 l 612 108.3 l 0 108.3 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 110.71 Tm (DEATH) Tj ET BT /F4 12 Tf 1 0 0 1 50.21 110.71 Tm (BENEFIT) Tj ET BT /F4 12 Tf 1 0 0 1 110.43 110.71 Tm (WILL) Tj ET BT /F4 12 Tf 1 0 0 1 150.65 110.71 Tm (REDUCE) Tj ET BT /F4 12 Tf 1 0 0 1 208.86 110.71 Tm (THE) Tj ET BT /F4 12 Tf 1 0 0 1 241.74 110.71 Tm (BENEFIT) Tj ET BT /F4 12 Tf 1 0 0 1 301.96 110.71 Tm (PAYABLE) Tj ET BT /F4 12 Tf 1 0 0 1 366.84 110.71 Tm (AT) Tj ET BT /F4 12 Tf 1 0 0 1 391.05 110.71 Tm (DEATH.) Tj ET BT /F4 12 Tf 1 0 0 1 451.8 110.71 Tm (ANY) Tj ET BT /F4 12 Tf 1 0 0 1 485.34 110.71 Tm (AMOUNT) Tj ET Q q n 0 108.3 m 612 108.3 l 612 96.3 l 0 96.3 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 98.71 Tm (WITHDRAWN) Tj ET BT /F4 12 Tf 1 0 0 1 86.33 98.71 Tm (MAY) Tj ET BT /F4 12 Tf 1 0 0 1 120.65 98.71 Tm (BE) Tj ET BT /F4 12 Tf 1 0 0 1 142.32 98.71 Tm (TAXABLE) Tj ET BT /F4 12 Tf 1 0 0 1 206 98.71 Tm (INCOME,) Tj ET BT /F4 12 Tf 1 0 0 1 265.32 98.71 Tm (SO) Tj ET BT /F4 12 Tf 1 0 0 1 286.99 98.71 Tm (YOU) Tj ET BT /F4 12 Tf 1 0 0 1 319.32 98.71 Tm (SHOULD) Tj ET BT /F4 12 Tf 1 0 0 1 375.66 98.71 Tm (CONSULT) Tj ET BT /F4 12 Tf 1 0 0 1 439.33 98.71 Tm (A) Tj ET BT /F4 12 Tf 1 0 0 1 453.66 98.71 Tm (TAX) Tj ET BT /F4 12 Tf 1 0 0 1 484.66 98.71 Tm (ADVISOR) Tj ET Q q n 0 96.3 m 612 96.3 l 612 84.3 l 0 84.3 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 86.71 Tm (BEFORE APPLYING FOR THIS BENEFIT.) Tj ET Q q n 0 84.3 m 612 84.3 l 612 72.3 l 0 72.3 l h W n Q q n 0 72.3 m 612 72.3 l 612 60.3 l 0 60.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 62.71 Tm (AMOUNT) Tj ET BT /F2 12 Tf 1 0 0 1 58.01 62.71 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 78.69 62.71 Tm (THE) Tj ET BT /F2 12 Tf 1 0 0 1 107.36 62.71 Tm (BENEFIT.) Tj ET BT /F2 12 Tf 1 0 0 1 170.37 62.71 Tm (You) Tj ET BT /F2 12 Tf 1 0 0 1 196.38 62.71 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 222.38 62.71 Tm (elect) Tj ET BT /F2 12 Tf 1 0 0 1 250.37 62.71 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 265.04 62.71 Tm (withdraw) Tj ET BT /F2 12 Tf 1 0 0 1 315.7 62.71 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 332.37 62.71 Tm (Accelerated) Tj ET BT /F2 12 Tf 1 0 0 1 395 62.71 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 429 62.71 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 469.66 62.71 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 484.33 62.71 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 507 62.71 Tm ($1,000) Tj ET Q q n 0 60.3 m 612 60.3 l 612 48.3 l 0 48.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 50.71 Tm (increment; subject to:) Tj ET Q q n 18 48.3 m 630 48.3 l 630 36.3 l 18 36.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 38.71 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 38.71 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 56.5 38.71 Tm (minimum) Tj ET BT /F2 12 Tf 1 0 0 1 109 38.71 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 124.83 38.71 Tm ($1,000) Tj ET BT /F2 12 Tf 1 0 0 1 163.66 38.71 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 179.48 38.71 Tm (10%) Tj ET BT /F2 12 Tf 1 0 0 1 207.3 38.71 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 223.13 38.71 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 243.62 38.71 Tm (Claimant's) Tj ET BT /F2 12 Tf 1 0 0 1 300.27 38.71 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 342.09 38.71 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 357.91 38.71 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 383.73 38.71 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 436.2 38.71 Tm ($whichever) Tj ET BT /F2 12 Tf 1 0 0 1 496 38.71 Tm (is) Tj ET Q q n 45.35 36.3 m 657.35 36.3 l 657.35 24.3 l 45.35 24.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 26.71 Tm (greater$; and) Tj ET Q q n 18 24.3 m 630 24.3 l 630 12.3 l 18 12.3 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 14.71 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 14.71 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 55.51 14.71 Tm (maximum) Tj ET BT /F2 12 Tf 1 0 0 1 109 14.71 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 123.82 14.71 Tm ($250,000) Tj ET BT /F2 12 Tf 1 0 0 1 173.65 14.71 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 188.47 14.71 Tm (75%) Tj ET BT /F2 12 Tf 1 0 0 1 215.3 14.71 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 230.12 14.71 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 249.61 14.71 Tm (Claimant's) Tj ET BT /F2 12 Tf 1 0 0 1 305.27 14.71 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 346.09 14.71 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 360.91 14.71 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 385.73 14.71 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 437.2 14.71 Tm ($whichever) Tj ET BT /F2 12 Tf 1 0 0 1 496 14.71 Tm (is) Tj ET Q q n 45.35 12.3 m 657.35 12.3 l 657.35 0.297 l 45.35 0.297 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 2.71 Tm (less$.) Tj ET Q Q q Q Q endstream endobj 22 0 obj <>>>>> endobj 155 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 718.85 cm q n 0 37.15 m 550.8 37.15 l 550.8 25.15 l 0 25.15 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 186.16 27.56 Tm (CERTIFICATE AMENDMENT) Tj ET Q q n 0 25.15 m 550.8 25.15 l 550.8 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 239 15.56 Tm ($Continued$) Tj ET Q q n 0 13.15 m 550.8 13.15 l 550.8 1.15 l 0 1.15 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 270.1 25.15 l 270.1 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-3.8-AMEND.01 MO) Tj ET Q q n 270.1 25.15 m 540.25 25.15 l 540.25 13.15 l 270.1 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 485.25 15.56 Tm (ADB-DEP.) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 270.4 3.56 Tm (18) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 658.65 m 612 658.65 l 612 646.65 l 0 646.65 l h W n Q q n 0 646.65 m 612 646.65 l 612 634.65 l 0 634.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 637.06 Tm (To determine the Accelerated Death Benefit, the Company will use the lesser of A or B below:) Tj ET Q q n 18 634.65 m 630 634.65 l 630 622.65 l 18 622.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 625.06 Tm (A.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 625.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 64.19 625.06 Tm (Claimant's) Tj ET BT /F2 12 Tf 1 0 0 1 119.19 625.06 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 159.36 625.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 173.53 625.06 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 197.7 625.06 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 248.52 625.06 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 282.02 625.06 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 294.2 625.06 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 307.71 625.06 Tm (force) Tj ET BT /F2 12 Tf 1 0 0 1 336.54 625.06 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 352.71 625.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 371.55 625.06 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 393.05 625.06 Tm (before) Tj ET BT /F2 12 Tf 1 0 0 1 427.88 625.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 446.71 625.06 Tm (Accelerated) Tj ET Q q n 45.35 622.65 m 657.35 622.65 l 657.35 610.65 l 45.35 610.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 613.06 Tm (Death Benefit is paid; or) Tj ET Q q n 18 610.65 m 630 610.65 l 630 598.65 l 18 598.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 601.06 Tm (B.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 601.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 63.63 601.06 Tm (Claimant's) Tj ET BT /F2 12 Tf 1 0 0 1 118.08 601.06 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 157.69 601.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 171.31 601.06 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 194.92 601.06 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 245.19 601.06 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 278.13 601.06 Tm (would) Tj ET BT /F2 12 Tf 1 0 0 1 311.76 601.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 326.7 601.06 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 339.66 601.06 Tm (force) Tj ET BT /F2 12 Tf 1 0 0 1 367.93 601.06 Tm (12) Tj ET BT /F2 12 Tf 1 0 0 1 383.55 601.06 Tm (months) Tj ET BT /F2 12 Tf 1 0 0 1 422.51 601.06 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 448.11 601.06 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 469.73 601.06 Tm (date;) Tj ET BT /F2 12 Tf 1 0 0 1 496.67 601.06 Tm (if) Tj ET Q q n 45.35 598.65 m 657.35 598.65 l 657.35 586.65 l 45.35 586.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 589.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 63.58 589.06 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 110.44 589.06 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 122.01 589.06 Tm (scheduled) Tj ET BT /F2 12 Tf 1 0 0 1 173.56 589.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 186.46 589.06 Tm (reduce,) Tj ET BT /F2 12 Tf 1 0 0 1 225.01 589.06 Tm (due) Tj ET BT /F2 12 Tf 1 0 0 1 245.9 589.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 258.8 589.06 Tm (age,) Tj ET BT /F2 12 Tf 1 0 0 1 282.02 589.06 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 316.25 589.06 Tm (12) Tj ET BT /F2 12 Tf 1 0 0 1 331.82 589.06 Tm (months) Tj ET BT /F2 12 Tf 1 0 0 1 370.72 589.06 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 396.27 589.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 414.49 589.06 Tm (Accelerated) Tj ET BT /F2 12 Tf 1 0 0 1 475.35 589.06 Tm (Death) Tj ET Q q n 45.35 586.65 m 657.35 586.65 l 657.35 574.65 l 45.35 574.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 577.06 Tm (Benefit is paid.) Tj ET Q q n 0 574.65 m 612 574.65 l 612 562.65 l 0 562.65 l h W n Q q n 0 562.65 m 612 562.65 l 612 550.65 l 0 550.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 553.06 Tm (ADMINISTRATIVE CHARGE:) Tj ET BT /F2 12 Tf 1 0 0 1 164.33 553.06 Tm (NONE) Tj ET Q q n 0 550.65 m 612 550.65 l 612 538.65 l 0 538.65 l h W n Q q n 0 538.65 m 612 538.65 l 612 526.65 l 0 526.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 529.06 Tm (WITHDRAWAL FEE:) Tj ET BT /F2 12 Tf 1 0 0 1 117.65 529.06 Tm (NONE) Tj ET Q q n 0 526.65 m 612 526.65 l 612 514.65 l 0 514.65 l h W n Q q n 0 514.65 m 612 514.65 l 612 502.65 l 0 502.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 505.06 Tm (EFFECT) Tj ET BT /F2 12 Tf 1 0 0 1 48.62 505.06 Tm (ON) Tj ET BT /F2 12 Tf 1 0 0 1 71.24 505.06 Tm (AMOUNT) Tj ET BT /F2 12 Tf 1 0 0 1 129.18 505.06 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 149.81 505.06 Tm (LIFE) Tj ET BT /F2 12 Tf 1 0 0 1 180.42 505.06 Tm (INSURANCE.) Tj ET BT /F2 12 Tf 1 0 0 1 262.65 505.06 Tm ("Remaining) Tj ET BT /F2 12 Tf 1 0 0 1 325.49 505.06 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 350.76 505.06 Tm (Insurance") Tj ET BT /F2 12 Tf 1 0 0 1 407.58 505.06 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 443.52 505.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 463.46 505.06 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 504.74 505.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 520.01 505.06 Tm (Life) Tj ET Q q n 0 502.65 m 612 502.65 l 612 490.65 l 0 490.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 493.06 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 52.15 493.06 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 86.99 493.06 Tm (remains) Tj ET BT /F2 12 Tf 1 0 0 1 130.49 493.06 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 145.34 493.06 Tm (force) Tj ET BT /F2 12 Tf 1 0 0 1 175.49 493.06 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 193.01 493.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 213.18 493.06 Tm (Claimant's) Tj ET BT /F2 12 Tf 1 0 0 1 269.51 493.06 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 291.02 493.06 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 318.51 493.06 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 335.35 493.06 Tm (Accelerated) Tj ET BT /F2 12 Tf 1 0 0 1 398.15 493.06 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 432.31 493.06 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 473.14 493.06 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 486.66 493.06 Tm (paid.) Tj ET BT /F2 12 Tf 1 0 0 1 521.34 493.06 Tm (The) Tj ET Q q n 0 490.65 m 612 490.65 l 612 478.65 l 0 478.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 481.06 Tm (Remaining Life Insurance will equal:) Tj ET Q q n 18 478.65 m 630 478.65 l 630 466.65 l 18 466.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 469.06 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 469.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 64.06 469.06 Tm (Claimant's) Tj ET BT /F2 12 Tf 1 0 0 1 118.94 469.06 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 158.98 469.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 173.03 469.06 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 197.06 469.06 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 247.75 469.06 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 281.13 469.06 Tm (was) Tj ET BT /F2 12 Tf 1 0 0 1 303.84 469.06 Tm (used) Tj ET BT /F2 12 Tf 1 0 0 1 329.89 469.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 343.27 469.06 Tm (determine) Tj ET BT /F2 12 Tf 1 0 0 1 395.3 469.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 414.01 469.06 Tm (Accelerated) Tj ET BT /F2 12 Tf 1 0 0 1 475.35 469.06 Tm (Death) Tj ET Q q n 45.35 466.65 m 657.35 466.65 l 657.35 454.65 l 45.35 454.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 457.06 Tm (Benefit $A or B above$; minus) Tj ET Q q n 18 454.65 m 630 454.65 l 630 442.65 l 18 442.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 445.06 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 445.06 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 67.36 445.06 Tm (percentage) Tj ET BT /F2 12 Tf 1 0 0 1 124.01 445.06 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 140.7 445.06 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 174.72 445.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 194.06 445.06 Tm (Claimant's) Tj ET BT /F2 12 Tf 1 0 0 1 249.58 445.06 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 297.56 445.06 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 310.26 445.06 Tm (scheduled) Tj ET BT /F2 12 Tf 1 0 0 1 362.93 445.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 376.95 445.06 Tm (reduce,) Tj ET BT /F2 12 Tf 1 0 0 1 416.61 445.06 Tm (due) Tj ET BT /F2 12 Tf 1 0 0 1 438.63 445.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 452.65 445.06 Tm (age;) Tj ET BT /F2 12 Tf 1 0 0 1 477.32 445.06 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 489.34 445.06 Tm (the) Tj ET Q q n 45.35 442.65 m 657.35 442.65 l 657.35 430.65 l 45.35 430.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 433.06 Tm (reduction) Tj ET BT /F2 12 Tf 1 0 0 1 94.65 433.06 Tm (occurs) Tj ET BT /F2 12 Tf 1 0 0 1 129.96 433.06 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 158.6 433.06 Tm (than) Tj ET BT /F2 12 Tf 1 0 0 1 183.25 433.06 Tm (12) Tj ET BT /F2 12 Tf 1 0 0 1 199.23 433.06 Tm (months) Tj ET BT /F2 12 Tf 1 0 0 1 238.56 433.06 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 264.52 433.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 283.17 433.06 Tm (Accelerated) Tj ET BT /F2 12 Tf 1 0 0 1 344.44 433.06 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 377.08 433.06 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 416.39 433.06 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 428.38 433.06 Tm (paid,) Tj ET BT /F2 12 Tf 1 0 0 1 456.03 433.06 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 477.34 433.06 Tm (while) Tj ET Q q n 45.35 430.65 m 657.35 430.65 l 657.35 418.65 l 45.35 418.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 421.06 Tm (he or she is still living; minus) Tj ET Q q n 18 418.65 m 630 418.65 l 630 406.65 l 18 406.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 409.06 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 409.06 Tm (the amount of the Accelerated Death Benefit withdrawn.) Tj ET Q q n 0 406.65 m 612 406.65 l 612 394.65 l 0 394.65 l h W n Q q n 0 394.65 m 612 394.65 l 612 382.65 l 0 382.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 385.06 Tm (PREMIUM:) Tj ET BT /F2 12 Tf 1 0 0 1 66.38 385.06 Tm (There) Tj ET BT /F2 12 Tf 1 0 0 1 97.87 385.06 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 109.39 385.06 Tm (no) Tj ET BT /F2 12 Tf 1 0 0 1 124.91 385.06 Tm (additional) Tj ET BT /F2 12 Tf 1 0 0 1 176.42 385.06 Tm (charge) Tj ET BT /F2 12 Tf 1 0 0 1 211.91 385.06 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 229.42 385.06 Tm (this) Tj ET BT /F2 12 Tf 1 0 0 1 250.27 385.06 Tm (benefit.) Tj ET BT /F2 12 Tf 1 0 0 1 293.62 385.06 Tm (Continuation) Tj ET BT /F2 12 Tf 1 0 0 1 359.81 385.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 373.32 385.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 391.5 385.06 Tm (Remaining) Tj ET BT /F2 12 Tf 1 0 0 1 447.67 385.06 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 471.17 385.06 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 521.33 385.06 Tm (will) Tj ET Q q n 0 382.65 m 612 382.65 l 612 370.65 l 0 370.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 373.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 14.52 373.06 Tm (subject) Tj ET BT /F2 12 Tf 1 0 0 1 51.7 373.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 64.23 373.06 Tm (timely) Tj ET BT /F2 12 Tf 1 0 0 1 98.09 373.06 Tm (payment) Tj ET BT /F2 12 Tf 1 0 0 1 142.6 373.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 155.79 373.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 173.64 373.06 Tm (premium) Tj ET BT /F2 12 Tf 1 0 0 1 220.16 373.06 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 237.35 373.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 255.2 373.06 Tm (reduced) Tj ET BT /F2 12 Tf 1 0 0 1 296.37 373.06 Tm (amount;) Tj ET BT /F2 12 Tf 1 0 0 1 338.89 373.06 Tm (unless) Tj ET BT /F2 12 Tf 1 0 0 1 372.08 373.06 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 393.28 373.06 Tm (qualify) Tj ET BT /F2 12 Tf 1 0 0 1 430.46 373.06 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 447.65 373.06 Tm (waiver) Tj ET BT /F2 12 Tf 1 0 0 1 483.49 373.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 496.68 373.06 Tm (premium) Tj ET Q q n 0 370.65 m 612 370.65 l 612 358.65 l 0 358.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 361.06 Tm (under the Policy's Extension of Death Benefit provision, if included.) Tj ET Q q n 0 358.65 m 612 358.65 l 612 346.65 l 0 346.65 l h W n Q q n 0 346.65 m 612 346.65 l 612 334.65 l 0 334.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 337.06 Tm (CONDITIONS.) Tj ET BT /F2 12 Tf 1 0 0 1 83.46 337.06 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 95.02 337.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 113.25 337.06 Tm (Claimant) Tj ET BT /F2 12 Tf 1 0 0 1 160.81 337.06 Tm (exercises) Tj ET BT /F2 12 Tf 1 0 0 1 208.35 337.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 226.58 337.06 Tm (Conversion) Tj ET BT /F2 12 Tf 1 0 0 1 285.48 337.06 Tm (Privilege) Tj ET BT /F2 12 Tf 1 0 0 1 332.37 337.06 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 357.91 337.06 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 372.81 337.06 Tm (Accelerated) Tj ET BT /F2 12 Tf 1 0 0 1 433.66 337.06 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 465.88 337.06 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 504.77 337.06 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 516.34 337.06 Tm (paid,) Tj ET Q q n 0 334.65 m 612 334.65 l 612 322.65 l 0 322.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 325.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 18.15 325.06 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 57.64 325.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 71.12 325.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 89.28 325.06 Tm (conversion) Tj ET BT /F2 12 Tf 1 0 0 1 145.42 325.06 Tm (policy) Tj ET BT /F2 12 Tf 1 0 0 1 178.91 325.06 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 201.06 325.06 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 219.89 325.06 Tm (exceed) Tj ET BT /F2 12 Tf 1 0 0 1 256.69 325.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 274.84 325.06 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 314.32 325.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 327.81 325.06 Tm (his) Tj ET BT /F2 12 Tf 1 0 0 1 345.31 325.06 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 358.79 325.06 Tm (her) Tj ET BT /F2 12 Tf 1 0 0 1 377.61 325.06 Tm (Remaining) Tj ET BT /F2 12 Tf 1 0 0 1 433.76 325.06 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 457.23 325.06 Tm (Insurance.) Tj ET BT /F2 12 Tf 1 0 0 1 513.86 325.06 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 325.06 Tm (the) Tj ET Q q n 0 322.65 m 612 322.65 l 612 310.65 l 0 310.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 313.06 Tm (Claimant) Tj ET BT /F2 12 Tf 1 0 0 1 48.2 313.06 Tm (has) Tj ET BT /F2 12 Tf 1 0 0 1 68.41 313.06 Tm (Accidental) Tj ET BT /F2 12 Tf 1 0 0 1 124.59 313.06 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 157.45 313.06 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 178.98 313.06 Tm (Dismemberment) Tj ET BT /F2 12 Tf 1 0 0 1 263.17 313.06 Tm (benefits) Tj ET BT /F2 12 Tf 1 0 0 1 305.36 313.06 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 336.89 313.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 355.76 313.06 Tm (Policy,) Tj ET BT /F2 12 Tf 1 0 0 1 393.64 313.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 412.51 313.06 Tm (Principal) Tj ET BT /F2 12 Tf 1 0 0 1 460.04 313.06 Tm (Sum) Tj ET BT /F2 12 Tf 1 0 0 1 486.26 313.06 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 509.13 313.06 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 528.67 313.06 Tm (be) Tj ET Q q n 0 310.65 m 612 310.65 l 612 298.65 l 0 298.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 301.06 Tm (affected by the payment of an Accelerated Death Benefit.) Tj ET Q q n 0 298.65 m 612 298.65 l 612 286.65 l 0 286.65 l h W n Q q n 0 286.65 m 612 286.65 l 612 274.65 l 0 274.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 277.06 Tm (EFFECT) Tj ET BT /F2 12 Tf 1 0 0 1 48.27 277.06 Tm (ON) Tj ET BT /F2 12 Tf 1 0 0 1 70.53 277.06 Tm (DEATH) Tj ET BT /F2 12 Tf 1 0 0 1 116.11 277.06 Tm (BENEFIT.) Tj ET BT /F2 12 Tf 1 0 0 1 178.29 277.06 Tm (When) Tj ET BT /F2 12 Tf 1 0 0 1 211.87 277.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 231.46 277.06 Tm (Claimant) Tj ET BT /F2 12 Tf 1 0 0 1 280.37 277.06 Tm (dies) Tj ET BT /F2 12 Tf 1 0 0 1 304.63 277.06 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 331.53 277.06 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 347.79 277.06 Tm (Accelerated) Tj ET BT /F2 12 Tf 1 0 0 1 410 277.06 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 443.58 277.06 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 483.82 277.06 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 496.75 277.06 Tm (paid,) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 277.06 Tm (the) Tj ET Q q n 0 274.65 m 612 274.65 l 612 262.65 l 0 262.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 265.06 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 39.42 265.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 52.83 265.06 Tm (Remaining) Tj ET BT /F2 12 Tf 1 0 0 1 108.91 265.06 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 132.32 265.06 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 182.38 265.06 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 195.14 265.06 Tm (force) Tj ET BT /F2 12 Tf 1 0 0 1 223.21 265.06 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 238.63 265.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 256.71 265.06 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 280.12 265.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 293.53 265.06 Tm (death) Tj ET BT /F2 12 Tf 1 0 0 1 322.94 265.06 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 345.03 265.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 359.78 265.06 Tm (paid) Tj ET BT /F2 12 Tf 1 0 0 1 383.86 265.06 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 397.28 265.06 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 406.03 265.06 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 438.1 265.06 Tm (Benefit.) Tj ET BT /F2 12 Tf 1 0 0 1 483.26 265.06 Tm (Your) Tj ET BT /F2 12 Tf 1 0 0 1 511.35 265.06 Tm (Death) Tj ET Q q n 0 262.65 m 612 262.65 l 612 250.65 l 0 250.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 253.06 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 40.24 253.06 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 63.83 253.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 80.08 253.06 Tm (paid) Tj ET BT /F2 12 Tf 1 0 0 1 105.66 253.06 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 119.91 253.06 Tm (accord) Tj ET BT /F2 12 Tf 1 0 0 1 156.81 253.06 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 183.06 253.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 202.64 253.06 Tm (Beneficiary) Tj ET BT /F2 12 Tf 1 0 0 1 263.53 253.06 Tm (section) Tj ET BT /F2 12 Tf 1 0 0 1 302.44 253.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 317.36 253.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 336.94 253.06 Tm (Policy.) 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Tj ET BT /F2 12 Tf 1 0 0 1 86.32 649.06 Tm (No Accelerated Death Benefit will be paid:) Tj ET Q q n 18 646.65 m 630 646.65 l 630 634.65 l 18 634.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 637.06 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 637.06 Tm (if any required premium is due and unpaid;) Tj ET Q q n 18 634.65 m 630 634.65 l 630 622.65 l 18 622.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 625.06 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 625.06 Tm (on any conversion policy purchased in accord with the Conversion Privilege;) Tj ET Q q n 18 622.65 m 630 622.65 l 630 610.65 l 18 610.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 613.06 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 613.06 Tm (without the written approval of the bankruptcy court, if you have filed for bankruptcy;) Tj ET Q q n 18 610.65 m 630 610.65 l 630 598.65 l 18 598.