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Tj ET Q q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-LTD-CERT 10) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 367.2 36 m 550.8 36 l 550.8 24 l 367.2 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 491.02 26.41 Tm (Face Page) Tj ET Q q n 0 24 m 550.8 24 l 550.8 12 l 0 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 87.6 cm q 1 0 0 1 0 608.1 cm q n 0 0 m 135 0 l 135 46.5 l 0 46.5 l h W n q 135 0 0 46.5 0 0 cm /img17855 Do Q Q Q q Q 0 0 0 rg BT /F3 14 Tf 1 0 0 1 203.4 642.13 Tm (The Lincoln National Life Insurance Company) Tj ET BT /F3 10 Tf 1 0 0 1 203.4 629.59 Tm (A Stock Company) Tj ET BT /F3 10 Tf 1 0 0 1 287.29 629.59 Tm (Home Office Location:) Tj ET BT /F3 10 Tf 1 0 0 1 385.58 629.59 Tm (Fort Wayne, Indiana) Tj ET BT /F3 10 Tf 1 0 0 1 203.4 618.09 Tm (Group Insurance Service Office:) Tj ET BT /F3 10 Tf 1 0 0 1 338.62 618.09 Tm (8801 Indian Hills Drive, Omaha, NE 68114-4066) Tj ET BT /F3 10 Tf 1 0 0 1 203.4 606.59 Tm (800-423-2765) Tj ET BT /F3 10 Tf 1 0 0 1 270.06 606.59 Tm (Online:) Tj ET BT /F3 10 Tf 1 0 0 1 302.56 606.59 Tm (www.LincolnFinancial.com) Tj ET q n 0 590.21 m 612 590.21 l 612 578.21 l 0 578.21 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 580.62 Tm (CERTIFIES THAT Group Policy No.) Tj ET BT /F3 12 Tf 1 0 0 1 185.33 580.62 Tm (000010232171) Tj ET BT /F3 12 Tf 1 0 0 1 257.33 580.62 Tm ( has been issued to) Tj ET Q q n 0 578.21 m 612 578.21 l 612 566.21 l 0 566.21 l h W n Q q n 0 566.21 m 612 566.21 l 612 554.21 l 0 554.21 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 219.84 556.62 Tm (鶹Ƶֱ) Tj ET Q q n 0 554.21 m 612 554.21 l 612 542.21 l 0 542.21 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 207.68 544.62 Tm (\(The Group Policyholder\)) Tj ET Q q n 0 542.21 m 612 542.21 l 612 530.21 l 0 530.21 l h W n Q q n 0 530.21 m 612 530.21 l 612 518.21 l 0 518.21 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 520.62 Tm (The Issue Date of the Policy is) Tj ET BT /F3 12 Tf 1 0 0 1 150.3 520.62 Tm (August 1, 2017) Tj ET BT /F3 12 Tf 1 0 0 1 223.97 520.62 Tm (.) Tj ET Q q n 0 518.21 m 612 518.21 l 612 506.21 l 0 506.21 l h W n Q q n 0 506.2 m 612 506.2 l 612 494.2 l 0 494.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 185.87 496.61 Tm (Certificate of Insurance for Class) Tj ET BT /F3 12 Tf 1 0 0 1 348.14 496.61 Tm (1) Tj ET Q q n 0 494.2 m 612 494.2 l 612 488.2 l 0 488.2 l h W n Q q n 41.4 488.2 m 284.4 488.2 l 284.4 476.2 l 41.4 476.2 l h W n Q q n 0 476.2 m 612 476.2 l 612 470.2 l 0 470.2 l h W n Q q n 0 470.2 m 612 470.2 l 612 464.2 l 0 464.2 l h W n Q q n 41.4 464.2 m 275.4 464.2 l 275.4 452.2 l 41.4 452.2 l h W n Q q n 0 452.2 m 612 452.2 l 612 440.2 l 0 440.2 l h W n Q q n 0 440.2 m 612 440.2 l 612 428.2 l 0 428.2 l h W n Q q n 0 428.2 m 612 428.2 l 612 416.2 l 0 416.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 418.61 Tm (You) Tj ET BT /F3 12 Tf 1 0 0 1 23.99 418.61 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 41.96 418.61 Tm (entitled) Tj ET BT /F3 12 Tf 1 0 0 1 81.28 418.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 93.94 418.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 111.92 418.61 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 153.23 418.61 Tm (described) Tj ET BT /F3 12 Tf 1 0 0 1 202.54 418.61 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 215.2 418.61 Tm (this) Tj ET BT /F3 12 Tf 1 0 0 1 235.86 418.61 Tm (Certificate) Tj ET BT /F3 12 Tf 1 0 0 1 289.82 418.61 Tm (only) Tj ET BT /F3 12 Tf 1 0 0 1 314.48 418.61 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 325.13 418.61 Tm (you) Tj ET BT /F3 12 Tf 1 0 0 1 346.46 418.61 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 364.43 418.61 Tm (eligible,) Tj ET BT /F3 12 Tf 1 0 0 1 406.74 418.61 Tm (become) Tj ET BT /F3 12 Tf 1 0 0 1 447.38 418.61 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 468.03 418.61 Tm (remain) Tj ET BT /F3 12 Tf 1 0 0 1 504.67 418.61 Tm (insured) Tj ET Q q n 0 416.2 m 612 416.2 l 612 404.2 l 0 404.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 406.61 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 31.77 406.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 50.88 406.61 Tm (provisions) Tj ET BT /F3 12 Tf 1 0 0 1 105.33 406.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 119.78 406.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 138.89 406.61 Tm (Policy.) Tj ET BT /F3 12 Tf 1 0 0 1 181.45 406.61 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 207.24 406.61 Tm (Certificate) Tj ET BT /F3 12 Tf 1 0 0 1 262.32 406.61 Tm (replaces) Tj ET BT /F3 12 Tf 1 0 0 1 306.08 406.61 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 327.85 406.61 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 356.96 406.61 Tm (certificates) Tj ET BT /F3 12 Tf 1 0 0 1 414.04 406.61 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 432.48 406.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 451.59 406.61 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 494.02 406.61 Tm (described) Tj ET Q q n 0 404.2 m 612 404.2 l 612 392.2 l 0 392.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 394.61 Tm (inside.) Tj ET BT /F3 12 Tf 1 0 0 1 38.81 394.61 Tm (As) Tj ET BT /F3 12 Tf 1 0 0 1 55.72 394.61 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 64.62 394.61 Tm (Certificate) Tj ET BT /F3 12 Tf 1 0 0 1 118.83 394.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 132.4 394.61 Tm (Insurance,) Tj ET BT /F3 12 Tf 1 0 0 1 185.62 394.61 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 195.86 394.61 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 207.44 394.61 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 226.35 394.61 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 235.25 394.61 Tm (contract) Tj ET BT /F3 12 Tf 1 0 0 1 277.46 394.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 291.03 394.61 Tm (insurance;) Tj ET BT /F3 12 Tf 1 0 0 1 343.92 394.61 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 354.16 394.61 Tm (only) Tj ET BT /F3 12 Tf 1 0 0 1 379.07 394.61 Tm (summarizes) Tj ET BT /F3 12 Tf 1 0 0 1 439.96 394.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 458.19 394.61 Tm (provisions) Tj ET BT /F3 12 Tf 1 0 0 1 511.77 394.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 394.61 Tm (the) Tj ET Q q n 0 392.2 m 612 392.2 l 612 380.2 l 0 380.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 382.61 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 34.22 382.61 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 55.1 382.61 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 66.66 382.61 Tm (subject) Tj ET BT /F3 12 Tf 1 0 0 1 104.2 382.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 117.09 382.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 135.3 382.61 Tm (Policy's) Tj ET BT /F3 12 Tf 1 0 0 1 176.35 382.61 Tm (terms.) Tj ET BT /F3 12 Tf 1 0 0 1 213.12 382.61 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 224.66 382.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 242.88 382.61 Tm (provisions) Tj ET BT /F3 12 Tf 1 0 0 1 296.43 382.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 309.98 382.61 Tm (this) Tj ET BT /F3 12 Tf 1 0 0 1 330.87 382.61 Tm (Certificate) Tj ET BT /F3 12 Tf 1 0 0 1 385.06 382.61 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 405.94 382.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 424.15 382.61 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 458.37 382.61 Tm (do) Tj ET BT /F3 12 Tf 1 0 0 1 473.93 382.61 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 492.81 382.61 Tm (agree,) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 382.61 Tm (the) Tj ET Q q n 0 380.2 m 612 380.2 l 612 368.2 l 0 368.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 370.61 Tm (provisions of the Policy will apply.) Tj ET Q q n 0 368.2 m 612 368.2 l 612 356.2 l 0 356.2 l h W n Q q 1 0 0 1 324 314.95 cm q n 0 0 m 162.75 0 l 162.75 41.25 l 0 41.25 l h W n q 162.75 0 0 41.25 0 0 cm /img17856 Do Q Q Q q Q Q q Q Q endstream endobj 2 0 obj <>>>>> endobj 51 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 734.4 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 216.51 26.41 Tm (鶹Ƶֱ) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 234 14.41 Tm (000010232171) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 195.98 2.41 Tm (SCHEDULE OF BENEFITS) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-SB) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 676.8 m 612 676.8 l 612 664.8 l 0 664.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 219.81 667.21 Tm (ELIGIBLE CLASS) Tj ET Q q n 0 664.8 m 612 664.8 l 612 652.8 l 0 652.8 l h W n Q q n 0 652.8 m 183.05 652.8 l 183.05 640.8 l 0 640.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 137.25 643.21 Tm (Class 1) Tj ET Q q n 204.65 652.8 m 572.4 652.8 l 572.4 640.8 l 204.65 640.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 204.65 643.21 Tm (All Full-Time Employees Working 30 Hours or more per week) Tj ET Q q n 0 640.8 m 183.05 640.8 l 183.05 628.8 l 0 628.8 l h W n Q q n 204.65 640.8 m 572.4 640.8 l 572.4 628.8 l 204.65 628.8 l h W n Q Q q Q Q endstream endobj 3 0 obj <>>>>> endobj 52 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 734.4 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 216.51 26.41 Tm (鶹Ƶֱ) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 234 14.41 Tm (000010232171) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 195.98 2.41 Tm (SCHEDULE OF BENEFITS) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-SB) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 676.8 m 612 676.8 l 612 664.8 l 0 664.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 260.67 667.21 Tm (For) Tj ET Q q n 0 664.8 m 612 664.8 l 612 652.8 l 0 652.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 86.68 655.21 Tm (Class 1 - All Full-Time Employees Working 30 Hours or more per week) Tj ET Q q n 0 652.8 m 612 652.8 l 612 640.8 l 0 640.8 l h W n Q q n 0 640.8 m 117.6 640.8 l 117.6 628.8 l 0 628.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 631.21 Tm (MINIMUM HOURS:) Tj ET Q q n 117.6 640.8 m 550.8 640.8 l 550.8 628.8 l 117.6 628.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 117.6 631.21 Tm (30 hours per week) Tj ET Q q n 0 615 m 117.6 615 l 117.6 603 l 0 603 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 605.41 Tm (WAITING PERIOD:) Tj ET Q q n 117.6 615 m 550.8 615 l 550.8 603 l 117.6 603 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 117.6 605.41 Tm (\(For date insurance begins, refer to Effective Date section\)) Tj ET Q q n 0.35 603 m 117.95 603 l 117.95 591 l 0.35 591 l h W n Q q n 117.95 603 m 551.15 603 l 551.15 591 l 117.95 591 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 117.95 593.41 Tm (1 year of continuous Active Work) Tj ET Q q n 0 591 m 612 591 l 612 579 l 0 579 l h W n Q q n 0 579 m 117.6 579 l 117.6 567 l 0 567 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 569.41 Tm (CONTRIBUTIONS:) Tj ET Q q n 117.6 579 m 550.8 579 l 550.8 567 l 117.6 567 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 117.6 569.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 160.58 569.41 Tm (employees) Tj ET BT /F3 12 Tf 1 0 0 1 218.88 569.41 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 240.52 569.41 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 262.84 569.41 Tm (required) Tj ET BT /F3 12 Tf 1 0 0 1 309.81 569.41 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 326.13 569.41 Tm (contribute) Tj ET BT /F3 12 Tf 1 0 0 1 381.77 569.41 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 398.09 569.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 419.74 569.41 Tm (cost) Tj ET BT /F3 12 Tf 1 0 0 1 446.06 569.41 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 463.04 569.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 484.69 569.41 Tm (Long-Term) Tj ET Q q n 117.6 567 m 550.8 567 l 550.8 555 l 117.6 555 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 117.6 557.41 Tm (Disability coverage.) Tj ET Q q n 0 555 m 612 555 l 612 543 l 0 543 l h W n Q q n 0 543 m 612 543 l 612 531 l 0 531 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 164.31 533.41 Tm (LONG-TERM DISABILITY BENEFITS) Tj ET Q q n 0 531 m 612 531 l 612 519 l 0 519 l h W n Q q n 0 519 m 155 519 l 155 507 l 0 507 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 509.41 Tm (BENEFIT PERCENTAGE:) Tj ET Q q n 155 519 m 550.8 519 l 550.8 507 l 155 507 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 155 509.41 Tm (60%) Tj ET Q q n 0 507 m 155 507 l 155 495 l 0 495 l h W n Q q n 155 507 m 550.8 507 l 550.8 495 l 155 495 l h W n Q q n 0 495 m 198 495 l 198 483 l 0 483 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 485.41 Tm (MAXIMUM MONTHLY BENEFIT:) Tj ET Q q n 198 495 m 550.8 495 l 550.8 483 l 198 483 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 198 485.41 Tm ($10,000) Tj ET Q q n 0 483 m 198 483 l 198 471 l 0 471 l h W n Q q n 198 483 m 550.8 483 l 550.8 471 l 198 471 l h W n Q q n 0 471 m 198 471 l 198 459 l 0 459 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 461.41 Tm (MINIMUM MONTHLY BENEFIT:) Tj ET Q q n 198 471 m 550.8 471 l 550.8 459 l 198 459 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 198 461.41 Tm ($100) Tj ET BT /F3 12 Tf 1 0 0 1 225.22 461.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 238.45 461.41 Tm (10%) Tj ET BT /F3 12 Tf 1 0 0 1 263.67 461.41 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 276.89 461.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 294.77 461.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 333.98 461.41 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 392.69 461.41 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 437.25 461.41 Tm (Benefit,) Tj ET BT /F3 12 Tf 1 0 0 1 478.8 461.41 Tm (whichever) Tj ET BT /F3 12 Tf 1 0 0 1 532 461.41 Tm (is) Tj ET Q q n 198 459 m 550.8 459 l 550.8 447 l 198 447 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 198 449.41 Tm (greater) Tj ET Q q n 0 447 m 198 447 l 198 435 l 0 435 l h W n Q q n 198 447 m 550.8 447 l 550.8 435 l 198 435 l h W n Q q n 0 435 m 612 435 l 612 423 l 0 423 l h W n Q q n 0 423 m 612 423 l 612 411 l 0 411 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 413.41 Tm (Long-Term) Tj ET BT /F3 12 Tf 1 0 0 1 62.65 413.41 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 117.33 413.41 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 164.66 413.41 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 185.99 413.41 Tm (PRE-EXISTING) Tj ET BT /F3 12 Tf 1 0 0 1 274.66 413.41 Tm (CONDITIONS) Tj ET BT /F3 12 Tf 1 0 0 1 355.33 413.41 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 381.34 413.41 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 400 413.41 Tm (subject) Tj ET BT /F3 12 Tf 1 0 0 1 441.33 413.41 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 458.01 413.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 480.01 413.41 Tm (Pre-Existing) Tj ET Q q n 0 411 m 612 411 l 612 399 l 0 399 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 401.41 Tm (Condition Exclusion on the Exclusion page.) Tj ET Q q n 0 399 m 612 399 l 612 387 l 0 387 l h W n Q q n 0 387 m 612 387 l 612 375 l 0 375 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 377.41 Tm (The Maximum Monthly Benefit will not exceed the Benefit Percentage times Basic Monthly Earnings.) Tj ET Q q n 0 375 m 612 375 l 612 363 l 0 363 l h W n Q q n 0 363 m 612 363 l 612 351 l 0 351 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 353.41 Tm (ELIMINATION) Tj ET BT /F3 12 Tf 1 0 0 1 83.05 353.41 Tm (PERIOD:) Tj ET BT /F3 12 Tf 1 0 0 1 133.46 353.41 Tm (180) Tj ET BT /F3 12 Tf 1 0 0 1 155.2 353.41 Tm (calendar) Tj ET BT /F3 12 Tf 1 0 0 1 199.57 353.41 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 225.3 353.41 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 239.04 353.41 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 290.11 353.41 Tm (caused) Tj ET BT /F3 12 Tf 1 0 0 1 326.49 353.41 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 342.23 353.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 360.63 353.41 Tm (same) Tj ET BT /F3 12 Tf 1 0 0 1 389.02 353.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 402.76 353.41 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 411.82 353.41 Tm (related) Tj ET BT /F3 12 Tf 1 0 0 1 448.2 353.41 Tm (Sickness) Tj ET BT /F3 12 Tf 1 0 0 1 493.94 353.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 507.67 353.41 Tm (Injury,) Tj ET Q q n 0 351 m 612 351 l 612 339 l 0 339 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 341.41 Tm (which must be accumulated within a 360 calendar day period.) Tj ET Q q n 0 339 m 612 339 l 612 327 l 0 327 l h W n Q 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 304.81 Tm (MAXIMUM) Tj ET BT /F3 12 Tf 1 0 0 1 65.7 304.81 Tm (BENEFIT) Tj ET BT /F3 12 Tf 1 0 0 1 118.72 304.81 Tm (PERIOD:) Tj ET BT /F3 12 Tf 1 0 0 1 172.79 304.81 Tm (\(For) Tj ET BT /F3 12 Tf 1 0 0 1 197.15 304.81 Tm (Sickness,) Tj ET BT /F3 12 Tf 1 0 0 1 245.84 304.81 Tm (Injury) Tj ET BT /F3 12 Tf 1 0 0 1 278.87 304.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 292.56 304.81 Tm (Pre-Existing) Tj ET BT /F3 12 Tf 1 0 0 1 356.25 304.81 Tm (Conditions\):) Tj ET BT /F3 12 Tf 1 0 0 1 419.95 304.81 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 442.3 304.81 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 481.98 304.81 Tm (Employees) Tj ET BT /F3 12 Tf 1 0 0 1 0 291.01 Tm (Social Security Normal Retirement Age, or the Maximum Benefit Period shown below \(whichever is later\).) 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Tj ET BT /F3 12 Tf 1 0 0 1 528 560.12 Tm (13) Tj ET BT /F3 12 Tf 1 0 0 1 0 532.52 Tm (Effective Dates) Tj ET BT /F3 12 Tf 1 0 0 1 74.29 532.52 Tm (.......................................................................................................................................................) Tj ET BT /F3 12 Tf 1 0 0 1 528 532.52 Tm (13) Tj ET BT /F3 12 Tf 1 0 0 1 0 504.92 Tm (Individual Termination) Tj ET BT /F3 12 Tf 1 0 0 1 111.64 504.92 Tm (..........................................................................................................................................) Tj ET BT /F3 12 Tf 1 0 0 1 528 504.92 Tm (15) Tj ET BT /F3 12 Tf 1 0 0 1 0 477.33 Tm (Total Disability Monthly Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 161.31 477.33 Tm (..........................................................................................................................) Tj ET BT /F3 12 Tf 1 0 0 1 528 477.33 Tm (17) Tj ET BT /F3 12 Tf 1 0 0 1 0 449.73 Tm (Residual Disability Monthly Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 177.98 449.73 Tm (....................................................................................................................) Tj ET BT /F3 12 Tf 1 0 0 1 528 449.73 Tm (18) Tj ET BT /F3 12 Tf 1 0 0 1 0 422.13 Tm (Other Income Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 109.3 422.13 Tm (...........................................................................................................................................) Tj ET BT /F3 12 Tf 1 0 0 1 528 422.13 Tm (20) Tj ET BT /F3 12 Tf 1 0 0 1 0 394.53 Tm (Recurrent Disability) Tj ET BT /F3 12 Tf 1 0 0 1 97.64 394.53 Tm (...............................................................................................................................................) 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Tj ET BT /F3 12 Tf 1 0 0 1 528 228.95 Tm (30) Tj ET BT /F3 12 Tf 1 0 0 1 0 201.35 Tm (Retirement Protection Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 143.96 201.35 Tm (................................................................................................................................) Tj ET BT /F3 12 Tf 1 0 0 1 528 201.35 Tm (31) Tj ET BT /F3 12 Tf 1 0 0 1 0 173.75 Tm (Family Care Expense Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 141.63 173.75 Tm (................................................................................................................................) Tj ET BT /F3 12 Tf 1 0 0 1 528 173.75 Tm (33) Tj ET BT /F3 12 Tf 1 0 0 1 0 146.15 Tm (Notice) Tj ET BT /F3 12 Tf 1 0 0 1 31.99 146.15 Tm (.....................................................................................................................................................................) Tj ET BT /F3 12 Tf 1 0 0 1 528 146.15 Tm (35) Tj ET Q q Q Q endstream endobj 5 0 obj <>>>>> endobj 130 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 746.4 cm q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 230.32 14.41 Tm (DEFINITIONS) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-2 10 PA) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 267.5 14.41 Tm (3) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 688.8 m 612 688.8 l 612 676.8 l 0 676.8 l h W n Q q n 0 676.8 m 612 676.8 l 612 664.8 l 0 664.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 667.21 Tm (As) Tj ET BT /F2 12 Tf 1 0 0 1 16.59 667.21 Tm (used) Tj ET BT /F2 12 Tf 1 0 0 1 43.18 667.21 Tm (throughout) Tj ET BT /F2 12 Tf 1 0 0 1 104.44 667.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 123.69 667.21 Tm (Policy,) Tj ET BT /F2 12 Tf 1 0 0 1 161.26 667.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 180.51 667.21 Tm (following) Tj ET BT /F2 12 Tf 1 0 0 1 231.1 667.21 Tm (terms) Tj ET BT /F2 12 Tf 1 0 0 1 263.66 667.21 Tm (shall) Tj ET BT /F2 12 Tf 1 0 0 1 290.92 667.21 Tm (have) Tj ET BT /F2 12 Tf 1 0 0 1 318.17 667.21 Tm (the) Tj ET BT /F2 12 Tf 1 0 0 1 337.42 667.21 Tm (meanings) Tj ET BT /F2 12 Tf 1 0 0 1 389.34 667.21 Tm (indicated) Tj ET BT /F2 12 Tf 1 0 0 1 439.93 667.21 Tm (below.) Tj ET BT /F2 12 Tf 1 0 0 1 479.43 667.21 Tm (Other) Tj ET BT /F2 12 Tf 1 0 0 1 513.33 667.21 Tm (parts) Tj ET Q q n 0 664.8 m 612 664.8 l 612 652.8 l 0 652.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 655.21 Tm (of the Policy contain definitions specific to those provisions.) Tj ET Q q n 0 652.8 m 612 652.8 l 612 640.8 l 0 640.8 l h W n Q q n 0 640.8 m 612 640.8 l 612 628.8 l 0 628.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 631.21 Tm (ACTIVE) Tj ET BT /F2 12 Tf 1 0 0 1 49.96 631.21 Tm (WORK) Tj ET BT /F3 12 Tf 1 0 0 1 92.57 631.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 105.85 631.21 Tm (ACTIVELY) Tj ET BT /F2 12 Tf 1 0 0 1 172.47 631.21 Tm (AT) Tj ET BT /F2 12 Tf 1 0 0 1 192.42 631.21 Tm (WORK) Tj ET BT /F3 12 Tf 1 0 0 1 235.03 631.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 268.97 631.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 283.57 631.21 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 342.34 631.21 Tm (full-time) Tj ET BT /F3 12 Tf 1 0 0 1 387.6 631.21 Tm (performance) Tj ET BT /F3 12 Tf 1 0 0 1 451.51 631.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 464.79 631.21 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 480.06 631.21 Tm (Main) Tj ET BT /F3 12 Tf 1 0 0 1 508.67 631.21 Tm (Duties) Tj ET Q q n 0 628.8 m 612 628.8 l 612 616.8 l 0 616.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 619.21 Tm (of his or her Own Occupation, for the regularly scheduled number of hours, at:) Tj ET Q q n 18 616.8 m 630 616.8 l 630 604.8 l 18 604.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 607.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 607.21 Tm (the Employer's usual place of business; or) Tj ET Q q n 18 604.8 m 630 604.8 l 630 592.8 l 18 592.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 595.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 595.21 Tm (any other business location where the Employer requires the Employee to travel.) Tj ET Q q n 0 592.8 m 612 592.8 l 612 580.8 l 0 580.8 l h W n Q q n 0 580.8 m 612 580.8 l 612 568.8 l 0 568.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 571.21 Tm (Unless) Tj ET BT /F3 12 Tf 1 0 0 1 37.03 571.21 Tm (disabled) Tj ET BT /F3 12 Tf 1 0 0 1 81.38 571.21 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 97.74 571.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 116.76 571.21 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 144.44 571.21 Tm (workday) Tj ET BT /F3 12 Tf 1 0 0 1 190.79 571.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 205.15 571.21 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 221.51 571.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 240.53 571.21 Tm (day) Tj ET BT /F3 12 Tf 1 0 0 1 262.22 571.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 276.57 571.21 Tm (absence,) Tj ET BT /F3 12 Tf 1 0 0 1 321.91 571.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 337.6 571.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 390.61 571.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 413.63 571.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 429.32 571.21 Tm (considered) Tj ET BT /F3 12 Tf 1 0 0 1 485.66 571.21 Tm (Actively) Tj ET BT /F3 12 Tf 1 0 0 1 531.34 571.21 Tm (at) Tj ET Q q n 0 568.8 m 612 568.8 l 612 556.8 l 0 556.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 559.21 Tm (Work on the following days:) Tj ET Q q n 18 556.8 m 630 556.8 l 630 544.8 l 18 544.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 547.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 547.21 Tm (a Saturday, Sunday or holiday that is not a scheduled workday;) Tj ET Q q n 18 544.8 m 630 544.8 l 630 532.8 l 18 532.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 535.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 535.21 Tm (a paid vacation day or other scheduled or unscheduled non-workday; or) Tj ET Q q n 18 532.8 m 630 532.8 l 630 520.8 l 18 520.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 523.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 523.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 54.61 523.21 Tm (non-medical) Tj ET BT /F3 12 Tf 1 0 0 1 118.52 523.21 Tm (leave) Tj ET BT /F3 12 Tf 1 0 0 1 147.76 523.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 161.69 523.21 Tm (absence) Tj ET BT /F3 12 Tf 1 0 0 1 203.6 523.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 217.52 523.21 Tm (12) Tj ET BT /F3 12 Tf 1 0 0 1 233.45 523.21 Tm (weeks) Tj ET BT /F3 12 Tf 1 0 0 1 267.37 523.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 281.3 523.21 Tm (less,) Tj ET BT /F3 12 Tf 1 0 0 1 306.23 523.21 Tm (whether) Tj ET BT /F3 12 Tf 1 0 0 1 348.81 523.21 Tm (taken) Tj ET BT /F3 12 Tf 1 0 0 1 378.73 523.21 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 404 523.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 422.59 523.21 Tm (Employer's) Tj ET BT /F3 12 Tf 1 0 0 1 480.67 523.21 Tm (prior) Tj ET Q q n 45.35 520.8 m 657.35 520.8 l 657.35 508.8 l 45.35 508.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 511.21 Tm (approval or on an emergency basis.) Tj ET Q q n 0 508.8 m 612 508.8 l 612 496.8 l 0 496.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 499.21 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 24.81 499.21 Tm (includes) Tj ET BT /F3 12 Tf 1 0 0 1 68.27 499.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 77.07 499.21 Tm (Military) Tj ET BT /F3 12 Tf 1 0 0 1 119.87 499.21 Tm (Leave) Tj ET BT /F3 12 Tf 1 0 0 1 152.65 499.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 166.12 499.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 180.92 499.21 Tm (approved) Tj ET BT /F3 12 Tf 1 0 0 1 229.04 499.21 Tm (Family) Tj ET BT /F3 12 Tf 1 0 0 1 266.52 499.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 279.98 499.21 Tm (Medical) Tj ET BT /F3 12 Tf 1 0 0 1 322.77 499.21 Tm (Leave) Tj ET BT /F3 12 Tf 1 0 0 1 355.55 499.21 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 377.02 499.21 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 388.5 499.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 408.64 499.21 Tm (due) Tj ET BT /F3 12 Tf 1 0 0 1 429.44 499.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 442.25 499.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 460.38 499.21 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 519.33 499.21 Tm (own) Tj ET Q q n 0 496.8 m 612 496.8 l 612 484.8 l 0 484.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 487.21 Tm (health condition.) Tj ET Q q n 0 484.8 m 612 484.8 l 612 472.8 l 0 472.8 l h W n Q q n 0 472.8 m 612 472.8 l 612 460.8 l 0 460.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 463.21 Tm (ANNUAL) Tj ET BT /F2 12 Tf 1 0 0 1 54.65 463.21 Tm (SALARY) Tj ET BT /F3 12 Tf 1 0 0 1 107.31 463.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 141.28 463.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 159.26 463.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 198.56 463.21 Tm (Employee's) Tj ET BT /F2 12 Tf 1 0 0 1 257.36 463.21 Tm (BASIC) Tj ET BT /F2 12 Tf 1 0 0 1 297.35 463.21 Tm (MONTHLY) Tj ET BT /F2 12 Tf 1 0 0 1 364 463.21 Tm (EARNINGS) Tj ET BT /F2 12 Tf 1 0 0 1 430.67 463.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 445.31 463.21 Tm (PREDISABILITY) Tj ET Q q n 0 460.8 m 612 460.8 l 612 448.8 l 0 448.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 451.21 Tm (INCOME) Tj ET BT /F3 12 Tf 1 0 0 1 53.67 451.21 Tm (multiplied by 12) Tj ET BT /F3 12 Tf 1 0 0 1 133 451.21 Tm (.) Tj ET Q q n 0 448.8 m 612 448.8 l 612 436.8 l 0 436.8 l h W n Q q n 0 436.8 m 612 436.8 l 612 424.8 l 0 424.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 427.21 Tm (BASIC) Tj ET BT /F2 12 Tf 1 0 0 1 41.4 427.21 Tm (MONTHLY) Tj ET BT /F2 12 Tf 1 0 0 1 109.45 427.21 Tm (EARNINGS) Tj ET BT /F3 12 Tf 1 0 0 1 177.52 427.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 192.23 427.21 Tm (PREDISABILITY) Tj ET BT /F2 12 Tf 1 0 0 1 291.65 427.21 Tm (INCOME) Tj ET BT /F3 12 Tf 1 0 0 1 347.03 427.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 382.41 427.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 401.79 427.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 442.5 427.21 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 502.7 427.21 Tm (average) Tj ET Q q n 0 424.8 m 612 424.8 l 612 412.8 l 0 412.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 415.21 Tm (monthly) Tj ET BT /F3 12 Tf 1 0 0 1 46.91 415.21 Tm (base) Tj ET BT /F3 12 Tf 1 0 0 1 75.14 415.21 Tm (salary) Tj ET BT /F3 12 Tf 1 0 0 1 110.69 415.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 127.59 415.21 Tm (hourly) Tj ET BT /F3 12 Tf 1 0 0 1 165.83 415.21 Tm (pay) Tj ET BT /F3 12 Tf 1 0 0 1 190.06 415.21 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 220.29 415.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 241.86 415.21 Tm (Employer) Tj ET BT /F3 12 Tf 1 0 0 1 296.08 415.21 Tm (before) Tj ET BT /F3 12 Tf 1 0 0 1 333.63 415.21 Tm (taxes) Tj ET BT /F3 12 Tf 1 0 0 1 365.19 415.21 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 384.1 415.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 405.67 415.21 Tm (Determination) Tj ET BT /F3 12 Tf 1 0 0 1 481.88 415.21 Tm (Date.) Tj ET BT /F3 12 Tf 1 0 0 1 521.34 415.21 Tm (The) Tj ET Q q n 0 412.8 m 612 412.8 l 612 400.8 l 0 400.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 403.21 Tm ("Determination Date") Tj ET BT /F3 12 Tf 1 0 0 1 114.96 403.21 Tm ( is the last day worked just prior to the date the Disability begins.) Tj ET Q q n 0 400.8 m 612 400.8 l 612 388.8 l 0 388.8 l h W n Q q n 0 388.8 m 612 388.8 l 612 376.8 l 0 376.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 379.21 Tm (It) Tj ET BT /F3 12 Tf 1 0 0 1 11.17 379.21 Tm (does) Tj ET BT /F2 12 Tf 1 0 0 1 37.01 379.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 57.52 379.21 Tm (include) Tj ET BT /F3 12 Tf 1 0 0 1 96.68 379.21 Tm (commissions,) Tj ET BT /F3 12 Tf 1 0 0 1 166.19 379.21 Tm (bonuses,) Tj ET BT /F3 12 Tf 1 0 0 1 211.7 379.21 Tm (overtime) Tj ET BT /F3 12 Tf 1 0 0 1 258.19 379.21 Tm (pay,) Tj ET BT /F3 12 Tf 1 0 0 1 282.35 379.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 296.19 379.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 317.35 379.21 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 345.85 379.21 Tm (extra) Tj ET BT /F3 12 Tf 1 0 0 1 373.67 379.21 Tm (compensation.) Tj ET BT /F3 12 Tf 1 0 0 1 447.16 379.21 Tm (It) Tj ET BT /F3 12 Tf 1 0 0 1 458.33 379.21 Tm (does) Tj ET BT /F2 12 Tf 1 0 0 1 484.17 379.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 504.68 379.21 Tm (include) Tj ET Q q n 0 376.8 m 612 376.8 l 612 364.8 l 0 364.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 367.21 Tm (income) Tj ET BT /F3 12 Tf 1 0 0 1 38.52 367.21 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 65.05 367.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 73.58 367.21 Tm (source) Tj ET BT /F3 12 Tf 1 0 0 1 108.11 367.21 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 135.97 367.21 Tm (than) Tj ET BT /F3 12 Tf 1 0 0 1 159.83 367.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 177.69 367.21 Tm (Employer.) Tj ET BT /F3 12 Tf 1 0 0 1 231.22 367.21 Tm (It) Tj ET BT /F3 12 Tf 1 0 0 1 241.75 367.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 263.62 367.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 282.16 367.21 Tm (exceed) Tj ET BT /F3 12 Tf 1 0 0 1 318.67 367.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 336.53 367.21 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 375.73 367.21 Tm (shown) Tj ET BT /F3 12 Tf 1 0 0 1 410.27 367.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 422.8 367.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 440.67 367.21 Tm (Employer's) Tj ET BT /F3 12 Tf 1 0 0 1 498.02 367.21 Tm (financial) Tj ET Q q n 0 364.8 m 612 364.8 l 612 352.8 l 0 352.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 355.21 Tm (records,) Tj ET BT /F3 12 Tf 1 0 0 1 42.1 355.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 60.55 355.21 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 100.33 355.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 118.11 355.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 151.22 355.21 Tm (premium) Tj ET BT /F3 12 Tf 1 0 0 1 198.33 355.21 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 218.11 355.21 Tm (been) Tj ET BT /F3 12 Tf 1 0 0 1 244.55 355.21 Tm (paid,) Tj ET BT /F3 12 Tf 1 0 0 1 272 355.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 285.78 355.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 304.23 355.21 Tm (Maximum) Tj ET BT /F3 12 Tf 1 0 0 1 358.01 355.21 Tm (Covered) Tj ET BT /F3 12 Tf 1 0 0 1 402.45 355.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 447.57 355.21 Tm (Earnings) Tj ET BT /F3 12 Tf 1 0 0 1 494.02 355.21 Tm (permitted) Tj ET Q q n 0 352.8 m 612 352.8 l 612 340.8 l 0 340.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 343.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 15.55 343.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 33.77 343.21 Tm (Policy;) Tj ET BT /F3 12 Tf 1 0 0 1 71.32 343.21 Tm (whichever) Tj ET BT /F3 12 Tf 1 0 0 1 124.85 343.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 136.41 343.21 Tm (less.) Tj ET BT /F3 12 Tf 1 0 0 1 160.96 343.21 Tm (\(Maximum) Tj ET BT /F3 12 Tf 1 0 0 1 218.51 343.21 Tm (Covered) Tj ET BT /F3 12 Tf 1 0 0 1 262.71 343.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 307.61 343.21 Tm (Earnings) Tj ET BT /F3 12 Tf 1 0 0 1 353.81 343.21 Tm (equals) Tj ET BT /F3 12 Tf 1 0 0 1 388.02 343.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 406.24 343.21 Tm (Maximum) Tj ET BT /F3 12 Tf 1 0 0 1 459.79 343.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 504.68 343.21 Tm (Benefit) Tj ET Q q n 0 340.8 m 612 340.8 l 612 328.8 l 0 328.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 331.21 Tm (divided) Tj ET BT /F3 12 Tf 1 0 0 1 39.36 331.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 54.72 331.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 72.74 331.21 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 111.42 331.21 Tm (Percentage) Tj ET BT /F3 12 Tf 1 0 0 1 167.42 331.21 Tm (shown) Tj ET BT /F3 12 Tf 1 0 0 1 202.12 331.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 214.82 331.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 232.84 331.21 Tm (Schedule) Tj ET BT /F3 12 Tf 1 0 0 1 280.19 331.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 293.54 331.21 Tm (Benefits.\)) Tj ET BT /F3 12 Tf 1 0 0 1 347.25 331.21 Tm (Exception:) Tj ET BT /F3 12 Tf 1 0 0 1 402.6 331.21 Tm (For) Tj ET BT /F3 12 Tf 1 0 0 1 422.63 331.21 Tm (purposes) Tj ET BT /F3 12 Tf 1 0 0 1 468.66 331.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 482.02 331.21 Tm (determining) Tj ET Q q n 0 328.8 m 612 328.8 l 612 316.8 l 0 316.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 319.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 19.49 319.21 Tm (Residual) Tj ET BT /F3 12 Tf 1 0 0 1 66.31 319.21 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 118.47 319.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 164.63 319.21 Tm (Benefit,) Tj ET BT /F3 12 Tf 1 0 0 1 207.78 319.21 Tm (Basic) Tj ET BT /F3 12 Tf 1 0 0 1 239.27 319.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 285.43 319.21 Tm (Earnings) Tj ET BT /F3 12 Tf 1 0 0 1 332.92 319.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 356.41 319.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 376.57 319.21 Tm (exceed) Tj ET BT /F3 12 Tf 1 0 0 1 414.71 319.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 434.19 319.21 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 475.02 319.21 Tm (shown) Tj ET BT /F3 12 Tf 1 0 0 1 511.18 319.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 319.21 Tm (the) Tj ET Q q n 0 316.8 m 612 316.8 l 612 304.8 l 0 304.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 307.21 Tm (Employer's financial records.) Tj ET Q q n 0 291 m 612 291 l 612 279 l 0 279 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 281.41 Tm (COMPANY) Tj ET BT /F3 12 Tf 1 0 0 1 69.18 281.41 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 106.36 281.41 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 131.54 281.41 Tm (Lincoln) Tj ET BT /F3 12 Tf 1 0 0 1 175.39 281.41 Tm (National) Tj ET BT /F3 12 Tf 1 0 0 1 223.23 281.41 Tm (Life) Tj ET BT /F3 12 Tf 1 0 0 1 249.74 281.41 Tm (Insurance) Tj ET BT /F3 12 Tf 1 0 0 1 302.91 281.41 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 349.57 281.41 Tm (,) Tj ET BT /F3 12 Tf 1 0 0 1 359.1 281.41 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 376.95 281.41 Tm (Indiana) Tj ET BT /F3 12 Tf 1 0 0 1 419.45 281.41 Tm (corporation.) Tj ET BT /F3 12 Tf 1 0 0 1 490.81 281.41 Tm (Its) Tj ET BT /F3 12 Tf 1 0 0 1 509.34 281.41 Tm (Group) Tj ET Q q n 0 279 m 612 279 l 612 267 l 0 267 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 269.41 Tm (Insurance Service Office address is) Tj ET BT /F3 12 Tf 1 0 0 1 172.26 269.41 Tm (8801 Indian Hills Drive, Omaha) Tj ET BT /F3 12 Tf 1 0 0 1 327.23 269.41 Tm (, Nebraska) Tj ET BT /F3 12 Tf 1 0 0 1 384.54 269.41 Tm (68114-4066) Tj ET BT /F3 12 Tf 1 0 0 1 442.54 269.41 Tm (.) Tj ET Q q n 0 267 m 612 267 l 612 255 l 0 255 l h W n Q q n 0 255 m 612 255 l 612 243 l 0 243 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 245.41 Tm (DAY) Tj ET BT /F3 12 Tf 1 0 0 1 29.1 245.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 42.2 245.41 Tm (DATE) Tj ET BT /F3 12 Tf 1 0 0 1 78.65 245.41 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 112.41 245.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 130.18 245.41 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 163.94 245.41 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 177.04 245.41 Tm (time) Tj ET BT /F3 12 Tf 1 0 0 1 201.47 245.41 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 222.57 245.41 Tm (begins) Tj ET BT /F3 12 Tf 1 0 0 1 257 245.41 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 268.77 245.41 Tm (12:01) Tj ET BT /F3 12 Tf 1 0 0 1 299.21 245.41 Tm (a.m.) Tj ET BT /F3 12 Tf 1 0 0 1 322.97 245.41 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 343.4 245.41 Tm (ends) Tj ET BT /F3 12 Tf 1 0 0 1 368.51 245.41 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 380.27 245.41 Tm (12:00) Tj ET BT /F3 12 Tf 1 0 0 1 410.71 245.41 Tm (midnight,) Tj ET BT /F3 12 Tf 1 0 0 1 460.15 245.41 Tm (standard) Tj ET BT /F3 12 Tf 1 0 0 1 503.91 245.41 Tm (time,) Tj ET BT /F3 12 Tf 1 0 0 1 531.34 245.41 Tm (at) Tj ET Q q n 0 243 m 612 243 l 612 231 l 0 231 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 233.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 17.85 233.41 Tm (Policyholder's) Tj ET BT /F3 12 Tf 1 0 0 1 89.2 233.41 Tm (place) Tj ET BT /F3 12 Tf 1 0 0 1 117.71 233.41 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 130.9 233.41 Tm (business.) Tj ET BT /F3 12 Tf 1 0 0 1 180.95 233.41 Tm (When) Tj ET BT /F3 12 Tf 1 0 0 1 212.79 233.41 Tm (used) Tj ET BT /F3 12 Tf 1 0 0 1 237.98 233.41 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 262.51 233.41 Tm (regard) Tj ET BT /F3 12 Tf 1 0 0 1 296.35 233.41 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 308.87 233.41 Tm (effective) Tj ET BT /F3 12 Tf 1 0 0 1 354.03 233.41 Tm (dates,) Tj ET BT /F3 12 Tf 1 0 0 1 384.88 233.41 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 394.74 233.41 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 428.59 233.41 Tm (12:01) Tj ET BT /F3 12 Tf 1 0 0 1 459.11 233.41 Tm (a.m.) Tj ET BT /F3 12 Tf 1 0 0 1 486.16 233.41 Tm (When) Tj ET BT /F3 12 Tf 1 0 0 1 518 233.41 Tm (used) Tj ET Q q n 0 231 m 612 231 l 612 219 l 0 219 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 221.41 Tm (with regard to termination dates, it means 12:00 midnight.) Tj ET Q q n 0 219 m 612 219 l 612 207 l 0 207 l h W n Q q n 0 207 m 612 207 l 612 195 l 0 195 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 197.41 Tm (DISABILITY) Tj ET BT /F3 12 Tf 1 0 0 1 73.69 197.41 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 83.69 197.41 Tm ( DISABLED) Tj ET BT /F3 12 Tf 1 0 0 1 148.04 197.41 Tm ( means Total Disability or Partial/Residual Disability.) Tj ET Q q n 0 181.2 m 612 181.2 l 612 169.2 l 0 169.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 171.61 Tm (DISABILITY BENEFIT,) Tj ET BT /F3 12 Tf 1 0 0 1 129.38 171.61 Tm ( when used with the term Retirement Plan, means a benefit that:) Tj ET Q q n 18 169.2 m 630 169.2 l 630 157.2 l 18 157.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 159.61 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 159.61 Tm (is payable under a Retirement Plan due to disability as defined in that plan; and) Tj ET Q q n 18 157.2 m 630 157.2 l 630 145.2 l 18 145.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 147.61 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 147.61 Tm (does) Tj ET BT /F3 12 Tf 1 0 0 1 71.49 147.61 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 90.96 147.61 Tm (reduce) Tj ET BT /F3 12 Tf 1 0 0 1 127.08 147.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 145.88 147.61 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 188.01 147.61 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 210.15 147.61 Tm (would) Tj ET BT /F3 12 Tf 1 0 0 1 244.29 147.61 Tm (have) Tj ET BT /F3 12 Tf 1 0 0 1 271.08 147.61 Tm (been) Tj ET BT /F3 12 Tf 1 0 0 1 297.88 147.61 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 322.68 147.61 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 336.82 147.61 Tm (Retirement) Tj ET BT /F3 12 Tf 1 0 0 1 394.27 147.61 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 438.41 147.61 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 451.21 147.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 470.01 147.61 Tm (normal) Tj ET Q q n 45.35 145.2 m 657.35 145.2 l 657.35 133.2 l 45.35 133.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 135.61 Tm (retirement age under the plan if the disability had not occurred.) Tj ET Q q n 0 133.2 m 612 133.2 l 612 121.2 l 0 121.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 123.61 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 11.92 123.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 30.5 123.61 Tm (payment) Tj ET BT /F3 12 Tf 1 0 0 1 75.74 123.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 89.66 123.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 108.24 123.61 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 145.48 123.61 Tm (does) Tj ET BT /F3 12 Tf 1 0 0 1 171.4 123.61 Tm (cause) Tj ET BT /F3 12 Tf 1 0 0 1 201.97 123.61 Tm (such) Tj ET BT /F3 12 Tf 1 0 0 1 227.89 123.61 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 237.14 123.61 Tm (reduction,) Tj ET BT /F3 12 Tf 1 0 0 1 289.38 123.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 307.96 123.61 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 345.2 123.61 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 367.79 123.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 383.04 123.61 Tm (deemed) Tj ET BT /F3 12 Tf 1 0 0 1 424.28 123.61 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 433.52 123.61 Tm (Retirement) Tj ET BT /F3 12 Tf 1 0 0 1 490.76 123.61 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 530 123.61 Tm (as) Tj ET Q q n 0 121.2 m 612 121.2 l 612 109.2 l 0 109.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 111.61 Tm (defined in the Policy.) Tj ET Q q n 0 109.2 m 612 109.2 l 612 97.2 l 0 97.2 l h W n Q Q q Q Q endstream endobj 6 0 obj <>>>>> endobj 131 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 734.4 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 230.32 26.41 Tm (DEFINITIONS) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 239 14.41 Tm (\(Continued\)) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-2 10 PA) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 267.5 14.41 Tm (4) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 676.8 m 612 676.8 l 612 664.8 l 0 664.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 667.21 Tm (ELIMINATION) Tj ET BT /F2 12 Tf 1 0 0 1 88.71 667.21 Tm (PERIOD) Tj ET BT /F3 12 Tf 1 0 0 1 139.4 667.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 174.08 667.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 192.77 667.21 Tm (number) Tj ET BT /F3 12 Tf 1 0 0 1 233.45 667.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 247.47 667.21 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 273.5 667.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 287.52 667.21 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 338.87 667.21 Tm (during) Tj ET BT /F3 12 Tf 1 0 0 1 374.23 667.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 407.58 667.21 Tm (no) Tj ET BT /F3 12 Tf 1 0 0 1 423.61 667.21 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 460.95 667.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 472.98 667.21 Tm (payable.) Tj ET BT /F3 12 Tf 1 0 0 1 521.34 667.21 Tm (The) Tj ET Q q n 0 664.8 m 612 664.8 l 612 652.8 l 0 652.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 655.21 Tm (Elimination Period is shown in the Schedule of Benefits.) Tj ET BT /F3 12 Tf 1 0 0 1 278.3 655.21 Tm (It applies as follows.) Tj ET Q q n 18 652.8 m 630 652.8 l 630 640.8 l 18 640.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 643.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 643.21 Tm (The Elimination Period:) Tj ET Q q n 45.35 640.8 m 657.35 640.8 l 657.35 628.8 l 45.35 628.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 631.21 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 631.21 Tm (begins on the first day of Disability; and) Tj ET Q q n 45.35 628.8 m 657.35 628.8 l 657.35 616.8 l 45.35 616.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 619.21 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 619.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 84.09 619.21 Tm (satisfied) Tj ET BT /F3 12 Tf 1 0 0 1 127.47 619.21 Tm (when) Tj ET BT /F3 12 Tf 1 0 0 1 156.85 619.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 174.89 619.21 Tm (required) Tj ET BT /F3 12 Tf 1 0 0 1 218.26 619.21 Tm (number) Tj ET BT /F3 12 Tf 1 0 0 1 258.3 619.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 271.69 619.21 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 297.07 619.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 308.46 619.21 Tm (accumulated) Tj ET BT /F3 12 Tf 1 0 0 1 372.48 619.21 Tm (within) Tj ET BT /F3 12 Tf 1 0 0 1 406.53 619.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 415.25 619.21 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 449.29 619.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 482 619.21 Tm (does) Tj ET Q q n 72.7 616.8 m 684.7 616.8 l 684.7 604.8 l 72.7 604.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 607.21 Tm (not exceed two times the Elimination Period.) Tj ET Q q n 45.35 604.8 m 657.35 604.8 l 657.35 592.8 l 45.35 592.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 595.21 Tm (During) Tj ET BT /F3 12 Tf 1 0 0 1 82.64 595.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 91.27 595.21 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 125.22 595.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 138.52 595.21 Tm (Disability,) Tj ET BT /F3 12 Tf 1 0 0 1 192.15 595.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 210.1 595.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 249.39 595.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 301.34 595.21 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 325.3 595.21 Tm (return) Tj ET BT /F3 12 Tf 1 0 0 1 357.25 595.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 369.88 595.21 Tm (full-time) Tj ET BT /F3 12 Tf 1 0 0 1 415.16 595.21 Tm (work,) Tj ET BT /F3 12 Tf 1 0 0 1 446.12 595.21 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 458.08 595.21 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 475.38 595.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 488.68 595.21 Tm (her) Tj ET Q q n 45.35 592.8 m 657.35 592.8 l 657.35 580.8 l 45.35 580.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 583.21 Tm (own) Tj ET BT /F3 12 Tf 1 0 0 1 69.11 583.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 82.21 583.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 102.63 583.21 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 130.39 583.21 Tm (occupation) Tj ET BT /F3 12 Tf 1 0 0 1 183.03 583.21 Tm (,) Tj ET BT /F3 12 Tf 1 0 0 1 189.13 583.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 206.22 583.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 220.64 583.21 Tm (accumulated) Tj ET BT /F3 12 Tf 1 0 0 1 284.37 583.21 Tm (number) Tj ET BT /F3 12 Tf 1 0 0 1 324.13 583.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 337.22 583.21 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 362.32 583.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 380.75 583.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 393.18 583.21 Tm (exceed) Tj ET BT /F3 12 Tf 1 0 0 1 429.58 583.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 447.34 583.21 Tm (Elimination) Tj ET Q q n 45.35 580.8 m 657.35 580.8 l 657.35 568.8 l 45.35 568.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 571.21 Tm (Period.) Tj ET Q q n 18 568.8 m 630 568.8 l 630 556.8 l 18 556.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 559.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 559.21 Tm (Only) Tj ET BT /F3 12 Tf 1 0 0 1 73.02 559.21 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 98.69 559.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 112.36 559.21 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 163.36 559.21 Tm (caused) Tj ET BT /F3 12 Tf 1 0 0 1 199.68 559.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 215.36 559.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 233.69 559.21 Tm (same) Tj ET BT /F3 12 Tf 1 0 0 1 262.02 559.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 275.68 559.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 284.68 559.21 Tm (related) Tj ET BT /F3 12 Tf 1 0 0 1 321 559.21 Tm (Sickness) Tj ET BT /F3 12 Tf 1 0 0 1 366.67 559.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 380.34 559.21 Tm (Injury) Tj ET BT /F3 12 Tf 1 0 0 1 413.34 559.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 435.68 559.21 Tm (count) Tj ET BT /F3 12 Tf 1 0 0 1 466.01 559.21 Tm (towards) Tj ET Q q n 45.35 556.8 m 657.35 556.8 l 657.35 544.8 l 45.35 544.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 547.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 64.28 547.21 Tm (Elimination) Tj ET BT /F3 12 Tf 1 0 0 1 125.2 547.21 Tm (Period.) Tj ET BT /F3 12 Tf 1 0 0 1 168.07 547.21 Tm (Days) Tj ET BT /F3 12 Tf 1 0 0 1 197 547.21 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 213.26 547.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 246.86 547.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 265.79 547.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 306.04 547.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 358.96 547.21 Tm (returns) Tj ET BT /F3 12 Tf 1 0 0 1 396.55 547.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 410.15 547.21 Tm (full-time) Tj ET BT /F3 12 Tf 1 0 0 1 456.4 547.21 Tm (work) Tj ET BT /F3 12 Tf 1 0 0 1 485.33 547.21 Tm (will) Tj ET Q q n 45.35 544.8 m 657.35 544.8 l 657.35 532.8 l 45.35 532.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 535.21 Tm (not count towards the Elimination Period.) Tj ET Q q n 0 532.8 m 612 532.8 l 612 520.8 l 0 520.8 l h W n Q q n 0 520.8 m 612 520.8 l 612 508.8 l 0 508.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 511.21 Tm (EMPLOYEE) Tj ET BT /F3 12 Tf 1 0 0 1 71.67 511.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 81.67 511.21 Tm ( FULL-TIME EMPLOYEE) Tj ET BT /F3 12 Tf 1 0 0 1 224.34 511.21 Tm ( means a person:) Tj ET Q q n 18 508.8 m 630 508.8 l 630 496.8 l 18 496.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 499.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 499.21 Tm (whose employment with the Employer is the person's main occupation;) Tj ET Q q n 18 496.8 m 630 496.8 l 630 484.8 l 18 484.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 487.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45 487.21 Tm (whose employment is for regular wage or salary, on a full-time basis;) Tj ET Q q n 18 484.8 m 630 484.8 l 630 472.8 l 18 472.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 475.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45 475.21 Tm (who) Tj ET BT /F3 12 Tf 1 0 0 1 69.56 475.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 81.46 475.21 Tm (regularly) Tj ET BT /F3 12 Tf 1 0 0 1 128.67 475.21 Tm (scheduled) Tj ET BT /F3 12 Tf 1 0 0 1 180.54 475.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 193.77 475.21 Tm (work) Tj ET BT /F3 12 Tf 1 0 0 1 222.33 475.21 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 234.88 475.21 Tm (such) Tj ET BT /F3 12 Tf 1 0 0 1 260.77 475.21 Tm (occupation) Tj ET BT /F3 12 Tf 1 0 0 1 317.31 475.21 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 329.87 475.21 Tm (least) Tj ET BT /F3 12 Tf 1 0 0 1 355.75 475.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 374.31 475.21 Tm (Minimum) Tj ET BT /F3 12 Tf 1 0 0 1 426.21 475.21 Tm (Hours) Tj ET BT /F3 12 Tf 1 0 0 1 459.44 475.21 Tm (shown) Tj ET BT /F3 12 Tf 1 0 0 1 494.67 475.21 Tm (in) Tj ET Q q n 45 472.8 m 657 472.8 l 657 460.8 l 45 460.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 463.21 Tm (the Schedule of Benefits;) Tj ET Q q n 18 460.8 m 630 460.8 l 630 448.8 l 18 448.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 451.21 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45 451.21 Tm (who is a member of an Eligible Class which is eligible for coverage under the Policy;) Tj ET Q q n 18 448.8 m 630 448.8 l 630 436.8 l 18 436.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 439.21 Tm (5.) Tj ET BT /F3 12 Tf 1 0 0 1 45 439.21 Tm (who is not a temporary or seasonal employee; and) Tj ET Q q n 18 436.8 m 630 436.8 l 630 424.8 l 18 424.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 427.21 Tm (6.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 427.21 Tm (who is a citizen of the United States or legally works in the United States.) Tj ET Q q n 0 424.8 m 612 424.8 l 612 412.8 l 0 412.8 l h W n Q q n 0 412.8 m 612 412.8 l 612 400.8 l 0 400.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 403.21 Tm (EMPLOYER) Tj ET BT /F3 12 Tf 1 0 0 1 72.81 403.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 106.94 403.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 125.07 403.21 Tm (Policyholder.) Tj ET BT /F3 12 Tf 1 0 0 1 196.34 403.21 Tm (It) Tj ET BT /F3 12 Tf 1 0 0 1 207.15 403.21 Tm (includes) Tj ET BT /F3 12 Tf 1 0 0 1 250.61 403.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 271.41 403.21 Tm (division,) Tj ET BT /F3 12 Tf 1 0 0 1 316.56 403.21 Tm (subsidiary) Tj ET BT /F3 12 Tf 1 0 0 1 369.36 403.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 382.83 403.21 Tm (affiliated) Tj ET BT /F3 12 Tf 1 0 0 1 429.61 403.21 Tm (company) Tj ET BT /F3 12 Tf 1 0 0 1 477.07 403.21 Tm (named) Tj ET BT /F3 12 Tf 1 0 0 1 512.53 403.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 403.21 Tm (the) Tj ET Q q n 0 400.8 m 612 400.8 l 612 388.8 l 0 388.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 391.21 Tm (Application or Participation Agreement.) Tj ET Q q n 0 388.8 m 612 388.8 l 612 376.8 l 0 376.8 l h W n Q q n 0 376.8 m 612 376.8 l 612 364.8 l 0 364.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 367.21 Tm (EVIDENCE) Tj ET BT /F2 12 Tf 1 0 0 1 69.36 367.21 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 92.04 367.21 Tm (INSURABILITY) Tj ET BT /F3 12 Tf 1 0 0 1 186.09 367.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 222.76 367.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 234.1 367.21 Tm (statement) Tj ET BT /F3 12 Tf 1 0 0 1 286.1 367.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 302.12 367.21 Tm (proof) Tj ET BT /F3 12 Tf 1 0 0 1 334.12 367.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 350.14 367.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 367.48 367.21 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 428.98 367.21 Tm (medical) Tj ET BT /F3 12 Tf 1 0 0 1 472.98 367.21 Tm (history.) Tj ET BT /F3 12 Tf 1 0 0 1 521.34 367.21 Tm (The) Tj ET Q q n 0 364.8 m 612 364.8 l 612 352.8 l 0 352.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 355.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 50.03 355.21 Tm (uses) Tj ET BT /F3 12 Tf 1 0 0 1 74.05 355.21 Tm (this) Tj ET BT /F3 12 Tf 1 0 0 1 94.75 355.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 107.45 355.21 Tm (determine) Tj ET BT /F3 12 Tf 1 0 0 1 158.79 355.21 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 176.15 355.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 189.51 355.21 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 208.2 355.21 Tm (acceptance) Tj ET BT /F3 12 Tf 1 0 0 1 264.18 355.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 281.53 355.21 Tm (insurance) Tj ET BT /F3 12 Tf 1 0 0 1 330.87 355.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 344.23 355.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 358.92 355.21 Tm (increased) Tj ET BT /F3 12 Tf 1 0 0 1 407.58 355.21 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 446.94 355.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 460.3 355.21 Tm (insurance.) Tj ET BT /F3 12 Tf 1 0 0 1 516 355.21 Tm (Such) Tj ET Q q n 0 352.8 m 612 352.8 l 612 340.8 l 0 340.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 343.21 Tm (proof will be provided at the Employee's own expense.) Tj ET Q q n 0 340.8 m 612 340.8 l 612 328.8 l 0 328.8 l h W n Q q n 0 328.8 m 612 328.8 l 612 316.8 l 0 316.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 319.21 Tm (FAMILY OR MEDICAL LEAVE) Tj ET BT /F3 12 Tf 1 0 0 1 175.01 319.21 Tm ( means an) Tj ET BT /F3 12 Tf 1 0 0 1 225.99 319.21 Tm (approved leave of absence that:) Tj ET Q q n 18 316.8 m 630 316.8 l 630 304.8 l 18 304.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 307.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 307.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 58.28 307.21 Tm (subject) Tj ET BT /F3 12 Tf 1 0 0 1 97.55 307.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 112.16 307.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 132.1 307.21 Tm (federal) Tj ET BT /F3 12 Tf 1 0 0 1 170.69 307.21 Tm (FMLA) Tj ET BT /F3 12 Tf 1 0 0 1 209.3 307.21 Tm (law) Tj ET BT /F3 12 Tf 1 0 0 1 231.91 307.21 Tm (\(the) Tj ET BT /F3 12 Tf 1 0 0 1 255.84 307.21 Tm (Family) Tj ET BT /F3 12 Tf 1 0 0 1 295.12 307.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 317.73 307.21 Tm (Medical) Tj ET BT /F3 12 Tf 1 0 0 1 362.32 307.21 Tm (Leave) Tj ET BT /F3 12 Tf 1 0 0 1 396.91 307.21 Tm (Act) Tj ET BT /F3 12 Tf 1 0 0 1 419.52 307.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 434.79 307.21 Tm (1993) Tj ET BT /F3 12 Tf 1 0 0 1 464.07 307.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 486.67 307.21 Tm (any) Tj ET Q q n 45 304.8 m 657 304.8 l 657 292.8 l 45 292.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 295.21 Tm (amendments to it\) or a similar state law;) Tj ET Q q n 18 292.8 m 630 292.8 l 630 280.8 l 18 280.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 283.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45 283.21 Tm (is taken in accord with the Employer's leave policy and the law which applies; and) Tj ET Q q n 18 280.8 m 630 280.8 l 630 268.8 l 18 268.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 271.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 271.21 Tm (does not exceed the period approved by the Employer and required by that law.) Tj ET Q q n 0 268.8 m 612 268.8 l 612 256.8 l 0 256.8 l h W n Q q n 0 256.8 m 612 256.8 l 612 244.8 l 0 244.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 247.21 Tm (Under) Tj ET BT /F3 12 Tf 1 0 0 1 33.26 247.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 51.2 247.21 Tm (federal) Tj ET BT /F3 12 Tf 1 0 0 1 87.78 247.21 Tm (FMLA) Tj ET BT /F3 12 Tf 1 0 0 1 124.39 247.21 Tm (law,) Tj ET BT /F3 12 Tf 1 0 0 1 147.99 247.21 Tm (such) Tj ET BT /F3 12 Tf 1 0 0 1 173.26 247.21 Tm (leaves) Tj ET BT /F3 12 Tf 1 0 0 1 206.52 247.21 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 224.45 247.21 Tm (permitted) Tj ET BT /F3 12 Tf 1 0 0 1 273.7 247.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 290.97 247.21 Tm (up) Tj ET BT /F3 12 Tf 1 0 0 1 306.25 247.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 318.85 247.21 Tm (12) Tj ET BT /F3 12 Tf 1 0 0 1 334.13 247.21 Tm (weeks) Tj ET BT /F3 12 Tf 1 0 0 1 367.39 247.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 380 247.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 388.6 247.21 Tm (12-month) Tj ET BT /F3 12 Tf 1 0 0 1 438.54 247.21 Tm (period,) Tj ET BT /F3 12 Tf 1 0 0 1 475.47 247.21 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 488.74 247.21 Tm (defined) Tj ET BT /F3 12 Tf 1 0 0 1 528 247.21 Tm (by) Tj ET Q q n 0 244.8 m 612 244.8 l 612 232.8 l 0 232.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 235.21 Tm (the Employer.) Tj ET BT /F3 12 Tf 1 0 0 1 73.98 235.21 Tm (The 12 weeks:) Tj ET Q q n 18 232.8 m 630 232.8 l 630 220.8 l 18 220.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 223.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 223.21 Tm (may consist of consecutive or intermittent work days; or) Tj ET Q q n 18 220.8 m 630 220.8 l 630 208.8 l 18 208.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 211.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 211.21 Tm (may be granted on a part-time equivalency basis.) Tj ET Q q n 0 208.8 m 612 208.8 l 612 196.8 l 0 196.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 199.21 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 11.83 199.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 27 199.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 79.49 199.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 91.34 199.21 Tm (entitled) Tj ET BT /F3 12 Tf 1 0 0 1 131.17 199.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 144.34 199.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 153.51 199.21 Tm (leave) Tj ET BT /F3 12 Tf 1 0 0 1 182.66 199.21 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 213.83 199.21 Tm (both) Tj ET BT /F3 12 Tf 1 0 0 1 239 199.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 257.5 199.21 Tm (federal) Tj ET BT /F3 12 Tf 1 0 0 1 294.65 199.21 Tm (FMLA) Tj ET BT /F3 12 Tf 1 0 0 1 331.83 199.21 Tm (law) Tj ET BT /F3 12 Tf 1 0 0 1 353 199.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 374.16 199.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 383.33 199.21 Tm (similar) Tj ET BT /F3 12 Tf 1 0 0 1 420.5 199.21 Tm (state) Tj ET BT /F3 12 Tf 1 0 0 1 446.33 199.21 Tm (law,) Tj ET BT /F3 12 Tf 1 0 0 1 470.5 199.21 Tm (he) Tj ET BT /F3 12 Tf 1 0 0 1 485.67 199.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 499.5 199.21 Tm (she) Tj ET BT /F3 12 Tf 1 0 0 1 519.34 199.21 Tm (may) Tj ET Q q n 0 196.8 m 612 196.8 l 612 184.8 l 0 184.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 187.21 Tm (elect) Tj ET BT /F3 12 Tf 1 0 0 1 25.71 187.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 43.44 187.21 Tm (more) Tj ET BT /F3 12 Tf 1 0 0 1 71.16 187.21 Tm (favorable) Tj ET BT /F3 12 Tf 1 0 0 1 119.53 187.21 Tm (leave) Tj ET BT /F3 12 Tf 1 0 0 1 147.91 187.21 Tm (\(but) Tj ET BT /F3 12 Tf 1 0 0 1 170.3 187.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 188.7 187.21 Tm (both\).) Tj ET BT /F3 12 Tf 1 0 0 1 223.16 187.21 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 234.22 187.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 248.61 187.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 300.33 187.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 311.4 187.21 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 326.46 187.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 340.86 187.21 Tm (FMLA) Tj ET BT /F3 12 Tf 1 0 0 1 377.26 187.21 Tm (leave) Tj ET BT /F3 12 Tf 1 0 0 1 405.64 187.21 Tm (due) Tj ET BT /F3 12 Tf 1 0 0 1 426.03 187.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 438.43 187.21 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 455.5 187.