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GROUP SUPPLEMENTAL LIFEACCIDENTAL DEATH AND DISMEMBERMENTCERTIFICATE OF COVERAGEforAMERICAN STEEL & SUPPLY INC.Policy Number: G/GA5V2954IMEffective Date: January 1, 2024

UHCLD-CERT-2/2008-TXUnitedHealthcare Insurance Company185 Asylum StreetHartford, Connecticut(Home Office)Policyholder: AMERICAN STEEL & SUPPLY INC.Effective Date: January 1, 2024Policy Number: G/GA5V2954IM - LIBeneficiary: As on file with the AdministratorWe, UnitedHealthcare Insurance Company, issue this Certificate to the Covered Person as evidence of insuranceunder the Policy We issued to the Policyholder shown above. This Certificate describes the benefits and otherimportant provisions of the Policy. Please read it carefully.The Policy may be amended, changed, cancelled or discontinued without the consent of the Covered Person orthe Covered Person’s beneficiary.The benefits described in this Certificate insure the Covered Person and, if applicable, any Dependents eligible forinsurance. This Certificate becomes effective at 12:01 A.M. Eastern Standard time on the Effective Date shownabove.Read the Group Certificate CarefullyThis is a legal contract between the Policyholder and Us. If the Policyholder has any questions or problems withthe Policy, We will be ready to help the Policyholder. The Policyholder may call upon his agent or Our HomeOffice for assistance at any time.If the Policyholder or the Covered Person have questions, need information about their insurance, or needassistance in resolving complaints, call 1-866-615-8727.It is signed at the Home Office of UnitedHealthcare Insurance Company as of the Effective Date shown above.Tracy A. Arney, Secretary Jessica Paik, PresidentGroup Term Life, Accidental Deathand Dismemberment InsurancePolicy Non-ParticipatingAdministrative Office:9900 Bren Road EastMinnetonka, MN 55343

UHCLD-CERT-2/2008-TXDeath benefits will be reduced if an acceleration-of-life insurance benefit is paid.DISCLOSURE: Receipt of Acceleration Death Benefits may affect You, Your spouse or Your family’s eligibility forpublic assistance programs such as medical assistance (Medicaid), Aid to Families with Dependent Children(AFDC), supplementary social security income (SSI), and drug assistance programs. You are advised to consultwith a qualified tax advisor and with social service agencies concerning how receipt of such payment will affectYou, Your spouse and Your family’s eligibility for public assistance.DISCLOSURE: The Accelerated Death Benefits offered under this Policy may or may not qualify for favorable taxtreatment under the Internal Revenue Code of 1986. Whether such benefits qualify depends on factors such asYour life expectancy at the time benefits are accelerated or whether you use the benefits to pay necessarylong-term care expense, such as nursing home care. If the Accelerated Death Benefits qualify for favorable taxtreatment, the benefits will be excludable from Your income and to subject to federal taxation. Tax laws relating toAccelerated Death Benefits are complex. You are advised to consult with a qualified tax advisor aboutcircumstances under which You could receive Accelerated Death Benefits excludable from income under federallaw.

5.2020¿Have a complaint or need help?If you have a problem with a claim or your premium, call your insurance company first. If you can’t work out theissue, the Texas Department of Insurance may be able to help.Even if you file a complaint with the Texas Department of Insurance, you should also file a complaint or appealthrough your insurance company If you don’t, you may lose your right to appeal.UnitedHealthcare Insurance CompanyTo get information or file a complaint with your insurance companyCall: UnitedHealthcare Insurance CompanyToll-free: 1-866-615-8727Mail: UnitedHealthcare Insurance Company Administrative Offices9900 Bren Road EastMinnetonka, MN 55343The Texas Department of InsuranceTo get help with an insurance question or file a complaint with the state:Call with a question: 1-800-252-3439File a complaint: www.tdi.texas.govEmail: ConsumerProtection@tdi.texas.govMail: MC 111-1A,P.O. Box 149091, Austin, TX 78714-9091¿Tiene una queja o necesita ayuda?Si tiene un problema con una reclamaci n o con su prima de seguro, llame primero a su compa a de seguros.Si no puede resolver el problema, es posible que el Departamento de Seguros de Texas (Texas Department ofInsurance, por su nombre en ingl s) pueda ayudar.Aun si usted presenta una queja ante el Departamento de Seguros de Texas, tambi n debe presentar una queja atrav s del proceso de quejas o de apelaciones de su compa a de seguros. Si no lo hace, podr a perder suderecho para apelar.UnitedHealthcare Insurance CompanyPara obtener informaci n o para presentar una queja ante su compa a de seguros:Llame a:UnitedHealthcare Insurance CompanyTel fono gratuito: 1-866-615-8727Direcci n postal: UnitedHealthcare Insurance Company Administrative Offices9900 Bren Road EastMinnetonka, MN 55343El Departamento de Seguros de TexasPara obtener ayuda con una pregunta relacionada con los seguros o para presentar una queja ante el estado:Llame con sus preguntas al: 1-800-252-3439Presente una queja en: www.tdi.texas.govCorreo electr nico: ConsumerProtection@tdi.texas.govDirecci n postal: MC 111-1A,P.O. Box 149091, Austin, TX 78714-9091

TOC-UHCTable of ContentsSCHEDULE OF BENEFITS 1..................................................................................................General Definitions 3.............................................................................................................Certificate General Provisions 5...............................................................................................Covered Person Eligibility, Effective Date and TerminationProvisions 6........................................................................................................................Dependents Eligibility, Effective Date and TerminationProvisions 8........................................................................................................................Life Insurance Benefit for Covered Person 10.............................................................................Waiver of Premium - Total Disability for Covered Person 12...........................................................Accelerated Death Benefit for Covered Person 14........................................................................Portability Privilege for Supplemental Life Insurance forCovered Person and Dependents 15.........................................................................................Accidental Death and Dismemberment Benefit for CoveredPerson 17........................................................................................................................ ....Life Insurance Benefit for Dependents 20..................................................................................Accidental Death and Dismemberment Benefit for Dependents 22.................................................

SCH-UHC-TX 1SCHEDULE OF BENEFITSThis schedule covers the following class(es) of Employees of companies and affiliates controlled by thePolicyholder:Covered Person Insurance: ALL Eligible EmployeesAll full-time Employees working at least 30 hours per week.Employee Waiting Period:An Employee is eligible for insurance on the later of the following dates:1. The Group Policy’s Effective Date, January 1, 20242. The first day of the month following the date the Covered Person completes 60 days of continuousemployment with the Policyholder.Cost of Insurance: The Covered Person is required to contribute to the cost of his insurance.Supplemental Life Insurance Benefit:The benefit amount applicable to the Covered Person is that which is elected at the time of enrollment.$10,000 to $100,000 in increments of $10,000Supplemental Life Insurance Benefit will reduce to 65% at age 65 , 50% at age 70 and terminate at retirement.Annual Earnings Definition: The Annual Earnings received from the Covered Person’s Employer for the yearending immediately prior to the Policy Anniversary period. Annual Earnings includes commissions for the yearending prior to the Policy Anniversary period. It does not include bonuses, overtime pay and other extracompensation. Annual Earnings will be rounded to the next higher thousand.Supplemental Accidental Death and Dismemberment Benefit:$10,000 to $100,000 in increments of $10,000Supplemental Accidental Death and Dismemberment Insurance Benefit will reduce to 65% at age 65 , 50% at age70 and terminate at retirement.Supplemental Accidental Death and Dismemberment Benefits are issued on an occupational/non-occupational (24 hour) basis.Accelerated Death Benefit:Up to 50% of the Supplemental Life Insurance in force to a maximum of $50,000 . Employee must have at least$10,000 in Life Insurance in-force to qualify for this benefit.Dependent Life Insurance:The Dependent’s Insurance included in this Certificate applies only to Employees who have elected, paidpremiums and are insured for Dependent Insurance.

SCHEDULE OF BENEFITSSCH-UHC-TX 2Supplemental Life Insurance Benefit:Spouse Choice of: $10,000 or$20,000Child (each)Less than 26 years of ageChoice of: $5,000 or$10,000Supplemental Accidental Death and Dismemberment Insurance Benefit:Spouse Choice of: $10,000 or$20,000Child (each)Less than 26 years of ageChoice of: $5,000 or$10,000Supplemental Dependent Accidental Death and Dismemberment Benefits are issued on an occupational/non-occupational (24 hour) basis.Evidence of Insurability RequirementsEvidence of insurability will be required:1. for any amount of Employee Supplemental Life Insurance in excess of $30,000 .2. for any elected increase in the amount of Employee Supplemental Life Insurance.3. for any amount of Employee Life Insurance if he does not apply for insurance within 31 days afterthe date he first became eligible.4. for any elected increase in the amount of Dependent Supplemental Life Insurance.5. for any amount of Dependent Life Insurance if the Covered Person does not apply for DependentInsurance within 31 days after the date the Dependent first became eligible.

DEF-UHC-TX 3GENERAL DEFINITIONSThe male pronoun, whenever used in the Policy, includes the female.Active Work or Actively at Work: The Covered Person reports for work at his usual place of employment or anyother business location where he is required to travel and is able to perform the material and substantial duties ofhis regular occupation for the entire normal workday. The Covered Person must be working at least the minimumnumber of hours per week in an Eligible Class, as shown in the Schedule of Benefits.For Employees of school districts whose teachers and other personnel have work schedules dependent upon theschool calendar, the Covered Person will be considered Actively at Work during a break in the school calendar ifhe was Actively at Work immediately prior to the break in the school calendar.Unless Disabled on the prior workday or on the day of absence, a Covered Person will be considered Actively atWork on the following days:1. a Saturday, Sunday or holiday which is not a scheduled workday;2. a paid vacation day, or other scheduled or unscheduled non-workday; or3. an excused or emergency leave of absence (except medical leave).Contributory or Non-Contributory Insurance: Contributory Insurance is insurance for which the CoveredPerson must apply and agree to make the required premium contributions. Non-Contributory Insurance isinsurance for which the Covered Person does not have to make any premium contributions.Covered Person: The Employee insured under the Policy. References to "Covered Person," "Covered Persons"and "Covered Person’s" throughout this Certificate are references to a Covered Person.Dependent: Includes1. a legal Spouse; and2. any unmarried Child.Effective January 1, 2024 , a Dependent includes a Child, whether a married or unmarried child.The Child must be under 26 years of age and:1. A natural child.2. A stepchild.3. A legally adopted child.4. A child placed for adoption.5. A child for whom legal guardianship has been awarded to the Covered Person or the CoveredPerson’s Spouse.However, the term Child will include a Child over the limiting age if the Child is:1. unmarried; and2. physically or mentally disabled; and3. financially dependent upon the Covered Person.No one can be a dependent of more than one Covered Person.Employee: A person who is:1. directly employed in the normal business of the Policyholder; and2. paid for services by the Policyholder; and3. Actively at Work for the Policyholder, or any subsidiary or affiliate insured under the Policy.