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 601.06 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 601.06 Tm (without the written consent of the beneficiary, if you have named an irrevocable beneficiary;) Tj ET Q q n 18 598.65 m 630 598.65 l 630 586.65 l 18 586.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 589.06 Tm ($5$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 589.06 Tm (without your written consent, if the Claimant is your Terminal Dependent spouse;) Tj ET Q q n 18 586.65 m 630 586.65 l 630 574.65 l 18 574.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 577.06 Tm ($6$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 577.06 Tm (without the written consent of the assignee, if you have assigned your rights under the Policy;) Tj ET Q q n 18 574.65 m 630 574.65 l 630 562.65 l 18 562.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 565.06 Tm ($7$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 565.06 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 56.08 565.06 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 76.8 565.06 Tm (part) Tj ET BT /F2 12 Tf 1 0 0 1 98.86 565.06 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 112.25 565.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 130.31 565.06 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 153.69 565.06 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 203.73 565.06 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 230.47 565.06 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 245.19 565.06 Tm (paid) Tj ET BT /F2 12 Tf 1 0 0 1 269.25 565.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 281.98 565.06 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 307.38 565.06 Tm (child,) Tj ET BT /F2 12 Tf 1 0 0 1 337.77 565.06 Tm (spouse) Tj ET BT /F2 12 Tf 1 0 0 1 373.84 565.06 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 387.23 565.06 Tm (former) Tj ET BT /F2 12 Tf 1 0 0 1 423.28 565.06 Tm (spouse;) Tj ET BT /F2 12 Tf 1 0 0 1 462.67 565.06 Tm (pursuant) Tj ET Q q n 45.35 562.65 m 657.35 562.65 l 657.35 550.65 l 45.35 550.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 553.06 Tm (to a legal separation agreement, divorce decree, child support order or other court order;) Tj ET Q q n 18 550.65 m 630 550.65 l 630 538.65 l 18 538.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 541.06 Tm ($8$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 541.06 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 55.88 541.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 73.75 541.06 Tm (Claimant) Tj ET BT /F2 12 Tf 1 0 0 1 120.94 541.06 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 132.15 541.06 Tm (Terminal) Tj ET BT /F2 12 Tf 1 0 0 1 179.33 541.06 Tm (due) Tj ET BT /F2 12 Tf 1 0 0 1 199.86 541.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 212.39 541.06 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 220.92 541.06 Tm (suicide) Tj ET BT /F2 12 Tf 1 0 0 1 258.12 541.06 Tm (attempt,) Tj ET BT /F2 12 Tf 1 0 0 1 300.31 541.06 Tm (while) Tj ET BT /F2 12 Tf 1 0 0 1 330.17 541.06 Tm (sane;) Tj ET BT /F2 12 Tf 1 0 0 1 358.03 541.06 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 371.23 541.06 Tm (due) Tj ET BT /F2 12 Tf 1 0 0 1 391.75 541.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 404.29 541.06 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 418.82 541.06 Tm (intentionally) Tj ET BT /F2 12 Tf 1 0 0 1 482.68 541.06 Tm (self-) Tj ET Q q n 45.35 538.65 m 657.35 538.65 l 657.35 526.65 l 45.35 526.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 529.06 Tm (inflicted injury;) Tj ET Q q n 18 526.65 m 630 526.65 l 630 514.65 l 18 514.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 517.06 Tm ($9$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 517.06 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 56.6 517.06 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 65.85 517.06 Tm (government) Tj ET BT /F2 12 Tf 1 0 0 1 127.09 517.06 Tm (agency) Tj ET BT /F2 12 Tf 1 0 0 1 164.99 517.06 Tm (requires) Tj ET BT /F2 12 Tf 1 0 0 1 207.56 517.06 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 229.48 517.06 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 243.39 517.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 261.98 517.06 Tm (Claimant) Tj ET BT /F2 12 Tf 1 0 0 1 309.89 517.06 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 323.14 517.06 Tm (use) Tj ET BT /F2 12 Tf 1 0 0 1 343.06 517.06 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 361.64 517.06 Tm (Accelerated) Tj ET BT /F2 12 Tf 1 0 0 1 422.85 517.06 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 455.43 517.06 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 494.67 517.06 Tm (to) Tj ET Q q n 45.35 514.65 m 657.35 514.65 l 657.35 502.65 l 45.35 502.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 505.06 Tm (apply for, receive or continue a government benefit or entitlement; or) Tj ET Q q n 18 502.65 m 630 502.65 l 630 490.65 l 18 490.65 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 493.06 Tm ($10$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 493.06 Tm (if an Accelerated Death Benefit has been previously paid for the Claimant under the Policy.) Tj ET Q q n 0 490.65 m 612 490.65 l 612 478.65 l 0 478.65 l h W n Q q n 0 478.65 m 612 478.65 l 612 466.65 l 0 466.65 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 469.06 Tm (This) Tj ET BT /F4 12 Tf 1 0 0 1 25.8 469.06 Tm (amendment) Tj ET BT /F4 12 Tf 1 0 0 1 89.58 469.06 Tm (takes) Tj ET BT /F4 12 Tf 1 0 0 1 119.36 469.06 Tm (effect) Tj ET BT /F4 12 Tf 1 0 0 1 150.45 469.06 Tm (on) Tj ET BT /F4 12 Tf 1 0 0 1 166.24 469.06 Tm (your) Tj ET BT /F4 12 Tf 1 0 0 1 193.36 469.06 Tm (effective) Tj ET BT /F4 12 Tf 1 0 0 1 239.1 469.06 Tm (date) Tj ET BT /F4 12 Tf 1 0 0 1 264.22 469.06 Tm (of) Tj ET BT /F4 12 Tf 1 0 0 1 277.33 469.06 Tm (coverage) Tj ET BT /F4 12 Tf 1 0 0 1 325.76 469.06 Tm (under) Tj ET BT /F4 12 Tf 1 0 0 1 359.55 469.06 Tm (the) Tj ET BT /F4 12 Tf 1 0 0 1 378.66 469.06 Tm (Policy.) Tj ET BT /F4 12 Tf 1 0 0 1 419.22 469.06 Tm (However,) Tj ET BT /F4 12 Tf 1 0 0 1 471.32 469.06 Tm (if) Tj ET BT /F4 12 Tf 1 0 0 1 481.77 469.06 Tm (you) Tj ET BT /F4 12 Tf 1 0 0 1 503.56 469.06 Tm (are) Tj ET BT /F4 12 Tf 1 0 0 1 523.33 469.06 Tm (not) Tj ET Q q n 0 466.65 m 612 466.65 l 612 454.65 l 0 454.65 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 457.06 Tm (Actively) Tj ET BT /F4 12 Tf 1 0 0 1 45.35 457.06 Tm (at) Tj ET BT /F4 12 Tf 1 0 0 1 58.72 457.06 Tm (Work) Tj ET BT /F4 12 Tf 1 0 0 1 92.09 457.06 Tm (on) Tj ET BT /F4 12 Tf 1 0 0 1 108.13 457.06 Tm (that) Tj ET BT /F4 12 Tf 1 0 0 1 132.17 457.06 Tm (date,) Tj ET BT /F4 12 Tf 1 0 0 1 160.54 457.06 Tm (the) Tj ET BT /F4 12 Tf 1 0 0 1 179.9 457.06 Tm (change) Tj ET BT /F4 12 Tf 1 0 0 1 219.27 457.06 Tm (will) Tj ET BT /F4 12 Tf 1 0 0 1 241.31 457.06 Tm (not) Tj ET BT /F4 12 Tf 1 0 0 1 261.35 457.06 Tm (take) Tj ET BT /F4 12 Tf 1 0 0 1 286.71 457.06 Tm (effect) Tj ET BT /F4 12 Tf 1 0 0 1 318.05 457.06 Tm (until) Tj ET BT /F4 12 Tf 1 0 0 1 345.43 457.06 Tm (the) Tj ET BT /F4 12 Tf 1 0 0 1 364.8 457.06 Tm (date) Tj ET BT /F4 12 Tf 1 0 0 1 390.17 457.06 Tm (you) Tj ET BT /F4 12 Tf 1 0 0 1 412.21 457.06 Tm (resume) Tj ET BT /F4 12 Tf 1 0 0 1 452.9 457.06 Tm (Active) Tj ET BT /F4 12 Tf 1 0 0 1 488.92 457.06 Tm (Work.) Tj ET BT /F4 12 Tf 1 0 0 1 528.66 457.06 Tm (In) Tj ET Q q n 0 454.65 m 612 454.65 l 612 442.65 l 0 442.65 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 445.06 Tm (all other respects, the Policy remains the same.) Tj ET Q q n 0 442.65 m 612 442.65 l 612 430.65 l 0 430.65 l h W n Q 0 0 0 rg BT /F4 12 Tf 1 0 0 1 216.94 419.95 Tm (THE LINCOLN NATIONAL LIFE INSURANCE COMPANY) Tj ET q 1 0 0 1 285.42 358.05 cm q n 0 0 m 172.5 0 l 172.5 45 l 0 45 l h W n q 172.5 0 0 45 0 0 cm /img17798 Do Q Q Q q Q Q q Q Q endstream endobj 24 0 obj <>/Font<>>>>> endobj 158 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 270.1 25.15 l 270.1 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-AMEND. PC1) Tj ET Q q n 270.1 25.15 m 540.25 25.15 l 540.25 13.15 l 270.1 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 436.28 15.56 Tm (Prior Ins. Cred. - Life) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 270.4 3.56 Tm (20) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 682 m 612 682 l 612 670 l 0 670 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 186.16 672.41 Tm (CERTIFICATE AMENDMENT) Tj ET Q q n 0 656.2 m 612 656.2 l 612 644.2 l 0 644.2 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 646.61 Tm (TO BE ATTACHED TO THE CERTIFICATE FOR GROUP POLICY NO:) Tj ET BT /F4 12 Tf 1 0 0 1 397.71 646.61 Tm (000400001000-22982) Tj ET Q q n 0 644.2 m 612 644.2 l 612 632.2 l 0 632.2 l h W n Q q n 0 632.2 m 612 632.2 l 612 620.2 l 0 620.2 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 622.61 Tm (ISSUED TO:) Tj ET BT /F4 12 Tf 1 0 0 1 73.69 622.61 Tm (É«ÖÐÉ« University) Tj ET Q q n 0 620.2 m 612 620.2 l 612 608.2 l 0 608.2 l h W n Q q n 0 608.2 m 612 608.2 l 612 596.2 l 0 596.2 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 598.61 Tm (Your Certificate is amended by the addition of the following provisions.) Tj ET Q q n 0 596.2 m 612 596.2 l 612 584.2 l 0 584.2 l h W n Q q n 0 584.2 m 612 584.2 l 612 572.2 l 0 572.2 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 126.49 574.61 Tm (PRIOR INSURANCE CREDIT UPON TRANSFER OF) Tj ET Q q n 0 572.2 m 612 572.2 l 612 560.2 l 0 560.2 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 185.99 562.61 Tm (LIFE INSURANCE CARRIERS) Tj ET Q q n 0 560.2 m 612 560.2 l 612 548.2 l 0 548.2 l h W n Q q n 0 548.2 m 612 548.2 l 612 536.2 l 0 536.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 538.61 Tm (This) Tj ET BT /F2 12 Tf 1 0 0 1 24.42 538.61 Tm (provision) Tj ET BT /F2 12 Tf 1 0 0 1 72.84 538.61 Tm (prevents) Tj ET BT /F2 12 Tf 1 0 0 1 116.58 538.61 Tm (loss) Tj ET BT /F2 12 Tf 1 0 0 1 138.35 538.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 151.43 538.61 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 170.51 538.61 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 219.58 538.61 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 265.97 538.61 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 283.05 538.61 Tm (you,) Tj ET BT /F2 12 Tf 1 0 0 1 307.13 538.61 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 339.55 538.61 Tm (could) Tj ET BT /F2 12 Tf 1 0 0 1 369.3 538.61 Tm (otherwise) Tj ET BT /F2 12 Tf 1 0 0 1 419.04 538.61 Tm (occur) Tj ET BT /F2 12 Tf 1 0 0 1 448.77 538.61 Tm (solely) Tj ET BT /F2 12 Tf 1 0 0 1 480.53 538.61 Tm (because) Tj ET BT /F2 12 Tf 1 0 0 1 521.59 538.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 534.67 538.61 Tm (a) Tj ET Q q n 0 536.2 m 612 536.2 l 612 524.2 l 0 524.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 526.61 Tm (transfer) Tj ET BT /F2 12 Tf 1 0 0 1 40.26 526.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 53.88 526.61 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 103.47 526.61 Tm (carriers.) Tj ET BT /F2 12 Tf 1 0 0 1 149.68 526.61 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 171.96 526.61 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 206.24 526.61 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 228.53 526.61 Tm (provide) Tj ET BT /F2 12 Tf 1 0 0 1 268.8 526.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 287.08 526.61 Tm (following) Tj ET BT /F2 12 Tf 1 0 0 1 337.36 526.61 Tm (Prior) Tj ET BT /F2 12 Tf 1 0 0 1 364.98 526.61 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 415.24 526.61 Tm (Credit,) Tj ET BT /F2 12 Tf 1 0 0 1 451.85 526.61 Tm (when) Tj ET BT /F2 12 Tf 1 0 0 1 481.46 526.61 Tm (it) Tj ET BT /F2 12 Tf 1 0 0 1 491.75 526.61 Tm (replaces) Tj ET BT /F2 12 Tf 1 0 0 1 534.67 526.61 Tm (a) Tj ET Q q n 0 524.2 m 612 524.2 l 612 512.2 l 0 512.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 514.61 Tm (prior plan.) Tj ET Q q n 0 512.2 m 612 512.2 l 612 500.2 l 0 500.2 l h W n Q q n 0 500.2 m 612 500.2 l 612 488.2 l 0 488.2 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 490.61 Tm ("Prior) Tj ET BT /F4 12 Tf 1 0 0 1 37.41 490.61 Tm (Plan") Tj ET BT /F2 12 Tf 1 0 0 1 70.83 490.61 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 104.92 490.61 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 113.67 490.61 Tm (prior) Tj ET BT /F2 12 Tf 1 0 0 1 140.42 490.61 Tm (carrier's) Tj ET BT /F2 12 Tf 1 0 0 1 181.98 490.61 Tm (group) Tj ET BT /F2 12 Tf 1 0 0 1 213.4 490.61 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 232.82 490.61 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 282.23 490.61 Tm (policy,) Tj ET BT /F2 12 Tf 1 0 0 1 318.65 490.61 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 351.4 490.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 369.49 490.61 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 403.58 490.61 Tm (replaced) Tj ET BT /F2 12 Tf 1 0 0 1 447.64 490.61 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 481.74 490.61 Tm (1) Tj ET BT /F2 12 Tf 1 0 0 1 491.16 490.61 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 511.92 490.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 490.61 Tm (the) Tj ET Q q n 0 488.2 m 612 488.2 l 612 476.2 l 0 476.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 478.61 Tm (prior plan's termination date.) Tj ET Q q n 0 476.2 m 612 476.2 l 612 464.2 l 0 464.2 l h W n Q q n 0 464.2 m 612 464.2 l 612 452.2 l 0 452.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 454.61 Tm (FAILURE) Tj ET BT /F2 12 Tf 1 0 0 1 54.76 454.61 Tm (TO) Tj ET BT /F2 12 Tf 1 0 0 1 74.85 454.61 Tm (SATISFY) Tj ET BT /F2 12 Tf 1 0 0 1 127.62 454.61 Tm (ACTIVE) Tj ET BT /F2 12 Tf 1 0 0 1 175.7 454.61 Tm (WORK) Tj ET BT /F2 12 Tf 1 0 0 1 216.46 454.61 Tm (RULE.) Tj ET BT /F2 12 Tf 1 0 0 1 258.97 454.61 Tm (Subject) Tj ET BT /F2 12 Tf 1 0 0 1 299.06 454.61 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 312.48 454.61 Tm (payment) Tj ET BT /F2 12 Tf 1 0 0 1 357.9 454.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 371.99 454.61 Tm (premiums,) Tj ET BT /F2 12 Tf 1 0 0 1 427.07 454.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 445.82 454.61 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 480.58 454.61 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 503.34 454.61 Tm (provide) Tj ET Q q n 0 452.2 m 612 452.2 l 612 440.2 l 0 440.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 442.61 Tm (life coverage if you:) Tj ET Q q n 18 440.2 m 630 440.2 l 630 428.2 l 18 428.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 430.61 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 430.61 Tm (were insured under the prior plan on its termination date;) Tj ET Q q n 18 428.2 m 630 428.2 l 630 416.2 l 18 416.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 418.61 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 418.61 Tm (were) Tj ET BT /F2 12 Tf 1 0 0 1 73.9 418.61 Tm (otherwise) Tj ET BT /F2 12 Tf 1 0 0 1 125.8 418.61 Tm (eligible) Tj ET BT /F2 12 Tf 1 0 0 1 167.02 418.61 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 199.59 418.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 219.48 418.61 Tm (Policy;) Tj ET BT /F2 12 Tf 1 0 0 1 258.73 418.61 Tm (but) Tj ET BT /F2 12 Tf 1 0 0 1 279.3 418.61 Tm (were) Tj ET BT /F2 12 Tf 1 0 0 1 307.85 418.61 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 328.43 418.61 Tm (Actively-At-Work) Tj ET BT /F2 12 Tf 1 0 0 1 422.3 418.61 Tm (due) Tj ET BT /F2 12 Tf 1 0 0 1 444.87 418.61 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 459.44 418.61 Tm (Injury) Tj ET BT /F2 12 Tf 1 0 0 1 494 418.61 Tm (or) Tj ET Q q n 45.35 416.2 m 657.35 416.2 l 657.35 404.2 l 45.35 404.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 406.61 Tm (Sickness on its Effective Date;) Tj ET Q q n 18 404.2 m 630 404.2 l 630 392.2 l 18 392.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 394.61 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 394.61 Tm (are not entitled to any extension of life insurance under the prior plan; and) Tj ET Q q n 18 392.2 m 630 392.2 l 630 380.2 l 18 380.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 382.61 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 382.61 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 63.13 382.61 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 81.6 382.61 Tm (Totally) Tj ET BT /F2 12 Tf 1 0 0 1 119.39 382.61 Tm (Disabled) Tj ET BT /F2 12 Tf 1 0 0 1 165.18 382.61 Tm ($as) Tj ET BT /F2 12 Tf 1 0 0 1 182.3 382.61 Tm (defined) Tj ET BT /F2 12 Tf 1 0 0 1 221.41 382.61 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 233.88 382.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 251.67 382.61 Tm (Extension) Tj ET BT /F2 12 Tf 1 0 0 1 302.8 382.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 315.93 382.61 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 347.71 382.61 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 386.16 382.61 Tm (section) Tj ET BT /F2 12 Tf 1 0 0 1 423.28 382.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 436.41 382.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 454.2 382.61 Tm (Policy$) Tj ET BT /F2 12 Tf 1 0 0 1 492 382.61 Tm (on) Tj ET Q q n 45.35 380.2 m 657.35 380.2 l 657.35 368.2 l 45.35 368.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 370.61 Tm (the date the Policy takes effect.) Tj ET Q q n 0 368.2 m 612 368.2 l 612 356.2 l 0 356.2 l h W n Q q n 0 356.2 m 612 356.2 l 612 344.2 l 0 344.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 346.61 Tm (AMOUNT) Tj ET BT /F2 12 Tf 1 0 0 1 56.03 346.61 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 74.74 346.61 Tm (LIFE) Tj ET BT /F2 12 Tf 1 0 0 1 103.43 346.61 Tm (INSURANCE.) Tj ET BT /F2 12 Tf 1 0 0 1 181.84 346.61 Tm (Until) Tj ET BT /F2 12 Tf 1 0 0 1 209.87 346.61 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 231.24 346.61 Tm (satisfy) Tj ET BT /F2 12 Tf 1 0 0 1 265.94 346.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 283.96 346.61 Tm (Policy's) Tj ET BT /F2 12 Tf 1 0 0 1 324.83 346.61 Tm (Active) Tj ET BT /F2 12 Tf 1 0 0 1 360.18 346.61 Tm (Work) Tj ET BT /F2 12 Tf 1 0 0 1 390.87 346.61 Tm (rule,) Tj ET BT /F2 12 Tf 1 0 0 1 415.89 346.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 433.92 346.61 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 473.28 346.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 486.64 346.61 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 512 346.61 Tm (group) Tj ET Q q n 0 344.2 m 612 344.2 l 612 332.2 l 0 332.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 334.61 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 19.65 334.61 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 69.28 334.61 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 100.26 334.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 118.58 334.61 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 152.91 334.61 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 175.23 334.61 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 194.22 334.61 Tm (exceed) Tj ET BT /F2 12 Tf 1 0 0 1 231.19 334.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 249.5 334.61 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 289.15 334.61 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 306.81 334.61 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 339.79 334.61 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 361.45 334.61 Tm (were) Tj ET BT /F2 12 Tf 1 0 0 1 388.42 334.61 Tm (insured) Tj ET BT /F2 12 Tf 1 0 0 1 427.4 334.61 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 458.38 334.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 476.7 334.61 Tm (prior) Tj ET BT /F2 12 Tf 1 0 0 1 503.68 334.61 Tm (plan) Tj ET BT /F2 12 Tf 1 0 0 1 528 334.61 Tm (on) Tj ET Q q n 0 332.2 m 612 332.2 l 612 320.2 l 0 320.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 322.61 Tm (its termination date.) Tj ET Q q n 0 320.2 m 612 320.2 l 612 308.2 l 0 308.2 l h W n Q q n 0 308.2 m 612 308.2 l 612 296.2 l 0 296.2 l h W n Q q n 0 296.2 m 612 296.2 l 612 284.2 l 0 284.2 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 286.61 Tm (This) Tj ET BT /F4 12 Tf 1 0 0 1 26.57 286.61 Tm (Amendment) Tj ET BT /F4 12 Tf 1 0 0 1 93.79 286.61 Tm (takes) Tj ET BT /F4 12 Tf 1 0 0 1 124.34 286.61 Tm (effect) Tj ET BT /F4 12 Tf 1 0 0 1 156.2 286.61 Tm (on) Tj ET BT /F4 12 Tf 1 0 0 1 172.76 286.61 Tm (your) Tj ET BT /F4 12 Tf 1 0 0 1 200.65 286.61 Tm (effective) Tj ET BT /F4 12 Tf 1 0 0 1 247.17 286.61 Tm (date) Tj ET BT /F4 12 Tf 1 0 0 1 273.05 286.61 Tm (of) Tj ET BT /F4 12 Tf 1 0 0 1 286.94 286.61 Tm (coverage) Tj ET BT /F4 12 Tf 1 0 0 1 336.13 286.61 Tm (under) Tj ET BT /F4 12 Tf 1 0 0 1 370.7 286.61 Tm (the) Tj ET BT /F4 12 Tf 1 0 0 1 390.58 286.61 Tm (Policy.) Tj ET BT /F4 12 Tf 1 0 0 1 432.68 286.61 Tm (In) Tj ET BT /F4 12 Tf 1 0 0 1 447.92 286.61 Tm (all) Tj ET BT /F4 12 Tf 1 0 0 1 464.47 286.61 Tm (other) Tj ET BT /F4 12 Tf 1 0 0 1 495.69 286.61 Tm (respects,) Tj ET Q q n 0 284.2 m 612 284.2 l 612 272.2 l 0 272.2 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 274.61 Tm (your Certificate remains the same.) Tj ET Q q n 0 272.2 m 612 272.2 l 612 260.2 l 0 260.2 l h W n Q q n 0 260.2 m 612 260.2 l 612 248.2 l 0 248.2 l h W n Q 0 0 0 rg BT /F4 12 Tf 1 0 0 1 216.94 237.51 Tm (THE LINCOLN NATIONAL LIFE INSURANCE COMPANY) Tj ET q 1 0 0 1 285.42 175.6 cm q n 0 0 m 172.5 0 l 172.5 45 l 0 45 l h W n q 172.5 0 0 45 0 0 cm /img17798 Do Q Q Q q Q Q q Q Q endstream endobj 25 0 obj <>/Font<>>>>> endobj 159 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 270.1 25.15 l 270.1 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-AMEND.DP) Tj ET Q q n 270.1 25.15 m 540.25 25.15 l 540.25 13.15 l 270.1 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 346.29 15.56 Tm (Dom. Partner – Same or Opp. Sex - Life) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 270.4 3.56 Tm (21) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 695.8 m 612 695.8 l 612 683.8 l 0 683.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 186.16 686.21 Tm (CERTIFICATE AMENDMENT) Tj ET Q q n 0 683.8 m 612 683.8 l 612 671.8 l 0 671.8 l h W n Q q n 0 671.8 m 612 671.8 l 612 659.8 l 0 659.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 170.66 662.21 Tm (DOMESTIC PARTNER COVERAGE) Tj ET Q q n 0 659.8 m 612 659.8 l 612 647.8 l 0 647.8 l h W n Q q n 0 647.8 m 612 647.8 l 612 635.8 l 0 635.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 638.21 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 22.48 638.21 Tm (definition) Tj ET BT /F2 12 Tf 1 0 0 1 72.96 638.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 86.77 638.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 95.92 638.21 Tm (DEPENDENT) Tj ET BT /F2 12 Tf 1 0 0 1 170.4 638.21 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 182.22 638.21 Tm (amended) Tj ET BT /F2 12 Tf 1 0 0 1 229.36 638.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 242.51 638.21 Tm (include) Tj ET BT /F2 12 Tf 1 0 0 1 281.65 638.21 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 307.47 638.21 Tm (Domestic) Tj ET BT /F2 12 Tf 1 0 0 1 357.28 638.21 Tm (Partner.) Tj ET BT /F2 12 Tf 1 0 0 1 402.57 638.21 Tm (Your) Tj ET BT /F2 12 Tf 1 0 0 1 431.06 638.21 Tm (Domestic) Tj ET BT /F2 12 Tf 1 0 0 1 480.87 638.21 Tm (Partner) Tj ET BT /F2 12 Tf 1 0 0 1 519.34 638.21 Tm (may) Tj ET Q q n 0 635.8 m 612 635.8 l 612 623.8 l 0 623.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 626.21 Tm (be enrolled for Dependent coverage under the Policy, in the same manner as a Spouse.) Tj ET Q q n 0 623.8 m 612 623.8 l 612 611.8 l 0 611.8 l h W n Q q n 0 611.8 m 612 611.8 l 612 599.8 l 0 599.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 602.21 Tm (DEFINITION.) Tj ET BT /F4 12 Tf 1 0 0 1 84.83 602.21 Tm ("Domestic) Tj ET BT /F4 12 Tf 1 0 0 1 143.39 602.21 Tm (Partner") Tj ET BT /F2 12 Tf 1 0 0 1 194.6 602.21 Tm (means) Tj ET BT /F2 12 Tf 1 0 0 1 229.84 602.21 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 256.41 602.21 Tm (partner,) Tj ET BT /F2 12 Tf 1 0 0 1 297.96 602.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 312.54 602.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 331.77 602.21 Tm (same) Tj ET BT /F2 12 Tf 1 0 0 1 361.01 602.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 375.58 602.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 394.82 602.21 Tm (opposite) Tj ET BT /F2 12 Tf 1 0 0 1 440.06 602.21 Tm (sex,) Tj ET BT /F2 12 Tf 1 0 0 1 463.63 602.21 Tm (when) Tj ET BT /F2 12 Tf 1 0 0 1 494.2 602.21 Tm (all) Tj ET BT /F2 12 Tf 1 0 0 1 510.77 602.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 602.21 Tm (the) Tj ET Q q n 0 599.8 m 612 599.8 l 612 587.8 l 0 587.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 590.21 Tm (following conditions are met.) Tj ET BT /F2 12 Tf 1 0 0 1 147.31 590.21 Tm (You and your partner:) Tj ET Q q n 18 587.8 m 630 587.8 l 630 575.8 l 18 575.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 578.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 578.21 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 63.61 578.21 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 82.55 578.21 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 113.48 578.21 Tm (age) Tj ET BT /F2 12 Tf 1 0 0 1 133.75 578.21 Tm (18;) Tj ET BT /F2 12 Tf 1 0 0 1 152.69 578.21 Tm (mentally) Tj ET BT /F2 12 Tf 1 0 0 1 198.29 578.21 Tm (incompetent;) Tj ET BT /F2 12 Tf 1 0 0 1 264.54 578.21 Tm (legally) Tj ET BT /F2 12 Tf 1 0 0 1 300.81 578.21 Tm (married) Tj ET BT /F2 12 Tf 1 0 0 1 341.73 578.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 354.67 578.21 Tm (someone) Tj ET BT /F2 12 Tf 1 0 0 1 400.94 578.21 Tm (else;) Tj ET BT /F2 12 Tf 1 0 0 1 426.54 578.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 440.14 578.21 Tm (related) Tj ET BT /F2 12 Tf 1 0 0 1 476.4 578.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 489.34 578.21 Tm (the) Tj ET Q q n 45.35 575.8 m 657.35 575.8 l 657.35 563.8 l 45.35 563.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 566.21 Tm (other by blood, to a degree that would bar legal marriage.) Tj ET Q q n 18 563.8 m 630 563.8 l 630 551.8 l 18 551.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 554.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 554.21 Tm (have not been in another Domestic Partner relationship within the prior 12 months.) Tj ET Q q n 18 551.8 m 630 551.8 l 630 539.8 l 18 539.