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 468.56 187.21 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 486.95 187.21 Tm (own) Tj ET BT /F3 12 Tf 1 0 0 1 510.68 187.21 Tm (health) Tj ET Q q n 0 184.8 m 612 184.8 l 612 172.8 l 0 172.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 175.21 Tm (condition on the date Policy coverage takes effect, he or she is not considered Actively at Work.) Tj ET Q q n 0 172.8 m 612 172.8 l 612 160.8 l 0 160.8 l h W n Q q n 0 160.8 m 612 160.8 l 612 148.8 l 0 148.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 151.21 Tm (FULL-TIME) Tj ET BT /F3 12 Tf 1 0 0 1 68 151.21 Tm (,) Tj ET BT /F3 12 Tf 1 0 0 1 75.39 151.21 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 89.78 151.21 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 100.83 151.21 Tm (applies) Tj ET BT /F3 12 Tf 1 0 0 1 139.21 151.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 152.93 151.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 171.98 151.21 Tm (Partial/Residual) Tj ET BT /F3 12 Tf 1 0 0 1 253.02 151.21 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 304.74 151.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 350.47 151.21 Tm (Benefit,) Tj ET BT /F3 12 Tf 1 0 0 1 393.18 151.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 428.22 151.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 447.27 151.21 Tm (average) Tj ET BT /F3 12 Tf 1 0 0 1 488.96 151.21 Tm (number) Tj ET BT /F3 12 Tf 1 0 0 1 530 151.21 Tm (of) Tj ET Q q n 0 148.8 m 612 148.8 l 612 136.8 l 0 136.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 139.21 Tm (hours) Tj ET BT /F3 12 Tf 1 0 0 1 30.24 139.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 48.48 139.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 88.04 139.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 140.27 139.21 Tm (was) Tj ET BT /F3 12 Tf 1 0 0 1 162.51 139.21 Tm (regularly) Tj ET BT /F3 12 Tf 1 0 0 1 209.4 139.21 Tm (scheduled) Tj ET BT /F3 12 Tf 1 0 0 1 260.96 139.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 273.87 139.21 Tm (work,) Tj ET BT /F3 12 Tf 1 0 0 1 305.11 139.21 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 317.34 139.21 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 334.92 139.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 348.49 139.21 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 367.39 139.21 Tm (Own) Tj ET BT /F3 12 Tf 1 0 0 1 394.3 139.21 Tm (Occupation,) Tj ET BT /F3 12 Tf 1 0 0 1 456.19 139.21 Tm (during) Tj ET BT /F3 12 Tf 1 0 0 1 491.1 139.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 509.33 139.21 Tm (month) Tj ET Q q n 0 136.8 m 612 136.8 l 612 124.8 l 0 124.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 127.21 Tm (just prior to:) Tj ET Q q n 18 124.8 m 630 124.8 l 630 112.8 l 18 112.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 115.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 115.21 Tm (the date the Elimination Period begins; or) Tj ET Q q n 18 112.8 m 630 112.8 l 630 100.8 l 18 100.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 103.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 103.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 65.57 103.21 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 91.11 103.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 107.99 103.21 Tm (approved) Tj ET BT /F3 12 Tf 1 0 0 1 158.19 103.21 Tm (leave) Tj ET BT /F3 12 Tf 1 0 0 1 189.06 103.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 204.62 103.21 Tm (absence) Tj ET BT /F3 12 Tf 1 0 0 1 248.15 103.21 Tm (begins,) Tj ET BT /F3 12 Tf 1 0 0 1 288.03 103.21 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 300.92 103.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 321.14 103.21 Tm (Elimination) Tj ET BT /F3 12 Tf 1 0 0 1 383.35 103.21 Tm (Period) Tj ET BT /F3 12 Tf 1 0 0 1 420.24 103.21 Tm (begins) Tj ET BT /F3 12 Tf 1 0 0 1 457.12 103.21 Tm (while) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 103.21 Tm (the) Tj ET Q q n 45.35 100.8 m 657.35 100.8 l 657.35 88.8 l 45.35 88.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 91.21 Tm (Insured Employee is continuing coverage during a leave of absence.) Tj ET Q q n 0 88.8 m 612 88.8 l 612 76.8 l 0 76.8 l h W n Q q n 0 76.8 m 612 76.8 l 612 64.8 l 0 64.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 67.2 Tm (INJURY) Tj ET BT /F3 12 Tf 1 0 0 1 48.33 67.2 Tm (means an accidental bodily Injury that:) Tj ET Q q n 18 64.8 m 630 64.8 l 630 52.8 l 18 52.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 55.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 55.21 Tm (requires treatment by a Physician; and) Tj ET Q q n 18 52.8 m 630 52.8 l 630 40.8 l 18 40.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 43.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 43.21 Tm (directly,) Tj ET BT /F3 12 Tf 1 0 0 1 89.91 43.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 112.15 43.21 Tm (independently) Tj ET BT /F3 12 Tf 1 0 0 1 185.04 43.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 199.95 43.21 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 216.86 43.21 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 246.42 43.21 Tm (causes,) Tj ET BT /F3 12 Tf 1 0 0 1 285.65 43.21 Tm (results) Tj ET BT /F3 12 Tf 1 0 0 1 321.89 43.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 336.14 43.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 346.38 43.21 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 398.62 43.21 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 421.53 43.21 Tm (begins) Tj ET BT /F3 12 Tf 1 0 0 1 457.77 43.21 Tm (while) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 43.21 Tm (the) Tj ET Q q n 45.35 40.8 m 657.35 40.8 l 657.35 28.8 l 45.35 28.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 31.2 Tm (Insured Employee is insured under the Policy.) Tj ET Q q n 18 28.8 m 630 28.8 l 630 16.8 l 18 16.8 l h W n Q Q q Q Q endstream endobj 7 0 obj <>>>>> endobj 133 0 obj <> endobj 132 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 734.4 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 230.32 26.41 Tm (DEFINITIONS) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 239 14.41 Tm (\(Continued\)) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-2 10 PA) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 267.5 14.41 Tm (5) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 676.8 m 612 676.8 l 612 664.8 l 0 664.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 667.21 Tm (INSURANCE MONTH) Tj ET BT /F3 12 Tf 1 0 0 1 121.01 667.21 Tm ( or) Tj ET BT /F2 12 Tf 1 0 0 1 137 667.21 Tm (POLICY MONTH) Tj ET BT /F3 12 Tf 1 0 0 1 236.34 667.21 Tm (means that period of time:) Tj ET Q q n 18 664.8 m 630 664.8 l 630 652.8 l 18 652.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 655.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 655.21 Tm (beginning) Tj ET BT /F3 12 Tf 1 0 0 1 96.83 655.21 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 108.97 655.21 Tm (12:01) Tj ET BT /F3 12 Tf 1 0 0 1 139.79 655.21 Tm (a.m.) Tj ET BT /F3 12 Tf 1 0 0 1 163.93 655.21 Tm (Standard) Tj ET BT /F3 12 Tf 1 0 0 1 210.07 655.21 Tm (Time,) Tj ET BT /F3 12 Tf 1 0 0 1 241.88 655.21 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 254.02 655.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 272.17 655.21 Tm (Policyholder's) Tj ET BT /F3 12 Tf 1 0 0 1 343.81 655.21 Tm (place) Tj ET BT /F3 12 Tf 1 0 0 1 372.6 655.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 386.08 655.21 Tm (business) Tj ET BT /F3 12 Tf 1 0 0 1 430.23 655.21 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 445.72 655.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 463.86 655.21 Tm (first) Tj ET BT /F3 12 Tf 1 0 0 1 486.67 655.21 Tm (day) Tj ET Q q n 45.35 652.8 m 657.35 652.8 l 657.35 640.8 l 45.35 640.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 643.21 Tm (of any calendar month; and) Tj ET Q q n 18 640.8 m 630 640.8 l 630 628.8 l 18 628.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 631.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 631.21 Tm (ending at 12:00 midnight on the) Tj ET BT /F3 12 Tf 1 0 0 1 202 631.21 Tm (last) Tj ET BT /F3 12 Tf 1 0 0 1 218.66 631.21 Tm ( day of the) Tj ET BT /F3 12 Tf 1 0 0 1 272.65 631.21 Tm (same) Tj ET BT /F3 12 Tf 1 0 0 1 297.3 631.21 Tm ( calendar month.) Tj ET Q q n 18 628.8 m 630 628.8 l 630 616.8 l 18 616.8 l h W n Q q n 0 616.8 m 612 616.8 l 612 604.8 l 0 604.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 607.21 Tm (INSURED EMPLOYEE) Tj ET BT /F3 12 Tf 1 0 0 1 125.68 607.21 Tm ( means an Employee for whom Policy coverage is in effect.) Tj ET Q q n 0 604.8 m 612 604.8 l 612 592.8 l 0 592.8 l h W n Q q n 0 592.8 m 612 592.8 l 612 580.8 l 0 580.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 583.21 Tm (MAIN DUTIES) Tj ET BT /F3 12 Tf 1 0 0 1 81.01 583.21 Tm ( or) Tj ET BT /F2 12 Tf 1 0 0 1 97.01 583.21 Tm (MATERIAL AND SUBSTANTIAL DUTIES) Tj ET BT /F3 12 Tf 1 0 0 1 327.39 583.21 Tm ( means those job tasks that:) Tj ET Q q n 18 580.8 m 630 580.8 l 630 568.8 l 18 568.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 571.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 571.21 Tm (are normally required to perform the Insured Employee's Own Occupation; and) Tj ET Q q n 18 568.8 m 630 568.8 l 630 556.8 l 18 556.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 559.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 559.21 Tm (could not reasonably be modified or omitted) Tj ET BT /F99 12 Tf 1 0 0 1 258.63 559.21 Tm (.) Tj ET Q q n 18 556.8 m 630 556.8 l 630 544.8 l 18 544.8 l h W n Q q n 0 544.8 m 612 544.8 l 612 532.8 l 0 532.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 535.21 Tm (To) Tj ET BT /F3 12 Tf 1 0 0 1 19.32 535.21 Tm (determine) Tj ET BT /F3 12 Tf 1 0 0 1 73.28 535.21 Tm (whether) Tj ET BT /F3 12 Tf 1 0 0 1 117.92 535.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 129.23 535.21 Tm (job) Tj ET BT /F3 12 Tf 1 0 0 1 150.55 535.21 Tm (task) Tj ET BT /F3 12 Tf 1 0 0 1 175.87 535.21 Tm (could) Tj ET BT /F3 12 Tf 1 0 0 1 208.52 535.21 Tm (reasonably) Tj ET BT /F3 12 Tf 1 0 0 1 266.48 535.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 283.8 535.21 Tm (modified) Tj ET BT /F3 12 Tf 1 0 0 1 333.11 535.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 349.09 535.21 Tm (omitted,) Tj ET BT /F3 12 Tf 1 0 0 1 394.74 535.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 415.39 535.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 468.04 535.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 492.69 535.21 Tm (apply) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 535.21 Tm (the) Tj ET Q q n 0 532.8 m 612 532.8 l 612 520.8 l 0 520.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 523.21 Tm (Americans) Tj ET BT /F3 12 Tf 1 0 0 1 57.12 523.21 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 83.59 523.21 Tm (Disabilities) Tj ET BT /F3 12 Tf 1 0 0 1 143.39 523.21 Tm (Act's) Tj ET BT /F3 12 Tf 1 0 0 1 172.69 523.21 Tm (standards) Tj ET BT /F3 12 Tf 1 0 0 1 223.15 523.21 Tm (concerning) Tj ET BT /F3 12 Tf 1 0 0 1 281.6 523.21 Tm (reasonable) Tj ET BT /F3 12 Tf 1 0 0 1 338.05 523.21 Tm (accommodation.) Tj ET BT /F3 12 Tf 1 0 0 1 427.97 523.21 Tm (It) Tj ET BT /F3 12 Tf 1 0 0 1 440.44 523.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 464.24 523.21 Tm (apply) Tj ET BT /F3 12 Tf 1 0 0 1 496.04 523.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 515.84 523.21 Tm (Act's) Tj ET Q q n 0 520.8 m 612 520.8 l 612 508.8 l 0 508.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 511.21 Tm (standards, whether or not:) Tj ET Q q n 18 508.8 m 630 508.8 l 630 496.8 l 18 496.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 499.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 499.21 Tm (the Employer is subject to the Act; or) Tj ET Q q n 18 496.8 m 630 496.8 l 630 484.8 l 18 484.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 487.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 487.21 Tm (the Insured Employee has requested such a job accommodation.) Tj ET Q q n 0 484.8 m 612 484.8 l 612 472.8 l 0 472.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 475.21 Tm (An) Tj ET BT /F3 12 Tf 1 0 0 1 19.96 475.21 Tm (Employer's) Tj ET BT /F3 12 Tf 1 0 0 1 79.4 475.21 Tm (failure) Tj ET BT /F3 12 Tf 1 0 0 1 116.01 475.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 130.63 475.21 Tm (modify) Tj ET BT /F3 12 Tf 1 0 0 1 170.59 475.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 185.87 475.21 Tm (omit) Tj ET BT /F3 12 Tf 1 0 0 1 213.17 475.21 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 243.11 475.21 Tm (job) Tj ET BT /F3 12 Tf 1 0 0 1 263.74 475.21 Tm (tasks) Tj ET BT /F3 12 Tf 1 0 0 1 293.03 475.21 Tm (does) Tj ET BT /F2 12 Tf 1 0 0 1 320.32 475.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 342.28 475.21 Tm (render) Tj ET BT /F3 12 Tf 1 0 0 1 378.22 475.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 398.17 475.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 439.45 475.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 493.39 475.21 Tm (unable) Tj ET BT /F3 12 Tf 1 0 0 1 530.67 475.21 Tm (to) Tj ET Q q n 0 472.8 m 612 472.8 l 612 460.8 l 0 460.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 463.21 Tm (perform the Main Duties of the job.) Tj ET Q q n 18 460.8 m 630 460.8 l 630 448.8 l 18 448.8 l h W n Q q n 0 448.8 m 612 448.8 l 612 436.8 l 0 436.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 439.21 Tm (Main Duties include those job tasks:) Tj ET Q q n 18 436.8 m 630 436.8 l 630 424.8 l 18 424.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 427.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 427.21 Tm (as described in the U.S. Department of Labor Dictionary of Occupational Titles; and) Tj ET Q q n 18 424.8 m 630 424.8 l 630 412.8 l 18 412.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 415.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 415.21 Tm (as performed in the general labor market and national economy.) Tj ET Q q n 0 412.8 m 612 412.8 l 612 400.8 l 0 400.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 403.21 Tm (Main Duties are) Tj ET BT /F2 12 Tf 1 0 0 1 80.31 403.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 96.98 403.21 Tm ( limited to those specific job tasks as performed for a certain firm or at a certain work site.) Tj ET Q q n 0 400.8 m 612 400.8 l 612 388.8 l 0 388.8 l h W n Q q n 0 388.8 m 612 388.8 l 612 376.8 l 0 376.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 379.21 Tm (MEDICALLY) Tj ET BT /F2 12 Tf 1 0 0 1 77.81 379.21 Tm (APPROPRIATE) Tj ET BT /F2 12 Tf 1 0 0 1 167.62 379.21 Tm (TREATMENT) Tj ET BT /F3 12 Tf 1 0 0 1 248.11 379.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 281.9 379.21 Tm (diagnostic) Tj ET BT /F3 12 Tf 1 0 0 1 334.37 379.21 Tm (services,) Tj ET BT /F3 12 Tf 1 0 0 1 379.16 379.21 Tm (consultation,) Tj ET BT /F3 12 Tf 1 0 0 1 443.96 379.21 Tm (care) Tj ET BT /F3 12 Tf 1 0 0 1 467.08 379.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 480.22 379.21 Tm (services) Tj ET BT /F3 12 Tf 1 0 0 1 522.01 379.21 Tm (that) Tj ET Q q n 0 376.8 m 612 376.8 l 612 364.8 l 0 364.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 367.21 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 18.04 367.21 Tm (consistent) Tj ET BT /F3 12 Tf 1 0 0 1 69.43 367.21 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 94.16 367.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 112.22 367.21 Tm (symptoms) Tj ET BT /F3 12 Tf 1 0 0 1 164.95 367.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 178.34 367.21 Tm (diagnosis) Tj ET BT /F3 12 Tf 1 0 0 1 227.07 367.21 Tm (causing) Tj ET BT /F3 12 Tf 1 0 0 1 267.12 367.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 285.18 367.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 324.56 367.21 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 383.44 367.21 Tm (Disability.) Tj ET BT /F3 12 Tf 1 0 0 1 440.56 367.21 Tm (Such) Tj ET BT /F3 12 Tf 1 0 0 1 467.96 367.21 Tm (treatment) Tj ET BT /F3 12 Tf 1 0 0 1 516.66 367.21 Tm (must) Tj ET Q q n 0 364.8 m 612 364.8 l 612 352.8 l 0 352.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 355.21 Tm (be rendered:) Tj ET Q q n 18 352.8 m 630 352.8 l 630 340.8 l 18 340.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 343.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 343.21 Tm (by a Physician whose license and any specialty are consistent with the disabling condition; and) Tj ET Q q n 18 340.8 m 630 340.8 l 630 328.8 l 18 328.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 331.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 331.21 Tm (according to generally accepted, professionally recognized standards of medical practice.) Tj ET Q q n 18 328.8 m 630 328.8 l 630 316.8 l 18 316.8 l h W n Q q n 0 316.8 m 612 316.8 l 612 304.8 l 0 304.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 307.21 Tm (MILITARY LEAVE) Tj ET BT /F3 12 Tf 1 0 0 1 107.02 307.21 Tm ( means a leave of absence that:) Tj ET Q q n 18 304.8 m 630 304.8 l 630 292.8 l 18 292.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 295.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 295.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 62.76 295.21 Tm (subject) Tj ET BT /F3 12 Tf 1 0 0 1 106.15 295.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 124.88 295.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 148.94 295.21 Tm (federal) Tj ET BT /F3 12 Tf 1 0 0 1 191.65 295.21 Tm (USERRA) Tj ET BT /F3 12 Tf 1 0 0 1 248.39 295.21 Tm (law) Tj ET BT /F3 12 Tf 1 0 0 1 275.12 295.21 Tm (\(the) Tj ET BT /F3 12 Tf 1 0 0 1 303.18 295.21 Tm (Uniformed) Tj ET BT /F3 12 Tf 1 0 0 1 365.23 295.21 Tm (Services) Tj ET BT /F3 12 Tf 1 0 0 1 415.28 295.21 Tm (Employment) Tj ET BT /F3 12 Tf 1 0 0 1 486.67 295.21 Tm (and) Tj ET Q q n 45.35 292.8 m 657.35 292.8 l 657.35 280.8 l 45.35 280.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 283.21 Tm (Reemployment Rights Act of 1994 and any amendments to it\);) Tj ET Q q n 18 280.8 m 630 280.8 l 630 268.8 l 18 268.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 271.2 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 271.2 Tm (is taken in accord with the Employer's leave policy and the federal USERRA law; and) Tj ET Q q n 18 268.8 m 630 268.8 l 630 256.8 l 18 256.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 259.2 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 259.2 Tm (does not exceed the period required by that law.) Tj ET Q q n 0 256.8 m 612 256.8 l 612 244.8 l 0 244.8 l h W n Q q n 0 244.8 m 612 244.8 l 612 232.8 l 0 232.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 235.21 Tm (MONTHLY) Tj ET BT /F2 12 Tf 1 0 0 1 66.98 235.21 Tm (BENEFIT) Tj ET BT /F3 12 Tf 1 0 0 1 123.31 235.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 157.62 235.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 175.93 235.21 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 215.57 235.21 Tm (payable) Tj ET BT /F3 12 Tf 1 0 0 1 256.53 235.21 Tm (monthly) Tj ET BT /F3 12 Tf 1 0 0 1 300.18 235.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 315.83 235.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 334.14 235.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 384.45 235.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 397.44 235.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 415.75 235.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 455.38 235.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 507.68 235.21 Tm (who) Tj ET BT /F3 12 Tf 1 0 0 1 532 235.21 Tm (is) Tj ET Q q n 0 232.8 m 612 232.8 l 612 220.8 l 0 220.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 223.21 Tm (Totally Disabled or Partially/Residually Disabled.) Tj ET Q q n 0 220.8 m 612 220.8 l 612 208.8 l 0 208.8 l h W n Q q n 0 208.8 m 612 208.8 l 612 196.8 l 0 196.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 199.21 Tm (OWN OCCUPATION or REGULAR OCCUPATION) Tj ET BT /F3 12 Tf 1 0 0 1 277.34 199.21 Tm ( means the occupation, trade or profession:) Tj ET Q q n 18 196.8 m 630 196.8 l 630 184.8 l 18 184.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 187.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 187.21 Tm (in which the Insured Employee was employed with the Employer prior to Disability; and) Tj ET Q q n 18 184.8 m 630 184.8 l 630 172.8 l 18 172.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 175.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 175.21 Tm (which was his or her main source of earned income prior to Disability.) Tj ET Q q n 0 172.8 m 612 172.8 l 612 160.8 l 0 160.8 l h W n Q q n 0 160.8 m 612 160.8 l 612 148.8 l 0 148.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 151.21 Tm (It) Tj ET BT /F3 12 Tf 1 0 0 1 12.07 151.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 47.46 151.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 57.52 151.21 Tm (collective) Tj ET BT /F3 12 Tf 1 0 0 1 108.9 151.21 Tm (description) Tj ET BT /F3 12 Tf 1 0 0 1 166.95 151.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 181.68 151.21 Tm (related) Tj ET BT /F3 12 Tf 1 0 0 1 219.06 151.21 Tm (jobs,) Tj ET BT /F3 12 Tf 1 0 0 1 246.8 151.21 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 261.53 151.21 Tm (defined) Tj ET BT /F3 12 Tf 1 0 0 1 302.25 151.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 318.98 151.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 338.38 151.21 Tm (U.S.) Tj ET BT /F3 12 Tf 1 0 0 1 364.46 151.21 Tm (Department) Tj ET BT /F3 12 Tf 1 0 0 1 425.83 151.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 440.56 151.21 Tm (Labor) Tj ET BT /F3 12 Tf 1 0 0 1 473.95 151.21 Tm (Dictionary) Tj ET BT /F3 12 Tf 1 0 0 1 530 151.21 Tm (of) Tj ET Q q n 0 148.8 m 612 148.8 l 612 136.8 l 0 136.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 139.21 Tm (Occupational Titles.) Tj ET BT /F3 12 Tf 1 0 0 1 103.3 139.21 Tm (It includes any work in the same occupation for pay or profit, regardless of:) Tj ET Q q n 18 136.79 m 630 136.79 l 630 124.79 l 18 124.79 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 127.2 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 127.2 Tm (whether such work is with the Employer, with some other firm, or on a self-employed basis; or) Tj ET Q q n 18 124.79 m 630 124.79 l 630 112.79 l 18 112.79 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 115.2 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 115.2 Tm (whether) Tj ET BT /F3 12 Tf 1 0 0 1 89.63 115.2 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 100.58 115.2 Tm (suitable) Tj ET BT /F3 12 Tf 1 0 0 1 143.53 115.2 Tm (opening) Tj ET BT /F3 12 Tf 1 0 0 1 187.82 115.2 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 201.45 115.2 Tm (currently) Tj ET BT /F3 12 Tf 1 0 0 1 250.39 115.2 Tm (available) Tj ET BT /F3 12 Tf 1 0 0 1 299.33 115.2 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 326.29 115.2 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 346.58 115.2 Tm (Employer) Tj ET BT /F3 12 Tf 1 0 0 1 399.52 115.2 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 415.15 115.2 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 430.11 115.2 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 450.4 115.2 Tm (local) Tj ET BT /F3 12 Tf 1 0 0 1 479.34 115.2 Tm (labor) Tj ET Q q n 45.35 112.79 m 657.35 112.79 l 657.35 100.79 l 45.35 100.79 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 103.2 Tm (market.) Tj ET Q q n 0 100.79 m 612 100.79 l 612 88.79 l 0 88.79 l h W n Q q n 0 88.79 m 612 88.79 l 612 76.79 l 0 76.79 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 79.2 Tm (OWN OCCUPATION PERIOD) Tj ET BT /F3 12 Tf 1 0 0 1 164.67 79.2 Tm ( means a period as shown in the Schedule of Benefits.) Tj ET Q q n 0 76.79 m 612 76.79 l 612 64.79 l 0 64.79 l h W n Q Q q Q Q endstream endobj 8 0 obj <>>>>> endobj 136 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 734.4 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 230.32 26.41 Tm (DEFINITIONS) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 239 14.41 Tm (\(Continued\)) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-2 10 PA) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 267.5 14.41 Tm (6) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 676.8 m 612 676.8 l 612 664.8 l 0 664.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 667.21 Tm (PARTIAL DISABILITY) Tj ET BT /F3 12 Tf 1 0 0 1 127.7 667.21 Tm ( or) Tj ET BT /F2 12 Tf 1 0 0 1 143.69 667.21 Tm (PARTIALLY DISABLED) Tj ET BT /F3 12 Tf 1 0 0 1 278.73 667.21 Tm ( will be defined as follows.) Tj ET Q q n 18 664.8 m 630 664.8 l 630 652.8 l 18 652.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 655.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 655.21 Tm (During) Tj ET BT /F3 12 Tf 1 0 0 1 83.28 655.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 101.88 655.21 Tm (Elimination) Tj ET BT /F3 12 Tf 1 0 0 1 162.48 655.21 Tm (Period) Tj ET BT /F3 12 Tf 1 0 0 1 197.75 655.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 219.02 655.21 Tm (Own) Tj ET BT /F3 12 Tf 1 0 0 1 246.29 655.21 Tm (Occupation) Tj ET BT /F3 12 Tf 1 0 0 1 305.54 655.21 Tm (Period,) Tj ET BT /F3 12 Tf 1 0 0 1 343.8 655.21 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 354.41 655.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 389.01 655.21 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 410.94 655.21 Tm (due) Tj ET BT /F3 12 Tf 1 0 0 1 432.2 655.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 445.48 655.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 460.74 655.21 Tm (Injury) Tj ET BT /F3 12 Tf 1 0 0 1 494 655.21 Tm (or) Tj ET Q q n 45.35 652.8 m 657.35 652.8 l 657.35 640.8 l 45.35 640.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 643.21 Tm (Sickness the Insured Employee:) Tj ET Q q n 45.35 640.8 m 657.35 640.8 l 657.35 628.8 l 45.35 628.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 631.21 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 631.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 87.46 631.21 Tm (unable) Tj ET BT /F3 12 Tf 1 0 0 1 126.21 631.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 142.3 631.21 Tm (perform) Tj ET BT /F3 12 Tf 1 0 0 1 187.71 631.21 Tm (one) Tj ET BT /F3 12 Tf 1 0 0 1 211.79 631.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 228.55 631.21 Tm (more) Tj ET BT /F3 12 Tf 1 0 0 1 259.96 631.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 276.72 631.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 298.14 631.21 Tm (Main) Tj ET BT /F3 12 Tf 1 0 0 1 330.23 631.21 Tm (Duties) Tj ET BT /F3 12 Tf 1 0 0 1 368.31 631.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 385.07 631.21 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 405.83 631.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 422.59 631.21 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 444.67 631.21 Tm (Own) Tj ET Q q n 72.7 628.8 m 684.7 628.8 l 684.7 616.8 l 72.7 616.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 619.21 Tm (Occupation; or is unable to perform such duties full-time; and) Tj ET Q q n 45.35 616.8 m 657.35 616.8 l 657.35 604.8 l 45.35 604.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 607.21 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 607.21 Tm (is engaged in Partial Disability Employment.) Tj ET Q q n 18 604.8 m 630 604.8 l 630 592.8 l 18 592.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 595.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 595.21 Tm (After) Tj ET BT /F3 12 Tf 1 0 0 1 76.03 595.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 96.05 595.21 Tm (Own) Tj ET BT /F3 12 Tf 1 0 0 1 124.75 595.21 Tm (Occupation) Tj ET BT /F3 12 Tf 1 0 0 1 185.42 595.21 Tm (Period,) Tj ET BT /F3 12 Tf 1 0 0 1 225.11 595.21 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 237.14 595.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 273.16 595.21 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 296.51 595.21 Tm (due) Tj ET BT /F3 12 Tf 1 0 0 1 319.2 595.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 333.9 595.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 350.58 595.21 Tm (Injury) Tj ET BT /F3 12 Tf 1 0 0 1 385.27 595.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 400.63 595.21 Tm (Sickness) Tj ET BT /F3 12 Tf 1 0 0 1 447.99 595.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 468.01 595.21 Tm (Insured) Tj ET Q q n 45.35 592.8 m 657.35 592.8 l 657.35 580.8 l 45.35 580.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 583.21 Tm (Employee:) Tj ET Q q n 45.35 580.8 m 657.35 580.8 l 657.35 568.8 l 45.35 568.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 571.21 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 571.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 84.09 571.21 Tm (unable) Tj ET BT /F3 12 Tf 1 0 0 1 119.46 571.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 132.17 571.21 Tm (perform) Tj ET BT /F3 12 Tf 1 0 0 1 174.2 571.21 Tm (one) Tj ET BT /F3 12 Tf 1 0 0 1 194.91 571.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 208.29 571.21 Tm (more) Tj ET BT /F3 12 Tf 1 0 0 1 236.33 571.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 249.71 571.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 267.75 571.21 Tm (Main) Tj ET BT /F3 12 Tf 1 0 0 1 296.46 571.21 Tm (Duties) Tj ET BT /F3 12 Tf 1 0 0 1 331.17 571.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 344.55 571.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 365.26 571.21 Tm (occupation) Tj ET BT /F3 12 Tf 1 0 0 1 421.29 571.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 454 571.21 Tm (his) Tj ET Q q n 72.7 568.8 m 684.7 568.8 l 684.7 556.8 l 72.7 556.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 559.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 87.79 559.21 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 108.2 559.21 Tm (training,) Tj ET BT /F3 12 Tf 1 0 0 1 153.62 559.21 Tm (education) Tj ET BT /F3 12 Tf 1 0 0 1 205.35 559.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 220.44 559.21 Tm (experience) Tj ET BT /F3 12 Tf 1 0 0 1 277.49 559.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 301.25 559.21 Tm (reasonably) Tj ET BT /F3 12 Tf 1 0 0 1 358.32 559.21 Tm (allow;) Tj ET BT /F3 12 Tf 1 0 0 1 393.41 559.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 408.49 559.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 421.59 559.21 Tm (unable) Tj ET BT /F3 12 Tf 1 0 0 1 458.67 559.21 Tm (to) Tj ET Q q n 72.7 556.8 m 684.7 556.8 l 684.7 544.8 l 72.7 544.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 547.21 Tm (perform such duties full-time; and) Tj ET Q q n 45.35 544.8 m 657.35 544.8 l 657.35 532.8 l 45.35 532.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 535.21 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 535.21 Tm (is engaged in Partial Disability Employment.) Tj ET Q q n 45.35 532.8 m 657.35 532.8 l 657.35 520.8 l 45.35 520.8 l h W n Q q n 0 520.8 m 612 520.8 l 612 508.8 l 0 508.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 511.21 Tm (PARTIAL) Tj ET BT /F2 12 Tf 1 0 0 1 59.96 511.21 Tm (DISABILITY) Tj ET BT /F2 12 Tf 1 0 0 1 136.6 511.21 Tm (EMPLOYMENT) Tj ET BT /F3 12 Tf 1 0 0 1 231.22 511.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 267.83 511.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 288.44 511.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 330.38 511.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 384.98 511.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 398.93 511.21 Tm (working) Tj ET BT /F3 12 Tf 1 0 0 1 444.88 511.21 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 459.49 511.21 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 479.45 511.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 495.39 511.21 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 516.67 511.21 Tm (Own) Tj ET Q q n 0 508.8 m 612 508.8 l 612 496.8 l 0 496.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 499.21 Tm (Occupation or any other occupation; however, because of a Partial Disability:) Tj ET Q q n 18 496.8 m 630 496.8 l 630 484.8 l 18 484.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 487.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 487.21 Tm (the Insured Employee's hours or production is reduced;) Tj ET Q q n 18 484.8 m 630 484.8 l 630 472.8 l 18 472.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 475.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 475.21 Tm (one or more Main Duties of the job are reassigned; or) Tj ET Q q n 18 472.8 m 630 472.8 l 630 460.8 l 18 460.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 463.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 463.21 Tm (the Insured Employee is working in a lower-paid occupation.) Tj ET Q q n 0 460.8 m 612 460.8 l 612 448.8 l 0 448.8 l h W n Q q n 0 448.8 m 612 448.8 l 612 436.8 l 0 436.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 439.21 Tm (During Partial Disability Employment, his or her current earnings:) Tj ET Q q n 18 436.8 m 630 436.8 l 630 424.8 l 18 424.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 427.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 427.21 Tm (must be at least 20% of Predisability Income; and) Tj ET Q q n 18 424.8 m 630 424.8 l 630 412.8 l 18 412.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 415.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 415.21 Tm (may not exceed the percentage specified in the Partial Disability Benefit section.) Tj ET Q q n 0 412.8 m 612 412.8 l 612 400.8 l 0 400.8 l h W n Q q n 0 400.8 m 612 400.8 l 612 388.8 l 0 388.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 391.21 Tm (PHYSICIAN) Tj ET BT /F3 12 Tf 1 0 0 1 67.34 391.21 Tm ( means:) Tj ET Q q n 18 388.8 m 630 388.8 l 630 376.8 l 18 376.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 379.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 379.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 56.56 379.21 Tm (legally) Tj ET BT /F3 12 Tf 1 0 0 1 95.1 379.21 Tm (qualified) Tj ET BT /F3 12 Tf 1 0 0 1 143.63 379.21 Tm (medical) Tj ET BT /F3 12 Tf 1 0 0 1 187.49 379.21 Tm (doctor) Tj ET BT /F3 12 Tf 1 0 0 1 224.03 379.21 Tm (who) Tj ET BT /F3 12 Tf 1 0 0 1 250.58 379.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 264.47 379.21 Tm (licensed) Tj ET BT /F3 12 Tf 1 0 0 1 309.67 379.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 324.88 379.21 Tm (practice) Tj ET BT /F3 12 Tf 1 0 0 1 368.74 379.21 Tm (medicine,) Tj ET BT /F3 12 Tf 1 0 0 1 421.6 379.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 436.82 379.21 Tm (prescribe) Tj ET BT /F3 12 Tf 1 0 0 1 486.67 379.21 Tm (and) Tj ET Q q n 45.35 376.8 m 657.35 376.8 l 657.35 364.8 l 45.35 364.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 367.21 Tm (administer drugs, or to perform surgery; or) Tj ET Q q n 18 364.8 m 630 364.8 l 630 352.8 l 18 352.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 355.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 355.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 66.8 355.21 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 95.58 355.21 Tm (duly) Tj ET BT /F3 12 Tf 1 0 0 1 121.04 355.21 Tm (licensed) Tj ET BT /F3 12 Tf 1 0 0 1 164.49 355.21 Tm (medical) Tj ET BT /F3 12 Tf 1 0 0 1 206.59 355.21 Tm (practitioner) Tj ET BT /F3 12 Tf 1 0 0 1 266.02 355.21 Tm (who) Tj ET BT /F3 12 Tf 1 0 0 1 290.81 355.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 302.94 355.21 Tm (deemed) Tj ET BT /F3 12 Tf 1 0 0 1 344.38 355.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 360.51 355.21 Tm (state) Tj ET BT /F3 12 Tf 1 0 0 1 386.62 355.21 Tm (law) Tj ET BT /F3 12 Tf 1 0 0 1 408.07 355.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 421.53 355.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 436.99 355.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 455.77 355.21 Tm (same) Tj ET BT /F3 12 Tf 1 0 0 1 484.55 355.21 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 498.67 355.21 Tm (a) Tj ET Q q n 45.35 352.8 m 657.35 352.8 l 657.35 340.8 l 45.35 340.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 343.21 Tm (legally qualified medical doctor.) Tj ET Q q n 0 340.8 m 612 340.8 l 612 328.8 l 0 328.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 331.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 22.58 331.21 Tm (medical) Tj ET BT /F3 12 Tf 1 0 0 1 64.49 331.21 Tm (doctor) Tj ET BT /F3 12 Tf 1 0 0 1 99.07 331.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 112.99 331.21 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 141.57 331.21 Tm (medical) Tj ET BT /F3 12 Tf 1 0 0 1 183.48 331.21 Tm (practitioner) Tj ET BT /F3 12 Tf 1 0 0 1 242.71 331.21 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 269.97 331.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 285.23 331.21 Tm (acting) Tj ET BT /F3 12 Tf 1 0 0 1 318.47 331.21 Tm (within) Tj ET BT /F3 12 Tf 1 0 0 1 353.07 331.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 371.65 331.21 Tm (scope) Tj ET BT /F3 12 Tf 1 0 0 1 402.9 331.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 416.82 331.21 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 434.75 331.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 448.67 331.21 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 467.92 331.21 Tm (license.) Tj ET BT /F3 12 Tf 1 0 0 1 512.09 331.21 Tm (He) Tj ET BT /F3 12 Tf 1 0 0 1 530 331.21 Tm (or) Tj ET Q q n 0 328.8 m 612 328.8 l 612 316.8 l 0 316.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 319.21 Tm (she) Tj ET BT /F3 12 Tf 1 0 0 1 22.2 319.21 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 51.74 319.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 69.27 319.21 Tm (qualified) Tj ET BT /F3 12 Tf 1 0 0 1 118.12 319.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 133.66 319.21 Tm (provide) Tj ET BT /F3 12 Tf 1 0 0 1 176.52 319.21 Tm (Medically) Tj ET BT /F3 12 Tf 1 0 0 1 231.37 319.21 Tm (Appropriate) Tj ET BT /F3 12 Tf 1 0 0 1 295.56 319.21 Tm (Treatment) Tj ET BT /F3 12 Tf 1 0 0 1 351.07 319.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 371.26 319.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 392.13 319.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 434.32 319.21 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 496 319.21 Tm (disabling) Tj ET Q q n 0 316.8 m 612 316.8 l 612 304.8 l 0 304.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 307.21 Tm (condition.) Tj ET Q q n 0 304.8 m 612 304.8 l 612 292.8 l 0 292.8 l h W n Q q n 0 292.8 m 612 292.8 l 612 280.8 l 0 280.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 283.21 Tm (Physician) Tj ET BT /F3 12 Tf 1 0 0 1 51.1 283.21 Tm (does) Tj ET BT /F2 12 Tf 1 0 0 1 77.53 283.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 98.63 283.21 Tm (include) Tj ET BT /F3 12 Tf 1 0 0 1 138.38 283.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 157.48 283.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 197.9 283.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 250.98 283.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 265.41 283.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 275.17 283.21 Tm (relative) Tj ET BT /F3 12 Tf 1 0 0 1 315.58 283.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 330.01 283.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 349.11 283.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 389.53 283.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 442.61 283.21 Tm (receiving) Tj ET BT /F3 12 Tf 1 0 0 1 491.69 283.21 Tm (treatment.) Tj ET Q q n 0 280.8 m 612 280.8 l 612 268.8 l 0 268.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 271.21 Tm (Relatives include:) Tj ET Q q n 18 268.8 m 630 268.8 l 630 256.8 l 18 256.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 259.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 259.21 Tm (the Insured Employee's spouse, siblings, parents, children and grandparents; and) Tj ET Q q n 18 256.8 m 630 256.8 l 630 244.8 l 18 244.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 247.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 247.21 Tm (his or her spouse's relatives of like degree.) Tj ET Q q n 0 244.8 m 612 244.8 l 612 232.8 l 0 232.8 l h W n Q q n 0 232.8 m 612 232.8 l 612 220.8 l 0 220.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 223.21 Tm (POLICY) Tj ET BT /F3 12 Tf 1 0 0 1 46.67 223.21 Tm ( means this group insurance Policy issued by the Company to the Policyholder.) Tj ET Q q n 0 220.8 m 612 220.8 l 612 208.8 l 0 208.8 l h W n Q q n 0 208.8 m 612 208.8 l 612 196.8 l 0 196.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 199.21 Tm (POLICYHOLDER) Tj ET BT /F3 12 Tf 1 0 0 1 102.39 199.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 136.76 199.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 155.14 199.21 Tm (person,) Tj ET BT /F3 12 Tf 1 0 0 1 193.85 199.21 Tm (company,) Tj ET BT /F3 12 Tf 1 0 0 1 244.55 199.21 Tm (trust) Tj ET BT /F3 12 Tf 1 0 0 1 269.6 199.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 283.31 199.21 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 311.68 199.21 Tm (organization) Tj ET BT /F3 12 Tf 1 0 0 1 375.37 199.21 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 389.08 199.21 Tm (shown) Tj ET BT /F3 12 Tf 1 0 0 1 424.13 199.21 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 439.85 199.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 458.22 199.21 Tm (Face) Tj ET BT /F3 12 Tf 1 0 0 1 484.59 199.21 Tm (Page) Tj ET BT /F3 12 Tf 1 0 0 1 511.63 199.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 199.21 Tm (the) Tj ET Q q n 0 196.8 m 612 196.8 l 612 184.8 l 0 184.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 187.21 Tm (Policy.) Tj ET Q q n 0 184.8 m 612 184.8 l 612 172.8 l 0 172.8 l h W n Q q n 0 172.8 m 612 172.8 l 612 160.8 l 0 160.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 163.21 Tm (PREDISABILITY INCOME) Tj ET BT /F3 12 Tf 1 0 0 1 148.36 163.21 Tm (See Basic Monthly Earnings definition.) Tj ET Q q n 0 160.8 m 612 160.8 l 612 148.8 l 0 148.8 l h W n Q q n 0 148.8 m 612 148.8 l 612 136.8 l 0 136.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 139.21 Tm (REGULAR) Tj ET BT /F2 12 Tf 1 0 0 1 65.12 139.21 Tm (CARE) Tj ET BT /F2 12 Tf 1 0 0 1 104.23 139.21 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 126 139.21 Tm (A) Tj ET BT /F2 12 Tf 1 0 0 1 139.78 139.21 Tm (PHYSICIAN) Tj ET BT /F3 12 Tf 1 0 0 1 212.23 139.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 227.34 139.21 Tm (REGULAR) Tj ET BT /F2 12 Tf 1 0 0 1 292.45 139.21 Tm (ATTENDANCE) Tj ET BT /F2 12 Tf 1 0 0 1 381.57 139.21 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 403.35 139.21 Tm (A) Tj ET BT /F2 12 Tf 1 0 0 1 417.12 139.21 Tm (PHYSICIAN) Tj ET BT /F3 12 Tf 1 0 0 1 489.57 139.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 139.21 Tm (the) Tj ET Q q n 0 136.8 m 612 136.8 l 612 124.8 l 0 124.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 127.21 Tm (Insured Employee:) Tj ET Q q n 18 124.8 m 630 124.8 l 630 112.8 l 18 112.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 115.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 115.21 Tm (personally) Tj ET BT /F3 12 Tf 1 0 0 1 100.43 115.21 Tm (visits) Tj ET BT /F3 12 Tf 1 0 0 1 130.86 115.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 141.28 115.21 Tm (Physician,) Tj ET BT /F3 12 Tf 1 0 0 1 196.04 115.21 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 211.13 115.21 Tm (often) Tj ET BT /F3 12 Tf 1 0 0 1 240.88 115.21 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 255.97 115.21 Tm (medically) Tj ET BT /F3 12 Tf 1 0 0 1 308.37 115.21 Tm (required) Tj ET BT /F3 12 Tf 1 0 0 1 353.45 115.21 Tm (according) Tj ET BT /F3 12 Tf 1 0 0 1 405.85 115.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 420.27 115.21 Tm (standard) Tj ET BT /F3 12 Tf 1 0 0 1 466.02 115.21 Tm (medical) Tj ET Q q n 45.35 112.8 m 657.35 112.8 l 657.35 100.8 l 45.35 100.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 103.21 Tm (practice to effectively manage and treat his or her disabling condition; and) Tj ET Q q n 18 100.8 m 630 100.8 l 630 88.8 l 18 88.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 91.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 91.21 Tm (receives) Tj ET BT /F3 12 Tf 1 0 0 1 88.03 91.21 Tm (Medically) Tj ET BT /F3 12 Tf 1 0 0 1 140.05 91.21 Tm (Appropriate) Tj ET BT /F3 12 Tf 1 0 0 1 201.41 91.21 Tm (Treatment,) Tj ET BT /F3 12 Tf 1 0 0 1 257.09 91.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 272.46 91.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 281.16 91.21 Tm (Physician) Tj ET BT /F3 12 Tf 1 0 0 1 331.2 91.21 Tm (whose) Tj ET BT /F3 12 Tf 1 0 0 1 365.24 91.21 Tm (license) Tj ET BT /F3 12 Tf 1 0 0 1 401.93 91.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 422.63 91.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 443.33 91.21 Tm (specialty) Tj ET BT /F3 12 Tf 1 0 0 1 489.35 91.21 Tm (are) Tj ET Q q n 45.35 88.8 m 657.35 88.8 l 657.35 76.8 l 45.35 76.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 79.2 Tm (consistent with the disabling condition.) Tj ET Q q n 0 76.8 m 612 76.8 l 612 64.8 l 0 64.8 l h W n Q q n 0 64.79 m 612 64.79 l 612 52.79 l 0 52.79 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 55.2 Tm (REGULAR OCCUPATION) Tj ET BT /F3 12 Tf 1 0 0 1 145.01 55.2 Tm (See Own Occupation or Regular Occupation definition.) Tj ET Q q n 0 52.79 m 612 52.79 l 612 40.79 l 0 40.79 l h W n Q Q q Q Q endstream endobj 9 0 obj <>>>>> endobj 137 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 734.4 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 230.32 26.41 Tm (DEFINITIONS) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 239 14.41 Tm (\(Continued\)) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-2 10 PA) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 267.5 14.41 Tm (7) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 676.8 m 612 676.8 l 612 664.8 l 0 664.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 667.21 Tm (RESIDUAL) Tj ET BT /F2 12 Tf 1 0 0 1 65.4 667.21 Tm (DISABILITY) Tj ET BT /F3 12 Tf 1 0 0 1 139.47 667.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 152.85 667.21 Tm (RESIDUALLY) Tj ET BT /F2 12 Tf 1 0 0 1 234.92 667.21 Tm (DISABLED) Tj ET BT /F3 12 Tf 1 0 0 1 299.66 667.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 333.7 667.21 Tm (that,) Tj ET BT /F3 12 Tf 1 0 0 1 358.07 667.21 Tm (due) Tj ET BT /F3 12 Tf 1 0 0 1 378.78 667.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 391.5 667.21 Tm (Sickness) Tj ET BT /F3 12 Tf 1 0 0 1 436.88 667.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 450.26 667.21 Tm (Injury,) Tj ET BT /F3 12 Tf 1 0 0 1 485.97 667.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 504.01 667.21 Tm (Insured) Tj ET Q q n 0 664.8 m 612 664.8 l 612 652.8 l 0 652.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 655.21 Tm (Employee is:) Tj ET Q q n 18 652.8 m 630 652.8 l 630 640.8 l 18 640.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 643.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 643.21 Tm (unable) Tj ET BT /F3 12 Tf 1 0 0 1 80.92 643.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 93.83 643.21 Tm (perform) Tj ET BT /F3 12 Tf 1 0 0 1 136.06 643.21 Tm (one) Tj ET BT /F3 12 Tf 1 0 0 1 156.96 643.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 170.54 643.21 Tm (more) Tj ET BT /F3 12 Tf 1 0 0 1 198.78 643.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 212.35 643.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 230.59 643.21 Tm (Main) Tj ET BT /F3 12 Tf 1 0 0 1 259.5 643.21 Tm (Duties) Tj ET BT /F3 12 Tf 1 0 0 1 294.41 643.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 307.99 643.21 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 325.57 643.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 339.15 643.21 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 358.05 643.21 Tm (Own) Tj ET BT /F3 12 Tf 1 0 0 1 384.96 643.21 Tm (Occupation,) Tj ET BT /F3 12 Tf 1 0 0 1 446.85 643.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 460.43 643.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 472.01 643.21 Tm (unable) Tj ET Q q n 45.35 640.8 m 657.35 640.8 l 657.35 628.8 l 45.35 628.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 631.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 58.02 631.21 Tm (perform) Tj ET BT /F3 12 Tf 1 0 0 1 100.01 631.21 Tm (such) Tj ET BT /F3 12 Tf 1 0 0 1 125.34 631.21 Tm (duties) Tj ET BT /F3 12 Tf 1 0 0 1 157.34 631.21 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 172.68 631.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 181.34 631.21 Tm (Full-Time) Tj ET BT /F3 12 Tf 1 0 0 1 233.34 631.21 Tm (Basis) Tj ET BT /F3 12 Tf 1 0 0 1 262.68 631.21 Tm (\(or) Tj ET BT /F3 12 Tf 1 0 0 1 280.01 631.21 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 293.34 631.21 Tm (long) Tj ET BT /F3 12 Tf 1 0 0 1 318.01 631.21 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 331.34 631.21 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 341.35 631.21 Tm (would) Tj ET BT /F3 12 Tf 1 0 0 1 374.69 631.21 Tm (normally) Tj ET BT /F3 12 Tf 1 0 0 1 421.35 631.21 Tm (take) Tj ET BT /F3 12 Tf 1 0 0 1 444.67 631.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 457.34 631.21 Tm (do) Tj ET BT /F3 12 Tf 1 0 0 1 472.68 631.21 Tm (them\);) Tj ET Q q n 45.35 628.8 m 657.35 628.8 l 657.35 616.8 l 45.35 616.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 619.21 Tm (and) Tj ET Q q n 18 616.8 m 630 616.8 l 630 604.8 l 18 604.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 607.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 607.21 Tm (is engaged in Residual Disability Employment.) Tj ET Q q n 0 604.8 m 612 604.8 l 612 592.8 l 0 592.8 l h W n Q q n 0 592.8 m 612 592.8 l 612 580.8 l 0 580.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 583.21 Tm (RESIDUAL) Tj ET BT /F2 12 Tf 1 0 0 1 67.35 583.21 Tm (DISABILITY) Tj ET BT /F2 12 Tf 1 0 0 1 143.38 583.21 Tm (EMPLOYMENT) Tj ET BT /F3 12 Tf 1 0 0 1 237.38 583.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 273.37 583.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 293.37 583.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 334.69 583.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 388.67 583.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 402.01 583.21 Tm (working) Tj ET BT /F3 12 Tf 1 0 0 1 447.35 583.21 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 461.34 583.21 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 480.68 583.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 496.01 583.21 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 516.67 583.21 Tm (Own) Tj ET Q q n 0 580.8 m 612 580.8 l 612 568.8 l 0 568.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 571.21 Tm (Occupation or any other occupation; however, because of a Residual Disability:) Tj ET Q q n 18 568.8 m 630 568.8 l 630 556.8 l 18 556.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 559.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 559.21 Tm (the Insured Employee's hours or production is reduced;) Tj ET Q q n 18 556.8 m 630 556.8 l 630 544.8 l 18 544.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 547.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 547.21 Tm (one or more Main Duties of the job are reassigned; or) Tj ET Q q n 18 544.8 m 630 544.8 l 630 532.8 l 18 532.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 535.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 535.21 Tm (the Insured Employee is working in a lower-paid occupation.) Tj ET Q q n 0 532.8 m 612 532.8 l 612 520.8 l 0 520.8 l h W n Q q n 0 520.8 m 612 520.8 l 612 508.8 l 0 508.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 511.21 Tm (During Residual Disability Employment, his or her current earnings:) Tj ET Q q n 18 508.8 m 630 508.8 l 630 496.8 l 18 496.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 499.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 499.21 Tm (must be at least 20% of Predisability Income; and) Tj ET Q q n 18 496.8 m 630 496.8 l 630 484.8 l 18 484.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 487.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 487.21 Tm (may not exceed the percentage specified in the Residual Disability Benefit section.) Tj ET Q q n 0 484.8 m 612 484.8 l 612 472.8 l 0 472.8 l h W n Q q n 0 472.8 m 612 472.8 l 612 460.8 l 0 460.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 463.21 Tm (RETIREMENT BENEFIT,) Tj ET BT /F3 12 Tf 1 0 0 1 140.69 463.21 Tm ( when used with the term Retirement Plan, means a benefit that:) Tj ET Q q n 18 460.8 m 630 460.8 l 630 448.8 l 18 448.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 451.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 451.21 Tm (is payable under a Retirement Plan either in a lump sum or in the form of periodic payments;) Tj ET Q q n 18 448.8 m 630 448.8 l 630 436.8 l 18 436.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 439.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 439.21 Tm (does) Tj ET BT /F3 12 Tf 1 0 0 1 74.36 439.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 96.7 439.21 Tm (represent) Tj ET BT /F3 12 Tf 1 0 0 1 147.68 439.21 Tm (contributions) Tj ET BT /F3 12 Tf 1 0 0 1 218.02 439.21 Tm (made) Tj ET BT /F3 12 Tf 1 0 0 1 251.02 439.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 270.03 439.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 288.36 439.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 331.36 439.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 387.02 439.21 Tm (\(Payments) Tj ET BT /F3 12 Tf 1 0 0 1 444.69 439.21 Tm (representing) Tj ET Q q n 45.35 436.8 m 657.35 436.8 l 657.35 424.8 l 45.35 424.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 427.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 99.76 427.21 Tm (contributions) Tj ET BT /F3 12 Tf 1 0 0 1 168.84 427.21 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 189.25 427.21 Tm (deemed) Tj ET BT /F3 12 Tf 1 0 0 1 232.32 427.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 247.41 427.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 264.49 427.21 Tm (received) Tj ET BT /F3 12 Tf 1 0 0 1 310.88 427.21 Tm (over) Tj ET BT /F3 12 Tf 1 0 0 1 337.96 427.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 358.38 427.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 400.12 427.21 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 461.36 427.21 Tm (expected) Tj ET Q q n 45.35 424.8 m 657.35 424.8 l 657.35 412.8 l 45.35 412.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 415.21 Tm (remaining life, regardless of when they are actually received.\); and) Tj ET Q q n 18 412.8 m 630 412.8 l 630 400.8 l 18 400.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 403.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 403.21 Tm (is payable upon:) Tj ET Q q n 45.35 400.8 m 657.35 400.8 l 657.35 388.8 l 45.35 388.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 391.21 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 391.21 Tm (early or normal retirement; or) Tj ET Q q n 45.35 388.8 m 657.35 388.8 l 657.35 376.8 l 45.35 376.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 379.21 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 379.21 Tm (disability) Tj ET BT /F3 12 Tf 1 0 0 1 121.01 379.21 Tm (\(if) Tj ET BT /F3 12 Tf 1 0 0 1 135.99 379.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 154.3 379.21 Tm (payment) Tj ET BT /F3 12 Tf 1 0 0 1 199.27 379.21 Tm (does) Tj ET BT /F3 12 Tf 1 0 0 1 224.91 379.21 Tm (reduce) Tj ET BT /F3 12 Tf 1 0 0 1 260.53 379.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 278.84 379.21 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 315.81 379.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 348.78 379.21 Tm (would) Tj ET BT /F3 12 Tf 1 0 0 1 382.43 379.21 Tm (have) Tj ET BT /F3 12 Tf 1 0 0 1 408.73 379.21 Tm (been) Tj ET BT /F3 12 Tf 1 0 0 1 435.03 379.21 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 459.34 379.21 Tm (at) Tj ET Q q n 72.7 376.8 m 684.7 376.8 l 684.7 364.8 l 72.7 364.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 367.21 Tm (the normal retirement age under the plan, if disability had not occurred\).) Tj ET Q q n 0 364.8 m 612 364.8 l 612 352.8 l 0 352.8 l h W n Q q n 0 352.8 m 612 352.8 l 612 340.8 l 0 340.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 343.21 Tm (RETIREMENT PLAN) Tj ET BT /F3 12 Tf 1 0 0 1 117.68 343.21 Tm ( means a defined benefit or defined contribution plan that:) Tj ET Q q n 18 340.8 m 630 340.8 l 630 328.8 l 18 328.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 331.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 331.21 Tm (provides Retirement Benefits to Employees; and) Tj ET Q q n 18 328.8 m 630 328.8 l 630 316.8 l 18 316.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 319.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 319.21 Tm (is not funded wholly by Employee contributions.) Tj ET Q q n 0 316.8 m 612 316.8 l 612 304.8 l 0 304.8 l h W n Q q n 0 304.8 m 612 304.8 l 612 292.8 l 0 292.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 295.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 21.84 295.21 Tm (term) Tj ET BT /F3 12 Tf 1 0 0 1 47.02 295.21 Tm (shall) Tj ET BT /F2 12 Tf 1 0 0 1 72.87 295.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 92.73 295.21 Tm (include) Tj ET BT /F3 12 Tf 1 0 0 1 131.24 295.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 151.75 295.21 Tm (401\(k\),) Tj ET BT /F3 12 Tf 1 0 0 1 189.93 295.21 Tm (profit-sharing) Tj ET BT /F3 12 Tf 1 0 0 1 259.1 295.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 272.29 295.21 Tm (thrift) Tj ET BT /F3 12 Tf 1 0 0 1 299.47 295.21 Tm (plan;) Tj ET BT /F3 12 Tf 1 0 0 1 326.65 295.21 Tm (informal) Tj ET BT /F3 12 Tf 1 0 0 1 371.16 295.21 Tm (salary) Tj ET BT /F3 12 Tf 1 0 0 1 403 295.21 Tm (continuance) Tj ET BT /F3 12 Tf 1 0 0 1 464.16 295.21 Tm (plan;) Tj ET BT /F3 12 Tf 1 0 0 1 491.34 295.21 Tm (individual) Tj ET Q q n 0 292.8 m 612 292.8 l 612 280.8 l 0 280.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 283.21 Tm (retirement) Tj ET BT /F3 12 Tf 1 0 0 1 55.27 283.21 Tm (account) Tj ET BT /F3 12 Tf 1 0 0 1 98.55 283.21 Tm (\(IRA\);) Tj ET BT /F3 12 Tf 1 0 0 1 136.5 283.21 Tm (tax) Tj ET BT /F3 12 Tf 1 0 0 1 157.12 283.21 Tm (sheltered) Tj ET BT /F3 12 Tf 1 0 0 1 206.4 283.21 Tm (annuity) Tj ET BT /F3 12 Tf 1 0 0 1 248.36 283.21 Tm (\(TSA\);) Tj ET BT /F3 12 Tf 1 0 0 1 288.32 283.21 Tm (stock) Tj ET BT /F3 12 Tf 1 0 0 1 319.61 283.21 Tm (ownership) Tj ET BT /F3 12 Tf 1 0 0 1 375.57 283.21 Tm (plan;) Tj ET BT /F3 12 Tf 1 0 0 1 405.52 283.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 421.48 283.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 432.77 283.21 Tm (non-qualified) Tj ET BT /F3 12 Tf 1 0 0 1 503.38 283.21 Tm (plan) Tj ET BT /F3 12 Tf 1 0 0 1 530 283.21 Tm (of) Tj ET Q q n 0 280.8 m 612 280.8 l 612 268.8 l 0 268.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 271.21 Tm (deferred compensation; or that part of any Retirement Plan funded by Employee contributions.) Tj ET Q q n 0 268.8 m 612 268.8 l 612 256.8 l 0 256.8 l h W n Q q n 0 256.8 m 612 256.8 l 612 244.8 l 0 244.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 247.21 Tm (An Employer's Retirement Plan is deemed to include any Retirement Plan:) Tj ET Q q n 18 244.8 m 630 244.8 l 630 232.8 l 18 232.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 235.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 235.21 Tm (which is part of any federal, state, county, municipal or association retirement system; and) Tj ET Q q n 18 232.8 m 630 232.8 l 630 220.8 l 18 220.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 223.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 223.21 Tm (for which the Insured Employee is eligible as a result of employment with the Employer.) Tj ET Q q n 0 220.8 m 612 220.8 l 612 208.8 l 0 208.8 l h W n Q q n 0 208.8 m 612 208.8 l 612 196.8 l 0 196.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 199.21 Tm (SICK LEAVE) Tj ET BT /F3 12 Tf 1 0 0 1 73.69 199.21 Tm ( or) Tj ET BT /F2 12 Tf 1 0 0 1 89.68 199.21 Tm (SALARY CONTINUANCE PLAN) Tj ET BT /F3 12 Tf 1 0 0 1 268.37 199.21 Tm ( means a plan that:) Tj ET Q q n 18 196.8 m 630 196.8 l 630 184.8 l 18 184.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 187.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 187.21 Tm (is established and maintained by the Employer for the benefit of Employees; and) Tj ET Q q n 18 184.8 m 630 184.8 l 630 172.8 l 18 172.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 175.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 175.21 Tm (continues) Tj ET BT /F3 12 Tf 1 0 0 1 94.81 175.21 Tm (payment) Tj ET BT /F3 12 Tf 1 0 0 1 139.61 175.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 153.08 175.21 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 168.55 175.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 182.01 175.21 Tm (part) Tj ET BT /F3 12 Tf 1 0 0 1 204.14 175.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 217.61 175.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 232.41 175.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 271.88 175.21 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 330.83 175.21 Tm (Predisability) Tj ET BT /F3 12 Tf 1 0 0 1 394.97 175.21 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 434.42 175.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 451.89 175.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 460.69 175.21 Tm (specified) Tj ET Q q n 45.35 172.8 m 657.35 172.8 l 657.35 160.8 l 45.35 160.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 163.21 Tm (period after he or she becomes Disabled.) Tj ET Q q n 0 160.8 m 612 160.8 l 612 148.8 l 0 148.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 151.21 Tm (It) Tj ET BT /F3 12 Tf 1 0 0 1 10.38 151.21 Tm (does) Tj ET BT /F2 12 Tf 1 0 0 1 35.43 151.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 55.15 151.21 Tm (include) Tj ET BT /F3 12 Tf 1 0 0 1 93.52 151.21 Tm (compensation) Tj ET BT /F3 12 Tf 1 0 0 1 163.22 151.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 180.94 151.21 Tm (Employer) Tj ET BT /F3 12 Tf 1 0 0 1 231.31 151.21 Tm (pays) Tj ET BT /F3 12 Tf 1 0 0 1 256.36 151.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 270.73 151.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 309.77 151.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 361.48 151.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 378.52 151.21 Tm (work) Tj ET BT /F3 12 Tf 1 0 0 1 406.23 151.21 Tm (actually) Tj ET BT /F3 12 Tf 1 0 0 1 447.27 151.21 Tm (performed) Tj ET BT /F3 12 Tf 1 0 0 1 500.29 151.21 Tm (during) Tj ET BT /F3 12 Tf 1 0 0 1 534.67 151.21 Tm (a) Tj ET Q q n 0 148.8 m 612 148.8 l 612 136.8 l 0 136.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 139.21 Tm (Disability.) Tj ET Q q n 0 136.8 m 612 136.8 l 612 124.8 l 0 124.8 l h W n Q q n 0 124.8 m 612 124.8 l 612 112.8 l 0 112.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 115.21 Tm (SICKNESS) Tj ET BT /F3 12 Tf 1 0 0 1 59.36 115.21 Tm ( means illness, pregnancy or disease.) Tj ET Q q n 0 112.79 m 612 112.79 l 612 100.79 l 0 100.79 l h W n Q q n 0 100.79 m 612 100.79 l 612 88.79 l 0 88.79 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 91.2 Tm (TOTAL) Tj ET BT /F2 12 Tf 1 0 0 1 47.91 91.2 Tm (COVERED) Tj ET BT /F2 12 Tf 1 0 0 1 113.82 91.2 Tm (PAYROLL) Tj ET BT /F3 12 Tf 1 0 0 1 178.39 91.2 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 214.95 91.2 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 235.51 91.2 Tm (total) Tj ET BT /F3 12 Tf 1 0 0 1 262.74 91.2 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 304.64 91.2 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 320.53 91.2 Tm (Basic) Tj ET BT /F3 12 Tf 1 0 0 1 353.09 91.2 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 400.33 91.2 Tm (Earnings) Tj ET BT /F3 12 Tf 1 0 0 1 448.89 91.2 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 468.78 91.2 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 486.68 91.2 Tm (Employees) Tj ET Q q n 0 88.79 m 612 88.79 l 612 76.79 l 0 76.79 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 79.2 Tm (insured under the Policy.) Tj ET Q q n 0 76.79 m 612 76.79 l 612 64.79 l 0 64.79 l h W n Q Q q Q Q endstream endobj 10 0 obj <>>>>> endobj 138 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 734.4 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 230.32 26.41 Tm (DEFINITIONS) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 239 14.41 Tm (\(Continued\)) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-2 10 PA) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 267.5 14.41 Tm (8) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 676.8 m 612 676.8 l 612 664.8 l 0 664.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 667.21 Tm (TOTAL DISABILITY) Tj ET BT /F3 12 Tf 1 0 0 1 118.71 667.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 128.7 667.21 Tm ( TOTALLY DISABLED) Tj ET BT /F3 12 Tf 1 0 0 1 254.74 667.21 Tm ( will be defined as follows.) Tj ET Q q n 18 664.8 m 630 664.8 l 630 652.8 l 18 652.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 655.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 655.21 Tm (During) Tj ET BT /F3 12 Tf 1 0 0 1 83.28 655.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 101.88 655.21 Tm (Elimination) Tj ET BT /F3 12 Tf 1 0 0 1 162.48 655.21 Tm (Period) Tj ET BT /F3 12 Tf 1 0 0 1 197.75 655.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 219.02 655.21 Tm (Own) Tj ET BT /F3 12 Tf 1 0 0 1 246.29 655.21 Tm (Occupation) Tj ET BT /F3 12 Tf 1 0 0 1 305.54 655.21 Tm (Period,) Tj ET BT /F3 12 Tf 1 0 0 1 343.8 655.21 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 354.41 655.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 389.01 655.21 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 410.94 655.21 Tm (due) Tj ET BT /F3 12 Tf 1 0 0 1 432.2 655.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 445.48 655.