GENERAL DEFINITIONSDEF-UHC-TX 4No director or officer of a Policyholder will be considered an Employee unless he meets the above conditions.Employer: The Policyholder and includes any division, subsidiary, or affiliated company named in the Policy.Employer does not include Employers of other related areas of practice for which the Covered Person may alsowork.Hospital or Medical Facility: A legally operated, accredited facility licensed to provide full-time care andTreatment for the condition for which benefits are payable under the Policy. It is operated by a full-time staff oflicensed physicians and registered nurses. It does not include facilities that primarily provide custodial, educationor rehabilitative care, or long-term institutional care on a residential basis.Injury: A bodily Injury resulting directly from an accident and independently of all other causes.Physician: A practitioner of the healing arts who is:1. duly licensed in the state in which the Treatment is received; and2. practicing within the scope of that license.The term Physician does not include the Covered Person, the Covered Person’s Spouse, children, parents,parents-in-law, or siblings.Regular Care: The Covered Person personally visits a Physician as often as is medically required to effectivelymanage and treat his disabling condition(s), according to generally accepted medical standards. The CoveredPerson is receiving appropriate Treatment and care, according to generally accepted medical standards, by aPhysician whose specialty or experience is appropriate for the disabling condition(s).Sickness: An illness, disease, pregnancy or complication of pregnancy.Treatment: consultation, advice, tests, attendance or observation, supplies or equipment, including the prescrip-tion or use of prescription drugs or medicines.We, Our and Us: UnitedHealthcare Insurance Company .

GEN-UHC-TX 5CERTIFICATE GENERAL PROVISIONSConformity With State or Federal Statutes: If any provision of the Certificate conflicts with any applicable law,the provision will be deemed to conform to the minimum requirements of the law.Discretionary Authority: When making a benefit determination under the Policy, We have the sole discretionaryauthority to determine the Covered Person’s or Dependent’s eligibility, if applicable, for benefits and to interpretthe terms, conditions, limitations, and exclusions, and all other provisions of the Policy including the Certificate ofCoverage and any riders or amendments. We may delegate this discretionary authority to other entities orpersons who provide services in regard to the administration of the Policy. This provision applies, however, onlywhere the interpretation of the Policy is governed by the Employee Retirement Income Security Act (ERISA). Thisprovision does not prevent the bringing of a legal action under the time limit for Legal Action provision, nor does itserve to deprive any insurance department of its statutory rights and obligations.Fraud: We will focus on all means necessary to support fraud detection, investigation, and prosecution. It may bea crime if the Covered Person or the Employer knowingly, and with intent to injure, defraud or deceive Us, files aclaim containing any false, incomplete, or misleading information. These actions, as well as submission of falseinformation, will result in denial of the Covered Person’s claim, and are subject to prosecution and punishment tothe full extent under state and/or federal law. We will pursue all appropriate legal remedies in the event ofinsurance fraud.Incontestability: We may not contest the validity of the Policy, except for the non-payment of premiums, after ithas been in force for two years from its date of issue. No statement made by any Covered Person relating to hisinsurability shall be used in contesting the validity of the insurance with respect to which such statement wasmade after such insurance has been in force prior to the contest for a period of two years during such person’slifetime, nor unless it is contained in a written instrument signed by him. This clause will not affect Our right tocontest claims made for accidental death or accidental dismemberment benefits.Information To Be Furnished: The Policyholder may be required to furnish any information needed toadminister the Policy. Clerical error by the Policyholder will not:1. affect the amount of insurance which would otherwise be in effect; or2. continue insurance which otherwise would be terminated; or3. result in the payment of benefits not otherwise payable.Once an error is discovered, an equitable adjustment in premium will be made. If the premium adjustmentinvolves the return of unearned premium, the amount of the return will be limited to the 12-month period, whichprecedes the date We receive proof such an adjustment should be made. We may inspect any of thePolicyholder’s records which relate to the Policy.Misstatement of Age: If a Covered Person’s age has been misstated, premiums will be subject to an equitableadjustment. If the amount of the benefit depends upon age, then the benefit will be that which would have beenpayable, based upon the person’s correct age.Records:The Policyholder must furnish all information required by Us to:1. compute premiums; and2. maintain necessary administrative records.Records of the Policyholder, which have a bearing on insurance, will be available for inspection by Us at anyreasonable time.Workers’ Compensation: The Policy is not to be construed to provide benefits required by Workers’ Compen-sation laws.

EELIG-UHC 6COVERED PERSON ELIGIBILITY, EFFECTIVE DATE AND TERMINATION PROVISIONSCovered Person’s Eligibility: Employees who work on a full-time basis for a Policyholder are eligible forinsurance after completion of the required Employee Waiting Period, provided they are in a class of Employeeswho are included. Employees will be considered to work on a full-time basis if they customarily work at least thenumber of hours per week shown in the Schedule of Benefits.An Employee will become eligible for insurance on the latest of the following dates:1. the Effective Date of the Policy;2. the end of the Employee Waiting Period shown in the Schedule of Benefits;3. the date the Policy is changed to include the Employee’s class; or4. the date the Employee enters a class eligible for insurance.Effective Date of Covered Person Insurance: If an Employee is not Actively at Work on the date his insurance isscheduled to take effect, it will take effect on the day after the date he returns to Active Work. If the Employee’sinsurance is scheduled to take effect on a non-working day, his Active Work status will be based on the lastworking day before the scheduled Effective Date of his insurance.An Employee must use forms provided by Us when applying for insurance.The Employee’s insurance will be effective at 12:01 A.M. Eastern Standard time as follows:1. if it is Non-contributory, on the date the Employee becomes eligible for insurance, regardless ofwhen he applies, or2. if it is Contributory, and the Employee makes application within 31 days after the date he firstbecame eligible, on the later of:a. the date the Employee is eligible for insurance, regardless of when he applies; orb. the date the Employee’s application is approved by Us if evidence of insurability is required.Evidence of insurability is required if an Employee applying for Contributory Insurance:1. does not apply for insurance within 31 days after the date he first became eligible; or2. he has previously terminated his insurance while in an eligible class.Effective Date of Change in Amount of Insurance: If there is an increase in the amount of the Covered Person’sinsurance, the increase will take effect on:1. the first day of the month on or next following the date of the increase, if the Covered Person isActively at Work on the date of increase;2. the date the Covered Person returns to Active Work if the Covered Person is not Actively at Work onthe first day of the month on or next following the date of the increase;3. the first day of the month on or next following the date of the increase, if the first day of the month isa non-working day and the Covered Person was Actively at Work on his last scheduled working daybefore the non-working day;4. the date of the increase if the Covered Person is on an approved layoff or leave of absence, forreasons other than a Sickness or Injury.If evidence of insurability is required, the increase will take effect on the later of the dates indicated above or thedate We approve his application.Neither an increase nor a decrease in insurance will affect a Payable Claim that occurs prior to the increase ordecrease.A decrease in the amount of the Covered Person’s insurance will take effect on the date of the decrease.

COVERED PERSON ELIGIBILITY, EFFECTIVE DATE AND TERMINATION PROVISIONSEELIG-UHC 7Family and Medical Leave of Absence: If the Covered Person is on a Family or Medical Leave of Absence, hisinsurance will be governed by his Employer’s policy on Family and Medical Leaves of Absence.We will continue the Covered Person’s insurance if the cost of his insurance continues to be paid and his Leave ofAbsence is approved in advance and in writing by his Employer.The Covered Person’s insurance will continue for up to the greater of:1. the leave period required by the Federal Family and Medical Leave Act of 1993; or2. the leave period required by applicable state law.While the Covered Person is on a Family or Medical Leave of Absence, We will use earnings from his Employerjust prior to the date his Leave of Absence started to determine Our payments to him.If the Covered Person’s insurance does not continue during a Family or Medical Leave of Absence, then when hereturns to Active Work:1. he will not have to meet a new Employee Waiting Period including a Waiting Period for insurance ofa Pre-Existing Condition, if applicable; and2. he will not have to give Us evidence of insurability to reinstate the insurance he had in effect beforehis Leave of Absence began.However, time spent on a Leave of Absence, without insurance, does not count toward satisfying his EmployeeWaiting Period.Termination of Covered Person Insurance: The Covered Person’s insurance will terminate at 12:00 midnightEastern Standard time on the earliest of the following dates:1. the last day of the period for which a premium payment is made, if the next payment is not made;2. the last day of the month during which he ceases to be a member of a class eligible for insurance;3. the date the Policy terminates, or a specific benefit terminates; or4. the last day of the month during which he ceases to be Actively at Work, unlessa. Active work ceases during an approved layoff, medical leave or non-medical leave of absence,the Life Insurance Benefit and the Accidental Death and Dismemberment Benefit will continuefor up to 3 months from the date he stopped active work.b. Active work ceases as a result of a disability due to a sickness or accidental injury and:i. that disability began before age 60; andii. the Covered Person remains continuously disabled.The Life Insurance and the Accidental Death and Dismemberment Benefit may be continuedfor up to 12 months from the date he stopped active work.5. the date he is no longer Actively at Work due to a labor dispute, including but limited to strike, workslow down or lock out.