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 542.21 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 542.21 Tm (are living together as each other's sole Domestic Partner; and intend to do so indefinitely.) Tj ET Q q n 18 539.8 m 630 539.8 l 630 527.8 l 18 527.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 530.21 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 530.21 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 63.41 530.21 Tm (jointly) Tj ET BT /F2 12 Tf 1 0 0 1 98.16 530.21 Tm (responsible) Tj ET BT /F2 12 Tf 1 0 0 1 156.23 530.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 173.64 530.21 Tm (each) Tj ET BT /F2 12 Tf 1 0 0 1 199.03 530.21 Tm (other's) Tj ET BT /F2 12 Tf 1 0 0 1 233.93 530.21 Tm (welfare) Tj ET BT /F2 12 Tf 1 0 0 1 273.31 530.21 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 294.05 530.21 Tm (financial) Tj ET BT /F2 12 Tf 1 0 0 1 339.44 530.21 Tm (obligations,) Tj ET BT /F2 12 Tf 1 0 0 1 399.19 530.21 Tm (including) Tj ET BT /F2 12 Tf 1 0 0 1 447.93 530.21 Tm (basic) Tj ET BT /F2 12 Tf 1 0 0 1 476 530.21 Tm (living) Tj ET Q q n 45.35 527.8 m 657.35 527.8 l 657.35 515.8 l 45.35 515.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 518.21 Tm (expenses.) Tj ET Q q n 18 515.8 m 630 515.8 l 630 503.8 l 18 503.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 506.21 Tm ($5$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 506.21 Tm (are in an exclusive, committed homosexual or heterosexual relationship with each other.) Tj ET Q q n 0 503.8 m 612 503.8 l 612 491.8 l 0 491.8 l h W n Q q n 0 491.8 m 612 491.8 l 612 479.8 l 0 479.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 482.21 Tm (PROOF.) Tj ET BT /F2 12 Tf 1 0 0 1 51.99 482.21 Tm (To) Tj ET BT /F2 12 Tf 1 0 0 1 68.82 482.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 83.64 482.21 Tm (eligible) Tj ET BT /F2 12 Tf 1 0 0 1 123.13 482.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 140.62 482.21 Tm (Domestic) Tj ET BT /F2 12 Tf 1 0 0 1 190.11 482.21 Tm (Partner) Tj ET BT /F2 12 Tf 1 0 0 1 228.26 482.21 Tm (Coverage) Tj ET BT /F2 12 Tf 1 0 0 1 277.74 482.21 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 308.56 482.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 326.72 482.21 Tm (Policy,) Tj ET BT /F2 12 Tf 1 0 0 1 363.88 482.21 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 385.38 482.21 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 406.21 482.21 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 431.7 482.21 Tm (Domestic) Tj ET BT /F2 12 Tf 1 0 0 1 481.19 482.21 Tm (Partner) Tj ET BT /F2 12 Tf 1 0 0 1 519.34 482.21 Tm (may) Tj ET Q q n 0 479.8 m 612 479.8 l 612 467.8 l 0 467.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 470.21 Tm (be required to furnish one or more of the following:) Tj ET Q q n 18 467.8 m 630 467.8 l 630 455.8 l 18 455.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 458.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 458.21 Tm (driver's licenses or passports showing a joint residence;) Tj ET Q q n 18 455.8 m 630 455.8 l 630 443.8 l 18 443.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 446.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 446.21 Tm (canceled rent checks, a joint-tenancy lease or jointly-held mortgage;) Tj ET Q q n 18 443.8 m 630 443.8 l 630 431.8 l 18 431.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 434.21 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 434.21 Tm (federal income tax return$s$ listing one as a dependent of the other;) Tj ET Q q n 18 431.8 m 630 431.8 l 630 419.8 l 18 419.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 422.21 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 422.21 Tm (titles to real or personal property, joint bank account statements or joint loans;) Tj ET Q q n 18 419.8 m 630 419.8 l 630 407.8 l 18 407.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 410.21 Tm ($5$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 410.21 Tm (copies of domestic partner registration papers or civil union documents, if available; or) Tj ET Q q n 18 407.8 m 630 407.8 l 630 395.8 l 18 395.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 398.21 Tm ($6$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 398.21 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 66.99 398.21 Tm (other) Tj ET BT /F2 12 Tf 1 0 0 1 95.97 398.21 Tm (evidence) Tj ET BT /F2 12 Tf 1 0 0 1 142.92 398.21 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 176.56 398.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 195.54 398.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 246.52 398.21 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 271.5 398.21 Tm (reasonably) Tj ET BT /F2 12 Tf 1 0 0 1 327.79 398.21 Tm (request) Tj ET BT /F2 12 Tf 1 0 0 1 366.76 398.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 380.41 398.21 Tm (show) Tj ET BT /F2 12 Tf 1 0 0 1 410.06 398.21 Tm (joint) Tj ET BT /F2 12 Tf 1 0 0 1 436.38 398.21 Tm (residency) Tj ET BT /F2 12 Tf 1 0 0 1 486.67 398.21 Tm (and) Tj ET Q q n 45.35 395.8 m 657.35 395.8 l 657.35 383.8 l 45.35 383.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 386.21 Tm (joint financial responsibilities.) Tj ET Q q n 0 383.8 m 612 383.8 l 612 371.8 l 0 371.8 l h W n Q q n 0 371.8 m 612 371.8 l 612 359.8 l 0 359.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 362.21 Tm (ELIGIBILITY) Tj ET BT /F2 12 Tf 1 0 0 1 76.7 362.21 Tm (.) Tj ET BT /F2 12 Tf 1 0 0 1 85.7 362.21 Tm (You become eligible for Domestic Partner Coverage on the latest of:) Tj ET Q q n 18 359.8 m 630 359.8 l 630 347.8 l 18 347.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 350.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 350.21 Tm (the effective date of this Domestic Partner Coverage amendment;) Tj ET Q q n 18 347.8 m 630 347.8 l 630 335.8 l 18 335.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 338.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 338.21 Tm (the date you become eligible for Personal Insurance under the Policy; or) Tj ET Q q n 18 335.8 m 630 335.8 l 630 323.8 l 18 323.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 326.21 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 326.21 Tm (12 months after the previous domestic partner relationship ends.) Tj ET Q q n 0 323.8 m 612 323.8 l 612 311.8 l 0 311.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 314.21 Tm (You may then make written application for Dependents Insurance, in accord with the terms of the Policy.) Tj ET Q q n 0 311.8 m 612 311.8 l 612 299.8 l 0 299.8 l h W n Q q n 0 299.8 m 612 299.8 l 612 287.8 l 0 287.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 290.21 Tm (TERMINATION) Tj ET BT /F2 12 Tf 1 0 0 1 88.68 290.21 Tm (.) Tj ET BT /F2 12 Tf 1 0 0 1 99.34 290.21 Tm (A) Tj ET BT /F2 12 Tf 1 0 0 1 111.84 290.21 Tm (domestic) Tj ET BT /F2 12 Tf 1 0 0 1 159 290.21 Tm (partnership) Tj ET BT /F2 12 Tf 1 0 0 1 216.81 290.21 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 241.3 290.21 Tm (end) Tj ET BT /F2 12 Tf 1 0 0 1 262.46 290.21 Tm (due) Tj ET BT /F2 12 Tf 1 0 0 1 283.62 290.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 296.79 290.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 305.95 290.21 Tm (partner's) Tj ET BT /F2 12 Tf 1 0 0 1 350.59 290.21 Tm (death,) Tj ET BT /F2 12 Tf 1 0 0 1 383.41 290.21 Tm (change) Tj ET BT /F2 12 Tf 1 0 0 1 421.22 290.21 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 434.38 290.21 Tm (residency) Tj ET BT /F2 12 Tf 1 0 0 1 484.2 290.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 498.02 290.21 Tm (financial) Tj ET Q q n 0 287.8 m 612 287.8 l 612 275.8 l 0 275.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 278.21 Tm (arrangements, or for other reasons.) Tj ET BT /F2 12 Tf 1 0 0 1 173.27 278.21 Tm (When the domestic partnership ends for any reason, you:) Tj ET Q q n 18 275.8 m 630 275.8 l 630 263.8 l 18 263.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 266.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 266.21 Tm (must give the Employer written notice within 30 days after the partnership ends; and) Tj ET Q q n 18 263.8 m 630 263.8 l 630 251.8 l 18 251.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 254.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 254.21 Tm (may not enroll a new Domestic Partner for 12 months following that notice.) Tj ET Q q n 0 251.8 m 612 251.8 l 612 239.8 l 0 239.8 l h W n Q q n 0 239.8 m 612 239.8 l 612 227.8 l 0 227.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 230.21 Tm (TAX) Tj ET BT /F4 12 Tf 1 0 0 1 28.78 230.21 Tm (AND) Tj ET BT /F4 12 Tf 1 0 0 1 58.22 230.21 Tm (LEGAL) Tj ET BT /F4 12 Tf 1 0 0 1 103.68 230.21 Tm (EFFECTS.) Tj ET BT /F2 12 Tf 1 0 0 1 167.57 230.21 Tm (You) Tj ET BT /F2 12 Tf 1 0 0 1 191.68 230.21 Tm (should) Tj ET BT /F2 12 Tf 1 0 0 1 227.13 230.21 Tm (seek) Tj ET BT /F2 12 Tf 1 0 0 1 251.9 230.21 Tm (counseling) Tj ET BT /F2 12 Tf 1 0 0 1 307.33 230.21 Tm (concerning) Tj ET BT /F2 12 Tf 1 0 0 1 364.08 230.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 382.18 230.21 Tm (tax) Tj ET BT /F2 12 Tf 1 0 0 1 400.29 230.21 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 421.06 230.21 Tm (legal) Tj ET BT /F2 12 Tf 1 0 0 1 447.82 230.21 Tm (effects) Tj ET BT /F2 12 Tf 1 0 0 1 483.24 230.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 496.68 230.21 Tm (enrolling) Tj ET Q q n 0 227.8 m 612 227.8 l 612 215.8 l 0 215.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 218.21 Tm (for Domestic Partner Coverage.) Tj ET Q q n 0 215.8 m 612 215.8 l 612 203.8 l 0 203.8 l h W n Q q n 0 203.8 m 612 203.8 l 612 191.8 l 0 191.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 194.21 Tm (This) Tj ET BT /F4 12 Tf 1 0 0 1 26.61 194.21 Tm (amendment) Tj ET BT /F4 12 Tf 1 0 0 1 91.2 194.21 Tm (takes) Tj ET BT /F4 12 Tf 1 0 0 1 121.79 194.21 Tm (effect) Tj ET BT /F4 12 Tf 1 0 0 1 153.68 194.21 Tm (on) Tj ET BT /F4 12 Tf 1 0 0 1 170.28 194.21 Tm (August) Tj ET BT /F4 12 Tf 1 0 0 1 210.89 194.21 Tm (1,) Tj ET BT /F4 12 Tf 1 0 0 1 223.82 194.21 Tm (2017,) Tj ET BT /F4 12 Tf 1 0 0 1 254.75 194.21 Tm (or) Tj ET BT /F4 12 Tf 1 0 0 1 270 194.21 Tm (on) Tj ET BT /F4 12 Tf 1 0 0 1 286.6 194.21 Tm (your) Tj ET BT /F4 12 Tf 1 0 0 1 314.52 194.21 Tm (effective) Tj ET BT /F4 12 Tf 1 0 0 1 361.08 194.21 Tm (date) Tj ET BT /F4 12 Tf 1 0 0 1 387 194.21 Tm (of) Tj ET BT /F4 12 Tf 1 0 0 1 400.93 194.21 Tm (coverage) Tj ET BT /F4 12 Tf 1 0 0 1 450.16 194.21 Tm (under) Tj ET BT /F4 12 Tf 1 0 0 1 484.76 194.21 Tm (the) Tj ET BT /F4 12 Tf 1 0 0 1 504.68 194.21 Tm (Policy;) Tj ET Q q n 0 191.8 m 612 191.8 l 612 179.8 l 0 179.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 182.21 Tm (whichever is later.) Tj ET BT /F4 12 Tf 1 0 0 1 99.64 182.21 Tm (In all other respects, this Certificate rema) Tj ET BT /F4 12 Tf 1 0 0 1 313.24 182.21 Tm (ins the same) Tj ET BT /F4 12 Tf 1 0 0 1 375.9 182.21 Tm (.) Tj ET Q q n 0 179.8 m 612 179.8 l 612 167.8 l 0 167.8 l h W n Q 0 0 0 rg BT /F4 12 Tf 1 0 0 1 212.43 136.1 Tm (THE LINCOLN NATIONAL LIFE INSURANCE COMPANY) Tj ET q 1 0 0 1 287.7 81.39 cm q n 0 0 m 172.5 0 l 172.5 45 l 0 45 l h W n q 172.5 0 0 45 0 0 cm /img17798 Do Q Q Q q Q Q q Q Q endstream endobj 26 0 obj <>/Font<>>>>> endobj 160 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 717.05 cm q n 0 38.95 m 550.8 38.95 l 550.8 26.95 l 0 26.95 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 186.16 29.36 Tm (CERTIFICATE AMENDMENT) Tj ET Q q n 0 26.95 m 550.8 26.95 l 550.8 14.95 l 0 14.95 l h W n Q 0 0 0 rg BT /F4 12 Tf 1 0 0 1 57.81 4.26 Tm (TO BE ATTACHED TO AND MADE A PART OF THE GROUP CERTIFICATE) Tj ET Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 270.1 25.15 l 270.1 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL02-CP-AMEND) Tj ET Q q n 270.1 25.15 m 540.25 25.15 l 540.25 13.15 l 270.1 13.15 l h W n Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 270.4 3.56 Tm (22) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 656.85 m 612 656.85 l 612 644.85 l 0 644.85 l h W n Q q n 0 644.85 m 612 644.85 l 612 632.85 l 0 632.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 635.26 Tm (AMENDMENT) Tj ET BT /F4 12 Tf 1 0 0 1 87.42 635.26 Tm (OF) Tj ET BT /F4 12 Tf 1 0 0 1 110.17 635.26 Tm (CLAIMS) Tj ET BT /F4 12 Tf 1 0 0 1 164.27 635.26 Tm (PROCEDURES.) Tj ET BT /F2 12 Tf 1 0 0 1 262.13 635.26 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 286.88 635.26 Tm (attached) Tj ET BT /F2 12 Tf 1 0 0 1 332.94 635.26 Tm (Claims) Tj ET BT /F2 12 Tf 1 0 0 1 373.03 635.26 Tm (Procedures) Tj ET BT /F2 12 Tf 1 0 0 1 432.44 635.26 Tm (have) Tj ET BT /F2 12 Tf 1 0 0 1 461.18 635.26 Tm (been) Tj ET BT /F2 12 Tf 1 0 0 1 489.92 635.26 Tm (revised) Tj ET BT /F2 12 Tf 1 0 0 1 530.67 635.26 Tm (to) Tj ET Q q n 0 632.85 m 612 632.85 l 612 620.85 l 0 620.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 623.26 Tm (comply with final regulations:) Tj ET Q q n 18 620.85 m 630 620.85 l 630 608.85 l 18 608.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 611.26 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 611.26 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 78.49 611.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 96.96 611.26 Tm (U.S.) Tj ET BT /F2 12 Tf 1 0 0 1 122.11 611.26 Tm (Department) Tj ET BT /F2 12 Tf 1 0 0 1 182.56 611.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 196.37 611.26 Tm (Labor's) Tj ET BT /F2 12 Tf 1 0 0 1 235.67 611.26 Tm (Pension) Tj ET BT /F2 12 Tf 1 0 0 1 277.48 611.26 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 298.62 611.26 Tm (Welfare) Tj ET BT /F2 12 Tf 1 0 0 1 341.06 611.26 Tm (Benefits) Tj ET BT /F2 12 Tf 1 0 0 1 384.86 611.26 Tm (Administration) Tj ET BT /F2 12 Tf 1 0 0 1 461.34 611.26 Tm ($PWBA$) Tj ET Q q n 45.35 608.85 m 657.35 608.85 l 657.35 596.85 l 45.35 596.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 599.26 Tm (issued on November 21, 2000; and) Tj ET Q q n 18 596.85 m 630 596.85 l 630 584.85 l 18 584.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 587.26 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 587.26 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 77.88 587.26 Tm (govern) Tj ET BT /F2 12 Tf 1 0 0 1 114.4 587.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 132.26 587.26 Tm (claims) Tj ET BT /F2 12 Tf 1 0 0 1 166.78 587.26 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 187.3 587.26 Tm (appeals) Tj ET BT /F2 12 Tf 1 0 0 1 226.49 587.26 Tm (process) Tj ET BT /F2 12 Tf 1 0 0 1 265.67 587.26 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 282.86 587.26 Tm (employee) Tj ET BT /F2 12 Tf 1 0 0 1 332.71 587.26 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 369.22 587.26 Tm (plans) Tj ET BT /F2 12 Tf 1 0 0 1 397.75 587.26 Tm (subject) Tj ET BT /F2 12 Tf 1 0 0 1 434.94 587.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 447.48 587.26 Tm (ERISA) Tj ET BT /F2 12 Tf 1 0 0 1 485.34 587.26 Tm ($the) Tj ET Q q n 45.35 584.85 m 657.35 584.85 l 657.35 572.85 l 45.35 572.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 575.26 Tm (Employee Retirement Income Security Act of 1974$.) Tj ET Q q n 0 572.85 m 612 572.85 l 612 560.85 l 0 560.85 l h W n Q q n 0 560.85 m 612 560.85 l 612 548.85 l 0 548.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 551.26 Tm (These) Tj ET BT /F2 12 Tf 1 0 0 1 33.5 551.26 Tm (revised) Tj ET BT /F2 12 Tf 1 0 0 1 72.99 551.26 Tm (Claims) Tj ET BT /F2 12 Tf 1 0 0 1 111.84 551.26 Tm (Procedures) Tj ET BT /F2 12 Tf 1 0 0 1 170 551.26 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 193.51 551.26 Tm (replace) Tj ET BT /F2 12 Tf 1 0 0 1 232.99 551.26 Tm (those) Tj ET BT /F2 12 Tf 1 0 0 1 263.16 551.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 277.34 551.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 296.85 551.26 Tm (Certificate) Tj ET BT /F2 12 Tf 1 0 0 1 352.33 551.26 Tm (effective) Tj ET BT /F2 12 Tf 1 0 0 1 399.14 551.26 Tm (January) Tj ET BT /F2 12 Tf 1 0 0 1 441.3 551.26 Tm (1,) Tj ET BT /F2 12 Tf 1 0 0 1 455.14 551.26 Tm (2002.) Tj ET BT /F2 12 Tf 1 0 0 1 491.83 551.26 Tm (They) Tj ET BT /F2 12 Tf 1 0 0 1 521.33 551.26 Tm (will) Tj ET Q q n 0 548.85 m 612 548.85 l 612 536.85 l 0 536.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 539.26 Tm (apply to all claims filed on or after that date.) Tj ET Q q n 0 536.85 m 612 536.85 l 612 524.85 l 0 524.85 l h W n Q q n 0 524.85 m 612 524.85 l 612 512.85 l 0 512.85 l h W n Q q n 0 512.85 m 612 512.85 l 612 500.85 l 0 500.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 503.26 Tm (This) Tj ET BT /F4 12 Tf 1 0 0 1 26.06 503.26 Tm (amendment) Tj ET BT /F4 12 Tf 1 0 0 1 90.1 503.26 Tm (takes) Tj ET BT /F4 12 Tf 1 0 0 1 120.14 503.26 Tm (effect) Tj ET BT /F4 12 Tf 1 0 0 1 151.48 503.26 Tm (on) Tj ET BT /F4 12 Tf 1 0 0 1 167.53 503.26 Tm (January) Tj ET BT /F4 12 Tf 1 0 0 1 213.59 503.26 Tm (1,) Tj ET BT /F4 12 Tf 1 0 0 1 225.96 503.26 Tm (2002,) Tj ET BT /F4 12 Tf 1 0 0 1 256.34 503.26 Tm (or) Tj ET BT /F4 12 Tf 1 0 0 1 271.04 503.26 Tm (on) Tj ET BT /F4 12 Tf 1 0 0 1 287.09 503.26 Tm (the) Tj ET BT /F4 12 Tf 1 0 0 1 306.46 503.26 Tm (insured's) Tj ET BT /F4 12 Tf 1 0 0 1 356.52 503.26 Tm (effective) Tj ET BT /F4 12 Tf 1 0 0 1 402.53 503.26 Tm (date) Tj ET BT /F4 12 Tf 1 0 0 1 427.9 503.26 Tm (of) Tj ET BT /F4 12 Tf 1 0 0 1 441.27 503.26 Tm (coverage) Tj ET BT /F4 12 Tf 1 0 0 1 489.95 503.26 Tm (under) Tj ET BT /F4 12 Tf 1 0 0 1 524 503.26 Tm (the) Tj ET Q q n 0 500.85 m 612 500.85 l 612 488.85 l 0 488.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 491.26 Tm (Policy; whichever is later.) Tj ET BT /F4 12 Tf 1 0 0 1 137.96 491.26 Tm (In all other respects, the Certificate remains the same.) Tj ET Q q n 0 488.85 m 612 488.85 l 612 476.85 l 0 476.85 l h W n Q 0 0 0 rg BT /F4 12 Tf 1 0 0 1 216.94 452.36 Tm (THE LINCOLN NATIONAL LIFE INSURANCE COMPANY) Tj ET q 1 0 0 1 285.42 390.45 cm q n 0 0 m 172.5 0 l 172.5 45 l 0 45 l h W n q 172.5 0 0 45 0 0 cm /img17798 Do Q Q Q q Q Q q Q Q endstream endobj 27 0 obj <>>>>> endobj 165 0 obj <> endobj 162 0 obj <> endobj 161 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 732 cm q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 203.16 14.41 Tm (CLAIMS PROCEDURES) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 63.81 2.41 Tm (FOR LIFE OR ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 270.1 25.15 l 270.1 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-8A 02) Tj ET BT /F2 12 Tf 1 0 0 1 76.16 15.56 Tm (PA) Tj ET Q q n 270.1 25.15 m 540.25 25.15 l 540.25 13.15 l 270.1 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 503.59 15.56 Tm (L/ADD) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 270.4 3.56 Tm (23) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 671.8 m 612 671.8 l 612 659.8 l 0 659.8 l h W n Q q n 0 659.8 m 612 659.8 l 612 647.8 l 0 647.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 650.21 Tm (NOTE:) Tj ET BT /F4 12 Tf 1 0 0 1 44.64 650.21 Tm (The) Tj ET BT /F4 12 Tf 1 0 0 1 67.96 650.21 Tm (Policy) Tj ET BT /F4 12 Tf 1 0 0 1 102.6 650.21 Tm (may) Tj ET BT /F4 12 Tf 1 0 0 1 127.91 650.21 Tm (include) Tj ET BT /F4 12 Tf 1 0 0 1 168.57 650.21 Tm (an) Tj ET BT /F4 12 Tf 1 0 0 1 184.56 650.21 Tm (Extension) Tj ET BT /F4 12 Tf 1 0 0 1 238.55 650.21 Tm (of) Tj ET BT /F4 12 Tf 1 0 0 1 251.86 650.21 Tm (Death) Tj ET BT /F4 12 Tf 1 0 0 1 285.84 650.21 Tm (Benefit,) Tj ET BT /F4 12 Tf 1 0 0 1 328.81 650.21 Tm (an) Tj ET BT /F4 12 Tf 1 0 0 1 344.8 650.21 Tm (Accelerated) Tj ET BT /F4 12 Tf 1 0 0 1 408.75 650.21 Tm (Death) Tj ET BT /F4 12 Tf 1 0 0 1 442.72 650.21 Tm (Benefit) Tj ET BT /F4 12 Tf 1 0 0 1 482.7 650.21 Tm (or) Tj ET BT /F4 12 Tf 1 0 0 1 497.34 650.21 Tm (a) Tj ET BT /F4 12 Tf 1 0 0 1 506.65 650.21 Tm (Living) Tj ET Q q n 0 647.8 m 612 647.8 l 612 635.8 l 0 635.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 638.21 Tm (Benefit.) Tj ET BT /F4 12 Tf 1 0 0 1 45.66 638.21 Tm (If so, please refer to that section for special claim procedures.) Tj ET Q q n 0 635.8 m 612 635.8 l 612 623.8 l 0 623.8 l h W n Q q n 0 623.8 m 612 623.8 l 612 611.8 l 0 611.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 614.21 Tm (NOTICE AND PROOF OF CLAIM) Tj ET Q q n 0 611.8 m 612 611.8 l 612 599.8 l 0 599.8 l h W n Q q n 0 599.8 m 612 599.8 l 612 587.8 l 0 587.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 590.21 Tm (Notice) Tj ET BT /F4 12 Tf 1 0 0 1 36.05 590.21 Tm (of) Tj ET BT /F4 12 Tf 1 0 0 1 49.44 590.21 Tm (Claim.) Tj ET BT /F2 12 Tf 1 0 0 1 90.57 590.21 Tm (Written) Tj ET BT /F2 12 Tf 1 0 0 1 130.61 590.21 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 163.33 590.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 176.73 590.21 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 191.45 590.21 Tm (accidental) Tj ET BT /F2 12 Tf 1 0 0 1 243.48 590.21 Tm (death) Tj ET BT /F2 12 Tf 1 0 0 1 272.87 590.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 286.26 590.21 Tm (dismemberment) Tj ET BT /F2 12 Tf 1 0 0 1 366.97 590.21 Tm (claim) Tj ET BT /F2 12 Tf 1 0 0 1 397.02 590.21 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 423.76 590.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 438.48 590.21 Tm (given) Tj ET BT /F2 12 Tf 1 0 0 1 468.54 590.21 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 502.61 590.21 Tm (20) Tj ET BT /F2 12 Tf 1 0 0 1 518 590.21 Tm (days) Tj ET Q q n 0 587.8 m 612 587.8 l 612 575.8 l 0 575.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 578.21 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 25.86 578.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 44.4 578.21 Tm (loss) Tj ET BT /F2 12 Tf 1 0 0 1 66.96 578.21 Tm (occurs;) Tj ET BT /F2 12 Tf 1 0 0 1 105.49 578.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 119.37 578.21 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 133.25 578.21 Tm (soon) Tj ET BT /F2 12 Tf 1 0 0 1 159.8 578.21 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 173.68 578.21 Tm (reasonably) Tj ET BT /F2 12 Tf 1 0 0 1 229.54 578.21 Tm (possible) Tj ET BT /F2 12 Tf 1 0 0 1 272.75 578.21 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 298.61 578.21 Tm (that.) Tj ET BT /F4 12 Tf 1 0 0 1 319.61 578.21 Tm (*) Tj ET BT /F2 12 Tf 1 0 0 1 333.37 578.21 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 355.91 578.21 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 389.11 578.21 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 416.33 578.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 431.54 578.21 Tm (sent) Tj ET BT /F2 12 Tf 1 0 0 1 454.75 578.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 467.96 578.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 486.5 578.21 Tm (Company's) Tj ET Q q n 0 575.8 m 612 575.8 l 612 563.8 l 0 563.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 566.21 Tm (Group Insurance Service) Tj ET BT /F2 12 Tf 1 0 0 1 119.29 566.21 Tm ( Office.) Tj ET BT /F2 12 Tf 1 0 0 1 161.93 566.21 Tm (It should include:) Tj ET Q q n 18 563.8 m 630 563.8 l 630 551.8 l 18 551.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 554.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 554.21 Tm (your name and address; and) Tj ET Q q n 18 551.8 m 630 551.8 l 630 539.8 l 18 539.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 542.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 542.21 Tm (the number of the Policy.) Tj ET Q q n 0 539.8 m 612 539.8 l 612 527.8 l 0 527.8 l h W n Q q n 0 527.8 m 612 527.8 l 612 515.8 l 0 515.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 518.21 Tm (Claim) Tj ET BT /F4 12 Tf 1 0 0 1 35.49 518.21 Tm (Forms.) Tj ET BT /F2 12 Tf 1 0 0 1 80.12 518.21 Tm (When) Tj ET BT /F2 12 Tf 1 0 0 1 112.93 518.21 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 146.41 518.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 160.56 518.21 Tm (claim) Tj ET BT /F2 12 Tf 1 0 0 1 191.37 518.21 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 203.53 518.21 Tm (received,) Tj ET BT /F2 12 Tf 1 0 0 1 251.32 518.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 270.14 518.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 320.96 518.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 343.79 518.21 Tm (send) Tj ET BT /F2 12 Tf 1 0 0 1 369.94 518.21 Tm (claim) Tj ET BT /F2 12 Tf 1 0 0 1 400.75 518.21 Tm (forms) Tj ET BT /F2 12 Tf 1 0 0 1 432.9 518.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 451.05 518.21 Tm (filing) Tj ET BT /F2 12 Tf 1 0 0 1 481.21 518.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 500.02 518.21 Tm (required) Tj ET Q q n 0 515.8 m 612 515.8 l 612 503.8 l 0 503.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 506.21 Tm (proof.) Tj ET BT /F2 12 Tf 1 0 0 1 35.04 506.21 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 46.05 506.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 63.74 506.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 113.42 506.21 Tm (does) Tj ET BT /F2 12 Tf 1 0 0 1 138.44 506.21 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 156.8 506.21 Tm (send) Tj ET BT /F2 12 Tf 1 0 0 1 181.82 506.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 199.5 506.21 Tm (forms) Tj ET BT /F2 12 Tf 1 0 0 1 230.52 506.21 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 264.21 506.21 Tm (15) Tj ET BT /F2 12 Tf 1 0 0 1 279.24 506.21 Tm (days;) Tj ET BT /F2 12 Tf 1 0 0 1 307.59 506.21 Tm (then) Tj ET BT /F2 12 Tf 1 0 0 1 331.27 506.21 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 352.3 506.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 365.32 506.21 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 390.34 506.21 Tm (Beneficiary) Tj ET BT /F2 12 Tf 1 0 0 1 449.33 506.21 Tm ($the) Tj ET BT /F2 12 Tf 1 0 0 1 471.01 506.21 Tm (claimant$) Tj ET BT /F2 12 Tf 1 0 0 1 519.34 506.21 Tm (may) Tj ET Q q n 0 503.8 m 612 503.8 l 612 491.8 l 0 491.