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 460.74 655.21 Tm (Injury) Tj ET BT /F3 12 Tf 1 0 0 1 494 655.21 Tm (or) Tj ET Q q n 45.35 652.8 m 657.35 652.8 l 657.35 640.8 l 45.35 640.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 643.21 Tm (Sickness) Tj ET BT /F3 12 Tf 1 0 0 1 91.08 643.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 109.47 643.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 149.19 643.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 201.57 643.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 213.31 643.21 Tm (unable) Tj ET BT /F3 12 Tf 1 0 0 1 249.02 643.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 262.09 643.21 Tm (perform) Tj ET BT /F3 12 Tf 1 0 0 1 304.46 643.21 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 320.19 643.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 333.92 643.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 352.31 643.21 Tm (Main) Tj ET BT /F3 12 Tf 1 0 0 1 381.37 643.21 Tm (Duties) Tj ET BT /F3 12 Tf 1 0 0 1 416.43 643.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 430.15 643.21 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 447.89 643.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 461.62 643.21 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 480.67 643.21 Tm (Own) Tj ET Q q n 45.35 640.8 m 657.35 640.8 l 657.35 628.8 l 45.35 628.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 631.21 Tm (Occupation.) Tj ET Q q n 18 628.8 m 630 628.8 l 630 616.8 l 18 616.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 619.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 619.21 Tm (After) Tj ET BT /F3 12 Tf 1 0 0 1 76.03 619.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 96.05 619.21 Tm (Own) Tj ET BT /F3 12 Tf 1 0 0 1 124.75 619.21 Tm (Occupation) Tj ET BT /F3 12 Tf 1 0 0 1 185.42 619.21 Tm (Period,) Tj ET BT /F3 12 Tf 1 0 0 1 225.11 619.21 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 237.14 619.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 273.16 619.21 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 296.51 619.21 Tm (due) Tj ET BT /F3 12 Tf 1 0 0 1 319.2 619.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 333.9 619.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 350.58 619.21 Tm (Injury) Tj ET BT /F3 12 Tf 1 0 0 1 385.27 619.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 400.63 619.21 Tm (Sickness) Tj ET BT /F3 12 Tf 1 0 0 1 447.99 619.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 468.01 619.21 Tm (Insured) Tj ET Q q n 45.35 616.8 m 657.35 616.8 l 657.35 604.8 l 45.35 604.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 607.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 99.01 607.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 112.02 607.21 Tm (unable) Tj ET BT /F3 12 Tf 1 0 0 1 149.01 607.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 163.35 607.21 Tm (perform) Tj ET BT /F3 12 Tf 1 0 0 1 207 607.21 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 224 607.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 239.01 607.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 258.67 607.21 Tm (Main) Tj ET BT /F3 12 Tf 1 0 0 1 289.01 607.21 Tm (Duties) Tj ET BT /F3 12 Tf 1 0 0 1 325.35 607.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 340.35 607.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 362.68 607.21 Tm (occupation) Tj ET BT /F3 12 Tf 1 0 0 1 420.33 607.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 454.67 607.21 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 473.68 607.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 488.68 607.21 Tm (her) Tj ET Q q n 45.35 604.8 m 657.35 604.8 l 657.35 592.8 l 45.35 592.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 595.21 Tm (training, education, experience, or physical or mental capacity will reasonably allow) Tj ET BT /F3 12 Tf 1 0 0 1 450.2 595.21 Tm (.) Tj ET Q q n 0 592.8 m 612 592.8 l 612 580.8 l 0 580.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 583.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 22.7 583.21 Tm (loss) Tj ET BT /F3 12 Tf 1 0 0 1 45.41 583.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 59.45 583.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 68.82 583.21 Tm (professional) Tj ET BT /F3 12 Tf 1 0 0 1 131.51 583.21 Tm (license,) Tj ET BT /F3 12 Tf 1 0 0 1 171.87 583.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 187.24 583.21 Tm (occupational) Tj ET BT /F3 12 Tf 1 0 0 1 252.59 583.21 Tm (license) Tj ET BT /F3 12 Tf 1 0 0 1 289.95 583.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 303.98 583.21 Tm (certification,) Tj ET BT /F3 12 Tf 1 0 0 1 368.99 583.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 383.03 583.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 392.4 583.21 Tm (driver's) Tj ET BT /F3 12 Tf 1 0 0 1 431.92 583.21 Tm (license) Tj ET BT /F3 12 Tf 1 0 0 1 469.28 583.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 487.31 583.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 508.68 583.21 Tm (reason) Tj ET Q q n 0 580.8 m 612 580.8 l 612 568.8 l 0 568.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 571.21 Tm (does) Tj ET BT /F2 12 Tf 1 0 0 1 22 571.21 Tm ( not) Tj ET BT /F3 12 Tf 1 0 0 1 41.67 571.21 Tm (, by itself, constitute Total Disability.) Tj ET Q q n 0 568.8 m 612 568.8 l 612 556.8 l 0 556.8 l h W n Q q n 0 556.8 m 612 556.8 l 612 544.8 l 0 544.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 547.21 Tm (WAITING) Tj ET BT /F2 12 Tf 1 0 0 1 60.25 547.21 Tm (PERIOD) Tj ET BT /F3 12 Tf 1 0 0 1 111.16 547.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 146.06 547.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 164.96 547.21 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 199.86 547.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 214.09 547.21 Tm (time) Tj ET BT /F3 12 Tf 1 0 0 1 239.66 547.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 255.23 547.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 308.12 547.21 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 335.7 547.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 351.27 547.21 Tm (employed) Tj ET BT /F3 12 Tf 1 0 0 1 402.83 547.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 416.4 547.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 431.97 547.21 Tm (eligible) Tj ET BT /F3 12 Tf 1 0 0 1 472.2 547.21 Tm (class) Tj ET BT /F3 12 Tf 1 0 0 1 499.77 547.21 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 547.21 Tm (the) Tj ET Q q n 0 544.8 m 612 544.8 l 612 532.8 l 0 532.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 535.21 Tm (Employer,) Tj ET BT /F3 12 Tf 1 0 0 1 54.78 535.21 Tm (before) Tj ET BT /F3 12 Tf 1 0 0 1 89.88 535.21 Tm (he) Tj ET BT /F3 12 Tf 1 0 0 1 105.66 535.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 120.11 535.21 Tm (she) Tj ET BT /F3 12 Tf 1 0 0 1 140.56 535.21 Tm (becomes) Tj ET BT /F3 12 Tf 1 0 0 1 187 535.21 Tm (eligible) Tj ET BT /F3 12 Tf 1 0 0 1 227.44 535.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 241.23 535.21 Tm (enroll) Tj ET BT /F3 12 Tf 1 0 0 1 273.67 535.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 292.12 535.21 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 339.88 535.21 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 371.65 535.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 390.77 535.21 Tm (Policy.) Tj ET BT /F3 12 Tf 1 0 0 1 433.35 535.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 456.46 535.21 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 491.57 535.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 506.02 535.21 Tm (service) Tj ET Q q n 0 532.8 m 612 532.8 l 612 520.8 l 0 520.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 523.21 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 27.99 523.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 43.97 523.21 Tm (continuous,) Tj ET BT /F3 12 Tf 1 0 0 1 104.28 523.21 Tm (except) Tj ET BT /F3 12 Tf 1 0 0 1 140.24 523.21 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 154.89 523.21 Tm (explained) Tj ET BT /F3 12 Tf 1 0 0 1 206.19 523.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 220.17 523.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 239.48 523.21 Tm (Eligibility) Tj ET BT /F3 12 Tf 1 0 0 1 292.8 523.21 Tm (provision) Tj ET BT /F3 12 Tf 1 0 0 1 342.79 523.21 Tm (captioned) Tj ET BT /F3 12 Tf 1 0 0 1 394.08 523.21 Tm (Prior) Tj ET BT /F3 12 Tf 1 0 0 1 422.73 523.21 Tm (Service) Tj ET BT /F3 12 Tf 1 0 0 1 463.37 523.21 Tm (Credit) Tj ET BT /F3 12 Tf 1 0 0 1 498.01 523.21 Tm (Towards) Tj ET Q q n 0 520.8 m 612 520.8 l 612 508.8 l 0 508.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 511.21 Tm (Waiting Period.) Tj ET Q q n 0 508.8 m 612 508.8 l 612 496.8 l 0 496.8 l h W n Q Q q Q Q endstream endobj 11 0 obj <>>>>> endobj 140 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 758.4 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 201.49 2.41 Tm (GENERAL PROVISIONS) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-5 04) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 267.5 14.41 Tm (9) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 684.6 m 612 684.6 l 612 672.6 l 0 672.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 675.01 Tm (ENTIRE CONTRACT) Tj ET BT /F3 12 Tf 1 0 0 1 117.69 675.01 Tm (.) Tj ET BT /F3 12 Tf 1 0 0 1 126.69 675.01 Tm (The entire contract between the parties shall consist of:) Tj ET Q q n 18 672.6 m 630 672.6 l 630 660.6 l 18 660.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 663.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 663.01 Tm (the Policy and any amendments to it;) Tj ET Q q n 18 660.6 m 630 660.6 l 630 648.6 l 18 648.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 651.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 651.01 Tm (the Policyholder's application \(a copy of which is attached to the Policy\);) Tj ET Q q n 18 648.6 m 630 648.6 l 630 636.6 l 18 636.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 639.01 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 639.01 Tm (any Participating Employers' applications or Participation Agreements; and) Tj ET Q q n 18 636.6 m 630 636.6 l 630 624.6 l 18 624.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 627.01 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 627.01 Tm (any individual applications of the Insured Employees.) Tj ET Q q n 0 624.6 m 612 624.6 l 612 612.6 l 0 612.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 615.01 Tm (In) Tj ET BT /F3 12 Tf 1 0 0 1 13.53 615.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 31.72 615.01 Tm (absence) Tj ET BT /F3 12 Tf 1 0 0 1 73.23 615.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 86.76 615.01 Tm (fraud,) Tj ET BT /F3 12 Tf 1 0 0 1 118.61 615.01 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 134.13 615.01 Tm (statements) Tj ET BT /F3 12 Tf 1 0 0 1 188.32 615.01 Tm (made) Tj ET BT /F3 12 Tf 1 0 0 1 217.84 615.01 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 233.37 615.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 251.56 615.01 Tm (Policyholder) Tj ET BT /F3 12 Tf 1 0 0 1 316.42 615.01 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 337.28 615.01 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 352.81 615.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 392.33 615.01 Tm (Employees) Tj ET BT /F3 12 Tf 1 0 0 1 449.18 615.01 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 467.36 615.01 Tm (representations) Tj ET Q q n 0 612.6 m 612 612.6 l 612 600.6 l 0 600.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 603.01 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 20.87 603.01 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 39.75 603.01 Tm (warranties.) Tj ET BT /F3 12 Tf 1 0 0 1 99.82 603.01 Tm (No) Tj ET BT /F3 12 Tf 1 0 0 1 118.03 603.01 Tm (statement) Tj ET BT /F3 12 Tf 1 0 0 1 167.56 603.01 Tm (made) Tj ET BT /F3 12 Tf 1 0 0 1 197.1 603.01 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 212.64 603.01 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 227.51 603.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 267.05 603.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 319.25 603.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 341.46 603.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 356.33 603.01 Tm (used) Tj ET BT /F3 12 Tf 1 0 0 1 381.87 603.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 394.75 603.01 Tm (contest) Tj ET BT /F3 12 Tf 1 0 0 1 432.29 603.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 450.5 603.01 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 497.34 603.01 Tm (provided) Tj ET Q q n 0 600.6 m 612 600.6 l 612 588.6 l 0 588.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 591.01 Tm (by the Policy, unless:) Tj ET Q q n 18 588.6 m 630 588.6 l 630 576.6 l 18 576.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 579.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 579.01 Tm (it is contained in a written statement signed by that Insured Employee; and) Tj ET Q q n 18 576.6 m 630 576.6 l 630 564.6 l 18 564.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 567.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 567.01 Tm (a copy of the statement has been furnished to that Insured Employee.) Tj ET Q q n 0 564.6 m 612 564.6 l 612 552.6 l 0 552.6 l h W n Q q n 0 552.6 m 612 552.6 l 612 540.6 l 0 540.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 543.01 Tm (INCONTESTABILITY.) Tj ET BT /F3 12 Tf 1 0 0 1 130.78 543.01 Tm (Except) Tj ET BT /F3 12 Tf 1 0 0 1 167.3 543.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 184.5 543.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 202.36 543.01 Tm (non-payment) Tj ET BT /F3 12 Tf 1 0 0 1 268.88 543.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 282.08 543.01 Tm (premiums) Tj ET BT /F3 12 Tf 1 0 0 1 333.28 543.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 346.49 543.01 Tm (fraud,) Tj ET BT /F3 12 Tf 1 0 0 1 378.01 543.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 395.87 543.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 445.74 543.01 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 469.61 543.01 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 488.15 543.01 Tm (contest) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 543.01 Tm (the) Tj ET Q q n 0 540.6 m 612 540.6 l 612 528.6 l 0 528.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 531.01 Tm (validity) Tj ET BT /F3 12 Tf 1 0 0 1 41.55 531.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 56.43 531.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 75.97 531.01 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 111.53 531.01 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 138.39 531.01 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 149.94 531.01 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 170.83 531.01 Tm (been) Tj ET BT /F3 12 Tf 1 0 0 1 198.36 531.01 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 212.58 531.01 Tm (force) Tj ET BT /F3 12 Tf 1 0 0 1 242.11 531.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 260.99 531.01 Tm (two) Tj ET BT /F3 12 Tf 1 0 0 1 283.88 531.01 Tm (years) Tj ET BT /F3 12 Tf 1 0 0 1 314.08 531.01 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 342.29 531.01 Tm (its) Tj ET BT /F3 12 Tf 1 0 0 1 358.52 531.01 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 383.39 531.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 398.27 531.01 Tm (issue;) Tj ET BT /F3 12 Tf 1 0 0 1 430.49 531.01 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 452.7 531.01 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 467.58 531.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 481.8 531.01 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 504.01 531.01 Tm (Insured) Tj ET Q q n 0 528.6 m 612 528.6 l 612 516.6 l 0 516.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 519.01 Tm (Employee,) Tj ET BT /F3 12 Tf 1 0 0 1 54.96 519.01 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 80.25 519.01 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 97.57 519.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 110.87 519.01 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 129.51 519.01 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 176.12 519.01 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 195.42 519.01 Tm (been) Tj ET BT /F3 12 Tf 1 0 0 1 221.39 519.01 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 234.03 519.01 Tm (force) Tj ET BT /F3 12 Tf 1 0 0 1 261.99 519.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 279.29 519.01 Tm (two) Tj ET BT /F3 12 Tf 1 0 0 1 300.6 519.01 Tm (years) Tj ET BT /F3 12 Tf 1 0 0 1 329.23 519.01 Tm (during) Tj ET BT /F3 12 Tf 1 0 0 1 363.87 519.01 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 381.19 519.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 394.49 519.01 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 413.13 519.01 Tm (lifetime.) Tj ET BT /F3 12 Tf 1 0 0 1 460.07 519.01 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 484.71 519.01 Tm (clause) Tj ET BT /F3 12 Tf 1 0 0 1 518 519.01 Tm (does) Tj ET Q q n 0 516.6 m 612 516.6 l 612 504.6 l 0 504.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 507.01 Tm (not preclude, at any time, the assertion of defenses based upon:) Tj ET Q q n 18 504.6 m 630 504.6 l 630 492.6 l 18 492.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 495.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 495.01 Tm (the Policy's eligibility requirements, exclusions and limitations; and) Tj ET Q q n 18 492.6 m 630 492.6 l 630 480.6 l 18 480.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 483.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 483.01 Tm (other Policy provisions unrelated to the validity of coverage.) Tj ET Q q n 18 480.6 m 630 480.6 l 630 468.6 l 18 468.6 l h W n Q q n 0 468.6 m 612 468.6 l 612 456.6 l 0 456.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 459.01 Tm (RESCISSION.) Tj ET BT /F3 12 Tf 1 0 0 1 84 459.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 106.81 459.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 157.63 459.01 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 177.77 459.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 196.58 459.01 Tm (right) Tj ET BT /F3 12 Tf 1 0 0 1 223.4 459.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 236.89 459.01 Tm (rescind) Tj ET BT /F3 12 Tf 1 0 0 1 275.69 459.01 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 297.17 459.01 Tm (insurance) Tj ET BT /F3 12 Tf 1 0 0 1 347.3 459.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 365.44 459.01 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 398.92 459.01 Tm (Evidence) Tj ET BT /F3 12 Tf 1 0 0 1 447.71 459.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 461.86 459.01 Tm (Insurability) Tj ET BT /F3 12 Tf 1 0 0 1 521.34 459.01 Tm (was) Tj ET Q q n 0 456.6 m 612 456.6 l 612 444.6 l 0 444.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 447.01 Tm (required, if:) Tj ET Q q n 18 444.6 m 630 444.6 l 630 432.6 l 18 432.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 435.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 435.01 Tm (an Insured Employee incurs a claim during the first two years of coverage; and) Tj ET Q q n 18 432.6 m 630 432.6 l 630 420.6 l 18 420.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 423.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 423.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 63.1 423.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 112.85 423.01 Tm (discovers) Tj ET BT /F3 12 Tf 1 0 0 1 161.25 423.01 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 182.33 423.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 200.08 423.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 239.15 423.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 290.89 423.01 Tm (made) Tj ET BT /F3 12 Tf 1 0 0 1 319.96 423.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 328.37 423.01 Tm (Material) Tj ET BT /F3 12 Tf 1 0 0 1 372.1 423.01 Tm (Misrepresentation) Tj ET BT /F3 12 Tf 1 0 0 1 461.83 423.01 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 476.92 423.01 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 494 423.01 Tm (or) Tj ET Q q n 45.35 420.6 m 657.35 420.6 l 657.35 408.6 l 45.35 408.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 411.01 Tm (her application.) Tj ET Q q n 0 408.6 m 612 408.6 l 612 396.6 l 0 396.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 399.01 Tm (A) Tj ET BT /F2 12 Tf 1 0 0 1 14.01 399.01 Tm ("Material) Tj ET BT /F2 12 Tf 1 0 0 1 70.66 399.01 Tm (Misrepresentation") Tj ET BT /F3 12 Tf 1 0 0 1 176.64 399.01 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 189.99 399.01 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 206.66 399.01 Tm (incomplete) Tj ET BT /F3 12 Tf 1 0 0 1 265.32 399.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 280.65 399.01 Tm (untrue) Tj ET BT /F3 12 Tf 1 0 0 1 316.65 399.01 Tm (statement) Tj ET BT /F3 12 Tf 1 0 0 1 367.98 399.01 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 391.32 399.01 Tm (caused) Tj ET BT /F3 12 Tf 1 0 0 1 429.31 399.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 449.32 399.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 501.32 399.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 516 399.01 Tm (issue) Tj ET Q q n 0 396.6 m 612 396.6 l 612 384.6 l 0 384.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 387.01 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 46.46 387.01 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 67.61 387.01 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 77.44 387.01 Tm (would) Tj ET BT /F3 12 Tf 1 0 0 1 110.59 387.01 Tm (have) Tj ET BT /F3 12 Tf 1 0 0 1 136.4 387.01 Tm (disapproved,) Tj ET BT /F3 12 Tf 1 0 0 1 201.21 387.01 Tm (had) Tj ET BT /F3 12 Tf 1 0 0 1 221.69 387.01 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 231.52 387.01 Tm (known) Tj ET BT /F3 12 Tf 1 0 0 1 267.34 387.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 285.16 387.01 Tm (truth.) Tj ET BT /F2 12 Tf 1 0 0 1 317.14 387.01 Tm ("To) Tj ET BT /F2 12 Tf 1 0 0 1 340.96 387.01 Tm (rescind") Tj ET BT /F3 12 Tf 1 0 0 1 388.11 387.01 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 421.93 387.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 434.42 387.01 Tm (cancel) Tj ET BT /F3 12 Tf 1 0 0 1 468.21 387.01 Tm (insurance) Tj ET BT /F3 12 Tf 1 0 0 1 517.35 387.01 Tm (back) Tj ET Q q n 0 384.6 m 612 384.6 l 612 372.6 l 0 372.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 375.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 12.94 375.01 Tm (its) Tj ET BT /F3 12 Tf 1 0 0 1 27.88 375.01 Tm (effective) Tj ET BT /F3 12 Tf 1 0 0 1 73.45 375.01 Tm (date.) Tj ET BT /F3 12 Tf 1 0 0 1 103.65 375.01 Tm (In) Tj ET BT /F3 12 Tf 1 0 0 1 117.25 375.01 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 138.85 375.01 Tm (event,) Tj ET BT /F3 12 Tf 1 0 0 1 171.44 375.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 189.71 375.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 239.98 375.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 262.25 375.01 Tm (refund) Tj ET BT /F3 12 Tf 1 0 0 1 297.18 375.01 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 312.77 375.01 Tm (premium) Tj ET BT /F3 12 Tf 1 0 0 1 359.7 375.01 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 383.97 375.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 401.57 375.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 419.83 375.01 Tm (rescinded) Tj ET BT /F3 12 Tf 1 0 0 1 469.42 375.01 Tm (insurance,) Tj ET BT /F3 12 Tf 1 0 0 1 522 375.01 Tm (less) Tj ET Q q n 0 372.6 m 612 372.6 l 612 360.6 l 0 360.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 363.01 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 21.66 363.01 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 63.98 363.01 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 88.97 363.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 107.3 363.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 126.29 363.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 166.61 363.01 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 226.43 363.01 Tm (claims.) Tj ET BT /F3 12 Tf 1 0 0 1 269.42 363.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 292.41 363.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 343.41 363.01 Tm (reserves) Tj ET BT /F3 12 Tf 1 0 0 1 387.05 363.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 406.05 363.01 Tm (right) Tj ET BT /F3 12 Tf 1 0 0 1 433.04 363.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 446.71 363.01 Tm (recover) Tj ET BT /F3 12 Tf 1 0 0 1 487.02 363.01 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 508.68 363.01 Tm (claims) Tj ET Q q n 0 360.6 m 612 360.6 l 612 348.6 l 0 348.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 351.01 Tm (paid in excess of such premiums.) Tj ET Q q n 0 348.6 m 612 348.6 l 612 336.6 l 0 336.6 l h W n Q q n 0 336.6 m 612 336.6 l 612 324.6 l 0 324.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 327.01 Tm (MISSTATEMENTS OF FACTS) Tj ET BT /F3 12 Tf 1 0 0 1 166.7 327.01 Tm (.) Tj ET BT /F3 12 Tf 1 0 0 1 175.7 327.01 Tm (If relevant facts about any person were misstated:) Tj ET Q q n 18 324.6 m 630 324.6 l 630 312.6 l 18 312.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 315.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 315.01 Tm (a fair adjustment of the premium will be made; and) Tj ET Q q n 18 312.6 m 630 312.6 l 630 300.6 l 18 300.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 303.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 303.01 Tm (the true facts will decide if and in what amount insurance is valid under the Policy.) Tj ET Q q n 0 300.6 m 612 300.6 l 612 288.6 l 0 288.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 291.01 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 11.75 291.01 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 26.84 291.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 66.58 291.01 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 125.82 291.01 Tm (age) Tj ET BT /F3 12 Tf 1 0 0 1 146.23 291.01 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 165.99 291.01 Tm (been) Tj ET BT /F3 12 Tf 1 0 0 1 192.4 291.01 Tm (misstated,) Tj ET BT /F3 12 Tf 1 0 0 1 244.48 291.01 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 265.57 291.01 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 307.31 291.01 Tm (shall) Tj ET BT /F3 12 Tf 1 0 0 1 333.73 291.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 348.82 291.01 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 361.91 291.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 380.33 291.01 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 420.08 291.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 438.5 291.01 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 462.92 291.01 Tm (premium) Tj ET BT /F3 12 Tf 1 0 0 1 510 291.01 Tm (would) Tj ET Q q n 0 288.6 m 612 288.6 l 612 276.6 l 0 276.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 279.01 Tm (have purchased at the correct age.) Tj ET Q q n 0 276.6 m 612 276.6 l 612 264.6 l 0 264.6 l h W n Q q n 0 264.6 m 612 264.6 l 612 252.6 l 0 252.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 255.01 Tm (POLICYHOLDER'S) Tj ET BT /F2 12 Tf 1 0 0 1 112.1 255.01 Tm (AGENCY) Tj ET BT /F3 12 Tf 1 0 0 1 164.1 255.01 Tm (.) Tj ET BT /F3 12 Tf 1 0 0 1 173.93 255.01 Tm (For) Tj ET BT /F3 12 Tf 1 0 0 1 194.02 255.01 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 209.42 255.01 Tm (purposes) Tj ET BT /F3 12 Tf 1 0 0 1 255.5 255.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 268.91 255.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 286.98 255.01 Tm (Policy,) Tj ET BT /F3 12 Tf 1 0 0 1 324.07 255.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 342.14 255.01 Tm (Policyholder) Tj ET BT /F3 12 Tf 1 0 0 1 406.88 255.01 Tm (acts) Tj ET BT /F3 12 Tf 1 0 0 1 428.95 255.01 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 444.36 255.01 Tm (its) Tj ET BT /F3 12 Tf 1 0 0 1 459.12 255.01 Tm (own) Tj ET BT /F3 12 Tf 1 0 0 1 483.2 255.01 Tm (behalf) Tj ET BT /F3 12 Tf 1 0 0 1 516.59 255.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 530 255.01 Tm (as) Tj ET Q q n 0 252.6 m 612 252.6 l 612 240.6 l 0 240.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 243.01 Tm (the Employee's agent.) Tj ET BT /F3 12 Tf 1 0 0 1 111.13 243.01 Tm (Under no circumstances will the Policyholder be deemed the Company's agent.) Tj ET Q q n 0 240.6 m 612 240.6 l 612 228.6 l 0 228.6 l h W n Q q n 0 228.6 m 612 228.6 l 612 216.6 l 0 216.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 219.01 Tm (CURRENCY) Tj ET BT /F3 12 Tf 1 0 0 1 68.67 219.01 Tm (.) Tj ET BT /F3 12 Tf 1 0 0 1 77.67 219.01 Tm (In administering the Policy:) Tj ET Q q n 18 216.6 m 630 216.6 l 630 204.6 l 18 204.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 207.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 207.01 Tm (all Predisability Income will be expressed in U.S. dollars; and) Tj ET Q q n 18 204.6 m 630 204.6 l 630 192.6 l 18 192.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 195.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 195.01 Tm (all premium and benefit amounts must be paid in U.S. dollars.) Tj ET Q q n 0 192.6 m 612 192.6 l 612 180.6 l 0 180.6 l h W n Q q n 0 180.6 m 612 180.6 l 612 168.6 l 0 168.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 171.01 Tm (WORKERS') Tj ET BT /F2 12 Tf 1 0 0 1 69.43 171.01 Tm (COMPENSATION) Tj ET BT /F2 12 Tf 1 0 0 1 172.18 171.01 Tm (OR) Tj ET BT /F2 12 Tf 1 0 0 1 193.6 171.01 Tm (STATE) Tj ET BT /F2 12 Tf 1 0 0 1 236.36 171.01 Tm (DISABILITY) Tj ET BT /F2 12 Tf 1 0 0 1 310.47 171.01 Tm (INSURANCE) Tj ET BT /F3 12 Tf 1 0 0 1 381.81 171.01 Tm (.) Tj ET BT /F3 12 Tf 1 0 0 1 391.64 171.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 413.71 171.01 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 447.8 171.01 Tm (does) Tj ET BT /F3 12 Tf 1 0 0 1 473.21 171.01 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 491.96 171.01 Tm (replace) Tj ET BT /F3 12 Tf 1 0 0 1 530 171.01 Tm (or) Tj ET Q q n 0 168.6 m 612 168.6 l 612 156.6 l 0 156.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 159.01 Tm (provide benefits required by:) Tj ET Q q n 18 156.6 m 630 156.6 l 630 144.6 l 18 144.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 147.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 147.01 Tm (Workers' Compensation laws; or) Tj ET Q q n 18 144.6 m 630 144.6 l 630 132.6 l 18 132.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 135.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 135.01 Tm (any state disability insurance plan laws.) Tj ET Q q n 0 132.6 m 612 132.6 l 612 120.6 l 0 120.6 l h W n Q q n 0 120.6 m 612 120.6 l 612 108.6 l 0 108.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 111.01 Tm (ASSIGNMENT) Tj ET BT /F3 12 Tf 1 0 0 1 80.68 111.01 Tm (.) Tj ET BT /F3 12 Tf 1 0 0 1 89.68 111.01 Tm (The rights and benefits under this Certificate may not be assigned.) Tj ET Q Q q Q Q endstream endobj 12 0 obj <>>>>> endobj 141 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 758.4 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 203.16 2.41 Tm (CLAIMS PROCEDURES) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-6 04 PA) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 265 14.41 Tm (10) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 684.6 m 612 684.6 l 612 672.6 l 0 672.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 675.01 Tm (NOTICE) Tj ET BT /F2 12 Tf 1 0 0 1 50.65 675.01 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 70.61 675.01 Tm (CLAIM.) Tj ET BT /F3 12 Tf 1 0 0 1 121.54 675.01 Tm (Written) Tj ET BT /F3 12 Tf 1 0 0 1 161.5 675.01 Tm (notice) Tj ET BT /F3 12 Tf 1 0 0 1 194.12 675.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 207.41 675.01 Tm (claim) Tj ET BT /F3 12 Tf 1 0 0 1 237.37 675.01 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 264.01 675.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 278.64 675.01 Tm (given) Tj ET BT /F3 12 Tf 1 0 0 1 308.6 675.01 Tm (during) Tj ET BT /F3 12 Tf 1 0 0 1 343.23 675.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 361.19 675.01 Tm (Elimination) Tj ET BT /F3 12 Tf 1 0 0 1 421.15 675.01 Tm (Period.) Tj ET BT /F3 12 Tf 1 0 0 1 462.08 675.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 484.04 675.01 Tm (notice) Tj ET BT /F3 12 Tf 1 0 0 1 516.66 675.01 Tm (must) Tj ET Q q n 0 672.6 m 612 672.6 l 612 660.6 l 0 660.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 663.01 Tm (be sent to the Company's Group Insurance Service Office.) Tj ET BT /F3 12 Tf 1 0 0 1 285.08 663.01 Tm (It should include:) Tj ET Q q n 18 660.6 m 630 660.6 l 630 648.6 l 18 648.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 651.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 651.01 Tm (the Insured Employee's name and address; and) Tj ET Q q n 18 648.6 m 630 648.6 l 630 636.6 l 18 636.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 639.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 639.01 Tm (the number of the Policy.) Tj ET Q q n 0 636.6 m 612 636.6 l 612 624.6 l 0 624.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 627.01 Tm (If this is not possible, written notice must be given as soon as it is reasonably possible.) Tj ET Q q n 0 624.6 m 612 624.6 l 612 612.6 l 0 612.6 l h W n Q q n 0 612.6 m 612 612.6 l 612 600.6 l 0 600.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 603.01 Tm (CLAIM) Tj ET BT /F2 12 Tf 1 0 0 1 46.59 603.01 Tm (FORMS.) Tj ET BT /F3 12 Tf 1 0 0 1 103.45 603.01 Tm (When) Tj ET BT /F3 12 Tf 1 0 0 1 137.36 603.01 Tm (notice) Tj ET BT /F3 12 Tf 1 0 0 1 171.95 603.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 187.2 603.01 Tm (claim) Tj ET BT /F3 12 Tf 1 0 0 1 219.12 603.01 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 232.39 603.01 Tm (received,) Tj ET BT /F3 12 Tf 1 0 0 1 281.28 603.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 301.2 603.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 353.13 603.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 377.06 603.01 Tm (send) Tj ET BT /F3 12 Tf 1 0 0 1 404.32 603.01 Tm (claim) Tj ET BT /F3 12 Tf 1 0 0 1 436.24 603.01 Tm (forms) Tj ET BT /F3 12 Tf 1 0 0 1 469.49 603.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 484.09 603.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 504.01 603.01 Tm (Insured) Tj ET Q q n 0 600.6 m 612 600.6 l 612 588.6 l 0 588.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 591.01 Tm (Employee.) Tj ET BT /F3 12 Tf 1 0 0 1 61.96 591.01 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 75.1 591.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 94.92 591.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 146.74 591.01 Tm (does) Tj ET BT /F3 12 Tf 1 0 0 1 173.89 591.01 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 194.38 591.01 Tm (send) Tj ET BT /F3 12 Tf 1 0 0 1 221.53 591.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 241.34 591.01 Tm (forms) Tj ET BT /F3 12 Tf 1 0 0 1 274.49 591.01 Tm (within) Tj ET BT /F3 12 Tf 1 0 0 1 310.31 591.01 Tm (15) Tj ET BT /F3 12 Tf 1 0 0 1 327.46 591.01 Tm (days,) Tj ET BT /F3 12 Tf 1 0 0 1 357.62 591.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 377.43 591.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 418.57 591.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 472.38 591.01 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 498.19 591.01 Tm (send) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 591.01 Tm (the) Tj ET Q q n 0 588.6 m 612 588.6 l 612 576.6 l 0 576.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 579.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 51.34 579.01 Tm (written) Tj ET BT /F3 12 Tf 1 0 0 1 90 579.01 Tm (proof) Tj ET BT /F3 12 Tf 1 0 0 1 120.67 579.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 135.34 579.01 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 187.34 579.01 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 201.35 579.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 211.35 579.01 Tm (letter.) Tj ET BT /F3 12 Tf 1 0 0 1 248.34 579.01 Tm (It) Tj ET BT /F3 12 Tf 1 0 0 1 260.35 579.01 Tm (should) Tj ET BT /F3 12 Tf 1 0 0 1 297.02 579.01 Tm (state) Tj ET BT /F3 12 Tf 1 0 0 1 323.69 579.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 343.02 579.01 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 367.68 579.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 387.01 579.01 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 439.02 579.01 Tm (began,) Tj ET BT /F3 12 Tf 1 0 0 1 475.34 579.01 Tm (its) Tj ET BT /F3 12 Tf 1 0 0 1 491.35 579.01 Tm (cause) Tj ET BT /F3 12 Tf 1 0 0 1 522.67 579.01 Tm (and) Tj ET Q q n 0 576.6 m 612 576.6 l 612 564.6 l 0 564.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 567.01 Tm (degree.) Tj ET BT /F3 12 Tf 1 0 0 1 40.98 567.01 Tm (The Company will periodically send the Insured Employee additional claim forms.) Tj ET Q q n 0 564.6 m 612 564.6 l 612 552.6 l 0 552.6 l h W n Q q n 0 552.6 m 612 552.6 l 612 540.6 l 0 540.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 543.01 Tm (PROOF) Tj ET BT /F2 12 Tf 1 0 0 1 45.52 543.01 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 65.7 543.01 Tm (CLAIM.) Tj ET BT /F3 12 Tf 1 0 0 1 117.08 543.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 139.26 543.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 189.45 543.01 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 216.31 543.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 231.15 543.01 Tm (given) Tj ET BT /F3 12 Tf 1 0 0 1 261.34 543.01 Tm (written) Tj ET BT /F3 12 Tf 1 0 0 1 298.85 543.01 Tm (proof) Tj ET BT /F3 12 Tf 1 0 0 1 328.36 543.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 341.88 543.01 Tm (claim) Tj ET BT /F3 12 Tf 1 0 0 1 372.06 543.01 Tm (within) Tj ET BT /F3 12 Tf 1 0 0 1 406.25 543.01 Tm (90) Tj ET BT /F3 12 Tf 1 0 0 1 421.77 543.01 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 447.29 543.01 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 472.79 543.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 490.97 543.01 Tm (end) Tj ET BT /F3 12 Tf 1 0 0 1 511.82 543.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 543.01 Tm (the) Tj ET Q q n 0 540.6 m 612 540.6 l 612 528.6 l 0 528.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 531.01 Tm (Elimination) Tj ET BT /F3 12 Tf 1 0 0 1 59.86 531.01 Tm (Period.) Tj ET BT /F3 12 Tf 1 0 0 1 100.59 531.01 Tm (When) Tj ET BT /F3 12 Tf 1 0 0 1 132.44 531.01 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 142.31 531.01 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 153.51 531.01 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 172.04 531.01 Tm (reasonably) Tj ET BT /F3 12 Tf 1 0 0 1 227.22 531.01 Tm (possible) Tj ET BT /F3 12 Tf 1 0 0 1 269.75 531.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 282.28 531.01 Tm (give) Tj ET BT /F3 12 Tf 1 0 0 1 306.14 531.01 Tm (written) Tj ET BT /F3 12 Tf 1 0 0 1 343.33 531.01 Tm (proof) Tj ET BT /F3 12 Tf 1 0 0 1 372.52 531.01 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 385.06 531.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 402.92 531.01 Tm (time) Tj ET BT /F3 12 Tf 1 0 0 1 427.44 531.01 Tm (required,) Tj ET BT /F3 12 Tf 1 0 0 1 473.62 531.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 491.48 531.01 Tm (claim) Tj ET BT /F3 12 Tf 1 0 0 1 521.33 531.01 Tm (will) Tj ET Q q n 0 528.6 m 612 528.6 l 612 516.6 l 0 516.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 519.01 Tm (not be reduced or denied solely for this reason, if the proof is filed:) Tj ET Q q n 18 516.6 m 630 516.6 l 630 504.6 l 18 504.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 507.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 507.01 Tm (as soon as reasonably possible; and) Tj ET Q q n 18 504.6 m 630 504.6 l 630 492.6 l 18 492.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 495.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 495.01 Tm (in no event later than one year after it was required.) Tj ET Q q n 0 492.6 m 612 492.6 l 612 480.6 l 0 480.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 483.01 Tm (These time limits will not apply while an Insured Employee lacks legal capacity.) Tj ET Q q n 0 480.6 m 612 480.6 l 612 468.6 l 0 468.6 l h W n Q q n 0 468.6 m 612 468.6 l 612 456.6 l 0 456.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 459.01 Tm (Proof) Tj ET BT /F3 12 Tf 1 0 0 1 30.33 459.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 43.99 459.01 Tm (claim) Tj ET BT /F3 12 Tf 1 0 0 1 74.31 459.01 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 101.31 459.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 116.3 459.01 Tm (provided) Tj ET BT /F3 12 Tf 1 0 0 1 162.62 459.01 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 174.95 459.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 193.27 459.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 232.92 459.01 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 292.07 459.01 Tm (own) Tj ET BT /F3 12 Tf 1 0 0 1 316.4 459.01 Tm (expense.) Tj ET BT /F3 12 Tf 1 0 0 1 365.37 459.01 Tm (It) Tj ET BT /F3 12 Tf 1 0 0 1 376.37 459.01 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 403.37 459.01 Tm (show) Tj ET BT /F3 12 Tf 1 0 0 1 432.37 459.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 450.69 459.01 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 474.34 459.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 492.67 459.01 Tm (Disability) Tj ET Q q n 0 456.6 m 612 456.6 l 612 444.6 l 0 444.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 447.01 Tm (began, its cause and degree. Documentation must include:) Tj ET Q q n 18 444.6 m 630 444.6 l 630 432.6 l 18 432.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 435.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 435.01 Tm (completed statements by the Insured Employee and the Employer;) Tj ET Q q n 18 432.6 m 630 432.6 l 630 420.6 l 18 420.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 423.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 423.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 54.25 423.01 Tm (completed) Tj ET BT /F3 12 Tf 1 0 0 1 107.8 423.01 Tm (statement) Tj ET BT /F3 12 Tf 1 0 0 1 157.36 423.01 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 172.93 423.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 191.16 423.01 Tm (attending) Tj ET BT /F3 12 Tf 1 0 0 1 239.39 423.01 Tm (Physician,) Tj ET BT /F3 12 Tf 1 0 0 1 292.62 423.01 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 325.52 423.01 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 352.43 423.01 Tm (describe) Tj ET BT /F3 12 Tf 1 0 0 1 395.98 423.01 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 416.88 423.01 Tm (restrictions) Tj ET BT /F3 12 Tf 1 0 0 1 473.77 423.01 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 423.01 Tm (the) Tj ET Q q n 45.35 420.6 m 657.35 420.6 l 657.35 408.6 l 45.35 408.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 411.01 Tm (Insured Employee's performance of the duties of his or her Regular Occupation;) Tj ET Q q n 18 408.6 m 630 408.6 l 630 396.6 l 18 396.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 399.01 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 399.01 Tm (proof of any other income received;) Tj ET Q q n 18 396.6 m 630 396.6 l 630 384.6 l 18 384.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 387.01 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 387.01 Tm (proof of any benefits available from other income sources, which may affect Policy benefits;) Tj ET Q q n 18 384.6 m 630 384.6 l 630 372.6 l 18 372.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 375.01 Tm (5.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 375.01 Tm (a signed authorization for the Company to obtain more information; and) Tj ET Q q n 18 372.6 m 630 372.6 l 630 360.6 l 18 360.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 363.01 Tm (6.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 363.01 Tm (any other items the Company may reasonably require in support of the claim.) Tj ET Q q n 0 360.6 m 612 360.6 l 612 348.6 l 0 348.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 351.01 Tm (Proof) Tj ET BT /F3 12 Tf 1 0 0 1 30.3 351.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 43.93 351.01 Tm (continued) Tj ET BT /F3 12 Tf 1 0 0 1 94.89 351.01 Tm (Disability,) Tj ET BT /F3 12 Tf 1 0 0 1 148.85 351.01 Tm (Regular) Tj ET BT /F3 12 Tf 1 0 0 1 190.48 351.01 Tm (Care) Tj ET BT /F3 12 Tf 1 0 0 1 216.76 351.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 230.39 351.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 239.36 351.01 Tm (Physician,) Tj ET BT /F3 12 Tf 1 0 0 1 292.65 351.01 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 313.62 351.01 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 334.58 351.01 Tm (Other) Tj ET BT /F3 12 Tf 1 0 0 1 365.53 351.01 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 405.15 351.01 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 448.78 351.01 Tm (affecting) Tj ET BT /F3 12 Tf 1 0 0 1 495.05 351.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 513.35 351.01 Tm (claim) Tj ET Q q n 0 348.6 m 612 348.6 l 612 336.6 l 0 336.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 339.01 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 26.4 339.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 40.79 339.01 Tm (given) Tj ET BT /F3 12 Tf 1 0 0 1 70.51 339.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 82.9 339.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 100.62 339.01 Tm (Company.) Tj ET BT /F3 12 Tf 1 0 0 1 156.41 339.01 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 180.8 339.01 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 207.2 339.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 221.59 339.01 Tm (supplied) Tj ET BT /F3 12 Tf 1 0 0 1 265.31 339.01 Tm (within) Tj ET BT /F3 12 Tf 1 0 0 1 299.04 339.01 Tm (45) Tj ET BT /F3 12 Tf 1 0 0 1 314.1 339.01 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 339.16 339.01 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 364.2 339.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 381.92 339.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 431.65 339.01 Tm (requests) Tj ET BT /F3 12 Tf 1 0 0 1 474.03 339.01 Tm (it.) Tj ET BT /F3 12 Tf 1 0 0 1 489.82 339.01 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 500.87 339.01 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 510.6 339.01 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 521.67 339.01 Tm (not,) Tj ET Q q n 0 336.6 m 612 336.6 l 612 324.6 l 0 324.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 327.01 Tm (benefits may be denied or suspended.) Tj ET Q q n 0 324.6 m 612 324.6 l 612 312.6 l 0 312.6 l h W n Q q n 0 312.6 m 612 312.6 l 612 300.6 l 0 300.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 303.01 Tm (EXAMINATION.) Tj ET BT /F3 12 Tf 1 0 0 1 98.34 303.01 Tm (The Company may have the Insured Employee examined:) Tj ET Q q n 18 300.6 m 630 300.6 l 630 288.6 l 18 288.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 291.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 291.01 Tm (by a Physician, specialist or vocational rehabilitation expert of the Company's choice;) Tj ET Q q n 18 288.6 m 630 288.6 l 630 276.6 l 18 276.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 279.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 279.01 Tm (as often as reasonably required while a claim or appeal is pending.) Tj ET Q q n 0 276.6 m 612 276.6 l 612 264.6 l 0 264.6 l h W n Q q n 0 264.6 m 612 264.6 l 612 252.6 l 0 252.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 255.01 Tm (Any such exam will be at the Company's expense.) Tj ET Q q n 0 252.6 m 612 252.6 l 612 240.6 l 0 240.6 l h W n Q q n 0 240.6 m 612 240.6 l 612 228.6 l 0 228.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 231.01 Tm (The Company may determine that \(in its opinion\) the Insured Employee has:) Tj ET Q q n 18 228.6 m 630 228.6 l 630 216.6 l 18 216.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 219.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 219.01 Tm (failed to cooperate with an examiner;) Tj ET Q q n 18 216.6 m 630 216.6 l 630 204.6 l 18 204.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 207.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 207.01 Tm (failed to take an exam scheduled by the Company; or) Tj ET Q q n 18 204.6 m 630 204.6 l 630 192.6 l 18 192.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 195.01 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 195.01 Tm (postponed such an exam more than twice.) Tj ET Q q n 0 192.6 m 612 192.6 l 612 180.6 l 0 180.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 183.01 Tm (In that event, benefits may be denied or suspended, until the required exam is completed.) Tj ET Q q n 0 180.6 m 612 180.6 l 612 168.6 l 0 168.6 l h W n Q q n 0 168.6 m 612 168.6 l 612 156.6 l 0 156.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 159.01 Tm (TIME) Tj ET BT /F2 12 Tf 1 0 0 1 36.12 159.01 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 56.89 159.01 Tm (PAYMENT) Tj ET BT /F2 12 Tf 1 0 0 1 121.66 159.01 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 142.44 159.01 Tm (CLAIMS.) Tj ET BT /F3 12 Tf 1 0 0 1 201.66 159.01 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 245.77 159.01 Tm (payable) Tj ET BT /F3 12 Tf 1 0 0 1 287.19 159.01 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 318.62 159.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 337.39 159.01 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 372.17 159.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 394.95 159.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 410.39 159.01 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 435.16 159.01 Tm (immediately) Tj ET BT /F3 12 Tf 1 0 0 1 499.25 159.01 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 159.01 Tm (the) Tj ET Q q n 0 156.6 m 612 156.6 l 612 144.6 l 0 144.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 147.01 Tm (Company receives complete proof of claim and confirms liability.) Tj ET BT /F3 12 Tf 1 0 0 1 322.9 147.01 Tm (After that:) Tj ET Q q n 18 144.6 m 630 144.6 l 630 132.6 l 18 132.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 135.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 135.01 Tm (Any) Tj ET BT /F3 12 Tf 1 0 0 1 70.81 135.01 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 113.59 135.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 137.06 135.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 153.18 135.01 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 178.64 135.01 Tm (monthly,) Tj ET BT /F3 12 Tf 1 0 0 1 226.44 135.01 Tm (during) Tj ET BT /F3 12 Tf 1 0 0 1 262.56 135.01 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 284.68 135.01 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 320.14 135.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 338.92 135.01 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 373.05 135.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 392.5 135.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 443.96 135.01 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 456.76 135.01 Tm (liable.) Tj ET BT /F3 12 Tf 1 0 0 1 496.01 135.01 Tm (If) Tj ET Q q n 45.35 132.6 m 657.35 132.6 l 657.35 120.6 l 45.35 120.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 123.01 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 86.58 123.01 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 104.47 123.01 Tm (due) Tj ET BT /F3 12 Tf 1 0 0 1 125.04 123.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 142.28 123.01 Tm (less) Tj ET BT /F3 12 Tf 1 0 0 1 163.52 123.01 Tm (than) Tj ET BT /F3 12 Tf 1 0 0 1 187.43 123.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 196 123.01 Tm (month,) Tj ET BT /F3 12 Tf 1 0 0 1 232.91 123.01 Tm (they) Tj ET BT /F3 12 Tf 1 0 0 1 256.81 123.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 278.73 123.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 293.3 123.01 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 317.2 123.01 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 332.44 123.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 341.01 123.01 Tm (pro) Tj ET BT /F3 12 Tf 1 0 0 1 360.25 123.01 Tm (rata) Tj ET BT /F3 12 Tf 1 0 0 1 381.48 123.01 Tm (basis.) Tj ET BT /F3 12 Tf 1 0 0 1 414.97 123.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 436.87 123.01 Tm (daily) Tj ET BT /F3 12 Tf 1 0 0 1 464.11 123.01 Tm (rate) Tj ET BT /F3 12 Tf 1 0 0 1 485.33 123.01 Tm (will) Tj ET Q q n 45.35 120.6 m 657.35 120.6 l 657.35 108.6 l 45.35 108.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 111.01 Tm (equal 1/30 of the Monthly Benefit.) Tj ET Q q n 18 108.6 m 630 108.6 l 630 96.6 l 18 96.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 99.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 99.01 Tm (Any) Tj ET BT /F3 12 Tf 1 0 0 1 72.78 99.01 Tm (balance,) Tj ET BT /F3 12 Tf 1 0 0 1 119.18 99.01 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 155.27 99.01 Tm (remains) Tj ET BT /F3 12 Tf 1 0 0 1 200.02 99.01 Tm (unpaid) Tj ET BT /F3 12 Tf 1 0 0 1 239.44 99.01 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 254.86 99.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 276.28 99.01 Tm (end) Tj ET BT /F3 12 Tf 1 0 0 1 300.37 99.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 317.13 99.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 338.55 99.01 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 375.97 99.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 392.73 99.01 Tm (liability,) Tj ET BT /F3 12 Tf 1 0 0 1 439.82 99.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 465.25 99.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 483.34 99.01 Tm (paid) Tj ET Q q n 45.35 96.6 m 657.35 96.6 l 657.35 84.6 l 45.35 84.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 87.01 Tm (immediately after the Company receives complete proof of claim and confirms liability.) Tj ET Q q n 0 84.6 m 612 84.6 l 612 72.6 l 0 72.6 l h W n Q Q q Q Q endstream endobj 13 0 obj <>>>>> endobj 142 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 734.4 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 203.16 26.41 Tm (CLAIMS PROCEDURES) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 239 14.41 Tm (\(Continued\)) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-6 04 PA) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 265 14.41 Tm (11) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 676.8 m 612 676.8 l 612 664.8 l 0 664.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 667.21 Tm (TO) Tj ET BT /F2 12 Tf 1 0 0 1 21.84 667.21 Tm (WHOM) Tj ET BT /F2 12 Tf 1 0 0 1 68.34 667.21 Tm (PAYABLE.) Tj ET BT /F3 12 Tf 1 0 0 1 137.7 667.21 Tm (All) Tj ET BT /F3 12 Tf 1 0 0 1 157.54 667.21 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 200.03 667.21 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 219.18 667.21 Tm (payable) Tj ET BT /F3 12 Tf 1 0 0 1 261 667.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 274.84 667.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 294.01 667.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 334.5 667.21 Tm (Employee,) Tj ET BT /F3 12 Tf 1 0 0 1 390.66 667.21 Tm (while) Tj ET BT /F3 12 Tf 1 0 0 1 421.83 667.21 Tm (living.) Tj ET BT /F3 12 Tf 1 0 0 1 461.84 667.21 Tm (After) Tj ET BT /F3 12 Tf 1 0 0 1 491.67 667.21 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 510.18 667.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 524.68 667.21 Tm (her) Tj ET Q q n 0 664.8 m 612 664.8 l 612 652.8 l 0 652.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 655.21 Tm (death, benefits will be payable as follows.) Tj ET Q q n 18 652.8 m 630 652.8 l 630 640.8 l 18 640.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 643.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 643.21 Tm (Any Survivor Benefit will be payable in accord with that section.) Tj ET Q q n 18 640.8 m 630 640.8 l 630 628.8 l 18 628.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 631.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 631.21 Tm (Any other benefits will be payable to the Insured Employee's estate.) Tj ET Q q n 0 628.8 m 612 628.8 l 612 616.8 l 0 616.8 l h W n Q q n 0 616.8 m 612 616.8 l 612 604.8 l 0 604.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 607.21 Tm (If a benefit becomes payable to:) Tj ET Q q n 18 604.8 m 630 604.8 l 630 592.8 l 18 592.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 595.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 595.21 Tm (the Insured Employee's estate; or) Tj ET Q q n 18 592.8 m 630 592.8 l 630 580.8 l 18 580.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 583.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 583.21 Tm (a minor or any other person who is not legally competent to give a valid receipt;) Tj ET Q q n 0 580.8 m 612 580.8 l 612 568.8 l 0 568.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 571.21 Tm (then) Tj ET BT /F3 12 Tf 1 0 0 1 25.49 571.21 Tm (up) Tj ET BT /F3 12 Tf 1 0 0 1 42.32 571.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 56.49 571.21 Tm ($2,000) Tj ET BT /F3 12 Tf 1 0 0 1 94.32 571.21 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 119.81 571.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 135.97 571.21 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 161.46 571.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 175.62 571.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 197.78 571.21 Tm (relative) Tj ET BT /F3 12 Tf 1 0 0 1 238.59 571.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 253.41 571.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 272.9 571.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 313.72 571.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 367.21 571.21 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 390.03 571.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 409.52 571.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 461.02 571.21 Tm (finds) Tj ET BT /F3 12 Tf 1 0 0 1 489.85 571.21 Tm (entitled) Tj ET BT /F3 12 Tf 1 0 0 1 530.67 571.21 Tm (to) Tj ET Q q n 0 568.8 m 612 568.8 l 612 556.8 l 0 556.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 559.21 Tm (payment.) Tj ET BT /F3 12 Tf 1 0 0 1 52.46 559.21 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 64.52 559.21 Tm (payment) Tj ET BT /F3 12 Tf 1 0 0 1 109.91 559.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 121.99 559.21 Tm (made) Tj ET BT /F3 12 Tf 1 0 0 1 152.04 559.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 165.45 559.21 Tm (good) Tj ET BT /F3 12 Tf 1 0 0 1 193.52 559.21 Tm (faith) Tj ET BT /F3 12 Tf 1 0 0 1 219.58 559.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 232.98 559.21 Tm (such) Tj ET BT /F3 12 Tf 1 0 0 1 259.05 559.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 268.44 559.21 Tm (relative,) Tj ET BT /F3 12 Tf 1 0 0 1 311.49 559.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 330.22 559.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 380.96 559.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 403.69 559.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 423.1 559.21 Tm (have) Tj ET BT /F3 12 Tf 1 0 0 1 449.82 559.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 463.22 559.21 Tm (pay) Tj ET BT /F3 12 Tf 1 0 0 1 484.62 559.21 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 506.68 559.21 Tm (benefit) Tj ET Q q n 0 556.8 m 612 556.8 l 612 544.8 l 0 544.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 547.21 Tm (again.) Tj ET Q q n 0 544.8 m 612 544.8 l 612 532.8 l 0 532.8 l h W n Q q n 0 532.8 m 612 532.8 l 612 520.8 l 0 520.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 523.21 Tm (NOTICE) Tj ET BT /F2 12 Tf 1 0 0 1 52.16 523.21 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 73.64 523.21 Tm (CLAIM) Tj ET BT /F2 12 Tf 1 0 0 1 119.79 523.21 Tm (DECISION.) Tj ET BT /F3 12 Tf 1 0 0 1 191.77 523.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 215.24 523.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 266.72 523.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 290.21 523.21 Tm (send) Tj ET BT /F3 12 Tf 1 0 0 1 317.02 523.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 336.49 523.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 377.3 523.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 430.77 523.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 440.91 523.21 Tm (written) Tj ET BT /F3 12 Tf 1 0 0 1 479.71 523.21 Tm (notice) Tj ET BT /F3 12 Tf 1 0 0 1 513.85 523.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 528.66 523.21 Tm (its) Tj ET Q q n 0 520.8 m 612 520.8 l 612 508.8 l 0 508.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 511.21 Tm (claim decision.) Tj ET BT /F3 12 Tf 1 0 0 1 78.64 511.21 Tm (If the Company denies any part of the claim, the written notice will explain:) Tj ET Q q n 18 508.8 m 630 508.8 l 630 496.8 l 18 496.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 499.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 499.21 Tm (the reason for the denial, under the terms of the Policy and any internal guidelines;) Tj ET Q q n 18 496.8 m 630 496.8 l 630 484.8 l 18 484.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 487.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 487.21 Tm (how the Insured Employee may request a review of the Company's decision; and) Tj ET Q q n 18 484.8 m 630 484.8 l 630 472.8 l 18 472.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 475.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 475.21 Tm (whether more information is needed to support the claim.) Tj ET Q q n 0 472.8 m 612 472.8 l 612 460.8 l 0 460.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 463.21 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 25.48 463.21 Tm (notice) Tj ET BT /F3 12 Tf 1 0 0 1 58.95 463.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 81.77 463.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 97.24 463.21 Tm (sent) Tj ET BT /F3 12 Tf 1 0 0 1 120.72 463.21 Tm (within) Tj ET BT /F3 12 Tf 1 0 0 1 155.53 463.21 Tm (15) Tj ET BT /F3 12 Tf 1 0 0 1 171.68 463.21 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 197.82 463.21 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 223.95 463.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 242.76 463.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 293.57 463.21 Tm (resolves) Tj ET BT /F3 12 Tf 1 0 0 1 337.04 463.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 355.85 463.21 Tm (claim.) Tj ET BT /F3 12 Tf 1 0 0 1 393.8 463.21 Tm (It) Tj ET BT /F3 12 Tf 1 0 0 1 405.27 463.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 428.09 463.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 443.56 463.21 Tm (sent) Tj ET BT /F3 12 Tf 1 0 0 1 467.04 463.21 Tm (within) Tj ET BT /F3 12 Tf 1 0 0 1 501.86 463.21 Tm (45) Tj ET BT /F3 12 Tf 1 0 0 1 518 463.21 Tm (days) Tj ET Q q n 0 460.8 m 612 460.8 l 612 448.8 l 0 448.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 451.21 Tm (after the Company receives the first proof of claim, if reasonably possible.) Tj ET Q q n 0 448.8 m 612 448.8 l 612 436.8 l 0 436.8 l h W n Q q n 0 436.8 m 612 436.8 l 612 424.8 l 0 424.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 427.21 Tm (Delay) Tj ET BT /F2 12 Tf 1 0 0 1 34 427.21 Tm (Notice.) Tj ET BT /F3 12 Tf 1 0 0 1 79 427.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 102.33 427.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 153.66 427.21 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 179 427.21 Tm (need) Tj ET BT /F3 12 Tf 1 0 0 1 206.32 427.21 Tm (more) Tj ET BT /F3 12 Tf 1 0 0 1 235.65 427.21 Tm (than) Tj ET BT /F3 12 Tf 1 0 0 1 260.99 427.21 Tm (15) Tj ET BT /F3 12 Tf 1 0 0 1 277.66 427.21 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 304.33 427.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 318.34 427.21 Tm (process) Tj ET BT /F3 12 Tf 1 0 0 1 359 427.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 378.33 427.21 Tm (claim,) Tj ET BT /F3 12 Tf 1 0 0 1 412.66 427.21 Tm (due) Tj ET BT /F3 12 Tf 1 0 0 1 434.66 427.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 448.67 427.21 Tm (matters) Tj ET BT /F3 12 Tf 1 0 0 1 488.66 427.21 Tm (beyond) Tj ET BT /F3 12 Tf 1 0 0 1 528.66 427.21 Tm (its) Tj ET Q q n 0 424.8 m 612 424.8 l 612 412.8 l 0 412.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 415.21 Tm (control.) Tj ET BT /F3 12 Tf 1 0 0 1 45.14 415.21 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 57.2 415.21 Tm (so,) Tj ET BT /F3 12 Tf 1 0 0 1 74.94 415.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 90.34 415.21 Tm (extension) Tj ET BT /F3 12 Tf 1 0 0 1 140.41 415.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 163.15 415.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 178.55 415.21 Tm (permitted.) Tj ET BT /F3 12 Tf 1 0 0 1 235.68 415.21 Tm (In) Tj ET BT /F3 12 Tf 1 0 0 1 249.75 415.21 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 271.82 415.21 Tm (event,) Tj ET BT /F3 12 Tf 1 0 0 1 304.88 415.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 323.61 415.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 374.35 415.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 397.09 415.21 Tm (send) Tj ET BT /F3 12 Tf 1 0 0 1 423.16 415.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 441.89 415.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 481.95 415.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 534.67 415.21 Tm (a) Tj ET Q q n 0 412.8 m 612 412.8 l 612 400.8 l 0 400.