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Home My WebLink AboutReliance Long Term Disability Polisy HomeOffice:Chicago,Illinois•AdministrativeOffice:Philadelphia,Pennsylvania POLICYHOLDER:POLICYNUMBER: CityofOakParkHeightsLTD122486 EFFECTIVEDATE: October1,2011 ANNIVERSARYDATES: October1,2012andeachOctober1st thereafter. PREMIUMDUEDATES: ThefirstPremiumisdueon theEffectiveDate.FurtherPremiumsareduemonthly,inadvance, on thefirstdayofeachmonth. ThisPolicyisdeliveredinMinnesotaandisgovernedbyitslawsand/ortheEmployeeRetirementIncomeSecurityActof 1974("ERISA")asamended,whereapplicable. RelianceStandardLife InsuranceCompanyisreferredtoas"we","our"or"us"in thisPolicy. ThePolicyholderandanysubsidiaries,divisionsoraffiliatesarereferredtoas"you","your"or"yours"in thisPolicy. WeagreetoprovideinsurancetoyouinexchangeforthepaymentofPremiumandasignedApplication.ThisPolicy providesincomereplacementbenefitsforTotalDisabilityfromSicknessor Injury.Itinsures thoseEligiblePersonsfor the MonthlyBenefitshownon theScheduleofBenefits. Theinsuranceissubject tothe termsandconditionsofthisPolicy. TheEffectiveDateofthisPolicyisshownabove.ThisPolicystaysineffectaslongasPremiumispaidwhendue.The “TERMINATIONOFTHISPOLICY”sectionof theGENERALPROVISIONSexplainswhen theinsurance terminates. ThisPolicyissignedbyourPresidentandSecretary. SecretaryPresident Countersigned_____________________________________________________________________________________ LicensedResidentAgent GROUPLONGTERMDISABILITYINSURANCE NON-PARTICIPATING LRS-6564Ed.4/06 RELIANCESTANDARD LIFEINSURANCECOMPANY Home Office:Chicago,Illinois AdministrativeOffice:Philadelphia,Pennsylvania GROUPPOLICYNUMBER:POLICYEFFECTIVEDATE: LTD122486October1,2011 POLICYDELIVEREDIN:ANNIVERSARYDATE: MinnesotaOctober1stineachyear Applicationismadetousby:CityofOakParkHeights ThisApplicationiscompletedinduplicate,onecopytobeattached toyourPolicyand theotherreturnedtous. Itisagreed thatthisApplicationtakes theplaceofanypreviousapplicationforyourPolicy. Signedat thisdayof. Policyholder:Agent: By:___________________________________________________________________________________ (Signature)(LicensedResidentAgent) ______________________________________________ (Title) Pleasesignandreturn. LRS-6564-1Ed.2/83 *BC1COAPLTD12248610/01/2011*RSL *BC2COAPCityofOakParkHeights RELIANCESTANDARD LIFEINSURANCECOMPANY Home Office:Chicago,Illinois AdministrativeOffice:Philadelphia,Pennsylvania GROUPPOLICYNUMBER:POLICYEFFECTIVEDATE: LTD122486October1,2011 POLICYDELIVEREDIN:ANNIVERSARYDATE: MinnesotaOctober1stineachyear Applicationismadetousby:CityofOakParkHeights ThisApplicationiscompletedinduplicate,onecopytobeattached toyourPolicyand theotherreturnedtous. Itisagreed thatthisApplicationtakes theplaceofanypreviousapplicationforyourPolicy. Signedat thisdayof. Policyholder:Agent: By:___________________________________________________________________________________ (Signature)(LicensedResidentAgent) ______________________________________________ (Title) LRS-6564-1Ed.2/83 TABLEOFCONTENTS Page SCHEDULEOFBENEFITS................................................................................................................................1.0 DEFINITIONS.....................................................................................................................................................2.0 CERTAINRESPONSIBILITIESOF THEPOLICYHOLDER.................................................................................3.0 TRANSFEROFINSURANCECOVERAGE........................................................................................................4.0 GENERALPROVISIONS...................................................................................................................................5.0 EntireContract Changes TimeLimitonCertainDefenses RecordsMaintained ClericalError MisstatementofAge NotinLieuofWorkers'Compensation ConformitywithStateLaws Certificateof Insurance TerminationofthisPolicy CLAIMSPROVISIONS.......................................................................................................................................6.0 NoticeofClaim ClaimForms WrittenProofofTotalDisability PaymentofClaims ArbitrationofClaims PhysicalExaminationandAutopsy LegalActions INDIVIDUALELIGIBILITY,EFFECTIVEDATEAND TERMINATION..................................................................7.0 GeneralGroup EligibilityRequirements EffectiveDateof IndividualInsurance TerminationofIndividual Insurance IndividualReinstatement PREMIUMS........................................................................................................................................................8.0 BENEFITPROVISIONS.....................................................................................................................................9.0 WORKSITEMODIFICATIONPROVISION........................................................................................................10.0 EXCLUSIONS..................................................................................................................................................11.0 LIMITATIONS...................................................................................................................................................12.0 SPECIFICINDEMNITYBENEFIT.....................................................................................................................13.0 SURVIVORBENEFIT-LUMPSUM.................................................................................................................14.0 WORK INCENTIVEANDCHILDCAREBENEFITS..........................................................................................15.0 EXTENSIONOFCOVERAGEUNDER THEFAMILYANDMEDICALLEAVEACTANDUNIFORMED SERVICESEMPLOYMENTANDREEMPLOYMENTRIGHTSACT(USERRA)................................................16.0 EXTENDEDDISABILITYBENEFIT..................................................................................................................17.0 LRS-6564-2Ed.2/83 REHABILITATIONBENEFIT............................................................................................................................18.0 LRS-6564-2Ed.2/83 SCHEDULEOFBENEFITS NAME OFSUBSIDIARIES,DIVISIONS ORAFFILIATESTOBECOVERED: NONE ELIGIBLECLASSES: Eachactive,Full-timeEmployeeexceptanypersonemployedonatemporaryorseasonalbasis. INDIVIDUALEFFECTIVEDATE: Thefirstofthemonthcoincidingwithornextfollowingthedaythepersonbecomes eligible. INDIVIDUALREINSTATEMENT: NotApplicable MINIMUMPARTICIPATIONREQUIREMENTS: Percentage:100%Numberof Insureds:10 LONGTERMDISABILITYBENEFIT ELIMINATIONPERIOD: 90consecutivedaysof TotalDisability. MONTHLYBENEFIT: TheMonthlyBenefitisanamountequalto662/3%ofCoveredMonthlyEarnings,payablein accordancewith thesectionentitledBenefitAmount. MINIMUMMONTHLYBENEFIT: InnoeventwilltheMonthlyBenefitpayabletoanInsuredbeless than$100. MAXIMUMMONTHLYBENEFIT: $6,000(thisisequal toamaximumCoveredMonthlyEarningsof$9,000). MAXIMUMDURATIONOFBENEFITS: Benefitswillnotaccruebeyondthelongerof:theDurationofBenefits;or NormalRetirementAge;specifiedbelow: AgeatDisablementDurationofBenefits(inyears) 61orlessToAge65 623½ 633 642½ 652 661¾ 671½ 681¼ 69ormore1 OR NormalRetirementAgeasdefinedby the1983Amendmentsto theUnitedStatesSocialSecurityActanddeterminedby the