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 494.21 Tm (send the Company written proof of claim in a letter.) Tj ET BT /F2 12 Tf 1 0 0 1 255.26 494.21 Tm (It should state the nature, date and cause of the loss.) Tj ET Q q n 0 491.8 m 612 491.8 l 612 479.8 l 0 479.8 l h W n Q q n 0 479.8 m 612 479.8 l 612 467.8 l 0 467.8 l h W n 0 0 0 rg BT /F148 12 Tf 1 0 0 1 0 470.21 Tm (Proof) Tj ET BT /F148 12 Tf 1 0 0 1 33.59 470.21 Tm (of) Tj ET BT /F148 12 Tf 1 0 0 1 48.59 470.21 Tm (Claim.) Tj ET BT /F149 12 Tf 1 0 0 1 93.4 470.21 Tm (The) Tj ET BT /F149 12 Tf 1 0 0 1 117.03 470.21 Tm (Company) Tj ET BT /F149 12 Tf 1 0 0 1 168.54 470.21 Tm (must) Tj ET BT /F149 12 Tf 1 0 0 1 196.59 470.21 Tm (be) Tj ET BT /F149 12 Tf 1 0 0 1 212.69 470.21 Tm (given) Tj ET BT /F149 12 Tf 1 0 0 1 244.07 470.21 Tm (written) Tj ET BT /F149 12 Tf 1 0 0 1 283.17 470.21 Tm (proof) Tj ET BT /F149 12 Tf 1 0 0 1 314.33 470.21 Tm (of) Tj ET BT /F149 12 Tf 1 0 0 1 329.11 470.21 Tm (claim) Tj ET BT /F149 12 Tf 1 0 0 1 360.47 470.21 Tm (within) Tj ET BT /F149 12 Tf 1 0 0 1 395.82 470.21 Tm (90) Tj ET BT /F149 12 Tf 1 0 0 1 412.59 470.21 Tm (days) Tj ET BT /F149 12 Tf 1 0 0 1 439.31 470.21 Tm (after) Tj ET BT /F149 12 Tf 1 0 0 1 466.47 470.21 Tm (the) Tj ET BT /F149 12 Tf 1 0 0 1 485.89 470.21 Tm (date) Tj ET BT /F149 12 Tf 1 0 0 1 510.62 470.21 Tm (of) Tj ET BT /F149 12 Tf 1 0 0 1 525.4 470.21 Tm (the) Tj ET Q q n 0 467.8 m 612 467.8 l 612 455.8 l 0 455.8 l h W n 0 0 0 rg BT /F149 12 Tf 1 0 0 1 0 458.21 Tm (loss;) Tj ET BT /F2 12 Tf 1 0 0 1 27.91 458.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 42.7 458.21 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 57.5 458.21 Tm (soon) Tj ET BT /F2 12 Tf 1 0 0 1 84.97 458.21 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 99.76 458.21 Tm (reasonably) Tj ET BT /F2 12 Tf 1 0 0 1 156.54 458.21 Tm (possible) Tj ET BT /F2 12 Tf 1 0 0 1 200.67 458.21 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 227.45 458.21 Tm (that.) Tj ET BT /F4 12 Tf 1 0 0 1 248.44 458.21 Tm (*) Tj ET BT /F2 12 Tf 1 0 0 1 264.04 458.21 Tm (Proof) Tj ET BT /F2 12 Tf 1 0 0 1 295.51 458.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 310.3 458.21 Tm (claim) Tj ET BT /F2 12 Tf 1 0 0 1 341.75 458.21 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 369.89 458.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 386.02 458.21 Tm (provided) Tj ET BT /F2 12 Tf 1 0 0 1 433.47 458.21 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 446.93 458.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 466.39 458.21 Tm (claimant's) Tj ET BT /F2 12 Tf 1 0 0 1 519.33 458.21 Tm (own) Tj ET Q q n 0 455.8 m 612 455.8 l 612 443.8 l 0 443.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 446.21 Tm (expense.) Tj ET BT /F2 12 Tf 1 0 0 1 49.44 446.21 Tm (It) Tj ET BT /F2 12 Tf 1 0 0 1 60.67 446.21 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 87.9 446.21 Tm (show) Tj ET BT /F2 12 Tf 1 0 0 1 117.13 446.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 135.69 446.21 Tm (nature,) Tj ET BT /F2 12 Tf 1 0 0 1 172.56 446.21 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 196.44 446.21 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 217.67 446.21 Tm (cause) Tj ET BT /F2 12 Tf 1 0 0 1 248.21 446.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 262.1 446.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 280.66 446.21 Tm (loss.) Tj ET BT /F2 12 Tf 1 0 0 1 310.12 446.21 Tm (In) Tj ET BT /F2 12 Tf 1 0 0 1 324.01 446.21 Tm (addition) Tj ET BT /F2 12 Tf 1 0 0 1 367.24 446.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 380.47 446.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 399.02 446.21 Tm (information) Tj ET BT /F2 12 Tf 1 0 0 1 459.57 446.21 Tm (requested) Tj ET BT /F2 12 Tf 1 0 0 1 509.44 446.21 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 446.21 Tm (the) Tj ET Q q n 0 443.8 m 612 443.8 l 612 431.8 l 0 431.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 434.21 Tm (claim form, documentation must include:) Tj ET Q q n 18 431.8 m 630 431.8 l 630 419.8 l 18 419.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 422.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 422.21 Tm (A certified copy of the death certificate, for proof of death.) Tj ET Q q n 18 419.8 m 630 419.8 l 630 407.8 l 18 407.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 410.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 410.21 Tm (A copy of any police report, for proof of accidental death or dismemberment.) Tj ET Q q n 18 407.8 m 630 407.8 l 630 395.8 l 18 395.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 398.21 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 398.21 Tm (A signed authorization for the Company to obtain more information.) Tj ET Q q n 18 395.8 m 630 395.8 l 630 383.8 l 18 383.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 386.21 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 386.21 Tm (Any other items the Company may reasonably require in support of the claim.) Tj ET Q q n 0 383.8 m 612 383.8 l 612 371.8 l 0 371.8 l h W n Q q n 0 371.8 m 612 371.8 l 612 359.8 l 0 359.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 362.21 Tm (*) Tj ET BT /F4 12 Tf 1 0 0 1 9.16 362.21 Tm (Exception:) Tj ET BT /F2 12 Tf 1 0 0 1 70.82 362.21 Tm (Failure) Tj ET BT /F2 12 Tf 1 0 0 1 107.98 362.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 120.48 362.21 Tm (give) Tj ET BT /F2 12 Tf 1 0 0 1 144.3 362.21 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 176.79 362.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 189.95 362.21 Tm (furnish) Tj ET BT /F2 12 Tf 1 0 0 1 227.11 362.21 Tm (proof) Tj ET BT /F2 12 Tf 1 0 0 1 256.26 362.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 269.42 362.21 Tm (claim) Tj ET BT /F2 12 Tf 1 0 0 1 299.24 362.21 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 333.07 362.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 350.9 362.21 Tm (required) Tj ET BT /F2 12 Tf 1 0 0 1 394.04 362.21 Tm (time) Tj ET BT /F2 12 Tf 1 0 0 1 418.53 362.21 Tm (period) Tj ET BT /F2 12 Tf 1 0 0 1 452.36 362.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 474.19 362.21 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 492.69 362.21 Tm (invalidate) Tj ET Q q n 0 359.8 m 612 359.8 l 612 347.8 l 0 347.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 350.21 Tm (or reduce the claim; if it is shown that it was done:) Tj ET Q q n 18 347.8 m 630 347.8 l 630 335.8 l 18 335.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 338.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 338.21 Tm (as soon as reasonably possible; and) Tj ET Q q n 18 335.8 m 630 335.8 l 630 323.8 l 18 323.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 326.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 326.21 Tm (in no event more than one year after it was required.) Tj ET Q q n 0 323.8 m 612 323.8 l 612 311.8 l 0 311.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 314.21 Tm (These time limits will not apply while the claimant lacks legal capacity.) Tj ET Q q n 0 311.8 m 612 311.8 l 612 299.8 l 0 299.8 l h W n Q q n 0 299.8 m 612 299.8 l 612 287.8 l 0 287.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 290.21 Tm (EXAM OR AUTOPSY.) Tj ET BT /F2 12 Tf 1 0 0 1 127 290.21 Tm (At anytime while a claim is pending, the Company may have you examined:) Tj ET Q q n 18 287.8 m 630 287.8 l 630 275.8 l 18 275.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 278.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 278.21 Tm (by a Physician of the Company's choice;) Tj ET Q q n 18 275.8 m 630 275.8 l 630 263.8 l 18 263.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 266.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 266.21 Tm (as often as reasonably required.) Tj ET Q q n 0 263.8 m 612 263.8 l 612 251.8 l 0 251.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 254.21 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 11.78 254.21 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 33.58 254.21 Tm (fail) Tj ET BT /F2 12 Tf 1 0 0 1 53.36 254.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 66.48 254.21 Tm (cooperate) Tj ET BT /F2 12 Tf 1 0 0 1 116.91 254.21 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 142.04 254.21 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 157.15 254.21 Tm (examiner) Tj ET BT /F2 12 Tf 1 0 0 1 205.59 254.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 219.37 254.21 Tm (fail) Tj ET BT /F2 12 Tf 1 0 0 1 239.16 254.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 252.28 254.21 Tm (take) Tj ET BT /F2 12 Tf 1 0 0 1 276.06 254.21 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 291.18 254.21 Tm (exam,) Tj ET BT /F2 12 Tf 1 0 0 1 323.95 254.21 Tm (without) Tj ET BT /F2 12 Tf 1 0 0 1 364.42 254.21 Tm (good) Tj ET BT /F2 12 Tf 1 0 0 1 392.21 254.21 Tm (cause;) Tj ET BT /F2 12 Tf 1 0 0 1 425.98 254.21 Tm (then) Tj ET BT /F2 12 Tf 1 0 0 1 450.43 254.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 468.88 254.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 519.34 254.21 Tm (may) Tj ET Q q n 0 251.8 m 612 251.8 l 612 239.8 l 0 239.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 242.21 Tm (deny) Tj ET BT /F2 12 Tf 1 0 0 1 27.72 242.21 Tm (benefits,) Tj ET BT /F2 12 Tf 1 0 0 1 73.1 242.21 Tm (until) Tj ET BT /F2 12 Tf 1 0 0 1 99.5 242.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 118.55 242.21 Tm (exam) Tj ET BT /F2 12 Tf 1 0 0 1 148.93 242.21 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 161.33 242.21 Tm (completed.) Tj ET BT /F2 12 Tf 1 0 0 1 223.09 242.21 Tm (In) Tj ET BT /F2 12 Tf 1 0 0 1 237.48 242.21 Tm (case) Tj ET BT /F2 12 Tf 1 0 0 1 262.53 242.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 276.92 242.21 Tm (death,) Tj ET BT /F2 12 Tf 1 0 0 1 310.3 242.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 329.35 242.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 380.41 242.21 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 405.46 242.21 Tm (also) Tj ET BT /F2 12 Tf 1 0 0 1 429.18 242.21 Tm (have) Tj ET BT /F2 12 Tf 1 0 0 1 456.23 242.21 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 471.95 242.21 Tm (autopsy) Tj ET BT /F2 12 Tf 1 0 0 1 513.67 242.21 Tm (done,) Tj ET Q q n 0 239.8 m 612 239.8 l 612 227.8 l 0 227.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 230.21 Tm (where it is not forbidden by law.) Tj ET BT /F2 12 Tf 1 0 0 1 162.3 230.21 Tm (Any such exam or autopsy will be at the Company's expense.) Tj ET Q q n 0 227.8 m 612 227.8 l 612 215.8 l 0 215.8 l h W n Q q n 0 215.8 m 612 215.8 l 612 203.8 l 0 203.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 206.21 Tm (TIME) Tj ET BT /F4 12 Tf 1 0 0 1 35.87 206.21 Tm (OF) Tj ET BT /F4 12 Tf 1 0 0 1 56.39 206.21 Tm (PAYMENT) Tj ET BT /F4 12 Tf 1 0 0 1 120.91 206.21 Tm (OF) Tj ET BT /F4 12 Tf 1 0 0 1 141.44 206.21 Tm (CLAIMS.) Tj ET BT /F2 12 Tf 1 0 0 1 200.16 206.21 Tm (Any) Tj ET BT /F2 12 Tf 1 0 0 1 224.69 206.21 Tm (benefits) Tj ET BT /F2 12 Tf 1 0 0 1 266.54 206.21 Tm (payable) Tj ET BT /F2 12 Tf 1 0 0 1 307.71 206.21 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 338.89 206.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 357.41 206.21 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 391.94 206.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 414.47 206.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 429.66 206.21 Tm (paid) Tj ET BT /F2 12 Tf 1 0 0 1 454.18 206.21 Tm (immediately) Tj ET BT /F2 12 Tf 1 0 0 1 518.02 206.21 Tm (after) Tj ET Q q n 0 203.8 m 612 203.8 l 612 191.8 l 0 191.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 194.21 Tm (the Company receives complete proof of claim and confirms liability.) Tj ET Q q n 0 191.8 m 612 191.8 l 612 179.8 l 0 179.8 l h W n Q q n 0 179.8 m 612 179.8 l 612 167.8 l 0 167.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 170.21 Tm (TO WHOM PAYABLE) Tj ET Q q n 0 167.8 m 612 167.8 l 612 155.8 l 0 155.8 l h W n Q q n 0 155.8 m 612 155.8 l 612 143.8 l 0 143.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 146.21 Tm (Death.) Tj ET BT /F2 12 Tf 1 0 0 1 41.75 146.21 Tm (Any) Tj ET BT /F2 12 Tf 1 0 0 1 66.47 146.21 Tm (benefits) Tj ET BT /F2 12 Tf 1 0 0 1 108.5 146.21 Tm (payable) Tj ET BT /F2 12 Tf 1 0 0 1 149.85 146.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 167.89 146.21 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 193.93 146.21 Tm (death) Tj ET BT /F2 12 Tf 1 0 0 1 223.97 146.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 246.68 146.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 262.05 146.21 Tm (paid) Tj ET BT /F2 12 Tf 1 0 0 1 286.76 146.21 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 300.14 146.21 Tm (accord) Tj ET BT /F2 12 Tf 1 0 0 1 336.16 146.21 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 361.54 146.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 380.24 146.21 Tm (Beneficiary,) Tj ET BT /F2 12 Tf 1 0 0 1 443.26 146.21 Tm (Facility) Tj ET BT /F2 12 Tf 1 0 0 1 483.96 146.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 498.01 146.21 Tm (Payment) Tj ET Q q n 0 143.8 m 612 143.8 l 612 131.8 l 0 131.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 134.21 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 22.52 134.21 Tm (Settlement) Tj ET BT /F2 12 Tf 1 0 0 1 79.04 134.21 Tm (Options) Tj ET BT /F2 12 Tf 1 0 0 1 122.24 134.21 Tm (sections) Tj ET BT /F2 12 Tf 1 0 0 1 166.09 134.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 181.29 134.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 201.14 134.21 Tm (Policy.) Tj ET BT /F2 12 Tf 1 0 0 1 245.2 134.21 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 258.39 134.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 278.24 134.21 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 314.11 134.21 Tm (includes) Tj ET BT /F2 12 Tf 1 0 0 1 359.29 134.21 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 416.47 134.21 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 441.65 134.21 Tm (Insurance;) Tj ET BT /F2 12 Tf 1 0 0 1 496.82 134.21 Tm (then) Tj ET BT /F2 12 Tf 1 0 0 1 522.67 134.21 Tm (any) Tj ET Q q n 0 131.8 m 612 131.8 l 612 119.8 l 0 119.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 122.21 Tm (benefits payable for an insured Dependent's death will be paid to:) Tj ET Q q n 18 119.8 m 630 119.8 l 630 107.8 l 18 107.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 110.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 110.21 Tm (you, if you survive that Dependent; or) Tj ET Q q n 18 107.8 m 630 107.8 l 630 95.8 l 18 95.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 98.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 98.21 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 71 98.21 Tm (Beneficiary,) Tj ET BT /F2 12 Tf 1 0 0 1 133.62 98.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 147.27 98.21 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 160.25 98.21 Tm (accord) Tj ET BT /F2 12 Tf 1 0 0 1 195.88 98.21 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 220.86 98.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 239.18 98.21 Tm (Facility) Tj ET BT /F2 12 Tf 1 0 0 1 279.49 98.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 293.14 98.21 Tm (Payment) Tj ET BT /F2 12 Tf 1 0 0 1 338.78 98.21 Tm (section;) Tj ET BT /F2 12 Tf 1 0 0 1 379.76 98.21 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 390.74 98.21 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 412.39 98.21 Tm (do) Tj ET BT /F2 12 Tf 1 0 0 1 428.04 98.21 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 447.03 98.21 Tm (survive) Tj ET BT /F2 12 Tf 1 0 0 1 486.01 98.21 Tm (that) Tj ET Q q n 45.35 95.8 m 657.35 95.8 l 657.35 83.8 l 45.35 83.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 86.21 Tm (Dependent.) Tj ET Q q n 0 83.8 m 612 83.8 l 612 71.8 l 0 71.8 l h W n Q q n 0 71.8 m 612 71.8 l 612 59.8 l 0 59.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 62.21 Tm (Dismemberment.) Tj ET BT /F2 12 Tf 1 0 0 1 97.97 62.21 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 110.8 62.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 130.29 62.21 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 165.79 62.21 Tm (includes) Tj ET BT /F2 12 Tf 1 0 0 1 210.61 62.21 Tm (Accidental) Tj ET BT /F2 12 Tf 1 0 0 1 267.42 62.21 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 300.9 62.21 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 323.06 62.21 Tm (Dismemberment) Tj ET BT /F2 12 Tf 1 0 0 1 407.88 62.21 Tm (Benefits;) Tj ET BT /F2 12 Tf 1 0 0 1 456.03 62.21 Tm (then) Tj ET BT /F2 12 Tf 1 0 0 1 481.53 62.21 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 503.68 62.21 Tm (benefit,) Tj ET Q q n 0 59.8 m 612 59.8 l 612 47.8 l 0 47.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 50.21 Tm (other than your death benefit, will be paid to you.) Tj ET Q q n 0 47.8 m 612 47.8 l 612 35.8 l 0 35.8 l h W n Q Q q Q Q endstream endobj 28 0 obj <>>>>> endobj 168 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 720 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 203.16 26.41 Tm (CLAIMS PROCEDURES) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 239 14.41 Tm ($Continued$) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 270.1 25.15 l 270.1 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-8A 02) Tj ET BT /F2 12 Tf 1 0 0 1 76.16 15.56 Tm (PA) Tj ET Q q n 270.1 25.15 m 540.25 25.15 l 540.25 13.15 l 270.1 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 503.59 15.56 Tm (L/ADD) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 270.4 3.56 Tm (24) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 659.8 m 612 659.8 l 612 647.8 l 0 647.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 650.21 Tm (NOTICE) Tj ET BT /F4 12 Tf 1 0 0 1 53.2 650.21 Tm (OF) Tj ET BT /F4 12 Tf 1 0 0 1 75.72 650.21 Tm (CLAIM) Tj ET BT /F4 12 Tf 1 0 0 1 122.91 650.21 Tm (DECISION.) Tj ET BT /F2 12 Tf 1 0 0 1 196.98 650.21 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 221.49 650.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 274.02 650.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 298.54 650.21 Tm (send) Tj ET BT /F2 12 Tf 1 0 0 1 326.39 650.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 346.91 650.21 Tm (claimant) Tj ET BT /F2 12 Tf 1 0 0 1 394.09 650.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 405.27 650.21 Tm (written) Tj ET BT /F2 12 Tf 1 0 0 1 445.12 650.21 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 480.3 650.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 496.15 650.21 Tm (its) Tj ET BT /F2 12 Tf 1 0 0 1 513.35 650.21 Tm (claim) Tj ET Q q n 0 647.8 m 612 647.8 l 612 635.8 l 0 635.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 638.21 Tm (decision.) Tj ET BT /F2 12 Tf 1 0 0 1 48.99 638.21 Tm (If the Company denies any part of the claim; then the written notice will explain:) Tj ET Q q n 18 635.8 m 630 635.8 l 630 623.8 l 18 623.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 626.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 626.21 Tm (the reason for the denial, under the terms of the Policy and any internal guidelines;) Tj ET Q q n 18 623.8 m 630 623.8 l 630 611.8 l 18 611.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 614.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 614.21 Tm (how the claimant may request a review of the Company's decision; and) Tj ET Q q n 18 611.8 m 630 611.8 l 630 599.8 l 18 599.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 602.21 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 602.21 Tm (whether more information is needed to support the claim.) Tj ET Q q n 0 599.8 m 612 599.8 l 612 587.8 l 0 587.8 l h W n Q q n 0 587.8 m 612 587.8 l 612 575.8 l 0 575.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 578.21 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 24.23 578.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 76.47 578.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 100.71 578.21 Tm (send) Tj ET BT /F2 12 Tf 1 0 0 1 128.28 578.21 Tm (this) Tj ET BT /F2 12 Tf 1 0 0 1 151.2 578.21 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 186.09 578.21 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 222.34 578.21 Tm (15) Tj ET BT /F2 12 Tf 1 0 0 1 239.91 578.21 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 267.48 578.21 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 295.04 578.21 Tm (resolving) Tj ET BT /F2 12 Tf 1 0 0 1 345.27 578.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 365.51 578.21 Tm (claim.) Tj ET BT /F2 12 Tf 1 0 0 1 406.31 578.21 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 419.88 578.21 Tm (reasonably) Tj ET BT /F2 12 Tf 1 0 0 1 477.43 578.21 Tm (possible,) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 578.21 Tm (the) Tj ET Q q n 0 575.8 m 612 575.8 l 612 563.8 l 0 563.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 566.21 Tm (Company will send it within:) Tj ET Q q n 18 563.8 m 630 563.8 l 630 551.8 l 18 551.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 554.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 554.21 Tm (90 days after receiving the first proof of a death or dismemberment claim; or) Tj ET Q q n 18 551.8 m 630 551.8 l 630 539.8 l 18 539.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 542.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 542.21 Tm (45) Tj ET BT /F2 12 Tf 1 0 0 1 61.59 542.21 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 87.82 542.21 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 114.04 542.21 Tm (receiving) Tj ET BT /F2 12 Tf 1 0 0 1 162.92 542.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 181.81 542.21 Tm (first) Tj ET BT /F2 12 Tf 1 0 0 1 205.38 542.21 Tm (proof) Tj ET BT /F2 12 Tf 1 0 0 1 235.61 542.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 249.84 542.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 259.41 542.21 Tm (claim) Tj ET BT /F2 12 Tf 1 0 0 1 290.3 542.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 308.53 542.21 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 330.09 542.21 Tm (Extension) Tj ET BT /F2 12 Tf 1 0 0 1 382.32 542.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 396.56 542.21 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 429.44 542.21 Tm (Benefit,) Tj ET BT /F2 12 Tf 1 0 0 1 472 542.21 Tm (Living) Tj ET Q q n 45.35 539.8 m 657.35 539.8 l 657.35 527.8 l 45.35 527.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 530.21 Tm (Benefit or Accelerated Death Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 226.93 530.21 Tm (available under the Policy.) Tj ET Q q n 0 527.8 m 612 527.8 l 612 515.8 l 0 515.8 l h W n Q q n 0 515.8 m 612 515.8 l 612 503.8 l 0 503.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 506.21 Tm (Delay) Tj ET BT /F4 12 Tf 1 0 0 1 32.6 506.21 Tm (Notice.) Tj ET BT /F2 12 Tf 1 0 0 1 74.81 506.21 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 86.08 506.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 104.02 506.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 153.96 506.21 Tm (needs) Tj ET BT /F2 12 Tf 1 0 0 1 184.56 506.21 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 212.49 506.21 Tm (than) Tj ET BT /F2 12 Tf 1 0 0 1 236.43 506.21 Tm (15) Tj ET BT /F2 12 Tf 1 0 0 1 251.71 506.21 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 276.98 506.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 289.6 506.21 Tm (process) Tj ET BT /F2 12 Tf 1 0 0 1 328.86 506.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 337.47 506.21 Tm (claim,) Tj ET BT /F2 12 Tf 1 0 0 1 370.4 506.21 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 383.01 506.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 391.61 506.21 Tm (special) Tj ET BT /F2 12 Tf 1 0 0 1 428.21 506.21 Tm (case;) Tj ET BT /F2 12 Tf 1 0 0 1 455.47 506.21 Tm (then) Tj ET BT /F2 12 Tf 1 0 0 1 479.41 506.21 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 494.01 506.21 Tm (extension) Tj ET Q q n 0 503.8 m 612 503.8 l 612 491.8 l 0 491.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 494.21 Tm (will be permitted.) Tj ET BT /F2 12 Tf 1 0 0 1 90.98 494.21 Tm (If needed, the Company will send the claimant a written delay notice:) Tj ET Q q n 18 491.8 m 630 491.8 l 630 479.8 l 18 479.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 482.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 482.21 Tm (by the 15) Tj ET BT /F2 7.2 Tf 1 0 0 1 90.01 485.81 Tm (th) Tj ET BT /F2 12 Tf 1 0 0 1 95.61 482.21 Tm ( day after receiving the first proof of claim; and) Tj ET Q q n 18 479.8 m 630 479.8 l 630 467.8 l 18 467.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 470.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 470.21 Tm (every 30 days after that, until the claim is resolved.) Tj ET Q q n 0 467.8 m 612 467.8 l 612 455.8 l 0 455.8 l h W n Q q n 0 455.8 m 612 455.8 l 612 443.8 l 0 443.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 446.21 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 21.77 446.21 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 54.2 446.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 75.98 446.21 Tm (explain) Tj ET BT /F2 12 Tf 1 0 0 1 114.41 446.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 132.18 446.21 Tm (special) Tj ET BT /F2 12 Tf 1 0 0 1 168.61 446.21 Tm (circumstances) Tj ET BT /F2 12 Tf 1 0 0 1 239.69 446.21 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 272.12 446.21 Tm (require) Tj ET BT /F2 12 Tf 1 0 0 1 309.21 446.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 326.99 446.21 Tm (delay,) Tj ET BT /F2 12 Tf 1 0 0 1 359.08 446.21 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 379.52 446.21 Tm (when) Tj ET BT /F2 12 Tf 1 0 0 1 408.62 446.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 417.06 446.21 Tm (decision) Tj ET BT /F2 12 Tf 1 0 0 1 460.16 446.21 Tm (can) Tj ET BT /F2 12 Tf 1 0 0 1 479.92 446.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 494.36 446.21 Tm (expected.) Tj ET Q q n 0 443.8 m 612 443.8 l 612 431.8 l 0 431.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 434.21 Tm (In any event, the Company must send written notice of its decision within:) Tj ET Q q n 18 431.8 m 630 431.8 l 630 419.8 l 18 419.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 422.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 422.21 Tm (180 days after receiving the first proof of a death or dismemberment claim; or) Tj ET Q q n 18 419.8 m 630 419.8 l 630 407.8 l 18 407.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 410.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 410.21 Tm (105) Tj ET BT /F2 12 Tf 1 0 0 1 67.21 410.21 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 93.07 410.21 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 118.91 410.21 Tm (receiving) Tj ET BT /F2 12 Tf 1 0 0 1 167.42 410.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 185.94 410.21 Tm (first) Tj ET BT /F2 12 Tf 1 0 0 1 209.13 410.21 Tm (proof) Tj ET BT /F2 12 Tf 1 0 0 1 238.99 410.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 252.84 410.