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 403.21 Tm (written delay notice:) Tj ET Q q n 18 400.8 m 630 400.8 l 630 388.8 l 18 388.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 391.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 391.21 Tm (by the 15) Tj ET BT /F3 7.2 Tf 1 0 0 1 90.01 394.81 Tm (th) Tj ET BT /F3 12 Tf 1 0 0 1 95.61 391.21 Tm ( day after receiving the first proof of claim; and) Tj ET Q q n 18 388.8 m 630 388.8 l 630 376.8 l 18 376.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 379.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 379.21 Tm (every 30 days after that, until the claim is resolved.) Tj ET Q q n 0 376.8 m 612 376.8 l 612 364.8 l 0 364.8 l h W n Q q n 0 364.8 m 612 364.8 l 612 352.8 l 0 352.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 355.21 Tm (The notice will explain:) Tj ET Q q n 18 352.8 m 630 352.8 l 630 340.8 l 18 340.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 343.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 343.21 Tm (what additional information is needed to determine liability; and) Tj ET Q q n 18 340.8 m 630 340.8 l 630 328.8 l 18 328.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 331.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 331.21 Tm (when a decision can be expected.) Tj ET Q q n 0 328.8 m 612 328.8 l 612 316.8 l 0 316.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 319.21 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 11.01 319.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 28.68 319.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 67.68 319.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 119.34 319.21 Tm (does) Tj ET BT /F3 12 Tf 1 0 0 1 144.35 319.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 162.7 319.21 Tm (receive) Tj ET BT /F3 12 Tf 1 0 0 1 200.35 319.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 208.69 319.21 Tm (written) Tj ET BT /F3 12 Tf 1 0 0 1 245.69 319.21 Tm (decision) Tj ET BT /F3 12 Tf 1 0 0 1 288.7 319.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 303.71 319.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 321.38 319.21 Tm (105) Tj ET BT /F3 7.2 Tf 1 0 0 1 339.38 322.81 Tm (th) Tj ET BT /F3 12 Tf 1 0 0 1 348 319.21 Tm (day) Tj ET BT /F3 12 Tf 1 0 0 1 368.34 319.21 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 393.33 319.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 411 319.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 460.68 319.21 Tm (receives) Tj ET BT /F3 12 Tf 1 0 0 1 503 319.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 520.67 319.21 Tm (first) Tj ET Q q n 0 316.8 m 612 316.8 l 612 304.8 l 0 304.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 307.21 Tm (proof of claim, there is a right to an immediate review, as if the claim was denied.) Tj ET Q q n 0 304.8 m 612 304.8 l 612 292.8 l 0 292.8 l h W n Q q n 0 292.8 m 612 292.8 l 612 280.8 l 0 280.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 283.21 Tm (Exception:) Tj ET BT /F3 12 Tf 1 0 0 1 62.01 283.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 84.01 283.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 134.01 283.21 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 158.01 283.21 Tm (need) Tj ET BT /F3 12 Tf 1 0 0 1 184.01 283.21 Tm (more) Tj ET BT /F3 12 Tf 1 0 0 1 212 283.21 Tm (information) Tj ET BT /F3 12 Tf 1 0 0 1 272 283.21 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 298.66 283.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 316.66 283.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 355.99 283.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 407.98 283.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 420.66 283.21 Tm (process) Tj ET BT /F3 12 Tf 1 0 0 1 459.99 283.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 468.65 283.21 Tm (claim.) Tj ET BT /F3 12 Tf 1 0 0 1 504.99 283.21 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 516.32 283.21 Tm (so,) Tj ET BT /F3 12 Tf 1 0 0 1 533.33 283.21 Tm (it) Tj ET Q q n 0 280.8 m 612 280.8 l 612 268.8 l 0 268.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 271.21 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 26.9 271.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 41.8 271.21 Tm (supplied) Tj ET BT /F3 12 Tf 1 0 0 1 86.03 271.21 Tm (within) Tj ET BT /F3 12 Tf 1 0 0 1 120.26 271.21 Tm (45) Tj ET BT /F3 12 Tf 1 0 0 1 135.83 271.21 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 161.39 271.21 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 186.94 271.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 205.16 271.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 255.39 271.21 Tm (requests) Tj ET BT /F3 12 Tf 1 0 0 1 298.28 271.21 Tm (it.) Tj ET BT /F3 12 Tf 1 0 0 1 315.08 271.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 337.31 271.21 Tm (resulting) Tj ET BT /F3 12 Tf 1 0 0 1 382.87 271.21 Tm (delay) Tj ET BT /F3 12 Tf 1 0 0 1 412.42 271.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 434.65 271.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 453.55 271.21 Tm (count) Tj ET BT /F3 12 Tf 1 0 0 1 483.78 271.21 Tm (towards) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 271.21 Tm (the) Tj ET Q q n 0 268.8 m 612 268.8 l 612 256.8 l 0 256.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 259.21 Tm (above time limits for claim processing.) Tj ET Q q n 0 256.8 m 612 256.8 l 612 244.8 l 0 244.8 l h W n Q q n 0 244.8 m 612 244.8 l 612 232.8 l 0 232.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 235.21 Tm (REVIEW) Tj ET BT /F2 12 Tf 1 0 0 1 53.31 235.21 Tm (PROCEDURE.) Tj ET BT /F3 12 Tf 1 0 0 1 138.91 235.21 Tm (Within) Tj ET BT /F3 12 Tf 1 0 0 1 175.53 235.21 Tm (180) Tj ET BT /F3 12 Tf 1 0 0 1 196.83 235.21 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 222.12 235.21 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 247.4 235.21 Tm (receiving) Tj ET BT /F3 12 Tf 1 0 0 1 295.34 235.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 303.96 235.21 Tm (denial) Tj ET BT /F3 12 Tf 1 0 0 1 336.58 235.21 Tm (notice,) Tj ET BT /F3 12 Tf 1 0 0 1 372.2 235.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 390.16 235.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 429.44 235.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 481.39 235.21 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 505.35 235.21 Tm (request) Tj ET Q q n 0 232.8 m 612 232.8 l 612 220.8 l 0 220.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 223.21 Tm (a claim review by sending the Company:) Tj ET Q q n 18 220.8 m 630 220.8 l 630 208.8 l 18 208.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 211.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 211.21 Tm (a written request; and) Tj ET Q q n 18 208.8 m 630 208.8 l 630 196.8 l 18 196.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 199.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 199.21 Tm (any written comments or other items to support the claim.) Tj ET Q q n 0 196.8 m 612 196.8 l 612 184.8 l 0 184.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 187.21 Tm (The Insured Employee may review certain non-privileged information relating to the request for review.) Tj ET Q q n 0 184.8 m 612 184.8 l 612 172.8 l 0 172.8 l h W n Q q n 0 172.8 m 612 172.8 l 612 160.8 l 0 160.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 163.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 21.95 163.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 71.9 163.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 93.86 163.21 Tm (review) Tj ET BT /F3 12 Tf 1 0 0 1 129.79 163.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 147.74 163.21 Tm (claim) Tj ET BT /F3 12 Tf 1 0 0 1 177.69 163.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 198.3 163.21 Tm (send) Tj ET BT /F3 12 Tf 1 0 0 1 223.59 163.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 241.53 163.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 280.81 163.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 332.75 163.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 341.37 163.21 Tm (written) Tj ET BT /F3 12 Tf 1 0 0 1 378.65 163.21 Tm (notice) Tj ET BT /F3 12 Tf 1 0 0 1 411.25 163.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 424.54 163.21 Tm (its) Tj ET BT /F3 12 Tf 1 0 0 1 439.17 163.21 Tm (decision.) Tj ET BT /F3 12 Tf 1 0 0 1 488.73 163.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 510.68 163.21 Tm (notice) Tj ET Q q n 0 160.8 m 612 160.8 l 612 148.8 l 0 148.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 151.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 22.25 151.21 Tm (state) Tj ET BT /F3 12 Tf 1 0 0 1 47.81 151.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 66.05 151.21 Tm (reasons) Tj ET BT /F3 12 Tf 1 0 0 1 105.62 151.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 123.19 151.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 141.42 151.21 Tm (Company's) Tj ET BT /F3 12 Tf 1 0 0 1 198.5 151.21 Tm (decision,) Tj ET BT /F3 12 Tf 1 0 0 1 245.06 151.21 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 275.96 151.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 294.2 151.21 Tm (terms) Tj ET BT /F3 12 Tf 1 0 0 1 324.44 151.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 338.01 151.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 356.25 151.21 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 390.49 151.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 411.4 151.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 432.3 151.21 Tm (internal) Tj ET BT /F3 12 Tf 1 0 0 1 472.53 151.21 Tm (guidelines.) Tj ET BT /F3 12 Tf 1 0 0 1 532.01 151.21 Tm (If) Tj ET Q q n 0 148.8 m 612 148.8 l 612 136.8 l 0 136.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 139.21 Tm (the Company upholds the denial of all or part of the claim, the notice will also describe:) Tj ET Q q n 18 136.8 m 630 136.8 l 630 124.8 l 18 124.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 127.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 127.21 Tm (any further appeal procedures available under the Policy;) Tj ET Q q n 18 124.8 m 630 124.8 l 630 112.8 l 18 112.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 115.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 115.21 Tm (the right to access relevant claim information; and) Tj ET Q q n 18 112.8 m 630 112.8 l 630 100.8 l 18 100.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 103.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 103.21 Tm (the right to request a state insurance department review, or to bring legal action.) Tj ET Q q n 0 100.8 m 612 100.8 l 612 88.8 l 0 88.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 91.21 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 24.5 91.21 Tm (notice) Tj ET BT /F3 12 Tf 1 0 0 1 56.99 91.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 78.82 91.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 93.31 91.21 Tm (sent) Tj ET BT /F3 12 Tf 1 0 0 1 115.81 91.21 Tm (within) Tj ET BT /F3 12 Tf 1 0 0 1 149.64 91.21 Tm (45) Tj ET BT /F3 12 Tf 1 0 0 1 164.81 91.21 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 189.97 91.21 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 215.11 91.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 232.94 91.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 282.77 91.21 Tm (receives) Tj ET BT /F3 12 Tf 1 0 0 1 325.24 91.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 343.07 91.21 Tm (request) Tj ET BT /F3 12 Tf 1 0 0 1 380.88 91.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 398.04 91.21 Tm (review,) Tj ET BT /F3 12 Tf 1 0 0 1 436.86 91.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 450.02 91.21 Tm (within) Tj ET BT /F3 12 Tf 1 0 0 1 483.85 91.21 Tm (90) Tj ET BT /F3 12 Tf 1 0 0 1 499.02 91.21 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 524.18 91.21 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 534.67 91.21 Tm (a) Tj ET Q q n 0 88.8 m 612 88.8 l 612 76.8 l 0 76.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 79.2 Tm (special case requires more time.) Tj ET Q q n 0 76.79 m 612 76.79 l 612 64.79 l 0 64.79 l h W n Q q n 0 64.79 m 612 64.79 l 612 52.79 l 0 52.79 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 55.2 Tm (Delay Notice.) Tj ET BT /F3 12 Tf 1 0 0 1 73.97 55.2 Tm (If the Company needs) Tj ET BT /F3 12 Tf 1 0 0 1 182.61 55.2 Tm (more than 45 days to process an appeal, in a special case:) Tj ET Q q n 18 52.79 m 630 52.79 l 630 40.79 l 18 40.79 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 43.2 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 43.2 Tm (an extension of up to 45 more days will be permitted; and) Tj ET Q q n 18 40.79 m 630 40.79 l 630 28.79 l 18 28.79 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 31.2 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 31.2 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 65.09 31.2 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 116.83 31.2 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 140.58 31.2 Tm (send) Tj ET BT /F3 12 Tf 1 0 0 1 167.65 31.2 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 187.39 31.2 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 228.46 31.2 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 282.19 31.2 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 292.59 31.2 Tm (written) Tj ET BT /F3 12 Tf 1 0 0 1 331.66 31.2 Tm (delay) Tj ET BT /F3 12 Tf 1 0 0 1 362.72 31.2 Tm (notice,) Tj ET BT /F3 12 Tf 1 0 0 1 400.12 31.2 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 417.2 31.2 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 436.94 31.2 Tm (30) Tj ET BT /F3 7.2 Tf 1 0 0 1 448.94 34.8 Tm (th) Tj ET BT /F3 12 Tf 1 0 0 1 459.62 31.2 Tm (day) Tj ET BT /F3 12 Tf 1 0 0 1 482.02 31.2 Tm (after) Tj ET Q q n 45.35 28.8 m 657.35 28.8 l 657.35 16.8 l 45.35 16.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 19.2 Tm (receiving the request for review.) Tj ET Q q n 0 16.8 m 612 16.8 l 612 4.8 l 0 4.8 l h W n Q Q q Q Q endstream endobj 14 0 obj <>>>>> endobj 143 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 734.4 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 203.16 26.41 Tm (CLAIMS PROCEDURES) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 239 14.41 Tm (\(Continued\)) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-6 04 PA) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 265 14.41 Tm (12) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 676.8 m 612 676.8 l 612 664.8 l 0 664.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 667.21 Tm (The notice will explain:) Tj ET Q q n 18 664.8 m 630 664.8 l 630 652.8 l 18 652.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 655.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 655.21 Tm (the special circumstances which require the delay;) Tj ET Q q n 18 652.8 m 630 652.8 l 630 640.8 l 18 640.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 643.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 643.21 Tm (whether more information is needed to review the claim; and) Tj ET Q q n 18 640.8 m 630 640.8 l 630 628.8 l 18 628.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 631.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 631.21 Tm (when a decision can be expected.) Tj ET Q q n 0 628.8 m 612 628.8 l 612 616.8 l 0 616.8 l h W n Q q n 0 616.8 m 612 616.8 l 612 604.8 l 0 604.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 607.21 Tm (Exception:) Tj ET BT /F3 12 Tf 1 0 0 1 61.94 607.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 83.9 607.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 133.87 607.21 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 157.83 607.21 Tm (need) Tj ET BT /F3 12 Tf 1 0 0 1 183.79 607.21 Tm (more) Tj ET BT /F3 12 Tf 1 0 0 1 211.75 607.21 Tm (information) Tj ET BT /F3 12 Tf 1 0 0 1 271.71 607.21 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 298.34 607.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 316.3 607.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 355.6 607.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 407.55 607.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 420.19 607.21 Tm (process) Tj ET BT /F3 12 Tf 1 0 0 1 459.48 607.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 474.11 607.21 Tm (appeal.) Tj ET BT /F3 12 Tf 1 0 0 1 515.03 607.21 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 526.33 607.21 Tm (so,) Tj ET Q q n 0 604.8 m 612 604.8 l 612 592.8 l 0 592.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 595.21 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 9.72 595.21 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 36.12 595.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 50.5 595.21 Tm (supplied) Tj ET BT /F3 12 Tf 1 0 0 1 94.22 595.21 Tm (within) Tj ET BT /F3 12 Tf 1 0 0 1 127.94 595.21 Tm (45) Tj ET BT /F3 12 Tf 1 0 0 1 142.99 595.21 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 168.04 595.21 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 193.08 595.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 210.79 595.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 260.51 595.21 Tm (requests) Tj ET BT /F3 12 Tf 1 0 0 1 302.89 595.21 Tm (it.) Tj ET BT /F3 12 Tf 1 0 0 1 318.67 595.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 340.38 595.21 Tm (resulting) Tj ET BT /F3 12 Tf 1 0 0 1 385.43 595.21 Tm (delay) Tj ET BT /F3 12 Tf 1 0 0 1 414.47 595.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 436.19 595.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 454.58 595.21 Tm (count) Tj ET BT /F3 12 Tf 1 0 0 1 484.29 595.21 Tm (towards) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 595.21 Tm (the) Tj ET Q q n 0 592.8 m 612 592.8 l 612 580.8 l 0 580.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 583.21 Tm (above time limits for appeal processing.) Tj ET Q q n 0 580.8 m 612 580.8 l 612 568.8 l 0 568.8 l h W n Q q n 0 568.8 m 612 568.8 l 612 556.8 l 0 556.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 559.21 Tm (Claims) Tj ET BT /F2 12 Tf 1 0 0 1 39.45 559.21 Tm (Subject) Tj ET BT /F2 12 Tf 1 0 0 1 81.56 559.21 Tm (to) Tj ET BT /F2 12 Tf 1 0 0 1 95 559.21 Tm (ERISA) Tj ET BT /F2 12 Tf 1 0 0 1 135.12 559.21 Tm (\() Tj ET BT /F3 12 Tf 1 0 0 1 139.12 559.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 191.21 559.21 Tm (Retirement) Tj ET BT /F3 12 Tf 1 0 0 1 247.97 559.21 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 287.4 559.21 Tm (Security) Tj ET BT /F3 12 Tf 1 0 0 1 330.84 559.21 Tm (Act) Tj ET BT /F3 12 Tf 1 0 0 1 351.61 559.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 365.05 559.21 Tm (1974\).) Tj ET BT /F3 12 Tf 1 0 0 1 402.93 559.21 Tm (Before) Tj ET BT /F3 12 Tf 1 0 0 1 439.03 559.21 Tm (bringing) Tj ET BT /F3 12 Tf 1 0 0 1 483.14 559.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 491.91 559.21 Tm (civil) Tj ET BT /F3 12 Tf 1 0 0 1 516.68 559.21 Tm (legal) Tj ET Q q n 0 556.8 m 612 556.8 l 612 544.8 l 0 544.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 547.21 Tm (action) Tj ET BT /F3 12 Tf 1 0 0 1 33.23 547.21 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 64.46 547.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 83.03 547.21 Tm (federal) Tj ET BT /F3 12 Tf 1 0 0 1 120.24 547.21 Tm (labor) Tj ET BT /F3 12 Tf 1 0 0 1 148.8 547.21 Tm (law) Tj ET BT /F3 12 Tf 1 0 0 1 170.04 547.21 Tm (known) Tj ET BT /F3 12 Tf 1 0 0 1 206.61 547.21 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 220.51 547.21 Tm (ERISA,) Tj ET BT /F3 12 Tf 1 0 0 1 262.09 547.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 277.32 547.21 Tm (employee) Tj ET BT /F3 12 Tf 1 0 0 1 327.88 547.21 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 365.1 547.21 Tm (plan) Tj ET BT /F3 12 Tf 1 0 0 1 389.67 547.21 Tm (participant) Tj ET BT /F3 12 Tf 1 0 0 1 444.89 547.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 458.79 547.21 Tm (beneficiary) Tj ET BT /F3 12 Tf 1 0 0 1 516.66 547.21 Tm (must) Tj ET Q q n 0 544.8 m 612 544.8 l 612 532.8 l 0 532.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 535.21 Tm (exhaust) Tj ET BT /F3 12 Tf 1 0 0 1 40.14 535.21 Tm (available) Tj ET BT /F3 12 Tf 1 0 0 1 86.92 535.21 Tm (administrative) Tj ET BT /F3 12 Tf 1 0 0 1 159.05 535.21 Tm (remedies.) Tj ET BT /F3 12 Tf 1 0 0 1 212.32 535.21 Tm (Under) Tj ET BT /F3 12 Tf 1 0 0 1 245.78 535.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 263.92 535.21 Tm (Policy,) Tj ET BT /F3 12 Tf 1 0 0 1 301.07 535.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 319.21 535.21 Tm (plan) Tj ET BT /F3 12 Tf 1 0 0 1 343.35 535.21 Tm (participant) Tj ET BT /F3 12 Tf 1 0 0 1 398.14 535.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 411.61 535.21 Tm (beneficiary) Tj ET BT /F3 12 Tf 1 0 0 1 469.05 535.21 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 495.87 535.21 Tm (first) Tj ET BT /F3 12 Tf 1 0 0 1 518.68 535.21 Tm (seek) Tj ET Q q n 0 532.8 m 612 532.8 l 612 520.8 l 0 520.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 523.21 Tm (two) Tj ET BT /F3 12 Tf 1 0 0 1 23.51 523.21 Tm (administrative) Tj ET BT /F3 12 Tf 1 0 0 1 97.67 523.21 Tm (reviews) Tj ET BT /F3 12 Tf 1 0 0 1 140.5 523.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 156 523.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 176.17 523.21 Tm (adverse) Tj ET BT /F3 12 Tf 1 0 0 1 218.33 523.21 Tm (claim) Tj ET BT /F3 12 Tf 1 0 0 1 250.49 523.21 Tm (decision,) Tj ET BT /F3 12 Tf 1 0 0 1 298.99 523.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 313.84 523.21 Tm (accord) Tj ET BT /F3 12 Tf 1 0 0 1 351.32 523.21 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 378.17 523.21 Tm (this) Tj ET BT /F3 12 Tf 1 0 0 1 401.01 523.21 Tm (section.) Tj ET BT /F3 12 Tf 1 0 0 1 449.02 523.21 Tm (After) Tj ET BT /F3 12 Tf 1 0 0 1 479.85 523.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 500.02 523.21 Tm (required) Tj ET Q q n 0 520.8 m 612 520.8 l 612 508.8 l 0 508.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 511.21 Tm (reviews:) Tj ET Q q n 18 508.8 m 630 508.8 l 630 496.8 l 18 496.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 499.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 499.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 62.33 499.21 Tm (ERISA) Tj ET BT /F3 12 Tf 1 0 0 1 102.65 499.21 Tm (plan) Tj ET BT /F3 12 Tf 1 0 0 1 128.96 499.21 Tm (participant) Tj ET BT /F3 12 Tf 1 0 0 1 185.92 499.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 201.57 499.21 Tm (beneficiary) Tj ET BT /F3 12 Tf 1 0 0 1 261.18 499.21 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 287.49 499.21 Tm (bring) Tj ET BT /F3 12 Tf 1 0 0 1 318.47 499.21 Tm (legal) Tj ET BT /F3 12 Tf 1 0 0 1 347.45 499.21 Tm (action) Tj ET BT /F3 12 Tf 1 0 0 1 382.42 499.21 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 415.39 499.21 Tm (Section) Tj ET BT /F3 12 Tf 1 0 0 1 457.04 499.21 Tm (502\(a\)) Tj ET BT /F3 12 Tf 1 0 0 1 494 499.21 Tm (of) Tj ET Q q n 45.35 496.8 m 657.35 496.8 l 657.35 484.8 l 45.35 484.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 487.21 Tm (ERISA; and) Tj ET Q q n 18 484.8 m 630 484.8 l 630 472.8 l 18 472.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 475.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 475.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 65.08 475.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 116.82 475.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 140.56 475.21 Tm (waive) Tj ET BT /F3 12 Tf 1 0 0 1 174.29 475.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 196.69 475.21 Tm (right) Tj ET BT /F3 12 Tf 1 0 0 1 224.42 475.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 238.83 475.21 Tm (assert) Tj ET BT /F3 12 Tf 1 0 0 1 271.22 475.21 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 294.29 475.21 Tm (he) Tj ET BT /F3 12 Tf 1 0 0 1 310.69 475.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 325.76 475.21 Tm (she) Tj ET BT /F3 12 Tf 1 0 0 1 346.83 475.21 Tm (failed) Tj ET BT /F3 12 Tf 1 0 0 1 379.22 475.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 393.62 475.21 Tm (exhaust) Tj ET BT /F3 12 Tf 1 0 0 1 435.35 475.21 Tm (administrative) Tj ET Q q n 45.35 472.8 m 657.35 472.8 l 657.35 460.8 l 45.35 460.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 463.21 Tm (remedies.) Tj ET Q q n 0 460.8 m 612 460.8 l 612 448.8 l 0 448.8 l h W n Q q n 0 448.8 m 612 448.8 l 612 436.8 l 0 436.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 439.21 Tm (RIGHT) Tj ET BT /F2 12 Tf 1 0 0 1 43.14 439.21 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 62.94 439.21 Tm (RECOVERY.) Tj ET BT /F3 12 Tf 1 0 0 1 140.87 439.21 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 151.99 439.21 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 193.11 439.21 Tm (have) Tj ET BT /F3 12 Tf 1 0 0 1 218.9 439.21 Tm (been) Tj ET BT /F3 12 Tf 1 0 0 1 244.68 439.21 Tm (overpaid) Tj ET BT /F3 12 Tf 1 0 0 1 289.79 439.21 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 304.92 439.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 325.38 439.21 Tm (long-term) Tj ET BT /F3 12 Tf 1 0 0 1 375.83 439.21 Tm (disability) Tj ET BT /F3 12 Tf 1 0 0 1 423.63 439.21 Tm (claim,) Tj ET BT /F3 12 Tf 1 0 0 1 456.42 439.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 474.21 439.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 524 439.21 Tm (has) Tj ET Q q n 0 436.8 m 612 436.8 l 612 424.8 l 0 424.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 427.21 Tm (the right to recover the excess from one or more of the following:) Tj ET Q q n 18 424.8 m 630 424.8 l 630 412.8 l 18 412.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 415.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 415.21 Tm (the Insured Employee, or his or her estate;) Tj ET Q q n 18 412.8 m 630 412.8 l 630 400.8 l 18 400.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 403.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 403.21 Tm (the Beneficiary, or his or her estate; or) Tj ET Q q n 18 400.8 m 630 400.8 l 630 388.8 l 18 388.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 391.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 391.21 Tm (an insurance company or other organization which has been overpaid.) Tj ET Q q n 18 388.8 m 630 388.8 l 630 376.8 l 18 376.8 l h W n Q q n 0 376.8 m 612 376.8 l 612 364.8 l 0 364.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 367.21 Tm (Such reimbursement is required whether the overpayment is due to:) Tj ET Q q n 18 364.8 m 630 364.8 l 630 352.8 l 18 352.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 355.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 355.21 Tm (the Company's error in processing a claim;) Tj ET Q q n 18 352.8 m 630 352.8 l 630 340.8 l 18 340.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 343.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 343.21 Tm (the Insured Employee's receipt of Other Income Benefits;) Tj ET Q q n 18 340.8 m 630 340.8 l 630 328.8 l 18 328.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 331.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 331.21 Tm (fraud, misrepresentation or omission of relevant facts; or) Tj ET Q q n 18 328.8 m 630 328.8 l 630 316.8 l 18 316.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 319.21 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 319.21 Tm (any other reason.) Tj ET Q q n 0 316.8 m 612 316.8 l 612 304.8 l 0 304.8 l h W n Q q n 0 304.8 m 612 304.8 l 612 292.8 l 0 292.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 295.21 Tm (LEGAL) Tj ET BT /F2 12 Tf 1 0 0 1 45.93 295.21 Tm (ACTIONS.) Tj ET BT /F3 12 Tf 1 0 0 1 111.43 295.21 Tm (No) Tj ET BT /F3 12 Tf 1 0 0 1 130.01 295.21 Tm (legal) Tj ET BT /F3 12 Tf 1 0 0 1 157.25 295.21 Tm (action) Tj ET BT /F3 12 Tf 1 0 0 1 190.48 295.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 203.73 295.21 Tm (recover) Tj ET BT /F3 12 Tf 1 0 0 1 243.62 295.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 264.86 295.21 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 306.76 295.21 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 331.33 295.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 346.57 295.21 Tm (brought) Tj ET BT /F3 12 Tf 1 0 0 1 387.81 295.21 Tm (until) Tj ET BT /F3 12 Tf 1 0 0 1 413.73 295.21 Tm (60) Tj ET BT /F3 12 Tf 1 0 0 1 429.65 295.21 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 455.56 295.21 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 481.45 295.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 500.02 295.21 Tm (required) Tj ET Q q n 0 292.8 m 612 292.8 l 612 280.8 l 0 280.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 283.21 Tm (written) Tj ET BT /F3 12 Tf 1 0 0 1 37.1 283.21 Tm (proof) Tj ET BT /F3 12 Tf 1 0 0 1 66.19 283.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 79.29 283.21 Tm (claim) Tj ET BT /F3 12 Tf 1 0 0 1 109.05 283.21 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 128.15 283.21 Tm (been) Tj ET BT /F3 12 Tf 1 0 0 1 153.91 283.21 Tm (given.) Tj ET BT /F3 12 Tf 1 0 0 1 189.78 283.21 Tm (No) Tj ET BT /F3 12 Tf 1 0 0 1 207.55 283.21 Tm (such) Tj ET BT /F3 12 Tf 1 0 0 1 232.65 283.21 Tm (legal) Tj ET BT /F3 12 Tf 1 0 0 1 259.08 283.21 Tm (action) Tj ET BT /F3 12 Tf 1 0 0 1 291.5 283.21 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 315.27 283.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 329.7 283.21 Tm (brought) Tj ET BT /F3 12 Tf 1 0 0 1 370.13 283.21 Tm (more) Tj ET BT /F3 12 Tf 1 0 0 1 397.89 283.21 Tm (than) Tj ET BT /F3 12 Tf 1 0 0 1 421.66 283.21 Tm (three) Tj ET BT /F3 12 Tf 1 0 0 1 448.74 283.21 Tm (years) Tj ET BT /F3 12 Tf 1 0 0 1 477.17 283.21 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 502.25 283.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 520.01 283.21 Tm (date) Tj ET Q q n 0 280.8 m 612 280.8 l 612 268.8 l 0 268.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 271.21 Tm (written proof of claim is required.) Tj ET Q q n 0 268.8 m 612 268.8 l 612 256.8 l 0 256.8 l h W n Q q n 0 256.8 m 612 256.8 l 612 244.8 l 0 244.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 247.21 Tm (COMPANY'S) Tj ET BT /F2 12 Tf 1 0 0 1 76.53 247.21 Tm (DISCRETIONARY) Tj ET BT /F2 12 Tf 1 0 0 1 182.41 247.21 Tm (AUTHORITY.) Tj ET BT /F3 12 Tf 1 0 0 1 267.16 247.21 Tm (Except) Tj ET BT /F3 12 Tf 1 0 0 1 304.34 247.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 322.2 247.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 340.73 247.21 Tm (functions) Tj ET BT /F3 12 Tf 1 0 0 1 389.26 247.21 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 411.12 247.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 429.65 247.21 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 464.18 247.21 Tm (clearly) Tj ET BT /F3 12 Tf 1 0 0 1 500.69 247.21 Tm (reserves) Tj ET Q q n 0 244.8 m 612 244.8 l 612 232.8 l 0 232.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 235.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 13.03 235.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 31.38 235.21 Tm (Policyholder) Tj ET BT /F3 12 Tf 1 0 0 1 96.4 235.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 110.09 235.21 Tm (Employer,) Tj ET BT /F3 12 Tf 1 0 0 1 164.1 235.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 182.46 235.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 232.81 235.21 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 252.5 235.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 270.86 235.21 Tm (authority) Tj ET BT /F3 12 Tf 1 0 0 1 317.88 235.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 330.9 235.21 Tm (manage) Tj ET BT /F3 12 Tf 1 0 0 1 371.91 235.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 390.26 235.21 Tm (Policy,) Tj ET BT /F3 12 Tf 1 0 0 1 427.63 235.21 Tm (interpret) Tj ET BT /F3 12 Tf 1 0 0 1 471.97 235.21 Tm (its) Tj ET BT /F3 12 Tf 1 0 0 1 487 235.21 Tm (provisions,) Tj ET Q q n 0 232.8 m 612 232.8 l 612 220.8 l 0 220.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 223.21 Tm (administer) Tj ET BT /F3 12 Tf 1 0 0 1 54.34 223.21 Tm (claims) Tj ET BT /F3 12 Tf 1 0 0 1 89.34 223.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 110.35 223.21 Tm (resolve) Tj ET BT /F3 12 Tf 1 0 0 1 148.69 223.21 Tm (questions) Tj ET BT /F3 12 Tf 1 0 0 1 197.71 223.21 Tm (arising) Tj ET BT /F3 12 Tf 1 0 0 1 234.05 223.21 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 265.05 223.21 Tm (it.) Tj ET BT /F3 12 Tf 1 0 0 1 282.09 223.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 304.43 223.21 Tm (Company's) Tj ET BT /F3 12 Tf 1 0 0 1 361.61 223.21 Tm (authority) Tj ET BT /F3 12 Tf 1 0 0 1 408.61 223.21 Tm (includes) Tj ET BT /F3 12 Tf 1 0 0 1 452.29 223.21 Tm (\(but) Tj ET BT /F3 12 Tf 1 0 0 1 475.3 223.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 486.99 223.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 506 223.21 Tm (limited) Tj ET Q q n 0 220.8 m 612 220.8 l 612 208.8 l 0 208.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 211.21 Tm (to\) the right to:) Tj ET Q q n 18 208.8 m 630 208.8 l 630 196.8 l 18 196.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 199.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 199.21 Tm (establish administrative procedures, determine eligibility and resolve claims questions;) Tj ET Q q n 18 196.8 m 630 196.8 l 630 184.8 l 18 184.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 187.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 187.21 Tm (determine what information the Company reasonably requires to make such decisions; and) Tj ET Q q n 18 184.8 m 630 184.8 l 630 172.8 l 18 172.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 175.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 175.21 Tm (resolve all matters when an internal claim review is requested.) Tj ET Q q n 0 172.8 m 612 172.8 l 612 160.8 l 0 160.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 163.21 Tm (Any) Tj ET BT /F3 12 Tf 1 0 0 1 23.93 163.21 Tm (decision) Tj ET BT /F3 12 Tf 1 0 0 1 67.19 163.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 85.11 163.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 135.04 163.21 Tm (makes) Tj ET BT /F3 12 Tf 1 0 0 1 168.97 163.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 181.57 163.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 199.49 163.21 Tm (exercise) Tj ET BT /F3 12 Tf 1 0 0 1 242.06 163.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 255.33 163.21 Tm (its) Tj ET BT /F3 12 Tf 1 0 0 1 269.93 163.21 Tm (authority) Tj ET BT /F3 12 Tf 1 0 0 1 316.52 163.21 Tm (shall) Tj ET BT /F3 12 Tf 1 0 0 1 342.45 163.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 357.04 163.21 Tm (conclusive) Tj ET BT /F3 12 Tf 1 0 0 1 411.62 163.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 432.22 163.21 Tm (binding;) Tj ET BT /F3 12 Tf 1 0 0 1 475.48 163.21 Tm (subject) Tj ET BT /F3 12 Tf 1 0 0 1 512.74 163.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 163.21 Tm (the) Tj ET Q q n 0 160.8 m 612 160.8 l 612 148.8 l 0 148.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 151.21 Tm (Insured Employee's rights to request a state insurance department review or to bring legal action.) Tj ET Q q n 0 148.8 m 612 148.8 l 612 136.8 l 0 136.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 139.21 Tm (This provision does not apply to residents of California.) Tj ET Q q n 0 136.8 m 612 136.8 l 612 124.8 l 0 124.8 l h W n Q Q q Q Q endstream endobj 15 0 obj <>>>>> endobj 144 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 758.4 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 231.65 2.41 Tm (ELIGIBILITY) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-7 04 PA) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 264 14.41 Tm (13) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 480 cm q n 0 276 m 612 276 l 612 264 l 0 264 l h W n Q q n 0 264 m 612 264 l 612 252 l 0 252 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 254.41 Tm (ELIGIBLE) Tj ET BT /F2 12 Tf 1 0 0 1 64.67 254.41 Tm (CLASSES.) Tj ET BT /F3 12 Tf 1 0 0 1 133 254.41 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 157.64 254.41 Tm (classes) Tj ET BT /F3 12 Tf 1 0 0 1 196.94 254.41 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 212.92 254.41 Tm (Employees) Tj ET BT /F3 12 Tf 1 0 0 1 272.22 254.41 Tm (eligible) Tj ET BT /F3 12 Tf 1 0 0 1 314.19 254.41 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 334.17 254.41 Tm (insurance) Tj ET BT /F3 12 Tf 1 0 0 1 386.13 254.41 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 406.76 254.41 Tm (shown) Tj ET BT /F3 12 Tf 1 0 0 1 444.08 254.41 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 459.39 254.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 480.04 254.41 Tm (Schedule) Tj ET BT /F3 12 Tf 1 0 0 1 530 254.41 Tm (of) Tj ET Q q n 0 252 m 612 252 l 612 240 l 0 240 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 242.41 Tm (Benefits.) Tj ET BT /F3 12 Tf 1 0 0 1 49.47 242.41 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 71.37 242.41 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 121.27 242.41 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 140.51 242.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 158.41 242.41 Tm (right) Tj ET BT /F3 12 Tf 1 0 0 1 184.32 242.41 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 196.89 242.41 Tm (review) Tj ET BT /F3 12 Tf 1 0 0 1 232.78 242.41 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 253.35 242.41 Tm (terminate) Tj ET BT /F3 12 Tf 1 0 0 1 301.9 242.41 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 322.47 242.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 335.7 242.41 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 350.94 242.41 Tm (classes) Tj ET BT /F3 12 Tf 1 0 0 1 387.5 242.41 Tm (eligible) Tj ET BT /F3 12 Tf 1 0 0 1 426.73 242.41 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 457.29 242.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 475.19 242.41 Tm (Policy,) Tj ET BT /F3 12 Tf 1 0 0 1 512.1 242.41 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 522.67 242.41 Tm (any) Tj ET Q q n 0 240 m 612 240 l 612 228 l 0 228 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 230.41 Tm (class ceases to be covered by the Policy.) Tj ET Q q n 0 228 m 612 228 l 612 216 l 0 216 l h W n Q q n 0 216 m 612 216 l 612 204 l 0 204 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 206.41 Tm (ELIGIBILITY DATE.) Tj ET BT /F3 12 Tf 1 0 0 1 122.04 206.41 Tm (An Employee becomes eligible for coverage provided by the Policy on the later of:) Tj ET Q q n 18 204 m 630 204 l 630 192 l 18 192 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 194.41 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 194.41 Tm (the Policy's date of issue; or) Tj ET Q q n 18 192 m 630 192 l 630 180 l 18 180 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 182.41 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 182.41 Tm (the date the Waiting Period is completed.) Tj ET Q q n 0 180 m 612 180 l 612 168 l 0 168 l h W n Q q n 0 168 m 612 168 l 612 156 l 0 156 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 158.41 Tm (Prior) Tj ET BT /F2 12 Tf 1 0 0 1 31.66 158.41 Tm (Service) Tj ET BT /F2 12 Tf 1 0 0 1 73.31 158.41 Tm (Credit) Tj ET BT /F2 12 Tf 1 0 0 1 110.97 158.41 Tm (Towards) Tj ET BT /F2 12 Tf 1 0 0 1 160.65 158.41 Tm (Waiting) Tj ET BT /F2 12 Tf 1 0 0 1 206.33 158.41 Tm (Period.) Tj ET BT /F3 12 Tf 1 0 0 1 252 158.41 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 274.99 158.41 Tm (Waiting) Tj ET BT /F3 12 Tf 1 0 0 1 317.99 158.41 Tm (Period) Tj ET BT /F3 12 Tf 1 0 0 1 353.66 158.41 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 366 158.41 Tm (shown) Tj ET BT /F3 12 Tf 1 0 0 1 401.68 158.41 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 415.35 158.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 434.35 158.41 Tm (Schedule) Tj ET BT /F3 12 Tf 1 0 0 1 482.67 158.41 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 497.01 158.41 Tm (Benefits.) Tj ET Q q n 0 156 m 612 156 l 612 144 l 0 144 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 146.41 Tm (Prior service in an Eligible Class will apply toward the Waiting Period, when:) Tj ET Q q n 18 144 m 630 144 l 630 132 l 18 132 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 134.41 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 134.41 Tm (a former Employee is rehired within one year after his or her employment ends; or) Tj ET Q q n 18 132 m 630 132 l 630 120 l 18 120 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 122.41 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 122.41 Tm (an Employee returns from an approved Family or Medical Leave within:) Tj ET Q q n 45.35 120 m 657.35 120 l 657.35 108 l 45.35 108 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 110.41 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72 110.41 Tm (the 12-week leave period required by federal law; or) Tj ET Q q n 45.35 108 m 657.35 108 l 657.35 96 l 45.35 96 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 98.41 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72 98.41 Tm (any longer period required by a similar state law; or) Tj ET Q q n 18 96 m 630 96 l 630 84 l 18 84 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 86.41 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 86.41 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 61.25 86.41 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 114.47 86.41 Tm (returns) Tj ET BT /F3 12 Tf 1 0 0 1 152.37 86.41 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 180.27 86.41 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 190.17 86.41 Tm (Military) Tj ET BT /F3 12 Tf 1 0 0 1 234.07 86.41 Tm (Leave) Tj ET BT /F3 12 Tf 1 0 0 1 267.95 86.41 Tm (within) Tj ET BT /F3 12 Tf 1 0 0 1 303.19 86.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 322.42 86.41 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 357.65 86.41 Tm (required) Tj ET BT /F3 12 Tf 1 0 0 1 402.21 86.41 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 418.78 86.41 Tm (federal) Tj ET BT /F3 12 Tf 1 0 0 1 456.66 86.41 Tm (USERRA) Tj ET Q q n 45.35 84 m 657.35 84 l 657.35 72 l 45.35 72 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 74.41 Tm (law.) Tj ET Q q n 0 72 m 612 72 l 612 60 l 0 60 l h W n Q q n 0 60 m 612 60 l 612 48 l 0 48 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 50.41 Tm (All other Policy provisions will apply.) Tj ET Q q n 0 48 m 612 48 l 612 36 l 0 36 l h W n Q q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (Those) Tj ET BT /F3 12 Tf 1 0 0 1 35.42 26.41 Tm (Employees) Tj ET BT /F3 12 Tf 1 0 0 1 94.84 26.41 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 116.27 26.41 Tm (employed) Tj ET BT /F3 12 Tf 1 0 0 1 169.69 26.41 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 197.12 26.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 217.88 26.41 Tm (Policyholder) Tj ET BT /F3 12 Tf 1 0 0 1 285.3 26.41 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 314.72 26.41 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 330.16 26.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 350.91 26.41 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 387.68 26.41 Tm (Effective) Tj ET BT /F3 12 Tf 1 0 0 1 437.74 26.41 Tm (Date) Tj ET BT /F3 12 Tf 1 0 0 1 466.49 26.41 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 493.25 26.41 Tm (apply) Tj ET BT /F3 12 Tf 1 0 0 1 526.01 26.41 Tm (for) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 14.41 Tm (insurance and become covered in accord with the provisions outlined below.) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 422.4 m 612 422.4 l 612 410.4 l 0 410.4 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 214.15 412.81 Tm (EFFECTIVE DATES) Tj ET Q q n 0 410.4 m 612 410.4 l 612 398.4 l 0 398.4 l h W n Q q n 0 398.4 m 612 398.4 l 612 386.4 l 0 386.4 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 388.81 Tm (EFFECTIVE) Tj ET BT /F2 12 Tf 1 0 0 1 72.11 388.81 Tm (DATE.) Tj ET BT /F3 12 Tf 1 0 0 1 115.32 388.81 Tm (An) Tj ET BT /F3 12 Tf 1 0 0 1 133.42 388.81 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 192.34 388.81 Tm (initial) Tj ET BT /F3 12 Tf 1 0 0 1 223.77 388.81 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 263.2 388.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 276.63 388.81 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 323.37 388.81 Tm (becomes) Tj ET BT /F3 12 Tf 1 0 0 1 368.79 388.81 Tm (effective) Tj ET BT /F3 12 Tf 1 0 0 1 414.19 388.81 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 426.28 388.81 Tm (12:01) Tj ET BT /F3 12 Tf 1 0 0 1 457.05 388.81 Tm (a.m.) Tj ET BT /F3 12 Tf 1 0 0 1 481.15 388.81 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 496.58 388.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 514.68 388.81 Tm (latest) Tj ET Q q n 0 386.4 m 612 386.4 l 612 374.4 l 0 374.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 376.81 Tm (of:) Tj ET Q q n 18 374.4 m 630 374.4 l 630 362.4 l 18 362.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 364.81 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 364.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 63.8 364.81 Tm (first) Tj ET BT /F3 12 Tf 1 0 0 1 86.91 364.81 Tm (day) Tj ET BT /F3 12 Tf 1 0 0 1 108.02 364.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 121.8 364.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 140.25 364.81 Tm (Insurance) Tj ET BT /F3 12 Tf 1 0 0 1 190.67 364.81 Tm (Month) Tj ET BT /F3 12 Tf 1 0 0 1 226.46 364.81 Tm (coinciding) Tj ET BT /F3 12 Tf 1 0 0 1 280.9 364.81 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 306.02 364.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 319.8 364.81 Tm (next) Tj ET BT /F3 12 Tf 1 0 0 1 344.24 364.81 Tm (following) Tj ET BT /F3 12 Tf 1 0 0 1 394.69 364.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 413.13 364.81 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 436.91 364.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 455.35 364.81 Tm (Employee) Tj ET Q q n 45.35 362.4 m 657.35 362.4 l 657.35 350.4 l 45.35 350.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 352.81 Tm (becomes eligible for the coverage;) Tj ET Q q n 18 350.4 m 630 350.4 l 630 338.4 l 18 338.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 340.81 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 340.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 64.59 340.81 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 89.15 340.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 108.38 340.81 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 161.61 340.81 Tm (resumes) Tj ET BT /F3 12 Tf 1 0 0 1 205.51 340.81 Tm (Active) Tj ET BT /F3 12 Tf 1 0 0 1 242.07 340.81 Tm (Work,) Tj ET BT /F3 12 Tf 1 0 0 1 276.97 340.81 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 288.88 340.81 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 308.79 340.81 Tm (Actively) Tj ET BT /F3 12 Tf 1 0 0 1 354.68 340.81 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 367.92 340.81 Tm (Work) Tj ET BT /F3 12 Tf 1 0 0 1 399.82 340.81 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 416.39 340.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 435.63 340.81 Tm (day) Tj ET BT /F3 12 Tf 1 0 0 1 457.53 340.81 Tm (he) Tj ET BT /F3 12 Tf 1 0 0 1 473.43 340.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 488 340.81 Tm (she) Tj ET Q q n 45.35 338.4 m 657.35 338.4 l 657.35 326.4 l 45.35 326.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 328.81 Tm (becomes eligible;) Tj ET Q q n 18 326.4 m 630 326.4 l 630 314.4 l 18 314.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 316.81 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 316.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 60.01 316.81 Tm ( date the Employee makes written application for coverage and signs;) Tj ET Q q n 45.35 314.4 m 657.35 314.4 l 657.35 302.4 l 45.35 302.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 304.81 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 304.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 81.85 304.81 Tm (payroll) Tj ET BT /F3 12 Tf 1 0 0 1 119.67 304.81 Tm (deduction) Tj ET BT /F3 12 Tf 1 0 0 1 170.82 304.81 Tm (order,) Tj ET BT /F3 12 Tf 1 0 0 1 202.96 304.81 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 214.12 304.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 232.6 304.81 Tm (Employees) Tj ET BT /F3 12 Tf 1 0 0 1 289.75 304.81 Tm (pay) Tj ET BT /F3 12 Tf 1 0 0 1 310.9 304.81 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 332.06 304.81 Tm (part) Tj ET BT /F3 12 Tf 1 0 0 1 354.54 304.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 368.36 304.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 386.85 304.81 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 421.34 304.81 Tm (premium;) Tj ET Q q n 72.7 302.4 m 684.7 302.4 l 684.7 290.4 l 72.7 290.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 292.81 Tm (or) Tj ET Q q n 45.35 290.4 m 657.35 290.4 l 657.35 278.4 l 45.35 278.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 280.81 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 280.81 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 87.55 280.81 Tm (order) Tj ET BT /F3 12 Tf 1 0 0 1 116.38 280.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 129.24 280.81 Tm (pay) Tj ET BT /F3 12 Tf 1 0 0 1 150.08 280.81 Tm (premiums) Tj ET BT /F3 12 Tf 1 0 0 1 201.6 280.81 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 228.44 280.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 246.62 280.81 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 305.63 280.81 Tm (Flexible) Tj ET BT /F3 12 Tf 1 0 0 1 348.47 280.81 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 391.98 280.81 Tm (Plan) Tj ET BT /F3 12 Tf 1 0 0 1 416.84 280.81 Tm (account,) Tj ET BT /F3 12 Tf 1 0 0 1 460.67 280.81 Tm (if) Tj ET Q q n 72.7 278.4 m 684.7 278.4 l 684.7 266.4 l 72.7 266.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 268.81 Tm (premiums are paid through such an account; or) Tj ET Q q n 18 266.4 m 630 266.4 l 630 254.4 l 18 254.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 256.81 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 256.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 60.01 256.81 Tm ( date the Company approves the Employee's Evidence of Insurability, if required.) Tj ET Q q n 0 254.4 m 612 254.4 l 612 242.4 l 0 242.4 l h W n Q 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 231.7 Tm (Any increased or additional coverage becomes effective at 12:01 a.m. on the latest of:) Tj ET q n 18 228.6 m 630 228.6 l 630 216.6 l 18 216.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 219.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 219.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 64.02 219.01 Tm (first) Tj ET BT /F3 12 Tf 1 0 0 1 87.35 219.01 Tm (day) Tj ET BT /F3 12 Tf 1 0 0 1 108.68 219.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 122.69 219.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 141.35 219.01 Tm (Insurance) Tj ET BT /F3 12 Tf 1 0 0 1 192 219.01 Tm (Month) Tj ET BT /F3 12 Tf 1 0 0 1 228.01 219.01 Tm (coinciding) Tj ET BT /F3 12 Tf 1 0 0 1 282.67 219.01 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 308.01 219.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 322.01 219.01 Tm (next) Tj ET BT /F3 12 Tf 1 0 0 1 346.68 219.01 Tm (following) Tj ET BT /F3 12 Tf 1 0 0 1 397.34 219.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 416.01 219.01 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 440 219.01 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 456.01 219.01 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 219.01 Tm (the) Tj ET Q q n 45.35 216.6 m 657.35 216.6 l 657.35 204.6 l 45.35 204.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 207.01 Tm (Insured Employee becomes eligible for the increase, if Actively at Work on that day;) Tj ET Q q n 18 204.6 m 630 204.6 l 630 192.6 l 18 192.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 195.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 195.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 64.04 195.01 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 88.05 195.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 106.74 195.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 146.76 195.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 199.44 195.01 Tm (resumes) Tj ET BT /F3 12 Tf 1 0 0 1 242.79 195.01 Tm (Active) Tj ET BT /F3 12 Tf 1 0 0 1 278.81 195.01 Tm (Work,) Tj ET BT /F3 12 Tf 1 0 0 1 313.16 195.01 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 324.52 195.01 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 343.88 195.01 Tm (Actively) Tj ET BT /F3 12 Tf 1 0 0 1 389.23 195.01 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 401.92 195.01 Tm (Work) Tj ET BT /F3 12 Tf 1 0 0 1 433.27 195.01 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 449.3 195.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 467.99 195.01 Tm (day) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 195.01 Tm (the) Tj ET Q q n 45.35 192.6 m 657.35 192.6 l 657.35 180.6 l 45.35 180.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 183.01 Tm (increase would otherwise take effect; or) Tj ET Q q n 18 180.6 m 630 180.6 l 630 168.6 l 18 168.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 171.01 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 171.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 60.01 171.01 Tm ( date) Tj ET BT /F3 12 Tf 1 0 0 1 86 171.01 Tm (any required Evidence of Insurability is approved by the Company.) Tj ET Q q n 18 168.6 m 630 168.6 l 630 156.6 l 18 156.6 l h W n Q q n 0 156.6 m 612 156.6 l 612 144.6 l 0 144.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 147.01 Tm (Any) Tj ET BT /F3 12 Tf 1 0 0 1 25.15 147.01 Tm (decrease) Tj ET BT /F3 12 Tf 1 0 0 1 70.93 147.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 94.08 147.01 Tm (take) Tj ET BT /F3 12 Tf 1 0 0 1 118.55 147.01 Tm (effect) Tj ET BT /F3 12 Tf 1 0 0 1 150.34 147.01 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 166.83 147.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 185.97 147.01 Tm (day) Tj ET BT /F3 12 Tf 1 0 0 1 207.78 147.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 222.26 147.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 241.4 147.01 Tm (change,) Tj ET BT /F3 12 Tf 1 0 0 1 282.87 147.01 Tm (whether) Tj ET BT /F3 12 Tf 1 0 0 1 326 147.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 340.48 147.01 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 360.3 147.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 379.44 147.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 419.91 147.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 473.05 147.01 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 485.54 147.01 Tm (Actively) Tj ET BT /F3 12 Tf 1 0 0 1 531.34 147.01 Tm (at) Tj ET Q q n 0 144.6 m 612 144.6 l 612 132.6 l 0 132.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 135.01 Tm (Work.) Tj ET Q q n 0 132.6 m 612 132.6 l 612 120.6 l 0 120.6 l h W n Q q n 0 120.6 m 612 120.6 l 612 108.6 l 0 108.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 111.01 Tm (EVIDENCE) Tj ET BT /F2 12 Tf 1 0 0 1 67.27 111.01 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 87.86 111.01 Tm (INSURABILITY.) Tj ET BT /F3 12 Tf 1 0 0 1 186.74 111.01 Tm (Evidence) Tj ET BT /F3 12 Tf 1 0 0 1 235.31 111.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 249.23 111.01 Tm (Insurability) Tj ET BT /F3 12 Tf 1 0 0 1 308.48 111.01 Tm (satisfactory) Tj ET BT /F3 12 Tf 1 0 0 1 367.72 111.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 380.98 111.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 399.56 111.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 450.15 111.01 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 477.42 111.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 492.67 111.01 Tm (submitted) Tj ET Q q n 0 108.6 m 612 108.6 l 612 96.6 l 0 96.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 99.01 Tm (when:) Tj ET Q q n 18 96.6 m 630 96.6 l 630 84.6 l 18 84.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 87.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 87.01 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 61.64 87.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 115.25 87.01 Tm (makes) Tj ET BT /F3 12 Tf 1 0 0 1 150.86 87.01 Tm (written) Tj ET BT /F3 12 Tf 1 0 0 1 189.81 87.01 Tm (application) Tj ET BT /F3 12 Tf 1 0 0 1 248.08 87.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 267.03 87.01 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 315.29 87.01 Tm (\(or) Tj ET BT /F3 12 Tf 1 0 0 1 334.25 87.01 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 350.53 87.01 Tm (increased) Tj ET BT /F3 12 Tf 1 0 0 1 400.8 87.01 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 441.75 87.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 456.7 87.01 Tm (coverage\)) Tj ET Q q n 45.35 84.6 m 657.35 84.6 l 657.35 72.6 l 45.35 72.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 75.01 Tm (more than 31 days after becoming eligible for the coverage; or) Tj ET Q q n 18 72.6 m 630 72.6 l 630 60.6 l 18 60.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 63.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 63.01 Tm (an Employee makes written application to enroll for coverage after he or she has requested:) Tj ET Q q n 45.35 60.6 m 657.35 60.6 l 657.35 48.6 l 45.35 48.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 51.01 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 51.01 Tm (to cancel insurance;) Tj ET Q q n 45.35 48.6 m 657.35 48.6 l 657.35 36.6 l 45.35 36.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 39.01 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 39.01 Tm (to stop payroll deductions for the insurance; or) Tj ET Q q n 45.35 36.6 m 657.35 36.6 l 657.35 24.6 l 45.35 24.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 27.01 Tm (c.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 27.01 Tm (to stop premium payments from the Flexible Benefits Plan account; or) Tj ET Q q n 18 24.6 m 630 24.6 l 630 12.6 l 18 12.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 15.01 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 15.01 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 93.44 15.01 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 106.23 15.01 Tm (elected) Tj ET BT /F3 12 Tf 1 0 0 1 144.99 15.01 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 171.76 15.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 191.21 15.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 244.65 15.01 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 265.43 15.01 Tm (caused) Tj ET BT /F3 12 Tf 1 0 0 1 302.87 15.01 Tm (insurance) Tj ET BT /F3 12 Tf 1 0 0 1 353.64 15.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 367.76 15.01 Tm (lapse,) Tj ET BT /F3 12 Tf 1 0 0 1 400.2 15.01 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 416.99 15.01 Tm (failing) Tj ET BT /F3 12 Tf 1 0 0 1 453.1 15.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 467.23 15.01 Tm (pay) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 15.01 Tm (the) Tj ET Q q n 45.35 12.6 m 657.35 12.6 l 657.35 0.597 l 45.35 0.597 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 3.01 Tm (required premium when due.) Tj ET Q Q q Q Q endstream endobj 16 0 obj <>>>>> endobj 145 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 734.4 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 214.15 26.41 Tm (EFFECTIVE DATES) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 239 14.41 Tm (\(Continued\)) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-7 04 PA) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 265 14.41 Tm (14) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 676.8 m 612 676.8 l 612 664.8 l 0 664.8 l h W n Q q n 0 664.8 m 612 664.8 l 612 652.8 l 0 652.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 655.21 Tm (EFFECTIVE) Tj ET BT /F2 12 Tf 1 0 0 1 71.85 655.21 Tm (DATE) Tj ET BT /F2 12 Tf 1 0 0 1 108.35 655.21 Tm (FOR) Tj ET BT /F2 12 Tf 1 0 0 1 136.85 655.21 Tm (CHANGE) Tj ET BT /F2 12 Tf 1 0 0 1 192.69 655.21 Tm (IN) Tj ET BT /F2 12 Tf 1 0 0 1 209.19 655.21 Tm (ELIGIBLE) Tj ET BT /F2 12 Tf 1 0 0 1 271.05 655.21 Tm (CLASS.) Tj ET BT /F3 12 Tf 1 0 0 1 319.07 655.21 Tm (An) Tj ET BT /F3 12 Tf 1 0 0 1 336.91 655.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 376.06 655.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 427.88 655.21 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 451.71 655.21 Tm (become) Tj ET BT /F3 12 Tf 1 0 0 1 492.19 655.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 500.68 655.21 Tm (member) Tj ET Q q n 0 652.8 m 612 652.8 l 612 640.8 l 0 640.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 643.21 Tm (of a different Eligible Class.) Tj ET BT /F3 12 Tf 1 0 0 1 141.63 643.21 Tm (Coverage under the different Eligible Class will be effective:) Tj ET Q q n 18 640.8 m 630 640.8 l 630 628.8 l 18 628.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 631.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 631.21 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 62.56 631.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 82.44 631.21 Tm (first) Tj ET BT /F3 12 Tf 1 0 0 1 106.98 631.21 Tm (day) Tj ET BT /F3 12 Tf 1 0 0 1 129.52 631.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 144.73 631.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 164.61 631.21 Tm (Insurance) Tj ET BT /F3 12 Tf 1 0 0 1 216.46 631.21 Tm (Month) Tj ET BT /F3 12 Tf 1 0 0 1 253.68 631.21 Tm (coinciding) Tj ET BT /F3 12 Tf 1 0 0 1 309.55 631.21 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 336.09 631.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 351.3 631.21 Tm (next) Tj ET BT /F3 12 Tf 1 0 0 1 377.18 631.21 Tm (following) Tj ET BT /F3 12 Tf 1 0 0 1 429.06 631.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 448.93 631.21 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 474.13 631.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 631.21 Tm (the) Tj ET Q q n 45.35 628.8 m 657.35 628.8 l 657.35 616.8 l 45.35 616.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 619.21 Tm (change;) Tj ET Q q n 18 616.8 m 630 616.8 l 630 604.8 l 18 604.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 607.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 607.21 Tm (except as stated in the Effective Date provision for increases or decreases.) Tj ET Q q n 0 604.8 m 612 604.8 l 612 592.8 l 0 592.8 l h W n Q q n 0 592.8 m 612 592.8 l 612 580.8 l 0 580.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 583.21 Tm (REINSTATEMENT) Tj ET BT /F2 12 Tf 1 0 0 1 110.04 583.21 Tm (RIGHTS.) Tj ET BT /F3 12 Tf 1 0 0 1 169.09 583.21 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 181.77 583.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 197.78 583.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 238.45 583.21 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 298.62 583.21 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 346.61 583.21 Tm (terminates) Tj ET BT /F3 12 Tf 1 0 0 1 401.27 583.21 Tm (due) Tj ET BT /F3 12 Tf 1 0 0 1 423.28 583.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 437.3 583.21 Tm (one) Tj ET BT /F3 12 Tf 1 0 0 1 459.31 583.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 473.99 583.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 493.34 583.21 Tm (following) Tj ET Q q n 0 580.8 m 612 580.8 l 612 568.8 l 0 568.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 571.21 Tm (breaks) Tj ET BT /F3 12 Tf 1 0 0 1 36.16 571.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 50.34 571.21 Tm (service,) Tj ET BT /F3 12 Tf 1 0 0 1 92.16 571.21 Tm (he) Tj ET BT /F3 12 Tf 1 0 0 1 108.33 571.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 123.17 571.21 Tm (she) Tj ET BT /F3 12 Tf 1 0 0 1 144 571.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 167.51 571.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 183.68 571.21 Tm (entitled) Tj ET BT /F3 12 Tf 1 0 0 1 224.51 571.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 238.69 571.21 Tm (reinstate) Tj ET BT /F3 12 Tf 1 0 0 1 284.18 571.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 303.68 571.21 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 351.83 571.21 Tm (upon) Tj ET BT /F3 12 Tf 1 0 0 1 380.67 571.21 Tm (resuming) Tj ET BT /F3 12 Tf 1 0 0 1 430.17 571.21 Tm (Active) Tj ET BT /F3 12 Tf 1 0 0 1 467 571.21 Tm (Work) Tj ET BT /F3 12 Tf 1 0 0 1 499.16 571.21 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 571.21 Tm (the) Tj ET Q q n 0 568.8 m 612 568.8 l 612 556.8 l 0 556.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 559.21 Tm (Employer) Tj ET BT /F3 12 Tf 1 0 0 1 52.13 559.21 Tm (within) Tj ET BT /F3 12 Tf 1 0 0 1 87.61 559.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 107.08 559.21 Tm (required) Tj ET BT /F3 12 Tf 1 0 0 1 151.87 559.21 Tm (timeframe.) Tj ET BT /F3 12 Tf 1 0 0 1 213.8 559.21 Tm (") Tj ET BT /F2 12 Tf 1 0 0 1 218.7 559.21 Tm (Reinstatement) Tj ET BT /F3 12 Tf 1 0 0 1 292.68 559.21 Tm (") Tj ET BT /F3 12 Tf 1 0 0 1 302.39 559.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 317.2 559.21 Tm ("to) Tj ET BT /F2 12 Tf 1 0 0 1 338.67 559.21 Tm (reinstate") Tj ET BT /F3 12 Tf 1 0 0 1 394.79 559.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 430.26 559.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 444.41 559.21 Tm (re-enroll) Tj ET BT /F3 12 Tf 1 0 0 1 490.53 559.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 509.33 559.21 Tm (Policy) Tj ET Q q n 0 556.8 m 612 556.8 l 612 544.8 l 0 544.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 547.21 Tm (coverage,) Tj ET BT /F3 12 Tf 1 0 0 1 51.21 547.21 Tm (without) Tj ET BT /F3 12 Tf 1 0 0 1 92.8 547.21 Tm (satisfying) Tj ET BT /F3 12 Tf 1 0 0 1 144.37 547.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 154.61 547.21 Tm (new) Tj ET BT /F3 12 Tf 1 0 0 1 179.52 547.21 Tm (Waiting) Tj ET BT /F3 12 Tf 1 0 0 1 223.09 547.21 Tm (Period) Tj ET BT /F3 12 Tf 1 0 0 1 259.33 547.