Insured’syearofbirth,asfollows: YearofBirthNormalRetirementAge 1937orbefore65years 193865yearsand2months 193965yearsand4months 194065yearsand6months 194165yearsand8months 194265yearsand10months 1943 thru195466years 195566yearsand2months 195666yearsand4months 195766yearsand6months 195866yearsand8months 195966yearsand10months 1960andafter67years LRS-6564-3-0690Page1.0 CHANGESINMONTHLYBENEFIT: IncreasesintheMonthlyBenefitareeffectiveonthefirstofthePolicymonth coincidingwithornextfollowingthedateofthechange,providedtheInsuredisActivelyatWorkontheeffectivedateof thechange.If theInsuredisnotActivelyatWorkon thatdate, theeffectivedateoftheincreasein thebenefitamountwill bedeferreduntilthedatetheInsuredreturnstoActive Work.DecreasesintheMonthlyBenefitareeffectiveonthefirst of thePolicymonthcoincidingwithornextfollowing thedate thechangeoccurs. CONTRIBUTIONS: Insured:0% Premiumcontributionswillnotbeincludedinthe Insured’sgrossincome. Forpurposesof filingtheInsured’sFederalIncomeTaxReturn,thismeansthatunderthelawasofthedatethisPolicy wasissued,theInsured’sMonthlyBenefitmightbetreatedastaxable.ItisrecommendedthattheInsuredcontact his/herpersonal taxadvisor. LRS-6564-3-0690Page1.1 DEFINITIONS "ActivelyatWork"and"ActiveWork"meanactuallyperformingonaFull-timebasisthematerialdutiespertainingto his/herjobintheplacewhereandthemannerinwhichthejobisnormallyperformed.Thisincludesapprovedtimeoff suchasvacation,jurydutyandfuneralleave,butdoesnotincludetimeoffasaresultofan InjuryorSickness. "AnyOccupation"meansanoccupationnormallyperformedinthenationaleconomy forwhichanInsuredisreasonably suitedbaseduponhis/hereducation,trainingorexperience. "Claimant"meansan Insuredwhomakesaclaimforbenefitsunder thisPolicyforalosscoveredby thisPolicyasaresult ofan InjurytooraSicknessof the Insured. "CoveredMonthlyEarnings"meanstheInsured'smonthlysalaryreceivedfromyouonthefirstofthePolicymonthjust beforethedateofTotalDisability,priortoanydeductionstoaSection125plan.CoveredMonthlyEarningsdoesnot includecommissions,overtimepay,bonusesoranyotherspecialcompensationnotreceivedasCoveredMonthly Earnings. Ifhourlypaidemployeesareinsured,thenumberofhoursworkedduringaregularworkweek,nottoexceedforty(40) hoursperweek,times4.333,willbeusedtodetermineCoveredMonthlyEarnings.Ifanemployeeispaidonanannual basis, then theCoveredMonthlyEarningswillbedeterminedbydividing thebasicannualsalaryby12. "EligiblePerson"meansapersonwhomeets theEligibilityRequirementsofthisPolicy. "EliminationPeriod"meansaperiodofconsecutivedaysofTotalDisability,asshownontheScheduleofBenefitspage, forwhichnobenefitispayable.Itbeginson thefirstdayofTotalDisability. InterruptionPeriod:If,duringtheEliminationPeriod,anInsuredreturnstoActive Workforlessthan30days,thenthe sameorrelatedTotalDisabilitywillbetreatedascontinuous.DaysthattheInsuredisActivelyatWorkduringthis interruptionperiodwillnotcounttowardstheEliminationPeriod.ThisinterruptionoftheEliminationPeriodwillnotapply toan Insuredwhobecomeseligibleunderanyothergrouplong termdisabilityinsuranceplan. "Full-time"meansworkingforyouforaminimumof40hoursduringaperson'sregularworkweek. "Hospital"or"Institution"meansafacilitylicensedtoprovidecareandtreatmentfortheconditioncausingtheInsured's TotalDisability. "Injury"meansbodilyInjuryresultingdirectlyfromanaccident,independentofallothercauses.TheInjurymustcause TotalDisabilitywhichbeginswhileinsurancecoverageisineffectfor theInsured. "Insured"meansapersonwhomeets theEligibilityRequirementsofthisPolicyandisenrolledforthisinsurance. "Physician"meansadulylicensedpractitionerwhoisrecognizedby thelawof thestateinwhich treatmentisreceivedas qualifiedtotreatthetypeofInjuryorSicknessforwhichclaimismade.ThePhysicianmaynotbetheInsuredora memberofhis/herimmediatefamily. "Premium"means theamountofmoneyneeded tokeep thisPolicyinforce. "RegularCare"meansTreatmentthatisadministeredasfrequentlyasismedicallyrequiredaccordingtoguidelines establishedbynationallyrecognizedauthorities,medicalresearch,healthcareorganizations,governmentalagenciesor rehabilitativeorganizations.CaremustberenderedpersonallybytheInsured'sPhysicianaccordingtogenerally acceptedmedicalstandardsintheInsured'slocality,beofademonstrablemedicalvalueandbenecessarytomeet his/herbasichealthneeds. "RegularOccupation"meanstheoccupationtheInsuredisroutinelyperformingwhenTotalDisabilitybegins.Wewill lookat the Insured'soccupationasitisnormallyperformedin thenationaleconomy,andnot theuniquedutiesperformed foraspecificemployerorinaspecificlocale. LRS-6564-4-0406-MNPage2.0 "RetirementBenefits"meanmoneywhichtheInsuredisentitledtoreceiveuponearlyornormalretirementordisability retirementunder: (1)anyplanofastate,countyormunicipalretirementsystem,ifsuchpensionbenefitsincludeanycreditfor employmentwithyou; (2)RetirementBenefitsundertheUnitedStatesSocialSecurityActof1935,asamendedorunderanysimilarplan oract;or (3)anemployer'sretirementplanwherepaymentsaremadeinalumpsumorperiodicallyanddonotrepresent contributionsmadebyan Insured. RetirementBenefitsdonotinclude: (1)afederalgovernmentemployeepensionbenefit; (2)a thriftplan; (3)adeferredcompensationplan; (4)anindividualretirementaccount(IRA); (5)a taxshelteredannuity(TSA); (6)astockownershipplan;or (7)aprofitsharingplan;or (8)section401(k),403(b)or457plans. "Sickness"meansillnessordiseasecausingTotalDisabilitywhichbeginswhileinsurancecoverageisineffectforthe Insured.Sicknessincludespregnancy,childbirth,miscarriageorabortion,oranycomplications therefrom. "TotallyDisabled"and"TotalDisability"mean, thatasaresultofan InjuryorSickness: (1)duringtheEliminationPeriodandforthefirst60monthsforwhichaMonthlyBenefitispayable,anInsured cannotperformthematerialdutiesofhis/herRegularOccupation; (a)"PartiallyDisabled"and"PartialDisability"meanthatasaresultofanInjuryorSicknessanInsuredis capableofperformingthematerialdutiesofhis/herRegularOccupationonapart-timebasisorsomeofthe materialdutiesona full-timebasis.AnInsuredwhoisPartiallyDisabledwillbeconsideredTotallyDisabled, exceptduringtheEliminationPeriod; (b)"ResidualDisability"meansbeingPartiallyDisabledduringtheEliminationPeriod.ResidualDisabilitywillbe considered TotalDisability;and (2)afteraMonthlyBenefithasbeenpaidfor60months,anInsuredcannotperformthematerialdutiesofAny Occupation.Weconsider the Insured TotallyDisabledifdue toan InjuryorSicknessheorsheiscapableofonly performingthematerialdutiesonapart-timebasisorpartofthematerialdutiesona Full-timebasis. Ifan Insuredisemployedbyyouandrequiresalicenseforsuchoccupation, thelossofsuchlicenseforanyreasondoes notinandofitselfconstitute"TotalDisability". "Treatment"meanscareconsistentwiththediagnosisoftheInsured'sInjuryorSicknessthathasitspurposeof maximizingtheInsured'smedicalimprovement.ItmustbeprovidedbyaPhysicianwhosespecialtyorexperienceis mostappropriatefortheInjuryorSicknessandconformswithgenerallyacceptedmedicalstandardstoeffectively manageand treat theInsured's InjuryorSickness. LRS-6564-4-0406-MNPage2.1 CERTAINRESPONSIBILITIESOFTHEPOLICYHOLDER ForthepurposesofthisPolicy,youactonyourbehalforastheemployee'sagent.Undernocircumstanceswillyoube deemedouragent. ComplianceWithAmericansWithDisabilitiesAct(ADA) Itisyourresponsibilitytoestablishandmaintainprocedureswhichcomplywiththeemployerresponsibilitiesofthe AmericansWithDisabilitiesActof1990,asamended. ComplianceWithTheEmployeeRetirementIncomeSecurityAct(ERISA) Itisyourresponsibilitytoestablishandmaintainprocedureswhichcomplywiththeemployerand/orPlanAdministrator