DELIG-UHC-TX 8DEPENDENTS ELIGIBILITY, EFFECTIVE DATE AND TERMINATION PROVISIONSDependent’s Eligibility: Dependents are eligible for insurance on the latest of the following dates:1. the date the Covered Person becomes eligible for Dependent Insurance;2. the date a person becomes a Dependent; or3. the date the Policy is amended to include the Covered Person’s class as being eligible forDependent Insurance.The Covered Person’s Spouse or Child will not be eligible for Dependent Insurance if the Spouse or Child is:1. eligible for insurance under the Policy as a Covered Person; or2. a member of the armed forces on active duty, except for duty of 30 days or less for training in theReservesor National Guard.Effective Date of Dependent Insurance: No insurance will take effect on any day the Dependent (other than anewborn child) is confined in a Hospital or Medical Facility. Instead, insurance will take effect on the day followingdischarge from the Hospital or Medical Facility.A Covered Person must use forms provided by Us when applying for Dependent Insurance.Dependents will not be insured until the Employee is insured.The Dependent Insurance will be effective at 12:01 A.M. Eastern Standard time:1. if it is Non-contributory, on the date the Dependent becomes eligible for insurance regardless ofwhen application was made; or2. if it is Contributory and the Covered Person makes application within 31 days after the date theDependent first became eligible, on the later of:a. the date the Dependent becomes eligible for insurance, regardless of when application ismade; orb. the date the Dependent’s application is approved by Us, if evidence of insurability is required.Evidence of insurability is required if a Covered Person applying for Contributory insurance:1. does not apply for Dependent insurance within 31 days after the date the Dependent first becameeligible; or2. has previously terminated Dependent insurance while in an eligible class.Effective Date of Change in Amount of Insurance: If there is an increase in the amount of the Dependent’sinsurance the increase will take effect on the same date that:1. the Covered Person’s class changes; or2. the Dependent’s status or class changes.If the Dependent is confined in a Hospital or Medical Facility on that date, any change will take effect on the dayfollowing discharge from the Hospital or Medical Facility.If evidence of insurability is required, the increase will take effect on the later of the dates indicated above or thedate We approve the application.A decrease in the amount the Dependent’s insurance will take effect on the date of the decrease.Termination of Dependent Insurance: Insurance on a Dependent will terminate at 12:00 midnight EasternStandard time on the earliest of the following dates:1. the last day of the month during which he ceases to be a Dependent as defined in the Policy*;

DEPENDENTS ELIGIBILITY, EFFECTIVE DATE AND TERMINATION PROVISIONSDELIG-UHC-TX 92. the last day of the month during which the Covered Person ceases to be a member of a classeligible for Dependent insurance;3. the date the Covered Person’s insurance under the Policy terminates;4. the last day of the month during which the Dependent becomes a member of the armed forces onactive duty, except for duty of 30 days or less for training in the Reserves or National Guard;5. the last day of the period for which a Dependent’s required premium payment is made, if the nextpayment is not made; or6. the date the Covered Person’s Life Insurance premiums are waived under the Waiver of Premium -Total Disability for Covered Person provision; or7. the date the Policy terminates, or a specific benefit terminates.*With respect to item 1 above, coverage of a Covered Person’s grandchild will not terminate solely because thegrandchild is no longer the Covered Person’s dependent for federal income tax purposes.

ELIFE-UHC-TX 10LIFE INSURANCE BENEFIT FOR COVERED PERSONDeath Benefits: We will pay the Covered Person’s beneficiary the amount of insurance in force on the date ofdeath. We will make the payment in the form of a lump sum within two months of receipt by Us of satisfactoryproof of the Covered Person’s death. The benefit will be paid in accordance with the beneficiary section.Assignment: Life insurance as provided by the Policy may be assigned as an absolute assignment only. Inmaking an assignment, the Covered Person must transfer all his present and future ownership rights to theperson to whom he assigned the insurance. This includes the right to change the beneficiary and to convert theinsurance. The Covered Person may not make a collateral or partial assignment of his insurance.Beneficiary: The Covered Person’s beneficiary will be the person(s) he names in writing to receive any amount ofinsurance payable due to his death.The Covered Person may name or change a beneficiary by giving Us written notice at Our Home Office on a formacceptable to Us. When We receive the notice, it will be effective on the date made, subject to any payment Wemay have made before We receive it.If the Covered Person names more than one beneficiary, those who survive will share equally unless the CoveredPerson specifies otherwise. If there is no named beneficiary living at the time of the Covered Person’s death, Wewill pay any amount due in the following order:1. to his legal Spouse; or2. to his natural or legally adopted children in equal shares; or3. to his estate.Notice of Claim: Written notice of a claim for death must be given to Us at Our Home Office by the CoveredPerson’s beneficiary within 30 days of the date of death. If it is not possible, written notice must be given as soonas it is reasonably possible to do so.The claim form is available from the Covered Person’s Employer, or can be requested from Us. If the form is notreceived from Us within 15 days of a request, written proof of claim should be sent to Us without waiting for theform. Written proof must show the cause of death. Also, a certified copy of the death certificate must be given toUs.Proof of Claim: Written proof of claim must be filed within 90 days of the loss. However, if it is not possible togive proof within 90 days, it must be given no later than one year after the time proof is otherwise required, exceptin the absence of legal capacity.Payment of Claim: Payment of Claim for loss of life will be paid in accordance with the beneficiary section. Allother benefits under the Policy are paid to the Covered Person.If the Covered Person has chosen an option, no one may change it unless the Covered Person consents inwriting. The Covered Person’s beneficiary may choose an option within 60 days after death if one has not beenchosen.Legal Action: The Covered Person may not bring suit to recover under this section until 60 days after he hasgiven Us written proof of loss. No suit may be brought more than three years after the date the proof of loss isrequired to be filed.Physical Examination and Autopsy: We have the right to have a Physician of Our choice examine the CoveredPerson as often as necessary, but not more often than once each three months, while the claim is pending. Wemay also have an autopsy made in case of death, unless not allowed by law. We will pay the cost of the exam andautopsy.Settlement Options: Instead of a single payment, the Covered Person may choose to have all or part of theinsurance paid under one of the settlement options We have available. We will give the Covered Person fullinformation about the options upon request.Conversion Privilege: The Covered Person may convert:

LIFE INSURANCE BENEFIT FOR COVERED PERSONELIFE-UHC-TX 111. all or part of his Life Insurance to an individual policy of life insurance, other than term insurance, ifhis insurance terminated because he ceases to be a member of a class eligible for insurance;2. the amount of insurance to an individual policy of life insurance, other than term insurance, that islost due to a reduction of insurance because of age;3. a limited amount of insurance to an individual policy of life insurance, other than term insurance, ifhe has been continuously insured under the Policy (or the policy it replaced) for five years and theinsurance terminated due to termination or amendment of the Policy. The amount the CoveredPerson may convert in this case is the smaller of the following:a. the amount of Life Insurance which terminates, less the amount he became eligible for underany Policy within 31 days after this insurance terminated; orb. $10,000The Covered Person may convert to any policy, other than term insurance, We are issuing for the purpose ofconversions. The conversion policy will not have disability or other supplementary benefits. No evidence ofinsurability will be required. The Covered Person must submit a written application and the first premium paymentfor the conversion policy to Our Home Office within 31 days after his insurance terminates. It is the CoveredPerson’s responsibility to pay the premiums for the conversion policy. The premium will be based on the amountand the form of the conversion policy, and on his class of risk and age on the date the conversion takes effect.If the Covered Person dies within the 31 days allowed for making application to convert, We will pay the amounthe was entitled under this Policy if the individual policy has not yet taken affect. We will do this whether or notapplication was made.A conversion policy is in lieu of benefits under this section of the Policy. However, if the Covered Person isqualified for the Waiver of Premium-Total Disability provision, the converted policy will be cancelled. Premiumspaid for the converted policy will be returned.Amounts of insurance that the Covered Person has ported will not be eligible for the Conversion Privilege unlessthe Certificate of Portability is returned.The conversion policy will take effect on the later of:1. its date of issue; or2. 31 days after the date this insurance terminates.The insurance under the Policy may be reinstated within one year after termination of employment, if the CoveredPerson has converted and he:1. gives Us proof that he was Totally Disabled when his insurance terminated and that his insurancewould have continued in force under the Waiver of Premium-Totally Disabled provision if he had notconverted; and2. surrenders the conversion policy to Us without claim in return for premiums paid less any unpaidpolicy loans.Employees rehired after converting insurance must either lapse that insurance or provide evidence of insurabilityto keep that individual policy.

WAIVER-UHC-TX 12WAIVER OF PREMIUM - TOTAL DISABILITY FOR COVERED PERSONWe will continue the Covered Person’s Life Insurance in force without premium payment while he remains TotallyDisabled if he:1. becomes Totally Disabled before age 60;2. remains Totally Disabled continuously for at least nine consecutive months;3. gives Us proof of Total Disability, as required.We will waive the Covered Person’s premium payment on a monthly basis, beginning the first day of the monthafter the month he became Totally Disabled. We will refund any premium paid for the Life Insurance after thatday. We will not refund premiums for any period more than 12 months before the date proof of disability wasfurnished. This Waiver of Premium will continue to be effective even if the Policy terminates after the CoveredPerson becomes Totally Disabled.Amount of Life Insurance Under the Total Disability Benefit: The amount of insurance continued would be theamount in force on the date the Covered Person became Totally Disabled. This amount will be reduced orterminated, based on the Schedule of Benefits in effect on the date of Total Disability. This amount will not beincreased while the Covered Person remains Totally Disabled. All other Benefits will be terminated.Death While Totally Disabled: If the Covered Person dies while his Life Insurance is being continued underWaiver of Premium, We will pay the amount of insurance if We receive proof:1. of the Covered Person’s death; and2. that Total Disability was continuous from the date it began to the date of death.Proof of Total Disability: We will provide forms which the Covered Person must use when giving Us proof ofTotal Disability. The Covered Person must give Us proof no later than 12 months after the date he became TotallyDisabled. We may at any time require proof that Total Disability continues. The Covered Person must give Usproof within 60 days after Our request. After the Covered Person has been Totally Disabled for more than twoyears from the date of Total Disability, We will not request proof any more than once a year. We may require theCovered Person to be examined, at Our expense, by a Physician of Our choice.Total Disability or Totally Disabled: For purposes of this section, the Covered Person will be considered TotallyDisabled if he is unable to perform each and every duty of his occupation at his usual place of employment andhe is unable to do the material and substantial duties of any job suited to his education, training or experience.We may require the Covered Person to be examined by a Physician, other medical practitioner or vocationalexpert of Our choice. We will pay for this examination. We can require an examination as often as it is reasonableto do so, but not more often than once each three months.Termination of the Total Disability Benefit: The Covered Person will no longer be eligible for the Total DisabilityBenefit and his Life Insurance will terminate on the earlier of the following dates:1. the date the Covered Person ceases to be Totally Disabled. However, if he is still eligible for LifeInsurance when he returns to Active Work, his Life Insurance may be continued in force if premiumpayments are resumed. If this is done, any increased amount of Life Insurance he may then beeligible for will take effect as described in the Effective Date of insurance provision; or2. the last day of the 60-day period following Our request for proof of Total Disability, if he does notgive Us proof or refuses to take a medical exam;3. the date the Covered Person reaches age 65;4. the date premium has been waived for 12 months and the Covered Person is considered to resideoutside the United States. The Covered Person is considered to reside outside the United Stateswhen he has been outside the United States for a total period of 6 months or more during any 12consecutive months for which premium has been waived.