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 274.24 547.21 Tm (providing) Tj ET BT /F3 12 Tf 1 0 0 1 325.82 547.21 Tm (Evidence) Tj ET BT /F3 12 Tf 1 0 0 1 375.37 547.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 390.28 547.21 Tm (Insurability.) Tj ET BT /F3 12 Tf 1 0 0 1 458.43 547.21 Tm (Reinstatement) Tj ET BT /F3 12 Tf 1 0 0 1 532 547.21 Tm (is) Tj ET Q q n 0 544.8 m 612 544.8 l 612 532.8 l 0 532.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 535.21 Tm (available upon:) Tj ET Q q n 18 532.8 m 630 532.8 l 630 520.8 l 18 520.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 523.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 523.21 Tm (return from an approved Family or Medical Leave within:) Tj ET Q q n 44.65 520.8 m 656.65 520.8 l 656.65 508.8 l 44.65 508.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 44.65 511.21 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72 511.21 Tm (the 12-week period required by federal law; or) Tj ET Q q n 44.65 508.8 m 656.65 508.8 l 656.65 496.8 l 44.65 496.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 44.65 499.21 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72 499.21 Tm (any longer period required by a similar state law;) Tj ET Q q n 18 496.8 m 630 496.8 l 630 484.8 l 18 484.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 487.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 487.21 Tm (return from a Military Leave within the period required by federal USERRA law;) Tj ET Q q n 18 484.8 m 630 484.8 l 630 472.8 l 18 472.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 475.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 475.21 Tm (return from any other approved leave of absence within six months after the leave begins;) Tj ET Q q n 18 472.8 m 630 472.8 l 630 460.8 l 18 460.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 463.21 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 463.21 Tm (return within 12 months following a lay off; or) Tj ET Q q n 18 460.8 m 630 460.8 l 630 448.8 l 18 448.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 451.21 Tm (5.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 451.21 Tm (return within 12 months following termination of employment for any other reason.) Tj ET Q q n 0 448.8 m 612 448.8 l 612 436.8 l 0 436.8 l h W n Q q n 0 436.8 m 612 436.8 l 612 424.8 l 0 424.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 427.21 Tm (To) Tj ET BT /F3 12 Tf 1 0 0 1 17.32 427.21 Tm (reinstate) Tj ET BT /F3 12 Tf 1 0 0 1 61.96 427.21 Tm (coverage,) Tj ET BT /F3 12 Tf 1 0 0 1 112.25 427.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 130.9 427.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 183.55 427.21 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 210.87 427.21 Tm (apply) Tj ET BT /F3 12 Tf 1 0 0 1 241.53 427.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 259.51 427.21 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 306.8 427.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 320.79 427.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 336.11 427.21 Tm (re-enrolled) Tj ET BT /F3 12 Tf 1 0 0 1 392.73 427.21 Tm (within) Tj ET BT /F3 12 Tf 1 0 0 1 427.39 427.21 Tm (31) Tj ET BT /F3 12 Tf 1 0 0 1 443.38 427.21 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 469.37 427.21 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 495.34 427.21 Tm (resuming) Tj ET Q q n 0 424.8 m 612 424.8 l 612 412.8 l 0 412.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 415.21 Tm (Active) Tj ET BT /F3 12 Tf 1 0 0 1 38.1 415.21 Tm (Work) Tj ET BT /F3 12 Tf 1 0 0 1 71.54 415.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 86.98 415.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 104.42 415.21 Tm (Eligible) Tj ET BT /F3 12 Tf 1 0 0 1 148.53 415.21 Tm (Class.) Tj ET BT /F3 12 Tf 1 0 0 1 183.65 415.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 208.42 415.21 Tm (reinstated) Tj ET BT /F3 12 Tf 1 0 0 1 261.18 415.21 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 303.28 415.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 319.39 415.21 Tm (insurance) Tj ET BT /F3 12 Tf 1 0 0 1 371.49 415.21 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 398.26 415.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 419.71 415.21 Tm (exceed) Tj ET BT /F3 12 Tf 1 0 0 1 459.13 415.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 479.9 415.21 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 522.01 415.21 Tm (that) Tj ET Q q n 0 412.8 m 612 412.8 l 612 400.8 l 0 400.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 403.21 Tm (terminated. Reinstatement will take effect on the date the Insured Employee returns to Active Work.) Tj ET Q q n 0 400.8 m 612 400.8 l 612 388.8 l 0 388.8 l h W n Q q n 0 388.8 m 612 388.8 l 612 376.8 l 0 376.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 379.21 Tm (If the above conditions are met, then:) Tj ET Q q n 18 376.8 m 630 376.8 l 630 364.8 l 18 364.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 367.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 367.21 Tm (the months of leave will count towards any unmet Pre-Existing Condition Exclusion period; and) Tj ET Q q n 18 364.8 m 630 364.8 l 630 352.8 l 18 352.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 355.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 355.21 Tm (a new Pre-Existing Condition Exclusion will not apply to the reinstated amount of insurance.) Tj ET Q q n 0 352.8 m 612 352.8 l 612 340.8 l 0 340.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 343.21 Tm (A new Pre-Existing Condition Exclusion will apply to any increased amount of insurance.) Tj ET Q Q q Q Q endstream endobj 17 0 obj <>>>>> endobj 146 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 744 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 187.16 2.41 Tm (INDIVIDUAL TERMINATION) Tj ET Q Q q Q q 1 0 0 1 36 36 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-8 04) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 265 14.41 Tm (15) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 72 cm q n 0 658.2 m 612 658.2 l 612 646.2 l 0 646.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 648.61 Tm (INDIVIDUAL) Tj ET BT /F2 12 Tf 1 0 0 1 77.25 648.61 Tm (TERMINATION) Tj ET BT /F2 12 Tf 1 0 0 1 169.17 648.61 Tm (OF) Tj ET BT /F2 12 Tf 1 0 0 1 189.08 648.61 Tm (COVERAGE.) Tj ET BT /F3 12 Tf 1 0 0 1 267.9 648.61 Tm (An) Tj ET BT /F3 12 Tf 1 0 0 1 285.81 648.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 325.04 648.61 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 383.76 648.61 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 430.3 648.61 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 452.21 648.61 Tm (terminate) Tj ET BT /F3 12 Tf 1 0 0 1 500.76 648.61 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 512.67 648.61 Tm (12:00) Tj ET Q q n 0 646.2 m 612 646.2 l 612 634.2 l 0 634.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 636.61 Tm (midnight on the earliest of:) Tj ET Q q n 18 634.2 m 630 634.2 l 630 622.2 l 18 622.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 624.61 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 624.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 64.83 624.61 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 89.63 624.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 109.1 624.61 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 144.59 624.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 159.4 624.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 178.88 624.61 Tm (Employer's) Tj ET BT /F3 12 Tf 1 0 0 1 237.84 624.61 Tm (participation) Tj ET BT /F3 12 Tf 1 0 0 1 303.3 624.61 Tm (terminates;) Tj ET BT /F3 12 Tf 1 0 0 1 361.43 624.61 Tm (but) Tj ET BT /F3 12 Tf 1 0 0 1 381.58 624.61 Tm (without) Tj ET BT /F3 12 Tf 1 0 0 1 423.07 624.61 Tm (prejudice) Tj ET BT /F3 12 Tf 1 0 0 1 472.52 624.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 486.67 624.61 Tm (any) Tj ET Q q n 45.35 622.2 m 657.35 622.2 l 657.35 610.2 l 45.35 610.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 612.61 Tm (claim incurred prior to termination;) Tj ET Q q n 18 610.2 m 630 610.2 l 630 598.2 l 18 598.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 600.61 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 600.61 Tm (the date the Insured Employee's Class is no longer eligible for insurance;) Tj ET Q q n 18 598.2 m 630 598.2 l 630 586.2 l 18 586.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 588.61 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 588.61 Tm (the date such Insured Employee ceases to be a member of an Eligible Class;) Tj ET Q q n 18 586.2 m 630 586.2 l 630 574.2 l 18 574.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 576.61 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 576.61 Tm (the last day of the Insurance Month in which the Insured Employee requests termination;) Tj ET Q q n 18 574.2 m 630 574.2 l 630 562.2 l 18 562.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 564.61 Tm (5.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 564.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 65.48 564.61 Tm (last) Tj ET BT /F3 12 Tf 1 0 0 1 87.62 564.61 Tm (day) Tj ET BT /F3 12 Tf 1 0 0 1 110.42 564.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 125.89 564.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 146.02 564.61 Tm (Insurance) Tj ET BT /F3 12 Tf 1 0 0 1 198.14 564.61 Tm (Month) Tj ET BT /F3 12 Tf 1 0 0 1 235.61 564.61 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 255.08 564.61 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 289.88 564.61 Tm (premium) Tj ET BT /F3 12 Tf 1 0 0 1 338.68 564.61 Tm (payment) Tj ET BT /F3 12 Tf 1 0 0 1 385.47 564.61 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 398.95 564.61 Tm (made) Tj ET BT /F3 12 Tf 1 0 0 1 430.41 564.61 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 447.88 564.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 468.01 564.61 Tm (Insured) Tj ET Q q n 45.35 562.2 m 657.35 562.2 l 657.35 550.2 l 45.35 550.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 552.61 Tm (Employee's behalf;) Tj ET Q q n 18 550.2 m 630 550.2 l 630 538.2 l 18 538.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 540.61 Tm (6.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 540.61 Tm (the end of the period for which the last required premium has been paid;) Tj ET Q q n 18 538.2 m 630 538.2 l 630 526.2 l 18 526.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 528.61 Tm (7.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 528.61 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 70.45 528.61 Tm (respect) Tj ET BT /F3 12 Tf 1 0 0 1 108.19 528.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 121.29 528.61 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 130.38 528.61 Tm (particular) Tj ET BT /F3 12 Tf 1 0 0 1 180.11 528.61 Tm (insurance) Tj ET BT /F3 12 Tf 1 0 0 1 229.86 528.61 Tm (benefit,) Tj ET BT /F3 12 Tf 1 0 0 1 269.94 528.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 288.36 528.61 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 312.11 528.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 330.54 528.61 Tm (portion) Tj ET BT /F3 12 Tf 1 0 0 1 368.96 528.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 382.72 528.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 401.15 528.61 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 435.58 528.61 Tm (providing) Tj ET BT /F3 12 Tf 1 0 0 1 486.01 528.61 Tm (that) Tj ET Q q n 45.35 526.2 m 657.35 526.2 l 657.35 514.2 l 45.35 514.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 516.61 Tm (benefit terminates;) Tj ET Q q n 18 514.2 m 630 514.2 l 630 502.2 l 18 502.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 504.61 Tm (8.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 504.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 64.17 504.61 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 88.32 504.61 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 104.48 504.61 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 137.97 504.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 156.79 504.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 196.94 504.61 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 256.58 504.61 Tm (employment) Tj ET BT /F3 12 Tf 1 0 0 1 320.73 504.61 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 346.22 504.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 365.04 504.61 Tm (Employer) Tj ET BT /F3 12 Tf 1 0 0 1 416.53 504.61 Tm (terminates;) Tj ET BT /F3 12 Tf 1 0 0 1 474 504.61 Tm (unless) Tj ET Q q n 45.35 502.2 m 657.35 502.2 l 657.35 490.2 l 45.35 490.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 492.61 Tm (coverage is continued as provided below; or) Tj ET Q q n 18 490.2 m 630 490.2 l 630 478.2 l 18 478.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 480.61 Tm (9.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 480.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 63.25 480.61 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 86.47 480.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 104.37 480.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 143.6 480.61 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 195.49 480.61 Tm (enters) Tj ET BT /F3 12 Tf 1 0 0 1 227.38 480.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 245.28 480.61 Tm (armed) Tj ET BT /F3 12 Tf 1 0 0 1 278.5 480.61 Tm (services) Tj ET BT /F3 12 Tf 1 0 0 1 320.39 480.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 333.62 480.61 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 354.18 480.61 Tm (state) Tj ET BT /F3 12 Tf 1 0 0 1 379.41 480.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 392.65 480.61 Tm (country) Tj ET BT /F3 12 Tf 1 0 0 1 432.54 480.61 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 447.78 480.61 Tm (active) Tj ET BT /F3 12 Tf 1 0 0 1 479.67 480.61 Tm (duty,) Tj ET Q q n 45.35 478.2 m 657.35 478.2 l 657.35 466.2 l 45.35 466.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 468.61 Tm (except) Tj ET BT /F3 12 Tf 1 0 0 1 81.69 468.61 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 100.7 468.61 Tm (duty) Tj ET BT /F3 12 Tf 1 0 0 1 127.06 468.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 142.08 468.61 Tm (30) Tj ET BT /F3 12 Tf 1 0 0 1 159.11 468.61 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 186.13 468.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 201.15 468.61 Tm (less) Tj ET BT /F3 12 Tf 1 0 0 1 224.17 468.61 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 243.19 468.61 Tm (training) Tj ET BT /F3 12 Tf 1 0 0 1 285.54 468.61 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 299.9 468.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 319.58 468.61 Tm (Reserves) Tj ET BT /F3 12 Tf 1 0 0 1 367.92 468.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 382.95 468.61 Tm (National) Tj ET BT /F3 12 Tf 1 0 0 1 429.29 468.61 Tm (Guard.) Tj ET BT /F3 12 Tf 1 0 0 1 472.33 468.61 Tm (\(If) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 468.61 Tm (the) Tj ET Q q n 45.35 466.2 m 657.35 466.2 l 657.35 454.2 l 45.35 454.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 456.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 86.65 456.61 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 140.62 456.61 Tm (sends) Tj ET BT /F3 12 Tf 1 0 0 1 172.6 456.61 Tm (proof) Tj ET BT /F3 12 Tf 1 0 0 1 203.91 456.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 219.22 456.61 Tm (military) Tj ET BT /F3 12 Tf 1 0 0 1 262.52 456.61 Tm (service,) Tj ET BT /F3 12 Tf 1 0 0 1 304.82 456.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 324.79 456.61 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 376.77 456.61 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 400.75 456.61 Tm (refund) Tj ET BT /F3 12 Tf 1 0 0 1 437.39 456.61 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 460.03 456.61 Tm (unearned) Tj ET Q q n 45.35 454.2 m 657.35 454.2 l 657.35 442.2 l 45.35 442.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 444.61 Tm (premium.\)) Tj ET Q q n 0 442.2 m 612 442.2 l 612 430.2 l 0 430.2 l h W n Q q n 0 430.2 m 612 430.2 l 612 418.2 l 0 418.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 420.61 Tm (CONTINUATION) Tj ET BT /F2 12 Tf 1 0 0 1 103.03 420.61 Tm (RIGHTS.) Tj ET BT /F3 12 Tf 1 0 0 1 166.75 420.61 Tm (Ceasing) Tj ET BT /F3 12 Tf 1 0 0 1 212.43 420.61 Tm (Active) Tj ET BT /F3 12 Tf 1 0 0 1 251.44 420.61 Tm (Work) Tj ET BT /F3 12 Tf 1 0 0 1 285.78 420.61 Tm (results) Tj ET BT /F3 12 Tf 1 0 0 1 324.13 420.61 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 340.48 420.61 Tm (termination) Tj ET BT /F3 12 Tf 1 0 0 1 402.82 420.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 419.83 420.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 441.51 420.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 484.52 420.61 Tm (Employee's) Tj ET Q q n 0 418.2 m 612 418.2 l 612 406.2 l 0 406.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 408.61 Tm (eligibility for insurance, but coverage may be continued as follows.) Tj ET Q q n 0 406.2 m 612 406.2 l 612 394.2 l 0 394.2 l h W n Q q n 18 394.2 m 630 394.2 l 630 382.2 l 18 382.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 384.61 Tm (1.) Tj ET BT /F2 12 Tf 1 0 0 1 45 384.61 Tm (Disability.) Tj ET BT /F3 12 Tf 1 0 0 1 105.23 384.61 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 117.16 384.61 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 132.43 384.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 172.36 384.61 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 224.96 384.61 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 236.9 384.61 Tm (absent) Tj ET BT /F3 12 Tf 1 0 0 1 271.5 384.61 Tm (due) Tj ET BT /F3 12 Tf 1 0 0 1 292.77 384.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 306.05 384.61 Tm (Total) Tj ET BT /F3 12 Tf 1 0 0 1 335.32 384.61 Tm (Disability,) Tj ET BT /F3 12 Tf 1 0 0 1 389.59 384.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 403.53 384.61 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 415.48 384.61 Tm (engaged) Tj ET BT /F3 12 Tf 1 0 0 1 459.4 384.61 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 472.68 384.61 Tm (Partial) Tj ET Q q n 45 382.2 m 657 382.2 l 657 370.2 l 45 370.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 372.61 Tm (Disability Employment, coverage may be continued during:) Tj ET Q q n 45 370.2 m 657 370.2 l 657 358.2 l 45 358.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 360.61 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72 360.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 92.08 360.61 Tm (Elimination) Tj ET BT /F3 12 Tf 1 0 0 1 154.16 360.61 Tm (Period;) Tj ET BT /F3 12 Tf 1 0 0 1 194.24 360.61 Tm (provided) Tj ET BT /F3 12 Tf 1 0 0 1 242.32 360.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 262.39 360.61 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 314.48 360.61 Tm (receives) Tj ET BT /F3 12 Tf 1 0 0 1 359.2 360.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 379.28 360.61 Tm (required) Tj ET BT /F3 12 Tf 1 0 0 1 424.68 360.61 Tm (premium) Tj ET Q q n 72 358.2 m 684 358.2 l 684 346.2 l 72 346.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72 348.61 Tm (from the Employer; and) Tj ET Q q n 45 346.2 m 657 346.2 l 657 334.2 l 45 334.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 336.61 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72 336.61 Tm (the period for which benefits are payable, without payment of premium.) Tj ET Q q n 45.35 334.2 m 657.35 334.2 l 657.35 322.2 l 45.35 322.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 324.61 Tm (Premium) Tj ET BT /F3 12 Tf 1 0 0 1 92.54 324.61 Tm (payments) Tj ET BT /F3 12 Tf 1 0 0 1 141.73 324.61 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 163.59 324.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 178.12 324.61 Tm (waived) Tj ET BT /F3 12 Tf 1 0 0 1 215.97 324.61 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 242.49 324.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 260.34 324.61 Tm (satisfaction) Tj ET BT /F3 12 Tf 1 0 0 1 318.19 324.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 331.38 324.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 349.24 324.61 Tm (Elimination) Tj ET BT /F3 12 Tf 1 0 0 1 409.09 324.61 Tm (Period) Tj ET BT /F3 12 Tf 1 0 0 1 443.62 324.61 Tm (until) Tj ET BT /F3 12 Tf 1 0 0 1 468.82 324.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 486.67 324.61 Tm (end) Tj ET Q q n 45.35 322.2 m 657.35 322.2 l 657.35 310.2 l 45.35 310.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 312.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 58.71 312.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 76.73 312.61 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 110.75 312.61 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 128.1 312.61 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 160.79 312.61 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 202.14 312.61 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 220.15 312.61 Tm (payable.) Tj ET BT /F3 12 Tf 1 0 0 1 267.18 312.61 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 278.54 312.61 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 325.2 312.61 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 336.57 312.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 349.26 312.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 363.95 312.61 Tm (continued) Tj ET BT /F3 12 Tf 1 0 0 1 414.63 312.61 Tm (following) Tj ET BT /F3 12 Tf 1 0 0 1 464.66 312.61 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 473.34 312.61 Tm (period) Tj ET Q q n 45.35 310.2 m 657.35 310.2 l 657.35 298.2 l 45.35 298.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 300.61 Tm (for which premiums were waived, premium payments must be resumed, as they become due.) Tj ET Q q n 18 298.2 m 630 298.2 l 630 286.2 l 18 286.2 l h W n Q q n 18 286.2 m 630 286.2 l 630 274.2 l 18 274.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 276.61 Tm (2.) Tj ET BT /F2 12 Tf 1 0 0 1 45 276.61 Tm (Family) Tj ET BT /F2 12 Tf 1 0 0 1 84.96 276.61 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 100.25 276.61 Tm (Medical) Tj ET BT /F2 12 Tf 1 0 0 1 145.53 276.61 Tm (Leave.) Tj ET BT /F3 12 Tf 1 0 0 1 187.12 276.61 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 199.07 276.61 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 214.36 276.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 254.32 276.61 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 306.93 276.61 Tm (goes) Tj ET BT /F3 12 Tf 1 0 0 1 332.89 276.61 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 348.86 276.61 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 364.15 276.61 Tm (approved) Tj ET BT /F3 12 Tf 1 0 0 1 412.76 276.61 Tm (Family) Tj ET BT /F3 12 Tf 1 0 0 1 450.72 276.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 464.68 276.61 Tm (Medical) Tj ET Q q n 45 274.2 m 657 274.2 l 657 262.2 l 45 262.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 264.61 Tm (Leave,) Tj ET BT /F3 12 Tf 1 0 0 1 83.13 264.61 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 106.27 264.61 Tm (is) Tj ET BT /F2 12 Tf 1 0 0 1 120.09 264.61 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 142.57 264.61 Tm (entitled) Tj ET BT /F3 12 Tf 1 0 0 1 184.38 264.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 199.53 264.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 220 264.61 Tm (more) Tj ET BT /F3 12 Tf 1 0 0 1 250.48 264.61 Tm (favorable) Tj ET BT /F3 12 Tf 1 0 0 1 301.6 264.61 Tm (continuation) Tj ET BT /F3 12 Tf 1 0 0 1 367.4 264.61 Tm (available) Tj ET BT /F3 12 Tf 1 0 0 1 416.52 264.61 Tm (during) Tj ET BT /F3 12 Tf 1 0 0 1 453.67 264.61 Tm (Disability,) Tj ET Q q n 45 262.2 m 657 262.2 l 657 250.2 l 45 250.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 252.61 Tm (coverage may be continued, until the earliest of:) Tj ET Q q n 45 250.2 m 657 250.2 l 657 238.2 l 45 238.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 240.61 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72 240.61 Tm (the end of the leave period approved by the Employer;) Tj ET Q q n 45 238.2 m 657 238.2 l 657 226.2 l 45 226.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 228.61 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72 228.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 93.16 228.61 Tm (end) Tj ET BT /F3 12 Tf 1 0 0 1 116.98 228.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 133.48 228.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 154.64 228.61 Tm (12-week) Tj ET BT /F3 12 Tf 1 0 0 1 202.45 228.61 Tm (leave) Tj ET BT /F3 12 Tf 1 0 0 1 234.26 228.61 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 271.42 228.61 Tm (required) Tj ET BT /F3 12 Tf 1 0 0 1 317.9 228.61 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 336.4 228.61 Tm (federal) Tj ET BT /F3 12 Tf 1 0 0 1 376.2 228.61 Tm (law,) Tj ET BT /F3 12 Tf 1 0 0 1 403.02 228.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 419.52 228.61 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 443.34 228.61 Tm (more) Tj ET Q q n 72 226.2 m 684 226.2 l 684 214.2 l 72 214.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72 216.61 Tm (favorable period required by a similar state law;) Tj ET Q q n 45 214.2 m 657 214.2 l 657 202.2 l 45 202.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 204.61 Tm (c.) Tj ET BT /F3 12 Tf 1 0 0 1 72 204.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 89.72 204.61 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 112.76 204.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 130.47 204.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 169.52 204.61 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 221.22 204.61 Tm (notifies) Tj ET BT /F3 12 Tf 1 0 0 1 260.27 204.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 277.99 204.61 Tm (Employer) Tj ET BT /F3 12 Tf 1 0 0 1 328.37 204.61 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 349.42 204.61 Tm (he) Tj ET BT /F3 12 Tf 1 0 0 1 363.8 204.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 376.85 204.61 Tm (she) Tj ET BT /F3 12 Tf 1 0 0 1 395.9 204.61 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 417.62 204.61 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 436.01 204.61 Tm (return;) Tj ET Q q n 72 202.2 m 684 202.2 l 684 190.2 l 72 190.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72 192.61 Tm (or) Tj ET Q q n 45 190.2 m 657 190.2 l 657 178.2 l 45 178.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 180.61 Tm (d.) Tj ET BT /F3 12 Tf 1 0 0 1 72 180.61 Tm (the date the Insured Employee begins employment with another employer.) Tj ET Q q n 45 178.2 m 657 178.2 l 657 166.2 l 45 166.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 168.61 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 66.69 168.61 Tm (required) Tj ET BT /F3 12 Tf 1 0 0 1 109.71 168.61 Tm (premium) Tj ET BT /F3 12 Tf 1 0 0 1 156.07 168.61 Tm (payments) Tj ET BT /F3 12 Tf 1 0 0 1 205.09 168.61 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 231.47 168.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 245.83 168.61 Tm (received) Tj ET BT /F3 12 Tf 1 0 0 1 289.5 168.61 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 315.86 168.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 333.56 168.61 Tm (Employer,) Tj ET BT /F3 12 Tf 1 0 0 1 386.92 168.61 Tm (throughout) Tj ET BT /F3 12 Tf 1 0 0 1 442.62 168.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 460.31 168.61 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 494 168.61 Tm (of) Tj ET Q q n 45 166.2 m 657 166.2 l 657 154.2 l 45 154.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 156.61 Tm (continued coverage.) Tj ET Q q n 18 154.2 m 630 154.2 l 630 142.2 l 18 142.2 l h W n Q q n 18 142.2 m 630 142.2 l 630 130.2 l 18 130.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 132.61 Tm (3.) Tj ET BT /F2 12 Tf 1 0 0 1 45 132.61 Tm (Military) Tj ET BT /F2 12 Tf 1 0 0 1 90.66 132.61 Tm (Leave.) Tj ET BT /F3 12 Tf 1 0 0 1 130.34 132.61 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 141.34 132.61 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 155.68 132.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 194.68 132.61 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 246.34 132.61 Tm (goes) Tj ET BT /F3 12 Tf 1 0 0 1 271.35 132.61 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 286.36 132.61 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 294.7 132.61 Tm (Military) Tj ET BT /F3 12 Tf 1 0 0 1 337.04 132.61 Tm (Leave,) Tj ET BT /F3 12 Tf 1 0 0 1 372.36 132.61 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 418.67 132.61 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 442.34 132.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 456.68 132.61 Tm (continued) Tj ET Q q n 45 130.2 m 657 130.2 l 657 118.2 l 45 118.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 120.61 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 62.29 120.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 80.25 120.61 Tm (same) Tj ET BT /F3 12 Tf 1 0 0 1 108.21 120.61 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 142.16 120.61 Tm (allowed) Tj ET BT /F3 12 Tf 1 0 0 1 183.45 120.61 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 200.74 120.61 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 215.37 120.61 Tm (approved) Tj ET BT /F3 12 Tf 1 0 0 1 263.32 120.61 Tm (Family) Tj ET BT /F3 12 Tf 1 0 0 1 300.62 120.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 313.92 120.61 Tm (Medical) Tj ET BT /F3 12 Tf 1 0 0 1 356.53 120.61 Tm (Leave.) Tj ET BT /F3 12 Tf 1 0 0 1 395.44 120.61 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 417.4 120.61 Tm (required) Tj ET BT /F3 12 Tf 1 0 0 1 460.68 120.61 Tm (premium) Tj ET Q q n 45 118.2 m 657 118.2 l 657 106.2 l 45 106.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 108.61 Tm (payments must be received from the Employer, throughout the period of continued coverage.) Tj ET Q q n 0 106.2 m 612 106.2 l 612 94.2 l 0 94.2 l h W n Q q n 18 94.2 m 630 94.2 l 630 82.2 l 18 82.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 18 84.61 Tm (4.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 84.61 Tm (Lay-off) Tj ET BT /F2 12 Tf 1 0 0 1 86.55 84.61 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 101.09 84.61 Tm (Other) Tj ET BT /F2 12 Tf 1 0 0 1 134.95 84.61 Tm (Leave.) Tj ET BT /F3 12 Tf 1 0 0 1 175.03 84.61 Tm (When) Tj ET BT /F3 12 Tf 1 0 0 1 206.89 84.61 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 221.43 84.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 260.63 84.61 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 312.49 84.61 Tm (ceases) Tj ET BT /F3 12 Tf 1 0 0 1 346.34 84.61 Tm (work) Tj ET BT /F3 12 Tf 1 0 0 1 374.21 84.61 Tm (due) Tj ET BT /F3 12 Tf 1 0 0 1 394.75 84.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 407.29 84.61 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 415.83 84.61 Tm (temporary) Tj ET BT /F3 12 Tf 1 0 0 1 468.35 84.61 Tm (lay-off,) Tj ET Q q n 45.35 82.2 m 657.35 82.2 l 657.35 70.2 l 45.35 70.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 72.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 58.85 72.61 Tm (due) Tj ET BT /F3 12 Tf 1 0 0 1 79.67 72.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 92.51 72.61 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 107.33 72.61 Tm (approved) Tj ET BT /F3 12 Tf 1 0 0 1 155.48 72.61 Tm (leave) Tj ET BT /F3 12 Tf 1 0 0 1 184.3 72.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 197.79 72.61 Tm (absence) Tj ET BT /F3 12 Tf 1 0 0 1 239.27 72.61 Tm (\(other) Tj ET BT /F3 12 Tf 1 0 0 1 271.42 72.61 Tm (than) Tj ET BT /F3 12 Tf 1 0 0 1 295.58 72.61 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 310.4 72.61 Tm (approved) Tj ET BT /F3 12 Tf 1 0 0 1 358.55 72.61 Tm (Family) Tj ET BT /F3 12 Tf 1 0 0 1 396.06 72.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 409.55 72.61 Tm (Medical) Tj ET BT /F3 12 Tf 1 0 0 1 452.37 72.61 Tm (Leave) Tj ET BT /F3 12 Tf 1 0 0 1 485.18 72.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 498.67 72.61 Tm (a) Tj ET Q q n 45.35 70.2 m 657.35 70.2 l 657.35 58.2 l 45.35 58.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 60.61 Tm (Military) Tj ET BT /F3 12 Tf 1 0 0 1 89.26 60.61 Tm (Leave\);) Tj ET BT /F3 12 Tf 1 0 0 1 130.47 60.61 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 178.35 60.61 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 203.59 60.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 219.49 60.61 Tm (continued) Tj ET BT /F3 12 Tf 1 0 0 1 271.39 60.61 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 289.96 60.61 Tm (three) Tj ET BT /F3 12 Tf 1 0 0 1 318.52 60.61 Tm (Insurance) Tj ET BT /F3 12 Tf 1 0 0 1 369.73 60.61 Tm (Months) Tj ET BT /F3 12 Tf 1 0 0 1 410.99 60.61 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 437.54 60.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 456.78 60.61 Tm (lay-off) Tj ET BT /F3 12 Tf 1 0 0 1 494 60.61 Tm (or) Tj ET Q q n 45.35 58.2 m 657.35 58.2 l 657.35 46.2 l 45.35 46.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 48.61 Tm (leave) Tj ET BT /F3 12 Tf 1 0 0 1 77.95 48.61 Tm (begins.) Tj ET BT /F3 12 Tf 1 0 0 1 126.86 48.61 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 152.8 48.61 Tm (required) Tj ET BT /F3 12 Tf 1 0 0 1 200.07 48.61 Tm (premium) Tj ET BT /F3 12 Tf 1 0 0 1 250.68 48.61 Tm (payments) Tj ET BT /F3 12 Tf 1 0 0 1 303.96 48.61 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 334.58 48.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 353.2 48.61 Tm (received) Tj ET BT /F3 12 Tf 1 0 0 1 401.12 48.61 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 431.73 48.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 453.68 48.61 Tm (Employer,) Tj ET Q q n 45.35 46.2 m 657.35 46.2 l 657.35 34.2 l 45.35 34.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 36.61 Tm (throughout the period of continued coverage.) Tj ET Q q n 0 34.2 m 612 34.2 l 612 22.2 l 0 22.2 l h W n Q Q q Q Q endstream endobj 18 0 obj <>>>>> endobj 147 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 720 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 187.16 26.41 Tm (INDIVIDUAL TERMINATION) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 239 14.41 Tm (\(Continued\)) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 36 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-8 04) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 265 14.41 Tm (16) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 72 cm q n 0 648 m 612 648 l 612 636 l 0 636 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 638.41 Tm (Conditions.) Tj ET BT /F3 12 Tf 1 0 0 1 66.12 638.41 Tm (In) Tj ET BT /F3 12 Tf 1 0 0 1 79.66 638.41 Tm (administering) Tj ET BT /F3 12 Tf 1 0 0 1 149.19 638.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 167.4 638.41 Tm (above) Tj ET BT /F3 12 Tf 1 0 0 1 199.6 638.41 Tm (continuation,) Tj ET BT /F3 12 Tf 1 0 0 1 266.14 638.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 284.34 638.41 Tm (Employer) Tj ET BT /F3 12 Tf 1 0 0 1 335.21 638.41 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 362.1 638.41 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 380.98 638.41 Tm (act) Tj ET BT /F3 12 Tf 1 0 0 1 398.51 638.41 Tm (so) Tj ET BT /F3 12 Tf 1 0 0 1 412.73 638.41 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 426.27 638.41 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 439.15 638.41 Tm (discriminate) Tj ET BT /F3 12 Tf 1 0 0 1 502.01 638.41 Tm (unfairly) Tj ET Q q n 0 636 m 612 636 l 612 624 l 0 624 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 626.41 Tm (among) Tj ET BT /F3 12 Tf 1 0 0 1 37.14 626.41 Tm (Employees) Tj ET BT /F3 12 Tf 1 0 0 1 94.93 626.41 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 108.74 626.41 Tm (similar) Tj ET BT /F3 12 Tf 1 0 0 1 146.55 626.41 Tm (situations.) Tj ET BT /F3 12 Tf 1 0 0 1 204.5 626.41 Tm (Insurance) Tj ET BT /F3 12 Tf 1 0 0 1 255.62 626.41 Tm (may) Tj ET BT /F2 12 Tf 1 0 0 1 280.75 626.41 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 301.9 626.41 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 317.7 626.41 Tm (continued) Tj ET BT /F3 12 Tf 1 0 0 1 369.5 626.41 Tm (when) Tj ET BT /F3 12 Tf 1 0 0 1 399.96 626.41 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 415.77 626.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 456.23 626.41 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 509.36 626.41 Tm (ceases) Tj ET Q q n 0 624 m 612 624 l 612 612 l 0 612 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 614.41 Tm (Active Work due to a labor dispute, strike, work slowdown or lockout.) Tj ET Q q n 0 612 m 612 612 l 612 600 l 0 600 l h W n Q q n 0 600 m 612 600 l 612 588 l 0 588 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 590.41 Tm (INDIVIDUAL) Tj ET BT /F2 12 Tf 1 0 0 1 77.96 590.41 Tm (TERMINATION) Tj ET BT /F2 12 Tf 1 0 0 1 170.6 590.41 Tm (DURING) Tj ET BT /F2 12 Tf 1 0 0 1 223.22 590.41 Tm (DISABILITY.) Tj ET BT /F3 12 Tf 1 0 0 1 304.82 590.41 Tm (Termination) Tj ET BT /F3 12 Tf 1 0 0 1 368.09 590.41 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 382.04 590.41 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 397.32 590.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 437.26 590.41 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 496.7 590.41 Tm (coverage) Tj ET Q q n 0 588 m 612 588 l 612 576 l 0 576 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 578.41 Tm (during a Disability will have no effect on benefits payable for that period of Disability.) Tj ET Q q n 0 576 m 612 576 l 612 564 l 0 564 l h W n Q Q q Q Q endstream endobj 19 0 obj <>>>>> endobj 148 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 758.4 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 151.14 2.41 Tm (TOTAL DISABILITY MONTHLY BENEFIT) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm 0 0 0 rg BT /F3 12 Tf 1 0 0 1 408 39.9 Tm (Any Occ, Standard Integ.) Tj ET BT /F3 12 Tf 1 0 0 1 0 26.1 Tm (GL3002-CERT-9 10 PA) Tj ET BT /F3 10 Tf 1 0 0 1 255.65 14.09 Tm (17) Tj ET BT /F3 10 Tf 1 0 0 1 494.74 14.09 Tm (07/01/21) Tj ET Q q Q q 1 0 0 1 36 72.2 cm q n 0 683.8 m 612 683.8 l 612 671.8 l 0 671.8 l h W n Q q n 0 671.8 m 612 671.8 l 612 659.8 l 0 659.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 662.21 Tm (BENEFIT) Tj ET BT /F3 12 Tf 1 0 0 1 52.68 662.21 Tm (.) Tj ET BT /F3 12 Tf 1 0 0 1 66.11 662.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 89.98 662.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 141.86 662.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 165.74 662.21 Tm (pay) Tj ET BT /F3 12 Tf 1 0 0 1 188.28 662.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 198.82 662.21 Tm (Total) Tj ET BT /F3 12 Tf 1 0 0 1 229.36 662.21 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 281.91 662.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 328.46 662.21 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 368.99 662.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 383.54 662.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 400.08 662.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 441.28 662.21 Tm (Employee,) Tj ET BT /F3 12 Tf 1 0 0 1 498.15 662.21 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 662.21 Tm (the) Tj ET Q q n 0 659.8 m 612 659.8 l 612 647.8 l 0 647.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 650.21 Tm (completion of the Elimination Period, if he or she:) Tj ET Q q n 18 647.8 m 630 647.8 l 630 635.8 l 18 635.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 638.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 638.21 Tm (is Totally Disabled;) Tj ET Q q n 18 635.8 m 630 635.8 l 630 623.8 l 18 623.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 626.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 626.21 Tm (becomes Disabled while insured for this benefit;) Tj ET Q q n 18 623.8 m 630 623.8 l 630 611.8 l 18 611.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 614.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 614.21 Tm (is under the Regular Care of a Physician; and) Tj ET Q q n 18 611.8 m 630 611.8 l 630 599.8 l 18 599.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 602.21 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 602.21 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 57.67 602.21 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 75.34 602.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 88.99 602.21 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 107.98 602.21 Tm (own) Tj ET BT /F3 12 Tf 1 0 0 1 132.3 602.21 Tm (expense,) Tj ET BT /F3 12 Tf 1 0 0 1 177.61 602.21 Tm (submits) Tj ET BT /F3 12 Tf 1 0 0 1 218.62 602.21 Tm (proof) Tj ET BT /F3 12 Tf 1 0 0 1 248.27 602.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 261.93 602.21 Tm (continued) Tj ET BT /F3 12 Tf 1 0 0 1 312.91 602.21 Tm (Total) Tj ET BT /F3 12 Tf 1 0 0 1 341.89 602.21 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 392.89 602.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 413.87 602.21 Tm (Physician's) Tj ET BT /F3 12 Tf 1 0 0 1 471.03 602.21 Tm (care) Tj ET BT /F3 12 Tf 1 0 0 1 494.67 602.21 Tm (to) Tj ET Q q n 45.35 599.8 m 657.35 599.8 l 657.35 587.8 l 45.35 587.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 590.21 Tm (the Company upon request.) Tj ET Q q n 0 587.8 m 612 587.8 l 612 575.8 l 0 575.8 l h W n Q q n 0 575.8 m 612 575.8 l 612 563.8 l 0 563.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 566.21 Tm (The Total Disability Monthly Benefit will cease on the earliest of:) Tj ET Q q n 18 563.8 m 630 563.8 l 630 551.8 l 18 551.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 554.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 554.21 Tm (the date the Insured Employee ceases to be Totally Disabled or dies;) Tj ET Q q n 18 551.8 m 630 551.8 l 630 539.8 l 18 539.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 542.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 542.21 Tm (the date the Maximum Benefit Period ends; or) Tj ET Q q n 18 539.8 m 630 539.8 l 630 527.8 l 18 527.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 530.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 530.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 63.47 530.21 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 86.91 530.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 105.03 530.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 144.48 530.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 196.59 530.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 208.05 530.21 Tm (able,) Tj ET BT /F3 12 Tf 1 0 0 1 234.5 530.21 Tm (but) Tj ET BT /F3 12 Tf 1 0 0 1 253.29 530.21 Tm (chooses) Tj ET BT /F3 12 Tf 1 0 0 1 294.74 530.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 313.53 530.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 326.33 530.21 Tm (engage) Tj ET BT /F3 12 Tf 1 0 0 1 363.76 530.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 376.56 530.21 Tm (Partial/Residual) Tj ET BT /F3 12 Tf 1 0 0 1 456.67 530.21 Tm (Disability) Tj ET Q q n 45.35 527.8 m 657.35 527.8 l 657.35 515.8 l 45.35 515.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 518.21 Tm (Employment:) Tj ET Q q n 45.35 515.8 m 657.35 515.8 l 657.35 503.8 l 45.35 503.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 506.21 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 506.21 Tm (in his or her Own Occupation, during the Own Occupation Period; or) Tj ET Q q n 45.35 503.8 m 657.35 503.8 l 657.35 491.8 l 45.35 491.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 494.21 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 494.21 Tm (in any occupation, after the Own Occupation Period.) Tj ET Q q n 0 491.8 m 612 491.8 l 612 479.8 l 0 479.8 l h W n Q q n 0 479.8 m 612 479.8 l 612 467.8 l 0 467.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 470.21 Tm (Proportional benefits will be paid for a partial month of Total Disability.) Tj ET Q q n 0 467.8 m 612 467.8 l 612 455.8 l 0 455.8 l h W n Q q n 0 455.8 m 612 455.8 l 612 443.8 l 0 443.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 446.21 Tm (At) Tj ET BT /F3 12 Tf 1 0 0 1 15.64 446.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 33.94 446.21 Tm (Company's) Tj ET BT /F3 12 Tf 1 0 0 1 91.08 446.21 Tm (option,) Tj ET BT /F3 12 Tf 1 0 0 1 128.39 446.21 Tm (Total) Tj ET BT /F3 12 Tf 1 0 0 1 157.35 446.21 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 208.33 446.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 253.3 446.21 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 292.27 446.21 Tm (payments) Tj ET BT /F3 12 Tf 1 0 0 1 341.9 446.21 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 366.2 446.21 Tm (also) Tj ET BT /F3 12 Tf 1 0 0 1 389.17 446.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 404.14 446.21 Tm (denied) Tj ET BT /F3 12 Tf 1 0 0 1 439.76 446.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 453.4 446.21 Tm (suspended) Tj ET BT /F3 12 Tf 1 0 0 1 507.03 446.21 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 522.67 446.21 Tm (any) Tj ET Q q n 0 443.8 m 612 443.8 l 612 431.8 l 0 431.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 434.21 Tm (of the following dates:) Tj ET Q q n 18 431.8 m 630 431.8 l 630 419.8 l 18 419.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 422.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 422.21 Tm (the date the Insured Employee \(without good cause\):) Tj ET Q q n 45.35 419.8 m 657.35 419.8 l 657.35 407.8 l 45.35 407.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 410.21 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 410.21 Tm (fails to take a required medical exam;) Tj ET Q q n 45.35 407.8 m 657.35 407.8 l 657.35 395.8 l 45.35 395.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 398.21 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 398.21 Tm (fails to cooperate with the examiner; or) Tj ET Q q n 45.35 395.8 m 657.35 395.8 l 657.35 383.8 l 45.35 383.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 386.21 Tm (c.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 386.21 Tm (postpones a required exam more than twice;) Tj ET Q q n 18 383.8 m 630 383.8 l 630 371.8 l 18 371.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 374.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 374.21 Tm (the 45th day after the Company mails a request for additional proof, if not given; or) Tj ET Q q n 18 371.8 m 630 371.8 l 630 359.8 l 18 359.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 362.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 362.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 63.37 362.21 Tm (45) Tj ET BT /F3 7.2 Tf 1 0 0 1 75.37 365.81 Tm (th) Tj ET BT /F3 12 Tf 1 0 0 1 84.33 362.21 Tm (day) Tj ET BT /F3 12 Tf 1 0 0 1 105.01 362.21 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 130.34 362.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 148.36 362.21 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 198.38 362.21 Tm (mails) Tj ET BT /F3 12 Tf 1 0 0 1 227.74 362.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 236.42 362.21 Tm (request) Tj ET BT /F3 12 Tf 1 0 0 1 274.43 362.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 291.78 362.21 Tm (proof) Tj ET BT /F3 12 Tf 1 0 0 1 321.13 362.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 334.48 362.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 352.5 362.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 391.85 362.21 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 450.69 362.21 Tm (application) Tj ET Q q n 45.35 359.8 m 657.35 359.8 l 657.35 347.8 l 45.35 347.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 350.21 Tm (for any Other Income Benefits to which he or she may be entitled, if not given) Tj ET BT /F3 12 Tf 1 0 0 1 421.24 350.21 Tm (.) Tj ET Q q n 0 347.8 m 612 347.8 l 612 335.8 l 0 335.8 l h W n Q q n 0 335.8 m 612 335.8 l 612 323.8 l 0 323.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 326.21 Tm (AMOUNT.) Tj ET BT /F3 12 Tf 1 0 0 1 63.66 326.21 Tm (The amount of the Total Disability Monthly Benefit equals:) Tj ET Q q n 18 323.8 m 630 323.8 l 630 311.8 l 18 311.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 314.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 314.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 63.64 314.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 103.26 314.21 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 162.37 314.21 Tm (Basic) Tj ET BT /F3 12 Tf 1 0 0 1 192.66 314.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 237.63 314.21 Tm (Earnings) Tj ET BT /F3 12 Tf 1 0 0 1 283.91 314.21 Tm (multiplied) Tj ET BT /F3 12 Tf 1 0 0 1 336.87 314.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 352.5 314.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 370.79 314.21 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 409.74 314.21 Tm (Percentage) Tj ET BT /F3 12 Tf 1 0 0 1 466.01 314.21 Tm (\(limited) Tj ET Q q n 45.35 311.8 m 657.35 311.8 l 657.35 299.8 l 45.35 299.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 302.21 Tm (to the Maximum Monthly Benefit\); minus) Tj ET Q q n 18 299.8 m 630 299.8 l 630 287.8 l 18 287.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 290.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 290.21 Tm (Other Income Benefits.) Tj ET Q q n 0 287.8 m 612 287.8 l 612 275.8 l 0 275.8 l h W n Q q n 0 275.8 m 612 275.8 l 612 263.8 l 0 263.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 266.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 21.9 266.21 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 61.13 266.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 74.36 266.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 92.26 266.21 Tm (Total) Tj ET BT /F3 12 Tf 1 0 0 1 120.83 266.21 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 171.4 266.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 215.98 266.21 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 254.54 266.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 276.44 266.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 295.02 266.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 309.58 266.21 Tm (less) Tj ET BT /F3 12 Tf 1 0 0 1 330.82 266.21 Tm (than) Tj ET BT /F3 12 Tf 1 0 0 1 354.72 266.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 372.62 266.21 Tm (Minimum) Tj ET BT /F3 12 Tf 1 0 0 1 423.86 266.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 468.44 266.21 Tm (Benefit,) Tj ET BT /F3 12 Tf 1 0 0 1 510 266.21 Tm (unless) Tj ET Q q n 0 263.8 m 612 263.8 l 612 251.8 l 0 251.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 254.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 19.66 254.21 Tm (Minimum) Tj ET BT /F3 12 Tf 1 0 0 1 72.66 254.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 118.99 254.21 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 159.31 254.21 Tm (plus) Tj ET BT /F3 12 Tf 1 0 0 1 184.31 254.21 Tm (Other) Tj ET BT /F3 12 Tf 1 0 0 1 216.63 254.21 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 257.61 254.21 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 302.59 254.21 Tm (would) Tj ET BT /F3 12 Tf 1 0 0 1 337.59 254.21 Tm (exceed) Tj ET BT /F3 12 Tf 1 0 0 1 375.89 254.21 Tm (100%) Tj ET BT /F3 12 Tf 1 0 0 1 408.88 254.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 423.88 254.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 443.53 254.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 484.52 254.21 Tm (Employee's) Tj ET Q q n 0 251.8 m 612 251.8 l 612 239.8 l 0 239.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 242.21 Tm (Basic Monthly Earnings.) Tj ET Q q n 0 239.8 m 612 239.8 l 612 227.8 l 0 227.8 l h W n Q q n 0 227.8 m 612 227.8 l 612 215.8 l 0 215.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 218.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 21.91 218.21 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 60.49 218.21 Tm (Percentage,) Tj ET BT /F3 12 Tf 1 0 0 1 119.39 218.21 Tm (Maximum) Tj ET BT /F3 12 Tf 1 0 0 1 172.64 218.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 217.24 218.21 Tm (Benefit,) Tj ET BT /F3 12 Tf 1 0 0 1 258.81 218.21 Tm (Minimum) Tj ET BT /F3 12 Tf 1 0 0 1 310.08 218.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 354.67 218.21 Tm (Benefit,) Tj ET BT /F3 12 Tf 1 0 0 1 396.25 218.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 416.84 218.21 Tm (Maximum) Tj ET BT /F3 12 Tf 1 0 0 1 470.09 218.21 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 508.67 218.21 Tm (Period) Tj ET Q q n 0 215.8 m 612 215.8 l 612 203.8 l 0 203.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 206.21 Tm (are shown in the Schedule of Benefits.) Tj ET Q Q q Q Q endstream endobj 20 0 obj <>>>>> endobj 149 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 758.4 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 141.14 2.41 Tm (RESIDUAL) Tj ET BT /F2 12 Tf 1 0 0 1 203.15 2.41 Tm ( DISABILITY MONTHLY BENEFIT) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 49.8 m 183.6 49.8 l 183.6 37.8 l 0 37.8 l h W n Q 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 27.11 Tm (GL3002-CERT-10 05 PA) Tj ET q n 183.6 49.8 m 367.2 49.8 l 367.2 37.8 l 183.6 37.8 l h W n Q q n 367.2 49.8 m 550.8 49.8 l 550.8 37.8 l 367.2 37.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 451.83 40.21 Tm (Any Occ) Tj ET BT /F3 12 Tf 1 0 0 1 497.81 40.21 Tm (Def.) Tj ET BT /F3 12 Tf 1 0 0 1 521.3 40.21 Tm (Res) Tj ET Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 264.65 14.41 Tm (18) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 503.74 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 71.4 cm q n 0 684.6 m 612 684.6 l 612 672.6 l 0 672.6 l h W n Q q n 0 672.6 m 612 672.6 l 612 660.6 l 0 660.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 663.01 Tm (BENEFIT) Tj ET BT /F3 12 Tf 1 0 0 1 52.68 663.01 Tm (.) Tj ET BT /F3 12 Tf 1 0 0 1 66.54 663.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 90.62 663.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 142.71 663.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 166.81 663.01 Tm (pay) Tj ET BT /F3 12 Tf 1 0 0 1 189.56 663.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 200.32 663.01 Tm (Residual) Tj ET BT /F3 12 Tf 1 0 0 1 247.74 663.01 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 300.5 663.01 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 347.26 663.01 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 388.01 663.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 402.77 663.01 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 419.53 663.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 460.94 663.01 Tm (Employee,) Tj ET BT /F3 12 Tf 1 0 0 1 518.02 663.01 Tm (after) Tj ET Q q n 0 660.6 m 612 660.6 l 612 648.6 l 0 648.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 651.01 Tm (completion of the Elimination Period, if he or she:) Tj ET Q q n 18 648.6 m 630 648.6 l 630 636.6 l 18 636.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 639.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 639.01 Tm (is Disabled;) Tj ET Q q n 18 636.6 m 630 636.6 l 630 624.6 l 18 624.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 627.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 627.01 Tm (becomes Disabled while insured for this benefit;) Tj ET Q q n 18 624.6 m 630 624.6 l 630 612.6 l 18 612.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 615.01 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 615.01 Tm (is engaged in Residual Disability Employment;) Tj ET Q q n 18 612.6 m 630 612.6 l 630 600.6 l 18 600.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 603.01 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 603.01 Tm (is earning at least 20% of Predisability Income when Residual Disability Employment begins;) Tj ET Q q n 18 600.6 m 630 600.6 l 630 588.6 l 18 588.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 591.01 Tm (5.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 591.01 Tm (is under the Regular Care of a Physician; and) Tj ET Q q n 18 588.6 m 630 588.6 l 630 576.6 l 18 576.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 579.01 Tm (6.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 579.01 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 57.19 579.01 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 74.38 579.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 87.56 579.01 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 106.07 579.01 Tm (own) Tj ET BT /F3 12 Tf 1 0 0 1 129.92 579.01 Tm (expense,) Tj ET BT /F3 12 Tf 1 0 0 1 174.75 579.01 Tm (submits) Tj ET BT /F3 12 Tf 1 0 0 1 215.28 579.01 Tm (proof) Tj ET BT /F3 12 Tf 1 0 0 1 244.46 579.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 257.64 579.01 Tm (continued) Tj ET BT /F3 12 Tf 1 0 0 1 308.14 579.01 Tm (Residual) Tj ET BT /F3 12 Tf 1 0 0 1 353.32 579.01 Tm (Disability,) Tj ET BT /F3 12 Tf 1 0 0 1 406.84 579.01 Tm (Physician's) Tj ET BT /F3 12 Tf 1 0 0 1 463.52 579.01 Tm (care) Tj ET BT /F3 12 Tf 1 0 0 1 486.67 579.01 Tm (and) Tj ET Q q n 45.35 576.6 m 657.35 576.6 l 657.35 564.6 l 45.35 564.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 567.01 Tm (reduced earnings to the Company upon request.) Tj ET Q q n 0 564.6 m 612 564.6 l 612 552.6 l 0 552.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 555.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 23.38 555.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 64.08 555.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 117.45 555.01 Tm (does) Tj ET BT /F3 12 Tf 1 0 0 1 144.17 555.01 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 164.22 555.01 Tm (have) Tj ET BT /F3 12 Tf 1 0 0 1 191.59 555.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 205.64 555.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 221.69 555.01 Tm (Totally) Tj ET BT /F3 12 Tf 1 0 0 1 261.06 555.01 Tm (Disabled) Tj ET BT /F3 12 Tf 1 0 0 1 308.44 555.01 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 336.48 555.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 350.54 555.01 Tm (receiving) Tj ET BT /F3 12 Tf 1 0 0 1 399.9 555.01 Tm (Residual) Tj ET BT /F3 12 Tf 1 0 0 1 446.61 555.01 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 498.66 555.01 Tm (Monthly) Tj ET Q q n 0 552.6 m 612 552.6 l 612 540.6 l 0 540.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 543.01 Tm (Benefits.) Tj ET BT /F3 12 Tf 1 0 0 1 53.25 543.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 77.04 543.01 Tm (Elimination) Tj ET BT /F3 12 Tf 1 0 0 1 138.83 543.01 Tm (Period) Tj ET BT /F3 12 Tf 1 0 0 1 175.29 543.01 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 201.08 543.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 217.54 543.01 Tm (satisfied) Tj ET BT /F3 12 Tf 1 0 0 1 262.66 543.01 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 279.79 543.01 Tm (days) Tj ET BT /F3 12 Tf 1 0 0 1 306.92 543.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 322.04 543.01 Tm (Total) Tj ET BT /F3 12 Tf 1 0 0 1 352.5 543.01 Tm (Disability,) Tj ET BT /F3 12 Tf 1 0 0 1 407.96 543.01 Tm (Residual) Tj ET BT /F3 12 Tf 1 0 0 1 455.08 543.01 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 507.55 543.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 522.67 543.01 Tm (any) Tj ET Q q n 0 540.6 m 612 540.6 l 612 528.6 l 0 528.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 531.01 Tm (combination of these.) Tj ET Q q n 0 528.6 m 612 528.6 l 612 516.6 l 0 516.6 l h W n Q q n 0 516.6 m 612 516.6 l 612 504.6 l 0 504.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 507.01 Tm (The Residual Disability Monthly Benefit will cease on the earliest of:) Tj ET Q q n 18 504.6 m 630 504.6 l 630 492.6 l 18 492.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 495.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 495.01 Tm (the date the Insured Employee ceases to be Residually Disabled or dies;) Tj ET Q q n 18 492.6 m 630 492.6 l 630 480.6 l 18 480.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 483.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 483.01 Tm (the date the Maximum Benefit Period ends;) Tj ET Q q n 18 480.6 m 630 480.6 l 630 468.6 l 18 468.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 471.01 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 471.01 Tm (the date the Insured Employee earns more than:) Tj ET Q q n 45.35 468.6 m 657.35 468.6 l 657.35 456.6 l 45.35 456.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 459.01 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 459.01 Tm (99%) Tj ET BT /F3 12 Tf 1 0 0 1 100.07 459.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 115.44 459.01 Tm (Predisability) Tj ET BT /F3 12 Tf 1 0 0 1 181.47 459.01 Tm (Income,) Tj ET BT /F3 12 Tf 1 0 0 1 225.83 459.01 Tm (until) Tj ET BT /F3 12 Tf 1 0 0 1 253.2 459.01 Tm (Residual) Tj ET BT /F3 12 Tf 1 0 0 1 300.57 459.01 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 353.27 459.01 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 399.99 459.01 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 445.35 459.01 Tm (have) Tj ET Q q n 72.7 456.6 m 684.7 456.6 l 684.7 444.6 l 72.7 444.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 447.01 Tm (been paid for 24 months for the same period of Disability; or) Tj ET Q q n 45.35 444.6 m 657.35 444.6 l 657.35 432.6 l 45.35 432.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 435.01 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 435.01 Tm (85%) Tj ET BT /F3 12 Tf 1 0 0 1 100.07 435.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 115.44 435.01 Tm (Predisability) Tj ET BT /F3 12 Tf 1 0 0 1 181.48 435.01 Tm (Income,) Tj ET BT /F3 12 Tf 1 0 0 1 225.84 435.01 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 253.19 435.01 Tm (Residual) Tj ET BT /F3 12 Tf 1 0 0 1 300.56 435.01 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 353.27 435.01 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 399.98 435.01 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 445.35 435.01 Tm (have) Tj ET Q q n 72.7 432.6 m 684.7 432.6 l 684.7 420.6 l 72.7 420.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 423.01 Tm (been paid for 24 months for the same period of Disability;) Tj ET Q q n 18 420.6 m 630 420.6 l 630 408.6 l 18 408.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 411.01 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 411.01 Tm (the date the Insured Employee is able, but chooses not to work full-time:) Tj ET Q q n 45.35 408.6 m 657.35 408.6 l 657.35 396.6 l 45.35 396.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 399.01 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 399.01 Tm (in his or her Own Occupation, during the Own Occupation Period; or) Tj ET Q q n 45.35 396.6 m 657.35 396.6 l 657.35 384.6 l 45.35 384.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 387.01 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 387.01 Tm (in any occupation, after the Own Occupation Period.) Tj ET Q q n 0 384.6 m 612 384.6 l 612 372.6 l 0 372.6 l h W n Q q n 0 372.6 m 612 372.6 l 612 360.6 l 0 360.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 363.01 Tm (Proportional benefits will be paid for a partial month of Residual Disability.) Tj ET Q q n 0 360.6 m 612 360.6 l 612 348.6 l 0 348.6 l h W n Q q n 0 348.6 m 612 348.6 l 612 336.6 l 0 336.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 339.01 Tm (At) Tj ET BT /F3 12 Tf 1 0 0 1 15.93 339.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 34.52 339.01 Tm (Company's) Tj ET BT /F3 12 Tf 1 0 0 1 91.94 339.01 Tm (option,) Tj ET BT /F3 12 Tf 1 0 0 1 129.53 339.01 Tm (Residual) Tj ET BT /F3 12 Tf 1 0 0 1 175.46 339.01 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 226.71 339.01 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 271.98 339.01 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 311.23 339.01 Tm (payments) Tj ET BT /F3 12 Tf 1 0 0 1 361.15 339.01 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 385.73 339.01 Tm (also) Tj ET BT /F3 12 Tf 1 0 0 1 408.99 339.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 424.24 339.01 Tm (denied) Tj ET BT /F3 12 Tf 1 0 0 1 460.16 339.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 474.08 339.01 Tm (suspended) Tj ET BT /F3 12 Tf 1 0 0 1 528 339.01 Tm (on) Tj ET Q q n 0 336.6 m 612 336.6 l 612 324.6 l 0 324.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 327.01 Tm (any of the following dates:) Tj ET Q q n 18 324.6 m 630 324.6 l 630 312.6 l 18 312.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 315.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 315.01 Tm (the date the Insured Employee \(without good cause\):) Tj ET Q q n 44.65 312.6 m 656.65 312.6 l 656.65 300.6 l 44.65 300.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 44.65 303.01 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72 303.01 Tm (fails to take a required medical exam;) Tj ET Q q n 44.65 300.6 m 656.65 300.6 l 656.65 288.6 l 44.65 288.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 44.65 291.01 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72 291.01 Tm (fails to cooperate with the examiner; or) Tj ET Q q n 44.65 288.6 m 656.65 288.6 l 656.65 276.6 l 44.65 276.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 44.65 279.01 Tm (c.) Tj ET BT /F3 12 Tf 1 0 0 1 72 279.01 Tm (postpones a required exam) Tj ET BT /F3 12 Tf 1 0 0 1 203.29 279.01 Tm (more than twice;) Tj ET Q q n 18 276.6 m 630 276.6 l 630 264.6 l 18 264.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 267.01 Tm (2) Tj ET BT /F99 12 Tf 1 0 0 1 24 267.01 Tm (.