responsibilitiesofERISAandtheaccompanyingregulations,whereapplicable. Distribution OfCertificatesOf Insurance ACertificateofInsurancewillbeprovidedtoyou foreachInsuredcoveredunderthisPolicy.TheCertificatewilloutline theinsurancecoverage,andexplaintheprovisions,benefitsandlimitationsofthisPolicy.Itisyourresponsibilityto distributetheappropriateCertificatesandanyupdatesorothernoticesfromus toeach Insured. MaintenanceOfRecords ItisyourresponsibilitytomaintainsufficientrecordsofeachInsured'sinsurance,includingadditions,terminationsand changes.Wereservetherighttoexaminetheserecordsattheplacewheretheyarekeptduringnormalbusinesshours orataplacemutuallyagreeabletoyouandus.Suchrecordsmustbemaintainedbyyouforatleast3yearsafterthis Policyterminates. Reporting OfEligibilityAndCoverageAmounts ItisyourresponsibilitytonotifyusonatimelybasisofallindividualseligibleforcoverageunderthisPolicy,ofall individualswhoseeligibilityforcoverageendsandofallchangesinindividualcoverageamounts. ItisyourresponsibilitytoprovideaccuratecensusandsalaryinformationonallInsuredsonorbeforeeachAnniversary Date,ifwerequestsuchinformation. TimelyPaymentOfPremiums Itisyourresponsibility topayallpremiumsrequiredunder thisPolicywhendue.Anychangein thepremiumcontribution basismustbeapprovedbyus. LRS-6564-114-0406Page3.0 TRANSFEROFINSURANCECOVERAGE IfanemployeewascoveredunderanygrouplongtermdisabilityinsuranceplanmaintainedbyyoupriortothisPolicy's EffectiveDate,thatemployeewillbeinsuredunderthisPolicy,providedthathe/sheisActivelyAtWorkandmeetsallof therequirementsforbeinganEligiblePersonunder thisPolicyonitsEffectiveDate. Ifanemployeewascoveredunderthepriorgrouplongtermdisabilityinsuranceplanmaintainedbyyoupriortothis Policy'sEffectiveDate,butwasnotActivelyatWorkduetoInjuryorSicknessontheEffectiveDateofthisPolicyand wouldotherwisequalifyasanEligiblePerson,coveragewillbeallowedunder thefollowingconditions: (1)Theemployeemusthavebeeninsuredwith thepriorcarrieronthedateof thetransfer;and (2)Premiumsmustbepaid;and (3)TotalDisabilitymustbeginonorafter thisPolicy'sEffectiveDate. Ifanemployeeisreceivinglongtermdisabilitybenefits,becomeseligibleforcoverageunderanothergrouplongterm disabilityinsuranceplan,orhasaperiodofrecurrentdisabilityunderthepriorgrouplongtermdisabilityinsuranceplan, thatemployeewillnotbecoveredunderthisPolicy.Ifpremiumshavebeenpaidontheemployee'sbehalfunderthis Policy, thosepremiumswillberefunded. Pre-existingConditionsLimitationCredit IfanemployeeisanEligiblePersonontheEffectiveDateofthisPolicy,anytimeusedtosatisfythePre-existing ConditionsLimitationofthepriorgrouplongtermdisabilityinsuranceplanwillbecreditedtowardsthesatisfactionofthe Pre-existingConditionsLimitationof thisPolicy. LRS-6564-116-0800Page4.0 GENERALPROVISIONS ENTIRECONTRACT: TheentirecontractbetweenyouandusisthisPolicy,yourApplication(acopyofwhichis attachedatissue)andanyattachedamendments. CHANGES: NoagenthasauthoritytochangeorwaiveanypartofthisPolicy.Tobevalid,anychangeorwaivermust beinwriting,signedbyeitherourPresident,aVicePresident,oraSecretary.Thechangeorwaivermustalsobe attached tothisPolicy. TIMELIMITONCERTAINDEFENSES: AfterthisPolicyhasbeeninforce fortwo(2)yearsfromitsEffectiveDate,no statementmadebyyoushallbeusedtovoidthisPolicy;andnostatementbyanyInsuredonawrittenapplicationfor insuranceshallbeused toreduceordenyaclaimafter the Insured'sinsurancecoverage,withrespect towhichclaimhas beenmade,hasbeenineffectfor two(2)years. RECORDSMAINTAINED: YoumustmaintainrecordsofallInsureds.Suchrecordsmustshow theessentialdataof the insurance,includingnewpersons,terminations,changes,etc.Thisinformationmustbereportedtousregularly.We reservetherighttoexaminetheinsurancerecordsmaintainedattheplacewheretheyarekept.Thisreviewwillonly takeplaceduringnormalbusinesshours. CLERICALERROR: Clericalerrorsinconnectionwith thisPolicyordelaysinkeepingrecordsfor thisPolicy,whetherby you,us,or thePlanAdministrator: (1)willnotterminateinsurance thatwouldotherwisehavebeeneffective;and (2)willnotcontinueinsurance thatwouldotherwisehaveceasedorshouldnothavebeenineffect. Ifappropriate,afairadjustmentofpremiumwillbemade tocorrectaclericalerror. MISSTATEMENTOFAGE: IfanInsured'sageismisstated,thePremiumwillbeadjusted.IftheInsured'sbenefitis affectedbythemisstatedage,itwillalsobeadjusted. Thebenefitwillbechanged to theamount theInsuredisentitledto athis/hercorrectage. NOTINLIEUOFWORKERS'COMPENSATION: ThisPolicyisnotaWorkers'CompensationPolicy.Itdoesnot provideWorkers'Compensationbenefits. CONFORMITYWITHSTATE LAWS: AnysectionofthisPolicy,whichonitsEffectiveDate,conflictswith thelawsof the stateinwhichthisPolicyisissued,isamendedbythisprovision.ThisPolicyisamendedtomeettheminimum requirementsof thoselaws. CERTIFICATEOFINSURANCE: WewillsendtoyouanindividualcertificateforeachInsured.Thecertificatewill outlinetheinsurancecoverage,statethisPolicy'sprovisionsthataffecttheInsured,andexplaintowhombenefitsare payable. TERMINATIONOFTHISPOLICY: Youmaycancel thisPolicyatanytimebygivinguswrittennotice.ThisPolicywillbe cancelledonthedatewereceiveyournoticeor,iflater, thedaterequestedinyournotice. ThisPolicywill terminateat theendofthe GracePeriodifPremiumhasnotbeenpaidbythatdate. Wemaycancel thisPolicywithinthirty-one(31)daysofwrittennoticepriortothedateofcancellation,only: (1)if thenumberof Insuredsisless than theMinimumParticipationNumbershownon theScheduleofBenefits;or (2)ifthepercentageofEligiblePersonsinsuredislessthantheMinimumParticipationPercentageshownonthe ScheduleofBenefits. YouwillstilloweusanyPremium thatisnotpaidup tothedate thisPolicyiscancelled.Wewillreturn,pro-rata,anypart of thePremiumpaidbeyond thedatethisPolicyiscancelled. TerminationofthisPolicywillnotaffectanyclaimwhichwascoveredpriortotermination,subjecttothetermsand conditionsof thisPolicy. LRS-6564-5-0394Page5.0 CLAIMSPROVISIONS NOTICEOFCLAIM: Writtennoticemustbegiventouswithinthirty-one(31)daysafteraTotalDisabilitycoveredbythis Policyoccurs,orassoonasreasonablypossible.ThenoticeshouldbesenttousatourAdministrativeOfficeortoour authorizedagent. Thenoticeshouldincludeyourname, thePolicyNumberand theInsured'sname. CLAIMFORMS: Whenwereceivethenoticeofclaim,wewillsendtheClaimanttheclaim formstofilewithus. Wewill send themwithinfifteen(15)daysafterwereceivenotice.Ifwedonot, thenproofof TotalDisabilitywillbemetbygiving usawrittenstatementofthetypeandextentoftheTotalDisability.Thestatementmustbesentwithinninety(90)days after thelossbegan. WRITTENPROOF OFTOTALDISABILITY: ForanyTotalDisabilitycoveredby thisPolicy,writtenproofmustbesentto uswithinninety(90)daysaftertheTotalDisabilityoccurs.Ifwrittenproofisnotgiveninthattime,theclaimwillnotbe invalidatednorreducedifitisshownthatwrittenproofwasgivenassoonaswasreasonablypossible.Inanyevent, proofmustbegivenwithinone(1)yearafter theTotalDisabilityoccurs,unlesstheClaimantislegallyincapableofdoing so. PAYMENT OFCLAIMS: Whenwereceivewrittenproofof TotalDisabilitycoveredby thisPolicy,wewillpayanybenefits due.Benefits thatprovideforperiodicpaymentwillbepaidforeachperiodaswebecomeliable. Wewillpaybenefits to theInsured,ifliving,orelse tohis/herestate. IftheInsuredhasdiedandwehavenotpaidallbenefitsdue,wemaypayupto$1,000toanyrelativebybloodor marriage,or totheexecutororadministratorofthe Insured'sestate.Thepaymentwillonlybemadetopersonsentitled