WAIVER OF PREMIUM - TOTAL DISABILITY FOR COVERED PERSONWAIVER-UHC-TX 13If the Covered Person’s Total Disability ends and he does not return to Active Work, then the Covered Person mayexercise the Conversion Privilege.

EACD-UHC-TX 14ACCELERATED DEATH BENEFIT FOR COVERED PERSONIf while insured under the Policy, the Covered Person becomes terminally ill (called the "qualifying event") with alife expectancy of less than 12 months and the Covered Person has met all of the conditions set forth below, Wewill pay the Covered Person the amount of insurance shown in the Schedule of Benefits.The Covered Person may elect to receive an Accelerated Death Benefit amount that is stated on the Schedule ofBenefits. However, an Accelerated Death Benefit payment against the Covered Person’s Life Insurance Benefitcan only be made once in the Covered Person’s lifetime.The Life Insurance Benefit amount will be reduced by the amount paid under this provision.The Covered Person must submit written medical evidence signed by the treating Physician and acceptable to Usthat he is:1. under a Physician’s care for that condition, and2. has a life expectancy of less than 12 months.The Accelerated Death Benefit amount will be paid to the Covered Person after the Covered Person meets all ofthe conditions listed above.We reserve the right to ask for a medical exam in connection with a claim. In the event that the Physician’sexaminations result in conflict with the medical evidence signed by the treating Physician, a second examinationfrom a Physician of Our choice (at Our expense) will be requested. This second exam will determine if theCovered Person has met the conditions stated above.The Covered Person must continue to pay any applicable premium for the amount of Life Insurance Benefitsremaining after the reduction.Upon the Covered Person’s death, the amount of Life Insurance Benefits paid to the Covered Person’s beneficiarywill be reduced by the amount already paid under this provision and this payment shall constitute full settlementof the death benefit payable under the Policy.At the time of payment of the Accelerated Death Benefit, We will send a statement to the Covered Personspecifying:1. the amount of benefits paid;2. the affect of the Accelerated Death Benefit payment on the death benefit face amount and futurepremiums; and3. the amount of Life Insurance benefits remaining.Limitations: Accelerated Death Benefits will not be payable if:1. the Covered Person has assigned his Life Insurance Benefits; or2. We have been notified that all or a portion of the Life Insurance Benefits are to be paid to theCovered Person’s former Spouse as part of a divorce agreement; or3. the Covered Person is required by law to accelerate benefits in order to meet the claims ofcreditor(s); or4. the Covered Person is required by a government agency to accelerate benefits in order to qualify fora government benefit or entitlement.The Accelerated Death Benefit is not available to Retired Covered Persons.

EDPORT-UHC-TX 15PORTABILITY PRIVILEGE FOR SUPPLEMENTAL LIFE INSURANCE FOR COVEREDPERSON AND DEPENDENTSThis provision applies only to the Covered Person’s and Dependent’s Supplemental Life Insurance Benefit. It doesnot apply to the Accidental Death and Dismemberment Benefit, as contained in the Policy.The Covered Person may not elect to port his insurance unless the Covered Person has been insured by thePolicy, or the one it replaced, for at least three consecutive months prior to the date the Covered Person’sinsurance under the Policy ends.The Covered Person may elect to continue all or part of the Covered Person and insured Dependent’sSupplemental Life Insurance Benefit by electing a portable Certificate of Insurance, subject to the following termsand restrictions.The Covered Person may "port" his insurance if the insurance under the Policy ends for any reason other than:1. termination of employment due to Sickness or Injury;2. failure to pay any required premium;3. the termination of the Policy; or4. attainment of age 70.The Covered Person may not port his insurance, or insurance for any of his insured Dependents, if the CoveredPerson has reached his 70th birthday on the day the Covered Person’s insurance under the Policy terminates.The Covered Person may port the full amount of his Supplemental Life Insurance Benefit amount as of the dayinsurance under the Policy terminates.The Covered Person may port the full amount of his insured Dependent Supplemental Life Insurance Benefitamount(s), if:1. the Spouse’s amount under the Policy is at least $10,000.If the Covered Person ports an amount of his Supplemental Life Insurance Benefit, then anyDependent amount(s) elected must be the same percentage as the Covered Person elected to port.The maximum Spouse amount that a Covered Person is eligible to port for all Spouse insurancescombined is the lesser of the Spouse’s in force insurance under the Policy, or $30,000.2. the Child’s amount under the Policy is at least $5,000.The Covered Person may port:1. his Supplemental Life Insurance amount only;2. his Supplemental Life Insurance amount and his insured Dependent Spouse’s Supplemental LifeInsurance amount;3. his Supplemental Life Insurance amount and the Supplemental Life Insurance amounts of allinsured Dependents; or4. if the Covered Person is a single parent, his Supplemental Life Insurance amount and theSupplemental Life Insurance amounts of all of his insured Dependent children.No other combinations of ported insurance amounts will be allowed.If the Covered Person dies and has insurance for his insured Dependents under Supplemental Life Insurance,each of the Covered Person’s then insured Dependents may port their Supplemental Life Insurance amounts aslimited above. However, the Covered Person’s then insured surviving Dependent Spouse must port in order forthe Covered Person’s then insured surviving Dependent children to port. If there is no surviving DependentSpouse, no Dependent children will be allowed to port.The Covered Person and insured Dependents can port to a portable Certificate of Insurance. The Certificate of

PORTABILITY PRIVILEGE FOR SUPPLEMENTAL LIFE INSURANCE FOR COVEREDPERSON AND DEPENDENTSEDPORT-UHC-TX 16Insurance provides term Group Life Insurance. This does not provide for Waiver of Premium benefit. The benefitsprovided by the portable Certificate of Insurance may not be identical to the benefits provided by the Policy.To get a portable Certificate of Insurance, the Covered Person or insured Dependent must apply to us in writingand pay the required premium. The Covered Person or insured Dependent has 31 days from the date insuranceunder the Policy ends to do this. We won’t ask for proof that the Covered Person or insured Dependent isinsurable.No Covered Person is allowed to convert his insurance, and elect a portable Certificate of Insurance at the sametime. If a situation arises in which a Covered Person would be eligible to both convert and port, he may onlyexercise one of these privileges. If a Covered Person elects to port coverage, and at a later time, the Policyterminates, he will be allowed to exercise the conversion privilege. The Covered Person may never be insuredunder both a converted policy and a portable Certificate of Insurance at the same time.Employees rehired after porting insurance must either lapse that insurance or provide evidence of insurability tokeep the porting insurance.

EADD-UHC-TX 17ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT FOR COVERED PERSONIf the Covered Person suffers a loss described below, We will pay the amount of insurance that applies. TheCovered Person, or the Covered Person’s beneficiary, must give Us proof that:1. Injury occurred while the insurance was in force under this section;2. loss occurred within 90 days after the Injury; and3. loss was due to Injury independent of all other causes.Amount of Insurance: The amount of insurance shown in the Schedule of Benefits will be paid according to thefollowing table:Loss of life 100%Loss of both hands or both feet 100%Loss of sight of both eyes 100%Loss of one hand and sight of oneeye100%Loss of one foot and sight of one eye 100%Quadriplegia 100%Paraplegia 50%Hemiplegia 50%Loss of one hand 50%Loss of one foot 50%Loss of sight of one eye 50%Loss of speech 25%Loss of hearing 25%Loss of sight means total and irrecoverable loss of sight. Loss of hands or feet means severance at or above thewrist or ankle. Loss of speech means the total and irrecoverable loss of speech. Loss of hearing means total andirrecoverable loss of hearing. Quadriplegia means total and permanent Paralysis of both upper and lower limbs.Paraplegia means total and permanent Paralysis of both lower limbs. Hemiplegia means total and permanentParalysis of upper and lower limbs on one side of the body. Paralysis means permanent impairment and loss ofthe ability to voluntarily move or to have sensation in any entire extremity. Paralysis must be the result of an Injuryto the brain or spinal cord and without the severance of a limb.In paying this benefit, We will consider only losses sustained while insured under this section of the Policy. We willpay no more than the full amount shown in the Schedule of Benefits for losses resulting from any one Injury.Seat Belt and Air Bag Benefit for Covered Person: We will pay an additional benefit for the loss of the CoveredPerson’s life that results from injuries sustained while driving or riding in a private Passenger Car if such CoveredPerson’s Seat Belt was properly fastened. A benefit is not payable under this provision, if:1. the Covered Person is either a driver or passenger, and the driver was legally intoxicated or underthe influence of drugs at the time of the accident; or2. the driver of the private Passenger Car does not hold a current and valid driver’s license at the timeof the accident.An additional Air Bag Benefit will be paid if:1. Seat Belt Benefit is payable; and