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 267.01 Tm (the 45) Tj ET BT /F3 7.2 Tf 1 0 0 1 75.01 270.61 Tm (th) Tj ET BT /F3 12 Tf 1 0 0 1 80.61 267.01 Tm ( day after the Company mails a request for additional proof, if not given; or) Tj ET Q q n 18 264.6 m 630 264.6 l 630 252.6 l 18 252.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 255.01 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 255.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 63.37 255.01 Tm (45) Tj ET BT /F3 7.2 Tf 1 0 0 1 75.37 258.61 Tm (th) Tj ET BT /F3 12 Tf 1 0 0 1 84.33 255.01 Tm (day) Tj ET BT /F3 12 Tf 1 0 0 1 105.01 255.01 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 130.34 255.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 148.36 255.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 198.38 255.01 Tm (mails) Tj ET BT /F3 12 Tf 1 0 0 1 227.74 255.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 236.42 255.01 Tm (request) Tj ET BT /F3 12 Tf 1 0 0 1 274.43 255.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 291.78 255.01 Tm (proof) Tj ET BT /F3 12 Tf 1 0 0 1 321.13 255.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 334.48 255.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 352.5 255.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 391.85 255.01 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 450.69 255.01 Tm (application) Tj ET Q q n 45.35 252.6 m 657.35 252.6 l 657.35 240.6 l 45.35 240.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 243.01 Tm (for any Other Income Benefits to which he or she may be entitled, if not given.) Tj ET Q Q q Q Q endstream endobj 21 0 obj <>>>>> endobj 151 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 734.4 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 141.14 26.41 Tm (RESIDUAL) Tj ET BT /F2 12 Tf 1 0 0 1 203.15 26.41 Tm ( DISABILITY MONTHLY BENEFIT) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 239 14.41 Tm (\(Continued\)) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 60 m 183.6 60 l 183.6 48 l 0 48 l h W n Q q n 183.6 60 m 367.2 60 l 367.2 48 l 183.6 48 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 212.5 50.41 Tm (Progressive Calculation) Tj ET Q q n 183.6 48 m 367.2 48 l 367.2 36 l 183.6 36 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 197.83 38.41 Tm (of Residual Disability Benefit) Tj ET Q q n 367.2 60 m 550.8 60 l 550.8 48 l 367.2 48 l h W n Q q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-10.6 PA) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 264.65 14.41 Tm (19) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 503.74 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 81.6 cm q n 0 652.8 m 612 652.8 l 612 640.8 l 0 640.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 643.21 Tm (PROGRESSIVE) Tj ET BT /F3 12 Tf 1 0 0 1 84.96 643.21 Tm (CALCULATION) Tj ET BT /F3 12 Tf 1 0 0 1 174.56 643.21 Tm (METHOD.) Tj ET BT /F3 12 Tf 1 0 0 1 237.44 643.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 260.37 643.21 Tm (Residual) Tj ET BT /F3 12 Tf 1 0 0 1 306.64 643.21 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 358.25 643.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 403.87 643.21 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 443.46 643.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 455.74 643.21 Tm (determined) Tj ET BT /F3 12 Tf 1 0 0 1 514 643.21 Tm (using) Tj ET Q q n 0 640.8 m 612 640.8 l 612 628.8 l 0 628.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 631.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 19.88 631.21 Tm (Progressive) Tj ET BT /F3 12 Tf 1 0 0 1 81.09 631.21 Tm (Calculation) Tj ET BT /F3 12 Tf 1 0 0 1 141.63 631.21 Tm (Method.) Tj ET BT /F3 12 Tf 1 0 0 1 192.41 631.21 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 218.96 631.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 254.84 631.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 274.72 631.21 Tm (Residual) Tj ET BT /F3 12 Tf 1 0 0 1 321.94 631.21 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 374.49 631.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 421.05 631.21 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 461.59 631.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 485.48 631.21 Tm (replace) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 631.21 Tm (the) Tj ET Q q n 0 628.8 m 612 628.8 l 612 616.8 l 0 616.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 619.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 41.1 619.21 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 101.7 619.21 Tm (Lost) Tj ET BT /F3 12 Tf 1 0 0 1 128.15 619.21 Tm (Income;) Tj ET BT /F3 12 Tf 1 0 0 1 172.58 619.21 Tm (provided) Tj ET BT /F3 12 Tf 1 0 0 1 220.36 619.21 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 232.14 619.21 Tm (does) Tj ET BT /F3 12 Tf 1 0 0 1 259.25 619.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 279.7 619.21 Tm (exceed) Tj ET BT /F3 12 Tf 1 0 0 1 318.12 619.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 337.9 619.21 Tm (Total) Tj ET BT /F3 12 Tf 1 0 0 1 368.34 619.21 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 420.78 619.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 467.24 619.21 Tm (Benefit,) Tj ET BT /F3 12 Tf 1 0 0 1 510.67 619.21 Tm (which) Tj ET Q q n 0 616.8 m 612 616.8 l 612 604.8 l 0 604.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 607.21 Tm (would otherwise be payable during Total Disability without the Residual Disability Employment.) Tj ET Q q n 0 604.8 m 612 604.8 l 612 592.8 l 0 592.8 l h W n Q q n 0 592.8 m 612 592.8 l 612 580.8 l 0 580.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 583.21 Tm (BENEFIT) Tj ET BT /F3 12 Tf 1 0 0 1 53.02 583.21 Tm (AMOUNT.) Tj ET BT /F3 12 Tf 1 0 0 1 116.06 583.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 138.41 583.21 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 178.09 583.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 191.78 583.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 210.13 583.21 Tm (Residual) Tj ET BT /F3 12 Tf 1 0 0 1 255.81 583.21 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 306.83 583.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 351.86 583.21 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 390.87 583.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 413.23 583.21 Tm (equal) Tj ET BT /F3 12 Tf 1 0 0 1 442.91 583.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 461.26 583.21 Tm (lesser) Tj ET BT /F3 12 Tf 1 0 0 1 492.27 583.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 505.95 583.21 Tm (A) Tj ET BT /F3 12 Tf 1 0 0 1 518.31 583.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 532 583.21 Tm (B) Tj ET Q q n 0 580.8 m 612 580.8 l 612 568.8 l 0 568.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 571.21 Tm (below.) Tj ET Q q n 18 568.8 m 630 568.8 l 630 556.8 l 18 556.8 l h W n Q q n 18 556.8 m 630 556.8 l 630 544.8 l 18 544.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 547.21 Tm (A.) Tj ET BT /F3 12 Tf 1 0 0 1 45 547.21 Tm (LOST) Tj ET BT /F3 12 Tf 1 0 0 1 80.81 547.21 Tm (INCOME:) Tj ET BT /F3 12 Tf 1 0 0 1 143.1 547.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 167.57 547.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 209.37 547.21 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 270.66 547.21 Tm (Predisability) Tj ET BT /F3 12 Tf 1 0 0 1 337.14 547.21 Tm (Income,) Tj ET BT /F3 12 Tf 1 0 0 1 381.93 547.21 Tm (minus) Tj ET BT /F3 12 Tf 1 0 0 1 417.08 547.21 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 434.88 547.21 Tm (Other) Tj ET BT /F3 12 Tf 1 0 0 1 468.02 547.21 Tm (Income) Tj ET Q q n 45 544.8 m 657 544.8 l 657 532.8 l 45 532.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 535.21 Tm (Benefits \(including earnings from Residual Disability Employment\).) Tj ET Q q n 18 532.8 m 630 532.8 l 630 520.8 l 18 520.8 l h W n Q q n 18 520.8 m 630 520.8 l 630 508.8 l 18 508.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 511.21 Tm (B.) Tj ET BT /F3 12 Tf 1 0 0 1 45 511.21 Tm (TOTAL DISABILITY MONTHLY BENEFIT otherwise payable:) Tj ET Q q n 45 508.8 m 657 508.8 l 657 496.8 l 45 496.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 499.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 72 499.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 100.4 499.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 146.12 499.21 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 211.35 499.21 Tm (Predisability) Tj ET BT /F3 12 Tf 1 0 0 1 281.75 499.21 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 327.47 499.21 Tm (multiplied) Tj ET BT /F3 12 Tf 1 0 0 1 386.54 499.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 408.28 499.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 432.68 499.21 Tm (Benefit) Tj ET Q q n 72 496.8 m 684 496.8 l 684 484.8 l 72 484.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72 487.21 Tm (Percentage \(limited to the Maximum Monthly Benefit\); minus) Tj ET Q q n 45 484.8 m 657 484.8 l 657 472.8 l 45 472.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 475.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 72 475.21 Tm (Other) Tj ET BT /F3 12 Tf 1 0 0 1 110.71 475.21 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 158.08 475.21 Tm (Benefits,) Tj ET BT /F3 12 Tf 1 0 0 1 212.46 475.21 Tm (except) Tj ET BT /F3 12 Tf 1 0 0 1 255.16 475.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 280.53 475.21 Tm (earnings) Tj ET BT /F3 12 Tf 1 0 0 1 332.57 475.21 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 367.29 475.21 Tm (Residual) Tj ET BT /F3 12 Tf 1 0 0 1 420.67 475.21 Tm (Disability) Tj ET Q q n 72 472.8 m 684 472.8 l 684 460.8 l 72 460.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72 463.21 Tm (Employment.) Tj ET Q q n 0 460.8 m 612 460.8 l 612 448.8 l 0 448.8 l h W n Q q n 0 448.8 m 612 448.8 l 612 436.8 l 0 436.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 439.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 22.66 439.21 Tm (Residual) Tj ET BT /F3 12 Tf 1 0 0 1 68.66 439.21 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 120 439.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 165.35 439.21 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 204.67 439.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 227.35 439.21 Tm (never) Tj ET BT /F3 12 Tf 1 0 0 1 258 439.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 273.33 439.21 Tm (less) Tj ET BT /F3 12 Tf 1 0 0 1 295.34 439.21 Tm (than) Tj ET BT /F3 12 Tf 1 0 0 1 320.01 439.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 338.67 439.21 Tm (Minimum) Tj ET BT /F3 12 Tf 1 0 0 1 390.68 439.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 436.03 439.21 Tm (Benefit;) Tj ET BT /F3 12 Tf 1 0 0 1 478.69 439.21 Tm (except) Tj ET BT /F3 12 Tf 1 0 0 1 514.01 439.21 Tm (when) Tj ET Q q n 0 436.8 m 612 436.8 l 612 424.8 l 0 424.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 427.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 21.78 427.21 Tm (Minimum) Tj ET BT /F3 12 Tf 1 0 0 1 76.91 427.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 125.36 427.21 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 167.81 427.21 Tm (plus) Tj ET BT /F3 12 Tf 1 0 0 1 194.93 427.21 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 240.04 427.21 Tm (received) Tj ET BT /F3 12 Tf 1 0 0 1 287.79 427.21 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 322.23 427.21 Tm (Workers) Tj ET BT /F3 12 Tf 1 0 0 1 374.66 427.21 Tm (Compensation) Tj ET BT /F3 12 Tf 1 0 0 1 451.11 427.21 Tm (and/or) Tj ET BT /F3 12 Tf 1 0 0 1 488.89 427.21 Tm (wage) Tj ET BT /F3 12 Tf 1 0 0 1 521.33 427.21 Tm (loss) Tj ET Q q n 0 424.8 m 612 424.8 l 612 412.8 l 0 412.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 415.21 Tm (replacement) Tj ET BT /F3 12 Tf 1 0 0 1 64.36 415.21 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 108.08 415.21 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 141.14 415.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 161.53 415.21 Tm (Pennsylvania) Tj ET BT /F3 12 Tf 1 0 0 1 231.26 415.21 Tm (Motor) Tj ET BT /F3 12 Tf 1 0 0 1 266.99 415.21 Tm (Vehicle) Tj ET BT /F3 12 Tf 1 0 0 1 310.03 415.21 Tm (Financial) Tj ET BT /F3 12 Tf 1 0 0 1 360.42 415.21 Tm (Responsibility) Tj ET BT /F3 12 Tf 1 0 0 1 435.5 415.21 Tm (Law) Tj ET BT /F3 12 Tf 1 0 0 1 462.55 415.21 Tm (would) Tj ET BT /F3 12 Tf 1 0 0 1 498.28 415.21 Tm (equal) Tj ET BT /F3 12 Tf 1 0 0 1 530 415.21 Tm (or) Tj ET Q q n 0 412.8 m 612 412.8 l 612 400.8 l 0 400.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 403.21 Tm (exceed 100% of Predisability Income.) Tj ET Q q n 0 400.8 m 612 400.8 l 612 388.8 l 0 388.8 l h W n Q q n 0 388.8 m 612 388.8 l 612 376.8 l 0 376.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 379.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 21.91 379.21 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 60.49 379.21 Tm (Percentage,) Tj ET BT /F3 12 Tf 1 0 0 1 119.39 379.21 Tm (Maximum) Tj ET BT /F3 12 Tf 1 0 0 1 172.64 379.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 217.24 379.21 Tm (Benefit,) Tj ET BT /F3 12 Tf 1 0 0 1 258.81 379.21 Tm (Minimum) Tj ET BT /F3 12 Tf 1 0 0 1 310.08 379.21 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 354.67 379.21 Tm (Benefit,) Tj ET BT /F3 12 Tf 1 0 0 1 396.25 379.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 416.84 379.21 Tm (Maximum) Tj ET BT /F3 12 Tf 1 0 0 1 470.09 379.21 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 508.67 379.21 Tm (Period) Tj ET Q q n 0 376.8 m 612 376.8 l 612 364.8 l 0 364.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 367.21 Tm (are shown in the Schedule of Benefits.) Tj ET Q q n 0 364.8 m 612 364.8 l 612 352.8 l 0 352.8 l h W n Q Q q Q Q endstream endobj 22 0 obj <>>>>> endobj 152 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 744 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 190.32 2.41 Tm (OTHER INCOME BENEFITS) Tj ET Q Q q Q q 1 0 0 1 36 36 cm q n 0 48 m 612 48 l 612 36 l 0 36 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 384.01 38.41 Tm (Any Occ,) Tj ET BT /F3 12 Tf 1 0 0 1 429.99 38.41 Tm ( Prim & Fam SS Integ.) Tj ET Q q n 0 36 m 357.35 36 l 357.35 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-11-INT 10) Tj ET Q q n 0 24 m 179.45 24 l 179.45 12 l 0 12 l h W n Q q n 179.45 24 m 357.35 24 l 357.35 12 l 179.45 12 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 257 14.41 Tm (20) Tj ET Q q n 357.35 24 m 540 24 l 540 12 l 357.35 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 493.64 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 84 cm q n 0 660 m 612 660 l 612 648 l 0 648 l h W n Q q n 0 648 m 612 648 l 612 636 l 0 636 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 638.41 Tm (OTHER) Tj ET BT /F2 12 Tf 1 0 0 1 47.32 638.41 Tm (INCOME) Tj ET BT /F2 12 Tf 1 0 0 1 101.96 638.41 Tm (BENEFITS) Tj ET BT /F3 12 Tf 1 0 0 1 165.3 638.41 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 199.93 638.41 Tm (benefits,) Tj ET BT /F3 12 Tf 1 0 0 1 244.89 638.41 Tm (awards,) Tj ET BT /F3 12 Tf 1 0 0 1 285.86 638.41 Tm (settlements) Tj ET BT /F3 12 Tf 1 0 0 1 343.82 638.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 357.8 638.41 Tm (Earnings) Tj ET BT /F3 12 Tf 1 0 0 1 404.43 638.41 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 431.73 638.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 450.37 638.41 Tm (following) Tj ET BT /F3 12 Tf 1 0 0 1 501.01 638.41 Tm (sources.) Tj ET Q q n 0 636 m 612 636 l 612 624 l 0 624 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 626.41 Tm (These) Tj ET BT /F3 12 Tf 1 0 0 1 32.61 626.41 Tm (amounts) Tj ET BT /F3 12 Tf 1 0 0 1 77.23 626.41 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 99.85 626.41 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 115.13 626.41 Tm (offset,) Tj ET BT /F3 12 Tf 1 0 0 1 149.41 626.41 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 162.7 626.41 Tm (determining) Tj ET BT /F3 12 Tf 1 0 0 1 224.64 626.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 243.26 626.41 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 283.21 626.41 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 297.16 626.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 315.78 626.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 355.72 626.41 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 415.16 626.41 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 460.45 626.41 Tm (Benefit.) Tj ET BT /F3 12 Tf 1 0 0 1 506.68 626.41 Tm (Except) Tj ET Q q n 0 624 m 612 624 l 612 612 l 0 612 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 614.41 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 17.39 614.41 Tm (Retirement) Tj ET BT /F3 12 Tf 1 0 0 1 74.11 614.41 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 117.51 614.41 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 138.23 614.41 Tm (Earnings,) Tj ET BT /F3 12 Tf 1 0 0 1 187.29 614.41 Tm (these) Tj ET BT /F3 12 Tf 1 0 0 1 215.35 614.41 Tm (amounts) Tj ET BT /F3 12 Tf 1 0 0 1 259.42 614.41 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 286.16 614.41 Tm (result) Tj ET BT /F3 12 Tf 1 0 0 1 316.22 614.41 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 342.95 614.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 361.02 614.41 Tm (same) Tj ET BT /F3 12 Tf 1 0 0 1 389.07 614.41 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 439.81 614.41 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 457.2 614.41 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 489.93 614.41 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 498.66 614.41 Tm (Monthly) Tj ET Q q n 0 612 m 612 612 l 612 600 l 0 600 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 602.41 Tm (Benefit is payable under the Policy.) Tj ET Q q n 0 600 m 612 600 l 612 588 l 0 588 l h W n Q q n 0 588 m 612 588 l 612 576 l 0 576 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 578.41 Tm (Workers') Tj ET BT /F2 12 Tf 1 0 0 1 55.4 578.41 Tm (Compensation.) Tj ET BT /F3 12 Tf 1 0 0 1 145.89 578.41 Tm (Any) Tj ET BT /F3 12 Tf 1 0 0 1 173.29 578.41 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 218.02 578.41 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 238.75 578.41 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 274.82 578.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 296.22 578.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 338.95 578.41 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 394.34 578.41 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 409.08 578.41 Tm (eligible) Tj ET BT /F3 12 Tf 1 0 0 1 451.81 578.41 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 485.87 578.41 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 497.94 578.41 Tm (law) Tj ET BT /F3 12 Tf 1 0 0 1 522.01 578.41 Tm (that) Tj ET Q q n 0 576 m 612 576 l 612 564 l 0 564 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 566.41 Tm (compensates for job related Injury or Sickness.) Tj ET BT /F3 12 Tf 1 0 0 1 231.6 566.41 Tm (This includes:) Tj ET Q q n 18 564 m 630 564 l 630 552 l 18 552 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 554.41 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 46.8 554.41 Tm (any Workers' Compensation or occupational disease law;) Tj ET Q q n 18 552 m 630 552 l 630 540 l 18 540 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 542.41 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 46.8 542.41 Tm (the Jones Act;) Tj ET Q q n 18 540 m 630 540 l 630 528 l 18 528 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 530.41 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 46.8 530.41 Tm (the Longshoreman's and Harbor Worker's Act;) Tj ET Q q n 18 528 m 630 528 l 630 516 l 18 516 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 518.41 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 46.8 518.41 Tm (the Maritime Doctrine of Maintenance, Wages or Cure; or) Tj ET Q q n 18 516 m 630 516 l 630 504 l 18 504 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 506.41 Tm (5.) Tj ET BT /F3 12 Tf 1 0 0 1 46.8 506.41 Tm (any plan provided in place of one of the above plans.) Tj ET Q q n 0 504 m 612 504 l 612 492 l 0 492 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 494.41 Tm (It) Tj ET BT /F3 12 Tf 1 0 0 1 11.93 494.41 Tm (includes) Tj ET BT /F3 12 Tf 1 0 0 1 56.52 494.41 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 78.44 494.41 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 121.02 494.41 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 139.61 494.41 Tm (partial) Tj ET BT /F3 12 Tf 1 0 0 1 174.86 494.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 189.45 494.41 Tm (total) Tj ET BT /F3 12 Tf 1 0 0 1 215.38 494.41 Tm (disability,) Tj ET BT /F3 12 Tf 1 0 0 1 267.64 494.41 Tm (whether) Tj ET BT /F3 12 Tf 1 0 0 1 310.89 494.41 Tm (temporary) Tj ET BT /F3 12 Tf 1 0 0 1 364.8 494.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 379.39 494.41 Tm (permanent.) Tj ET BT /F3 12 Tf 1 0 0 1 442.23 494.41 Tm (It) Tj ET BT /F3 12 Tf 1 0 0 1 454.16 494.41 Tm (also) Tj ET BT /F3 12 Tf 1 0 0 1 478.09 494.41 Tm (includes) Tj ET BT /F3 12 Tf 1 0 0 1 522.67 494.41 Tm (any) Tj ET Q q n 0 492 m 612 492 l 612 480 l 0 480 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 482.41 Tm (benefits for vocational rehabilitation.) Tj ET Q q n 0 480 m 612 480 l 612 468 l 0 468 l h W n Q q n 0 468 m 612 468 l 612 456 l 0 456 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 458.41 Tm (Other) Tj ET BT /F2 12 Tf 1 0 0 1 33.89 458.41 Tm (Compulsory) Tj ET BT /F2 12 Tf 1 0 0 1 100.46 458.41 Tm (Benefits.) Tj ET BT /F3 12 Tf 1 0 0 1 151.24 458.41 Tm (Any) Tj ET BT /F3 12 Tf 1 0 0 1 175.14 458.41 Tm (disability) Tj ET BT /F3 12 Tf 1 0 0 1 223.04 458.41 Tm (income) Tj ET BT /F3 12 Tf 1 0 0 1 261.59 458.41 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 302.81 458.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 320.7 458.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 359.91 458.41 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 411.8 458.41 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 423.03 458.41 Tm (eligible) Tj ET BT /F3 12 Tf 1 0 0 1 462.25 458.41 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 474.81 458.41 Tm (receive) Tj ET BT /F3 12 Tf 1 0 0 1 512.68 458.41 Tm (under) Tj ET Q q n 0 456 m 612 456 l 612 444 l 0 444 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 446.41 Tm (any other compulsory benefit act or law.) Tj ET BT /F3 12 Tf 1 0 0 1 200.27 446.41 Tm (This includes \(but is not limited to\):) Tj ET Q q n 18 444 m 630 444 l 630 432 l 18 432 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 434.41 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 46.8 434.41 Tm (state temporary disability income benefit laws;) Tj ET Q q n 18 432 m 630 432 l 630 420 l 18 420 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 422.41 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 46.8 422.41 Tm (state no fault auto insurance laws; or) Tj ET Q q n 18 420 m 630 420 l 630 408 l 18 408 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 410.41 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 46.8 410.41 Tm (any other compulsory benefit act or law.) Tj ET Q q n 0 408 m 612 408 l 612 396 l 0 396 l h W n Q q n 0 396 m 612 396 l 612 384 l 0 384 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 386.41 Tm (Other Insurance Plans.) Tj ET BT /F3 12 Tf 1 0 0 1 125 386.41 Tm (Any disability income benefits for which the Insured Employee is eligible under:) Tj ET Q q n 18 384 m 630 384 l 630 372 l 18 372 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 374.41 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 46.8 374.41 Tm (any other group insurance plan \(except credit or mortgage insurance\); or) Tj ET Q q n 18 372 m 630 372 l 630 360 l 18 360 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 362.41 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 46.8 362.41 Tm (any no fault auto plan.) Tj ET Q q n 0 360 m 612 360 l 612 348 l 0 348 l h W n Q q n 0 348 m 612 348 l 612 336 l 0 336 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 338.41 Tm (Employee) Tj ET BT /F2 12 Tf 1 0 0 1 54.06 338.41 Tm (Benefit) Tj ET BT /F2 12 Tf 1 0 0 1 94.12 338.41 Tm (Plans.) Tj ET BT /F3 12 Tf 1 0 0 1 131.94 338.41 Tm (Any) Tj ET BT /F3 12 Tf 1 0 0 1 156 338.41 Tm (disability) Tj ET BT /F3 12 Tf 1 0 0 1 204.07 338.41 Tm (income) Tj ET BT /F3 12 Tf 1 0 0 1 242.8 338.41 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 284.19 338.41 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 301.58 338.41 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 334.31 338.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 352.37 338.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 391.76 338.41 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 443.82 338.41 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 455.22 338.41 Tm (eligible) Tj ET BT /F3 12 Tf 1 0 0 1 494.62 338.41 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 338.41 Tm (the) Tj ET Q q n 0 336 m 612 336 l 612 324 l 0 324 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 326.41 Tm (Employer's) Tj ET BT /F3 12 Tf 1 0 0 1 57.76 326.41 Tm (Sick) Tj ET BT /F3 12 Tf 1 0 0 1 82.7 326.41 Tm (Leave) Tj ET BT /F3 12 Tf 1 0 0 1 115.62 326.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 129.22 326.41 Tm (Salary) Tj ET BT /F3 12 Tf 1 0 0 1 163.49 326.41 Tm (Continuance) Tj ET BT /F3 12 Tf 1 0 0 1 227.74 326.41 Tm (Plan.) Tj ET BT /F3 12 Tf 1 0 0 1 259.29 326.41 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 284.23 326.41 Tm (does) Tj ET BT /F2 12 Tf 1 0 0 1 309.84 326.41 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 330.12 326.41 Tm (include) Tj ET BT /F3 12 Tf 1 0 0 1 369.04 326.41 Tm (vacation) Tj ET BT /F3 12 Tf 1 0 0 1 413.3 326.41 Tm (pay,) Tj ET BT /F3 12 Tf 1 0 0 1 437.23 326.41 Tm (severance) Tj ET BT /F3 12 Tf 1 0 0 1 488.14 326.41 Tm (pay) Tj ET BT /F3 12 Tf 1 0 0 1 509.07 326.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 522.67 326.41 Tm (pay) Tj ET Q q n 0 324 m 612 324 l 612 312 l 0 312 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 314.41 Tm (for work actually performed during a Disability) Tj ET BT /F3 12 Tf 1 0 0 1 228.6 314.41 Tm (.) Tj ET Q q n 0 312 m 612 312 l 612 300 l 0 300 l h W n Q q n 0 300 m 612 300 l 612 288 l 0 288 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 290.41 Tm (Employer's) Tj ET BT /F2 12 Tf 1 0 0 1 62.29 290.41 Tm (Retirement) Tj ET BT /F2 12 Tf 1 0 0 1 123.88 290.41 Tm (Plan.) Tj ET BT /F3 12 Tf 1 0 0 1 157.47 290.41 Tm (Any) Tj ET BT /F3 12 Tf 1 0 0 1 181.77 290.41 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 232.72 290.41 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 276.34 290.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 289.96 290.41 Tm (Retirement) Tj ET BT /F3 12 Tf 1 0 0 1 346.9 290.41 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 390.52 290.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 408.81 290.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 448.42 290.41 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 500.7 290.41 Tm (receives) Tj ET Q q n 0 288 m 612 288 l 612 276 l 0 276 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 278.41 Tm (under the Employer's Retirement Plan.) Tj ET Q q n 0 276 m 612 276 l 612 264 l 0 264 l h W n Q q n 0 264 m 612 264 l 612 252 l 0 252 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 254.41 Tm (Social) Tj ET BT /F2 12 Tf 1 0 0 1 38.09 254.41 Tm (Security) Tj ET BT /F2 12 Tf 1 0 0 1 88.16 254.41 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 114.92 254.41 Tm (other) Tj ET BT /F2 12 Tf 1 0 0 1 149.66 254.41 Tm (Government) Tj ET BT /F2 12 Tf 1 0 0 1 221.73 254.41 Tm (Retirement) Tj ET BT /F2 12 Tf 1 0 0 1 287.12 254.41 Tm (Plans.) Tj ET BT /F3 12 Tf 1 0 0 1 332.96 254.41 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 359.03 254.41 Tm (following) Tj ET BT /F3 12 Tf 1 0 0 1 413.11 254.41 Tm (Social) Tj ET BT /F3 12 Tf 1 0 0 1 450.52 254.41 Tm (Security) Tj ET BT /F3 12 Tf 1 0 0 1 497.93 254.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 515.34 254.41 Tm (other) Tj ET Q q n 0 252 m 612 252 l 612 240 l 0 240 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 242.41 Tm (Government Retirement Plan benefits will be offset:) Tj ET Q q n 18 240 m 630 240 l 630 228 l 18 228 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 230.41 Tm (1.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 230.41 Tm (disability) Tj ET BT /F2 12 Tf 1 0 0 1 97.04 230.41 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 141.37 230.41 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 159.7 230.41 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 193.37 230.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 212.36 230.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 252.69 230.41 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 305.68 230.41 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 318.02 230.41 Tm (eligible;) Tj ET BT /F3 12 Tf 1 0 0 1 361.68 230.41 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 383.34 230.41 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 401.67 230.41 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 435.34 230.41 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 457 230.41 Tm (spouse) Tj ET BT /F3 12 Tf 1 0 0 1 494 230.41 Tm (or) Tj ET Q q n 45.35 228 m 657.35 228 l 657.35 216 l 45.35 216 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 218.41 Tm (child is eligible, because of the Insured Employee's Disability;) Tj ET Q q n 18 216 m 630 216 l 630 204 l 18 204 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 206.41 Tm (2.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 206.41 Tm (unreduced) Tj ET BT /F2 12 Tf 1 0 0 1 103.21 206.41 Tm (retirement) Tj ET BT /F2 12 Tf 1 0 0 1 161.03 206.41 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 204.21 206.41 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 221.39 206.41 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 253.9 206.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 271.75 206.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 310.93 206.41 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 362.77 206.41 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 373.96 206.41 Tm (eligible;) Tj ET BT /F3 12 Tf 1 0 0 1 416.47 206.41 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 436.98 206.41 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 454.16 206.41 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 486.67 206.41 Tm (any) Tj ET Q q n 45.35 204 m 657.35 204 l 657.35 192 l 45.35 192 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 194.41 Tm (spouse) Tj ET BT /F3 12 Tf 1 0 0 1 84.71 194.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 101.39 194.41 Tm (child) Tj ET BT /F3 12 Tf 1 0 0 1 132.07 194.41 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 146.77 194.41 Tm (eligible,) Tj ET BT /F3 12 Tf 1 0 0 1 192.44 194.41 Tm (because) Tj ET BT /F3 12 Tf 1 0 0 1 237.11 194.41 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 253.79 194.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 275.14 194.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 317.82 194.41 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 379.99 194.41 Tm (eligibility) Tj ET BT /F3 12 Tf 1 0 0 1 433.34 194.41 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 454.03 194.41 Tm (unreduced) Tj ET Q q n 45.35 192 m 657.35 192 l 657.35 180 l 45.35 180 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 182.41 Tm (retirement benefits; or) Tj ET Q q n 18 180 m 630 180 l 630 168 l 18 168 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 170.41 Tm (3.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 170.41 Tm (reduced) Tj ET BT /F2 12 Tf 1 0 0 1 89.76 170.41 Tm (retirement) Tj ET BT /F2 12 Tf 1 0 0 1 147.48 170.41 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 190.56 170.41 Tm (actually) Tj ET BT /F3 12 Tf 1 0 0 1 231.63 170.41 Tm (received) Tj ET BT /F3 12 Tf 1 0 0 1 275.35 170.41 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 290.44 170.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 308.19 170.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 347.26 170.41 Tm (Employee;) Tj ET BT /F3 12 Tf 1 0 0 1 402.34 170.41 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 422.75 170.41 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 437.84 170.41 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 458.25 170.41 Tm (spouse) Tj ET BT /F3 12 Tf 1 0 0 1 494 170.41 Tm (or) Tj ET Q q n 45.35 168 m 657.35 168 l 657.35 156 l 45.35 156 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 158.41 Tm (child, because of the Insured Employee's receipt of reduced retirement benefits.) Tj ET Q q n 0 156 m 612 156 l 612 144 l 0 144 l h W n Q q n 0 144 m 612 144 l 612 132 l 0 132 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 134.41 Tm (As used above,) Tj ET BT /F2 12 Tf 1 0 0 1 75.98 134.41 Tm ("Government Retirement Plans") Tj ET BT /F3 12 Tf 1 0 0 1 245.94 134.41 Tm ( include disability and retirement benefits under:) Tj ET Q q n 18 132 m 630 132 l 630 120 l 18 120 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 122.41 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 122.41 Tm (the federal Social Security Act, Jones Act or Railroad Retirement Act;) Tj ET Q q n 18 120 m 630 120 l 630 108 l 18 108 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 110.41 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 110.41 Tm (the Canada Pension Plan or Quebec Pension Plan;) Tj ET Q q n 18 108 m 630 108 l 630 96 l 18 96 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 98.41 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 98.41 Tm (any similar plan or act of any country, state, province or other political unit; or) Tj ET Q q n 18 96 m 630 96 l 630 84 l 18 84 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 86.41 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 86.41 Tm (any plan provided in place of one of the above plans.) Tj ET Q q n 0 84 m 612 84 l 612 72 l 0 72 l h W n Q Q q Q Q endstream endobj 23 0 obj <>>>>> endobj 153 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 720 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 190.32 26.41 Tm (OTHER INCOME BENEFITS) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 239 14.41 Tm (\(Continued\)) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 36 cm q n 0 48 m 612 48 l 612 36 l 0 36 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 384.01 38.41 Tm (Any Occ,) Tj ET BT /F3 12 Tf 1 0 0 1 429.99 38.41 Tm ( Prim & Fam SS Integ.) Tj ET Q q n 0 36 m 357.35 36 l 357.35 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-11-INT 10) Tj ET Q q n 0 24 m 179.45 24 l 179.45 12 l 0 12 l h W n Q q n 179.45 24 m 357.35 24 l 357.35 12 l 179.45 12 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 257 14.41 Tm (21) Tj ET Q q n 357.35 24 m 540 24 l 540 12 l 357.35 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 493.64 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 84 cm q n 0 636 m 612 636 l 612 624 l 0 624 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 626.41 Tm ("Earnings") Tj ET BT /F3 12 Tf 1 0 0 1 60.01 626.41 Tm (,) Tj ET BT /F3 12 Tf 1 0 0 1 66.43 626.41 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 79.85 626.41 Tm (used) Tj ET BT /F3 12 Tf 1 0 0 1 105.27 626.41 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 118.03 626.41 Tm (this) Tj ET BT /F3 12 Tf 1 0 0 1 138.79 626.41 Tm (provision,) Tj ET BT /F3 12 Tf 1 0 0 1 190.55 626.41 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 224.63 626.41 Tm (pay) Tj ET BT /F3 12 Tf 1 0 0 1 245.39 626.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 263.47 626.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 302.88 626.41 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 354.96 626.41 Tm (earns) Tj ET BT /F3 12 Tf 1 0 0 1 383.7 626.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 397.12 626.41 Tm (receives) Tj ET BT /F3 12 Tf 1 0 0 1 439.85 626.41 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 466.6 626.41 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 487.35 626.41 Tm (occupation) Tj ET Q q n 0 624 m 612 624 l 612 612 l 0 612 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 614.41 Tm (or form of employment, as reported for federal income tax purposes.) Tj ET BT /F3 12 Tf 1 0 0 1 335.22 614.41 Tm (Earnings include \(but are not limited to\) a:) Tj ET Q q n 18 612 m 630 612 l 630 600 l 18 600 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 602.41 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 602.41 Tm (salaried or hourly Employee's gross earnings \(shown on Form W-2\); including:) Tj ET Q q n 45.35 600 m 657.35 600 l 657.35 588 l 45.35 588 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 590.41 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72 590.41 Tm (wages, tips, commissions, bonuses and overtime pay; and) Tj ET Q q n 45.35 588 m 657.35 588 l 657.35 576 l 45.35 576 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 578.41 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72 578.41 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 94.61 578.41 Tm (pre-tax) Tj ET BT /F3 12 Tf 1 0 0 1 133.87 578.41 Tm (contributions) Tj ET BT /F3 12 Tf 1 0 0 1 202.48 578.41 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 217.09 578.41 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 227.7 578.41 Tm (Section) Tj ET BT /F3 12 Tf 1 0 0 1 268.97 578.41 Tm (125) Tj ET BT /F3 12 Tf 1 0 0 1 292.25 578.41 Tm (Plan,) Tj ET BT /F3 12 Tf 1 0 0 1 321.87 578.41 Tm (flexible) Tj ET BT /F3 12 Tf 1 0 0 1 363.8 578.41 Tm (spending) Tj ET BT /F3 12 Tf 1 0 0 1 412.41 578.41 Tm (account,) Tj ET BT /F3 12 Tf 1 0 0 1 458 578.41 Tm (or) Tj ET Q q n 72.7 576 m 684.7 576 l 684.7 564 l 72.7 564 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 566.41 Tm (qualified deferred compensation plan;) Tj ET Q q n 18 564 m 630 564 l 630 552 l 18 552 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 554.41 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 554.41 Tm (proprietor's net profit \(figured from Form 1040, Schedule C\);) Tj ET Q q n 18 552 m 630 552 l 630 540 l 18 540 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 542.41 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 542.41 Tm (professional corporation shareholder's net profit \(figured from Form 1040, Schedule C\);) Tj ET Q q n 18 540 m 630 540 l 630 528 l 18 528 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 530.41 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 530.41 Tm (partner's) Tj ET BT /F3 12 Tf 1 0 0 1 89.82 530.41 Tm (net) Tj ET BT /F3 12 Tf 1 0 0 1 108.15 530.41 Tm (earnings) Tj ET BT /F3 12 Tf 1 0 0 1 152.46 530.41 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 179.45 530.41 Tm (self-employment) Tj ET BT /F3 12 Tf 1 0 0 1 264.42 530.41 Tm (\(shown) Tj ET BT /F3 12 Tf 1 0 0 1 303.42 530.41 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 319.08 530.41 Tm (Schedule) Tj ET BT /F3 12 Tf 1 0 0 1 366.73 530.41 Tm (K-1\)) Tj ET BT /F3 12 Tf 1 0 0 1 393.05 530.41 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 414.04 530.41 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 435.03 530.41 Tm (W-2) Tj ET BT /F3 12 Tf 1 0 0 1 460.01 530.41 Tm (earnings;) Tj ET Q q n 45.35 528 m 657.35 528 l 657.35 516 l 45.35 516 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 518.41 Tm (and) Tj ET Q q n 18 516 m 630 516 l 630 504 l 18 504 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 506.41 Tm (5.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 506.41 Tm (Subchapter) Tj ET BT /F3 12 Tf 1 0 0 1 103.45 506.41 Tm (S) Tj ET BT /F3 12 Tf 1 0 0 1 114.24 506.41 Tm (Corporation) Tj ET BT /F3 12 Tf 1 0 0 1 176.34 506.41 Tm (shareholder's) Tj ET BT /F3 12 Tf 1 0 0 1 243.26 506.41 Tm (net) Tj ET BT /F3 12 Tf 1 0 0 1 262.04 506.41 Tm (earnings) Tj ET BT /F3 12 Tf 1 0 0 1 306.8 506.41 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 334.24 506.41 Tm (trade) Tj ET BT /F3 12 Tf 1 0 0 1 362.34 506.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 376.45 506.41 Tm (business) Tj ET BT /F3 12 Tf 1 0 0 1 421.24 506.41 Tm (activities) Tj ET BT /F3 12 Tf 1 0 0 1 468.67 506.41 Tm (\(shown) Tj ET Q q n 45.35 504 m 657.35 504 l 657.35 492 l 45.35 492 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 494.41 Tm (on Schedule K-1\).) Tj ET Q q n 0 478.2 m 612 478.2 l 612 466.2 l 0 466.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 468.61 Tm (Exceptions.) Tj ET BT /F3 12 Tf 1 0 0 1 65.29 468.61 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 87.09 468.61 Tm (following) Tj ET BT /F3 12 Tf 1 0 0 1 136.9 468.61 Tm (will) Tj ET BT /F2 12 Tf 1 0 0 1 158.71 468.61 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 178.52 468.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 192.99 468.61 Tm (considered) Tj ET BT /F3 12 Tf 1 0 0 1 248.12 468.61 Tm (Other) Tj ET BT /F3 12 Tf 1 0 0 1 278.58 468.61 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 317.71 468.61 Tm (Benefits,) Tj ET BT /F3 12 Tf 1 0 0 1 363.84 468.61 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 384.31 468.61 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 406.12 468.61 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 424.6 468.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 439.07 468.61 Tm (offset) Tj ET BT /F3 12 Tf 1 0 0 1 469.54 468.61 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 482.02 468.61 Tm (determining) Tj ET Q q n 0 466.2 m 612 466.2 l 612 454.2 l 0 454.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 456.61 Tm (the Monthly Benefit:) Tj ET Q q n 18 454.2 m 630 454.2 l 630 442.2 l 18 442.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 444.61 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 444.61 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 54.26 444.61 Tm (cost-of-living) Tj ET BT /F3 12 Tf 1 0 0 1 123.17 444.61 Tm (increase) Tj ET BT /F3 12 Tf 1 0 0 1 166.05 444.61 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 178.97 444.61 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 199.88 444.61 Tm (Other) Tj ET BT /F3 12 Tf 1 0 0 1 230.79 444.61 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 270.36 444.61 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 309.26 444.61 Tm (\(except) Tj ET BT /F3 12 Tf 1 0 0 1 348.15 444.61 Tm (Earnings\);) Tj ET BT /F3 12 Tf 1 0 0 1 401.73 444.61 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 412.64 444.61 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 422.89 444.61 Tm (takes) Tj ET BT /F3 12 Tf 1 0 0 1 451.13 444.61 Tm (effect) Tj ET BT /F3 12 Tf 1 0 0 1 482.02 444.61 Tm (after) Tj ET Q q n 45.35 442.2 m 657.35 442.2 l 657.35 430.2 l 45.35 430.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 432.61 Tm (the first offset for that benefit during a period of Disability;) Tj ET Q q n 18 430.2 m 630 430.2 l 630 418.2 l 18 418.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 420.61 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 420.61 Tm (reimbursement for hospital, medical or surgical expense;) Tj ET Q q n 18 418.2 m 630 418.2 l 630 406.2 l 18 406.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 408.61 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 408.61 Tm (reimbursement for attorney fees and other reasonable costs of claiming Other Income Benefits;) Tj ET Q q n 18 406.2 m 630 406.2 l 630 394.2 l 18 394.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 396.61 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 396.61 Tm (group credit or mortgage disability insurance benefits;) Tj ET Q q n 18 394.2 m 630 394.2 l 630 382.2 l 18 382.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 384.61 Tm (5.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 384.61 Tm (early) Tj ET BT /F3 12 Tf 1 0 0 1 73.06 384.61 Tm (retirement) Tj ET BT /F3 12 Tf 1 0 0 1 126.1 384.61 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 167.81 384.61 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 189.53 384.61 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 207.91 384.61 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 226.97 384.61 Tm (elected) Tj ET BT /F3 12 Tf 1 0 0 1 264.67 384.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 278.4 384.61 Tm (received) Tj ET BT /F3 12 Tf 1 0 0 1 322.76 384.61 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 353.81 384.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 372.2 384.61 Tm (federal) Tj ET BT /F3 12 Tf 1 0 0 1 409.23 384.61 Tm (Social) Tj ET BT /F3 12 Tf 1 0 0 1 442.96 384.61 Tm (Security) Tj ET BT /F3 12 Tf 1 0 0 1 486.67 384.61 Tm (Act) Tj ET Q q n 45.35 382.2 m 657.35 382.2 l 657.35 370.2 l 45.35 370.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 372.61 Tm (or other Government Retirement Plan;) Tj ET Q q n 18 370.2 m 630 370.2 l 630 358.2 l 18 358.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 360.61 Tm (6.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 360.61 Tm (any amounts under the Employer's Retirement Plan that:) Tj ET Q q n 45.35 358.2 m 657.35 358.2 l 657.35 346.2 l 45.35 346.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 348.61 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72 348.61 Tm (represent the Insured Employee's contributions; or) Tj ET Q q n 45.35 346.2 m 657.35 346.2 l 657.35 334.2 l 45.35 334.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 336.61 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72 336.61 Tm (are received upon termination of employment without being disabled or retired;) Tj ET Q q n 18 334.2 m 630 334.2 l 630 322.2 l 18 322.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 324.61 Tm (7.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 324.61 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 87.11 324.61 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 114.22 324.61 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 123.33 324.61 Tm (401\(k\),) Tj ET BT /F3 12 Tf 1 0 0 1 162.1 324.61 Tm (profit-sharing) Tj ET BT /F3 12 Tf 1 0 0 1 231.86 324.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 245.63 324.61 Tm (thrift) Tj ET BT /F3 12 Tf 1 0 0 1 273.41 324.61 Tm (plan;) Tj ET BT /F3 12 Tf 1 0 0 1 301.18 324.61 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 316.29 324.61 Tm (individual) Tj ET BT /F3 12 Tf 1 0 0 1 368.73 324.61 Tm (retirement) Tj ET BT /F3 12 Tf 1 0 0 1 421.81 324.61 Tm (account) Tj ET BT /F3 12 Tf 1 0 0 1 462.9 324.61 Tm (\(IRA\);) Tj ET BT /F3 12 Tf 1 0 0 1 498.67 324.61 Tm (a) Tj ET Q q n 45.35 322.2 m 657.35 322.2 l 657.35 310.2 l 45.35 310.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 312.61 Tm (tax) Tj ET BT /F3 12 Tf 1 0 0 1 65.81 312.61 Tm (sheltered) Tj ET BT /F3 12 Tf 1 0 0 1 114.93 312.61 Tm (annuity) Tj ET BT /F3 12 Tf 1 0 0 1 156.73 312.61 Tm (\(TSA\);) Tj ET BT /F3 12 Tf 1 0 0 1 196.53 312.61 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 207.66 312.61 Tm (stock) Tj ET BT /F3 12 Tf 1 0 0 1 238.79 312.61 Tm (ownership) Tj ET BT /F3 12 Tf 1 0 0 1 294.59 312.61 Tm (plan;) Tj ET BT /F3 12 Tf 1 0 0 1 324.39 312.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 340.19 312.61 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 351.32 312.61 Tm (non-qualified) Tj ET BT /F3 12 Tf 1 0 0 1 421.77 312.61 Tm (plan) Tj ET BT /F3 12 Tf 1 0 0 1 448.23 312.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 464.03 312.61 Tm (deferred) Tj ET Q q n 45.35 310.2 m 657.35 310.2 l 657.35 298.2 l 45.35 298.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 300.61 Tm (compensation;) Tj ET Q q n 18 298.2 m 630 298.2 l 630 286.2 l 18 286.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 288.61 Tm (8.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 288.61 Tm (vacation pay, holiday pay, or severance pay; or) Tj ET Q q n 18 286.2 m 630 286.2 l 630 274.2 l 18 274.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 276.61 Tm (9.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 276.61 Tm (disability) Tj ET BT /F3 12 Tf 1 0 0 1 93.81 276.61 Tm (income) Tj ET BT /F3 12 Tf 1 0 0 1 132.93 276.61 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 174.71 276.61 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 205.83 276.61 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 226.95 276.61 Tm (individual) Tj ET BT /F3 12 Tf 1 0 0 1 279.41 276.61 Tm (policy,) Tj ET BT /F3 12 Tf 1 0 0 1 316.2 276.61 Tm (association) Tj ET BT /F3 12 Tf 1 0 0 1 373.32 276.61 Tm (group) Tj ET BT /F3 12 Tf 1 0 0 1 405.11 276.61 Tm (plan,) Tj ET BT /F3 12 Tf 1 0 0 1 432.57 276.61 Tm (franchise) Tj ET BT /F3 12 Tf 1 0 0 1 480.34 276.61 Tm (plan,) Tj ET Q q n 45.35 274.2 m 657.35 274.2 l 657.35 262.2 l 45.35 262.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 264.61 Tm (or auto liability insurance policy \(except no fault auto insurance\).) Tj ET Q q n 0 262.2 m 612 262.2 l 612 250.2 l 0 250.2 l h W n Q q n 0 250.2 m 612 250.2 l 612 238.2 l 0 238.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 240.61 Tm (RULES) Tj ET BT /F2 12 Tf 1 0 0 1 43.99 240.61 Tm (FOR) Tj ET BT /F2 12 Tf 1 0 0 1 73.3 240.61 Tm (OTHER) Tj ET BT /F2 12 Tf 1 0 0 1 120.63 240.61 Tm (INCOME) Tj ET BT /F2 12 Tf 1 0 0 1 175.27 240.61 Tm (BENEFIT) Tj ET BT /F2 12 Tf 1 0 0 1 231.93 240.61 Tm (OFFSETS.) Tj ET BT /F3 12 Tf 1 0 0 1 296.24 240.61 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 308.21 240.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 326.85 240.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 366.82 240.61 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 419.45 240.61 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 444.09 240.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 459.4 240.61 Tm (entitled) Tj ET BT /F3 12 Tf 1 0 0 1 499.36 240.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 512.68 240.61 Tm (Other) Tj ET Q q n 0 238.2 m 612 238.2 l 612 226.2 l 0 226.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 228.61 Tm (Income Benefits that affect Policy benefits, the following rules will apply.) Tj ET Q q n 0 226.2 m 612 226.2 l 612 214.2 l 0 214.2 l h W n Q q n 0 214.2 m 612 214.2 l 612 202.2 l 0 202.2 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 204.61 Tm (Claiming) Tj ET BT /F2 12 Tf 1 0 0 1 50.99 204.61 Tm (Other) Tj ET BT /F2 12 Tf 1 0 0 1 85.3 204.61 Tm (Income) Tj ET BT /F2 12 Tf 1 0 0 1 126.95 204.61 Tm (Benefits.) Tj ET BT /F3 12 Tf 1 0 0 1 178.58 204.61 Tm (An) Tj ET BT /F3 12 Tf 1 0 0 1 196.9 204.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 236.54 204.61 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 288.84 204.61 Tm (who) Tj ET BT /F3 12 Tf 1 0 0 1 313.16 204.61 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 337.48 204.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 352.46 204.61 Tm (entitled) Tj ET BT /F3 12 Tf 1 0 0 1 392.1 204.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 405.09 204.61 Tm (some) Tj ET BT /F3 12 Tf 1 0 0 1 434.07 204.61 Tm (Other) Tj ET BT /F3 12 Tf 1 0 0 1 465.04 204.61 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 504.68 204.61 Tm (Benefit) Tj ET Q q n 0 202.2 m 612 202.2 l 612 190.2 l 0 190.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 192.61 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 11.29 192.61 Tm (required) Tj ET BT /F3 12 Tf 1 0 0 1 54.56 192.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 67.19 192.61 Tm (actively) Tj ET BT /F3 12 Tf 1 0 0 1 108.46 192.61 Tm (pursue) Tj ET BT /F3 12 Tf 1 0 0 1 143.74 192.61 Tm (it.) Tj ET BT /F3 12 Tf 1 0 0 1 159.99 192.61 Tm (For) Tj ET BT /F3 12 Tf 1 0 0 1 179.95 192.61 Tm (example,) Tj ET BT /F3 12 Tf 1 0 0 1 226.89 192.61 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 237.51 192.61 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 278.78 192.61 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 302.73 192.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 317.35 192.61 Tm (payable) Tj ET BT /F3 12 Tf 1 0 0 1 357.95 192.61 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 388.56 192.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 406.51 192.61 Tm (federal) Tj ET BT /F3 12 Tf 1 0 0 1 443.11 192.61 Tm (Social) Tj ET BT /F3 12 Tf 1 0 0 1 476.39 192.61 Tm (Security) Tj ET BT /F3 12 Tf 1 0 0 1 519.67 192.61 Tm (Act,) Tj ET Q q n 0 190.2 m 612 190.2 l 612 178.2 l 0 178.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 180.61 Tm (the Insured Employee:) Tj ET Q q n 18 178.2 m 630 178.2 l 630 166.2 l 18 166.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 168.61 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 168.61 Tm (must apply for such benefits on a timely basis;) Tj ET Q q n 18 166.2 m 630 166.2 l 630 154.2 l 18 154.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 156.61 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 156.61 Tm (must file a request for reconsideration, if benefits are denied; and) Tj ET Q q n 18 154.2 m 630 154.2 l 630 142.2 l 18 142.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 144.61 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 144.61 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 74.77 144.61 Tm (request) Tj ET BT /F3 12 Tf 1 0 0 1 115.51 144.61 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 126.92 144.61 Tm (hearing) Tj ET BT /F3 12 Tf 1 0 0 1 168.99 144.61 Tm (before) Tj ET BT /F3 12 Tf 1 0 0 1 205.72 144.61 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 223.13 144.61 Tm (Administrative) Tj ET BT /F3 12 Tf 1 0 0 1 301.21 144.61 Tm (Law) Tj ET BT /F3 12 Tf 1 0 0 1 328.62 144.61 Tm (Judge,) Tj ET BT /F3 12 Tf 1 0 0 1 365.7 144.61 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 379.11 144.61 Tm (denied) Tj ET BT /F3 12 Tf 1 0 0 1 417.19 144.61 Tm (again) Tj ET BT /F3 12 Tf 1 0 0 1 449.26 144.61 Tm (\(unless) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 144.61 Tm (the) Tj ET Q q n 45.35 142.2 m 657.35 142.2 l 657.35 130.2 l 45.35 130.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 132.61 Tm (Company waives this in writing\).) Tj ET Q q n 0 130.2 m 612 130.2 l 612 118.2 l 0 118.2 l h W n Q q n 0 118.2 m 612 118.2 l 612 106.2 l 0 106.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 108.61 Tm (An) Tj ET BT /F3 12 Tf 1 0 0 1 18.93 108.61 Tm (Employer) Tj ET BT /F3 12 Tf 1 0 0 1 70.51 108.61 Tm (whose) Tj ET BT /F3 12 Tf 1 0 0 1 105.44 108.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 145.69 108.61 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 198.61 108.61 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 223.53 108.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 239.12 108.61 Tm (entitled) Tj ET BT /F3 12 Tf 1 0 0 1 279.37 108.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 292.97 108.61 Tm (Workers') Tj ET BT /F3 12 Tf 1 0 0 1 340.71 108.61 Tm (Compensation) Tj ET BT /F3 12 Tf 1 0 0 1 414.3 108.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 428.56 108.61 Tm (similar) Tj ET BT /F3 12 Tf 1 0 0 1 466.15 108.61 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 508.4 108.61 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 520.67 108.61 Tm (also) Tj ET Q q n 0 106.2 m 612 106.2 l 612 94.2 l 0 94.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 96.61 Tm (required) Tj ET BT /F3 12 Tf 1 0 0 1 43.73 96.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 56.8 96.61 Tm (cooperate) Tj ET BT /F3 12 Tf 1 0 0 1 107.19 96.61 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 120.27 96.61 Tm (filing) Tj ET BT /F3 12 Tf 1 0 0 1 150.01 96.61 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 171.75 96.61 Tm (claim.) Tj ET BT /F3 12 Tf 1 0 0 1 208.9 96.61 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 220.63 96.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 239.04 96.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 278.77 96.61 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 331.17 96.61 Tm (fails) Tj ET BT /F3 12 Tf 1 0 0 1 355.58 96.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 368.66 96.61 Tm (pursue) Tj ET BT /F3 12 Tf 1 0 0 1 404.4 96.61 Tm (Other) Tj ET BT /F3 12 Tf 1 0 0 1 435.46 96.61 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 475.19 96.61 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 518.93 96.61 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 534.67 96.61 Tm (a) Tj ET Q q n 0 94.2 m 612 94.2 l 612 82.2 l 0 82.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 84.61 Tm (timely basis, the Company has the option to:) Tj ET Q q n 18 82.2 m 630 82.2 l 630 70.2 l 18 70.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 72.61 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 72.61 Tm (deny or suspend Monthly Benefits; or) Tj ET Q q n 18 70.2 m 630 70.2 l 630 58.2 l 18 58.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 60.61 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 60.61 Tm (reduce Monthly Benefits by an estimated amount.) Tj ET Q q n 0 58.2 m 612 58.2 l 612 46.2 l 0 46.2 l h W n Q Q q Q Q endstream endobj 24 0 obj <>>>>> endobj 154 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 720 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 190.32 26.41 Tm (OTHER INCOME BENEFITS) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 239 14.41 Tm (\(Continued\)) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 36 cm q n 0 48 m 612 48 l 612 36 l 0 36 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 384.01 38.41 Tm (Any Occ,) Tj ET BT /F3 12 Tf 1 0 0 1 429.99 38.41 Tm ( Prim & Fam SS Integ.) Tj ET Q q n 0 36 m 357.35 36 l 357.35 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-11-INT 10) Tj ET Q q n 0 24 m 179.45 24 l 179.45 12 l 0 12 l h W n Q q n 179.45 24 m 357.35 24 l 357.35 12 l 179.45 12 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 257 14.41 Tm (22) Tj ET Q q n 357.35 24 m 540 24 l 540 12 l 357.35 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 493.64 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 84 cm q n 0 636 m 612 636 l 612 624 l 0 624 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 626.41 Tm (Estimating) Tj ET BT /F2 12 Tf 1 0 0 1 61.63 626.41 Tm (Offsets.) Tj ET BT /F3 12 Tf 1 0 0 1 111.88 626.41 Tm (While) Tj ET BT /F3 12 Tf 1 0 0 1 146.83 626.41 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 157.79 626.41 Tm (claim) Tj ET BT /F3 12 Tf 1 0 0 1 190.08 626.41 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 209.7 626.41 Tm (Social) Tj ET BT /F3 12 Tf 1 0 0 1 245.32 626.41 Tm (Security) Tj ET BT /F3 12 Tf 1 0 0 1 290.94 626.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 306.57 626.41 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 336.86 626.41 Tm (Government) Tj ET BT /F3 12 Tf 1 0 0 1 402.47 626.41 Tm (Retirement) Tj ET BT /F3 12 Tf 1 0 0 1 461.42 626.41 Tm (Plan) Tj ET BT /F3 12 Tf 1 0 0 1 488.38 626.41 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 532 626.41 Tm (is) Tj ET Q q n 0 624 m 612 624 l 612 612 l 0 612 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 614.41 Tm (pending,) Tj ET BT /F3 12 Tf 1 0 0 1 46 614.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 65 614.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 105.33 614.41 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 158.32 614.41 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 185.99 614.41 Tm (elect) Tj ET BT /F3 12 Tf 1 0 0 1 212.98 614.41 Tm (one) Tj ET BT /F3 12 Tf 1 0 0 1 234.65 614.41 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 248.98 614.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 267.98 614.41 Tm (following) Tj ET BT /F3 12 Tf 1 0 0 1 318.99 614.41 Tm (options) Tj ET BT /F3 12 Tf 1 0 0 1 358.66 614.41 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 372.34 614.41 Tm (writing.) Tj ET BT /F3 12 Tf 1 0 0 1 418.68 614.41 Tm (\(If) Tj ET BT /F3 12 Tf 1 0 0 1 435.01 614.41 Tm (no) Tj ET BT /F3 12 Tf 1 0 0 1 451.35 614.41 Tm (written) Tj ET BT /F3 12 Tf 1 0 0 1 489.68 614.41 Tm (election) Tj ET BT /F3 12 Tf 1 0 0 1 532 614.41 Tm (is) Tj ET Q q n 0 612 m 612 612 l 612 600 l 0 600 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 602.41 Tm (made, Monthly Benefits will be reduced in accord with Option 1.\)) Tj ET Q q n 0 600 m 612 600 l 612 588 l 0 588 l h W n Q q n 18 588 m 630 588 l 630 576 l 18 576 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 578.41 Tm (1.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 578.41 Tm (Reduced) Tj ET BT /F2 12 Tf 1 0 0 1 94.36 578.41 Tm (Monthly) Tj ET BT /F2 12 Tf 1 0 0 1 142.7 578.41 Tm (Benefits.) Tj ET BT /F3 12 Tf 1 0 0 1 195.71 578.41 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 218.71 578.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 259.04 578.41 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 312.04 578.41 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 337.04 578.41 Tm (receive) Tj ET BT /F3 12 Tf 1 0 0 1 376.01 578.41 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 421.69 578.41 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 466.03 578.41 Tm (reduced) Tj ET Q q n 45.35 576 m 657.35 576 l 657.35 564 l 45.35 564 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 566.41 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 61.94 566.41 Tm (estimated) Tj ET BT /F3 12 Tf 1 0 0 1 112.52 566.41 Tm (Social) Tj ET BT /F3 12 Tf 1 0 0 1 147.1 566.41 Tm (Security) Tj ET BT /F3 12 Tf 1 0 0 1 191.68 566.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 206.27 566.41 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 235.52 566.41 Tm (Government) Tj ET BT /F3 12 Tf 1 0 0 1 300.09 566.41 Tm (Retirement) Tj ET BT /F3 12 Tf 1 0 0 1 358 566.41 Tm (Plan) Tj ET BT /F3 12 Tf 1 0 0 1 383.92 566.41 Tm (benefits.) Tj ET BT /F3 12 Tf 1 0 0 1 434.09 566.41 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 457.34 566.41 Tm (Company) Tj ET Q q n 45.35 564 m 657.35 564 l 657.35 552 l 45.35 552 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 554.41 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 67.98 554.41 Tm (adjust) Tj ET BT /F3 12 Tf 1 0 0 1 100.6 554.41 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 135.22 554.41 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 177.17 554.41 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 198.45 554.41 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 221.08 554.41 Tm (refund) Tj ET BT /F3 12 Tf 1 0 0 1 256.35 554.41 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 277.64 554.41 Tm (underpayment,) Tj ET BT /F3 12 Tf 1 0 0 1 353.24 554.41 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 366.53 554.41 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 375.81 554.41 Tm (lump) Tj ET BT /F3 12 Tf 1 0 0 1 404.44 554.41 Tm (sum,) Tj ET BT /F3 12 Tf 1 0 0 1 431.4 554.41 Tm (upon) Tj ET BT /F3 12 Tf 1 0 0 1 459.36 554.41 Tm (receiving) Tj ET Q q n 45.35 552 m 657.35 552 l 657.35 540 l 45.35 540 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 542.41 Tm (proof of:) Tj ET Q q n 45.35 540 m 657.35 540 l 657.35 528 l 45.35 528 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 530.41 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72 530.41 Tm (the amount actually awarded; or) Tj ET Q q n 45.35 528 m 657.35 528 l 657.35 516 l 45.35 516 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 518.41 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72 518.41 Tm (the claim denial and completion of any appeal the Company requires.) Tj ET Q q n 0 516 m 612 516 l 612 504 l 0 504 l h W n Q q n 18 504 m 630 504 l 630 492 l 18 492 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 494.41 Tm (2.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 494.41 Tm (Unreduced) Tj ET BT /F2 12 Tf 1 0 0 1 108.39 494.41 Tm (Monthly) Tj ET BT /F2 12 Tf 1 0 0 1 158.77 494.41 Tm (Benefits.) Tj ET BT /F3 12 Tf 1 0 0 1 215.85 494.41 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 240.88 494.41 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 283.24 494.41 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 338.27 494.41 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 365.3 494.41 Tm (receive) Tj ET BT /F3 12 Tf 1 0 0 1 406.31 494.41 Tm (unreduced) Tj ET BT /F3 12 Tf 1 0 0 1 462.66 494.41 Tm (Monthly) Tj ET Q q n 45.35 492 m 657.35 492 l 657.35 480 l 45.35 480 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 482.41 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 89.21 482.41 Tm (while) Tj ET BT /F3 12 Tf 1 0 0 1 119.74 482.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 138.26 482.41 Tm (claim) Tj ET BT /F3 12 Tf 1 0 0 1 168.79 482.41 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 180.66 482.41 Tm (pending.) Tj ET BT /F3 12 Tf 1 0 0 1 230.05 482.41 Tm (He) Tj ET BT /F3 12 Tf 1 0 0 1 247.91 482.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 261.78 482.41 Tm (she) Tj ET BT /F3 12 Tf 1 0 0 1 281.64 482.41 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 308.85 482.41 Tm (agree) Tj ET BT /F3 12 Tf 1 0 0 1 338.69 482.41 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 351.89 482.41 Tm (writing) Tj ET BT /F3 12 Tf 1 0 0 1 390.42 482.41 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 403.62 482.41 Tm (promptly) Tj ET BT /F3 12 Tf 1 0 0 1 451.49 482.41 Tm (refund) Tj ET BT /F3 12 Tf 1 0 0 1 486.67 482.41 Tm (any) Tj ET Q q n 45.35 480 m 657.35 480 l 657.35 468 l 45.35 468 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 470.41 Tm (overpayment) Tj ET BT /F3 12 Tf 1 0 0 1 111.69 470.41 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 133.38 470.41 Tm (results,) Tj ET BT /F3 12 Tf 1 0 0 1 171.41 470.41 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 184.45 470.41 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 193.47 470.41 Tm (lump) Tj ET BT /F3 12 Tf 1 0 0 1 221.84 470.41 Tm (sum,) Tj ET BT /F3 12 Tf 1 0 0 1 248.54 470.41 Tm (upon) Tj ET BT /F3 12 Tf 1 0 0 1 276.24 470.41 Tm (receiving) Tj ET BT /F3 12 Tf 1 0 0 1 324.58 470.41 Tm (Social) Tj ET BT /F3 12 Tf 1 0 0 1 358.28 470.41 Tm (Security) Tj ET BT /F3 12 Tf 1 0 0 1 401.97 470.