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 262.03 410.21 Tm (claim) Tj ET BT /F2 12 Tf 1 0 0 1 292.55 410.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 310.4 410.21 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 331.59 410.21 Tm (Extension) Tj ET BT /F2 12 Tf 1 0 0 1 383.45 410.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 397.31 410.21 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 429.82 410.21 Tm (Benefit,) Tj ET BT /F2 12 Tf 1 0 0 1 472 410.21 Tm (Living) Tj ET Q q n 45.35 407.8 m 657.35 407.8 l 657.35 395.8 l 45.35 395.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 398.21 Tm (Benefit or Accelerated Death Benefit available under the Policy.) Tj ET Q q n 0 395.8 m 612 395.8 l 612 383.8 l 0 383.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 386.21 Tm (If the Company fails to do so; then there is a right to an immediate review, as if the claim was denied.) Tj ET Q q n 0 383.8 m 612 383.8 l 612 371.8 l 0 371.8 l h W n Q q n 0 371.8 m 612 371.8 l 612 359.8 l 0 359.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 362.21 Tm (Exception:) Tj ET BT /F2 12 Tf 1 0 0 1 64.75 362.21 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 77.45 362.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 96.83 362.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 148.2 362.21 Tm (needs) Tj ET BT /F2 12 Tf 1 0 0 1 180.23 362.21 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 209.6 362.21 Tm (information) Tj ET BT /F2 12 Tf 1 0 0 1 270.96 362.21 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 299 362.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 318.37 362.21 Tm (claimant) Tj ET BT /F2 12 Tf 1 0 0 1 364.4 362.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 378.44 362.21 Tm (process) Tj ET BT /F2 12 Tf 1 0 0 1 419.14 362.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 429.18 362.21 Tm (claim;) Tj ET BT /F2 12 Tf 1 0 0 1 463.88 362.21 Tm (then) Tj ET BT /F2 12 Tf 1 0 0 1 489.25 362.21 Tm (it) Tj ET BT /F2 12 Tf 1 0 0 1 500.63 362.21 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 528.67 362.21 Tm (be) Tj ET Q q n 0 359.8 m 612 359.8 l 612 347.8 l 0 347.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 350.21 Tm (supplied) Tj ET BT /F2 12 Tf 1 0 0 1 44.76 350.21 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 79.53 350.21 Tm (45) Tj ET BT /F2 12 Tf 1 0 0 1 95.63 350.21 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 121.72 350.21 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 147.8 350.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 166.56 350.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 217.32 350.21 Tm (requests) Tj ET BT /F2 12 Tf 1 0 0 1 260.74 350.21 Tm (it.) Tj ET BT /F2 12 Tf 1 0 0 1 278.61 350.21 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 301.36 350.21 Tm (resulting) Tj ET BT /F2 12 Tf 1 0 0 1 347.46 350.21 Tm (delay) Tj ET BT /F2 12 Tf 1 0 0 1 377.54 350.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 400.31 350.21 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 419.74 350.21 Tm (count) Tj ET BT /F2 12 Tf 1 0 0 1 450.5 350.21 Tm (towards) Tj ET BT /F2 12 Tf 1 0 0 1 492.59 350.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 511.35 350.21 Tm (above) Tj ET Q q n 0 347.8 m 612 347.8 l 612 335.8 l 0 335.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 338.21 Tm (time limits for claim processing.) Tj ET Q q n 0 335.8 m 612 335.8 l 612 323.8 l 0 323.8 l h W n Q q n 0 323.8 m 612 323.8 l 612 311.8 l 0 311.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 314.21 Tm (REVIEW PROCEDURE.) Tj ET BT /F2 12 Tf 1 0 0 1 138.01 314.21 Tm (The claimant may request a claim review, within:) Tj ET Q q n 18 311.8 m 630 311.8 l 630 299.8 l 18 299.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 302.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 302.21 Tm (60 days after receiving a denial notice of a death or dismemberment claim; or) Tj ET Q q n 18 299.8 m 630 299.8 l 630 287.8 l 18 287.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 290.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 290.21 Tm (180) Tj ET BT /F2 12 Tf 1 0 0 1 66.96 290.21 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 92.57 290.21 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 118.16 290.21 Tm (receiving) Tj ET BT /F2 12 Tf 1 0 0 1 166.42 290.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 175.36 290.21 Tm (denial) Tj ET BT /F2 12 Tf 1 0 0 1 208.29 290.21 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 241.23 290.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 254.84 290.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 263.77 290.21 Tm (claim) Tj ET BT /F2 12 Tf 1 0 0 1 294.04 290.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 311.65 290.21 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 332.59 290.21 Tm (Extension) Tj ET BT /F2 12 Tf 1 0 0 1 384.19 290.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 397.8 290.21 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 430.07 290.21 Tm (Benefit,) Tj ET BT /F2 12 Tf 1 0 0 1 472 290.21 Tm (Living) Tj ET Q q n 45.35 287.8 m 657.35 287.8 l 657.35 275.8 l 45.35 275.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 278.21 Tm (Benefit or Accelerated Death Benefit available under the Policy.) Tj ET Q q n 0 275.8 m 612 275.8 l 612 263.8 l 0 263.8 l h W n Q q n 0 263.8 m 612 263.8 l 612 251.8 l 0 251.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 254.21 Tm (To) Tj ET BT /F2 12 Tf 1 0 0 1 16.6 254.21 Tm (request) Tj ET BT /F2 12 Tf 1 0 0 1 54.52 254.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 63.11 254.21 Tm (review,) Tj ET BT /F2 12 Tf 1 0 0 1 102.03 254.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 119.96 254.21 Tm (claimant) Tj ET BT /F2 12 Tf 1 0 0 1 164.54 254.21 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 191.15 254.21 Tm (send) Tj ET BT /F2 12 Tf 1 0 0 1 216.41 254.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 234.34 254.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 284.27 254.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 292.86 254.21 Tm (written) Tj ET BT /F2 12 Tf 1 0 0 1 330.12 254.21 Tm (request,) Tj ET BT /F2 12 Tf 1 0 0 1 371.04 254.21 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 391.64 254.21 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 412.23 254.21 Tm (written) Tj ET BT /F2 12 Tf 1 0 0 1 449.49 254.21 Tm (comments) Tj ET BT /F2 12 Tf 1 0 0 1 502.08 254.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 515.34 254.21 Tm (other) Tj ET Q q n 0 251.8 m 612 251.8 l 612 239.8 l 0 239.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 242.21 Tm (items) Tj ET BT /F2 12 Tf 1 0 0 1 29.49 242.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 42.31 242.21 Tm (support) Tj ET BT /F2 12 Tf 1 0 0 1 81.8 242.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 99.95 242.21 Tm (claim.) Tj ET BT /F2 12 Tf 1 0 0 1 136.58 242.21 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 158.73 242.21 Tm (claimant) Tj ET BT /F2 12 Tf 1 0 0 1 203.53 242.21 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 227.68 242.21 Tm (review) Tj ET BT /F2 12 Tf 1 0 0 1 263.82 242.21 Tm (certain) Tj ET BT /F2 12 Tf 1 0 0 1 299.95 242.21 Tm (non-privileged) Tj ET BT /F2 12 Tf 1 0 0 1 374.09 242.21 Tm (information) Tj ET BT /F2 12 Tf 1 0 0 1 434.23 242.21 Tm (relating) Tj ET BT /F2 12 Tf 1 0 0 1 474.37 242.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 487.2 242.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 505.35 242.21 Tm (request) Tj ET Q q n 0 239.8 m 612 239.8 l 612 227.8 l 0 227.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 230.21 Tm (for review.) Tj ET Q q n 0 227.8 m 612 227.8 l 612 215.8 l 0 215.8 l h W n Q q n 0 215.8 m 612 215.8 l 612 203.8 l 0 203.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 206.21 Tm (Notice) Tj ET BT /F4 12 Tf 1 0 0 1 36.06 206.21 Tm (of) Tj ET BT /F4 12 Tf 1 0 0 1 49.47 206.21 Tm (Decision.) Tj ET BT /F2 12 Tf 1 0 0 1 102.62 206.21 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 124.69 206.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 174.76 206.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 196.84 206.21 Tm (review) Tj ET BT /F2 12 Tf 1 0 0 1 232.9 206.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 250.97 206.21 Tm (claim) Tj ET BT /F2 12 Tf 1 0 0 1 281.04 206.21 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 301.78 206.21 Tm (send) Tj ET BT /F2 12 Tf 1 0 0 1 327.19 206.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 345.26 206.21 Tm (claimant) Tj ET BT /F2 12 Tf 1 0 0 1 389.98 206.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 398.72 206.21 Tm (written) Tj ET BT /F2 12 Tf 1 0 0 1 436.12 206.21 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 468.85 206.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 482.26 206.21 Tm (its) Tj ET BT /F2 12 Tf 1 0 0 1 497.01 206.21 Tm (decision.) Tj ET Q q n 0 203.8 m 612 203.8 l 612 191.8 l 0 191.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 194.21 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 22.38 194.21 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 55.42 194.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 77.81 194.21 Tm (explain) Tj ET BT /F2 12 Tf 1 0 0 1 116.85 194.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 135.23 194.21 Tm (reasons) Tj ET BT /F2 12 Tf 1 0 0 1 174.94 194.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 192.65 194.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 211.03 194.21 Tm (Company's) Tj ET BT /F2 12 Tf 1 0 0 1 268.25 194.21 Tm (decision,) Tj ET BT /F2 12 Tf 1 0 0 1 314.96 194.21 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 346.01 194.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 364.39 194.21 Tm (terms) Tj ET BT /F2 12 Tf 1 0 0 1 394.77 194.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 408.49 194.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 426.87 194.21 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 461.26 194.21 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 482.3 194.21 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 503.35 194.21 Tm (internal) Tj ET Q q n 0 191.8 m 612 191.8 l 612 179.8 l 0 179.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 182.21 Tm (guidelines.) Tj ET BT /F2 12 Tf 1 0 0 1 58.32 182.21 Tm (If the Company upholds the denial of all or part of the claim; then the notice will also describe:) Tj ET Q q n 18 179.8 m 630 179.8 l 630 167.8 l 18 167.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 170.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 170.21 Tm (any further appeal procedures available under the Policy;) Tj ET Q q n 18 167.8 m 630 167.8 l 630 155.8 l 18 155.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 158.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 158.21 Tm (the right to access relevant claim information; and) Tj ET Q q n 18 155.8 m 630 155.8 l 630 143.8 l 18 143.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 146.21 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 146.21 Tm (the right to request a state insurance department review, or to bring legal action.) Tj ET Q q n 0 143.8 m 612 143.8 l 612 131.8 l 0 131.8 l h W n Q q n 0 131.8 m 612 131.8 l 612 119.8 l 0 119.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 122.21 Tm (For) Tj ET BT /F2 12 Tf 1 0 0 1 21.1 122.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 30.86 122.21 Tm (death) Tj ET BT /F2 12 Tf 1 0 0 1 61.29 122.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 75.72 122.21 Tm (dismemberment) Tj ET BT /F2 12 Tf 1 0 0 1 157.46 122.21 Tm (claim,) Tj ET BT /F2 12 Tf 1 0 0 1 191.55 122.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 210.65 122.21 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 244.4 122.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 267.5 122.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 283.26 122.21 Tm (sent) Tj ET BT /F2 12 Tf 1 0 0 1 307.03 122.21 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 342.13 122.21 Tm (60) Tj ET BT /F2 12 Tf 1 0 0 1 358.57 122.21 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 385 122.21 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 411.41 122.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 430.5 122.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 481.6 122.21 Tm (receives) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 122.21 Tm (the) Tj ET Q q n 0 119.8 m 612 119.8 l 612 107.8 l 0 107.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 110.21 Tm (request) Tj ET BT /F2 12 Tf 1 0 0 1 38.44 110.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 56.22 110.21 Tm (review;) Tj ET BT /F2 12 Tf 1 0 0 1 95.98 110.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 109.77 110.21 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 144.22 110.21 Tm (120) Tj ET BT /F2 12 Tf 1 0 0 1 166.01 110.21 Tm (days,) Tj ET BT /F2 12 Tf 1 0 0 1 194.79 110.21 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 205.9 110.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 215.02 110.21 Tm (special) Tj ET BT /F2 12 Tf 1 0 0 1 252.12 110.21 Tm (case) Tj ET BT /F2 12 Tf 1 0 0 1 276.55 110.21 Tm (requires) Tj ET BT /F2 12 Tf 1 0 0 1 318.99 110.21 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 347.43 110.21 Tm (time.) Tj ET BT /F2 12 Tf 1 0 0 1 379.33 110.21 Tm (For) Tj ET BT /F2 12 Tf 1 0 0 1 399.78 110.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 408.89 110.21 Tm (claim) Tj ET BT /F2 12 Tf 1 0 0 1 439.33 110.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 457.11 110.21 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 478.22 110.21 Tm (Extension) Tj ET BT /F2 12 Tf 1 0 0 1 530 110.21 Tm (of) Tj ET Q q n 0 107.8 m 612 107.8 l 612 95.8 l 0 95.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 98.21 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 32.54 98.21 Tm (Benefit,) Tj ET BT /F2 12 Tf 1 0 0 1 74.75 98.21 Tm (Living) Tj ET BT /F2 12 Tf 1 0 0 1 110.63 98.21 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 149.84 98.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 163.72 98.21 Tm (Accelerated) Tj ET BT /F2 12 Tf 1 0 0 1 224.9 98.21 Tm (Death) Tj ET BT /F2 12 Tf 1 0 0 1 257.44 98.21 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 296.64 98.21 Tm (available) Tj ET BT /F2 12 Tf 1 0 0 1 343.84 98.21 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 375.05 98.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 393.59 98.21 Tm (Policy,) Tj ET BT /F2 12 Tf 1 0 0 1 431.15 98.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 449.7 98.21 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 482.9 98.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 505.46 98.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 520.67 98.21 Tm (sent) Tj ET Q q n 0 95.8 m 612 95.8 l 612 83.8 l 0 83.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 86.21 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 34.38 86.21 Tm (45) Tj ET BT /F2 12 Tf 1 0 0 1 50.09 86.21 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 75.8 86.21 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 101.49 86.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 119.86 86.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 170.23 86.21 Tm (receives) Tj ET BT /F2 12 Tf 1 0 0 1 213.25 86.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 231.62 86.21 Tm (request) Tj ET BT /F2 12 Tf 1 0 0 1 269.98 86.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 287.69 86.21 Tm (review;) Tj ET BT /F2 12 Tf 1 0 0 1 327.38 86.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 341.09 86.21 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 375.47 86.21 Tm (90) Tj ET BT /F2 12 Tf 1 0 0 1 391.18 86.21 Tm (days,) Tj ET BT /F2 12 Tf 1 0 0 1 419.89 86.21 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 430.93 86.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 439.96 86.21 Tm (special) Tj ET BT /F2 12 Tf 1 0 0 1 476.99 86.21 Tm (case) Tj ET BT /F2 12 Tf 1 0 0 1 501.35 86.21 Tm (requires) Tj ET Q q n 0 83.8 m 612 83.8 l 612 71.8 l 0 71.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 74.2 Tm (more time.) Tj ET Q q n 0 71.8 m 612 71.8 l 612 59.8 l 0 59.8 l h W n Q Q q Q Q endstream endobj 29 0 obj <>>>>> endobj 169 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 720 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 203.16 26.41 Tm (CLAIMS PROCEDURES) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 239 14.41 Tm ($Continued$) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 270.1 25.15 l 270.1 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-8A 02) Tj ET BT /F2 12 Tf 1 0 0 1 76.16 15.56 Tm (PA) Tj ET Q q n 270.1 25.15 m 540.25 25.15 l 540.25 13.15 l 270.1 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 503.59 15.56 Tm (L/ADD) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 270.4 3.56 Tm (25) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 659.8 m 612 659.8 l 612 647.8 l 0 647.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 650.21 Tm (Delay) Tj ET BT /F4 12 Tf 1 0 0 1 33.46 650.21 Tm (Notice.) Tj ET BT /F2 12 Tf 1 0 0 1 77.38 650.21 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 89.51 650.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 108.3 650.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 159.1 650.21 Tm (needs) Tj ET BT /F2 12 Tf 1 0 0 1 190.56 650.21 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 219.35 650.21 Tm (time) Tj ET BT /F2 12 Tf 1 0 0 1 244.81 650.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 258.28 650.21 Tm (process) Tj ET BT /F2 12 Tf 1 0 0 1 298.4 650.21 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 313.86 650.21 Tm (appeal,) Tj ET BT /F2 12 Tf 1 0 0 1 352.31 650.21 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 365.78 650.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 375.24 650.21 Tm (special) Tj ET BT /F2 12 Tf 1 0 0 1 412.69 650.21 Tm (case;) Tj ET BT /F2 12 Tf 1 0 0 1 440.81 650.21 Tm (then) Tj ET BT /F2 12 Tf 1 0 0 1 465.6 650.21 Tm (it) Tj ET BT /F2 12 Tf 1 0 0 1 476.41 650.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 499.21 650.21 Tm (send) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 650.21 Tm (the) Tj ET Q q n 0 647.8 m 612 647.8 l 612 635.8 l 0 635.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 638.21 Tm (claimant a written delay notice, by the 30) Tj ET BT /F2 7.2 Tf 1 0 0 1 198.6 641.81 Tm (th) Tj ET BT /F2 12 Tf 1 0 0 1 204.2 638.21 Tm ( day after receiving the request for review.) Tj ET BT /F2 12 Tf 1 0 0 1 414.1 638.21 Tm (The notice will explain:) Tj ET Q q n 18 635.8 m 630 635.8 l 630 623.8 l 18 623.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 626.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 626.21 Tm (the special circumstances which require the delay;) Tj ET Q q n 18 623.8 m 630 623.8 l 630 611.8 l 18 611.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 614.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 614.21 Tm (whether more information is needed to review the claim; and) Tj ET Q q n 18 611.8 m 630 611.8 l 630 599.8 l 18 599.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 602.21 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 602.21 Tm (when a decision can be expected.) Tj ET Q q n 0 599.8 m 612 599.8 l 612 587.8 l 0 587.8 l h W n Q q n 0 587.8 m 612 587.8 l 612 575.8 l 0 575.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 578.21 Tm (Exception:) Tj ET BT /F2 12 Tf 1 0 0 1 63.57 578.21 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 75.68 578.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 94.46 578.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 145.24 578.21 Tm (needs) Tj ET BT /F2 12 Tf 1 0 0 1 176.68 578.21 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 205.45 578.21 Tm (information) Tj ET BT /F2 12 Tf 1 0 0 1 266.23 578.21 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 293.67 578.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 312.45 578.21 Tm (claimant) Tj ET BT /F2 12 Tf 1 0 0 1 357.88 578.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 371.34 578.21 Tm (process) Tj ET BT /F2 12 Tf 1 0 0 1 411.44 578.21 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 426.89 578.21 Tm (appeal;) Tj ET BT /F2 12 Tf 1 0 0 1 465.65 578.21 Tm (then) Tj ET BT /F2 12 Tf 1 0 0 1 490.43 578.21 Tm (it) Tj ET BT /F2 12 Tf 1 0 0 1 501.22 578.21 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 528.67 578.21 Tm (be) Tj ET Q q n 0 575.8 m 612 575.8 l 612 563.8 l 0 563.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 566.21 Tm (supplied) Tj ET BT /F2 12 Tf 1 0 0 1 44.76 566.21 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 79.53 566.21 Tm (45) Tj ET BT /F2 12 Tf 1 0 0 1 95.63 566.21 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 121.72 566.21 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 147.8 566.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 166.56 566.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 217.32 566.21 Tm (requests) Tj ET BT /F2 12 Tf 1 0 0 1 260.74 566.21 Tm (it.) Tj ET BT /F2 12 Tf 1 0 0 1 278.61 566.21 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 301.36 566.21 Tm (resulting) Tj ET BT /F2 12 Tf 1 0 0 1 347.46 566.21 Tm (delay) Tj ET BT /F2 12 Tf 1 0 0 1 377.54 566.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 400.31 566.21 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 419.74 566.21 Tm (count) Tj ET BT /F2 12 Tf 1 0 0 1 450.5 566.21 Tm (towards) Tj ET BT /F2 12 Tf 1 0 0 1 492.59 566.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 511.35 566.21 Tm (above) Tj ET Q q n 0 563.8 m 612 563.8 l 612 551.8 l 0 551.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 554.21 Tm (time limits for appeal processing.) Tj ET Q q n 0 551.8 m 612 551.8 l 612 539.8 l 0 539.8 l h W n Q q n 0 539.8 m 612 539.8 l 612 527.8 l 0 527.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 530.21 Tm (Claims) Tj ET BT /F4 12 Tf 1 0 0 1 39.45 530.21 Tm (Subject) Tj ET BT /F4 12 Tf 1 0 0 1 81.56 530.21 Tm (to) Tj ET BT /F4 12 Tf 1 0 0 1 95 530.21 Tm (ERISA) Tj ET BT /F2 12 Tf 1 0 0 1 135.12 530.21 Tm ($Employee) Tj ET BT /F2 12 Tf 1 0 0 1 191.21 530.21 Tm (Retirement) Tj ET BT /F2 12 Tf 1 0 0 1 247.97 530.21 Tm (Income) Tj ET BT /F2 12 Tf 1 0 0 1 287.4 530.21 Tm (Security) Tj ET BT /F2 12 Tf 1 0 0 1 330.84 530.21 Tm (Act) Tj ET BT /F2 12 Tf 1 0 0 1 351.61 530.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 365.05 530.21 Tm (1974$.) Tj ET BT /F2 12 Tf 1 0 0 1 402.93 530.21 Tm (Before) Tj ET BT /F2 12 Tf 1 0 0 1 439.03 530.21 Tm (bringing) Tj ET BT /F2 12 Tf 1 0 0 1 483.14 530.21 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 491.91 530.21 Tm (civil) Tj ET BT /F2 12 Tf 1 0 0 1 516.68 530.21 Tm (legal) Tj ET Q q n 0 527.8 m 612 527.8 l 612 515.8 l 0 515.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 518.21 Tm (action) Tj ET BT /F2 12 Tf 1 0 0 1 33.23 518.21 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 64.46 518.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 83.03 518.21 Tm (federal) Tj ET BT /F2 12 Tf 1 0 0 1 120.24 518.21 Tm (labor) Tj ET BT /F2 12 Tf 1 0 0 1 148.8 518.21 Tm (law) Tj ET BT /F2 12 Tf 1 0 0 1 170.04 518.21 Tm (known) Tj ET BT /F2 12 Tf 1 0 0 1 206.61 518.21 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 220.51 518.21 Tm (ERISA,) Tj ET BT /F2 12 Tf 1 0 0 1 262.09 518.21 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 277.32 518.21 Tm (employee) Tj ET BT /F2 12 Tf 1 0 0 1 327.88 518.21 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 365.1 518.21 Tm (plan) Tj ET BT /F2 12 Tf 1 0 0 1 389.67 518.21 Tm (participant) Tj ET BT /F2 12 Tf 1 0 0 1 444.89 518.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 458.79 518.21 Tm (beneficiary) Tj ET BT /F2 12 Tf 1 0 0 1 516.66 518.21 Tm (must) Tj ET Q q n 0 515.8 m 612 515.8 l 612 503.8 l 0 503.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 506.21 Tm (exhaust) Tj ET BT /F2 12 Tf 1 0 0 1 40.95 506.21 Tm (available) Tj ET BT /F2 12 Tf 1 0 0 1 88.56 506.21 Tm (administrative) Tj ET BT /F2 12 Tf 1 0 0 1 161.5 506.21 Tm (remedies.) Tj ET BT /F2 12 Tf 1 0 0 1 216.41 506.21 Tm (Under) Tj ET BT /F2 12 Tf 1 0 0 1 250.69 506.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 269.65 506.21 Tm (Policy,) Tj ET BT /F2 12 Tf 1 0 0 1 307.61 506.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 326.57 506.21 Tm (claimant) Tj ET BT /F2 12 Tf 1 0 0 1 372.18 506.21 Tm (must) Tj ET BT /F2 12 Tf 1 0 0 1 399.81 506.21 Tm (first) Tj ET BT /F2 12 Tf 1 0 0 1 423.44 506.21 Tm (seek) Tj ET BT /F2 12 Tf 1 0 0 1 449.06 506.21 Tm (two) Tj ET BT /F2 12 Tf 1 0 0 1 471.35 506.21 Tm (administrative) Tj ET Q q n 0 503.8 m 612 503.8 l 612 491.8 l 0 491.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 494.21 Tm (reviews) Tj ET BT /F2 12 Tf 1 0 0 1 41.59 494.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 55.85 494.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 74.78 494.21 Tm (adverse) Tj ET BT /F2 12 Tf 1 0 0 1 115.69 494.21 Tm (claim) Tj ET BT /F2 12 Tf 1 0 0 1 146.61 494.21 Tm (decision,) Tj ET BT /F2 12 Tf 1 0 0 1 193.87 494.21 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 207.47 494.21 Tm (accord) Tj ET BT /F2 12 Tf 1 0 0 1 243.72 494.21 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 269.32 494.21 Tm (this) Tj ET BT /F2 12 Tf 1 0 0 1 290.92 494.21 Tm (section.) Tj ET BT /F2 12 Tf 1 0 0 1 336.45 494.21 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 348.71 494.21 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 364.3 494.21 Tm (ERISA) Tj ET BT /F2 12 Tf 1 0 0 1 403.24 494.21 Tm (claimant) Tj ET BT /F2 12 Tf 1 0 0 1 448.82 494.21 Tm (brings) Tj ET BT /F2 12 Tf 1 0 0 1 483.09 494.21 Tm (legal) Tj ET BT /F2 12 Tf 1 0 0 1 510.68 494.21 Tm (action) Tj ET Q q n 0 491.8 m 612 491.8 l 612 479.8 l 0 479.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 482.21 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 30.63 482.21 Tm (Section) Tj ET BT /F2 12 Tf 1 0 0 1 69.93 482.21 Tm (502$a$) Tj ET BT /F2 12 Tf 1 0 0 1 104.55 482.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 117.85 482.21 Tm (ERISA) Tj ET BT /F2 12 Tf 1 0 0 1 155.82 482.21 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 181.11 482.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 199.07 482.21 Tm (required) Tj ET BT /F2 12 Tf 1 0 0 1 242.36 482.21 Tm (reviews;) Tj ET BT /F2 12 Tf 1 0 0 1 286.31 482.21 Tm (then) Tj ET BT /F2 12 Tf 1 0 0 1 310.28 482.