to it.AnexpenseincurredasaresultoftheInsured'slastillness,deathorburialwillentitleapersontothispayment.The paymentswillceasewhenavalidclaimismade forthebenefit.Wewillnotbeliable foranypaymentwehavemadein goodfaith. RelianceStandardLife InsuranceCompanyshallserveas theclaimsreview fiduciarywithrespect to theinsurancepolicy andthePlan.TheclaimsreviewfiduciaryhasthediscretionaryauthoritytointerpretthePlanandtheinsurancepolicy andtodetermineeligibility forbenefits.Decisionsbytheclaimsreviewfiduciaryshallbecomplete,finalandbindingon allparties. ARBITRATIONOFCLAIMS: AnyclaimordisputearisingfromorrelatingtoourdeterminationregardingtheInsured's TotalDisabilitymaybesettledbyarbitrationwhenagreedtobytheInsuredandusinaccordancewiththeRulesfor HealthandAccidentClaimsof theAmericanArbitrationAssociationorbyanyothermethodagreeable to theInsuredand us.InthecaseofaclaimunderanEmployeeRetirementIncomeSecurityAct(hereinafterreferredtoasERISA)Plan, theInsured'sERISAclaimappealremedies,ifapplicable,mustbeexhaustedbeforetheclaimmaybesubmittedto arbitration.Judgmentupontheawardrenderedbythearbitratorsmaybeenteredinanycourthavingjurisdictionover suchawards. UnlessotherwiseagreedtobytheInsuredandus,anysuchawardwillbebindingontheInsuredandusforaperiodof twelve(12)monthsafteritisrenderedassumingthattheawardisnotbasedonfraudulentinformationandtheInsured continuestobeTotallyDisabled.Attheendofsuchtwelve(12)monthperiod,theissueof TotalDisabilitymayagainbe submitted toarbitrationinaccordancewith thisprovision. AnycostsofsaidarbitrationproceedingsleviedbytheAmericanArbitrationAssociationortheorganizationorperson(s) conducting theproceedingswillbepaidbyus. PHYSICALEXAMINATIONANDAUTOPSY: Wewill,atourexpense,havetherighttohaveaClaimantinterviewed and/orexamined: (1)physically; (2)psychologically;and/or (3)psychiatrically; todeterminetheexistenceofanyTotalDisabilitywhichisthebasisforaclaim.Thisrightmaybeusedasoftenasitis reasonablyrequiredwhileaclaimispending. Wecanhaveanautopsymadeunlessprohibitedbylaw. LRS-6564-6-0394Page6.0 LEGALACTIONS: Nolegalactionmaybebroughtagainstus torecoveron thisPolicywithinsixty(60)daysafterwritten proofoflosshasbeengivenasrequiredbythisPolicy.Noactionmaybebroughtafterthree(3)years(Kansas, five(5) years;SouthCarolina,six(6)years)from thetimewrittenproofoflossisreceived. LRS-6564-6-0394Page6.1 INDIVIDUALELIGIBILITY,EFFECTIVEDATEANDTERMINATION GENERAL GROUP: Thegeneralgroupwillbeyouremployeesandemployeesofanysubsidiaries,divisionsoraffiliates namedontheScheduleofBenefitspage. ELIGIBILITYREQUIREMENTS: Apersoniseligible forinsuranceunderthisPolicyifhe/sheisamemberofanEligible Class,asshownon theScheduleofBenefitspage. EFFECTIVEDATEOFINDIVIDUALINSURANCE: IfyoupaytheentirePremiumdueforanEligiblePerson,the insuranceforsuchEligiblePersonwillgointoeffectontheIndividualEffectiveDate,asshownontheScheduleof Benefitspage. IfanEligiblePersonpaysapartofthePremium,he/shemustapplyinwritingfortheinsurancetogointoeffect.He/she willbecomeinsuredon thelatestof: (1)the IndividualEffectiveDateasshownon theScheduleofBenefitspage,ifhe/sheappliesonorbeforethatdate; (2)onthefirstofthemonthcoincidingwithornextfollowingthedatehe/sheapplies,ifhe/sheapplieswithinthirty- one(31)daysfrom thedatehe/she firstmettheEligibilityRequirements;or (3)onthefirstofthemonthcoincidingwithornextfollowingthedateweapproveanyrequiredproofofhealth acceptable tous.Werequire thisproofifapersonapplies: (a)after thirty-one(31)daysfrom thedatehe/she firstmettheEligibilityRequirements;or (b)afterhe/sheterminatedthisinsurancebutremainedinanEligibleClassasshownontheScheduleof Benefitspage. TheinsuranceforanEligiblePersonwillnotgointoeffectonadatehe/sheisnotActivelyatWorkbecauseofaSickness orInjury. Theinsurancewillgointoeffectafter thepersonisActivelyatWorkforone(1)fulldayinanEligibleClass,as shownon theScheduleofBenefitspage. TERMINATION OF INDIVIDUALINSURANCE: TheinsuranceofanInsuredwill terminateonthe firstofthefollowingto occur: (1)thedate thisPolicy terminates; (2)thedate theInsuredceases tomeet theEligibilityRequirements; (3)theendoftheperiodforwhichPremiumhasbeenpaidforthe Insured;or (4)thedate theInsuredentersmilitaryservice(notincludingReserveorNational Guard). INDIVIDUALREINSTATEMENT: Theinsuranceofaterminatedpersonmaybereinstatedifhe/shereturnstoActive WorkwithyouwithintheperiodoftimeasshownontheScheduleofBenefitspage.He/shemustalsobeamemberof anEligibleClass,asshownon theScheduleofBenefitspage,andhavebeen: (1)onaleaveofabsenceapprovedbyyou;or (2)on temporarylay-off. Thepersonwillnotberequiredto fulfilltheEligibilityRequirementsofthisPolicyagain.Theinsurancewillgointoeffect afterhe/shereturnstoActiveWorkforone(1)fullday.Ifapersonreturnsafterhavingresignedorhavingbeen discharged,he/shewillberequiredtofulfilltheEligibilityRequirementsofthisPolicyagain.Ifapersonreturnsafter terminatinginsuranceathis/herrequestorforfailure topayPremiumwhendue,proofofhealthacceptable tousmustbe submittedbeforehe/shemaybereinstated. LRS-6564-7-0208Page7.0 PREMIUMS PREMIUMPAYMENT: AllPremiumsaretobepaidbyyoutous,ortoanauthorizedagent,onorbeforetheduedate. ThePremiumDueDatesarestatedon thisPolicy'sfacepage. PREMIUMRATE: ThePremiumduewillbe therateper$100.00of theentireamountofCoveredMonthlyEarnings then in force. Wewill furnishtoyouthePremiumRateonthisPolicy'sEffectiveDateandwhenitischanged.Wehavethe righttochange thePremiumRate: (1)when theextentofcoverageischangedbyamendment; (2)onanyPremiumDueDateafter thesecondPolicyAnniversary;or (3)onanyPremiumDueDateonorafter thefirstPolicyAnniversaryifyourentiregroup'sCoveredMonthlyEarnings changesby15%ormorefromsuchgroup'sCoveredMonthlyEarningson thisPolicy'sEffectiveDate. WewillnotchangethePremiumRatedueto(2)or(3)abovemorethanonceinanytwelve(12)monthperiod. Wewill tellyouinwritingatleast thirty-one(31)daysbeforethedateofachangedue to(2)or(3)above. GRACEPERIOD :Youmaypay thePremiumup to thirty-one(31)daysafter thedateitisdue. ThisPolicystaysinforce duringthistime.IfthePremiumisnotpaidduringthegraceperiod,thisPolicywillterminate.Youwillstilloweusthe Premiumup to thedatethisPolicyterminates. WAIVER OF PREMIUM: NoPremiumisdueusforan Insuredwhilehe/sheisreceivingMonthlyBenefitsfromus. Once MonthlyBenefitsceaseduetotheendofhis/herTotalDisability,Premiumpaymentsmustbeginagainifinsuranceisto continue. LRS-6564-8Ed.8/09Page8.0 BENEFITPROVISIONS INSURINGCLAUSE: WewillpayaMonthlyBenefitifan Insured: (1)is TotallyDisabledas theresultofaSicknessor Injurycoveredby thisPolicy; (2)isunder theregularcareofaPhysician; (3)hascompletedtheEliminationPeriod;and (4)submitssatisfactoryproofof TotalDisabilitytous. BENEFITAMOUNT: Tofigurethebenefitamountpayable: (1)multiplyanInsured'sCoveredMonthlyEarningsbythebenefitpercentage(s),asshownontheScheduleof Benefitspage; (2)take thelesseroftheamount: (a)ofstep(1)above;or (b)theMaximumMonthlyBenefit,asshownon theScheduleofBenefitspage;and (3)subtract OtherIncomeBenefits,asshownbelow, fromstep(2)above. Wewillpayatleast theMinimumMonthlyBenefit,asshownon theScheduleofBenefitspage. OTHER INCOMEBENEFITS: Other IncomeBenefitsare: (1)disabilityincomebenefitsanInsurediseligibletoreceivebecauseofhis/herTotalDisabilityunderanygroup insuranceplan(s); (2)disabilityincomebenefitsanInsurediseligibletoreceivebecauseofhis/herTotalDisabilityunderany governmentalretirementsystem,exceptbenefitspayableunderafederalgovernmentemployeepension