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT FOR COVERED PERSONEADD-UHC-TX 182. the private Passenger Car is equipped with a single Air Bag and the Covered Person is the driver; or3. the private Passenger Car is equipped with an Air Bag for both the driver and for the frontpassenger seat and the Covered Person is the driver or front seat passenger; or4. the private Passenger Car is equipped with an Air Bag for the driver seat, for the front passengerseat and for all rear passenger seats and the Covered Person is the driver, front seat passenger orrear seat passenger; and5. the police report or other evidence establishes that the Air Bag inflated properly upon impact.We will pay:1. A Seat Belt benefit of an amount equal to 10% of the full amount of Accidental Death andDismemberment Benefit; or2. A Seat Belt and Air Bag Benefit of an amount equal to 10% of the full amount of Accidental Deathand Dismemberment Benefit.However, the amount payable will not exceed $10,000 for the Seat Belt Benefit or $20,000 for thecombined Seat Belt and Air Bag Benefit.The accident causing the Covered Person’s death must occur while the Covered Person is insured under thePolicy.Passenger Car means: for the purposes of this Accidental Death and Dismemberment Benefit, any validlyregistered four-wheel private Passenger Car. Seat Belt means any restraint device which meets published federalsafety standards, has been installed by the car manufacturer or reinstalled according to the manufacturer’sspecifications and has not been altered after such installation. The investigating officer must certify the correctposition of the Seat Belt. A copy of the police report must be submitted with the claim.Air Bag means: for the purposes of this Accidental Death and Dismemberment Benefit, a supplemental restraintsystem that inflates for added protection to the head and chest areas. The Air Bag must meet published federalsafety standards, be installed by the car manufacturer or consist of proper replacement parts as required by thecar manufacturer’s specifications and not have been altered after such installation.Limitations: We will not pay a benefit for a loss caused directly or indirectly by:1. disease, bodily or mental infirmity, or medical or surgical Treatment of these;2. suicide or intentionally self-inflicted Injury, while sane or insane;3. participation in a riot or insurrection, or commission of an assault or felony;4. war or any act of war, declared or undeclared while the Covered Person is serving in the armedservices;5. use of any drug, hallucinogen, controlled substance, or narcotic unless prescribed by a Physician;6. driving while intoxicated, as defined by the applicable state law where the loss occurred;7. engaging in the following hazardous activities, including skydiving, hang gliding, auto racing,mountain climbing, Russian Roulette, autoerotic asphyxiation or bungee jumping;8. Injury arising out of or in the course of any occupation or employment for pay or profit, or anyInjury or Sickness for which the Covered Person is entitled to benefits under any WorkersCompensation Law, Employers Liability Law or similar law, unless this insurance is issued on an 24hour basis as shown in the Schedule of Benefits;9. travel or flight in, or descent from any aircraft, unless as a fare-paying passenger on a commercialairline flying between established airports on: a) a scheduled route; or b) a charter flight seating 15or more people.Notice of Claim: Written notice of a claim for death or Injury must be given to Us at Our Home Office by theCovered Person or his beneficiary within 30 days of the date of death or the date the Injury occurred. If it is notpossible, written notice must be given as soon as it is reasonably possible to do so.The claim form is available from the Covered Person’s Employer, or can be requested from Us. If the Covered

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT FOR COVERED PERSONEADD-UHC-TX 19Person does not receive the form from Us within 15 days of his request, written proof of claim should be sent toUs without waiting for the form. Written proof should establish facts about the claim such as date of occurrence,nature, and extent of the loss involved.Proof of Claim: Written proof of claim must be filed within 90 days of the loss. However, if it is not possible togive proof within 90 days, it must be given no later than one year after the time proof is otherwise required, exceptin the absence of legal capacity.Payment of Claim: Payment of Claim for loss of life will be paid in a lump sum within two months of receipt by Usof satisfactory Proof of Claim. The benefit will be paid in accordance with the beneficiary section. All other benefitsunder the Policy are paid to the Covered Person.If the Covered Person has chosen an option, no one may change it unless the Covered Person consents inwriting. The Covered Person’s beneficiary may choose an option within 60 days after death if one has not beenchosen.Legal Action: The Covered Person may not bring suit to recover under this section until 60 days after he hasgiven Us written proof of loss. No suit may be brought more than three years after the date the proof of loss isrequired to be filed.Physical Examination and Autopsy: We have the right to have a Physician of Our choice examine the CoveredPerson as often as necessary, but not more often than once each three months, while the claim is pending. Wemay also have an autopsy made in case of death, unless not allowed by law. We will pay the cost of the exam andautopsy.Assignment:Accidental Death and Dismemberment insurance provided by the Policy cannot be assigned.

DLIFE-UHC-TX 20LIFE INSURANCE BENEFIT FOR DEPENDENTSDeath Benefits: We will pay the Life Insurance Benefit amount in force on a Dependent in the form of a lumpsum, if insured under this section of the Policy, within two months of receipt by Us of satisfactory proof of hisdeath. The amount of insurance is shown in the Schedule of Benefits. Eligible Dependents are defined in the"General Definitions" section of the Policy.Assignment:The Dependent Life Insurance Benefit provided by the Policy cannot be assigned.Beneficiary: Benefits will be paid to:1. the Covered Person, if living;2. the legal Spouse of the Covered Person, if the Covered Person is not living; or3. the estate of the Dependent, if the legal Spouse of the Covered Person is not living.Notice of Claim: Written notice of a claim for death must be given to Us at Our Home Office by the CoveredPerson or his beneficiary within 30 days of the date of death. If it is not possible, written notice must be given assoon as it is reasonably possible to do so.The claim form is available from the Covered Person’s Employer, or can be requested from Us. If the form is notreceived from Us within 15 days of a request, written proof of claim should be sent to Us without waiting for theform. Written proof must show the cause of death. Also, a certified copy of the death certificate must be given toUs.Proof of Claim: Written proof of claim must be filed within 90 days of the loss. However, if it is not possible togive proof within 90 days, it must be given no later than one year after the time proof is otherwise required, exceptin the absence of legal capacity.Payment of Claim: Payment of Claim for loss of life will be paid in accordance with the beneficiary section. Allother benefits under the Policy are paid to the Covered Person.If the Covered Person has chosen an option, no one may change it unless the Covered Person consents inwriting. The Covered Person’s beneficiary may choose an option within 60 days after death if one has not beenchosen.Legal Action: The Covered Person may not bring suit to recover under this section until 60 days after he hasgiven Us written proof of loss. No suit may be brought more than three years after the date the proof of loss isrequired to be filed.Physical Examination and Autopsy: We have the right to have a Physician of Our choice examine the insuredDependent, as often as necessary while the claim is pending, but not more often than once each three months.We may also have an autopsy made in case of death, unless not allowed by law. We will pay the cost of the examand autopsy.Conversion: A Dependent may convert all or part of his Life Insurance to an individual life policy, other than terminsurance, if his insurance terminates because:1. the Covered Person ceases to be a member of a class eligible for Life Insurance;2. the Covered Person’s legal Spouse lost insurance due to a reduction of insurance because of age;3. the Covered Person is Totally Disabled or dies; or4. the Dependent is no longer eligible for Dependent Life Insurance. A Dependent may convert alimited amount of insurance to an individual life policy, other than term insurance, if he wascontinuously insured under the Policy (or the policy it replaced) for five years if his insuranceterminated due to the Policy being terminated or amended.The amount the Dependent may convert in this case is the smaller of the following:

LIFE INSURANCE BENEFIT FOR DEPENDENTSDLIFE-UHC-TX 211. the Life Insurance Benefit amount which terminates less the amount he may become eligible forunder any group within 31 days after this insurance terminated; or2. $10,000.The Dependent may convert to any policy We are using for the purpose of conversions. The conversion policy willnot have disability or other supplemental benefits. No evidence of insurability is required. The Dependent mustsubmit a written application and the first premium to Our Home Office within 31 days after this insuranceterminated. It is the Covered Person’s responsibility to pay the premiums for the conversion policy. The premiumwill be based on the amount and form of the conversion policy, and on the Dependent’s class of risk and age onthe date the conversion takes effect.If the Dependent dies within the 31 days allowed for making application to convert, We will pay the amount hewas entitled under this Policy if the individual policy has not taken effect. We will do this whether or notapplication was made.The conversion policy will take effect on the later of:1. its date of issue; or2. 31 days after the date this insurance terminated.Amounts of insurance that the insured Dependent has ported will not be eligible for the Conversion Privilegeunless the Certificate of Insurance is returned.

DADD-UHC-TX 22ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT FOR DEPENDENTSIf the Dependent suffers a loss described below, We will pay the amount of insurance that applies. The CoveredPerson, or the Covered Person’s beneficiary, must give Us proof that:1. Injury occurred while the insurance was in force under this section;2. loss occurred within 90 days after the Injury; and3. loss was due to Injury independent of all other causes.Amount of Insurance: The amount of insurance shown in the Schedule of Benefits will be paid according to thefollowing table:Loss of life 100%Loss of both hands or both feet 100%Loss of sight of both eyes 100%Loss of one hand and sight of oneeye100%Loss of one foot and sight of one eye 100%Quadriplegia 100%Paraplegia 50%Hemiplegia 50%Loss of one hand 50%Loss of one foot 50%Loss of sight of one eye 50%Loss of speech 25%Loss of hearing 25%Loss of sight means total and irrecoverable loss of sight. Loss of hands or feet means severance at or above thewrist or ankle. Loss of speech means the total and irrecoverable loss of speech. Loss of hearing means total andirrecoverable loss of hearing. Quadriplegia means total and permanent Paralysis of both upper and lower limbs.Paraplegia means total and permanent Paralysis of both lower limbs. Hemiplegia means total and permanentParalysis of upper and lower limbs on one side of the body. Paralysis means permanent impairment and loss ofthe ability to voluntarily move or to have sensation in any entire extremity. Paralysis must be the result of an Injuryto the brain or spinal cord and without the severance of a limb.In paying this benefit, We will consider only losses sustained while insured under this section of the Policy. We willpay no more than the full amount shown in the Schedule of Benefits for losses resulting from any one Injury.Seat Belt and Air Bag Benefit for Dependent: We will pay an additional benefit for the loss of the Dependent’slife that results from injuries sustained while driving or riding in a private Passenger Car if such Dependent’s SeatBelt was properly fastened. A benefit is not payable under this provision, if:1. the Dependent is either a driver or passenger, and the driver was legally intoxicated or under theinfluence of drugs at the time of the accident; or2. the driver of the private Passenger Car does not hold a current and valid driver’s license at the timeof the accident.An additional Air Bag Benefit will be paid if:1. Seat Belt Benefit is payable; and