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 328.24 482.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 378.21 482.21 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 400.18 482.21 Tm (waive) Tj ET BT /F2 12 Tf 1 0 0 1 432.14 482.21 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 452.77 482.21 Tm (right) Tj ET BT /F2 12 Tf 1 0 0 1 478.74 482.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 491.38 482.21 Tm (assert) Tj ET BT /F2 12 Tf 1 0 0 1 522.01 482.21 Tm (that) Tj ET Q q n 0 479.8 m 612 479.8 l 612 467.8 l 0 467.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 470.21 Tm (he or she failed to exhaust administrative remedies.) Tj ET Q q n 0 467.8 m 612 467.8 l 612 455.8 l 0 455.8 l h W n Q q n 0 455.8 m 612 455.8 l 612 443.8 l 0 443.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 446.21 Tm (RIGHT) Tj ET BT /F4 12 Tf 1 0 0 1 44.14 446.21 Tm (OF) Tj ET BT /F4 12 Tf 1 0 0 1 64.94 446.21 Tm (RECOVERY.) Tj ET BT /F2 12 Tf 1 0 0 1 144.88 446.21 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 157.01 446.21 Tm (benefits) Tj ET BT /F2 12 Tf 1 0 0 1 199.14 446.21 Tm (have) Tj ET BT /F2 12 Tf 1 0 0 1 225.92 446.21 Tm (been) Tj ET BT /F2 12 Tf 1 0 0 1 252.71 446.21 Tm (overpaid) Tj ET BT /F2 12 Tf 1 0 0 1 298.83 446.21 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 314.96 446.21 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 336.43 446.21 Tm (claim;) Tj ET BT /F2 12 Tf 1 0 0 1 370.55 446.21 Tm (then) Tj ET BT /F2 12 Tf 1 0 0 1 395.34 446.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 414.14 446.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 464.94 446.21 Tm (has) Tj ET BT /F2 12 Tf 1 0 0 1 485.07 446.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 503.87 446.21 Tm (right) Tj ET BT /F2 12 Tf 1 0 0 1 530.67 446.21 Tm (to) Tj ET Q q n 0 443.8 m 612 443.8 l 612 431.8 l 0 431.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 434.21 Tm (recover the excess, from one or more of:) Tj ET Q q n 18 431.8 m 630 431.8 l 630 419.8 l 18 419.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 422.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 422.21 Tm (you or your estate;) Tj ET Q q n 18 419.8 m 630 419.8 l 630 407.8 l 18 407.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 410.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 410.21 Tm (your Beneficiary, or his or her estate; or) Tj ET Q q n 18 407.8 m 630 407.8 l 630 395.8 l 18 395.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 398.21 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 398.21 Tm (an insurance company or other organization which has been overpaid.) Tj ET Q q n 0 395.8 m 612 395.8 l 612 383.8 l 0 383.8 l h W n Q q n 0 383.8 m 612 383.8 l 612 371.8 l 0 371.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 374.21 Tm (LEGAL) Tj ET BT /F4 12 Tf 1 0 0 1 45.93 374.21 Tm (ACTIONS.) Tj ET BT /F2 12 Tf 1 0 0 1 111.43 374.21 Tm (No) Tj ET BT /F2 12 Tf 1 0 0 1 130.01 374.21 Tm (legal) Tj ET BT /F2 12 Tf 1 0 0 1 157.25 374.21 Tm (action) Tj ET BT /F2 12 Tf 1 0 0 1 190.48 374.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 203.73 374.21 Tm (recover) Tj ET BT /F2 12 Tf 1 0 0 1 243.62 374.21 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 264.86 374.21 Tm (benefits) Tj ET BT /F2 12 Tf 1 0 0 1 306.76 374.21 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 331.33 374.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 346.57 374.21 Tm (brought) Tj ET BT /F2 12 Tf 1 0 0 1 387.81 374.21 Tm (until) Tj ET BT /F2 12 Tf 1 0 0 1 413.73 374.21 Tm (60) Tj ET BT /F2 12 Tf 1 0 0 1 429.65 374.21 Tm (days) Tj ET BT /F2 12 Tf 1 0 0 1 455.56 374.21 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 481.45 374.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 500.02 374.21 Tm (required) Tj ET Q q n 0 371.8 m 612 371.8 l 612 359.8 l 0 359.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 362.21 Tm (written) Tj ET BT /F2 12 Tf 1 0 0 1 37.1 362.21 Tm (proof) Tj ET BT /F2 12 Tf 1 0 0 1 66.19 362.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 79.29 362.21 Tm (claim) Tj ET BT /F2 12 Tf 1 0 0 1 109.05 362.21 Tm (has) Tj ET BT /F2 12 Tf 1 0 0 1 128.15 362.21 Tm (been) Tj ET BT /F2 12 Tf 1 0 0 1 153.91 362.21 Tm (given.) Tj ET BT /F2 12 Tf 1 0 0 1 189.78 362.21 Tm (No) Tj ET BT /F2 12 Tf 1 0 0 1 207.55 362.21 Tm (such) Tj ET BT /F2 12 Tf 1 0 0 1 232.65 362.21 Tm (legal) Tj ET BT /F2 12 Tf 1 0 0 1 259.08 362.21 Tm (action) Tj ET BT /F2 12 Tf 1 0 0 1 291.5 362.21 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 315.27 362.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 329.7 362.21 Tm (brought) Tj ET BT /F2 12 Tf 1 0 0 1 370.13 362.21 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 397.89 362.21 Tm (than) Tj ET BT /F2 12 Tf 1 0 0 1 421.66 362.21 Tm (three) Tj ET BT /F2 12 Tf 1 0 0 1 448.74 362.21 Tm (years) Tj ET BT /F2 12 Tf 1 0 0 1 477.17 362.21 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 502.25 362.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 520.01 362.21 Tm (date) Tj ET Q q n 0 359.8 m 612 359.8 l 612 347.8 l 0 347.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 350.21 Tm (written proof of claim is required.) Tj ET Q q n 0 347.8 m 612 347.8 l 612 335.8 l 0 335.8 l h W n Q q n 0 335.8 m 612 335.8 l 612 323.8 l 0 323.8 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 326.21 Tm (COMPANY'S) Tj ET BT /F4 12 Tf 1 0 0 1 76.53 326.21 Tm (DISCRETIONARY) Tj ET BT /F4 12 Tf 1 0 0 1 182.41 326.21 Tm (AUTHORITY.) Tj ET BT /F2 12 Tf 1 0 0 1 267.16 326.21 Tm (Except) Tj ET BT /F2 12 Tf 1 0 0 1 304.34 326.21 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 322.2 326.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 340.73 326.21 Tm (functions) Tj ET BT /F2 12 Tf 1 0 0 1 389.26 326.21 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 411.12 326.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 429.65 326.21 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 464.18 326.21 Tm (clearly) Tj ET BT /F2 12 Tf 1 0 0 1 500.69 326.21 Tm (reserves) Tj ET Q q n 0 323.8 m 612 323.8 l 612 311.8 l 0 311.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 314.21 Tm (to the Group Policyholder or Employer, the Company has the authority to:) Tj ET Q q n 18 311.8 m 630 311.8 l 630 299.8 l 18 299.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 302.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 302.21 Tm (manage the Policy and administer claims under it; and) Tj ET Q q n 18 299.8 m 630 299.8 l 630 287.8 l 18 287.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 290.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 290.21 Tm (interpret the provisions and resolve questions arising under the Policy.) Tj ET Q q n 0 287.8 m 612 287.8 l 612 275.8 l 0 275.8 l h W n Q q n 0 275.8 m 612 275.8 l 612 263.8 l 0 263.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 266.21 Tm (The Company's authority includes $but is not limited to$ the right to:) Tj ET Q q n 18 263.8 m 630 263.8 l 630 251.8 l 18 251.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 254.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 254.21 Tm (establish and enforce procedures for administering the Policy and claims under it;) Tj ET Q q n 18 251.8 m 630 251.8 l 630 239.8 l 18 239.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 242.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 242.21 Tm (determine your eligibility for insurance and entitlement to benefits;) Tj ET Q q n 18 239.8 m 630 239.8 l 630 227.8 l 18 227.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 230.21 Tm ($3$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 230.21 Tm (determine what information the Company reasonably requires to make such decisions; and) Tj ET Q q n 18 227.8 m 630 227.8 l 630 215.8 l 18 215.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 218.21 Tm ($4$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 218.21 Tm (resolve all matters when a claim review is requested.) Tj ET Q q n 0 215.8 m 612 215.8 l 612 203.8 l 0 203.8 l h W n Q q n 0 203.8 m 612 203.8 l 612 191.8 l 0 191.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 194.21 Tm (Any) Tj ET BT /F2 12 Tf 1 0 0 1 24.63 194.21 Tm (decision) Tj ET BT /F2 12 Tf 1 0 0 1 68.59 194.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 87.22 194.21 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 137.85 194.21 Tm (makes,) Tj ET BT /F2 12 Tf 1 0 0 1 175.47 194.21 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 188.78 194.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 207.4 194.21 Tm (exercise) Tj ET BT /F2 12 Tf 1 0 0 1 250.68 194.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 264.64 194.21 Tm (its) Tj ET BT /F2 12 Tf 1 0 0 1 279.94 194.21 Tm (authority,) Tj ET BT /F2 12 Tf 1 0 0 1 330.24 194.21 Tm (shall) Tj ET BT /F2 12 Tf 1 0 0 1 356.87 194.21 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 372.16 194.21 Tm (conclusive) Tj ET BT /F2 12 Tf 1 0 0 1 427.45 194.21 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 448.74 194.21 Tm (binding;) Tj ET BT /F2 12 Tf 1 0 0 1 492.71 194.21 Tm (subject) Tj ET BT /F2 12 Tf 1 0 0 1 530.67 194.21 Tm (to) Tj ET Q q n 0 191.8 m 612 191.8 l 612 179.8 l 0 179.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 182.21 Tm (you or your Beneficiary's rights to:) Tj ET Q q n 18 179.8 m 630 179.8 l 630 167.8 l 18 167.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 170.21 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 170.21 Tm (request a state insurance department review; or) Tj ET Q q n 18 167.8 m 630 167.8 l 630 155.8 l 18 155.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 158.21 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 158.21 Tm (bring legal action.) Tj ET Q Q q Q Q endstream endobj 30 0 obj <>>>>> endobj 171 0 obj <> endobj 170 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 722.4 cm q n 0 48 m 612 48 l 612 36 l 0 36 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 151.32 38.41 Tm (NOTICE OF PROTECTION PROVIDED BY) Tj ET Q q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 48.3 26.41 Tm (PENNSYLVANIA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION) Tj ET 2 J 1.14 w [] 0 d 0 0 0 RG 48.87 24.53 m 491.13 24.53 l S 1 w [] 0 d Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 37.15 m 183.6 37.15 l 183.6 25.15 l 0 25.15 l h W n Q q n 183.6 37.15 m 367.2 37.15 l 367.2 25.15 l 183.6 25.15 l h W n Q q n 367.2 37.15 m 550.8 37.15 l 550.8 25.15 l 367.2 25.15 l h W n Q q n 0 25.15 m 183.6 25.15 l 183.6 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GAN-GRP-PA NOTICE-P/C) Tj ET Q q n 183.6 25.15 m 367.2 25.15 l 367.2 13.15 l 183.6 13.15 l h W n Q q n 367.2 25.15 m 550.8 25.15 l 550.8 13.15 l 367.2 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 512.67 15.56 Tm (11/20) Tj ET Q q n 0 13.15 m 183.6 13.15 l 183.6 1.15 l 0 1.15 l h W n Q q n 183.6 13.15 m 367.2 13.15 l 367.2 1.15 l 183.6 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 265 3.56 Tm (26) Tj ET Q q n 367.2 13.15 m 550.8 13.15 l 550.8 1.15 l 367.2 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.44 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 58.75 cm q n 0 649.85 m 612 649.85 l 612 637.85 l 0 637.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 640.26 Tm (This) Tj ET BT /F2 12 Tf 1 0 0 1 24.72 640.26 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 57.43 640.26 Tm (provides) Tj ET BT /F2 12 Tf 1 0 0 1 102.15 640.26 Tm (a) Tj ET BT /F4 12 Tf 1 0 0 1 110.86 640.26 Tm (brief) Tj ET BT /F4 12 Tf 1 0 0 1 138.91 640.26 Tm (summary) Tj ET BT /F2 12 Tf 1 0 0 1 190.96 640.26 Tm (regarding) Tj ET BT /F2 12 Tf 1 0 0 1 240.33 640.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 258.38 640.26 Tm (protections) Tj ET BT /F2 12 Tf 1 0 0 1 315.09 640.26 Tm (provided) Tj ET BT /F2 12 Tf 1 0 0 1 361.14 640.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 373.86 640.26 Tm (policyholders) Tj ET BT /F2 12 Tf 1 0 0 1 442.57 640.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 457.96 640.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 476.01 640.26 Tm (Pennsylvania) Tj ET Q q n 0 637.85 m 612 637.85 l 612 625.85 l 0 625.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 628.26 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 26.59 628.26 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 50.51 628.26 Tm (Health) Tj ET BT /F2 12 Tf 1 0 0 1 89.1 628.26 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 142.33 628.26 Tm (Guaranty) Tj ET BT /F2 12 Tf 1 0 0 1 193.58 628.26 Tm (Association) Tj ET BT /F2 12 Tf 1 0 0 1 256.84 628.26 Tm ($“the) Tj ET BT /F2 12 Tf 1 0 0 1 287.42 628.26 Tm (Association”$.) Tj ET BT /F2 12 Tf 1 0 0 1 363 628.26 Tm (This) Tj ET BT /F2 12 Tf 1 0 0 1 390.94 628.26 Tm (protection) Tj ET BT /F2 12 Tf 1 0 0 1 446.18 628.26 Tm (was) Tj ET BT /F2 12 Tf 1 0 0 1 471.44 628.26 Tm (created) Tj ET BT /F2 12 Tf 1 0 0 1 512.68 628.26 Tm (under) Tj ET Q q n 0 625.85 m 612 625.85 l 612 613.85 l 0 613.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 616.26 Tm (Pennsylvania law, which determines who and what is covered and the amounts of coverage.) Tj ET Q q n 0 613.85 m 612 613.85 l 612 601.85 l 0 601.85 l h W n Q q n 0 601.85 m 612 601.85 l 612 589.85 l 0 589.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 592.26 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 22.5 592.26 Tm (Association) Tj ET BT /F2 12 Tf 1 0 0 1 83 592.26 Tm (was) Tj ET BT /F2 12 Tf 1 0 0 1 105.5 592.26 Tm (established) Tj ET BT /F2 12 Tf 1 0 0 1 162.66 592.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 175.84 592.26 Tm (provide) Tj ET BT /F2 12 Tf 1 0 0 1 216.34 592.26 Tm (protection) Tj ET BT /F2 12 Tf 1 0 0 1 268.83 592.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 282.01 592.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 300.51 592.26 Tm (unlikely) Tj ET BT /F2 12 Tf 1 0 0 1 343.68 592.26 Tm (event) Tj ET BT /F2 12 Tf 1 0 0 1 373.51 592.26 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 395.34 592.26 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 421.18 592.26 Tm (member) Tj ET BT /F2 12 Tf 1 0 0 1 464.34 592.26 Tm (life,) Tj ET BT /F2 12 Tf 1 0 0 1 487.17 592.26 Tm (annuity,) Tj ET BT /F2 12 Tf 1 0 0 1 530 592.26 Tm (or) Tj ET Q q n 0 589.85 m 612 589.85 l 612 577.85 l 0 577.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 580.26 Tm (health) Tj ET BT /F2 12 Tf 1 0 0 1 32.36 580.26 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 81.38 580.26 Tm (company,) Tj ET BT /F2 12 Tf 1 0 0 1 131.4 580.26 Tm (RANLI) Tj ET BT /F2 12 Tf 1 0 0 1 171.11 580.26 Tm (PPO,) Tj ET BT /F2 12 Tf 1 0 0 1 199.16 580.26 Tm (hospital) Tj ET BT /F2 12 Tf 1 0 0 1 240.2 580.26 Tm (plan) Tj ET BT /F2 12 Tf 1 0 0 1 263.9 580.26 Tm (corporation,) Tj ET BT /F2 12 Tf 1 0 0 1 325.25 580.26 Tm (professional) Tj ET BT /F2 12 Tf 1 0 0 1 386.94 580.26 Tm (health) Tj ET BT /F2 12 Tf 1 0 0 1 419.3 580.26 Tm (services) Tj ET BT /F2 12 Tf 1 0 0 1 460.99 580.26 Tm (plan) Tj ET BT /F2 12 Tf 1 0 0 1 484.69 580.26 Tm (corporation) Tj ET Q q n 0 577.85 m 612 577.85 l 612 565.85 l 0 565.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 568.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 13.46 568.26 Tm (health) Tj ET BT /F2 12 Tf 1 0 0 1 46.25 568.26 Tm (maintenance) Tj ET BT /F2 12 Tf 1 0 0 1 110.34 568.26 Tm (organization) Tj ET BT /F2 12 Tf 1 0 0 1 173.79 568.26 Tm ($member) Tj ET BT /F2 12 Tf 1 0 0 1 220.56 568.26 Tm (insurer$) Tj ET BT /F2 12 Tf 1 0 0 1 261.35 568.26 Tm (becomes) Tj ET BT /F2 12 Tf 1 0 0 1 306.79 568.26 Tm (financially) Tj ET BT /F2 12 Tf 1 0 0 1 361.57 568.26 Tm (unable) Tj ET BT /F2 12 Tf 1 0 0 1 397.02 568.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 409.82 568.26 Tm (meet) Tj ET BT /F2 12 Tf 1 0 0 1 436.61 568.26 Tm (its) Tj ET BT /F2 12 Tf 1 0 0 1 451.41 568.26 Tm (obligations.) Tj ET BT /F2 12 Tf 1 0 0 1 511.21 568.26 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 522.66 568.26 Tm (this) Tj ET Q q n 0 565.85 m 612 565.85 l 612 553.85 l 0 553.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 556.26 Tm (should) Tj ET BT /F2 12 Tf 1 0 0 1 36.66 556.26 Tm (happen,) Tj ET BT /F2 12 Tf 1 0 0 1 78.96 556.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 98.28 556.26 Tm (Association) Tj ET BT /F2 12 Tf 1 0 0 1 159.59 556.26 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 182.91 556.26 Tm (typically) Tj ET BT /F2 12 Tf 1 0 0 1 229.55 556.26 Tm (arrange) Tj ET BT /F2 12 Tf 1 0 0 1 270.18 556.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 284.17 556.26 Tm (provide) Tj ET BT /F2 12 Tf 1 0 0 1 325.48 556.26 Tm (coverage,) Tj ET BT /F2 12 Tf 1 0 0 1 376.43 556.26 Tm (pay) Tj ET BT /F2 12 Tf 1 0 0 1 398.41 556.26 Tm (claims,) Tj ET BT /F2 12 Tf 1 0 0 1 437.39 556.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 452.04 556.26 Tm (otherwise) Tj ET BT /F2 12 Tf 1 0 0 1 503.34 556.26 Tm (provide) Tj ET Q q n 0 553.85 m 612 553.85 l 612 541.85 l 0 541.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 544.26 Tm (protection) Tj ET BT /F2 12 Tf 1 0 0 1 52.92 544.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 66.53 544.26 Tm (accordance) Tj ET BT /F2 12 Tf 1 0 0 1 124.75 544.26 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 150.36 544.26 Tm (Pennsylvania) Tj ET BT /F2 12 Tf 1 0 0 1 218.62 544.26 Tm (law.) Tj ET BT /F2 12 Tf 1 0 0 1 243.21 544.26 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 266.14 544.26 Tm (protection) Tj ET BT /F2 12 Tf 1 0 0 1 319.06 544.26 Tm (provided) Tj ET BT /F2 12 Tf 1 0 0 1 365.99 544.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 382.26 544.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 401.19 544.26 Tm (Association) Tj ET BT /F2 12 Tf 1 0 0 1 462.12 544.26 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 474.4 544.26 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 494 544.26 Tm (unlimited) Tj ET Q q n 0 541.85 m 612 541.85 l 612 529.85 l 0 529.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 532.26 Tm (and is not a substitute for consumers' care in selecting companies that are well managed and financially stable.) Tj ET Q q n 0 529.85 m 612 529.85 l 612 517.85 l 0 517.85 l h W n Q q n 0 517.85 m 612 517.85 l 612 505.85 l 0 505.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 508.26 Tm (Below) Tj ET BT /F2 12 Tf 1 0 0 1 35.21 508.26 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 47.1 508.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 56.31 508.26 Tm (brief) Tj ET BT /F2 12 Tf 1 0 0 1 82.84 508.26 Tm (summary) Tj ET BT /F2 12 Tf 1 0 0 1 131.38 508.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 145.26 508.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 163.8 508.26 Tm (coverages,) Tj ET BT /F2 12 Tf 1 0 0 1 218.65 508.26 Tm (exclusions) Tj ET BT /F2 12 Tf 1 0 0 1 273.19 508.26 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 294.4 508.26 Tm (limits) Tj ET BT /F2 12 Tf 1 0 0 1 325.62 508.26 Tm (provided) Tj ET BT /F2 12 Tf 1 0 0 1 372.16 508.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 388.04 508.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 406.58 508.26 Tm (Association.) Tj ET BT /F2 12 Tf 1 0 0 1 470.12 508.26 Tm (This) Tj ET BT /F2 12 Tf 1 0 0 1 495.34 508.26 Tm (summary) Tj ET Q q n 0 505.85 m 612 505.85 l 612 493.85 l 0 493.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 496.26 Tm (does) Tj ET BT /F2 12 Tf 1 0 0 1 26.33 496.26 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 45.99 496.26 Tm (cover) Tj ET BT /F2 12 Tf 1 0 0 1 76.97 496.26 Tm (all) Tj ET BT /F2 12 Tf 1 0 0 1 93.3 496.26 Tm (provisions) Tj ET BT /F2 12 Tf 1 0 0 1 147.63 496.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 161.96 496.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 180.95 496.26 Tm (law;) Tj ET BT /F2 12 Tf 1 0 0 1 205.94 496.26 Tm (nor) Tj ET BT /F2 12 Tf 1 0 0 1 226.27 496.26 Tm (does) Tj ET BT /F2 12 Tf 1 0 0 1 252.59 496.26 Tm (it) Tj ET BT /F2 12 Tf 1 0 0 1 263.59 496.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 277.26 496.26 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 298.91 496.26 Tm (way) Tj ET BT /F2 12 Tf 1 0 0 1 323.24 496.26 Tm (change) Tj ET BT /F2 12 Tf 1 0 0 1 361.54 496.26 Tm (anyone's) Tj ET BT /F2 12 Tf 1 0 0 1 407.36 496.26 Tm (rights) Tj ET BT /F2 12 Tf 1 0 0 1 439.02 496.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 453.35 496.26 Tm (obligations) Tj ET BT /F2 12 Tf 1 0 0 1 511.01 496.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 496.26 Tm (the) Tj ET Q q n 0 493.85 m 612 493.85 l 612 481.85 l 0 481.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 484.26 Tm (rights or obligations of the Association.) Tj ET Q q n 0 481.85 m 612 481.85 l 612 469.85 l 0 469.85 l h W n Q q n 0 469.85 m 612 469.85 l 612 457.85 l 0 457.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 235.33 460.26 Tm (COVERAGE) Tj ET 2 J 1.14 w [] 0 d 0 0 0 RG 235.9 458.38 m 304.1 458.38 l S 1 w [] 0 d Q q n 0 457.85 m 612 457.85 l 612 445.85 l 0 445.85 l h W n Q q n 0 445.85 m 612 445.85 l 612 433.85 l 0 433.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 436.26 Tm (Persons Covered) Tj ET 2 J 1.14 w [] 0 d 0 0 0 RG 0.57 434.38 m 85.74 434.38 l S 1 w [] 0 d Q q n 0 433.85 m 612 433.85 l 612 421.85 l 0 421.85 l h W n Q q n 0 421.85 m 612 421.85 l 612 409.85 l 0 409.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 412.26 Tm (Generally,) Tj ET BT /F2 12 Tf 1 0 0 1 56.3 412.26 Tm (individuals) Tj ET BT /F2 12 Tf 1 0 0 1 115.62 412.26 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 140.27 412.26 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 157.59 412.26 Tm (protected) Tj ET BT /F2 12 Tf 1 0 0 1 208.22 412.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 226.21 412.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 246.86 412.26 Tm (Association) Tj ET BT /F2 12 Tf 1 0 0 1 309.5 412.26 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 322.82 412.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 343.47 412.26 Tm (member) Tj ET BT /F2 12 Tf 1 0 0 1 388.78 412.26 Tm (insurer) Tj ET BT /F2 12 Tf 1 0 0 1 428.09 412.26 Tm (was) Tj ET BT /F2 12 Tf 1 0 0 1 452.74 412.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 464.05 412.26 Tm (member) Tj ET BT /F2 12 Tf 1 0 0 1 509.36 412.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 412.26 Tm (the) Tj ET Q q n 0 409.85 m 612 409.85 l 612 397.85 l 0 397.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 400.26 Tm (Association) Tj ET BT /F2 12 Tf 1 0 0 1 60.08 400.26 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 80.81 400.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 98.89 400.26 Tm (individual) Tj ET BT /F2 12 Tf 1 0 0 1 150.97 400.26 Tm (lives) Tj ET BT /F2 12 Tf 1 0 0 1 177.05 400.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 189.79 400.26 Tm (Pennsylvania) Tj ET BT /F2 12 Tf 1 0 0 1 257.2 400.26 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 269.27 400.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 287.35 400.26 Tm (time) Tj ET BT /F2 12 Tf 1 0 0 1 312.09 400.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 330.16 400.26 Tm (member) Tj ET BT /F2 12 Tf 1 0 0 1 372.9 400.26 Tm (insurer) Tj ET BT /F2 12 Tf 1 0 0 1 409.63 400.26 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 421.05 400.26 Tm (determined) Tj ET BT /F2 12 Tf 1 0 0 1 478.44 400.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 493.86 400.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 502.6 400.26 Tm (court) Tj ET BT /F2 12 Tf 1 0 0 1 530.67 400.26 Tm (to) Tj ET Q q n 0 397.85 m 612 397.85 l 612 385.85 l 0 385.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 388.26 Tm (be insolvent. Coverage is also provided to policy beneficiaries, payees or assignees of such individuals.) Tj ET Q q n 0 385.85 m 612 385.85 l 612 373.85 l 0 373.85 l h W n Q q n 0 373.85 m 612 373.85 l 612 361.85 l 0 361.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 364.26 Tm (Amounts of Coverage) Tj ET 2 J 1.14 w [] 0 d 0 0 0 RG 0.57 362.38 m 110.74 362.38 l S 1 w [] 0 d Q q n 0 361.85 m 612 361.85 l 612 349.85 l 0 349.85 l h W n Q q n 0 349.85 m 612 349.85 l 612 337.85 l 0 337.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 340.26 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 22.88 340.26 Tm (basic) Tj ET BT /F2 12 Tf 1 0 0 1 51.75 340.26 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 99.27 340.26 Tm (protections) Tj ET BT /F2 12 Tf 1 0 0 1 156.81 340.26 Tm (provided) Tj ET BT /F2 12 Tf 1 0 0 1 203.68 340.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 219.9 340.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 238.78 340.26 Tm (Association) Tj ET BT /F2 12 Tf 1 0 0 1 299.66 340.26 Tm (per) Tj ET BT /F2 12 Tf 1 0 0 1 319.2 340.26 Tm (insured) Tj ET BT /F2 12 Tf 1 0 0 1 358.75 340.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 372.3 340.26 Tm (each) Tj ET BT /F2 12 Tf 1 0 0 1 398.5 340.26 Tm (insolvency) Tj ET BT /F2 12 Tf 1 0 0 1 454.71 340.26 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 473.57 340.26 Tm (limited) Tj ET BT /F2 12 Tf 1 0 0 1 511.79 340.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 340.26 Tm (the) Tj ET Q q n 0 337.85 m 612 337.85 l 612 325.85 l 0 325.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 328.26 Tm (aggregate) Tj ET BT /F2 12 Tf 1 0 0 1 52.37 328.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 67.44 328.26 Tm ($300,000) Tj ET BT /F2 12 Tf 1 0 0 1 118.18 328.26 Tm ($or) Tj ET BT /F2 12 Tf 1 0 0 1 137.91 328.26 Tm ($500,000) Tj ET BT /F2 12 Tf 1 0 0 1 188.65 328.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 203.72 328.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 224.12 328.26 Tm (case) Tj ET BT /F2 12 Tf 1 0 0 1 250.51 328.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 266.24 328.26 Tm (health) Tj ET BT /F2 12 Tf 1 0 0 1 301.3 328.26 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 340.35 328.26 Tm (plans$,) Tj ET BT /F2 12 Tf 1 0 0 1 378.42 328.26 Tm (including) Tj ET BT /F2 12 Tf 1 0 0 1 429.48 328.26 Tm (specific) Tj ET BT /F2 12 Tf 1 0 0 1 472.53 328.26 Tm (limits) Tj ET BT /F2 12 Tf 1 0 0 1 505.61 328.26 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 328.26 Tm (the) Tj ET Q q n 0 325.85 m 612 325.85 l 612 313.85 l 0 313.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 316.26 Tm (following types of coverage but not in excess of the contractual obligations of the member insurer;) Tj ET Q q n 0 313.85 m 612 313.85 l 612 301.85 l 0 301.85 l h W n Q q n 0 301.85 m 612 301.85 l 612 289.85 l 0 289.