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 415.66 470.41 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 444.02 470.41 Tm (Government) Tj ET Q q n 45.35 468 m 657.35 468 l 657.35 456 l 45.35 456 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 458.41 Tm (Retirement Plan benefits.) Tj ET BT /F3 12 Tf 1 0 0 1 172.99 458.41 Tm (If he or she does not promptly refund an overpayment:) Tj ET Q q n 45.35 456 m 657.35 456 l 657.35 444 l 45.35 444 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 446.41 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72 446.41 Tm (the Company will reduce or eliminate future payments; and) Tj ET Q q n 45.35 444 m 657.35 444 l 657.35 432 l 45.35 432 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 434.41 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72 434.41 Tm (the Minimum Monthly Benefit will not apply, until the amount is repaid.) Tj ET Q q n 0 432 m 612 432 l 612 420 l 0 420 l h W n Q q n 0 420 m 612 420 l 612 408 l 0 408 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 410.41 Tm (Lump Sum Payments.) Tj ET BT /F3 12 Tf 1 0 0 1 119.68 410.41 Tm (Other Income Benefits that are paid in a lump sum will be pro rated as follows.) Tj ET Q q n 18 408 m 630 408 l 630 396 l 18 396 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 398.41 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 398.41 Tm (The lump sum will be pro rated on a monthly basis, over the time period for which it is given.) Tj ET Q q n 18 396 m 630 396 l 630 384 l 18 384 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 386.41 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 386.41 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 57.99 386.41 Tm (no) Tj ET BT /F3 12 Tf 1 0 0 1 74.64 386.41 Tm (time) Tj ET BT /F3 12 Tf 1 0 0 1 100.62 386.41 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 135.92 386.41 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 148.57 386.41 Tm (stated,) Tj ET BT /F3 12 Tf 1 0 0 1 184.21 386.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 203.52 386.41 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 254.84 386.41 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 278.15 386.41 Tm (continue) Tj ET BT /F3 12 Tf 1 0 0 1 324.12 386.41 Tm (its) Tj ET BT /F3 12 Tf 1 0 0 1 340.11 386.41 Tm (estimated) Tj ET BT /F3 12 Tf 1 0 0 1 390.74 386.41 Tm (monthly) Tj ET BT /F3 12 Tf 1 0 0 1 435.39 386.41 Tm (offset) Tj ET BT /F3 12 Tf 1 0 0 1 467.37 386.41 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 486.01 386.41 Tm (that) Tj ET Q q n 45.35 384 m 657.35 384 l 657.35 372 l 45.35 372 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 374.41 Tm (benefit, until full amount is offset.) Tj ET Q q n 18 372 m 630 372 l 630 360 l 18 360 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 362.41 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 362.41 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 56.66 362.41 Tm (no) Tj ET BT /F3 12 Tf 1 0 0 1 71.98 362.41 Tm (estimated) Tj ET BT /F3 12 Tf 1 0 0 1 121.29 362.41 Tm (monthly) Tj ET BT /F3 12 Tf 1 0 0 1 164.61 362.41 Tm (offset) Tj ET BT /F3 12 Tf 1 0 0 1 195.25 362.41 Tm (was) Tj ET BT /F3 12 Tf 1 0 0 1 217.23 362.41 Tm (being) Tj ET BT /F3 12 Tf 1 0 0 1 247.21 362.41 Tm (made) Tj ET BT /F3 12 Tf 1 0 0 1 276.52 362.41 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 293.83 362.41 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 315.14 362.41 Tm (benefit,) Tj ET BT /F3 12 Tf 1 0 0 1 354.78 362.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 372.76 362.41 Tm (lump) Tj ET BT /F3 12 Tf 1 0 0 1 400.75 362.41 Tm (sum) Tj ET BT /F3 12 Tf 1 0 0 1 424.07 362.41 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 446.06 362.41 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 460.7 362.41 Tm (pro) Tj ET BT /F3 12 Tf 1 0 0 1 480.02 362.41 Tm (rated) Tj ET Q q n 45.35 360 m 657.35 360 l 657.35 348 l 45.35 348 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 350.41 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 62.78 350.41 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 73.54 350.41 Tm (monthly) Tj ET BT /F3 12 Tf 1 0 0 1 118.97 350.41 Tm (basis) Tj ET BT /F3 12 Tf 1 0 0 1 148.4 350.41 Tm (over) Tj ET BT /F3 12 Tf 1 0 0 1 175.15 350.41 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 185.91 350.41 Tm (reasonable) Tj ET BT /F3 12 Tf 1 0 0 1 242.65 350.41 Tm (time) Tj ET BT /F3 12 Tf 1 0 0 1 269.4 350.41 Tm (period.) Tj ET BT /F3 12 Tf 1 0 0 1 319.35 350.41 Tm (It) Tj ET BT /F3 12 Tf 1 0 0 1 332.12 350.41 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 356.21 350.41 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 376.98 350.41 Tm (exceed) Tj ET BT /F3 12 Tf 1 0 0 1 415.71 350.41 Tm (60) Tj ET BT /F3 12 Tf 1 0 0 1 433.14 350.41 Tm (months) Tj ET BT /F3 12 Tf 1 0 0 1 473.91 350.41 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 350.41 Tm (the) Tj ET Q q n 45.35 348 m 657.35 348 l 657.35 336 l 45.35 336 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 338.41 Tm (Maximum Benefit Period \(whichever occurs first\).) Tj ET Q q n 0 336 m 612 336 l 612 324 l 0 324 l h W n Q q n 0 324 m 612 324 l 612 312 l 0 312 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 314.41 Tm (Cost-of-Living) Tj ET BT /F2 12 Tf 1 0 0 1 78.51 314.41 Tm (Freeze.) Tj ET BT /F3 12 Tf 1 0 0 1 123.16 314.41 Tm (After) Tj ET BT /F3 12 Tf 1 0 0 1 152.33 314.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 170.83 314.41 Tm (first) Tj ET BT /F3 12 Tf 1 0 0 1 194.01 314.41 Tm (deduction) Tj ET BT /F3 12 Tf 1 0 0 1 245.17 314.41 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 263.01 314.41 Tm (each) Tj ET BT /F3 12 Tf 1 0 0 1 288.83 314.41 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 302.68 314.41 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 321.18 314.41 Tm (Other) Tj ET BT /F3 12 Tf 1 0 0 1 352.35 314.41 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 392.18 314.41 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 436.01 314.41 Tm (\(except) Tj ET BT /F3 12 Tf 1 0 0 1 475.17 314.41 Tm (Earnings\),) Tj ET BT /F3 12 Tf 1 0 0 1 528.66 314.41 Tm (its) Tj ET Q q n 0 312 m 612 312 l 612 300 l 0 300 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 302.41 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 40.45 302.41 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 63.58 302.41 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 79.37 302.41 Tm (frozen.) Tj ET BT /F3 12 Tf 1 0 0 1 121.93 302.41 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 145.05 302.41 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 190.85 302.41 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 230.63 302.41 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 253.76 302.41 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 273.55 302.41 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 289.34 302.41 Tm (further) Tj ET BT /F3 12 Tf 1 0 0 1 326.44 302.41 Tm (reduced) Tj ET BT /F3 12 Tf 1 0 0 1 368.88 302.41 Tm (due) Tj ET BT /F3 12 Tf 1 0 0 1 390.67 302.41 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 404.46 302.41 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 426.25 302.41 Tm (cost-of-living) Tj ET BT /F3 12 Tf 1 0 0 1 496.03 302.41 Tm (increases) Tj ET Q q n 0 300 m 612 300 l 612 288 l 0 288 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 290.41 Tm (payable under these Other Income Benefits.) Tj ET Q Q q Q Q endstream endobj 25 0 obj <>>>>> endobj 155 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 758.4 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 195.15 2.41 Tm (RECURRENT DISABILITY) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-12 04 PA) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 265 14.41 Tm (23) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 698.4 m 612 698.4 l 612 686.4 l 0 686.4 l h W n Q q n 0 686.4 m 612 686.4 l 612 674.4 l 0 674.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 676.81 Tm (") Tj ET BT /F2 12 Tf 1 0 0 1 4.9 676.81 Tm (Recurrent) Tj ET BT /F2 12 Tf 1 0 0 1 60.68 676.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 110.02 676.81 Tm (") Tj ET BT /F3 12 Tf 1 0 0 1 118.06 676.81 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 151.86 676.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 160.32 676.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 210.8 676.81 Tm (caused) Tj ET BT /F3 12 Tf 1 0 0 1 246.58 676.81 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 261.72 676.81 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 276.19 676.81 Tm (Injury) Tj ET BT /F3 12 Tf 1 0 0 1 308.66 676.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 321.79 676.81 Tm (Sickness) Tj ET BT /F3 12 Tf 1 0 0 1 366.93 676.81 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 388.07 676.81 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 399.21 676.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 417.01 676.81 Tm (same) Tj ET BT /F3 12 Tf 1 0 0 1 444.81 676.81 Tm (as,) Tj ET BT /F3 12 Tf 1 0 0 1 460.95 676.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 474.08 676.81 Tm (related) Tj ET BT /F3 12 Tf 1 0 0 1 509.87 676.81 Tm (to,) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 676.81 Tm (the) Tj ET Q q n 0 674.4 m 612 674.4 l 612 662.4 l 0 662.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 664.81 Tm (cause) Tj ET BT /F3 12 Tf 1 0 0 1 30.16 664.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 43.66 664.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 52.5 664.81 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 79.33 664.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 130.17 664.81 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 147.67 664.81 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 180.51 664.81 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 225.36 664.81 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 268.85 664.81 Tm (were) Tj ET BT /F3 12 Tf 1 0 0 1 295.68 664.81 Tm (payable.) Tj ET BT /F3 12 Tf 1 0 0 1 343.01 664.81 Tm (A) Tj ET BT /F3 12 Tf 1 0 0 1 355.18 664.81 Tm (Recurrent) Tj ET BT /F3 12 Tf 1 0 0 1 406 664.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 456.84 664.81 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 479.02 664.81 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 493.85 664.81 Tm (treated) Tj ET BT /F3 12 Tf 1 0 0 1 530 664.81 Tm (as) Tj ET Q q n 0 662.4 m 612 662.4 l 612 650.4 l 0 650.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 652.81 Tm (follows.) Tj ET Q q n 0 650.4 m 612 650.4 l 612 638.4 l 0 638.4 l h W n Q q n 18 638.4 m 630 638.4 l 630 626.4 l 18 626.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 628.81 Tm (1.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 628.81 Tm (New) Tj ET BT /F2 12 Tf 1 0 0 1 72.19 628.81 Tm (Disability.) Tj ET BT /F3 12 Tf 1 0 0 1 132.9 628.81 Tm (A) Tj ET BT /F3 12 Tf 1 0 0 1 145.75 628.81 Tm (Recurrent) Tj ET BT /F3 12 Tf 1 0 0 1 197.25 628.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 248.76 628.81 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 271.61 628.81 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 287.12 628.81 Tm (treated) Tj ET BT /F3 12 Tf 1 0 0 1 323.95 628.81 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 338.13 628.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 347.64 628.81 Tm (new) Tj ET BT /F3 12 Tf 1 0 0 1 371.82 628.81 Tm (Disability,) Tj ET BT /F3 12 Tf 1 0 0 1 426.33 628.81 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 437.85 628.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 456.69 628.81 Tm (Recurrent) Tj ET Q q n 45.35 626.4 m 657.35 626.4 l 657.35 614.4 l 45.35 614.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 616.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 97.12 616.81 Tm (begins) Tj ET BT /F3 12 Tf 1 0 0 1 132.88 616.81 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 159.3 616.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 178.39 616.81 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 218.82 616.81 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 271.9 616.81 Tm (returns) Tj ET BT /F3 12 Tf 1 0 0 1 309.66 616.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 323.43 616.81 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 341.87 616.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 356.3 616.81 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 376.06 616.81 Tm (Own) Tj ET BT /F3 12 Tf 1 0 0 1 403.82 616.81 Tm (Occupation) Tj ET BT /F3 12 Tf 1 0 0 1 463.57 616.81 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 616.81 Tm (the) Tj ET Q q n 45.35 614.4 m 657.35 614.4 l 657.35 602.4 l 45.35 602.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 604.81 Tm (Employer:) Tj ET Q q n 45.35 602.4 m 657.35 602.4 l 657.35 590.4 l 45.35 590.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 592.81 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 592.81 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 87.99 592.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 96.61 592.81 Tm (full-time) Tj ET BT /F3 12 Tf 1 0 0 1 141.88 592.81 Tm (basis) Tj ET BT /F3 12 Tf 1 0 0 1 169.17 592.81 Tm (working) Tj ET BT /F3 12 Tf 1 0 0 1 212.46 592.81 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 224.41 592.81 Tm (least) Tj ET BT /F3 12 Tf 1 0 0 1 249.69 592.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 267.64 592.81 Tm (Minimum) Tj ET BT /F3 12 Tf 1 0 0 1 318.93 592.81 Tm (Number) Tj ET BT /F3 12 Tf 1 0 0 1 361.54 592.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 374.83 592.81 Tm (Hours) Tj ET BT /F3 12 Tf 1 0 0 1 407.45 592.81 Tm (Per) Tj ET BT /F3 12 Tf 1 0 0 1 426.74 592.81 Tm (Week) Tj ET BT /F3 12 Tf 1 0 0 1 458 592.81 Tm (as) Tj ET Q q n 72.7 590.4 m 684.7 590.4 l 684.7 578.4 l 72.7 578.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 580.81 Tm (shown in the Schedule of Benefits; and) Tj ET Q q n 45.35 578.4 m 657.35 578.4 l 657.35 566.4 l 45.35 566.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 568.81 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 568.81 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 89.7 568.81 Tm (six) Tj ET BT /F3 12 Tf 1 0 0 1 106.71 568.81 Tm (consecutive) Tj ET BT /F3 12 Tf 1 0 0 1 166.35 568.81 Tm (months) Tj ET BT /F3 12 Tf 1 0 0 1 204.7 568.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 217.7 568.81 Tm (more) Tj ET BT /F3 12 Tf 1 0 0 1 245.36 568.81 Tm (following) Tj ET BT /F3 12 Tf 1 0 0 1 295.03 568.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 312.69 568.81 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 335.68 568.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 353.35 568.81 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 379.68 568.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 430.01 568.81 Tm (benefits) Tj ET Q q n 72.7 566.4 m 684.7 566.4 l 684.7 554.4 l 72.7 554.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 556.81 Tm (ended.) Tj ET Q q n 45 554.4 m 657 554.4 l 657 542.4 l 45 542.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 544.81 Tm (A) Tj ET BT /F3 12 Tf 1 0 0 1 60.56 544.81 Tm (new) Tj ET BT /F3 12 Tf 1 0 0 1 87.44 544.81 Tm (Elimination) Tj ET BT /F3 12 Tf 1 0 0 1 150.98 544.81 Tm (Period) Tj ET BT /F3 12 Tf 1 0 0 1 189.2 544.81 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 219.43 544.81 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 237.64 544.81 Tm (completed) Tj ET BT /F3 12 Tf 1 0 0 1 294.51 544.81 Tm (before) Tj ET BT /F3 12 Tf 1 0 0 1 332.05 544.81 Tm (further) Tj ET BT /F3 12 Tf 1 0 0 1 371.58 544.81 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 419.81 544.81 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 466.69 544.81 Tm (become) Tj ET Q q n 45 542.4 m 657 542.4 l 657 530.4 l 45 530.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 532.81 Tm (payable.) Tj ET BT /F3 12 Tf 1 0 0 1 91.31 532.81 Tm (A new Maximum Benefit Period will apply.) Tj ET Q q n 45 530.4 m 657 530.4 l 657 518.4 l 45 518.4 l h W n Q q n 18 518.4 m 630 518.4 l 630 506.4 l 18 506.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 508.81 Tm (2.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 508.81 Tm (Prior) Tj ET BT /F2 12 Tf 1 0 0 1 76.67 508.81 Tm (Disability.) Tj ET BT /F3 12 Tf 1 0 0 1 137.03 508.81 Tm (A) Tj ET BT /F3 12 Tf 1 0 0 1 149.7 508.81 Tm (Recurrent) Tj ET BT /F3 12 Tf 1 0 0 1 201.01 508.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 252.35 508.81 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 275.02 508.81 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 290.36 508.81 Tm (treated) Tj ET BT /F3 12 Tf 1 0 0 1 327 508.81 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 341.01 508.81 Tm (part) Tj ET BT /F3 12 Tf 1 0 0 1 363.67 508.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 377.67 508.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 396.33 508.81 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 423.67 508.81 Tm (Disability,) Tj ET BT /F3 12 Tf 1 0 0 1 478 508.81 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 508.81 Tm (the) Tj ET Q q n 45.35 506.4 m 657.35 506.4 l 657.35 494.4 l 45.35 494.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 496.81 Tm (Recurrent) Tj ET BT /F3 12 Tf 1 0 0 1 96.57 496.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 147.8 496.81 Tm (begins) Tj ET BT /F3 12 Tf 1 0 0 1 183.04 496.81 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 208.92 496.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 227.49 496.81 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 267.38 496.81 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 319.94 496.81 Tm (returns) Tj ET BT /F3 12 Tf 1 0 0 1 357.17 496.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 370.41 496.81 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 388.32 496.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 402.22 496.81 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 421.45 496.81 Tm (Own) Tj ET BT /F3 12 Tf 1 0 0 1 448.69 496.81 Tm (Occupation) Tj ET Q q n 45.35 494.4 m 657.35 494.4 l 657.35 482.4 l 45.35 482.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 484.81 Tm (with the Employer:) Tj ET Q q n 45.35 482.4 m 657.35 482.4 l 657.35 470.4 l 45.35 470.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 472.81 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 472.81 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 87.99 472.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 96.61 472.81 Tm (full-time) Tj ET BT /F3 12 Tf 1 0 0 1 141.88 472.81 Tm (basis) Tj ET BT /F3 12 Tf 1 0 0 1 169.17 472.81 Tm (working) Tj ET BT /F3 12 Tf 1 0 0 1 212.46 472.81 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 224.41 472.81 Tm (least) Tj ET BT /F3 12 Tf 1 0 0 1 249.69 472.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 267.64 472.81 Tm (Minimum) Tj ET BT /F3 12 Tf 1 0 0 1 318.93 472.81 Tm (Number) Tj ET BT /F3 12 Tf 1 0 0 1 361.54 472.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 374.83 472.81 Tm (Hours) Tj ET BT /F3 12 Tf 1 0 0 1 407.45 472.81 Tm (Per) Tj ET BT /F3 12 Tf 1 0 0 1 426.74 472.81 Tm (Week) Tj ET BT /F3 12 Tf 1 0 0 1 458 472.81 Tm (as) Tj ET Q q n 72.7 470.4 m 684.7 470.4 l 684.7 458.4 l 72.7 458.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 460.81 Tm (shown in the Schedule of Benefits; but) Tj ET Q q n 45.35 458.4 m 657.35 458.4 l 657.35 446.4 l 45.35 446.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 448.81 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 448.81 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 93.06 448.81 Tm (less) Tj ET BT /F3 12 Tf 1 0 0 1 117.43 448.81 Tm (than) Tj ET BT /F3 12 Tf 1 0 0 1 144.45 448.81 Tm (six) Tj ET BT /F3 12 Tf 1 0 0 1 164.82 448.81 Tm (consecutive) Tj ET BT /F3 12 Tf 1 0 0 1 227.83 448.81 Tm (months) Tj ET BT /F3 12 Tf 1 0 0 1 269.54 448.81 Tm (following) Tj ET BT /F3 12 Tf 1 0 0 1 322.57 448.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 343.6 448.81 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 369.95 448.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 390.98 448.81 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 420.67 448.81 Tm (Disability) Tj ET Q q n 72.7 446.4 m 684.7 446.4 l 684.7 434.4 l 72.7 434.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 436.81 Tm (benefits ended.) Tj ET Q q n 45 434.4 m 657 434.4 l 657 422.4 l 45 422.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 424.81 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 67.9 424.81 Tm (completion) Tj ET BT /F3 12 Tf 1 0 0 1 126.12 424.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 140.36 424.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 149.93 424.81 Tm (new) Tj ET BT /F3 12 Tf 1 0 0 1 174.16 424.81 Tm (Elimination) Tj ET BT /F3 12 Tf 1 0 0 1 235.06 424.81 Tm (Period) Tj ET BT /F3 12 Tf 1 0 0 1 270.63 424.81 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 282.87 424.81 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 302.44 424.81 Tm (required) Tj ET BT /F3 12 Tf 1 0 0 1 346.66 424.81 Tm (before) Tj ET BT /F3 12 Tf 1 0 0 1 381.54 424.81 Tm (further) Tj ET BT /F3 12 Tf 1 0 0 1 418.43 424.81 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 464.01 424.81 Tm (Benefits) Tj ET Q q n 45 422.4 m 657 422.4 l 657 410.4 l 45 410.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 412.81 Tm (become) Tj ET BT /F3 12 Tf 1 0 0 1 85.7 412.81 Tm (payable.) Tj ET BT /F3 12 Tf 1 0 0 1 132.79 412.81 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 154.84 412.81 Tm (same) Tj ET BT /F3 12 Tf 1 0 0 1 182.89 412.81 Tm (Maximum) Tj ET BT /F3 12 Tf 1 0 0 1 236.27 412.81 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 274.98 412.81 Tm (Period) Tj ET BT /F3 12 Tf 1 0 0 1 309.7 412.81 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 331.76 412.81 Tm (apply) Tj ET BT /F3 12 Tf 1 0 0 1 361.81 412.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 374.53 412.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 392.58 412.81 Tm (Recurrent) Tj ET BT /F3 12 Tf 1 0 0 1 443.28 412.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 494 412.81 Tm (as) Tj ET Q q n 45 410.4 m 657 410.4 l 657 398.4 l 45 398.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 400.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 59.83 400.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 79.98 400.81 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 108.8 400.81 Tm (Disability.) Tj ET BT /F3 12 Tf 1 0 0 1 170.12 400.81 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 194.27 400.81 Tm (Predisability) Tj ET BT /F3 12 Tf 1 0 0 1 260.42 400.81 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 301.9 400.81 Tm (used) Tj ET BT /F3 12 Tf 1 0 0 1 329.39 400.81 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 344.22 400.81 Tm (determining) Tj ET BT /F3 12 Tf 1 0 0 1 407.7 400.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 427.85 400.81 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 456.67 400.81 Tm (Disability) Tj ET Q q n 45 398.4 m 657 398.4 l 657 386.4 l 45 386.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 388.81 Tm (benefit will apply as well.) Tj ET Q q n 0 386.4 m 612 386.4 l 612 374.4 l 0 374.4 l h W n Q q n 45 374.4 m 657 374.4 l 657 362.4 l 45 362.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 364.81 Tm (In) Tj ET BT /F3 12 Tf 1 0 0 1 58.8 364.81 Tm (addition,) Tj ET BT /F3 12 Tf 1 0 0 1 104.92 364.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 114.05 364.81 Tm (Recurrent) Tj ET BT /F3 12 Tf 1 0 0 1 165.16 364.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 216.29 364.81 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 238.75 364.81 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 253.88 364.81 Tm (treated) Tj ET BT /F3 12 Tf 1 0 0 1 290.32 364.81 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 304.12 364.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 313.24 364.81 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 340.37 364.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 391.5 364.81 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 402.63 364.81 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 418.42 364.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 432.22 364.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 450.67 364.81 Tm (subsequent) Tj ET Q q n 45.35 362.4 m 657.35 362.4 l 657.35 350.4 l 45.35 350.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 352.81 Tm (events) Tj ET BT /F3 12 Tf 1 0 0 1 79.06 352.81 Tm (occur) Tj ET BT /F3 12 Tf 1 0 0 1 108.76 352.81 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 121.15 352.81 Tm (less) Tj ET BT /F3 12 Tf 1 0 0 1 142.2 352.81 Tm (than) Tj ET BT /F3 12 Tf 1 0 0 1 165.92 352.81 Tm (six) Tj ET BT /F3 12 Tf 1 0 0 1 182.98 352.81 Tm (consecutive) Tj ET BT /F3 12 Tf 1 0 0 1 242.67 352.81 Tm (months) Tj ET BT /F3 12 Tf 1 0 0 1 281.06 352.81 Tm (following) Tj ET BT /F3 12 Tf 1 0 0 1 330.78 352.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 348.49 352.81 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 371.53 352.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 389.25 352.81 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 415.63 352.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 466.01 352.81 Tm (benefits) Tj ET Q q n 45.35 350.4 m 657.35 350.4 l 657.35 338.4 l 45.35 338.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 340.81 Tm (end under the Policy:) Tj ET Q q n 45.35 338.4 m 657.35 338.4 l 657.35 326.4 l 45.35 326.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 328.81 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 328.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 81.23 328.81 Tm (job) Tj ET BT /F3 12 Tf 1 0 0 1 99.77 328.81 Tm (opening) Tj ET BT /F3 12 Tf 1 0 0 1 141.63 328.81 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 152.84 328.81 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 171.38 328.81 Tm (available) Tj ET BT /F3 12 Tf 1 0 0 1 217.89 328.81 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 235.09 328.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 252.95 328.81 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 292.15 328.81 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 344 328.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 356.54 328.81 Tm (return) Tj ET BT /F3 12 Tf 1 0 0 1 388.4 328.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 400.94 328.81 Tm (work) Tj ET BT /F3 12 Tf 1 0 0 1 428.8 328.81 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 453.34 328.81 Tm (the) Tj ET Q q n 72.7 326.4 m 684.7 326.4 l 684.7 314.4 l 72.7 314.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 316.81 Tm (Employer;) Tj ET Q q n 45.35 314.4 m 657.35 314.4 l 657.35 302.4 l 45.35 302.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 304.81 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 304.81 Tm (the Insured Employee's coverage under the Policy terminates;) Tj ET Q q n 45.35 302.4 m 657.35 302.4 l 657.35 290.4 l 45.35 290.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 292.81 Tm (c.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 292.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 90.96 292.81 Tm (former) Tj ET BT /F3 12 Tf 1 0 0 1 127.2 292.81 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 179.45 292.81 Tm (returns) Tj ET BT /F3 12 Tf 1 0 0 1 216.37 292.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 229.3 292.81 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 246.9 292.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 260.49 292.81 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 279.41 292.81 Tm (Own) Tj ET BT /F3 12 Tf 1 0 0 1 306.33 292.81 Tm (Occupation) Tj ET BT /F3 12 Tf 1 0 0 1 365.24 292.81 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 390.17 292.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 399.1 292.81 Tm (new) Tj ET BT /F3 12 Tf 1 0 0 1 422.68 292.81 Tm (employer) Tj ET Q q n 72.7 290.4 m 684.7 290.4 l 684.7 278.4 l 72.7 278.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 280.81 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 87.99 280.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 96.61 280.81 Tm (full-time) Tj ET BT /F3 12 Tf 1 0 0 1 141.88 280.81 Tm (basis) Tj ET BT /F3 12 Tf 1 0 0 1 169.17 280.81 Tm (working) Tj ET BT /F3 12 Tf 1 0 0 1 212.46 280.81 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 224.41 280.81 Tm (least) Tj ET BT /F3 12 Tf 1 0 0 1 249.69 280.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 267.64 280.81 Tm (Minimum) Tj ET BT /F3 12 Tf 1 0 0 1 318.93 280.81 Tm (Number) Tj ET BT /F3 12 Tf 1 0 0 1 361.54 280.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 374.83 280.81 Tm (Hours) Tj ET BT /F3 12 Tf 1 0 0 1 407.45 280.81 Tm (Per) Tj ET BT /F3 12 Tf 1 0 0 1 426.74 280.81 Tm (Week) Tj ET BT /F3 12 Tf 1 0 0 1 458 280.81 Tm (as) Tj ET Q q n 72.7 278.4 m 684.7 278.4 l 684.7 266.4 l 72.7 266.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72.7 268.81 Tm (shown in the Schedule of Benefits;) Tj ET Q q n 45.35 266.4 m 657.35 266.4 l 657.35 254.4 l 45.35 254.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 256.81 Tm (d.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 256.81 Tm (benefits are not payable under any other group long-term disability plan; and) Tj ET Q q n 45.35 254.4 m 657.35 254.4 l 657.35 242.4 l 45.35 242.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 244.81 Tm (e.) Tj ET BT /F3 12 Tf 1 0 0 1 72.7 244.81 Tm (a Recurrent Disability begins.) Tj ET Q q n 45.35 242.4 m 657.35 242.4 l 657.35 230.4 l 45.35 230.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 232.81 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 91.25 232.81 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 111.15 232.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 131.71 232.81 Tm (former) Tj ET BT /F3 12 Tf 1 0 0 1 170.27 232.81 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 224.83 232.81 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 249.4 232.81 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 266.63 232.81 Tm (reinstated) Tj ET BT /F3 12 Tf 1 0 0 1 319.19 232.81 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 339.09 232.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 359.65 232.81 Tm (Recurrent) Tj ET BT /F3 12 Tf 1 0 0 1 412.87 232.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 466.11 232.81 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 232.81 Tm (the) Tj ET Q q n 45.35 230.4 m 657.35 230.4 l 657.35 218.4 l 45.35 218.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 220.81 Tm (completion) Tj ET BT /F3 12 Tf 1 0 0 1 103.29 220.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 117.25 220.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 126.53 220.81 Tm (new) Tj ET BT /F3 12 Tf 1 0 0 1 150.48 220.81 Tm (Elimination) Tj ET BT /F3 12 Tf 1 0 0 1 211.09 220.81 Tm (Period) Tj ET BT /F3 12 Tf 1 0 0 1 246.38 220.81 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 269 220.81 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 288.29 220.81 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 303.58 220.81 Tm (required) Tj ET BT /F3 12 Tf 1 0 0 1 347.51 220.81 Tm (before) Tj ET BT /F3 12 Tf 1 0 0 1 382.11 220.81 Tm (further) Tj ET BT /F3 12 Tf 1 0 0 1 418.72 220.81 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 464.01 220.81 Tm (Benefits) Tj ET Q q n 45.35 218.4 m 657.35 218.4 l 657.35 206.4 l 45.35 206.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 208.81 Tm (become) Tj ET BT /F3 12 Tf 1 0 0 1 86.36 208.81 Tm (payable.) Tj ET BT /F3 12 Tf 1 0 0 1 134.08 208.81 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 156.44 208.81 Tm (same) Tj ET BT /F3 12 Tf 1 0 0 1 184.79 208.81 Tm (Maximum) Tj ET BT /F3 12 Tf 1 0 0 1 238.49 208.81 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 277.52 208.81 Tm (Period,) Tj ET BT /F3 12 Tf 1 0 0 1 315.55 208.81 Tm (Exclusions,) Tj ET BT /F3 12 Tf 1 0 0 1 374.91 208.81 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 395.94 208.81 Tm (Limitations) Tj ET BT /F3 12 Tf 1 0 0 1 454.97 208.81 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 477.34 208.81 Tm (apply) Tj ET Q q n 45.35 206.4 m 657.35 206.4 l 657.35 194.4 l 45.35 194.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 196.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 60.81 196.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 81.59 196.81 Tm (Recurrent) Tj ET BT /F3 12 Tf 1 0 0 1 135.03 196.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 188.48 196.81 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 204.6 196.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 220.06 196.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 240.84 196.81 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 270.29 196.81 Tm (Disability.) Tj ET BT /F3 12 Tf 1 0 0 1 332.87 196.81 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 357.65 196.81 Tm (Predisability) Tj ET BT /F3 12 Tf 1 0 0 1 424.44 196.81 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 466.55 196.81 Tm (used) Tj ET BT /F3 12 Tf 1 0 0 1 494.67 196.81 Tm (in) Tj ET Q q n 45.35 194.4 m 657.35 194.4 l 657.35 182.4 l 45.35 182.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 184.81 Tm (determining) Tj ET BT /F3 12 Tf 1 0 0 1 108.85 184.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 129.03 184.81 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 157.88 184.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 210.73 184.81 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 249.57 184.81 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 273.75 184.81 Tm (apply) Tj ET BT /F3 12 Tf 1 0 0 1 305.93 184.81 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 321.45 184.81 Tm (well.) Tj ET BT /F3 12 Tf 1 0 0 1 356.15 184.81 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 401.66 184.81 Tm (reinstated) Tj ET BT /F3 12 Tf 1 0 0 1 453.82 184.81 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 486.66 184.81 Tm (this) Tj ET Q q n 45.35 182.4 m 657.35 182.4 l 657.35 170.4 l 45.35 170.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 172.81 Tm (provision) Tj ET BT /F3 12 Tf 1 0 0 1 95.18 172.81 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 114.33 172.81 Tm (subject) Tj ET BT /F3 12 Tf 1 0 0 1 152.81 172.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 166.64 172.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 185.8 172.81 Tm (Policy's) Tj ET BT /F3 12 Tf 1 0 0 1 227.8 172.81 Tm (terms) Tj ET BT /F3 12 Tf 1 0 0 1 258.95 172.81 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 280.77 172.81 Tm (conditions) Tj ET BT /F3 12 Tf 1 0 0 1 335.27 172.81 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 357.76 172.81 Tm (were) Tj ET BT /F3 12 Tf 1 0 0 1 385.57 172.81 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 399.4 172.81 Tm (effect) Tj ET BT /F3 12 Tf 1 0 0 1 431.2 172.81 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 444.36 172.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 463.52 172.81 Tm (time) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 172.81 Tm (the) Tj ET Q q n 45.35 170.4 m 657.35 170.4 l 657.35 158.4 l 45.35 158.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 160.81 Tm (prior Disability began.) Tj ET Q q n 0 158.4 m 612 158.4 l 612 146.4 l 0 146.4 l h W n Q q n 0 146.4 m 612 146.4 l 612 134.4 l 0 134.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 136.81 Tm (To) Tj ET BT /F3 12 Tf 1 0 0 1 16.5 136.81 Tm (qualify) Tj ET BT /F3 12 Tf 1 0 0 1 53.66 136.81 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 70.81 136.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 79.31 136.81 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 123.81 136.81 Tm (Benefit,) Tj ET BT /F3 12 Tf 1 0 0 1 165.3 136.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 183.13 136.81 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 222.28 136.81 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 274.1 136.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 287.26 136.81 Tm (former) Tj ET BT /F3 12 Tf 1 0 0 1 323.08 136.81 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 374.9 136.81 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 401.4 136.81 Tm (earn) Tj ET BT /F3 12 Tf 1 0 0 1 425.22 136.81 Tm (less) Tj ET BT /F3 12 Tf 1 0 0 1 446.38 136.81 Tm (than) Tj ET BT /F3 12 Tf 1 0 0 1 470.21 136.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 488.04 136.81 Tm (percentage) Tj ET Q q n 0 134.4 m 612 134.4 l 612 122.4 l 0 122.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 124.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 13.65 124.81 Tm (Predisability) Tj ET BT /F3 12 Tf 1 0 0 1 77.96 124.81 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 117.59 124.81 Tm (specified) Tj ET BT /F3 12 Tf 1 0 0 1 164.55 124.81 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 177.54 124.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 195.85 124.81 Tm (Partial) Tj ET BT /F3 12 Tf 1 0 0 1 230.82 124.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 281.8 124.81 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 326.79 124.81 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 365.76 124.81 Tm (section.) Tj ET BT /F3 12 Tf 1 0 0 1 410.05 124.81 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 455.04 124.81 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 494.01 124.81 Tm (payments) Tj ET Q q n 0 122.4 m 612 122.4 l 612 110.4 l 0 110.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 112.81 Tm (will be subject to all other terms of the Policy that applied to the prior Disability.) Tj ET Q q n 0 110.4 m 612 110.4 l 612 98.4 l 0 98.4 l h W n Q Q q Q Q endstream endobj 26 0 obj <>>>>> endobj 156 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 758.4 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 172.32 2.41 Tm (PROGRESSIVE INCOME BENEFIT) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-12D 01) Tj ET Q q n 183.6 36 m 550.8 36 l 550.8 24 l 183.6 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 477.02 26.41 Tm (ADL Benefit) Tj ET Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 265 14.41 Tm (24) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 698.4 m 612 698.4 l 612 686.4 l 0 686.4 l h W n Q q n 0 686.4 m 612 686.4 l 612 674.4 l 0 674.4 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 676.81 Tm (EFFECTIVE DATE.) Tj ET BT /F3 12 Tf 1 0 0 1 114.02 676.81 Tm (An Insured Employee will become insured for the Progressive Income Benefit on:) Tj ET Q q n 18 674.4 m 630 674.4 l 630 662.4 l 18 662.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 664.81 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 664.81 Tm (the effective date of his or her coverage for Long Term Disability Benefits under the Policy; or) Tj ET Q q n 18 662.4 m 630 662.4 l 630 650.4 l 18 650.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 652.81 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 652.81 Tm (the effective date of this provision, if it is added later by amending the Policy.) Tj ET Q q n 0 650.4 m 612 650.4 l 612 638.4 l 0 638.4 l h W n Q q n 0 638.4 m 612 638.4 l 612 626.4 l 0 626.4 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 628.81 Tm (Exception:) Tj ET BT /F3 12 Tf 1 0 0 1 62.3 628.81 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 84.44 628.81 Tm (effective) Tj ET BT /F3 12 Tf 1 0 0 1 129.88 628.81 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 153.35 628.81 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 175.51 628.81 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 190.31 628.81 Tm (delayed) Tj ET BT /F3 12 Tf 1 0 0 1 231.11 628.81 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 248.59 628.81 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 263.39 628.81 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 302.87 628.81 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 355 628.81 Tm (who) Tj ET BT /F3 12 Tf 1 0 0 1 379.15 628.81 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 390.64 628.81 Tm (unable) Tj ET BT /F3 12 Tf 1 0 0 1 426.11 628.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 438.92 628.81 Tm (perform) Tj ET BT /F3 12 Tf 1 0 0 1 481.06 628.81 Tm (one) Tj ET BT /F3 12 Tf 1 0 0 1 501.86 628.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 515.34 628.81 Tm (more) Tj ET Q q n 0 626.4 m 612 626.4 l 612 614.4 l 0 614.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 616.81 Tm (Activities) Tj ET BT /F3 12 Tf 1 0 0 1 51.63 616.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 66.59 616.81 Tm (Daily) Tj ET BT /F3 12 Tf 1 0 0 1 98.23 616.81 Tm (Living) Tj ET BT /F3 12 Tf 1 0 0 1 135.19 616.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 150.16 616.81 Tm (suffers) Tj ET BT /F3 12 Tf 1 0 0 1 187.79 616.81 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 216.08 616.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 226.38 616.81 Tm (Cognitive) Tj ET BT /F3 12 Tf 1 0 0 1 278.68 616.81 Tm (Impairment) Tj ET BT /F3 12 Tf 1 0 0 1 339.63 616.81 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 356.6 616.81 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 379.57 616.81 Tm (date.) Tj ET BT /F3 12 Tf 1 0 0 1 412.49 616.81 Tm (In) Tj ET BT /F3 12 Tf 1 0 0 1 427.46 616.81 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 450.42 616.81 Tm (event,) Tj ET BT /F3 12 Tf 1 0 0 1 484.38 616.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 504.01 616.81 Tm (Insured) Tj ET Q q n 0 614.4 m 612 614.4 l 612 602.4 l 0 602.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 604.81 Tm (Employee will become insured for this benefit on the first day he or she:) Tj ET Q q n 18 602.4 m 630 602.4 l 630 590.4 l 18 590.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 592.81 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 592.81 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 57.27 592.81 Tm (able) Tj ET BT /F3 12 Tf 1 0 0 1 81.18 592.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 94.43 592.81 Tm (safely) Tj ET BT /F3 12 Tf 1 0 0 1 127 592.81 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 148.24 592.81 Tm (completely) Tj ET BT /F3 12 Tf 1 0 0 1 205.48 592.81 Tm (perform) Tj ET BT /F3 12 Tf 1 0 0 1 248.04 592.81 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 263.95 592.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 277.87 592.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 296.45 592.81 Tm (Activities) Tj ET BT /F3 12 Tf 1 0 0 1 347.02 592.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 360.94 592.81 Tm (Daily) Tj ET BT /F3 12 Tf 1 0 0 1 391.52 592.81 Tm (Living) Tj ET BT /F3 12 Tf 1 0 0 1 427.43 592.81 Tm (without) Tj ET BT /F3 12 Tf 1 0 0 1 468.02 592.81 Tm (another) Tj ET Q q n 45.35 590.4 m 657.35 590.4 l 657.35 578.4 l 45.35 578.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 580.81 Tm (person's active, hands-on help; or) Tj ET Q q n 18 578.4 m 630 578.4 l 630 566.4 l 18 566.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 568.81 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 568.81 Tm (no longer suffers from a Cognitive Impairment.) Tj ET Q q n 0 566.4 m 612 566.4 l 612 554.4 l 0 554.4 l h W n Q q n 0 554.4 m 612 554.4 l 612 542.4 l 0 542.4 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 544.81 Tm (BENEFIT.) Tj ET BT /F3 12 Tf 1 0 0 1 62.36 544.81 Tm (After) Tj ET BT /F3 12 Tf 1 0 0 1 91.02 544.81 Tm (completion) Tj ET BT /F3 12 Tf 1 0 0 1 148.34 544.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 161.68 544.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 179.68 544.81 Tm (Elimination) Tj ET BT /F3 12 Tf 1 0 0 1 239.68 544.81 Tm (Period) Tj ET BT /F3 12 Tf 1 0 0 1 274.35 544.81 Tm (shown) Tj ET BT /F3 12 Tf 1 0 0 1 309.02 544.81 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 321.69 544.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 339.69 544.81 Tm (Schedule) Tj ET BT /F3 12 Tf 1 0 0 1 387.02 544.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 400.35 544.81 Tm (Insurance,) Tj ET BT /F3 12 Tf 1 0 0 1 453.33 544.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 471.33 544.81 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 521.33 544.81 Tm (will) Tj ET Q q n 0 542.4 m 612 542.4 l 612 530.4 l 0 530.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 532.81 Tm (pay an additional monthly benefit to an Insured Employee; if he or she:) Tj ET Q q n 18 530.4 m 630 530.4 l 630 518.4 l 18 518.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 520.81 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 520.81 Tm (is receiving Total Disability or Partial Disability Monthly Benefits under the Policy; and) Tj ET Q q n 18 518.4 m 630 518.4 l 630 506.4 l 18 506.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 508.81 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 508.81 Tm (submits) Tj ET BT /F3 12 Tf 1 0 0 1 85.81 508.81 Tm (proof) Tj ET BT /F3 12 Tf 1 0 0 1 114.92 508.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 128.03 508.81 Tm (suffering) Tj ET BT /F3 12 Tf 1 0 0 1 174.46 508.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 192.24 508.81 Tm (Loss) Tj ET BT /F3 12 Tf 1 0 0 1 218.02 508.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 231.14 508.81 Tm (Activities) Tj ET BT /F3 12 Tf 1 0 0 1 280.91 508.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 294.02 508.81 Tm (Daily) Tj ET BT /F3 12 Tf 1 0 0 1 323.8 508.81 Tm (Living) Tj ET BT /F3 12 Tf 1 0 0 1 358.91 508.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 372.02 508.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 380.46 508.81 Tm (Cognitive) Tj ET BT /F3 12 Tf 1 0 0 1 430.91 508.81 Tm (Impairment) Tj ET BT /F3 12 Tf 1 0 0 1 490.01 508.81 Tm (\(as) Tj ET Q q n 45.35 506.4 m 657.35 506.4 l 657.35 494.4 l 45.35 494.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 496.81 Tm (defined below\).) Tj ET Q q n 0 494.4 m 612 494.4 l 612 482.4 l 0 482.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 484.81 Tm (Proof must be submitted at the Insured Employee's own expense.) Tj ET Q q n 0 482.4 m 612 482.4 l 612 470.4 l 0 470.4 l h W n Q q n 0 470.4 m 612 470.4 l 612 458.4 l 0 458.4 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 460.81 Tm (AMOUNT.) Tj ET BT /F3 12 Tf 1 0 0 1 63.66 460.81 Tm (The amount of the Progressive Income Benefit:) Tj ET Q q n 18 458.4 m 630 458.4 l 630 446.4 l 18 446.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 448.81 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 448.81 Tm (will equal 20% of the Insured Employee's Basic Monthly Earnings; but) Tj ET Q q n 18 446.4 m 630 446.4 l 630 434.4 l 18 434.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 436.81 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 436.81 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 67.97 436.81 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 87.26 436.81 Tm (exceed) Tj ET BT /F3 12 Tf 1 0 0 1 124.52 436.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 143.13 436.81 Tm (Maximum) Tj ET BT /F3 12 Tf 1 0 0 1 197.08 436.81 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 242.38 436.81 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 281.65 436.81 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 299.6 436.81 Tm (Long) Tj ET BT /F3 12 Tf 1 0 0 1 328.88 436.81 Tm (Term) Tj ET BT /F3 12 Tf 1 0 0 1 358.82 436.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 410.11 436.81 Tm (Benefits,) Tj ET BT /F3 12 Tf 1 0 0 1 457.05 436.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 471 436.81 Tm ($5,000) Tj ET Q q n 45.35 434.4 m 657.35 434.4 l 657.35 422.4 l 45.35 422.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 424.81 Tm (per month \(whichever is less\).) Tj ET Q q n 0 422.4 m 612 422.4 l 612 410.4 l 0 410.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 412.81 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 21.98 412.81 Tm (Maximum) Tj ET BT /F3 12 Tf 1 0 0 1 75.3 412.81 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 119.95 412.81 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 158.59 412.81 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 175.91 412.81 Tm (Long) Tj ET BT /F3 12 Tf 1 0 0 1 204.56 412.81 Tm (Term) Tj ET BT /F3 12 Tf 1 0 0 1 233.86 412.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 284.52 412.81 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 327.83 412.81 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 339.15 412.81 Tm (shown) Tj ET BT /F3 12 Tf 1 0 0 1 373.81 412.81 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 386.46 412.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 404.44 412.81 Tm (Schedule) Tj ET BT /F3 12 Tf 1 0 0 1 451.75 412.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 465.06 412.81 Tm (Insurance.) Tj ET BT /F3 12 Tf 1 0 0 1 521.34 412.81 Tm (The) Tj ET Q q n 0 410.4 m 612 410.4 l 612 398.4 l 0 398.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 400.81 Tm (Progressive) Tj ET BT /F3 12 Tf 1 0 0 1 59.17 400.81 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 98.33 400.81 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 136.82 400.81 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 158.66 400.81 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 177.17 400.81 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 191.68 400.81 Tm (reduced) Tj ET BT /F3 12 Tf 1 0 0 1 232.83 400.81 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 248 400.81 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 268.5 400.81 Tm (Other) Tj ET BT /F3 12 Tf 1 0 0 1 299 400.81 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 338.16 400.81 Tm (Benefits,) Tj ET BT /F3 12 Tf 1 0 0 1 384.32 400.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 397.5 400.81 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 412.67 400.81 Tm (earnings) Tj ET BT /F3 12 Tf 1 0 0 1 456.5 400.81 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 483 400.81 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 503.5 400.81 Tm (form) Tj ET BT /F3 12 Tf 1 0 0 1 530 400.81 Tm (of) Tj ET Q q n 0 398.4 m 612 398.4 l 612 386.4 l 0 386.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 388.81 Tm (employment.) Tj ET Q q n 0 386.4 m 612 386.4 l 612 374.4 l 0 374.4 l h W n Q q n 0 374.4 m 612 374.4 l 612 362.4 l 0 362.4 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 364.81 Tm (DURATION.) Tj ET BT /F3 12 Tf 1 0 0 1 74.34 364.81 Tm (This Progressive Income Benefit will cease on the earliest of:) Tj ET Q q n 18 362.4 m 630 362.4 l 630 350.4 l 18 350.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 352.81 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 352.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 63.35 352.81 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 86.68 352.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 104.68 352.81 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 144 352.81 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 195.99 352.81 Tm (no) Tj ET BT /F3 12 Tf 1 0 0 1 211.33 352.81 Tm (longer) Tj ET BT /F3 12 Tf 1 0 0 1 245.33 352.81 Tm (suffers) Tj ET BT /F3 12 Tf 1 0 0 1 281.32 352.81 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 307.99 352.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 325.99 352.81 Tm (Loss) Tj ET BT /F3 12 Tf 1 0 0 1 352 352.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 365.33 352.81 Tm (Activities) Tj ET BT /F3 12 Tf 1 0 0 1 415.33 352.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 428.67 352.81 Tm (Daily) Tj ET BT /F3 12 Tf 1 0 0 1 458.67 352.81 Tm (Living) Tj ET BT /F3 12 Tf 1 0 0 1 494 352.81 Tm (or) Tj ET Q q n 45.35 350.4 m 657.35 350.4 l 657.35 338.4 l 45.35 338.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 340.81 Tm (Cognitive Impairment \(as defined below\);) Tj ET Q q n 18 338.4 m 630 338.4 l 630 326.4 l 18 326.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 328.81 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 328.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 64.83 328.81 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 89.63 328.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 109.1 328.81 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 149.91 328.81 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 203.37 328.81 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 216.19 328.81 Tm (no) Tj ET BT /F3 12 Tf 1 0 0 1 233.01 328.81 Tm (longer) Tj ET BT /F3 12 Tf 1 0 0 1 268.48 328.81 Tm (entitled) Tj ET BT /F3 12 Tf 1 0 0 1 309.28 328.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 323.43 328.81 Tm (Total) Tj ET BT /F3 12 Tf 1 0 0 1 353.57 328.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 405.72 328.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 420.53 328.81 Tm (Partial) Tj ET BT /F3 12 Tf 1 0 0 1 456.67 328.81 Tm (Disability) Tj ET Q q n 45.35 326.4 m 657.35 326.4 l 657.35 314.4 l 45.35 314.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 316.81 Tm (Monthly Benefits under the Policy;) Tj ET Q q n 18 314.4 m 630 314.4 l 630 302.4 l 18 302.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 304.81 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 304.81 Tm (the date the Maximum Benefit Period ends; or) Tj ET Q q n 18 302.4 m 630 302.4 l 630 290.4 l 18 290.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 292.81 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 292.81 Tm (the date the Insured Employee dies.) Tj ET Q q n 0 290.4 m 612 290.4 l 612 278.4 l 0 278.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 280.81 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 11.86 280.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 30.39 280.81 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 64.92 280.81 Tm (includes) Tj ET BT /F3 12 Tf 1 0 0 1 108.78 280.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 117.98 280.81 Tm (Family) Tj ET BT /F3 12 Tf 1 0 0 1 155.85 280.81 Tm (Income) Tj ET BT /F3 12 Tf 1 0 0 1 195.7 280.81 Tm (Benefit,) Tj ET BT /F3 12 Tf 1 0 0 1 237.89 280.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 256.42 280.81 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 296.28 280.81 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 320.81 280.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 334.01 280.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 352.54 280.81 Tm (Eligible) Tj ET BT /F3 12 Tf 1 0 0 1 394.4 280.81 Tm (Surviving) Tj ET BT /F3 12 Tf 1 0 0 1 445.6 280.81 Tm (Spouse) Tj ET BT /F3 12 Tf 1 0 0 1 484.14 280.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 498.01 280.81 Tm (Children) Tj ET Q q n 0 278.4 m 612 278.4 l 612 266.4 l 0 266.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 268.81 Tm (will not increase due to the Insured Employee's receipt of this Progressive Income Benefit.) Tj ET Q q n 0 266.4 m 612 266.4 l 612 254.4 l 0 254.4 l h W n Q q n 0 254.4 m 612 254.4 l 612 242.4 l 0 242.4 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 244.81 Tm (DEFINITIONS) Tj ET Q q n 0 242.4 m 612 242.4 l 612 230.4 l 0 230.4 l h W n Q q n 0 230.4 m 612 230.4 l 612 218.4 l 0 218.4 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 220.81 Tm ("Loss) Tj ET BT /F2 12 Tf 1 0 0 1 33.79 220.81 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 47.57 220.81 Tm (Activities) Tj ET BT /F2 12 Tf 1 0 0 1 99.33 220.81 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 113.11 220.81 Tm (Daily) Tj ET BT /F2 12 Tf 1 0 0 1 144.23 220.81 Tm (Living") Tj ET BT /F3 12 Tf 1 0 0 1 188.02 220.81 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 222.46 220.81 Tm (that,) Tj ET BT /F3 12 Tf 1 0 0 1 247.23 220.81 Tm (due) Tj ET BT /F3 12 Tf 1 0 0 1 268.34 220.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 281.46 220.81 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 296.57 220.81 Tm (Injury) Tj ET BT /F3 12 Tf 1 0 0 1 329.68 220.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 343.45 220.81 Tm (Sickness,) Tj ET BT /F3 12 Tf 1 0 0 1 392.24 220.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 410.68 220.81 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 450.45 220.81 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 502.88 220.81 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 522.66 220.81 Tm (lost) Tj ET Q q n 0 218.4 m 612 218.4 l 612 206.4 l 0 206.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 208.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 19.96 208.81 Tm (ability) Tj ET BT /F3 12 Tf 1 0 0 1 55.93 208.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 70.56 208.81 Tm (safely) Tj ET BT /F3 12 Tf 1 0 0 1 104.52 208.81 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 127.14 208.81 Tm (completely) Tj ET BT /F3 12 Tf 1 0 0 1 185.76 208.81 Tm (perform) Tj ET BT /F2 12 Tf 1 0 0 1 229.71 208.81 Tm (two) Tj ET BT /F2 12 Tf 1 0 0 1 253.67 208.81 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 270.3 208.81 Tm (more) Tj ET BT /F3 12 Tf 1 0 0 1 302.25 208.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 317.55 208.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 337.51 208.81 Tm (following) Tj ET BT /F3 12 Tf 1 0 0 1 389.48 208.81 Tm (six) Tj ET BT /F3 12 Tf 1 0 0 1 408.78 208.81 Tm (Activities) Tj ET BT /F3 12 Tf 1 0 0 1 460.74 208.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 476.04 208.81 Tm (Daily) Tj ET BT /F3 12 Tf 1 0 0 1 508 208.81 Tm (Living) Tj ET Q q n 0 206.4 m 612 206.4 l 612 194.4 l 0 194.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 196.81 Tm (without another person's active, hands-on help with all or most of the activity.) Tj ET Q q n 0 194.4 m 612 194.4 l 612 182.4 l 0 182.4 l h W n Q q n 0 182.4 m 612 182.4 l 612 170.4 l 0 170.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 172.81 Tm (The six Activities of Daily Living are:) Tj ET Q q n 18 170.4 m 630 170.4 l 630 158.4 l 18 158.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 160.81 Tm (1.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 160.81 Tm (Bathing) Tj ET BT /F3 12 Tf 1 0 0 1 86.03 160.81 Tm ( - washing self in a tub, in a shower or by sponge bath; with or without equipment.) Tj ET Q q n 18 158.4 m 630 158.4 l 630 146.4 l 18 146.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 148.81 Tm (2.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 148.81 Tm (Dressing) Tj ET BT /F3 12 Tf 1 0 0 1 93.83 148.81 Tm (-) Tj ET BT /F3 12 Tf 1 0 0 1 101.64 148.81 Tm (putting) Tj ET BT /F3 12 Tf 1 0 0 1 139.46 148.81 Tm (on,) Tj ET BT /F3 12 Tf 1 0 0 1 158.27 148.81 Tm (taking) Tj ET BT /F3 12 Tf 1 0 0 1 192.08 148.81 Tm (off,) Tj ET BT /F3 12 Tf 1 0 0 1 212.88 148.81 Tm (fastening) Tj ET BT /F3 12 Tf 1 0 0 1 260.68 148.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 274.49 148.81 Tm (unfastening) Tj ET BT /F3 12 Tf 1 0 0 1 334.29 148.81 Tm (garments,) Tj ET BT /F3 12 Tf 1 0 0 1 385.09 148.81 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 406.23 148.81 Tm (medically) Tj ET BT /F3 12 Tf 1 0 0 1 457.36 148.81 Tm (necessary) Tj ET Q q n 45.35 146.4 m 657.35 146.4 l 657.35 134.4 l 45.35 134.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 136.81 Tm (braces, or any artificial limbs normally worn.) Tj ET Q q n 18 134.4 m 630 134.4 l 630 122.4 l 18 122.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 124.81 Tm (3.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 124.81 Tm (Toileting) Tj ET BT /F3 12 Tf 1 0 0 1 91.35 124.81 Tm ( - getting to, from, on and off toilet and performing related personal hygiene.) Tj ET Q q n 18 122.4 m 630 122.4 l 630 110.4 l 18 110.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 112.81 Tm (4.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 112.81 Tm (Transferring) Tj ET BT /F3 12 Tf 1 0 0 1 115.55 112.81 Tm (-) Tj ET BT /F3 12 Tf 1 0 0 1 123.08 112.81 Tm (moving) Tj ET BT /F3 12 Tf 1 0 0 1 163.29 112.81 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 176.16 112.81 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 197.03 112.81 Tm (out) Tj ET BT /F3 12 Tf 1 0 0 1 215.9 112.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 229.44 112.81 Tm (bed,) Tj ET BT /F3 12 Tf 1 0 0 1 253.3 112.81 Tm (chair) Tj ET BT /F3 12 Tf 1 0 0 1 280.82 112.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 294.36 112.81 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 315.22 112.81 Tm (wheelchair;) Tj ET BT /F3 12 Tf 1 0 0 1 374.73 112.81 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 399.6 112.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 413.14 112.81 Tm (without) Tj ET BT /F3 12 Tf 1 0 0 1 453.35 112.81 Tm (equipment) Tj ET Q q n 45.35 110.4 m 657.35 110.4 l 657.35 98.4 l 45.35 98.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 100.81 Tm (such) Tj ET BT /F3 12 Tf 1 0 0 1 70.92 100.81 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 84.49 100.81 Tm (canes,) Tj ET BT /F3 12 Tf 1 0 0 1 117.72 100.81 Tm (walkers,) Tj ET BT /F3 12 Tf 1 0 0 1 161.61 100.81 Tm (crutches,) Tj ET BT /F3 12 Tf 1 0 0 1 208.17 100.81 Tm (grab) Tj ET BT /F3 12 Tf 1 0 0 1 233.06 100.81 Tm (bars,) Tj ET BT /F3 12 Tf 1 0 0 1 259.63 100.81 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 287.86 100.81 Tm (support) Tj ET BT /F3 12 Tf 1 0 0 1 327.44 100.81 Tm (devices,) Tj ET BT /F3 12 Tf 1 0 0 1 370 100.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 383.57 100.81 Tm (mechanical) Tj ET BT /F3 12 Tf 1 0 0 1 441.78 100.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 455.35 100.81 Tm (motorized) Tj ET Q q n 45.35 98.4 m 657.35 98.4 l 657.35 86.4 l 45.35 86.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 88.81 Tm (devices.) Tj ET Q q n 18 86.4 m 630 86.4 l 630 74.4 l 18 74.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 76.81 Tm (5.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 76.81 Tm (Continence) Tj ET BT /F2 12 Tf 1 0 0 1 108.14 76.81 Tm (-) Tj ET BT /F3 12 Tf 1 0 0 1 116.93 76.81 Tm (voluntarily) Tj ET BT /F3 12 Tf 1 0 0 1 174.39 76.81 Tm (maintaining) Tj ET BT /F3 12 Tf 1 0 0 1 236.51 76.81 Tm (control) Tj ET BT /F3 12 Tf 1 0 0 1 275.29 76.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 290.08 76.81 Tm (bladder) Tj ET BT /F3 12 Tf 1 0 0 1 330.86 76.81 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 352.98 76.81 Tm (bowel) Tj ET BT /F3 12 Tf 1 0 0 1 387.11 76.81 Tm (function;) Tj ET BT /F3 12 Tf 1 0 0 1 435.23 76.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 450.02 76.81 Tm (performing) Tj ET Q q n 45.35 74.4 m 657.35 74.4 l 657.35 62.4 l 45.35 62.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 64.81 Tm (related personal hygiene, including care of any catheter or colostomy bag, if not continent.) Tj ET Q q n 18 62.4 m 630 62.4 l 630 50.4 l 18 50.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 52.81 Tm (6.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 52.81 Tm (Eating) Tj ET BT /F3 12 Tf 1 0 0 1 82.49 52.81 Tm (-) Tj ET BT /F3 12 Tf 1 0 0 1 89.61 52.81 Tm (once) Tj ET BT /F3 12 Tf 1 0 0 1 115.39 52.81 Tm (food) Tj ET BT /F3 12 Tf 1 0 0 1 140.52 52.81 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 151.65 52.81 Tm (prepared) Tj ET BT /F3 12 Tf 1 0 0 1 196.75 52.81 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 217.2 52.81 Tm (made) Tj ET BT /F3 12 Tf 1 0 0 1 246.32 52.81 Tm (available,) Tj ET BT /F3 12 Tf 1 0 0 1 295.75 52.81 Tm (getting) Tj ET BT /F3 12 Tf 1 0 0 1 332.21 52.81 Tm (nourishment) Tj ET BT /F3 12 Tf 1 0 0 1 395.33 52.81 Tm (into) Tj ET BT /F3 12 Tf 1 0 0 1 417.13 52.81 Tm (one's) Tj ET BT /F3 12 Tf 1 0 0 1 444.42 52.81 Tm (body) Tj ET BT /F3 12 Tf 1 0 0 1 471.55 52.81 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 486.67 52.81 Tm (any) Tj ET Q q n 45.35 50.4 m 657.35 50.4 l 657.35 38.4 l 45.35 38.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 40.81 Tm (means.) Tj ET BT /F3 12 Tf 1 0 0 1 86.8 40.81 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 112.03 40.81 Tm (includes) Tj ET BT /F3 12 Tf 1 0 0 1 155.91 40.81 Tm (eating) Tj ET BT /F3 12 Tf 1 0 0 1 189.13 40.81 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 216.35 40.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 225.57 40.81 Tm (table,) Tj ET BT /F3 12 Tf 1 0 0 1 255.79 40.81 Tm (tray) Tj ET BT /F3 12 Tf 1 0 0 1 278.34 40.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 292.23 40.81 Tm (container) Tj ET BT /F3 12 Tf 1 0 0 1 340.77 40.81 Tm (\(such) Tj ET BT /F3 12 Tf 1 0 0 1 370.65 40.81 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 384.55 40.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 393.77 40.81 Tm (bowl) Tj ET BT /F3 12 Tf 1 0 0 1 421.66 40.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 435.55 40.81 Tm (cup\);) Tj ET BT /F3 12 Tf 1 0 0 1 464.11 40.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 478 40.81 Tm (using) Tj ET Q q n 45.35 38.4 m 657.35 38.4 l 657.35 26.4 l 45.35 26.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 28.81 Tm (special equipment \(such as a feeding tube or intravenous tube\).) Tj ET Q q n 0 26.4 m 612 26.4 l 612 14.4 l 0 14.4 l h W n Q Q q Q Q endstream endobj 27 0 obj <>>>>> endobj 157 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 734.4 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 172.32 26.41 Tm (PROGRESSIVE INCOME BENEFIT) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 239 14.41 Tm (\(Continued\)) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-12D 01) Tj ET Q q n 183.6 36 m 550.8 36 l 550.8 24 l 183.6 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 477.02 26.41 Tm (ADL Benefit) Tj ET Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 265 14.41 Tm (25) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 676.8 m 612 676.8 l 612 664.8 l 0 664.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 667.21 Tm ("Cognitive Impairment") Tj ET BT /F3 12 Tf 1 0 0 1 127.65 667.21 Tm ( means that due to an Injury or Sickness, the Insured Employee:) Tj ET Q q n 18 664.8 m 630 664.8 l 630 652.8 l 18 652.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 655.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 655.21 Tm (has suffered a permanent deterioration or loss of cognitive or intellectual capacity; and) Tj ET Q q n 18 652.8 m 630 652.8 l 630 640.8 l 18 640.