benefit; (3)allbenefits(exceptmedicalordeathbenefits)includinganysettlementmadeinplaceofsuchbenefits(whether ornotliabilityisadmitted)anInsurediseligible toreceivebecauseofhis/her TotalDisabilityunder: (a)Workers'CompensationLaws; (b)occupationaldiseaselaw; (c)anyotherlawsoflikeintentas(a)or(b)above;and (d)anycompulsorybenefitlaw(exceptbenefitspayableunder theMinnesotaNo-FaultMotorVehicleLaw); (4)anyof thefollowing that theInsurediseligible toreceivefromyou: (a)anyformalsalarycontinuanceplan; (b)wages,salaryorothercompensation,excludingtheamountallowablewhenengagedinRehabilitative Employment;and (c)commissionsormonies,includingvestedrenewalcommissions,but,excludingcommissionsormonies that the Insuredearnedprior toTotalDisabilitywhicharepaidafterTotalDisabilityhasbegun; (5)thatpartofdisabilitybenefitspaidforbyyouthatanInsurediseligibletoreceivebecauseofhis/herTotal Disabilityunderagroupretirementplan;and (6)thatpartofRetirementBenefitspaidforbyyouthatanInsurediseligibletoreceiveunderagroupretirement plan;and (7)disabilityorRetirementBenefitsundertheUnitedStatesSocialSecurityAct,theCanadianpensionplans,or anyothergovernmentplanforwhich: (a)an Insurediseligible toreceivebecauseofhis/her TotalDisabilityoreligibilityforRetirementBenefits;and (b)an Insured'sdependentsareeligibletoreceivedueto(a)above. DisabilityandearlyRetirementBenefitswillbeoffsetonlyifsuchbenefitsareelectedby the Insuredordonotreduce the amountofhis/heraccruednormalRetirementBenefitsthenfunded. RetirementBenefitsundernumber(7)abovewillnotapplytodisabilitieswhichbeginafterage70forthoseInsureds alreadyreceivingSocialSecurityRetirementBenefitswhilecontinuing toworkbeyondage70. Benefitsabovewillbeestimatedif thebenefits: (1)havenotbeenappliedfor;or (2)havebeenappliedforandadecisionispending;or (3)havebeendeniedandthedenialmaybeappealed. TheMonthlyBenefitwillbereducedbytheestimatedamount.Ifbenefitshavebeenestimated,theMonthlyBenefitwill beadjustedwhenwereceiveproof: (1)of theamountawarded;or (2)thatbenefitshavebeendeniedand thedenialcannotbefurtherappealed. LRS-6564-9-0406-MNPage9.0 Ifwehaveunderpaidanybenefitforanyreason,wewillmakealumpsumpayment.Ifwehaveoverpaidanybenefitfor anyreason,theoverpaymentmustberepaidtous.Atouroption,wemayreducetheMonthlyBenefitorask foralump sumrefund.IfwereducetheMonthlyBenefit,theMinimumMonthlyBenefit,ifany,asshownontheScheduleof Benefitspage,wouldnotapply.Interestdoesnotaccrueonanyunderpaidoroverpaidbenefitunlessrequiredby applicablelaw. ForeachdayofaperiodofTotalDisabilitylessthanafullmonth,theamountpayablewillbe1/30thoftheMonthly Benefit. COSTOFLIVINGFREEZE: AftertheinitialdeductionforanyOtherIncomeBenefits,theMonthlyBenefitwillnotbe furtherreduceddue toanycostoflivingincreasespayableunder these OtherIncomeBenefits. LUMPSUMPAYMENTS: IfOtherIncomeBenefitsarepaidinalumpsum,thesumwillbeproratedovertheperiodof timetowhichtheOtherIncomebenefitsapply.Ifnoperiodoftimeisgiven,thesumwillbeproratedoversixty(60) months. TERMINATIONOFMONTHLYBENEFIT: TheMonthlyBenefitwillstopon theearliestof: (1)thedate theInsuredceases tobe TotallyDisabled; (2)thedate theInsureddies; (3)theMaximumDurationofBenefits,asshownon theScheduleofBenefitspage,hasended; (4)thedate theInsuredfails tofurnish therequiredproofof TotalDisability. RECURRENTDISABILITY: If,afteraperiodofTotalDisabilityforwhichbenefitsarepayable,anInsuredreturnsto ActiveWorkforatleastsix(6)consecutivemonths,anyrecurrentTotalDisabilityforthesameorrelatedcausewillbe partofanewperiodof TotalDisability.AnewEliminationPeriodmustbecompletedbeforeanyfurtherMonthlyBenefits arepayable. Ifan Insuredreturns toActiveWorkforless thansix(6)months,arecurrent TotalDisabilityforthesameorrelatedcause willbepartof thesame TotalDisability.AnewEliminationPeriodisnotrequired. Ourliability fortheentireperiodwillbe subject tothe termsof thisPolicyfortheoriginalperiodof TotalDisability. ThisRecurrentDisabilitysectionwillnotapplytoanInsuredwhobecomeseligibleforinsurancecoverageunderany othergrouplong termdisabilityinsuranceplan. LRS-6564-9-0406-MNPage9.1 WORKSITEMODIFICATIONPROVISION IfanInsuredisTotallyDisabled,participatinginarehabilitationprogramandreceivingaMonthlyBenefitandhe/sheis abletoreturntoActiveWorkshouldyoumakeamodificationtotheInsured'sworksite,thenyoumaybeeligiblefor WorksiteModificationReimbursement. Youwillbereimbursedfor100%oftheactualandreasonableexpensespaidforeligibleworksitemodificationsto accommodate theInsured'sreturn toActiveWork,uptoamaximumreimbursementof$2,000.00. Eligibleworksitemodificationsinclude: ; 1.providingthe Insuredwithamoreaccessibleparkingspaceorentranceor 2.removingitemsfromtheworksitewhichrepresentbarriersorhazards to the Insured;or 3.specialseating,furnitureorequipmentfor theInsured'sworkstation;or 4.providingspecialtrainingmaterialsor translationservicesduring the Insured's training;or 5.anyotherservices thatwedeemnecessary tohelp theInsuredreturn toActiveWorkwithyou. Inorderforthisreimbursementtobepayable,theInsuredmusthaveaTotalDisabilitythatresultssolelyfromthe Insured'sinabilitytoperformhisorherRegularOccupationatyourworksite.TheInsuredmustalsohavethephysical andmentalabilitiesneededtoperformhisorherRegularOccupationoranotheroccupationatyourworksite,butonly with thehelpoftheproposedworksitemodification. Aworksitemodificationmayfirstbeproposedbyeitheryou,theInsuredorhisorherPhysician,orbyus.Awritten proposalmustthenbedevelopedwithinputfromyou,theInsuredorhisorherPhysician.Theproposalmuststatethe purposeoftheproposedworksitemodification,thetimes,datesandcostsofthemodifications.Anyproposalmustbein writingandissubjecttoourapproval,yourapprovalandtheapprovaloftheInsuredpriortoanyreimbursementbeing paid. Oncetheworksitemodificationhasbeenapprovedinwriting,youmustmaketheworksitemodification.Uponreceiptof proofsatisfactory tous that themodificationsfor the Insuredhavebeenmadeasapprovedandyouhavepaid theperson ororganization thatprovidedtheworksitemodification,wewill thenreimburseyouup tothelimitshownabove. LRS-6564-115-0597Page10.0 EXCLUSIONS WewillnotpayaMonthlyBenefitforany TotalDisabilitycausedby: (1)anactofwar,declaredorundeclared;or (2)anintentionallyself-inflicted Injury;or (3)commissionoforattempt tocommitafelonyand/orbeingengagedinanillegaloccupation. LRS-6564-10-0788Page11.0 LIMITATIONS MENTALORNERVOUSDISORDERS: MonthlyBenefitsforTotalDisabilitycausedbyorcontributedtobymentalor nervousdisorderswillnotbepayablebeyondanaggregatelifetimemaximumdurationof twenty-four(24)monthsunless theInsuredisinaHospitalorInstitutionattheendofthetwenty-four(24)monthperiod.TheMonthlyBenefitwillbe payablewhilesoconfined,butnotbeyond theMaximumDurationofBenefits. IfanInsuredwasconfinedinaHospitalor Institutionand: (1)TotalDisabilitycontinuesbeyonddischarge; (2)theconfinementwasduringaperiodofTotalDisability;and (3)theperiodofconfinementwasforatleastfourteen(14)consecutivedays; thenupondischarge,MonthlyBenefitswillbepayablefor thegreaterof: (1)theunusedportionof thetwenty-four(24)monthperiod;or (2)ninety(90)days; butinnoeventbeyond theMaximumDurationofBenefits,asshownon theScheduleofBenefitspage. MentalorNervousDisordersaredefinedtoincludedisorderswhicharediagnosed toincludeaconditionsuchas: (1)bipolardisorder(manicdepressivesyndrome); (2)schizophrenia; (3)delusional(paranoid)disorders; (4)psychoticdisorders; (5)depressivedisorders; (6)anxietydisorders; (7)somatoformdisorders(psychosomaticillness); (8)eatingdisorders;or (9)mentalillness. SUBSTANCEABUSE: MonthlyBenefitsfor TotalDisabilitydue to the Insuredbeingunder theinfluenceofanynarcotic, unlessadministeredontheadviceofaPhysician,willbepayablewhile theInsuredisaparticipantinaSubstanceAbuse RehabilitationProgram. TheMonthlyBenefitwillnotbepayablebeyond twenty-four(24)months. If,duringaperiodof TotalDisabilitydue toSubstanceAbuseforwhichaMonthlyBenefitispayable,an Insuredisable to performRehabilitativeEmployment,theMonthlyBenefit,less50%ofanyofthemoneyreceived fromthisRehabilitative Employmentwillbepaiduntil:(1) the Insuredisperformingallthematerialdutiesofhis/herRegularOccupationonafull- timebasis;or(2)theendoftwenty-four(24)consecutivemonthsfromthedatethattheEliminationPeriodissatisfied, whicheverisearlier.All termsandconditionsof theRehabilitationBenefitwillapply toRehabilitativeEmploymentdueto SubstanceAbuse. "SubstanceAbuse"means thepatternofpathologicaluseofaSubstancewhichischaracterizedby: (1)impairmentsinsocialand/oroccupationalfunctioning; (2)debilitatingphysicalcondition; (3)inabilitytoabstainfromorreduceconsumptionof theSubstance;or (4)theneedfordailySubstanceuseforadequatefunctioning. "Substance"meansthosedrugsincludedontheDepartmentofHealth,RetardationandHospitals'SubstanceAbuselist ofaddictivedrugs,except tobaccoandcaffeineareexcluded. ASubstanceAbuseRehabilitationProgrammeansaprogramsupervisedbyaPhysicianoralicensedrehabilitation specialistapprovedbyus. PRE-EXISTINGCONDITIONS: BenefitswillnotbepaidforaTotalDisability: (1)causedby; (2)contributedtoby;or (3)resultingfrom; aPre-existingConditionunlesstheInsuredhasbeenActivelyatWorkforone(1) fulldayfollowingtheendoftwelve(12) consecutivemonthsfromthedatehe/shebecameanInsured. LRS-6564-11-0406-MNPage12.0 "Pre-ExistingCondition"meansanySicknessorInjuryforwhichtheInsuredreceivedmedicalTreatment,consultation, careorservices,includingdiagnosticprocedures,ortookprescribeddrugsormedicines,duringthethree(3)months immediatelypriorto theInsured'seffectivedateofinsurance. LRS-6564-11-0406-MNPage12.1 SPECIFICINDEMNITYBENEFIT Ifthe InsuredsuffersanyoneoftheLosseslistedbelow fromanaccidentresultinginan Injury,wewillpayaguaranteed minimumnumberofMonthlyBenefitpayments,asshownbelow.However: (1)theLossmustoccurwithinonehundredandeighty(180)days;and (2)the Insuredmustlivepast theEliminationPeriod. ForLossof:NumberofMonthlyBenefitPayments: BothHands........................................................................................................................................................46Months Both Feet...........................................................................................................................................................46Months EntireSightinBothEyes....................................................................................................................................46Months HearinginBothEars...........................................................................................................................................46Months Speech..............................................................................................................................................................46Months OneHandand OneFoot....................................................................................................................................46Months OneHandandEntireSightinOneEye...............................................................................................................46Months One FootandEntireSightin OneEye................................................................................................................46Months OneArm.............................................................................................................................................................35Months OneLeg.............................................................................................................................................................35Months OneHand..........................................................................................................................................................23Months One Foot............................................................................................................................................................23Months EntireSightinOneEye......................................................................................................................................15Months Hearingin OneEar.............................................................................................................................................15Months "Loss(es)"withrespect to: (1)handorfoot,means thecompleteseverance throughorabovethewristoranklejoint; (2)armorleg,means thecompleteseverance throughorabove theelboworkneejoint;or (3)sight,speechorhearing,means totalandirrecoverableLoss thereof. Ifmore thanone(1)Lossresultsfromanyoneaccident,paymentwillbemadefor theLossforwhichthegreatestnumber ofMonthlyBenefitpaymentsisprovided. TheamountpayableistheMonthlyBenefit,asshownontheScheduleofBenefitspage,withnoreductionfromOther IncomeBenefits. ThenumberofMonthlyBenefitpaymentswillnotceaseif theInsuredreturns toActiveWork. IfdeathoccursafterwebeginpayingMonthlyBenefits,butbefore theSpecificIndemnityBenefithasbeenpaidaccording totheaboveschedule,thebalanceremainingat timeofdeathwillbepaid totheInsured’sestate,unlessabeneficiaryis onrecordwithusunder thisPolicy. Benefitsmaybepayablelonger thanshownaboveaslongas the InsuredisstillTotallyDisabled,subjectto theMaximum DurationofBenefits,asshownon theScheduleofBenefitspage. LRS-6564-13Ed.2/83Page13.0 SURVIVORBENEFIT- LUMPSUM WewillpayabenefittoanInsured’sSurvivorwhenwereceiveproof that the Insureddiedwhile: (1)he/shewasreceivingMonthlyBenefitsfromus;and (2)he/shewas TotallyDisabledforatleastonehundredandeighty(180)consecutivedays. Thebenefitwillbeanamountequalto3timestheInsured’slastMonthlyBenefit.ThelastMonthlyBenefitisthebenefit theInsuredwaseligibletoreceiverightbeforehis/herdeath.ItisnotreducedbywagesearnedwhileinRehabilitative Employment. “Survivor”meansan Insured’sspouse. Ifthespousediesbefore the Insuredorifthe Insuredwaslegallyseparated, then theInsured’snatural,legallyadoptedorstep-child(ren),whoareunderagetwenty-five(25)willbetheSurvivor(s).If therearenoeligibleSurvivors,paymentwillbemadetotheInsured’sestate,unlessabeneficiaryisonrecordwithus under thisPolicy. Abenefitpayable toaminormaybepaid to theminor’slegallyappointedguardian. If thereisnoguardian,atouroption, wemaypay thebenefittoanadultthathas,inouropinion,assumedthecustodyandmainsupportoftheminor.Wewill notbeliableforanypaymentwehavemadeingoodfaith. LRS-6564-14Ed.1/00Page14.0 WORK INCENTIVEANDCHILDCAREBENEFITS WORK INCENTIVEBENEFIT Duringthefirsttwelve(12)monthsofRehabilitativeEmploymentduringwhichaMonthlyBenefitispayable,wewillnot offsetearningsfromsuchRehabilitativeEmploymentuntilthesumof: (1)theMonthlyBenefitprior tooffsetswithOther IncomeBenefits;and (2)earningsfromRehabilitativeEmployment; exceed100%ofthe Insured'sCoveredMonthlyEarnings.Ifthesumaboveexceeds100%ofCoveredMonthlyEarnings, ourBenefitAmountwillbereducedbysuchexcessamountuntilthesumof(1)and(2)aboveequals100%. CHILDCAREBENEFIT WewillallowaChildCareBenefit