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 292.26 Tm (Life insurance:) Tj ET Q q n 0 289.85 m 612 289.85 l 612 277.85 l 0 277.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 280.26 Tm (o Up to $300,000 in death benefits including up to $100,000 in net cash surrender or withdrawal value.) Tj ET Q q n 0 277.85 m 612 277.85 l 612 265.85 l 0 265.85 l h W n Q q n 0 265.85 m 612 265.85 l 612 253.85 l 0 253.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 256.26 Tm (Accident, accident and health, or health insurance $including HMOs$:) Tj ET Q q n 18 253.85 m 630 253.85 l 630 241.85 l 18 241.85 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 244.26 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 244.26 Tm (Up to $500,000 for health benefit plans, with some exceptions.) Tj ET Q q n 18 241.85 m 630 241.85 l 630 229.85 l 18 229.85 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 232.26 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 232.26 Tm (Up to $300,000 for disability income benefits.) Tj ET Q q n 18 229.85 m 630 229.85 l 630 217.85 l 18 217.85 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 220.26 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 220.26 Tm (Up to $300,000 for long-term care insurance benefits.) Tj ET Q q n 18 217.85 m 630 217.85 l 630 205.85 l 18 205.85 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 208.26 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 208.26 Tm (Up to $100,000 for all other types of health insurance.) Tj ET Q q n 0 205.85 m 612 205.85 l 612 193.85 l 0 193.85 l h W n Q q n 0 193.85 m 612 193.85 l 612 181.85 l 0 181.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 184.26 Tm (Individual annuities) Tj ET Q q n 18 181.85 m 630 181.85 l 630 169.85 l 18 169.85 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 172.26 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 172.26 Tm (Up) Tj ET BT /F2 12 Tf 1 0 0 1 56.01 172.26 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 70.68 172.26 Tm ($250,000) Tj ET BT /F2 12 Tf 1 0 0 1 121.03 172.26 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 135.7 172.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 155.71 172.26 Tm (present) Tj ET BT /F2 12 Tf 1 0 0 1 195.7 172.26 Tm (value) Tj ET BT /F2 12 Tf 1 0 0 1 227.03 172.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 242.37 172.26 Tm (benefits,) Tj ET BT /F2 12 Tf 1 0 0 1 288.7 172.26 Tm (including) Tj ET BT /F2 12 Tf 1 0 0 1 339.37 172.26 Tm (cash) Tj ET BT /F2 12 Tf 1 0 0 1 366.03 172.26 Tm (surrender) Tj ET BT /F2 12 Tf 1 0 0 1 416.68 172.26 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 439.35 172.26 Tm (net) Tj ET BT /F2 12 Tf 1 0 0 1 459.35 172.26 Tm (cash) Tj ET BT /F2 12 Tf 1 0 0 1 486.02 172.26 Tm (withdrawal) Tj ET Q q n 36 169.85 m 648 169.85 l 648 157.85 l 36 157.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 36 160.26 Tm (values.) Tj ET Q q n 0 157.85 m 612 157.85 l 612 145.85 l 0 145.85 l h W n Q q n 0 145.85 m 612 145.85 l 612 133.85 l 0 133.85 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 117.65 136.26 Tm (LIMITATIONS AND EXCLUSIONS FROM COVERAGE) Tj ET 2 J 1.14 w [] 0 d 0 0 0 RG 118.22 134.38 m 421.78 134.38 l S 1 w [] 0 d Q q n 0 133.85 m 612 133.85 l 612 121.85 l 0 121.85 l h W n Q q n 0 121.85 m 612 121.85 l 612 109.85 l 0 109.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 112.26 Tm (The Association also does not provide coverage for:) Tj ET Q q n 0 109.85 m 612 109.85 l 612 97.85 l 0 97.85 l h W n Q q n 18 97.85 m 630 97.85 l 630 85.85 l 18 85.85 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 88.26 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 88.26 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 56.93 88.26 Tm (policy) Tj ET BT /F2 12 Tf 1 0 0 1 90.52 88.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 104.12 88.26 Tm (contract) Tj ET BT /F2 12 Tf 1 0 0 1 146.37 88.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 159.96 88.26 Tm (portion) Tj ET BT /F2 12 Tf 1 0 0 1 198.23 88.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 211.83 88.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 220.75 88.26 Tm (policy) Tj ET BT /F2 12 Tf 1 0 0 1 254.35 88.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 267.95 88.26 Tm (contract) Tj ET BT /F2 12 Tf 1 0 0 1 310.19 88.26 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 343.12 88.26 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 354.73 88.26 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 373.66 88.26 Tm (guaranteed) Tj ET BT /F2 12 Tf 1 0 0 1 429.9 88.26 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 445.5 88.26 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 463.76 88.26 Tm (member) Tj ET BT /F2 12 Tf 1 0 0 1 506.68 88.26 Tm (insurer) Tj ET Q q n 36 85.85 m 648 85.85 l 648 73.85 l 36 73.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 36 76.26 Tm (or for which the individual has assumed the risk, such as a variable contract sold by prospectus;) Tj ET Q q n 18 73.85 m 630 73.85 l 630 61.85 l 18 61.85 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 64.26 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 64.26 Tm (claims) Tj ET BT /F2 12 Tf 1 0 0 1 72.43 64.26 Tm (based) Tj ET BT /F2 12 Tf 1 0 0 1 104.86 64.26 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 121.97 64.26 Tm (marketing) Tj ET BT /F2 12 Tf 1 0 0 1 175.72 64.26 Tm (materials) Tj ET BT /F2 12 Tf 1 0 0 1 224.81 64.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 239.91 64.26 Tm (other) Tj ET BT /F2 12 Tf 1 0 0 1 269.68 64.26 Tm (documents) Tj ET BT /F2 12 Tf 1 0 0 1 326.77 64.26 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 361.2 64.26 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 380.96 64.26 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 401.4 64.26 Tm (approved) Tj ET BT /F2 12 Tf 1 0 0 1 451.15 64.26 Tm (policy) Tj ET BT /F2 12 Tf 1 0 0 1 486.26 64.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 501.36 64.26 Tm (contract) Tj ET Q q n 36 61.85 m 648 61.85 l 648 49.85 l 36 49.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 36 52.26 Tm (forms,) Tj ET BT /F2 12 Tf 1 0 0 1 71.95 52.26 Tm (claims) Tj ET BT /F2 12 Tf 1 0 0 1 108.24 52.26 Tm (based) Tj ET BT /F2 12 Tf 1 0 0 1 140.52 52.26 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 157.48 52.26 Tm (misrepresentations) Tj ET BT /F2 12 Tf 1 0 0 1 252.41 52.26 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 267.37 52.26 Tm (policy) Tj ET BT /F2 12 Tf 1 0 0 1 302.32 52.26 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 317.27 52.26 Tm (contract) Tj ET BT /F2 12 Tf 1 0 0 1 360.88 52.26 Tm (benefits,) Tj ET BT /F2 12 Tf 1 0 0 1 406.82 52.26 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 429.1 52.26 Tm (other) Tj ET BT /F2 12 Tf 1 0 0 1 458.72 52.26 Tm (extra-contractual) Tj ET Q q n 36 49.85 m 648 49.85 l 648 37.85 l 36 37.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 36 40.26 Tm (claims;) Tj ET Q q n 18 37.85 m 630 37.85 l 630 25.85 l 18 25.85 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 28.26 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 28.26 Tm (any policy of reinsurance $unless an assumption certificate was issued$;) Tj ET Q q n 18 25.85 m 630 25.85 l 630 13.85 l 18 13.85 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 16.26 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 16.26 Tm (interest rate yields or increases based on an index that exceed an average rate specified by statute;) Tj ET Q Q q Q Q endstream endobj 31 0 obj <>>>>> endobj 178 0 obj <>/Border[0 0 0]/Rect[439.79 444 526.43 456]/Subtype/Link>> endobj 179 0 obj <>/Border[0 0 0]/Rect[252 324 362.3 336]/Subtype/Link>> endobj 180 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 758.4 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 37.15 m 183.6 37.15 l 183.6 25.15 l 0 25.15 l h W n Q q n 183.6 37.15 m 367.2 37.15 l 367.2 25.15 l 183.6 25.15 l h W n Q q n 367.2 37.15 m 550.8 37.15 l 550.8 25.15 l 367.2 25.15 l h W n Q q n 0 25.15 m 183.6 25.15 l 183.6 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GAN-GRP-PA NOTICE-P/C) Tj ET Q q n 183.6 25.15 m 367.2 25.15 l 367.2 13.15 l 183.6 13.15 l h W n Q q n 367.2 25.15 m 550.8 25.15 l 550.8 13.15 l 367.2 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 512.67 15.56 Tm (11/20) Tj ET Q q n 0 13.15 m 183.6 13.15 l 183.6 1.15 l 0 1.15 l h W n Q q n 183.6 13.15 m 367.2 13.15 l 367.2 1.15 l 183.6 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 265 3.56 Tm (27) Tj ET Q q n 367.2 13.15 m 550.8 13.15 l 550.8 1.15 l 367.2 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.44 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 58.75 cm q n 18 697.25 m 630 697.25 l 630 685.25 l 18 685.25 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 687.66 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 687.66 Tm (dividends,) Tj ET BT /F2 12 Tf 1 0 0 1 88.87 687.66 Tm (experience) Tj ET BT /F2 12 Tf 1 0 0 1 144.04 687.66 Tm (rating) Tj ET BT /F2 12 Tf 1 0 0 1 175.25 687.66 Tm (credits,) Tj ET BT /F2 12 Tf 1 0 0 1 213.44 687.66 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 226.65 687.66 Tm (credits) Tj ET BT /F2 12 Tf 1 0 0 1 261.84 687.66 Tm (given) Tj ET BT /F2 12 Tf 1 0 0 1 291.71 687.66 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 304.26 687.66 Tm (connection) Tj ET BT /F2 12 Tf 1 0 0 1 360.11 687.66 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 384.66 687.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 402.53 687.66 Tm (administration) Tj ET BT /F2 12 Tf 1 0 0 1 475.06 687.66 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 488.26 687.66 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 496.8 687.66 Tm (policy) Tj ET BT /F2 12 Tf 1 0 0 1 530 687.66 Tm (or) Tj ET Q q n 36 685.25 m 648 685.25 l 648 673.25 l 36 673.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 36 675.66 Tm (contract by a group contractholder;) Tj ET Q q n 18 673.25 m 630 673.25 l 630 661.25 l 18 661.25 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 663.66 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 663.66 Tm (employers') Tj ET BT /F2 12 Tf 1 0 0 1 92.5 663.66 Tm (plans) Tj ET BT /F2 12 Tf 1 0 0 1 122.19 663.66 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 144.54 663.66 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 163.54 663.66 Tm (self-funded) Tj ET BT /F2 12 Tf 1 0 0 1 222.54 663.66 Tm ($that) Tj ET BT /F2 12 Tf 1 0 0 1 248.88 663.66 Tm (is,) Tj ET BT /F2 12 Tf 1 0 0 1 264.24 663.66 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 283.93 663.66 Tm (insured) Tj ET BT /F2 12 Tf 1 0 0 1 323.61 663.66 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 339.97 663.66 Tm (member) Tj ET BT /F2 12 Tf 1 0 0 1 383.64 663.66 Tm (insurer,) Tj ET BT /F2 12 Tf 1 0 0 1 424.32 663.66 Tm (even) Tj ET BT /F2 12 Tf 1 0 0 1 451.32 663.66 Tm (if) Tj ET BT /F2 12 Tf 1 0 0 1 463.01 663.66 Tm (member) Tj ET BT /F2 12 Tf 1 0 0 1 506.68 663.66 Tm (insurer) Tj ET Q q n 36 661.25 m 648 661.25 l 648 649.25 l 36 649.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 36 651.66 Tm (administers them$;) Tj ET Q q n 18 649.25 m 630 649.25 l 630 637.25 l 18 637.25 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 639.66 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 639.66 Tm (unallocated) Tj ET BT /F2 12 Tf 1 0 0 1 94.88 639.66 Tm (annuity) Tj ET BT /F2 12 Tf 1 0 0 1 134.45 639.66 Tm (contracts) Tj ET BT /F2 12 Tf 1 0 0 1 181.34 639.66 Tm ($which) Tj ET BT /F2 12 Tf 1 0 0 1 218.23 639.66 Tm (give) Tj ET BT /F2 12 Tf 1 0 0 1 242.47 639.66 Tm (rights) Tj ET BT /F2 12 Tf 1 0 0 1 273.37 639.66 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 286.28 639.66 Tm (group) Tj ET BT /F2 12 Tf 1 0 0 1 317.85 639.66 Tm (contractholders,) Tj ET BT /F2 12 Tf 1 0 0 1 398.39 639.66 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 417.3 639.66 Tm (individuals$) Tj ET BT /F2 12 Tf 1 0 0 1 478.2 639.66 Tm (other) Tj ET BT /F2 12 Tf 1 0 0 1 506.43 639.66 Tm (than) Tj ET BT /F2 12 Tf 1 0 0 1 530.67 639.66 Tm (in) Tj ET Q q n 36 637.25 m 648 637.25 l 648 625.25 l 36 625.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 36 627.66 Tm (limited circumstances and amounts;) Tj ET Q q n 18 625.25 m 630 625.25 l 630 613.25 l 18 613.25 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 615.66 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 615.66 Tm (certain) Tj ET BT /F2 12 Tf 1 0 0 1 72.03 615.66 Tm (contracts) Tj ET BT /F2 12 Tf 1 0 0 1 118.73 615.66 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 151.44 615.66 Tm (establish) Tj ET BT /F2 12 Tf 1 0 0 1 196.82 615.66 Tm (benefits) Tj ET BT /F2 12 Tf 1 0 0 1 238.19 615.66 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 253.58 615.66 Tm (reference) Tj ET BT /F2 12 Tf 1 0 0 1 301.58 615.66 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 314.3 615.66 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 323.01 615.66 Tm (portfolio) Tj ET BT /F2 12 Tf 1 0 0 1 368.39 615.66 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 381.77 615.66 Tm (assets) Tj ET BT /F2 12 Tf 1 0 0 1 413.16 615.66 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 431.87 615.66 Tm (owned) Tj ET BT /F2 12 Tf 1 0 0 1 467.25 615.66 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 482.64 615.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 500.68 615.66 Tm (member) Tj ET Q q n 36 613.25 m 648 613.25 l 648 601.25 l 36 601.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 36 603.66 Tm (insurer; or) Tj ET Q q n 18 601.25 m 630 601.25 l 630 589.25 l 18 589.25 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 591.66 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 591.66 Tm (policies) Tj ET BT /F2 12 Tf 1 0 0 1 77.4 591.66 Tm (providing) Tj ET BT /F2 12 Tf 1 0 0 1 128.14 591.66 Tm (health) Tj ET BT /F2 12 Tf 1 0 0 1 161.53 591.66 Tm (care) Tj ET BT /F2 12 Tf 1 0 0 1 185.58 591.66 Tm (benefits) Tj ET BT /F2 12 Tf 1 0 0 1 227.64 591.66 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 245.7 591.66 Tm (Medicare) Tj ET BT /F2 12 Tf 1 0 0 1 295.08 591.66 Tm (Parts) Tj ET BT /F2 12 Tf 1 0 0 1 323.16 591.66 Tm (C) Tj ET BT /F2 12 Tf 1 0 0 1 335.23 591.66 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 349.3 591.66 Tm (D) Tj ET BT /F2 12 Tf 1 0 0 1 362.04 591.66 Tm (coverage,) Tj ET BT /F2 12 Tf 1 0 0 1 412.42 591.66 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 430.48 591.66 Tm (Medicaid) Tj ET BT /F2 12 Tf 1 0 0 1 479.87 591.66 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 493.94 591.66 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 591.66 Tm (the) Tj ET Q q n 36 589.25 m 648 589.25 l 648 577.25 l 36 577.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 36 579.66 Tm (Pennsylvania program for Comprehensive Health Care for Uninsured Children.) Tj ET Q q n 0 577.25 m 612 577.25 l 612 565.25 l 0 565.25 l h W n Q q n 0 565.25 m 612 565.25 l 612 553.25 l 0 553.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 555.66 Tm (The following policies and persons are among those that are excluded from Association coverage:) Tj ET Q q n 36 553.25 m 648 553.25 l 648 541.25 l 36 541.25 l h W n Q q n 18 541.25 m 630 541.25 l 630 529.25 l 18 529.25 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 531.66 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 531.66 Tm (A) Tj ET BT /F2 12 Tf 1 0 0 1 47.97 531.66 Tm (policy) Tj ET BT /F2 12 Tf 1 0 0 1 81.26 531.66 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 94.56 531.66 Tm (contract) Tj ET BT /F2 12 Tf 1 0 0 1 136.51 531.66 Tm (issued) Tj ET BT /F2 12 Tf 1 0 0 1 169.81 531.66 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 185.11 531.66 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 199.74 531.66 Tm (insurer) Tj ET BT /F2 12 Tf 1 0 0 1 236.36 531.66 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 257.66 531.66 Tm (was) Tj ET BT /F2 12 Tf 1 0 0 1 279.62 531.66 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 298.26 531.66 Tm (authorized) Tj ET BT /F2 12 Tf 1 0 0 1 352.2 531.66 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 364.84 531.66 Tm (do) Tj ET BT /F2 12 Tf 1 0 0 1 380.14 531.66 Tm (business) Tj ET BT /F2 12 Tf 1 0 0 1 424.11 531.66 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 436.75 531.66 Tm (Pennsylvania) Tj ET BT /F2 12 Tf 1 0 0 1 504.04 531.66 Tm (when) Tj ET BT /F2 12 Tf 1 0 0 1 533.33 531.66 Tm (it) Tj ET Q q n 36 529.25 m 648 529.25 l 648 517.25 l 36 517.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 36 519.66 Tm (issued the policy or contract) Tj ET Q q n 18 517.25 m 630 517.25 l 630 505.25 l 18 505.25 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 507.66 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 507.66 Tm (If the person is provided coverage by the guaranty association of another state) Tj ET Q q n 18 505.25 m 630 505.25 l 630 493.25 l 18 493.25 l h W n 0 0 0 rg BT /F156 12 Tf 1 0 0 1 18 495.66 Tm (x) Tj ET BT /F2 12 Tf 1 0 0 1 36 495.66 Tm (A) Tj ET BT /F2 12 Tf 1 0 0 1 49.74 495.66 Tm (policy) Tj ET BT /F2 12 Tf 1 0 0 1 84.81 495.66 Tm (issued) Tj ET BT /F2 12 Tf 1 0 0 1 119.89 495.66 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 136.96 495.66 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 147.36 495.66 Tm (fraternal) Tj ET BT /F2 12 Tf 1 0 0 1 193.07 495.66 Tm (benefit) Tj ET BT /F2 12 Tf 1 0 0 1 231.47 495.66 Tm (society,) Tj ET BT /F2 12 Tf 1 0 0 1 273.53 495.66 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 283.93 495.66 Tm (mandatory) Tj ET BT /F2 12 Tf 1 0 0 1 340.32 495.66 Tm (state) Tj ET BT /F2 12 Tf 1 0 0 1 367.39 495.66 Tm (pooling) Tj ET BT /F2 12 Tf 1 0 0 1 409.13 495.66 Tm (plan,) Tj ET BT /F2 12 Tf 1 0 0 1 437.87 495.66 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 448.27 495.66 Tm (mutual) Tj ET BT /F2 12 Tf 1 0 0 1 486.67 495.66 Tm (assessment) Tj ET Q q n 36 493.25 m 648 493.25 l 648 481.25 l 36 481.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 36 483.66 Tm (company) Tj ET BT /F2 12 Tf 1 0 0 1 83.85 483.66 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 97.71 483.66 Tm (similar) Tj ET BT /F2 12 Tf 1 0 0 1 134.9 483.66 Tm (plan) Tj ET BT /F2 12 Tf 1 0 0 1 159.42 483.66 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 172.61 483.66 Tm (which) Tj ET BT /F2 12 Tf 1 0 0 1 205.8 483.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 224.32 483.66 Tm (policyholder) Tj ET BT /F2 12 Tf 1 0 0 1 288.83 483.66 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 300.7 483.66 Tm (subject) Tj ET BT /F2 12 Tf 1 0 0 1 338.55 483.66 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 351.74 483.66 Tm (future) Tj ET BT /F2 12 Tf 1 0 0 1 384.26 483.66 Tm (assessments,) Tj ET BT /F2 12 Tf 1 0 0 1 449.12 483.66 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 462.97 483.66 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 478.83 483.66 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 494.02 483.66 Tm (insurance) Tj ET Q q n 36 481.25 m 648 481.25 l 648 469.25 l 36 469.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 36 471.66 Tm (exchange) Tj ET Q q n 0 469.25 m 612 469.25 l 612 457.25 l 0 457.25 l h W n Q q n 0 457.25 m 612 457.25 l 612 445.25 l 0 445.25 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 242.99 447.66 Tm (NOTICES) Tj ET 2 J 1.14 w [] 0 d 0 0 0 RG 243.56 445.78 m 296.44 445.78 l S 1 w [] 0 d Q q n 0 445.25 m 612 445.25 l 612 433.25 l 0 433.25 l h W n Q q n 0 433.25 m 612 433.25 l 612 421.25 l 0 421.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 423.66 Tm (Member) Tj ET BT /F2 12 Tf 1 0 0 1 44.38 423.66 Tm (insurers) Tj ET BT /F2 12 Tf 1 0 0 1 86.09 423.66 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 99.81 423.66 Tm (their) Tj ET BT /F2 12 Tf 1 0 0 1 125.53 423.66 Tm (agents) Tj ET BT /F2 12 Tf 1 0 0 1 159.91 423.66 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 178.28 423.66 Tm (required) Tj ET BT /F2 12 Tf 1 0 0 1 221.99 423.66 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 237.71 423.66 Tm (law) Tj ET BT /F2 12 Tf 1 0 0 1 258.76 423.66 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 271.82 423.66 Tm (give) Tj ET BT /F2 12 Tf 1 0 0 1 296.2 423.66 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 309.93 423.66 Tm (send) Tj ET BT /F2 12 Tf 1 0 0 1 335.65 423.66 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 357.37 423.66 Tm (this) Tj ET BT /F2 12 Tf 1 0 0 1 378.43 423.66 Tm (notice,) Tj ET BT /F2 12 Tf 1 0 0 1 414.48 423.66 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 435.53 423.66 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 453.9 423.66 Tm (prohibited) Tj ET BT /F2 12 Tf 1 0 0 1 506.95 423.66 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 522.67 423.66 Tm (law) Tj ET Q q n 0 421.25 m 612 421.25 l 612 409.25 l 0 409.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 411.66 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 26.84 411.66 Tm (using) Tj ET BT /F2 12 Tf 1 0 0 1 56.35 411.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 74.52 411.66 Tm (existence) Tj ET BT /F2 12 Tf 1 0 0 1 122.67 411.66 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 136.17 411.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 154.34 411.66 Tm (Association) Tj ET BT /F2 12 Tf 1 0 0 1 214.51 411.66 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 227.36 411.66 Tm (induce) Tj ET BT /F2 12 Tf 1 0 0 1 262.85 411.66 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 284.36 411.66 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 297.2 411.66 Tm (purchase) Tj ET BT /F2 12 Tf 1 0 0 1 343.36 411.66 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 364.19 411.66 Tm (kind) Tj ET BT /F2 12 Tf 1 0 0 1 389.04 411.66 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 402.54 411.66 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 452.03 411.66 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 465.53 411.66 Tm (other) Tj ET BT /F2 12 Tf 1 0 0 1 493.7 411.66 Tm (coverage.) Tj ET Q q n 0 409.25 m 612 409.25 l 612 397.25 l 0 397.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 399.66 Tm (Policyholders) Tj ET BT /F2 12 Tf 1 0 0 1 69.4 399.66 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 94.15 399.66 Tm (additional) Tj ET BT /F2 12 Tf 1 0 0 1 145.54 399.66 Tm (questions) Tj ET BT /F2 12 Tf 1 0 0 1 194.29 399.66 Tm (should) Tj ET BT /F2 12 Tf 1 0 0 1 229.7 399.66 Tm (first) Tj ET BT /F2 12 Tf 1 0 0 1 252.44 399.66 Tm (contact) Tj ET BT /F2 12 Tf 1 0 0 1 290.49 399.66 Tm (their) Tj ET BT /F2 12 Tf 1 0 0 1 315.89 399.66 Tm (member) Tj ET BT /F2 12 Tf 1 0 0 1 358.62 399.66 Tm (insurer) Tj ET BT /F2 12 Tf 1 0 0 1 395.35 399.66 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 408.75 399.66 Tm (agent.) Tj ET BT /F2 12 Tf 1 0 0 1 441.15 399.66 Tm (To) Tj ET BT /F2 12 Tf 1 0 0 1 457.88 399.66 Tm (learn) Tj ET BT /F2 12 Tf 1 0 0 1 485.28 399.66 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 513.34 399.66 Tm (about) Tj ET Q q n 0 397.25 m 612 397.25 l 612 385.25 l 0 385.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 387.66 Tm (coverages) Tj ET BT /F2 12 Tf 1 0 0 1 52.6 387.66 Tm (provided) Tj ET BT /F2 12 Tf 1 0 0 1 99.88 387.66 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 116.51 387.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 135.79 387.66 Tm (Association,) Tj ET BT /F2 12 Tf 1 0 0 1 200.08 387.66 Tm (please) Tj ET BT /F2 12 Tf 1 0 0 1 234.69 387.66 Tm (visit) Tj ET BT /F2 12 Tf 1 0 0 1 259.99 387.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 279.27 387.66 Tm (Association’s) Tj ET BT /F2 12 Tf 1 0 0 1 349.22 387.66 Tm (website) Tj ET BT /F2 12 Tf 1 0 0 1 390.51 387.66 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 403.79 387.66 Tm (www.palifega.org) Tj ET BT /F2 12 Tf 1 0 0 1 490.43 387.66 Tm (.) Tj ET BT /F2 12 Tf 1 0 0 1 498.06 387.66 Tm (You) Tj ET BT /F2 12 Tf 1 0 0 1 523.35 387.66 Tm (can) Tj ET Q q n 0 385.25 m 612 385.25 l 612 373.25 l 0 373.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 375.66 Tm (obtain) Tj ET BT /F2 12 Tf 1 0 0 1 33.44 375.66 Tm (additional) Tj ET BT /F2 12 Tf 1 0 0 1 84.87 375.66 Tm (information) Tj ET BT /F2 12 Tf 1 0 0 1 144.97 375.66 Tm (from) Tj ET BT /F2 12 Tf 1 0 0 1 171.75 375.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 189.85 375.66 Tm (Association) Tj ET BT /F2 12 Tf 1 0 0 1 249.96 375.66 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 265.4 375.66 Tm (contacting) Tj ET BT /F2 12 Tf 1 0 0 1 318.83 375.66 Tm (it) Tj ET BT /F2 12 Tf 1 0 0 1 328.94 375.66 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 341.05 375.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 359.15 375.66 Tm (address) Tj ET BT /F2 12 Tf 1 0 0 1 398.59 375.66 Tm (below.) Tj ET BT /F2 12 Tf 1 0 0 1 434.36 375.66 Tm (You) Tj ET BT /F2 12 Tf 1 0 0 1 458.47 375.66 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 482.58 375.66 Tm (also) Tj ET BT /F2 12 Tf 1 0 0 1 505.35 375.66 Tm (contact) Tj ET Q q n 0 373.25 m 612 373.25 l 612 361.25 l 0 361.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 363.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 18.77 363.66 Tm (Pennsylvania) Tj ET BT /F2 12 Tf 1 0 0 1 86.88 363.66 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 137.63 363.66 Tm (Department) Tj ET BT /F2 12 Tf 1 0 0 1 198.39 363.66 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 211.83 363.66 Tm (file) Tj ET BT /F2 12 Tf 1 0 0 1 231.94 363.66 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 241.37 363.66 Tm (complaint) Tj ET BT /F2 12 Tf 1 0 0 1 293.48 363.66 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 318.92 363.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 337.7 363.66 Tm (Pennsylvania) Tj ET BT /F2 12 Tf 1 0 0 1 405.8 363.66 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 456.55 363.66 Tm (Commissioner) Tj ET BT /F2 12 Tf 1 0 0 1 530.67 363.66 Tm (to) Tj ET Q q n 0 361.25 m 612 361.25 l 612 349.25 l 0 349.