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT FOR DEPENDENTSDADD-UHC-TX 232. the private Passenger Car is equipped with a single Air Bag and the Dependent is the driver; or3. the private Passenger Car is equipped with an Air Bag for both the driver and for the frontpassenger seat and the Dependent is the driver or front seat passenger; or4. the private Passenger Car is equipped with an Air Bag for the driver seat, for the front passengerseat and for all rear passenger seats and the Dependent is the driver, front seat passenger or rearseat passenger; and5. the police report or other evidence establishes that the Air Bag inflated properly upon impact.We will pay:1. A Seat Belt benefit of an amount equal to 10% of the full amount of the Dependent’s AccidentalDeath and Dismemberment Benefit; or2. A Seat Belt and Air Bag Benefit of an amount equal to 10% of the full amount of Dependent’sAccidental Death and Dismemberment Benefit.However, the amount payable will not exceed $10,000 for the Seat Belt Benefit or $20,000 for thecombined Seat Belt and Air Bag Benefit.The accident causing the Dependent’s death must occur while the Dependent is insured under the Policy.Passenger Car means: for the purposes of this Accidental Death and Dismemberment Benefit, any validlyregistered four-wheel private Passenger Car. Seat Belt means any restraint device which meets published federalsafety standards, has been installed by the car manufacturer or reinstalled according to the manufacturer’sspecifications and has not been altered after such installation. The investigating officer must certify the correctposition of the Seat Belt. A copy of the police report must be submitted with the claim.Air Bag means: for the purposes of this Accidental Death and Dismemberment Benefit, a supplemental restraintsystem that inflates for added protection to the head and chest areas. The Air Bag must meet published federalsafety standards, be installed by the car manufacturer or consist of proper replacement parts as required by thecar manufacturer’s specifications and not have been altered after such installation.Limitations: We will not pay a benefit for a loss caused directly or indirectly by:1. disease, bodily or mental infirmity, or medical or surgical Treatment of these;2. suicide or intentionally self-inflicted Injury, while sane or insane;3. participation in a riot or insurrection, or commission of an assault or felony;4. war or any act of war, declared or undeclared, while the Covered Person is serving in the armedservices;5. use of any drug, hallucinogen, controlled substance, or narcotic unless prescribed by a Physician;6. driving while intoxicated, as defined by the applicable state law where the loss occurred;7. engaging in the following hazardous activities, including skydiving, hang gliding, auto racing,mountain climbing, Russian Roulette, autoerotic asphyxiation or bungee jumping;8. Injury arising out of or in the course of any occupation or employment for pay or profit, or anyInjury or Sickness for which the insured Dependent is entitled to benefits under any WorkersCompensation Law, Employers Liability Law or similar law, unless this insurance is issued on an 24hour basis as shown in the Schedule of Benefits;9. travel or flight in, or descent from any aircraft, unless as a fare-paying passenger on a commercialairline flying between established airports on: a)a scheduled route; or b)a charter flight seating 15 ormore people.Notice of Claim: Written notice of a claim for death or Injury must be given to Us at Our Home Office by theCovered Person or his beneficiary within 30 days of the date of death or the date the Injury occurred. If it is notpossible, written notice must be given as soon as it is reasonably possible to do so. The notice should identify theinsured Dependent.The claim form is available from the Covered Person’s Employer, or can be requested from Us. If the Covered

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT FOR DEPENDENTSDADD-UHC-TX 24Person does not receive the form from Us within 15 days of his request, written proof of claim should be sent toUs without waiting for the form. Written proof should establish facts about the claim such as date of occurrence,nature, and extent of the loss involved.Proof of Claim: Written proof of claim must be filed within 90 days of the loss. However, if it is not possible togive proof within 90 days, it must be given no later than one year after the time proof is otherwise required, exceptin the absence of legal capacity.Payment of Claim: Payment of Claim for loss of life will be paid in a lump sum within two months of receipt by Usof satisfactory Proof of Claim. The benefit will be paid in accordance with the beneficiary section. All other benefitsunder the Policy are paid to the Covered Person.If the Covered Person has chosen an option, no one may change it unless the Covered Person consents inwriting. The Covered Person’s beneficiary may choose an option within 60 days after death if one has not beenchosen.Legal Action: The Covered Person may not bring suit to recover under this section until 60 days after he hasgiven Us written proof of loss. No suit may be brought more than three years after the date the proof of loss isrequired to be filed.Physical Examination and Autopsy: We have the right to have a Physician of Our choice examine the insuredDependent, as often as necessary while the claim is pending, but not more often than once each three months.We may also have an autopsy made in case of death, unless not allowed by law. We will pay the cost of the examand autopsy.Assignment:Accidental Death and Dismemberment insurance provided by the Policy cannot be assigned.

UHCL-AMEND

UHCL-AMENDSTATUTORYPROVISIONSALASKAResidents of the state of Alaska, the following provisions are included to bring your Certificate into conformity withAlaska state law:Dependent DefinitionWhen dependent coverage is included in the Certificate of Coverage and Domestic Partners are described in thedefinition of a Dependent. Any references to gender (i.e., "of the opposite or same sex" or "of the same sex") in theDomestic Partner and Domestic Partnership definitions are deleted and do not apply to you.Discretionary AuthorityThe Discretionary Authority provision is shown in the CERTIFICATEGENERAL PROVISIONSsection, is deleted inits entirety.Accidental Death and Dismemberment Benefit LimitationsThe travel/flight limitation in the Accidental Death Benefit or Accidental Death and Dismemberment Benefit isamended with regard to charter flights by deleting the phrase "seating 15 or more people".ARKANSASResidents of the state of Arkansas, the following provision is included to bring your Certificate into conformity withArkansas state law:Insurer Information NoticeAny questions regarding the Policy may be directed to:UnitedHealthcare Insurance CompanyAdministrative Offices9900 Bren Road EastMinnetonka, MN 553431-866-615-8727Policyholders have the right to file a complaint with the Arkansas Insurance Department (AID). You may call AIDto request a complaint form at (800) 852-5494 or (501) 371-2640 or write the Department at:Arkansas Insurance Department1 Commerce Way, Suite 102Little Rock, Arkansas 77202IDAHOResidents of the state of Idaho, the following provision is included to bring your Certificate into conformity withIdaho state law:IncontestabilityThe Incontestability provision in the CERTIFICATEGENERALPROVISIONSsection is modified to read as follows:Incontestability: We may not contest the validity of the Policy, except for the non-payment of premiums orfraudulent misrepresentations, after it has been in force for one year from its date of issue. No statement made byany Covered Person relating to his insurability shall be used in contesting the validity of the insurance withrespect to which such statement was made after such insurance has been force prior to the contest for a periodof one year during such person’s lifetime, unless it is contained in a written instrument signed by him. This clausewill not affect Our right to contest claims made for accidental death or accidental dismemberment benefits.LOUISIANA

UHCL-AMENDResidents of the state of Louisiana, the following provision is included to bring your Certificate into conformitywith Louisiana state law:Dependent Supplemental Life Insurance and Accidental Death and Dismemberment Insurance Benefit:When dependent insurance is included in the Certificate of Coverage SCHEDULE OF BENEFITS, Child underDependent Life Insurance Age, must be from live birth. When dependent coverage is included in the Certificate ofCoverage, the definition of "Child" includes Grandchildren.Incontestability: The Incontestability provision in the CERTIFICATEGENERAL PROVISIONS section is modifiedto read as follows:Incontestability: We may not contest the validity of the Policy, except for the non-payment of premiums, after ithas been in force for two years from its date of issue. No statement made by any Covered Person relating to hisinsurability shall be used in contesting the validity of the insurance with respect to which such statement wasmade after such insurance has been in force prior to the contest for a period of two years during such person’slifetime, nor unless it is contained in a written instrument signed by him and a copy of the instrument containingthe statement is or has been furnished to such person or to his beneficiary. This clause will not affect Our right tocontest claims made for accidental death or accidental dismemberment benefits.MINNESOTAMinnesota has determined that its statutory requirements apply to Minnesota residence when non-Minnesotasitused Employers have 25 or more Employees residing in Minnesota.Any questions regarding these statutory requirements may be directed in writing to:UnitedHealthcare Specialty BenefitsContract ServicesMN017-W7009900 Bren Road EastMinnetonka, MN 55343Dependent Child Definition When dependent coverage is included in the Certificate of Coverage, the definitionof "Child" includes Grandchildren.Legal Action The Legal Action provision(s) in the Certificate of Coverage are modified so that the maximumnumber of years suit may be brought after date the proof of loss is required to be filed, has been amended fromthree to five years.MISSOURIResidents of the state of Missouri, the following provision is included to bring your Certificate into conformity withMissouri state law:Proof of Claim The Proof of Claim provision(s) in the Certificate of Coverage are modified to include thefollowing:The maximum number of years proof of claim must be given by, after it was otherwise required, is changed fromone to three years.SuicideWhen a Suicide Limitation for Life Insurance is included in the Certificate of Coverage, no benefit will be paid forany loss caused directly or indirectly from suicide occurring within one year after the Covered Person’s initialeffective date or effective date or any increase of additional insurance.In the event the insured dies as a result of suicide within one year from the date of issue of the policy, thePolicyholder shall promptly refund all premiums paid for coverage.WaiverWhen a WAIVER OF PREMIUM section is included in the Certificate of Coverage the definition of Total Disabilityor Totally Disabled is replaced with the following:Total Disability or Totally Disabled: For purposes of this section, means the Covered Person’s inability,

UHCL-AMENDbecause of sickness or injury to perform the material and substantial duties of the Covered Person’s occupationfor a period of at least twelve (12) months, unless the total benefit period is less than twelve (12) months. After theinitial benefit period, total disability shall mean the Covered Person’s inability to perform the material andsubstantial duties of any occupation for which the insured is qualified by education, training or experience.MONTANAResidents of the state of Montana, the following provision is included to bring your Certificate into conformity withMontana state law:Conformity with Montana Statutes: For Montana residents, the provisions of this Policy are intended to conformto the minimum requirements of Montana law. If any provision of the Policy conflicts with any Montana statutes,the provision will be deemed to conform to the minimum requirements of the Montana law.Discretionary Authority When a Discretionary Authority provision is shown in the CERTIFICATE GENERALPROVISIONSsection it is hereby deleted in its entirety.Dependent Definition When dependent coverage is included in the Certificate of Coverage, the definition of aDependent Child shall include a child placed for adoption.When dependent coverage is included in the Certificate of Coverage and Domestic Partners are described in thedefinition of a Dependent, the definition of a Domestic Partner will be expanded to include a person of theopposite or same sex.Conversion Privilege The Conversion Privilege provision shown in the LIFE INSURANCE BENEFIT FORCOVEREDPERSON section is modified to allow a Covered Person to convert a limited amount of insurance to anindividual policy of life insurance, other than term, if he has been continuously insured under the Policy (or thepolicy it replaced) for three years and the insurance terminated due to termination or amendment of the Policy.When dependent life insurance coverage is included in the Certificate of Coverage, the Conversion Privilegeprovision shown in the LIFE INSURANCE BENEFIT FOR DEPENDENTS section is modified to allow a Dependentto convert a limited amount of insurance to an individual life policy, other than term, if he was continuouslyinsured under the Policy (or the policy it replaced) for three years if his insurance terminated due to the Policybeing terminated or amended.NEW HAMPSHIREResidents of the state of New Hampshire, the following provision is included to bring your Certificate intoconformity with New Hampshire state law:NEW HAMPSHIRE LIFE CERTIFICATE OF INSURANCEConversion PrivilegeThe Conversion Privilege provision shown in the LIFE INSURANCE BENEFIT FOR COVERED PERSON sectionis expanded to include the following:The Covered Person will be given written notice of this conversion privilege and its duration within 15 days afterthe date of termination of the Policy. If this notice is given more than 15 days after the date of termination, thetime allowed for the exercise of the privilege of conversion will be extended for a period of 15 days following thedate of the written notice. Such notice will be mailed to the Covered Person at the last address furnished to thePolicyholder.When dependent life insurance coverage is included in the Certificate of Coverage, the Conversion Privilegeprovision shown in the LIFE INSURANCE BENEFIT FOR DEPENDENTS section is expanded to include thefollowing:The Dependent will be given written notice of this conversion privilege and its duration within 15 days after thedate of termination of the Policy. IF this notice is given more than 15 days after the date of termination, the timeallowed for the exercise of the privilege of conversion will be extended for a period of 15 days following the date ofthe written notice. Such notice will be mailed to the Dependent at the last address furnished to the Policyholder.Proof of Claim