toanInsuredif: (1)the Insuredisreceivingbenefitsunder theWorkIncentiveBenefit; (2)the Insured'sChild(ren)is(are)under14yearsofage; (3)thechildcareisprovidedbyanon-relative;and (4)thechargesforchildcarearedocumentedbyareceiptfromthecaregiver,includingsocialsecuritynumberor taxpayeridentificationnumber. Duringthetwelve(12)monthperiodinwhichtheInsurediseligiblefortheWorkIncentiveBenefit,anamountequalto actualexpensesincurredforchildcare,uptoamaximumof$250.00permonth,willbeaddedtotheInsured'sCovered MonthlyEarningswhencalculating theBenefitAmountunder theWork IncentiveBenefit. Child(ren)means: theInsured'sunmarriedchild(ren),includinganyfosterchild,adoptedchildorstepchildwhoresidesin the Insured'shomeandisfinanciallydependenton theInsuredforsupportandmaintenance. LRS-6564-60-0100Page15.0 EXTENSIONOFCOVERAGEUNDERTHE FAMILYANDMEDICALLEAVEACTANDUNIFORMEDSERVICES EMPLOYMENTANDREEMPLOYMENTRIGHTSACT(USERRA) FamilyandMedicalLeave ofAbsence: WewillcontinuetheInsured'scoverageinaccordancewithyourpoliciesregardingleaveundertheFamilyandMedical LeaveActof1993,asamended,oranysimilarstatelaw,asamended,if: (1)thepremiumforsuch Insuredcontinues tobepaidduring theleave;and (2)youhaveapprovedtheInsured'sleaveinwritingandprovideacopyofsuchapprovalwithinthirty-one(31)days ofourrequest. Aslongas theaboverequirementsaresatisfied,wewillcontinuecoverageuntilthelaterof: (1)theendoftheleaveperiodrequiredbythe FamilyandMedicalLeaveActof1993,asamended;or (2)theendoftheleaveperiodrequiredbyanysimilarstatelaw,asamended. MilitaryServices LeaveofAbsence: WewillcontinuetheInsured’scoverageinaccordancewithyourpoliciesregardingMilitaryServicesLeaveofAbsence underUSERRAifthepremiumforsuch Insuredcontinues tobepaidduringtheleave. Aslongas theaboverequirementissatisfied,wewillcontinuecoverageuntil theendof theperiodrequiredbyUSERRA. ThisPolicy,whilecoverageisbeingcontinuedunderthisMilitaryServicesLeaveofAbsenceextension,doesnotcover anylosswhichoccurswhileonactivedutyinthemilitaryifsuchlossiscausedbyorarisesoutofsuchmilitaryservice, includingbutnotlimited towaroranyactofwar,whetherdeclaredorundeclared. While the Insuredisona FamilyandMedicalLeaveofAbsenceforanyreasonother thanhisorherownillness,injuryor disabilityorMilitaryServicesLeaveofAbsenceheorshewillbeconsideredActivelyatWork.Anychangessuchas revisions tocoveragedue toage,classorsalarychanges,asapplicable,willapplyduring theleaveexcept thatincreases intheamountofinsurance,whetherautomaticorsubjecttoelection,willnotbeeffectiveforanInsuredwhoisnot consideredActivelyatWorkuntilthe Insuredhasreturned toActiveWorkforone(1)fullday. Aleaveofabsence takeninaccordancewith the FamilyandMedicalLeaveActof1993orUSERRAwillrunconcurrently withanyotherapplicablecontinuationofinsuranceprovisionin thisPolicy. The Insured'scoveragewillceaseunder thisextensionon theearliestof: (1)thedate thisPolicy terminates;or (2)theendoftheperiodforwhichpremiumhasbeenpaidfor theInsured;or (3)thedatesuchleaveshouldendinaccordancewithyourpoliciesregarding FamilyandMedicalLeaveofAbsence andMilitaryServicesLeaveofAbsenceincompliancewiththeFamilyandMedicalLeaveActof1993,as amendedandUSERRA.CoveragewillnotbeterminatedforanInsuredwhobecomesTotallyDisabledduring theperiodoftheleaveandwhoiseligibleforbenefitsaccordingtothetermsofthisPolicy.AnyMonthlyBenefit whichbecomespayablewillbebasedon the Insured'sCoveredMonthlyEarningsimmediatelypriortothedateof TotalDisability. Shouldyouchoosenottocontinuethe Insured'scoverageduringaFamilyandMedicalLeaveofAbsenceand/orMilitary ServicesLeaveofAbsence, the Insured'scoveragewillbereinstated. LRS-6564-73-0708Page16.0 EXTENDEDDISABILITYBENEFIT WewillpayanExtendedDisabilityBenefit toanInsuredif theInsured: (1)meetsall therequirementsofTotalDisabilityofthisPolicy;and (2)isreceivingaTotalDisabilityBenefitunderthisPolicythatwillbeexhaustedbecausetheMaximumDurationof Benefitshasended;and (3)isunable tofunctionwithoutanotherperson'sDirectAssistanceorverbaldirectiondue to: (a)aninability toperformatleast twoActivitiesofDailyLiving(ADL)asdefined;or (b)CognitiveImpairmentasdefined;and (4)iseither: (a)confinedasanInpatientinaSkilledNursingHome,RehabilitationFacilityorRehabilitativeHospitalinwhich patientsreceivecarefromlicensedmedicalprofessionals;or (b)receivingHomeHealthCareorHospiceCare;and (5)makesaWrittenRequestfor thisbenefitwithinthirty(30)daysafter theMaximumDurationofBenefitshasended. TheExtendedDisabilityBenefit: (1)willbeanamountequalto85%oftheMonthlyBenefitafteroffsetswithOtherIncomeBenefitswhichwaspayable priorto theInsuredqualifyingfor theExtendedDisabilityBenefituptoamaximumof$5,000permonth;and (2)ispayableforamaximumofsixty(60)monthsmeasuredfromthedatethattheMaximumDurationofBenefitshas ended. Definitions : “ActivitiesofDailyLiving(ADL)”means: (1)Bathing- theabilitytowashoneselfin the tuborshowerorbyspongebathfromabasinwithoutDirectAssistance; (2)Dressing-theabilitytochangeclotheswithoutDirectAssistance,including fasteningandunfasteninganymedically necessarybracesorartificiallimbs; (3)Eating/Feeding- theabilitytoeatwithoutDirectAssistance,oncefoodhasbeenpreparedandmadeavailable; (4)Transferring-theabilitytomoveinandoutofachairorbedwithoutDirectAssistance,exceptwiththeaidof equipment(includingsupportandothermechanicaldevices);and (5)Toileting-theabilitytogettoandfromandonandoffthetoilet,tomaintainareasonablelevelofpersonalhygiene and toadjustclothingwithoutDirectAssistance. “CognitivelyImpaired”and“CognitiveImpairment”meanstheInsured’sconfusionordisorientationduetoorganic changesinthebrainresultinginadeteriorationorlossinintellectualcapacityasconfirmedbycognitiveorothertests satisfactory tous. “DirectAssistance”meanstheInsuredrequirescontinuoushelporoversighttobeabletoperformtheActivityofDaily Living(ADL). “HomeHealthCare”meansmedicalandnon-medicalservices,providedinanInsured’sresidenceduetoInjuryor Sickness,including:visitingnurseservices;physical,respiratory,occupationalorspeechtherapy;nutritionalcounseling; andhomehealthaideservices.HomeHealthCareservicesmustbe:(1)prescribedbyandprovidedunderthe supervisionofaPhysician;and(2)renderedbyalicensedhomehealthcareproviderwhoisnotamemberofthe Insured’simmediatefamily.HomeHealthCaredoesnotinclude:homemaker,companionandhomedeliveredmeals services;norinformalcareservicesprovidedbyfamilymembersofthe Insured. “HospiceCare”meansaprogramofcarewhichcoordinatesthespecialneedsofapersonwithaTerminalIllness. HospiceCaremustbe:(1)prescribedbyandprovidedunderthesupervisionofaPhysician;and(2)renderedbya licensedhospicecareproviderwhoisnotamemberofthe Insured’simmediatefamily. LRS-6564-205-0501Page17.0 “Inpatient”meansapersonconfinedinaSkilledNursingHome,RehabilitationFacilityorRehabilitativeHospital,for whomadailyroomandboardchargeismade. “Pre-existingCondition”meanswithrespecttotheExtendedDisabilityBenefitonly,anySicknessorInjuryforwhichthe Insuredreceivedmedicaltreatment,consultation,careorservices,includingdiagnosticprocedures,ortookprescribed drugsormedicines,during the twelve(12)monthsimmediatelyprecedingthe Insured’seffectivedateofinsurance. “RehabilitationFacilityorRehabilitativeHospital”meansanyfacilityorHospitalthatislicensedinthestateinwhichitis operatingtoproviderehabilitationservices,therapyorretrainingtotheInsuredtoenablehimorhertowalk, communicate,and/orfunctionasamemberofsociety. “SkilledNursingHome”meansa facilityorpartofa