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 351.66 Tm (allege) Tj ET BT /F2 12 Tf 1 0 0 1 31.78 351.66 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 40.24 351.66 Tm (violation) Tj ET BT /F2 12 Tf 1 0 0 1 86.04 351.66 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 99.16 351.66 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 119.62 351.66 Tm (provisions) Tj ET BT /F2 12 Tf 1 0 0 1 172.76 351.66 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 185.89 351.66 Tm (Pennsylvania) Tj ET BT /F2 12 Tf 1 0 0 1 253.01 351.66 Tm (laws) Tj ET BT /F2 12 Tf 1 0 0 1 278.14 351.66 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 298.6 351.66 Tm (regulations) Tj ET BT /F2 12 Tf 1 0 0 1 355.06 351.66 Tm (relating) Tj ET BT /F2 12 Tf 1 0 0 1 394.84 351.66 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 407.31 351.66 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 456.42 351.66 Tm (including) Tj ET BT /F2 12 Tf 1 0 0 1 504.88 351.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 522.67 351.66 Tm (law) Tj ET Q q n 0 349.25 m 612 349.25 l 612 337.25 l 0 337.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 339.66 Tm (establishing the Association:) Tj ET Q q n 0 337.25 m 612 337.25 l 612 325.25 l 0 325.25 l h W n Q q n 0 325.25 m 612 325.25 l 612 313.25 l 0 313.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 315.66 Tm (Pennsylvania Life and Health Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 216 315.66 Tm (Pennsylvania Insurance Department) Tj ET Q q n 0 313.25 m 612 313.25 l 612 301.25 l 0 301.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 303.66 Tm (Guaranty Association) Tj ET BT /F2 12 Tf 1 0 0 1 216 303.66 Tm (1209 Strawberry Square) Tj ET Q q n 0 301.25 m 612 301.25 l 612 289.25 l 0 289.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 291.66 Tm (290 King of Prussia Road) Tj ET BT /F2 12 Tf 1 0 0 1 216 291.66 Tm (Harrisburg, PA 17120) Tj ET Q q n 0 289.25 m 612 289.25 l 612 277.25 l 0 277.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 279.66 Tm (Radnor Station Building 2, Suite 218) Tj ET BT /F2 12 Tf 1 0 0 1 216 279.66 Tm (1-877-881-6388) Tj ET Q q n 0 277.25 m 612 277.25 l 612 265.25 l 0 265.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 267.66 Tm (Radnor, PA 19087) Tj ET BT /F2 12 Tf 1 0 0 1 216 267.66 Tm (www.insurance.pa.gov) Tj ET Q q n 0 265.25 m 612 265.25 l 612 253.25 l 0 253.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 255.66 Tm ($610$ 975-0572) Tj ET Q q n 0 253.25 m 612 253.25 l 612 241.25 l 0 241.25 l h W n Q q n 0 241.25 m 612 241.25 l 612 229.25 l 0 229.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 231.66 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 22.92 231.66 Tm (summary) Tj ET BT /F2 12 Tf 1 0 0 1 71.85 231.66 Tm (information) Tj ET BT /F2 12 Tf 1 0 0 1 132.77 231.66 Tm (provided) Tj ET BT /F2 12 Tf 1 0 0 1 179.69 231.66 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 195.95 231.66 Tm (this) Tj ET BT /F2 12 Tf 1 0 0 1 217.56 231.66 Tm (notice) Tj ET BT /F2 12 Tf 1 0 0 1 251.14 231.66 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 272.73 231.66 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 289 231.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 307.92 231.66 Tm (Association’s) Tj ET BT /F2 12 Tf 1 0 0 1 377.51 231.66 Tm (web) Tj ET BT /F2 12 Tf 1 0 0 1 401.77 231.66 Tm (site) Tj ET BT /F2 12 Tf 1 0 0 1 422.7 231.66 Tm (do) Tj ET BT /F2 12 Tf 1 0 0 1 438.96 231.66 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 458.56 231.66 Tm (limit) Tj ET BT /F2 12 Tf 1 0 0 1 485.5 231.66 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 499.76 231.66 Tm (alter) Tj ET BT /F2 12 Tf 1 0 0 1 525.34 231.66 Tm (the) Tj ET Q q n 0 229.25 m 612 229.25 l 612 217.25 l 0 217.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 219.66 Tm (more) Tj ET BT /F2 12 Tf 1 0 0 1 31.22 219.66 Tm (comprehensive) Tj ET BT /F2 12 Tf 1 0 0 1 110.43 219.66 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 134.32 219.66 Tm (detailed) Tj ET BT /F2 12 Tf 1 0 0 1 178.87 219.66 Tm (provisions) Tj ET BT /F2 12 Tf 1 0 0 1 235.44 219.66 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 252 219.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 273.22 219.66 Tm (law) Tj ET BT /F2 12 Tf 1 0 0 1 297.12 219.66 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 321.01 219.66 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 342.22 219.66 Tm (subject) Tj ET BT /F2 12 Tf 1 0 0 1 382.78 219.66 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 398.68 219.66 Tm (change) Tj ET BT /F2 12 Tf 1 0 0 1 439.22 219.66 Tm (without) Tj ET BT /F2 12 Tf 1 0 0 1 482.46 219.66 Tm (notice.) Tj ET BT /F2 12 Tf 1 0 0 1 521.34 219.66 Tm (The) Tj ET Q q n 0 217.25 m 612 217.25 l 612 205.25 l 0 205.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 207.66 Tm (statements) Tj ET BT /F2 12 Tf 1 0 0 1 56.07 207.66 Tm (made) Tj ET BT /F2 12 Tf 1 0 0 1 87.47 207.66 Tm (herein) Tj ET BT /F2 12 Tf 1 0 0 1 122.87 207.66 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 142.94 207.66 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 162.34 207.66 Tm (information) Tj ET BT /F2 12 Tf 1 0 0 1 224.42 207.66 Tm (purposes) Tj ET BT /F2 12 Tf 1 0 0 1 272.49 207.66 Tm (only.) Tj ET BT /F2 12 Tf 1 0 0 1 302.24 207.66 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 326.32 207.66 Tm (Association) Tj ET BT /F2 12 Tf 1 0 0 1 388.39 207.66 Tm (has) Tj ET BT /F2 12 Tf 1 0 0 1 409.8 207.66 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 430.55 207.66 Tm (reviewed) Tj ET BT /F2 12 Tf 1 0 0 1 479.95 207.66 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 502.69 207.66 Tm (specific) Tj ET Q q n 0 205.25 m 612 205.25 l 612 193.25 l 0 193.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 195.66 Tm (policy,) Tj ET BT /F2 12 Tf 1 0 0 1 37.29 195.66 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 51.59 195.66 Tm (verified) Tj ET BT /F2 12 Tf 1 0 0 1 93.19 195.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 112.15 195.66 Tm (information) Tj ET BT /F2 12 Tf 1 0 0 1 173.1 195.66 Tm (provided) Tj ET BT /F2 12 Tf 1 0 0 1 220.06 195.66 Tm (regarding) Tj ET BT /F2 12 Tf 1 0 0 1 270.33 195.66 Tm (residency) Tj ET BT /F2 12 Tf 1 0 0 1 320.61 195.66 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 334.9 195.66 Tm (other) Tj ET BT /F2 12 Tf 1 0 0 1 363.86 195.66 Tm (relevant) Tj ET BT /F2 12 Tf 1 0 0 1 406.79 195.66 Tm (factors.) Tj ET BT /F2 12 Tf 1 0 0 1 446.74 195.66 Tm (Moreover,) Tj ET BT /F2 12 Tf 1 0 0 1 501.35 195.66 Tm (whether) Tj ET Q q n 0 193.25 m 612 193.25 l 612 181.25 l 0 181.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 183.66 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 47.71 183.66 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 70.78 183.66 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 86.51 183.66 Tm (provided) Tj ET BT /F2 12 Tf 1 0 0 1 133.57 183.66 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 147.3 183.66 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 169.03 183.66 Tm (specific) Tj ET BT /F2 12 Tf 1 0 0 1 210.75 183.66 Tm (policyholder) Tj ET BT /F2 12 Tf 1 0 0 1 275.81 183.66 Tm (can) Tj ET BT /F2 12 Tf 1 0 0 1 296.86 183.66 Tm (only) Tj ET BT /F2 12 Tf 1 0 0 1 322.6 183.66 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 338.33 183.66 Tm (determined) Tj ET BT /F2 12 Tf 1 0 0 1 396.71 183.66 Tm (by) Tj ET BT /F2 12 Tf 1 0 0 1 413.11 183.66 Tm (reference) Tj ET BT /F2 12 Tf 1 0 0 1 462.14 183.66 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 475.87 183.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 494.94 183.66 Tm (statute) Tj ET BT /F2 12 Tf 1 0 0 1 530.67 183.66 Tm (in) Tj ET Q q n 0 181.25 m 612 181.25 l 612 169.25 l 0 169.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 171.66 Tm (effect,) Tj ET BT /F2 12 Tf 1 0 0 1 35.59 171.66 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 49.54 171.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 69.48 171.66 Tm (earliest,) Tj ET BT /F2 12 Tf 1 0 0 1 112.41 171.66 Tm (at) Tj ET BT /F2 12 Tf 1 0 0 1 126.36 171.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 146.31 171.66 Tm (time) Tj ET BT /F2 12 Tf 1 0 0 1 172.92 171.66 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 196.2 171.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 216.14 171.66 Tm (member) Tj ET BT /F2 12 Tf 1 0 0 1 260.75 171.66 Tm (insurer) Tj ET BT /F2 12 Tf 1 0 0 1 299.35 171.66 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 312.64 171.66 Tm (declared) Tj ET BT /F2 12 Tf 1 0 0 1 358.56 171.66 Tm (insolvent.) Tj ET BT /F2 12 Tf 1 0 0 1 410.85 171.66 Tm (No) Tj ET BT /F2 12 Tf 1 0 0 1 430.8 171.66 Tm (final) Tj ET BT /F2 12 Tf 1 0 0 1 458.07 171.66 Tm (determination) Tj ET BT /F2 12 Tf 1 0 0 1 530 171.66 Tm (of) Tj ET Q q n 0 169.25 m 612 169.25 l 612 157.25 l 0 157.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 159.66 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 50.02 159.66 Tm (can) Tj ET BT /F2 12 Tf 1 0 0 1 73.4 159.66 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 91.44 159.66 Tm (made) Tj ET BT /F2 12 Tf 1 0 0 1 124.15 159.66 Tm (until) Tj ET BT /F2 12 Tf 1 0 0 1 152.88 159.66 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 164.92 159.66 Tm (member) Tj ET BT /F2 12 Tf 1 0 0 1 210.96 159.66 Tm (insurer) Tj ET BT /F2 12 Tf 1 0 0 1 251 159.66 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 265.73 159.66 Tm (declared) Tj ET BT /F2 12 Tf 1 0 0 1 313.08 159.66 Tm (insolvent) Tj ET BT /F2 12 Tf 1 0 0 1 363.81 159.66 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 387.85 159.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 409.23 159.66 Tm (specific) Tj ET BT /F2 12 Tf 1 0 0 1 453.27 159.66 Tm (factual) Tj ET BT /F2 12 Tf 1 0 0 1 492.63 159.66 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 516.68 159.66 Tm (legal) Tj ET Q q n 0 157.25 m 612 157.25 l 612 145.25 l 0 145.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 147.66 Tm (circumstances) Tj ET BT /F2 12 Tf 1 0 0 1 71.49 147.66 Tm (can) Tj ET BT /F2 12 Tf 1 0 0 1 91.67 147.66 Tm (be) Tj ET BT /F2 12 Tf 1 0 0 1 106.52 147.66 Tm (reviewed.) Tj ET BT /F2 12 Tf 1 0 0 1 157.02 147.66 Tm (Nothing) Tj ET BT /F2 12 Tf 1 0 0 1 199.88 147.66 Tm (contained) Tj ET BT /F2 12 Tf 1 0 0 1 250.06 147.66 Tm (herein) Tj ET BT /F2 12 Tf 1 0 0 1 283.56 147.66 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 295.09 147.66 Tm (intended) Tj ET BT /F2 12 Tf 1 0 0 1 339.94 147.66 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 352.8 147.66 Tm (guarantee) Tj ET BT /F2 12 Tf 1 0 0 1 402.96 147.66 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 449.78 147.66 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 467.3 147.66 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 488.15 147.66 Tm (insured,) Tj ET BT /F2 12 Tf 1 0 0 1 530 147.66 Tm (or) Tj ET Q q n 0 145.25 m 612 145.25 l 612 133.25 l 0 133.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 135.66 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 14.71 135.66 Tm (bind) Tj ET BT /F2 12 Tf 1 0 0 1 41.43 135.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 61.47 135.66 Tm (Association) Tj ET BT /F2 12 Tf 1 0 0 1 123.5 135.66 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 138.22 135.66 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 160.92 135.66 Tm (way.) Tj ET BT /F2 12 Tf 1 0 0 1 189.29 135.66 Tm (Finally,) Tj ET BT /F2 12 Tf 1 0 0 1 231.67 135.66 Tm (this) Tj ET BT /F2 12 Tf 1 0 0 1 254.39 135.66 Tm (summary) Tj ET BT /F2 12 Tf 1 0 0 1 304.43 135.66 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 327.14 135.66 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 347.17 135.66 Tm (Association’s) Tj ET BT /F2 12 Tf 1 0 0 1 417.88 135.66 Tm (web) Tj ET BT /F2 12 Tf 1 0 0 1 443.25 135.66 Tm (site) Tj ET BT /F2 12 Tf 1 0 0 1 465.29 135.66 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 485.32 135.66 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 504.69 135.66 Tm (general) Tj ET Q q n 0 133.25 m 612 133.25 l 612 121.25 l 0 121.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 123.66 Tm (information purposes and should not be relied upon as legal advice.) Tj ET Q q n 0 121.25 m 612 121.25 l 612 109.25 l 0 109.25 l h W n Q Q q Q Q endstream endobj 32 0 obj <>/Font<>>>>> endobj 181 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 21.6 cm q n 0 38.6 m 540.25 38.6 l 540.25 26.6 l 0 26.6 l h W n Q q n 0 25.15 m 270.1 25.15 l 270.1 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 15.56 Tm (GL1102-AMEND.SUICIDE) Tj ET Q q n 270.1 25.15 m 540.25 25.15 l 540.25 13.15 l 270.1 13.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 491.93 15.56 Tm (VIT LIFE) Tj ET Q q n 0 13.15 m 257.4 13.15 l 257.4 1.15 l 0 1.15 l h W n Q q n 257.4 13.15 m 293.4 13.15 l 293.4 1.15 l 257.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 270.4 3.56 Tm (28) Tj ET Q q n 293.4 13.15 m 540.25 13.15 l 540.25 1.15 l 293.4 1.15 l h W n 0 0 0 rg BT /F2 10 Tf 1 0 0 1 504.69 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 60.2 cm q n 0 682 m 612 682 l 612 670 l 0 670 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 186.16 672.41 Tm (CERTIFICATE AMENDMENT) Tj ET Q q n 0 656.2 m 612 656.2 l 612 644.2 l 0 644.2 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 646.61 Tm (TO BE ATTACHED TO THE CERTIFICATE FOR GROUP POLICY NO:) Tj ET BT /F4 12 Tf 1 0 0 1 397.71 646.61 Tm (000400001000) Tj ET Q q n 0 644.2 m 612 644.2 l 612 632.2 l 0 632.2 l h W n Q q n 0 632.2 m 612 632.2 l 612 620.2 l 0 620.2 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 622.61 Tm (ISSUED) Tj ET BT /F4 12 Tf 1 0 0 1 49.07 622.61 Tm (TO:) Tj ET BT /F4 12 Tf 1 0 0 1 81.83 622.61 Tm (The) Tj ET BT /F4 12 Tf 1 0 0 1 107.55 622.61 Tm (Commerce) Tj ET BT /F4 12 Tf 1 0 0 1 169.23 622.61 Tm (Trust) Tj ET BT /F4 12 Tf 1 0 0 1 203.61 622.61 Tm (Company) Tj ET BT /F4 12 Tf 1 0 0 1 259.33 622.61 Tm (as) Tj ET BT /F4 12 Tf 1 0 0 1 275.72 622.61 Tm (Trustee) Tj ET BT /F4 12 Tf 1 0 0 1 320.75 622.61 Tm (for) Tj ET BT /F4 12 Tf 1 0 0 1 341.79 622.61 Tm (The) Tj ET BT /F4 12 Tf 1 0 0 1 367.51 622.61 Tm (Lincoln) Tj ET BT /F4 12 Tf 1 0 0 1 412.57 622.61 Tm (National) Tj ET BT /F4 12 Tf 1 0 0 1 462.29 622.61 Tm (Life) Tj ET BT /F4 12 Tf 1 0 0 1 488.66 622.61 Tm (Insurance) Tj ET Q q n 0 620.2 m 612 620.2 l 612 608.2 l 0 608.2 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 610.61 Tm (Company) Tj ET BT /F4 12 Tf 1 0 0 1 53.01 610.61 Tm (Voluntary Insurance Trust) Tj ET Q q n 0 608.2 m 612 608.2 l 612 596.2 l 0 596.2 l h W n Q q n 0 596.2 m 612 596.2 l 612 584.2 l 0 584.2 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 586.61 Tm (For Participating Employer:) Tj ET BT /F4 12 Tf 1 0 0 1 152.64 586.61 Tm (É«ÖÐÉ« University $22982$) Tj ET Q q n 0 584.2 m 612 584.2 l 612 572.2 l 0 572.2 l h W n Q q n 0 572.2 m 612 572.2 l 612 560.2 l 0 560.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 562.61 Tm (It is agreed that the above policy be amended as follows.) Tj ET Q q n 0 560.2 m 612 560.2 l 612 548.2 l 0 548.2 l h W n Q q n 0 548.2 m 612 548.2 l 612 536.2 l 0 536.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 538.61 Tm (Any exclusion for suicide for a death benefit under life insurance coverage is amended to read as follows:) Tj ET Q q n 0 536.2 m 612 536.2 l 612 524.2 l 0 524.2 l h W n Q q n 0 524.2 m 612 524.2 l 612 512.2 l 0 512.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 514.61 Tm (EXCLUSION.) Tj ET BT /F2 12 Tf 1 0 0 1 77 514.61 Tm (Benefits will not be payable if your death or the death of your Dependent:) Tj ET Q q n 18 512.2 m 630 512.2 l 630 500.2 l 18 500.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 502.61 Tm ($1$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 502.61 Tm (results from suicide while sane or insane; and) Tj ET Q q n 18 500.2 m 630 500.2 l 630 488.2 l 18 488.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 490.61 Tm ($2$) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 490.61 Tm (occurs) Tj ET BT /F2 12 Tf 1 0 0 1 79.68 490.61 Tm (within) Tj ET BT /F2 12 Tf 1 0 0 1 113.36 490.61 Tm (one) Tj ET BT /F2 12 Tf 1 0 0 1 133.7 490.61 Tm (year) Tj ET BT /F2 12 Tf 1 0 0 1 157.36 490.61 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 182.35 490.61 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 207.36 490.61 Tm (Personal) Tj ET BT /F2 12 Tf 1 0 0 1 251.7 490.61 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 274.69 490.61 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 324.35 490.61 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 337.35 490.61 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 386.34 490.61 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 403.35 490.61 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 424.35 490.61 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 479.34 490.61 Tm (takes) Tj ET Q q n 45.35 488.2 m 657.35 488.2 l 657.35 476.2 l 45.35 476.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 45.35 478.61 Tm (effect.) Tj ET Q q n 0 476.2 m 612 476.2 l 612 464.2 l 0 464.2 l h W n Q q n 0 464.2 m 612 464.2 l 612 452.2 l 0 452.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 454.61 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 11.86 454.61 Tm (benefits) Tj ET BT /F2 12 Tf 1 0 0 1 53.72 454.61 Tm (are) Tj ET BT /F2 12 Tf 1 0 0 1 72.23 454.61 Tm (not) Tj ET BT /F2 12 Tf 1 0 0 1 91.44 454.61 Tm (payable) Tj ET BT /F2 12 Tf 1 0 0 1 132.62 454.61 Tm (as) Tj ET BT /F2 12 Tf 1 0 0 1 146.49 454.61 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 155.68 454.61 Tm (result) Tj ET BT /F2 12 Tf 1 0 0 1 186.21 454.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 200.08 454.61 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 225.94 454.61 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 239.81 454.61 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 265.67 454.61 Tm (Dependent's) Tj ET BT /F2 12 Tf 1 0 0 1 328.35 454.61 Tm (suicide,) Tj ET BT /F2 12 Tf 1 0 0 1 369.21 454.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 387.74 454.61 Tm (Company) Tj ET BT /F2 12 Tf 1 0 0 1 438.28 454.61 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 460.81 454.61 Tm (promptly) Tj ET BT /F2 12 Tf 1 0 0 1 508.68 454.61 Tm (refund) Tj ET Q q n 0 452.2 m 612 452.2 l 612 440.2 l 0 440.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 442.61 Tm (any premium from your or your Dependent's Effective Date of coverage.) Tj ET Q q n 0 440.2 m 612 440.2 l 612 428.2 l 0 428.2 l h W n Q q n 0 428.2 m 612 428.2 l 612 416.2 l 0 416.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 418.61 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 11.62 418.61 Tm (there) Tj ET BT /F2 12 Tf 1 0 0 1 39.24 418.61 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 50.87 418.61 Tm (an) Tj ET BT /F2 12 Tf 1 0 0 1 65.83 418.61 Tm (increase) Tj ET BT /F2 12 Tf 1 0 0 1 108.76 418.61 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 121.73 418.61 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 147.35 418.61 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 186.98 418.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 200.61 418.61 Tm (Personal) Tj ET BT /F2 12 Tf 1 0 0 1 245.56 418.61 Tm (Life) Tj ET BT /F2 12 Tf 1 0 0 1 269.18 418.61 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 319.45 418.61 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 333.08 418.61 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 358.71 418.61 Tm (Dependent's) Tj ET BT /F2 12 Tf 1 0 0 1 421.15 418.61 Tm (amount) Tj ET BT /F2 12 Tf 1 0 0 1 460.77 418.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 474.4 418.61 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 494.02 418.61 Tm (insurance) Tj ET Q q n 0 416.2 m 612 416.2 l 612 404.2 l 0 404.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 406.61 Tm (following) Tj ET BT /F2 12 Tf 1 0 0 1 50.19 406.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 68.37 406.61 Tm (Effective) Tj ET BT /F2 12 Tf 1 0 0 1 115.86 406.61 Tm (Date) Tj ET BT /F2 12 Tf 1 0 0 1 142.03 406.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 155.54 406.61 Tm (coverage,) Tj ET BT /F2 12 Tf 1 0 0 1 205.37 406.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 223.55 406.61 Tm (one-year) Tj ET BT /F2 12 Tf 1 0 0 1 269.04 406.61 Tm (period) Tj ET BT /F2 12 Tf 1 0 0 1 303.22 406.61 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 325.4 406.61 Tm (apply;) Tj ET BT /F2 12 Tf 1 0 0 1 358.92 406.61 Tm (but) Tj ET BT /F2 12 Tf 1 0 0 1 377.78 406.61 Tm (only) Tj ET BT /F2 12 Tf 1 0 0 1 402.63 406.61 Tm (for) Tj ET BT /F2 12 Tf 1 0 0 1 420.14 406.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 438.32 406.61 Tm (increased) Tj ET BT /F2 12 Tf 1 0 0 1 487.15 406.61 Tm (Amount) Tj ET BT /F2 12 Tf 1 0 0 1 530 406.61 Tm (of) Tj ET Q q n 0 404.2 m 612 404.2 l 612 392.2 l 0 392.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 394.61 Tm (Personal Life Insurance or the increased amount of Dependent's life insurance.) Tj ET Q q n 0 392.2 m 612 392.2 l 612 380.2 l 0 380.2 l h W n Q q n 0 380.2 m 612 380.2 l 612 368.2 l 0 368.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 370.61 Tm (If) Tj ET BT /F2 12 Tf 1 0 0 1 11.08 370.61 Tm (you) Tj ET BT /F2 12 Tf 1 0 0 1 32.16 370.61 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 45.24 370.61 Tm (your) Tj ET BT /F2 12 Tf 1 0 0 1 70.32 370.61 Tm (Dependent) Tj ET BT /F2 12 Tf 1 0 0 1 125.39 370.61 Tm (were) Tj ET BT /F2 12 Tf 1 0 0 1 151.79 370.61 Tm (covered) Tj ET BT /F2 12 Tf 1 0 0 1 192.84 370.61 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 223.25 370.61 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 243.66 370.61 Tm (prior) Tj ET BT /F2 12 Tf 1 0 0 1 270.07 370.61 Tm (group) Tj ET BT /F2 12 Tf 1 0 0 1 301.15 370.61 Tm (life) Tj ET BT /F2 12 Tf 1 0 0 1 320.23 370.61 Tm (insurance) Tj ET BT /F2 12 Tf 1 0 0 1 369.29 370.61 Tm (policy) Tj ET BT /F2 12 Tf 1 0 0 1 402.37 370.61 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 423.45 370.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 441.19 370.61 Tm (Policy) Tj ET BT /F2 12 Tf 1 0 0 1 474.95 370.61 Tm (replaced) Tj ET BT /F2 12 Tf 1 0 0 1 518.67 370.61 Tm (with) Tj ET Q q n 0 368.2 m 612 368.2 l 612 356.2 l 0 356.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 358.61 Tm (1) Tj ET BT /F2 12 Tf 1 0 0 1 9.49 358.61 Tm (day) Tj ET BT /F2 12 Tf 1 0 0 1 30.31 358.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 43.79 358.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 61.94 358.61 Tm (prior) Tj ET BT /F2 12 Tf 1 0 0 1 88.76 358.61 Tm (plan's) Tj ET BT /F2 12 Tf 1 0 0 1 119.74 358.61 Tm (termination) Tj ET BT /F2 12 Tf 1 0 0 1 178.55 358.61 Tm (date,) Tj ET BT /F2 12 Tf 1 0 0 1 205.03 358.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 223.18 358.61 Tm (continuous) Tj ET BT /F2 12 Tf 1 0 0 1 279.33 358.61 Tm (months) Tj ET BT /F2 12 Tf 1 0 0 1 318.16 358.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 331.65 358.61 Tm (coverage) Tj ET BT /F2 12 Tf 1 0 0 1 378.44 358.61 Tm (under) Tj ET BT /F2 12 Tf 1 0 0 1 409.25 358.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 427.4 358.61 Tm (prior) Tj ET BT /F2 12 Tf 1 0 0 1 454.22 358.61 Tm (plan) Tj ET BT /F2 12 Tf 1 0 0 1 478.37 358.61 Tm (just) Tj ET BT /F2 12 Tf 1 0 0 1 499.2 358.61 Tm (before) Tj ET BT /F2 12 Tf 1 0 0 1 533.33 358.61 Tm (it) Tj ET Q q n 0 356.2 m 612 356.2 l 612 344.2 l 0 344.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 346.61 Tm (terminated will count toward the one-year period.) Tj ET Q q n 0 344.2 m 612 344.2 l 612 332.2 l 0 332.2 l h W n Q q n 0 332.2 m 612 332.2 l 612 320.2 l 0 320.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 322.61 Tm (The) Tj ET BT /F2 12 Tf 1 0 0 1 22.16 322.61 Tm (effective) Tj ET BT /F2 12 Tf 1 0 0 1 67.62 322.61 Tm (date) Tj ET BT /F2 12 Tf 1 0 0 1 91.11 322.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 104.6 322.61 Tm (this) Tj ET BT /F2 12 Tf 1 0 0 1 125.44 322.61 Tm (Certificate) Tj ET BT /F2 12 Tf 1 0 0 1 179.58 322.61 Tm (Amendment) Tj ET BT /F2 12 Tf 1 0 0 1 242.4 322.61 Tm (is) Tj ET BT /F4 12 Tf 1 0 0 1 253.9 322.61 Tm (August 1, 2017) Tj ET BT /F4 12 Tf 1 0 0 1 333.08 322.61 Tm (or) Tj ET BT /F4 12 Tf 1 0 0 1 347.9 322.61 Tm (your) Tj ET BT /F4 12 Tf 1 0 0 1 375.4 322.61 Tm (effective) Tj ET BT /F4 12 Tf 1 0 0 1 421.53 322.61 Tm (date) Tj ET BT /F4 12 Tf 1 0 0 1 447.03 322.61 Tm (of) Tj ET BT /F4 12 Tf 1 0 0 1 460.52 322.61 Tm (coverage) Tj ET BT /F4 12 Tf 1 0 0 1 509.33 322.61 Tm (under) Tj ET Q q n 0 320.2 m 612 320.2 l 612 308.2 l 0 308.2 l h W n 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 310.61 Tm (the) Tj ET BT /F4 12 Tf 1 0 0 1 21.69 310.61 Tm (Policy) Tj ET BT /F4 12 Tf 1 0 0 1 58.71 310.61 Tm ($whichever) Tj ET BT /F4 12 Tf 1 0 0 1 121.05 310.61 Tm (is) Tj ET BT /F4 12 Tf 1 0 0 1 134.74 310.61 Tm (later$) Tj ET BT /F2 12 Tf 1 0 0 1 162.72 310.61 Tm (;) Tj ET BT /F2 12 Tf 1 0 0 1 171.75 310.61 Tm (but) Tj ET BT /F2 12 Tf 1 0 0 1 192.77 310.61 Tm (only) Tj ET BT /F2 12 Tf 1 0 0 1 219.8 310.61 Tm (with) Tj ET BT /F2 12 Tf 1 0 0 1 246.83 310.61 Tm (respect) Tj ET BT /F2 12 Tf 1 0 0 1 286.5 310.61 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 301.52 310.61 Tm (losses) Tj ET BT /F2 12 Tf 1 0 0 1 335.89 310.61 Tm (incurred) Tj ET BT /F2 12 Tf 1 0 0 1 381.56 310.61 Tm (on) Tj ET BT /F2 12 Tf 1 0 0 1 399.25 310.61 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 414.94 310.61 Tm (after) Tj ET BT /F2 12 Tf 1 0 0 1 442.61 310.61 Tm (that) Tj ET BT /F2 12 Tf 1 0 0 1 466.3 310.61 Tm (date.) Tj ET BT /F2 12 Tf 1 0 0 1 500.67 310.61 Tm (Nothing) Tj ET Q q n 0 308.2 m 612 308.2 l 612 296.2 l 0 296.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 298.61 Tm (contained) Tj ET BT /F2 12 Tf 1 0 0 1 50.44 298.61 Tm (in) Tj ET BT /F2 12 Tf 1 0 0 1 63.57 298.61 Tm (this) Tj ET BT /F2 12 Tf 1 0 0 1 84.7 298.61 Tm (Certificate) Tj ET BT /F2 12 Tf 1 0 0 1 139.13 298.61 Tm (Amendment) Tj ET BT /F2 12 Tf 1 0 0 1 202.24 298.61 Tm (shall) Tj ET BT /F2 12 Tf 1 0 0 1 228.7 298.61 Tm (change) Tj ET BT /F2 12 Tf 1 0 0 1 266.47 298.61 Tm (any) Tj ET BT /F2 12 Tf 1 0 0 1 287.59 298.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 301.38 298.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 319.83 298.61 Tm (terms) Tj ET BT /F2 12 Tf 1 0 0 1 350.28 298.61 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 371.4 298.61 Tm (conditions) Tj ET BT /F2 12 Tf 1 0 0 1 425.2 298.61 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 438.98 298.61 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 457.44 298.61 Tm (Policy,) Tj ET BT /F2 12 Tf 1 0 0 1 494.9 298.61 Tm (except) Tj ET BT /F2 12 Tf 1 0 0 1 530 298.61 Tm (as) Tj ET Q q n 0 296.2 m 612 296.2 l 612 284.2 l 0 284.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 286.61 Tm (stated above.) 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