UHCL-AMENDThe Proof of Claim provision(s) in the Certificate of Coverage is modified to include the following:Failure to furnish such proof of claim within the Certificate of Coverage stated time limit will not invalidate norreduce any claim if it is shown not to have been reasonably possible to furnish such proof and that such proofwas furnished as soon as it was reasonably possible.Discretionary AuthorityThe Discretionary Authority provision in the Certificate of Coverage GENERAL PROVISIONS section is deleted inits entirety.Dependent Definition When dependent coverage is included in the Certificate of Coverage, partners to a CivilUnion are included in the definition of Spouse.Incontestability The Incontestability provision in the CERTIFICATEGENERAL PROVISIONS section, is modifiedto remove the phrase "or fraudulent misrepresentations" from the first sentence. Also, the last sentence. "Thisclause will not affect Our right to contest claims made for accidental death or accidental dismembermentbenefits." is deleted.Total Disability or Totally Disabled The first paragraph of the Total Disability or Totally Disabled provision in theWAIVER OF PREMIUM TOTAL DISABILITY FOR COVERED PERSON section may not be more restrictive thanspecifying material and substantial duties of his occupation, and now reads as follows:Total Disability or Totally Disabled: For purposes of this section, the Covered Person will be considered TotallyDisabled if he is unable to perform the material and substantial duties of his own occupation.Continuation During Labor Dispute: is added to the COVERED PERSON ELIGIBILITY, EFFECTIVE DATE ANDTERMINATION PROVISIONS, whenever the employer pays a portion of the premium:The Covered Person may continue coverage if he ceases to be Actively at Work due to strike, lockout or otherlabor dispute.We will notify the Covered Person in writing by mail to your last known address of your right to continue coverageand pay premiums to the Policyholder as they become due.Coverage will continue for a maximum of 6 months provided the required premium is paid.The continuation of coverage end on the earliest to occur of the following:1. the date coverage would normally end under the Termination provisions;2. the date the strike, lockout or labor dispute ends;3. the date the Covered Person becomes a full-time employee with another employer.4. The last day of a period of 6 continuous months following the date the Covered Person was nolonger Actively at Work.If this Policy is no longer in force when the continued coverage ends, the Covered Person may exercise theConversion Privilege as outlined in the Life Insurance Benefit.NEW HAMPSHIRE Accidental Death and Dismemberment CERTIFICATE OF INSURANCE30 Day Free Look: The Covered Person has the right to return this certificate within 30 days of its delivery and tohave the premium refunded if, after examination, he is not satisfied for any reason.Any reference to Waiting Period(s) or Age Reduction(s) within the Certificate of Coverage are deleted in theirentiretyEffective Date of Covered Person InsuranceThe Effective Date of Covered Person Insurance provision in the COVERED PERSON ELIGIBILITY, EFFECTIVEDATE AND TERMINATIONSPROVISIONSsection is modified to remove any reference to evidence of insurability.

UHCL-AMENDIncapacitated Child ContinuationWhen dependent coverage is included in the Certificate of Coverage, the following is added to the DEPENDENTSELIGIBILIGY, EFFECTIVEDATE AND TERMINATION PROVISIONSsection.Incapacitated Child Continuation: If, on the date a a child reaches Age 26. and the Covered Person’s coverageis still in force and he or she is covered under the Policy; and an Incapacitated Child, as defined; his or hercoverage will not terminate solely due to age. The Covered Person must give Us notice of the incapacity within 31days of the termination date.Incapacitated Child: Your child who is: mentally or physically handicapped and incapable of earning his or herown living; and unmarried and primarily dependent on You for support and maintenance.The child’s coverage will continue as long as: the incapacity continues; and the required premium is paid.We may, from time to time, require proof of continued incapacity and dependency. After the first two years, Wecannot require proof more than once each year.NORTH CAROLINAResidents of the state of North Carolina, the following provision is included to bring your Certificate intoconformity with North Carolina state law:Proof of ClaimThe Proof of Claim provision(s) in the Certificate of Coverage are modified to include the following:Written proof of claim must be filed within 180 days of the loss. However, if it is not possible to give proof within180 days, it must be given no later than one year after the time proof is otherwise required, except in the absenceof legal capacity.Portability Privilege for Supplemental Life Insurance for Covered Person and Dependents The PortabilityPrivilege for Supplemental Life Insurance of Covered Person and Portability Privilege for Supplemental LifeInsurance for Covered Person and Dependents sections are modified to remove the exclusion of individuals witha Sickness or Injury from the second paragraph and termination due to Sickness or Injury from the list ofLimitations.The restriction "Employees rehired after porting insurance must either lapse that insurance or provide evidence ofinsurability to keep the porting insurance"is also removed.NORTH DAKOTAResidents of the state of North Dakota, the following provision is included to bring your Certificate into conformitywith North Dakota state law:20 Day Right to Examine Certificate: There is a 20 day right to review this Certificate. If You decide not to keepit, it may be returned to Us within 20 days of the original Certificate Effective Date. In that event, We will considerit void from the Certificate Effective Date and refund all premium paid. Any claims paid during the initial 20 dayperiod will be deducted from the refund.Dependent Child Definition When dependent coverage is included in the Certificate of Coverage, the definitionof a Child includes a Child of a dependent.Payment of Claim The Payment of Claim provision(s) in the Certificate of Coverage are modified so that claimswill be made within 2 months of receipt by Us of acceptable Proof of Claim. If acceptable written proof is filedwithin 180 days of the loss, the amount will include reasonable interest accrued from the date of loss.Legal Action The Legal Action provision(s) in the Certificate of Coverage are modified so that the maximumnumber of years suit may be brought after date the proof of loss is required to be filed, has been amended fromthree to five years.OKLAHOMAResidents of the state of Oklahoma, the following provision is included to bring your Certificate into conformitywith Oklahoma state law:

UHCL-AMENDCertificates delivered to residents of state of Oklahoma are subject to Oklahoma laws.Dependent Child DefinitionWhen dependent coverage is included in the Certificate of Coverage, the term "Child" includes a natural child,legally adopted child, stepchild, foster child or any child who is under the custody of the Covered PersonIncontestability The Incontestability provision in the CERTIFICATEGENERAL PROVISIONS section, is modifiedto remove "the phrase or fraudulent misrepresentations" from the first sentence.TEXASResidents of the state of Texas, the following provision is included to bring your Certificate into conformity withTexas state law:¿Have a complaint or need help?If you have a problem with a claim or your premium, call your insurance company first. If you can’t work out theissue, the Texas Department of Insurance may be able to help.Even if you file a complaint with the Texas Department of Insurance, you should also file a complaint or appealthrough your insurance company If you don’t, you may lose your right to appeal.UnitedHealthcare Insurance CompanyTo get information or file a complaint with your insurance companyCall: UnitedHealthcare Insurance CompanyToll-free: 1-866-615-8727Mail: UnitedHealthcare Insurance Company Administrative Offices9900 Bren Road EastMinnetonka, MN 55343The Texas Department of InsuranceTo get help with an insurance question or file a complaint with the state:Call with a question: 1-800-252-3439File a complaint: www.tdi.texas.govEmail: ConsumerProtection@tdi.texas.govMail: MC 111-1A,P.O. Box 149091, Austin, TX 78714-9091

UHCL-AMEND¿Tiene una queja o necesita ayuda?Si tiene un problema con una reclamaci n o con su prima de seguro, llame primero a su compa a de seguros.Si no puede resolver el problema, es posible que el Departamento de Seguros de Texas (Texas Department ofInsurance, por su nombre en ingl s) pueda ayudar.Aun si usted presenta una queja ante el Departamento de Seguros de Texas, tambi n debe presentar una queja atrav s del proceso de quejas o de apelaciones de su compa a de seguros. Si no lo hace, podr a perder suderecho para apelar.UnitedHealthcare Insurance CompanyPara obtener informaci n o para presentar una queja ante su compa a de seguros:Llame a:UnitedHealthcare Insurance CompanyTel fono gratuito: 1-866-615-8727Direcci n postal: UnitedHealthcare Insurance Company Administrative Offices9900 Bren Road EastMinnetonka, MN 55343El Departamento de Seguros de TexasPara obtener ayuda con una pregunta relacionada con los seguros o para presentar una queja ante el estado:Llame con sus preguntas al: 1-800-252-3439Presente una queja en: www.tdi.texas.govCorreo electr nico: ConsumerProtection@tdi.texas.govDirecci n postal: MC 111-1A,P.O. Box 149091, Austin, TX 78714-9091Accelerated Death BenefitDeath benefits will be reduced if an acceleration-of-life insurance benefit is paid.DISCLOSURE: Receipt of Acceleration Death Benefits may affect You, Your spouse or Your family’s eligibility forpublic assistance programs such as medical assistance (Medicaid), Aid to Families with Dependent Children(AFDC), supplementary social security income (SSI), and drug assistance programs. You are advised to consultwith a qualified tax advisor and with social service agencies concerning how receipt of such payment will affectYou, Your spouse and Your family’s eligibility for public assistance.DISCLOSURE: The Accelerated Death Benefits offered under this Policy may or may not qualify for favorable taxtreatment under the Internal Revenue Code of 1986. Whether such benefits qualify depends on factors such asYour life expectancy at the time benefits are accelerated or whether you use the benefits to pay necessarylong-term care expense, such as nursing home care. If the Accelerated Death Benefits qualify for favorable taxtreatment, the benefits will be excludable from Your income and to subject to federal taxation. Tax laws relating toAccelerated Death Benefits are complex. You are advised to consult with a qualified tax advisor aboutcircumstances under which You could receive Accelerated Death Benefits excludable from income under federallaw.We reserve the right to ask for a medical exam in connection with a claim. In the event that the Physician’sexaminations result in conflict with the medical evidence signed by the treating Physician, a second examinationfrom a Physician of Our choice (at Our expense) will be requested. This second exam will determine if theCovered Person has met the conditions stated above.At the time of payment of the Accelerated Death Benefit, We will send a statement to the Covered Personspecifying:1. the amount of benefits paid;2. the affect of the Accelerated Death Benefit payment on the death benefit face amount and futurepremiums; and3. the amount of Life Insurance benefits remaining.Incontestability The Incontestability provision in the CERTIFICATE GENERAL PROVISIONS section is modifiedto remove the phrase "or fraudulent misrepresentations" from the first sentence.Dependent Child Definition When dependent coverage is included in the Certificate of Coverage, the definitionof "Child" includes Grandchildren.