facilitythatislicensedorcertifiedinthestateinwhichitisoperating toprovideSkilledNursingCare. “SkilledNursingCare”means thatlevelofcarewhich: (1)requires the trainingandskillsofaRegisteredNurse; (2)isprescribedbyaPhysician; (3)isbasedongenerallyrecognizedandacceptedstandardsofhealthcareby theAmericanMedicalAssociation;and (4)isappropriatefor thediagnosisand treatmentof theInsured’sSicknessor Injury. “TerminalIllness”meansaSicknessorphysicalcondition thatiscertifiedbyaPhysicianinawrittenstatement,onaform prescribedbyus, toreasonablybeexpected toresultindeathinless than12months. “WrittenRequest”meansarequestmade,inwriting,by the Insured tous. Pre-existingConditionsLimitation: Withrespect to theExtendedDisabilityBenefitonly,benefitswillnotbepaidfora TotalDisability: (1)causedby; (2)contributedtoby;or (3)resultingfrom; aPre-existingConditionunless the InsuredhasbeenActivelyatWorkforone(1)fulldayfollowing theendof twenty-four (24)consecutivemonthsmeasuredfrom theInsured’seffectivedateofinsurancewithus. NobenefitswillbepaidundertheExtendedDisabilityBenefitiftheInsured’sTotalDisabilityoccurredbeforethe Insured’seffectivedateofinsurancewithus. TheExtendedDisabilityBenefitwillcease tobepayableon theearliestof thefollowingdates: (1)thedate theInsureddies;or (2)thedate theInsurednolongermeets therequirementsof TotalDisabilityof thisPolicy;or (3)thedate theInsured: (a)isnolongerconfinedasanInpatientinaSkilledNursingHome,RehabilitativeFacilityorRehabilitationHospital; or (b)isnolongerreceivingHomeHealthCareorHospiceCare;or (4)thedate theInsuredisnolongerconsideredCognitivelyImpaired;or (5)thedate theInsuredisnolongerunabletoperformatleast twoActivitiesofDailyLiving(ADL);or (6)thedate theInsuredreceiveshisorhersixtieth(60th)monthlyExtendedDisabilityBenefitpayment. TheExtendedDisabilityBenefitwillnotbepayableforTotalDisabilitywhichiscausedbyorresultsfromconditionsfor whichMonthlyBenefitsarespecificallylimitedbythisPolicysuchasMentalorNervousDisorders,alcoholism,drug addiction,orotherSubstanceAbuse,musculoskeletalandconnectivetissuedisorders,chronicfatiguesyndrome, EnvironmentalAllergicorReactiveIllness,orSelf-ReportedConditions. LRS-6564-205-0501Page17.1 If thisPolicycontainsaSurvivorBenefit,ActivitiesofDailyLivingBenefit(ADL),CatastrophicCareBenefit,Supplemental PensionBenefit,LivingBenefit,CostofLivingBenefitoraConversionPrivilege,suchbenefitsarenotapplicablewhen receivingbenefitsunder theExtendedDisabilityBenefit. LRS-6564-205-0501Page17.2 REHABILITATIONBENEFIT "RehabilitativeEmployment"meansworkinAnyOccupationforwhichtheInsured'straining,educationorexperiencewill reasonablyallow.TheworkmustbeapprovedbyaPhysicianoralicensedorcertifiedrehabilitationspecialistapproved byus.RehabilitativeEmploymentincludesworkperformedwhilePartiallyDisabled,butdoesnotincludeperformingall thematerialdutiesofhis/herRegular Occupationonafull-timebasis. IfanInsuredisreceivingaMonthlyBenefitbecausehe/sheisconsideredTotallyDisabledunderthetermsofthisPolicy andisabletoperformRehabilitativeEmployment,wewillcontinuetopaytheMonthlyBenefitlessanamountequalto 50%ofearningsreceivedthroughsuchRehabilitativeEmployment. IfanInsuredisabletoperformRehabilitativeEmploymentwhenTotallyDisabledduetoSubstanceAbuse,wewill continuetopaytheMonthlyBenefitlessanamountequalto50%ofearningsreceivedthroughsuchRehabilitative Employment.ThisMonthlyBenefitispayableforamaximumoftwenty-four(24)consecutivemonthsfromthedatethe EliminationPeriodissatisfied. AnInsuredwillbeconsideredabletoperformRehabilitativeEmploymentifaPhysicianorlicensedorcertified rehabilitationspecialistapprovedbyusdetermines thathe/shecanperformsuchemployment. IfanInsuredrefusessuch RehabilitativeEmployment,orhasbeenperformingRehabilitativeEmploymentandrefusestocontinuesuch employment,even thoughaPhysicianorlicensedorcertifiedrehabilitationspecialistapprovedbyushasdetermined that he/sheisabletoperformRehabilitativeEmployment,theMonthlyBenefitwillbereducedby50%,withoutregardtothe MinimumMonthlyBenefit. LRS-6564-82-0994Page18.0 RELIANCESTANDARDLIFEINSURANCECOMPANY 2001MarketStreet,Suite1500 Philadelphia,PA19103-7090 (267)256-3500 Toll-freetelephonenumber:1-800-644-1103 NOTICECONCERNINGPOLICYHOLDERRIGHTS INAN INSOLVENCYUNDERTHEMINNESOTALIFEANDHEALTH INSURANCEGUARANTYASSOCIATIONLAW Iftheinsurerthatissuedyourlife,annuity,orhealthinsurancepolicybecomesimpairedorinsolvent,youare entitledtocompensationforyourpolicyfromtheassetsofthatinsurer.Theamountyourecoverwilldependonthe financialconditionof theinsurer. Inaddition,residentsofMinnesotawhopurchaselifeinsurance,annuities,orhealthinsurancefrominsurance companiesauthorized todobusinessinMinnesotaareprotected,SUBJECTTOLIMITSANDEXCLUSIONS,in theevent theinsurerbecomesfinanciallyimpairedorinsolvent.ThisprotectionisprovidedbytheMinnesotaLifeandHealth Insurance GuarantyAssociation. MinnesotaLife&HealthInsurance GuarantyAssociation 4760WhiteBearParkway,Suite101 WhiteBearlake,MN55110 (651)407-3149 Themaximumamounttheguarantyassociationwillpayforallpoliciesissuedononelifebythesameinsureris limited to$300,000.Subjecttothis$300,000limit, theguarantyassociationwillpayup to$300,000inlifeinsurancedeath benefits,$100,000innetcashsurrenderandnetcashwithdrawalvalues forlifeinsurance,$300,000inhealthinsurance benefits,includinganynetcashsurrenderandnetcashwithdrawalvalues,$100,000inannuitynetcashsurrenderand netcashwithdrawalvalues,$300,000inpresentvalueofannuitybenefitsforannuitieswhicharepartofastructured settlementorforannuitiesinregard towhichperiodicannuitybenefits,foraperiodofnotless than theannuitant'slifetime orforaperiodcertainofnotless than tenyears,havebegun tobepaidonorbefore thedateofimpairmentorinsolvency, orifnocoveragelimithasbeenspecified foracoveredpolicyorbenefit,thecoveragelimitshallbe$300,000inpresent value.Unallocatedannuitycontractsissuedtoretirementplans,otherthandefinedbenefitplans,establishedunder section401,403(b)or457oftheInternalRevenueCodeof1986,asamendedthroughDecember31,1992,arecovered upto$100,000innetcashsurrenderandnetcashwithdrawalvalues,forMinnesotaresidentscoveredbytheplan provided,however,thattheassociationshallnotberesponsibleformorethan$7,500,000inclaimsforallMinnesota residentscoveredbytheplan.Iftotalclaimsexceed$7,500,000,the$7,500,000shallbeproratedamongallclaimants. Thesearethemaximumclaimamounts.Coveragebytheguarantyassociationisalsosubjecttoothersubstantial limitationsandexclusionsandrequirescontinuedresidencyinMinnesota.Ifyourclaimexceedstheguaranty association'slimits,youmaystillrecoverapartorallofthatamount fromtheproceedsoftheliquidationoftheinsolvent insurer,ifanyexist.Fundstopayclaimsmaynotbeimmediatelyavailable. Theguarantyassociationassessesinsurers licensed toselllifeandhealthinsuranceinMinnesotaaftertheinsolvencyoccurs.Claimsarepaidfromthisassessment. THECOVERAGEPROVIDEDBY THE GUARANTYASSOCIATIONISNOTASUBSTITUTEFORUSINGCARE INSELECTINGINSURANCECOMPANIES THATAREWELLMANAGEDAND FINANCIALLYSTABLE. INSELECTING ANINSURANCECOMPANYORPOLICY,YOUSHOULDNOTRELYONCOVERAGEBYTHEGUARANTY ASSOCIATION. LRS-8665-0302 THISNOTICEISREQUIREDBYMINNESOTASTATELAWTOADVISEPOLICYHOLDERSOFLIFE, ANNUITY,ORHEALTHINSURANCEPOLICIESOFTHEIRRIGHTSINTHEEVENTTHEIRINSURANCECARRIER BECOMESFINANCIALLYINSOLVENT. THISNOTICEINNOWAYIMPLIESTHAT THECOMPANYCURRENTLYHAS ANYTYPEOFFINANCIALPROBLEMS.ALLLIFE,ANNUITY,ANDHEALTH INSURANCEPOLICIESAREREQUIRED TOPROVIDETHISNOTICE LRS-8665-0302