UHCL-AMENDDeath Benefits A Life Insurance Death Benefit will be paid as a lump sum, within two months of satisfactory proofof the Covered Person’s death.An Accidental Death and Dismemberment Benefit Death Benefit will be paid as a lump sum, within two months ofsatisfactory proof of the Covered Person’s death.Physical Examination and Autopsy The Physical Examination and Autopsy provision(s) in the Certificate ofCoverage are modified so that the examination may be as often as necessary, but not more often than once eachthree months, while the claim is pending.Supplemental Life Limitations/Suicide The Supplemental Life Limitations/Suicide provision in the LIFE IN-SURANCE BENEFIT FOR COVERED PERSONS section is modified so that in the event a suicide applies to aloss, We will refund premiums paid for the amount of insurance not paid.WASHINGTONResidents of the state of Washington, the following provision is included to bring your Certificate into conformitywith Washington state law:Accelerated Death BenefitWhen an ACCELERATED DEATH BENEFIT section is include in the Certificate of Coverage, the followingAccelerated Death Benefit Notice is also included:If you receive payment of accelerated death benefits from a life insurance policy, you may lose your right toreceive certain public funds, such as Medicare, Medicaid, Social Security, Supplemental Security, SupplementalSecurity Income (SSI), and possibly others. Also, receiving accelerated benefits from a life insurance policy mayhave tax consequences for you. We cannot give you advice about this. You may wish to obtain advice from a taxprofessional or an attorney before you decide to receive accelerated benefits from a life insurance policy.This Accelerated Death Benefit is not intended to qualify under section 101(g)(26 U.S.C. 101(g) or section770B(26U.S.C. 7702B) of the Internal Revenue Code of 1986 as amended by Public Law 104-191.Accidental Death and Dismemberment BenefitThe first paragraph shown in the ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT FOR COVEREDPERSON section is replaced by the following:The Covered Person suffers a loss described below, We will pay the amount of insurance that applies. TheCovered Person, or the Covered Person’s beneficiary, must give Us proof that:1. Injury occurred while the insurance was in force under this section;2. loss occurred within 365 days after the Injury; and3. loss was due to Injury independent of all other causes.When dependent Accidental Death and Dismemberment coverage is included in the Certificate of Coverage, thefirst paragraph shown in the ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT FOR COVERED DEPEN-DENT section is replaced by the following:The Dependent suffers a loss described below, We will pay the amount of insurance that applies. The CoveredPerson, or the Covered Person’s beneficiary, must give Us proof that:1. Injury occurred while the insurance was in force under this section;2. loss occurred within 365 days after the Injury; and3. loss was due to Injury independent of all other causes.Incontestability The Incontestability provision in the CERTIFICATE GENERAL PROVISIONS section is modifiedto remove the phrase "or fraudulent misrepresentations" from the first sentence.Supplemental Life Limitations/Suicide The Supplemental Life Limitations/Suicide provision in the LIFE IN-SURANCE BENEFIT FOR COVEREDPERSONS section is deleted in its entirety.Effective Date of Dependent Insurance When dependent coverage is included in the Certificate of Coverage, theEffective Date of Dependent Insurance provision in the DEPENDENTS ELIGILBILITY, EFFECTIVE DATE ANDTERMINATION PROVISIONSsection, is modified to change 31 days to 60 days.

This provision applies only where the interpretation of the Policy is governed by the EmployeeRetirement Income Security Act (ERISA).STATEMENT OF EMPLOYEE ERISA RIGHTSThe Employee Retirement Income Security Act of 1974 (ERISA) guarantees certain rights and protections toparticipants of welfare plans. Federal law and regulations require that a "Statement of ERISA Rights" be includedin this description of the Plan.You may examine, without charge, all Plan documents, including any insurance contracts, collective bargainingagreements, annual reports, summary plan descriptions and other documents filed with the Department of Labor.You can examine copies of these documents in the Plan Administrator’s office or at other specified locations, oryou can ask your supervisor where copies of the documents are available.If you want a personal copy of Plan documents or related material, you should send a written request to the PlanAdministrator. You will be charged only the actual cost of these copies.You are entitled to receive a summary of the Plan’s annual financial report. The Plan Administrator is required bylaw to furnish each participant with a copy of this summary annual report.In addition to creating rights for Plan participants, ERISA imposes duties upon the people who are responsible forthe operation of the employee benefit plan. These individuals, called "fiduciaries," have an obligation to administerthe Plan prudently and to act in the interest of Plan participants and beneficiaries. The named fiduciary for thisPlan is the Plan Sponsor. No one, including the Employer or any other person, may fire a Covered Person orotherwise discriminate against a Covered Person in any way to prevent that person from obtaining a benefit orexercising their rights under ERISA.When you become eligible for payments from the Plan, you should follow the appropriate steps for filing a claim.In case of claim denial, in whole or in part, you must receive a written explanation of the reason for the denial.You have the right to have your claim reviewed and reconsidered.Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request materials fromthe Plan and do not receive them within 30 days, you may file suit in a federal court. In such a case, the courtmay require the Plan Administrator to provide you the materials and pay you up to $110 per day until you receiveyour materials, unless the materials were not sent because of reasons beyond the control of the PlanAdministrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file a suit ina state or federal court provided you have exhausted the procedures and complied with the timeframes for reviewof the adverse claim decision provided below. If it should happen that Plan fiduciaries misuse the Plan’s money,or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department ofLabor, or you may file suit in a federal court. The court will decide who should pay costs and legal fees. Forexample, if you are successful, the court may order the person you sued to pay those costs and fees. If you loseor if the court finds your suit to be frivolous, you may be ordered to pay these costs and fees.If you have any questions about your Plan, you should contact the Plan Administrator. If you have any questionsabout this statement or about your rights under ERISA, contact the nearest Area Office of the Employee BenefitsSecurity Administration, United States Department of Labor listed in your telephone directory or the Division ofTechnical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200Constitution Avenue, N.W., Washington, D.C. 20210.CLAIMS DENIAL FOR LIFE INSURANCENotice of a decision to deny a claim (in whole or in part) shall be furnished to the claimant within 90 daysfollowing the receipt of the claim or within 90 days following the expiration of the initial 90 day period, in a casewhere there are special circumstances requiring extension of time for processing the claim. If special circumstan-ces require an extension of time for processing the claim, written notice of the extension shall be furnished to theclaimant prior to the expiration of the initial 90 day period.The notice of extension shall indicate the special circumstances requiring the extension and the date by which thenotice of decision with respect to the claim is expected to be furnished. If a claim is denied (in whole or in part)notice shall be provided to the claimant in writing and shall set forth: 1) the reason(s) for the denial; 2) reference

to the provision(s) of the Plan on which the denial is based; 3) a description of any additional material orinformation necessary for the claimant to perfect the claim, if the claim was denied because the claimant failed toprovide all necessary information, and an explanation of why such material or information is necessary; and 4) anexplanation of the claim review procedure. If written notice of the denial is not furnished to the claimant within 90days (or if an extension was required, 180 days) from the date the claim was received, the claim shall be deemeddenied and the claimant shall then be permitted to proceed with the procedure set forth below.REVIEW OF DENIED CLAIMS AND COMPLAINT PROCEDURE FOR LIFE INSURANCEIf a covered person or any person claiming through a covered person wishes to have a denied claim reviewed, awritten request must be sent to the address identified in the claim denial letter.Any complaint or dispute related to review of denied claims shall be resolved in accordance with the procedureset forth by the Plan Sponsor and outlined below.1. The complainant may contact the Insurance Carrier’s service representative in an attempt to resolvethe complaint in an informal manner.2. If the complainant is not satisfied with any attempts at informal resolution, the complainant mustsubmit a written request for review of a denied claim or a written notice of the complaint or disputeto the address identified on the claim denial letter within 60 days of receipt of the claim denialnotice. The complainant may submit supporting documentation or information to be considered.The complainant must submit any requested additional information or documents.3. A written notice of the final decision will usually be sent to the complainant within 60 days of receiptof the written request for review of a denied claim or notice of a complaint or dispute. However, ifspecial circumstances require an extension of time to reach a final decision, written notice of thefinal decision will be sent as soon as possible following the expiration of the initial 60 day period,but no later than 120 days following receipt of the request for review of a denied claim or notice of acomplaint or dispute. If special circumstances require such an extension of time, written notice ofthe extension shall be furnished to the complainant prior to the expiration of the initial 60 dayperiod. The written notice of the final decision will give specific reason(s) for the decision andreferences to the provision(s) of the Plan on which the decision is based. If the final written decisionis not furnished to the complainant within 60 days (or if an extension was required, 120 days) fromthe date of receipt of the request for review of a denied claim or notice of a complaint or dispute, therequest for review or the complaint or dispute shall be deemed to be rejected and denied on review.