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 643.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 643.21 Tm (requires) Tj ET BT /F3 12 Tf 1 0 0 1 87.24 643.21 Tm (another) Tj ET BT /F3 12 Tf 1 0 0 1 126.47 643.21 Tm (person's) Tj ET BT /F3 12 Tf 1 0 0 1 168.53 643.21 Tm (active,) Tj ET BT /F3 12 Tf 1 0 0 1 203.42 643.21 Tm (hands-on) Tj ET BT /F3 12 Tf 1 0 0 1 250.66 643.21 Tm (help) Tj ET BT /F3 12 Tf 1 0 0 1 274.56 643.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 287.8 643.21 Tm (verbal) Tj ET BT /F3 12 Tf 1 0 0 1 321.02 643.21 Tm (cues) Tj ET BT /F3 12 Tf 1 0 0 1 345.59 643.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 358.17 643.21 Tm (prevent) Tj ET BT /F3 12 Tf 1 0 0 1 397.39 643.21 Tm (harm) Tj ET BT /F3 12 Tf 1 0 0 1 425.29 643.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 437.87 643.21 Tm (self) Tj ET BT /F3 12 Tf 1 0 0 1 458.44 643.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 471.67 643.21 Tm (others,) Tj ET Q q n 45.35 640.8 m 657.35 640.8 l 657.35 628.8 l 45.35 628.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 631.21 Tm (due to that impairment.) Tj ET Q q n 0 628.8 m 612 628.8 l 612 616.8 l 0 616.8 l h W n Q q n 0 616.8 m 612 616.8 l 612 604.8 l 0 604.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 607.21 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 22.07 607.21 Tm (impairment) Tj ET BT /F3 12 Tf 1 0 0 1 80.8 607.21 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 107.55 607.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 122.28 607.21 Tm (diagnosed) Tj ET BT /F3 12 Tf 1 0 0 1 174.35 607.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 189.76 607.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 198.5 607.21 Tm (Physician,) Tj ET BT /F3 12 Tf 1 0 0 1 251.57 607.21 Tm (based) Tj ET BT /F3 12 Tf 1 0 0 1 282.31 607.21 Tm (upon) Tj ET BT /F3 12 Tf 1 0 0 1 309.72 607.21 Tm (clinical) Tj ET BT /F3 12 Tf 1 0 0 1 348.44 607.21 Tm (evidence) Tj ET BT /F3 12 Tf 1 0 0 1 394.49 607.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 415.23 607.21 Tm (reliable) Tj ET BT /F3 12 Tf 1 0 0 1 454.62 607.21 Tm (standardized) Tj ET BT /F3 12 Tf 1 0 0 1 518.67 607.21 Tm (tests) Tj ET Q q n 0 604.8 m 612 604.8 l 612 592.8 l 0 592.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 595.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 13.52 595.21 Tm (short) Tj ET BT /F3 12 Tf 1 0 0 1 41.05 595.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 54.57 595.21 Tm (long-term) Tj ET BT /F3 12 Tf 1 0 0 1 105.42 595.21 Tm (memory;) Tj ET BT /F3 12 Tf 1 0 0 1 152.27 595.21 Tm (orientation) Tj ET BT /F3 12 Tf 1 0 0 1 207.79 595.21 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 221.31 595.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 234.17 595.21 Tm (person,) Tj ET BT /F3 12 Tf 1 0 0 1 272.69 595.21 Tm (place) Tj ET BT /F3 12 Tf 1 0 0 1 301.53 595.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 322.38 595.21 Tm (time;) Tj ET BT /F3 12 Tf 1 0 0 1 350.57 595.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 371.43 595.21 Tm (deductive) Tj ET BT /F3 12 Tf 1 0 0 1 421.6 595.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 435.12 595.21 Tm (abstract) Tj ET BT /F3 12 Tf 1 0 0 1 475.96 595.21 Tm (reasoning.) Tj ET BT /F3 12 Tf 1 0 0 1 532.67 595.21 Tm (It) Tj ET Q q n 0 592.8 m 612 592.8 l 612 580.8 l 0 580.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 583.21 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 25.91 583.21 Tm (result) Tj ET BT /F3 12 Tf 1 0 0 1 57.81 583.21 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 86.39 583.21 Tm (moderate) Tj ET BT /F3 12 Tf 1 0 0 1 136.28 583.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 150.85 583.21 Tm (severe) Tj ET BT /F3 12 Tf 1 0 0 1 186.75 583.21 Tm (head) Tj ET BT /F3 12 Tf 1 0 0 1 214.65 583.21 Tm (trauma,) Tj ET BT /F3 12 Tf 1 0 0 1 256.21 583.21 Tm (stroke,) Tj ET BT /F3 12 Tf 1 0 0 1 293.78 583.21 Tm (Alzheimer's) Tj ET BT /F3 12 Tf 1 0 0 1 356.5 583.21 Tm (disease) Tj ET BT /F3 12 Tf 1 0 0 1 396.4 583.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 411.64 583.21 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 441.55 583.21 Tm (form) Tj ET BT /F3 12 Tf 1 0 0 1 470.12 583.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 485.36 583.21 Tm (irreversible) Tj ET Q q n 0 580.8 m 612 580.8 l 612 568.8 l 0 568.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 571.21 Tm (dementia.) Tj ET Q q n 0 568.8 m 612 568.8 l 612 556.8 l 0 556.8 l h W n Q q n 0 556.8 m 612 556.8 l 612 544.8 l 0 544.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 547.21 Tm ("Mental) Tj ET BT /F2 12 Tf 1 0 0 1 48.16 547.21 Tm (Sickness,") Tj ET BT /F3 12 Tf 1 0 0 1 106.01 547.21 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 120.85 547.21 Tm (used) Tj ET BT /F3 12 Tf 1 0 0 1 147.68 547.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 161.86 547.21 Tm (this) Tj ET BT /F3 12 Tf 1 0 0 1 184.04 547.21 Tm (provision,) Tj ET BT /F3 12 Tf 1 0 0 1 237.21 547.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 272.71 547.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 294.88 547.21 Tm (emotional,) Tj ET BT /F3 12 Tf 1 0 0 1 350.71 547.21 Tm (behavioral,) Tj ET BT /F3 12 Tf 1 0 0 1 409.19 547.21 Tm (psychological,) Tj ET BT /F3 12 Tf 1 0 0 1 483.68 547.21 Tm (personality,) Tj ET Q q n 0 544.8 m 612 544.8 l 612 532.8 l 0 532.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 535.21 Tm (adjustment,) Tj ET BT /F3 12 Tf 1 0 0 1 59.85 535.21 Tm (mood) Tj ET BT /F3 12 Tf 1 0 0 1 91.38 535.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 105.57 535.21 Tm (stress-related) Tj ET BT /F3 12 Tf 1 0 0 1 173.07 535.21 Tm (abnormality,) Tj ET BT /F3 12 Tf 1 0 0 1 238.25 535.21 Tm (disorder,) Tj ET BT /F3 12 Tf 1 0 0 1 284.76 535.21 Tm (disturbance,) Tj ET BT /F3 12 Tf 1 0 0 1 347.27 535.21 Tm (dysfunction) Tj ET BT /F3 12 Tf 1 0 0 1 408.12 535.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 422.31 535.21 Tm (syndrome;) Tj ET BT /F3 12 Tf 1 0 0 1 477.17 535.21 Tm (regardless) Tj ET BT /F3 12 Tf 1 0 0 1 530 535.21 Tm (of) Tj ET Q q n 0 532.8 m 612 532.8 l 612 520.8 l 0 520.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 523.21 Tm (its cause.) Tj ET BT /F3 12 Tf 1 0 0 1 49.99 523.21 Tm (It includes, but is not limited to:) Tj ET Q q n 18 520.8 m 630 520.8 l 630 508.8 l 18 508.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 511.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 511.21 Tm (schizophrenia or schizoaffective disorder;) Tj ET Q q n 18 508.8 m 630 508.8 l 630 496.8 l 18 496.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 499.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 499.21 Tm (bipolar affective disorder, manic depression, or other psychosis; and) Tj ET Q q n 18 496.8 m 630 496.8 l 630 484.8 l 18 484.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 487.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 487.21 Tm (obsessive-compulsive, depressive, panic or anxiety disorders.) Tj ET Q q n 0 484.8 m 612 484.8 l 612 472.8 l 0 472.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 475.21 Tm (These) Tj ET BT /F3 12 Tf 1 0 0 1 32.86 475.21 Tm (conditions) Tj ET BT /F3 12 Tf 1 0 0 1 87.07 475.21 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 105.93 475.21 Tm (usually) Tj ET BT /F3 12 Tf 1 0 0 1 144.81 475.21 Tm (treated) Tj ET BT /F3 12 Tf 1 0 0 1 181.66 475.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 197.87 475.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 207.41 475.21 Tm (psychiatrist,) Tj ET BT /F3 12 Tf 1 0 0 1 269.94 475.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 279.48 475.21 Tm (clinical) Tj ET BT /F3 12 Tf 1 0 0 1 319 475.21 Tm (psychologist) Tj ET BT /F3 12 Tf 1 0 0 1 383.88 475.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 398.09 475.21 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 426.95 475.21 Tm (qualified) Tj ET BT /F3 12 Tf 1 0 0 1 473.82 475.21 Tm (mental) Tj ET BT /F3 12 Tf 1 0 0 1 510.68 475.21 Tm (health) Tj ET Q q n 0 472.8 m 612 472.8 l 612 460.8 l 0 460.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 463.21 Tm (care provider.) Tj ET BT /F3 12 Tf 1 0 0 1 72.63 463.21 Tm (Treatment usually involves psychotherapy, psychotropic drugs or similar methods of treatment.) Tj ET Q q n 0 460.8 m 612 460.8 l 612 448.8 l 0 448.8 l h W n Q q n 0 448.8 m 612 448.8 l 612 436.8 l 0 436.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 439.21 Tm (Mental) Tj ET BT /F3 12 Tf 1 0 0 1 41.39 439.21 Tm (Sickness) Tj ET BT /F3 12 Tf 1 0 0 1 90.79 439.21 Tm (does) Tj ET BT /F2 12 Tf 1 0 0 1 120.19 439.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 144.26 439.21 Tm (include) Tj ET BT /F3 12 Tf 1 0 0 1 186.98 439.21 Tm (irreversible) Tj ET BT /F3 12 Tf 1 0 0 1 249.02 439.21 Tm (dementia) Tj ET BT /F3 12 Tf 1 0 0 1 300.39 439.21 Tm (resulting) Tj ET BT /F3 12 Tf 1 0 0 1 349.79 439.21 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 380.52 439.21 Tm (stroke;) Tj ET BT /F3 12 Tf 1 0 0 1 420.58 439.21 Tm (trauma;) Tj ET BT /F3 12 Tf 1 0 0 1 464.63 439.21 Tm (viral) Tj ET BT /F3 12 Tf 1 0 0 1 494.02 439.21 Tm (infection;) Tj ET Q q n 0 436.8 m 612 436.8 l 612 424.8 l 0 424.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 427.21 Tm (Alzheimer's) Tj ET BT /F3 12 Tf 1 0 0 1 61.68 427.21 Tm (disease;) Tj ET BT /F3 12 Tf 1 0 0 1 103.88 427.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 118.08 427.21 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 146.95 427.21 Tm (conditions) Tj ET BT /F3 12 Tf 1 0 0 1 201.16 427.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 234.69 427.21 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 253.55 427.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 273.09 427.21 Tm (usually) Tj ET BT /F3 12 Tf 1 0 0 1 311.96 427.21 Tm (treated) Tj ET BT /F3 12 Tf 1 0 0 1 348.82 427.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 365.02 427.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 374.56 427.21 Tm (mental) Tj ET BT /F3 12 Tf 1 0 0 1 411.42 427.21 Tm (health) Tj ET BT /F3 12 Tf 1 0 0 1 444.95 427.21 Tm (care) Tj ET BT /F3 12 Tf 1 0 0 1 469.14 427.21 Tm (provider) Tj ET BT /F3 12 Tf 1 0 0 1 514 427.21 Tm (using) Tj ET Q q n 0 424.8 m 612 424.8 l 612 412.8 l 0 412.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 415.21 Tm (psychotherapy, psychotropic drugs, or similar methods of treatment.) Tj ET Q q n 0 412.8 m 612 412.8 l 612 400.8 l 0 400.8 l h W n Q q n 0 400.8 m 612 400.8 l 612 388.8 l 0 388.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 391.21 Tm ("Pre-Existing) Tj ET BT /F2 12 Tf 1 0 0 1 76.66 391.21 Tm (Condition,") Tj ET BT /F3 12 Tf 1 0 0 1 143.68 391.21 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 159.68 391.21 Tm (used) Tj ET BT /F3 12 Tf 1 0 0 1 187.68 391.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 203.01 391.21 Tm (this) Tj ET BT /F3 12 Tf 1 0 0 1 226.36 391.21 Tm (provision,) Tj ET BT /F3 12 Tf 1 0 0 1 280.69 391.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 317.36 391.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 328.69 391.21 Tm (Sickness) Tj ET BT /F3 12 Tf 1 0 0 1 376.69 391.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 392.69 391.21 Tm (Injury) Tj ET BT /F3 12 Tf 1 0 0 1 428.02 391.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 448.02 391.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 483.35 391.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 504.01 391.21 Tm (Insured) Tj ET Q q n 0 388.8 m 612 388.8 l 612 376.8 l 0 376.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 379.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 53.5 379.21 Tm (received) Tj ET BT /F3 12 Tf 1 0 0 1 98.99 379.21 Tm (treatment) Tj ET BT /F3 12 Tf 1 0 0 1 149.16 379.21 Tm (within) Tj ET BT /F3 12 Tf 1 0 0 1 184.68 379.21 Tm (3) Tj ET BT /F3 12 Tf 1 0 0 1 195.53 379.21 Tm (months) Tj ET BT /F3 12 Tf 1 0 0 1 235.72 379.21 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 263.9 379.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 278.09 379.21 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 296.95 379.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 311.8 379.21 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 331.97 379.21 Tm (effective) Tj ET BT /F3 12 Tf 1 0 0 1 378.79 379.21 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 403.63 379.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 422.48 379.21 Tm (this) Tj ET BT /F3 12 Tf 1 0 0 1 444.67 379.21 Tm (benefit.) Tj ET BT /F3 12 Tf 1 0 0 1 490.69 379.21 Tm (Treatment) Tj ET Q q n 0 376.8 m 612 376.8 l 612 364.8 l 0 364.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 367.21 Tm (includes) Tj ET BT /F3 12 Tf 1 0 0 1 43.37 367.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 52.08 367.21 Tm (Physician's) Tj ET BT /F3 12 Tf 1 0 0 1 108.95 367.21 Tm (consultation,) Tj ET BT /F3 12 Tf 1 0 0 1 173.99 367.21 Tm (care) Tj ET BT /F3 12 Tf 1 0 0 1 197.35 367.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 218.05 367.21 Tm (services;) Tj ET BT /F3 12 Tf 1 0 0 1 263.42 367.21 Tm (diagnostic) Tj ET BT /F3 12 Tf 1 0 0 1 316.12 367.21 Tm (measures;) Tj ET BT /F3 12 Tf 1 0 0 1 367.49 367.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 388.19 367.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 406.23 367.21 Tm (prescription,) Tj ET BT /F3 12 Tf 1 0 0 1 469.93 367.21 Tm (refill) Tj ET BT /F3 12 Tf 1 0 0 1 496.63 367.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 510.01 367.21 Tm (taking) Tj ET Q q n 0 364.8 m 612 364.8 l 612 352.8 l 0 352.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 355.21 Tm (of prescribed drugs or medicines.) Tj ET Q q n 0 352.8 m 612 352.8 l 612 340.8 l 0 340.8 l h W n Q q n 0 340.8 m 612 340.8 l 612 328.8 l 0 328.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 331.21 Tm (EXCLUSIONS AND LIMITATIONS) Tj ET Q q n 0 328.8 m 612 328.8 l 612 316.8 l 0 316.8 l h W n Q q n 0 316.8 m 612 316.8 l 612 304.8 l 0 304.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 307.21 Tm (Prior) Tj ET BT /F2 12 Tf 1 0 0 1 30.45 307.21 Tm (Disability.) Tj ET BT /F3 12 Tf 1 0 0 1 89.07 307.21 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 113.54 307.21 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 149.99 307.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 171.8 307.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 190.27 307.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 204.73 307.21 Tm (payable) Tj ET BT /F3 12 Tf 1 0 0 1 245.18 307.21 Tm (during) Tj ET BT /F3 12 Tf 1 0 0 1 279.65 307.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 288.11 307.21 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 321.9 307.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 335.04 307.21 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 385.5 307.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 417.97 307.21 Tm (begins) Tj ET BT /F3 12 Tf 1 0 0 1 452.43 307.21 Tm (before) Tj ET BT /F3 12 Tf 1 0 0 1 486.22 307.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 504.01 307.21 Tm (Insured) Tj ET Q q n 0 304.8 m 612 304.8 l 612 292.8 l 0 292.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 295.21 Tm (Employee's effective date of coverage under this benefit.) Tj ET Q q n 0 292.8 m 612 292.8 l 612 280.8 l 0 280.8 l h W n Q q n 0 280.8 m 612 280.8 l 612 268.8 l 0 268.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 271.21 Tm (Pre-Existing) Tj ET BT /F2 12 Tf 1 0 0 1 67.05 271.21 Tm (Conditions.) Tj ET BT /F3 12 Tf 1 0 0 1 132.19 271.21 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 156.58 271.21 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 192.96 271.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 214.69 271.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 233.08 271.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 247.47 271.21 Tm (payable) Tj ET BT /F3 12 Tf 1 0 0 1 287.84 271.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 304.89 271.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 313.28 271.21 Tm (Loss) Tj ET BT /F3 12 Tf 1 0 0 1 339.01 271.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 352.06 271.21 Tm (Activities) Tj ET BT /F3 12 Tf 1 0 0 1 401.78 271.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 414.84 271.21 Tm (Daily) Tj ET BT /F3 12 Tf 1 0 0 1 444.56 271.21 Tm (Living) Tj ET BT /F3 12 Tf 1 0 0 1 479.61 271.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 492.67 271.21 Tm (Cognitive) Tj ET Q q n 0 268.8 m 612 268.8 l 612 256.8 l 0 256.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 259.21 Tm (Impairment:) Tj ET Q q n 18 256.8 m 630 256.8 l 630 244.8 l 18 244.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 247.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 247.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 79.8 247.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 92.93 247.21 Tm (caused) Tj ET BT /F3 12 Tf 1 0 0 1 130.7 247.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 145.82 247.21 Tm (contributed) Tj ET BT /F3 12 Tf 1 0 0 1 205.6 247.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 220.05 247.21 Tm (by,) Tj ET BT /F3 12 Tf 1 0 0 1 240.18 247.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 255.3 247.21 Tm (results) Tj ET BT /F3 12 Tf 1 0 0 1 291.75 247.21 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 320.2 247.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 330.65 247.21 Tm (Pre-Existing) Tj ET BT /F3 12 Tf 1 0 0 1 395.77 247.21 Tm (Condition) Tj ET BT /F3 12 Tf 1 0 0 1 448.9 247.21 Tm (\(as) Tj ET BT /F3 12 Tf 1 0 0 1 468.02 247.21 Tm (defined) Tj ET Q q n 45.35 244.8 m 657.35 244.8 l 657.35 232.8 l 45.35 232.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 235.21 Tm (above\); and) Tj ET Q q n 18 232.8 m 630 232.8 l 630 220.8 l 18 220.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 223.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 223.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 79.86 223.21 Tm (begins) Tj ET BT /F3 12 Tf 1 0 0 1 116.38 223.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 130.9 223.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 150.75 223.21 Tm (first) Tj ET BT /F3 12 Tf 1 0 0 1 175.26 223.21 Tm (12) Tj ET BT /F3 12 Tf 1 0 0 1 192.45 223.21 Tm (months) Tj ET BT /F3 12 Tf 1 0 0 1 232.97 223.21 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 260.14 223.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 279.99 223.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 321.16 223.21 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 381.83 223.21 Tm (effective) Tj ET BT /F3 12 Tf 1 0 0 1 428.98 223.21 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 454.15 223.21 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 486.66 223.21 Tm (this) Tj ET Q q n 45.35 220.8 m 657.35 220.8 l 657.35 208.8 l 45.35 208.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 211.21 Tm (benefit.) Tj ET Q q n 0 208.8 m 612 208.8 l 612 196.8 l 0 196.8 l h W n Q q n 0 196.8 m 612 196.8 l 612 184.8 l 0 184.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 187.21 Tm (Mental) Tj ET BT /F2 12 Tf 1 0 0 1 39.68 187.21 Tm (Sickness) Tj ET BT /F2 12 Tf 1 0 0 1 86.04 187.21 Tm (and) Tj ET BT /F2 12 Tf 1 0 0 1 108.41 187.21 Tm (Substance) Tj ET BT /F2 12 Tf 1 0 0 1 163.45 187.21 Tm (Abuse.) Tj ET BT /F3 12 Tf 1 0 0 1 204.5 187.21 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 228.85 187.21 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 265.19 187.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 286.88 187.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 305.23 187.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 319.58 187.21 Tm (payable) Tj ET BT /F3 12 Tf 1 0 0 1 359.91 187.21 Tm (during) Tj ET BT /F3 12 Tf 1 0 0 1 394.26 187.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 402.61 187.21 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 436.28 187.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 449.3 187.21 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 499.65 187.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 532 187.21 Tm (is) Tj ET Q q n 0 184.8 m 612 184.8 l 612 172.8 l 0 172.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 175.21 Tm (caused) Tj ET BT /F3 12 Tf 1 0 0 1 37.24 175.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 51.83 175.21 Tm (contributed) Tj ET BT /F3 12 Tf 1 0 0 1 111.08 175.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 125.01 175.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 141.6 175.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 156.19 175.21 Tm (results) Tj ET BT /F3 12 Tf 1 0 0 1 192.12 175.21 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 220.04 175.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 229.96 175.21 Tm (Mental) Tj ET BT /F3 12 Tf 1 0 0 1 268.55 175.21 Tm (Sickness,) Tj ET BT /F3 12 Tf 1 0 0 1 318.14 175.21 Tm (alcoholism,) Tj ET BT /F3 12 Tf 1 0 0 1 378.39 175.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 392.98 175.21 Tm (voluntary) Tj ET BT /F3 12 Tf 1 0 0 1 443.57 175.21 Tm (use) Tj ET BT /F3 12 Tf 1 0 0 1 464.16 175.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 478.75 175.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 488.67 175.21 Tm (Controlled) Tj ET Q q n 0 172.8 m 612 172.8 l 612 160.8 l 0 160.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 163.21 Tm (Substance;) Tj ET BT /F3 12 Tf 1 0 0 1 55.54 163.21 Tm (unless) Tj ET BT /F3 12 Tf 1 0 0 1 89.08 163.21 Tm (prescribed) Tj ET BT /F3 12 Tf 1 0 0 1 142.6 163.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 158.14 163.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 167.01 163.21 Tm (Physician.) Tj ET BT /F3 12 Tf 1 0 0 1 223.77 163.21 Tm (Controlled) Tj ET BT /F3 12 Tf 1 0 0 1 278.64 163.21 Tm (Substances) Tj ET BT /F3 12 Tf 1 0 0 1 335.51 163.21 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 353.7 163.21 Tm (those) Tj ET BT /F3 12 Tf 1 0 0 1 382.58 163.21 Tm (defined) Tj ET BT /F3 12 Tf 1 0 0 1 422.1 163.21 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 435.64 163.21 Tm (such) Tj ET BT /F3 12 Tf 1 0 0 1 461.18 163.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 474.06 163.21 Tm (Title) Tj ET BT /F3 12 Tf 1 0 0 1 500.26 163.21 Tm (II) Tj ET BT /F3 12 Tf 1 0 0 1 511.8 163.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 163.21 Tm (the) Tj ET Q q n 0 160.8 m 612 160.8 l 612 148.8 l 0 148.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 151.21 Tm (Comprehensive Drug Abuse Prevention and Control Act of 1970, and any amendments to it.) Tj ET Q q n 0 148.8 m 612 148.8 l 612 136.8 l 0 136.8 l h W n Q q n 0 136.8 m 612 136.8 l 612 124.8 l 0 124.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 127.21 Tm (Other) Tj ET BT /F2 12 Tf 1 0 0 1 34.07 127.21 Tm (Provisions.) Tj ET BT /F3 12 Tf 1 0 0 1 97.23 127.21 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 121.98 127.21 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 158.71 127.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 180.79 127.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 195.53 127.21 Tm (subject) Tj ET BT /F3 12 Tf 1 0 0 1 232.93 127.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 245.68 127.21 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 261.08 127.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 274.49 127.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 292.57 127.21 Tm (Definitions,) Tj ET BT /F3 12 Tf 1 0 0 1 352.97 127.21 Tm (Exclusions,) Tj ET BT /F3 12 Tf 1 0 0 1 412.05 127.21 Tm (Proof) Tj ET BT /F3 12 Tf 1 0 0 1 442.13 127.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 455.54 127.21 Tm (Claim,) Tj ET BT /F3 12 Tf 1 0 0 1 491.28 127.21 Tm (Waiver) Tj ET BT /F3 12 Tf 1 0 0 1 530 127.21 Tm (of) Tj ET Q q n 0 124.8 m 612 124.8 l 612 112.8 l 0 112.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 115.21 Tm (Premium and other provisions of the Policy.) Tj ET Q Q q Q Q endstream endobj 28 0 obj <>>>>> endobj 158 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 758.4 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 230.99 2.41 Tm (EXCLUSIONS) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm 0 0 0 rg BT /F3 12 Tf 1 0 0 1 478.64 39.11 Tm (3/12 Pre-Ex.) Tj ET q n 0 36 m 245.75 36 l 245.75 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-13 10 PA) Tj ET Q q n 0 24 m 245.75 24 l 245.75 12 l 0 12 l h W n Q q n 245.75 24 m 305.75 24 l 305.75 12 l 245.75 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 265 14.41 Tm (26) Tj ET Q q n 305.75 24 m 550.8 24 l 550.8 12 l 305.75 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 503.74 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 71.4 cm q n 0 684.6 m 612 684.6 l 612 672.6 l 0 672.6 l h W n Q q n 0 672.6 m 612 672.6 l 612 660.6 l 0 660.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 663.01 Tm (GENERAL EXCLUSIONS.) Tj ET BT /F3 12 Tf 1 0 0 1 149.37 663.01 Tm (The Policy will not cover any period of Total or Residual Disability:) Tj ET Q q n 18 660.6 m 630 660.6 l 630 648.6 l 18 648.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 651.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 651.01 Tm (due to war, declared or undeclared, or any act of war;) Tj ET Q q n 18 648.6 m 630 648.6 l 630 636.6 l 18 636.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 639.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45 639.01 Tm (due to intentionally self-inflicted injuries;) Tj ET Q q n 18 636.6 m 630 636.6 l 630 624.6 l 18 624.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 627.01 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45 627.01 Tm (due to active participation in a riot;) Tj ET Q q n 18 624.6 m 630 624.6 l 630 612.6 l 18 612.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 615.01 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45 615.01 Tm (due to the Insured Employee's committing of or the attempting to commit a felony;) Tj ET Q q n 18 612.6 m 630 612.6 l 630 600.6 l 18 600.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 603.01 Tm (5.) Tj ET BT /F3 12 Tf 1 0 0 1 45 603.01 Tm (during which the Insured Employee is incarcerated for the commission of a felony;) Tj ET Q q n 18 600.6 m 630 600.6 l 630 588.6 l 18 588.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 591.01 Tm (6.) Tj ET BT /F3 12 Tf 1 0 0 1 45 591.01 Tm (during which the Insured Employee is not under the Regular Care of a Physician; or) Tj ET Q q n 18 588.6 m 630 588.6 l 630 576.6 l 18 576.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 579.01 Tm (7.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 579.01 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 71.25 579.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 89.83 579.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 129.74 579.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 182.3 579.01 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 202.22 579.01 Tm (resided) Tj ET BT /F3 12 Tf 1 0 0 1 240.79 579.01 Tm (outside) Tj ET BT /F3 12 Tf 1 0 0 1 279.38 579.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 297.95 579.01 Tm (United) Tj ET BT /F3 12 Tf 1 0 0 1 334.53 579.01 Tm (States) Tj ET BT /F3 12 Tf 1 0 0 1 367.12 579.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 381.03 579.01 Tm (Canada) Tj ET BT /F3 12 Tf 1 0 0 1 420.93 579.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 438.85 579.01 Tm (more) Tj ET BT /F3 12 Tf 1 0 0 1 467.42 579.01 Tm (than) Tj ET BT /F3 12 Tf 1 0 0 1 492 579.01 Tm (12) Tj ET Q q n 45.35 576.6 m 657.35 576.6 l 657.35 564.6 l 45.35 564.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 567.01 Tm (consecutive benefit months for purposes other than employment with the Employer.) Tj ET Q q n 0 564.6 m 612 564.6 l 612 552.6 l 0 552.6 l h W n Q q n 0 552.6 m 612 552.6 l 612 540.6 l 0 540.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 543.01 Tm (PRE-EXISTING CONDITION EXCLUSION.) Tj ET BT /F3 12 Tf 1 0 0 1 243.71 543.01 Tm (The Policy will not cover any Total or Residual) Tj ET BT /F3 12 Tf 1 0 0 1 475.32 543.01 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 522.66 543.01 Tm (:) Tj ET Q q n 18 540.6 m 630 540.6 l 630 528.6 l 18 528.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 531.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 531.01 Tm (which is caused or contributed to by, or results from a Pre-Existing Condition; and) Tj ET Q q n 18 528.6 m 630 528.6 l 630 516.6 l 18 516.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 519.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 519.01 Tm (which begins in the first) Tj ET BT /F3 12 Tf 1 0 0 1 164.33 519.01 Tm (12 months) Tj ET BT /F3 12 Tf 1 0 0 1 214.67 519.01 Tm ( after the Insured Employee's Effective Date.) Tj ET Q q n 0 516.6 m 612 516.6 l 612 504.6 l 0 504.6 l h W n Q q n 0 504.6 m 612 504.6 l 612 492.6 l 0 492.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 495.01 Tm ("Pre-Existing) Tj ET BT /F3 12 Tf 1 0 0 1 68.63 495.01 Tm (Condition") Tj ET BT /F3 12 Tf 1 0 0 1 125.28 495.01 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 159.67 495.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 168.74 495.01 Tm (Sickness) Tj ET BT /F3 12 Tf 1 0 0 1 214.48 495.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 228.21 495.01 Tm (Injury) Tj ET BT /F3 12 Tf 1 0 0 1 261.28 495.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 279.01 495.01 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 312.08 495.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 330.48 495.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 370.2 495.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 422.59 495.01 Tm (received) Tj ET BT /F3 12 Tf 1 0 0 1 466.97 495.01 Tm (medical) Tj ET BT /F3 12 Tf 1 0 0 1 508.69 495.01 Tm (advice) Tj ET Q q n 0 492.6 m 612 492.6 l 612 480.6 l 0 480.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 483.01 Tm (or treatment within) Tj ET BT /F3 12 Tf 1 0 0 1 94.97 483.01 Tm (3 months) Tj ET BT /F3 12 Tf 1 0 0 1 142.31 483.01 Tm (prior to the Insured Employee's Effective Date.) Tj ET Q q n 0 480.6 m 612 480.6 l 612 468.6 l 0 468.6 l h W n Q Q q Q Q endstream endobj 29 0 obj <>>>>> endobj 159 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 758.4 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 119.96 2.41 Tm (SPECIFIED INJURIES OR SICKNESSES LIMITATION) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 48 m 183.6 48 l 183.6 36 l 0 36 l h W n Q q n 183.6 48 m 367.2 48 l 367.2 36 l 183.6 36 l h W n Q q n 367.2 48 m 550.8 48 l 550.8 36 l 367.2 36 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 464.32 38.41 Tm (Specified Limit) Tj ET Q q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-14 98) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 264.65 14.41 Tm (27) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 503.74 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 69.6 cm q n 0 686.4 m 612 686.4 l 612 674.4 l 0 674.4 l h W n Q q n 0 674.4 m 612 674.4 l 612 662.4 l 0 662.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 664.81 Tm (LIMITATION.) Tj ET BT /F3 12 Tf 1 0 0 1 81.63 664.81 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 93.61 664.81 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 108.92 664.81 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 148.9 664.81 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 201.54 664.81 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 213.54 664.81 Tm (Disabled) Tj ET BT /F3 12 Tf 1 0 0 1 260.18 664.81 Tm (primarily) Tj ET BT /F3 12 Tf 1 0 0 1 308.83 664.81 Tm (due) Tj ET BT /F3 12 Tf 1 0 0 1 330.14 664.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 343.47 664.81 Tm (one) Tj ET BT /F3 12 Tf 1 0 0 1 364.78 664.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 378.77 664.81 Tm (more) Tj ET BT /F3 12 Tf 1 0 0 1 407.42 664.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 421.4 664.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 440.05 664.81 Tm (Specified) Tj ET BT /F3 12 Tf 1 0 0 1 489.36 664.81 Tm (Injuries) Tj ET BT /F3 12 Tf 1 0 0 1 530 664.81 Tm (or) Tj ET Q q n 0 662.4 m 612 662.4 l 612 650.4 l 0 650.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 652.81 Tm (Sicknesses defined below; then Partial or Total Disability) Tj ET BT /F3 12 Tf 1 0 0 1 279.27 652.81 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 320.61 652.81 Tm ( Benefits:) Tj ET Q q n 18 650.4 m 630 650.4 l 630 638.4 l 18 638.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 640.81 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 640.81 Tm (will be payable subject to the terms of the Policy; but) Tj ET Q q n 18 638.4 m 630 638.4 l 630 626.4 l 18 626.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 628.81 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 628.81 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 67.81 628.81 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 82.93 628.81 Tm (limited) Tj ET BT /F3 12 Tf 1 0 0 1 120.73 628.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 133.85 628.81 Tm (24) Tj ET BT /F3 12 Tf 1 0 0 1 149.65 628.81 Tm (months) Tj ET BT /F3 12 Tf 1 0 0 1 188.78 628.81 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 206.57 628.81 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 227.69 628.81 Tm (one) Tj ET BT /F3 12 Tf 1 0 0 1 248.81 628.81 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 283.26 628.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 297.06 628.81 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 344.39 628.81 Tm (;) Tj ET BT /F3 12 Tf 1 0 0 1 351.52 628.81 Tm (unless) Tj ET BT /F3 12 Tf 1 0 0 1 385.31 628.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 403.77 628.81 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 443.55 628.81 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 496 628.81 Tm (is) Tj ET Q q n 45.35 626.4 m 657.35 626.4 l 657.35 614.4 l 45.35 614.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 616.81 Tm (confined to a Hospital.) Tj ET Q q n 0 614.4 m 612 614.4 l 612 602.4 l 0 602.4 l h W n Q q n 0 602.4 m 612 602.4 l 612 590.4 l 0 590.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 592.81 Tm ("Specified Injuries or Sicknesses" include any) Tj ET BT /F3 12 Tf 1 0 0 1 224.41 592.81 Tm (Mental Sickness) Tj ET BT /F3 12 Tf 1 0 0 1 303.4 592.81 Tm (, as defined below.) Tj ET Q q n 0 590.4 m 612 590.4 l 612 578.4 l 0 578.4 l h W n Q q n 0 578.4 m 612 578.4 l 612 566.4 l 0 566.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 568.81 Tm (CONDITIONS) Tj ET Q q n 18 566.4 m 630 566.4 l 630 554.4 l 18 554.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 556.81 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 556.81 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 56.42 556.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 74.16 556.81 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 113.23 556.81 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 164.96 556.81 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 176.04 556.81 Tm (confined) Tj ET BT /F3 12 Tf 1 0 0 1 221.1 556.81 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 233.51 556.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 241.92 556.81 Tm (Hospital) Tj ET BT /F3 12 Tf 1 0 0 1 285.66 556.81 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 297.4 556.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 315.14 556.81 Tm (end) Tj ET BT /F3 12 Tf 1 0 0 1 335.54 556.81 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 348.61 556.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 366.35 556.81 Tm (24) Tj ET BT /F3 7.2 Tf 1 0 0 1 378.35 560.41 Tm (th) Tj ET BT /F3 12 Tf 1 0 0 1 390.11 556.81 Tm (month) Tj ET BT /F3 12 Tf 1 0 0 1 423.86 556.81 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 440.93 556.81 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 473.33 556.81 Tm (Policy) Tj ET Q q n 45.35 554.4 m 657.35 554.4 l 657.35 542.4 l 45.35 542.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 544.81 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 86.93 544.81 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 105.17 544.81 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 129.42 544.81 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 147 544.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 165.25 544.81 Tm (Specified) Tj ET BT /F3 12 Tf 1 0 0 1 214.16 544.81 Tm (Injury) Tj ET BT /F3 12 Tf 1 0 0 1 247.08 544.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 260.66 544.81 Tm (Sickness;) Tj ET BT /F3 12 Tf 1 0 0 1 309.59 544.81 Tm (then) Tj ET BT /F3 12 Tf 1 0 0 1 333.84 544.81 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 375.42 544.81 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 397.67 544.81 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 412.59 544.81 Tm (payable) Tj ET BT /F3 12 Tf 1 0 0 1 453.49 544.81 Tm (until) Tj ET BT /F3 12 Tf 1 0 0 1 479.09 544.81 Tm (he) Tj ET BT /F3 12 Tf 1 0 0 1 494 544.81 Tm (or) Tj ET Q q n 45.35 542.4 m 657.35 542.4 l 657.35 530.4 l 45.35 530.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 532.81 Tm (she is discharged from that facility.) Tj ET Q q n 18 530.4 m 630 530.4 l 630 518.4 l 18 518.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 520.81 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 520.81 Tm (In) Tj ET BT /F3 12 Tf 1 0 0 1 59.44 520.81 Tm (no) Tj ET BT /F3 12 Tf 1 0 0 1 75.53 520.81 Tm (event) Tj ET BT /F3 12 Tf 1 0 0 1 105.61 520.81 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 128.37 520.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 147.12 520.81 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 192.56 520.81 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 231.97 520.81 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 247.39 520.81 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 272.14 520.81 Tm (beyond) Tj ET BT /F3 12 Tf 1 0 0 1 311.56 520.81 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 330.31 520.81 Tm (Maximum) Tj ET BT /F3 12 Tf 1 0 0 1 384.4 520.81 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 423.82 520.81 Tm (Period) Tj ET BT /F3 12 Tf 1 0 0 1 459.24 520.81 Tm (shown) Tj ET BT /F3 12 Tf 1 0 0 1 494.67 520.81 Tm (in) Tj ET Q q n 45.35 518.4 m 657.35 518.4 l 657.35 506.4 l 45.35 506.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 508.81 Tm (the Schedule of Insurance, however.) Tj ET Q q n 18 506.4 m 630 506.4 l 630 494.4 l 18 494.4 l h W n Q q n 0 494.4 m 612 494.4 l 612 482.4 l 0 482.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 484.81 Tm (DEFINITIONS) Tj ET Q q n 0 482.4 m 612 482.4 l 612 470.4 l 0 470.4 l h W n Q q n 0 470.4 m 612 470.4 l 612 458.4 l 0 458.4 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 460.81 Tm ("Hospital,") Tj ET BT /F3 12 Tf 1 0 0 1 59.67 460.81 Tm ( as used in this provision, means:) Tj ET Q q n 18 458.4 m 630 458.4 l 630 446.4 l 18 446.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 448.81 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 448.81 Tm (a general hospital which:) Tj ET Q q n 44.65 446.4 m 656.65 446.4 l 656.65 434.4 l 44.65 434.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 44.65 436.81 Tm (\(a\)) Tj ET BT /F3 12 Tf 1 0 0 1 72 436.81 Tm (is licensed, approved or certified by the state where it is located;) Tj ET Q q n 44.65 434.4 m 656.65 434.4 l 656.65 422.4 l 44.65 422.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 44.65 424.81 Tm (\(b\)) Tj ET BT /F3 12 Tf 1 0 0 1 72 424.81 Tm (is recognized by the Joint Commission on the Accreditation of Hospitals; or) Tj ET Q q n 44.65 422.4 m 656.65 422.4 l 656.65 410.4 l 44.65 410.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 44.65 412.81 Tm (\(c\)) Tj ET BT /F3 12 Tf 1 0 0 1 72 412.81 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 83.55 412.81 Tm (operated) Tj ET BT /F3 12 Tf 1 0 0 1 128.41 412.81 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 141.29 412.81 Tm (treat) Tj ET BT /F3 12 Tf 1 0 0 1 166.15 412.81 Tm (resident) Tj ET BT /F3 12 Tf 1 0 0 1 207.69 412.81 Tm (inpatients;) Tj ET BT /F3 12 Tf 1 0 0 1 261.23 412.81 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 280.77 412.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 289.64 412.81 Tm (registered) Tj ET BT /F3 12 Tf 1 0 0 1 340.5 412.81 Tm (nurse) Tj ET BT /F3 12 Tf 1 0 0 1 370.04 412.81 Tm (always) Tj ET BT /F3 12 Tf 1 0 0 1 406.91 412.81 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 422.46 412.81 Tm (duty;) Tj ET BT /F3 12 Tf 1 0 0 1 450.67 412.81 Tm (and) Tj ET Q q n 72 410.4 m 684 410.4 l 684 398.4 l 72 398.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 72 400.81 Tm (has a lab, x-ray facility and place where major surgery is performed; and) Tj ET Q q n 18 398.4 m 630 398.4 l 630 386.4 l 18 386.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 388.81 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 388.81 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 54.33 388.81 Tm (skilled) Tj ET BT /F3 12 Tf 1 0 0 1 89.98 388.81 Tm (nursing) Tj ET BT /F3 12 Tf 1 0 0 1 129.63 388.81 Tm (care) Tj ET BT /F3 12 Tf 1 0 0 1 153.26 388.81 Tm (facility) Tj ET BT /F3 12 Tf 1 0 0 1 190.89 388.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 204.54 388.81 Tm (unit,) Tj ET BT /F3 12 Tf 1 0 0 1 229.86 388.81 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 262.84 388.81 Tm (provides) Tj ET BT /F3 12 Tf 1 0 0 1 307.82 388.81 Tm (convalescent) Tj ET BT /F3 12 Tf 1 0 0 1 373.44 388.81 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 387.08 388.81 Tm (nursing) Tj ET BT /F3 12 Tf 1 0 0 1 426.74 388.81 Tm (care;) Tj ET BT /F3 12 Tf 1 0 0 1 453.7 388.81 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 474.67 388.81 Tm (which) Tj ET Q q n 45.35 386.4 m 657.35 386.4 l 657.35 374.4 l 45.35 374.4 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 376.81 Tm (is recognized as a skilled nursing care facility under Medicare.) Tj ET Q q n 0 360.6 m 612 360.6 l 612 348.6 l 0 348.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 351.01 Tm (The term Hospital also includes:) Tj ET Q q n 18 348.6 m 630 348.6 l 630 336.6 l 18 336.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 339.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 339.01 Tm (a Mental Hospital when treatment is for a Mental Sickness) Tj ET BT /F3 12 Tf 1 0 0 1 326.95 339.01 Tm (.) Tj ET Q q n 0 322.8 m 612 322.8 l 612 310.8 l 0 310.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 313.21 Tm ("Mental Hospital") Tj ET BT /F3 12 Tf 1 0 0 1 96.32 313.21 Tm ( means a health care facility \(or its psychiatric unit\) which:) Tj ET Q q n 18 310.8 m 630 310.8 l 630 298.8 l 18 298.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 301.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 301.21 Tm (is licensed, certified or approved as a mental hospital by the state where it is located;) Tj ET Q q n 18 298.8 m 630 298.8 l 630 286.8 l 18 286.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 289.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 289.21 Tm (is equipped to treat resident inpatients' mental diseases or disorders; and) Tj ET Q q n 18 286.8 m 630 286.8 l 630 274.8 l 18 274.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 277.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 277.21 Tm (has a resident psychiatrist on duty or on call at all times.) Tj ET Q q n 0 274.8 m 612 274.8 l 612 262.8 l 0 262.8 l h W n Q q n 0 262.8 m 612 262.8 l 612 250.8 l 0 250.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 253.21 Tm ("Mental) Tj ET BT /F2 12 Tf 1 0 0 1 47.36 253.21 Tm (Sickness") Tj ET BT /F3 12 Tf 1 0 0 1 101.41 253.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 136.1 253.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 157.47 253.21 Tm (emotional,) Tj ET BT /F3 12 Tf 1 0 0 1 212.5 253.21 Tm (behavioral,) Tj ET BT /F3 12 Tf 1 0 0 1 270.18 253.21 Tm (psychological,) Tj ET BT /F3 12 Tf 1 0 0 1 343.87 253.21 Tm (personality,) Tj ET BT /F3 12 Tf 1 0 0 1 404.23 253.21 Tm (adjustment,) Tj ET BT /F3 12 Tf 1 0 0 1 463.93 253.21 Tm (mood) Tj ET BT /F3 12 Tf 1 0 0 1 495.3 253.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 509.34 253.21 Tm (stress-) Tj ET Q q n 0 250.8 m 612 250.8 l 612 238.8 l 0 238.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 241.21 Tm (related) Tj ET BT /F3 12 Tf 1 0 0 1 36.32 241.21 Tm (abnormality,) Tj ET BT /F3 12 Tf 1 0 0 1 100.98 241.21 Tm (disorder,) Tj ET BT /F3 12 Tf 1 0 0 1 146.98 241.21 Tm (disturbance,) Tj ET BT /F3 12 Tf 1 0 0 1 208.97 241.21 Tm (dysfunction) Tj ET BT /F3 12 Tf 1 0 0 1 269.3 241.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 282.97 241.21 Tm (syndrome;) Tj ET BT /F3 12 Tf 1 0 0 1 337.31 241.21 Tm (regardless) Tj ET BT /F3 12 Tf 1 0 0 1 389.63 241.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 403.3 241.21 Tm (its) Tj ET BT /F3 12 Tf 1 0 0 1 418.31 241.21 Tm (cause.) Tj ET BT /F3 12 Tf 1 0 0 1 455.31 241.21 Tm (It) Tj ET BT /F3 12 Tf 1 0 0 1 466.32 241.21 Tm (includes,) Tj ET BT /F3 12 Tf 1 0 0 1 512.99 241.21 Tm (but) Tj ET BT /F3 12 Tf 1 0 0 1 532 241.21 Tm (is) Tj ET Q q n 0 238.8 m 612 238.8 l 612 226.8 l 0 226.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 229.21 Tm (not limited to:) Tj ET Q q n 18 226.8 m 630 226.8 l 630 214.8 l 18 214.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 217.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 217.21 Tm (schizophrenia or schizoaffective disorder;) Tj ET Q q n 18 214.8 m 630 214.8 l 630 202.8 l 18 202.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 205.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 205.21 Tm (bipolar affective disorder, manic depression, or other psychosis; and) Tj ET Q q n 18 202.8 m 630 202.8 l 630 190.8 l 18 190.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 193.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 193.21 Tm (obsessive-compulsive, depressive, panic or anxiety disorders.) Tj ET Q q n 0 190.8 m 612 190.8 l 612 178.8 l 0 178.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 181.21 Tm (These) Tj ET BT /F3 12 Tf 1 0 0 1 32.86 181.21 Tm (conditions) Tj ET BT /F3 12 Tf 1 0 0 1 87.07 181.21 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 105.93 181.21 Tm (usually) Tj ET BT /F3 12 Tf 1 0 0 1 144.81 181.21 Tm (treated) Tj ET BT /F3 12 Tf 1 0 0 1 181.66 181.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 197.87 181.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 207.41 181.21 Tm (psychiatrist,) Tj ET BT /F3 12 Tf 1 0 0 1 269.94 181.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 279.48 181.21 Tm (clinical) Tj ET BT /F3 12 Tf 1 0 0 1 319 181.21 Tm (psychologist) Tj ET BT /F3 12 Tf 1 0 0 1 383.88 181.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 398.09 181.21 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 426.95 181.21 Tm (qualified) Tj ET BT /F3 12 Tf 1 0 0 1 473.82 181.21 Tm (mental) Tj ET BT /F3 12 Tf 1 0 0 1 510.68 181.21 Tm (health) Tj ET Q q n 0 178.8 m 612 178.8 l 612 166.8 l 0 166.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 169.21 Tm (care provider.) Tj ET BT /F3 12 Tf 1 0 0 1 72.63 169.21 Tm (Treatment usually involves psychotherapy, psychotropic drugs or similar methods of treatment.) Tj ET Q q n 0 166.8 m 612 166.8 l 612 154.8 l 0 154.8 l h W n Q q n 0 154.8 m 612 154.8 l 612 142.8 l 0 142.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 145.21 Tm (Mental Sickness does) Tj ET BT /F2 12 Tf 1 0 0 1 106.99 145.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 123.66 145.21 Tm ( include irreversible dementia resulting from:) Tj ET Q q n 18 142.8 m 630 142.8 l 630 130.8 l 18 130.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 133.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 133.21 Tm (stroke, trauma, viral infection, Alzheimer's disease; or) Tj ET Q q n 18 130.8 m 630 130.8 l 630 118.8 l 18 118.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 121.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 121.21 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 77.04 121.21 Tm (conditions) Tj ET BT /F3 12 Tf 1 0 0 1 134.07 121.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 170.43 121.21 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 192.12 121.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 214.49 121.21 Tm (usually) Tj ET BT /F3 12 Tf 1 0 0 1 256.18 121.21 Tm (treated) Tj ET BT /F3 12 Tf 1 0 0 1 295.86 121.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 314.9 121.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 327.26 121.21 Tm (mental) Tj ET BT /F3 12 Tf 1 0 0 1 366.95 121.21 Tm (health) Tj ET BT /F3 12 Tf 1 0 0 1 403.3 121.21 Tm (care) Tj ET BT /F3 12 Tf 1 0 0 1 430.31 121.21 Tm (provider) Tj ET BT /F3 12 Tf 1 0 0 1 478 121.21 Tm (using) Tj ET Q q n 45.35 118.8 m 657.35 118.8 l 657.35 106.8 l 45.35 106.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 109.21 Tm (psychotherapy, psychotropic drugs, or similar methods of treatment.) Tj ET Q q n 0 106.8 m 612 106.8 l 612 94.8 l 0 94.8 l h W n Q q n 0 94.8 m 612 94.8 l 612 82.8 l 0 82.8 l h W n Q Q q Q Q endstream endobj 30 0 obj <>>>>> endobj 160 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 758.4 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 69.97 2.41 Tm (VOLUNTARY VOCATIONAL REHABILITATION BENEFIT PROVISION) Tj ET Q Q q Q q 1 0 0 1 36 11.85 cm q n 0 48 m 183.6 48 l 183.6 36 l 0 36 l h W n Q q n 183.6 48 m 367.2 48 l 367.2 36 l 183.6 36 l h W n Q q n 367.2 48 m 550.8 48 l 550.8 36 l 367.2 36 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 453.99 38.41 Tm (Voluntary Rehab.) Tj ET Q q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-14.3 98 PA) Tj ET Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 264.65 14.41 Tm (28) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 503.74 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 59.85 cm q n 0 696.15 m 612 696.15 l 612 684.15 l 0 684.15 l h W n Q q n 0 684.15 m 612 684.15 l 612 672.15 l 0 672.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 674.56 Tm (BENEFIT.) Tj ET BT /F3 12 Tf 1 0 0 1 59.19 674.56 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 70.61 674.56 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 85.36 674.56 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 124.78 674.56 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 176.86 674.56 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 188.29 674.56 Tm (Disabled) Tj ET BT /F3 12 Tf 1 0 0 1 234.37 674.56 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 255.13 674.56 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 266.56 674.56 Tm (receiving) Tj ET BT /F3 12 Tf 1 0 0 1 314.63 674.56 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 348.73 674.56 Tm (benefits;) Tj ET BT /F3 12 Tf 1 0 0 1 393.48 674.56 Tm (then) Tj ET BT /F3 12 Tf 1 0 0 1 417.57 674.56 Tm (he) Tj ET BT /F3 12 Tf 1 0 0 1 432.32 674.56 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 445.74 674.56 Tm (she) Tj ET BT /F3 12 Tf 1 0 0 1 465.17 674.56 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 489.26 674.56 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 504.01 674.56 Tm (eligible) Tj ET Q q n 0 672.15 m 612 672.15 l 612 660.15 l 0 660.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 662.56 Tm (for a Vocational Rehabilitation Benefit.) Tj ET BT /F3 12 Tf 1 0 0 1 196.27 662.56 Tm (This Benefit consists of services which may include:) Tj ET Q q n 18 660.15 m 630 660.15 l 630 648.15 l 18 648.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 650.56 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 650.56 Tm (vocational evaluation, counseling, training or job placement;) Tj ET Q q n 18 648.15 m 630 648.15 l 630 636.15 l 18 636.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 638.56 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 638.56 Tm (job modification or special equipment; and) Tj ET Q q n 18 636.15 m 630 636.15 l 630 624.15 l 18 624.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 626.56 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 626.56 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 73.85 626.56 Tm (services) Tj ET BT /F3 12 Tf 1 0 0 1 116.34 626.56 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 149.51 626.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 168.02 626.56 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 218.52 626.56 Tm (deems) Tj ET BT /F3 12 Tf 1 0 0 1 253.03 626.56 Tm (reasonably) Tj ET BT /F3 12 Tf 1 0 0 1 308.85 626.56 Tm (necessary) Tj ET BT /F3 12 Tf 1 0 0 1 359.33 626.56 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 372.51 626.56 Tm (help) Tj ET BT /F3 12 Tf 1 0 0 1 397.01 626.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 415.52 626.56 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 455.35 626.56 Tm (Employee) Tj ET Q q n 45.35 624.15 m 657.35 624.15 l 657.35 612.15 l 45.35 612.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 614.56 Tm (return to work.) Tj ET Q q n 0 612.15 m 612 612.15 l 612 600.15 l 0 600.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 602.56 Tm (The Company will determine the Insured Employee's eligibility and the amount of any Benefit payable.) Tj ET Q q n 0 600.15 m 612 600.15 l 612 588.15 l 0 588.15 l h W n Q q n 0 588.15 m 612 588.15 l 612 576.15 l 0 576.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 578.56 Tm (ELIGIBILITY.) Tj ET BT /F3 12 Tf 1 0 0 1 79.64 578.56 Tm (An Insured Employee may be eligible for this Benefit, if the Company finds that he or she:) Tj ET Q q n 18 576.15 m 630 576.15 l 630 564.15 l 18 564.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 566.56 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 566.56 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 65.33 566.56 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 74.65 566.56 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 125.97 566.56 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 147.95 566.56 Tm (prevents) Tj ET BT /F3 12 Tf 1 0 0 1 192.59 566.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 211.24 566.56 Tm (performance) Tj ET BT /F3 12 Tf 1 0 0 1 275.85 566.56 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 289.84 566.56 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 307.83 566.56 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 321.81 566.56 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 341.12 566.56 Tm (regular) Tj ET BT /F3 12 Tf 1 0 0 1 379.09 566.56 Tm (occupation;) Tj ET BT /F3 12 Tf 1 0 0 1 439.06 566.56 Tm (and,) Tj ET BT /F3 12 Tf 1 0 0 1 463.37 566.56 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 566.56 Tm (the) Tj ET Q q n 45.35 564.15 m 657.35 564.15 l 657.35 552.15 l 45.35 552.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 554.56 Tm (Own) Tj ET BT /F3 12 Tf 1 0 0 1 73.31 554.56 Tm (Occupation) Tj ET BT /F3 12 Tf 1 0 0 1 133.24 554.56 Tm (Period,) Tj ET BT /F3 12 Tf 1 0 0 1 172.2 554.56 Tm (also) Tj ET BT /F3 12 Tf 1 0 0 1 196.15 554.56 Tm (lacks) Tj ET BT /F3 12 Tf 1 0 0 1 225.43 554.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 244.72 554.56 Tm (skills,) Tj ET BT /F3 12 Tf 1 0 0 1 277.69 554.56 Tm (training) Tj ET BT /F3 12 Tf 1 0 0 1 319.63 554.56 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 334.25 554.56 Tm (experience) Tj ET BT /F3 12 Tf 1 0 0 1 390.84 554.56 Tm (needed) Tj ET BT /F3 12 Tf 1 0 0 1 429.44 554.56 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 443.4 554.56 Tm (perform) Tj ET BT /F3 12 Tf 1 0 0 1 486.67 554.56 Tm (any) Tj ET Q q n 45.35 552.15 m 657.35 552.15 l 657.35 540.15 l 45.35 540.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 542.56 Tm (other gainful occupation;) Tj ET Q q n 18 540.15 m 630 540.15 l 630 528.15 l 18 528.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 530.56 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 530.56 Tm (has the physical and mental abilities needed to complete a Program; and) Tj ET Q q n 18 528.15 m 630 528.15 l 630 516.15 l 18 516.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 518.56 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 518.56 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 57.53 518.56 Tm (reasonably) Tj ET BT /F3 12 Tf 1 0 0 1 113.68 518.56 Tm (expected) Tj ET BT /F3 12 Tf 1 0 0 1 160.49 518.56 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 174 518.56 Tm (return) Tj ET BT /F3 12 Tf 1 0 0 1 206.83 518.56 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 220.33 518.56 Tm (work) Tj ET BT /F3 12 Tf 1 0 0 1 249.17 518.56 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 275.32 518.56 Tm (completing) Tj ET BT /F3 12 Tf 1 0 0 1 333.49 518.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 352.32 518.56 Tm (Program;) Tj ET BT /F3 12 Tf 1 0 0 1 401.15 518.56 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 414.66 518.56 Tm (view) Tj ET BT /F3 12 Tf 1 0 0 1 442.16 518.56 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 456.33 518.56 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 474.51 518.56 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 488.68 518.56 Tm (her) Tj ET Q q n 45.35 516.15 m 657.35 516.15 l 657.35 504.15 l 45.35 504.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 506.56 Tm (degree of motivation and the labor force demand for workers in the proposed occupation.) Tj ET Q q n 0 504.15 m 612 504.15 l 612 492.15 l 0 492.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 494.56 Tm (The Company must also find that the cost of the proposed services is less than its expected claim liability.) Tj ET Q q n 0 492.15 m 612 492.15 l 612 480.15 l 0 480.15 l h W n Q q n 0 480.15 m 612 480.15 l 612 468.15 l 0 468.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 470.56 Tm (AMOUNT.) Tj ET BT /F3 12 Tf 1 0 0 1 65.42 470.56 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 88.96 470.56 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 129.83 470.56 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 144.71 470.56 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 166.91 470.56 Tm (Vocational) Tj ET BT /F3 12 Tf 1 0 0 1 224.44 470.56 Tm (Rehabilitation) Tj ET BT /F3 12 Tf 1 0 0 1 297.3 470.56 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 337.5 470.56 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 361.05 470.56 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 381.26 470.56 Tm (exceed) Tj ET BT /F3 12 Tf 1 0 0 1 419.45 470.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 438.99 470.56 Tm (Company's) Tj ET BT /F3 12 Tf 1 0 0 1 497.36 470.56 Tm (expected) Tj ET Q q n 0 468.15 m 612 468.15 l 612 456.15 l 0 456.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 458.56 Tm (claims) Tj ET BT /F3 12 Tf 1 0 0 1 34.72 458.56 Tm (liability.) Tj ET BT /F3 12 Tf 1 0 0 1 81.83 458.56 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 106.56 458.56 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 143.27 458.56 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 165.33 458.56 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 184.06 458.56 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 198.78 458.56 Tm (payable) Tj ET BT /F3 12 Tf 1 0 0 1 239.49 458.56 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 256.87 458.56 Tm (services) Tj ET BT /F3 12 Tf 1 0 0 1 298.92 458.56 Tm (covered) Tj ET BT /F3 12 Tf 1 0 0 1 340.28 458.56 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 371 458.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 389.05 458.56 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 428.44 458.56 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 487.31 458.56 Tm (health) Tj ET BT /F3 12 Tf 1 0 0 1 520.03 458.56 Tm (care) Tj ET Q q n 0 456.15 m 612 456.15 l 612 444.15 l 0 444.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 446.56 Tm (plan) Tj ET BT /F3 12 Tf 1 0 0 1 24.56 446.56 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 38.45 446.56 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 59.68 446.56 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 88.23 446.56 Tm (vocational) Tj ET BT /F3 12 Tf 1 0 0 1 142.11 446.56 Tm (rehabilitation) Tj ET BT /F3 12 Tf 1 0 0 1 209.99 446.56 Tm (program.) Tj ET BT /F3 12 Tf 1 0 0 1 261.44 446.56 Tm (Payment) Tj ET BT /F3 12 Tf 1 0 0 1 307.33 446.56 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 331.89 446.56 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 347.11 446.56 Tm (made) Tj ET BT /F3 12 Tf 1 0 0 1 377 446.56 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 390.23 446.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 408.79 446.56 Tm (provider) Tj ET BT /F3 12 Tf 1 0 0 1 453.34 446.56 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 467.23 446.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 485.79 446.56 Tm (services,) Tj ET BT /F3 12 Tf 1 0 0 1 531.34 446.56 Tm (at) Tj ET Q q n 0 444.15 m 612 444.15 l 612 432.15 l 0 432.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 434.56 Tm (the Company's option.) Tj ET Q q n 0 432.15 m 612 432.15 l 612 420.15 l 0 420.15 l h W n Q q n 0 420.15 m 612 420.15 l 612 408.15 l 0 408.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 410.56 Tm (CONDITIONS.) Tj ET BT /F3 12 Tf 1 0 0 1 88.83 410.56 Tm (Either) Tj ET BT /F3 12 Tf 1 0 0 1 124.4 410.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 145.31 410.56 Tm (Company,) Tj ET BT /F3 12 Tf 1 0 0 1 201.23 410.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 222.14 410.56 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 264.38 410.56 Tm (Employee,) Tj ET BT /F3 12 Tf 1 0 0 1 322.28 410.56 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 338.53 410.56 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 358.78 410.56 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 375.03 410.56 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 396.6 410.56 Tm (Physician) Tj ET BT /F3 12 Tf 1 0 0 1 449.52 410.56 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 476.43 410.56 Tm (first) Tj ET BT /F3 12 Tf 1 0 0 1 502.01 410.56 Tm (propose) Tj ET Q q n 0 408.15 m 612 408.15 l 612 396.15 l 0 396.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 398.56 Tm (vocational) Tj ET BT /F3 12 Tf 1 0 0 1 53.5 398.56 Tm (rehabilitation.) Tj ET BT /F3 12 Tf 1 0 0 1 127.52 398.56 Tm (When) Tj ET BT /F3 12 Tf 1 0 0 1 159.7 398.56 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 168.54 398.56 Tm (Program) Tj ET BT /F3 12 Tf 1 0 0 1 213.39 398.56 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 224.92 398.56 Tm (approved) Tj ET BT /F3 12 Tf 1 0 0 1 273.08 398.56 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 288.61 398.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 306.79 398.56 Tm (Company,) Tj ET BT /F3 12 Tf 1 0 0 1 359.97 398.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 378.15 398.56 Tm (Policy's) Tj ET BT /F3 12 Tf 1 0 0 1 419.18 398.56 Tm (definition) Tj ET BT /F3 12 Tf 1 0 0 1 469.35 398.56 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 482.87 398.56 Tm ("Disability") Tj ET Q q n 0 396.15 m 612 396.15 l 612 384.15 l 0 384.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 386.56 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 22.36 386.56 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 37.38 386.56 Tm (waived) Tj ET BT /F3 12 Tf 1 0 0 1 75.73 386.56 Tm (during) Tj ET BT /F3 12 Tf 1 0 0 1 110.75 386.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 129.1 386.56 Tm (rehabilitation) Tj ET BT /F3 12 Tf 1 0 0 1 196.77 386.56 Tm (period;) Tj ET BT /F3 12 Tf 1 0 0 1 234.46 386.56 Tm (but) Tj ET BT /F3 12 Tf 1 0 0 1 253.48 386.56 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 263.85 386.56 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 286.21 386.56 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 301.23 386.56 Tm (reapplied) Tj ET BT /F3 12 Tf 1 0 0 1 349.56 386.56 Tm (after) Tj ET BT /F3 12 Tf 1 0 0 1 375.23 386.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 393.59 386.56 Tm (Program) Tj ET BT /F3 12 Tf 1 0 0 1 438.6 386.56 Tm (ends.) Tj ET BT /F3 12 Tf 1 0 0 1 470.99 386.56 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 493.34 386.56 Tm (Company) Tj ET Q q n 0 384.15 m 612 384.15 l 612 372.15 l 0 372.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 374.56 Tm (will determine the amount and duration of any Long Term Disability benefits payable after the Program ends.) Tj ET Q q n 0 372.15 m 612 372.15 l 612 360.15 l 0 360.15 l h W n Q q n 0 360.15 m 612 360.15 l 612 348.15 l 0 348.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 350.56 Tm (DEFINITION) Tj ET Q q n 0 348.15 m 612 348.15 l 612 336.15 l 0 336.15 l h W n Q q n 0 336.15 m 612 336.15 l 612 324.15 l 0 324.15 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 326.56 Tm ("Program") Tj ET BT /F3 12 Tf 1 0 0 1 59.3 326.56 Tm ( means a written vocational rehabilitation program:) Tj ET Q q n 18 324.15 m 630 324.15 l 630 312.15 l 18 312.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 314.56 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 314.56 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 78.01 314.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 96.01 314.56 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 146.01 314.56 Tm (develops) Tj ET BT /F3 12 Tf 1 0 0 1 192.01 314.56 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 216.68 314.56 Tm (input) Tj ET BT /F3 12 Tf 1 0 0 1 244.69 314.56 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 271.35 314.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 289.35 314.56 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 328.68 314.56 Tm (Employee;) Tj ET BT /F3 12 Tf 1 0 0 1 384 314.56 Tm (his) Tj ET BT /F3 12 Tf 1 0 0 1 401.34 314.56 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 414.68 314.56 Tm (her) Tj ET BT /F3 12 Tf 1 0 0 1 433.34 314.56 Tm (Physician;) Tj ET BT /F3 12 Tf 1 0 0 1 486.67 314.56 Tm (and) Tj ET Q q n 45.35 312.15 m 657.35 312.15 l 657.35 300.15 l 45.35 300.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 302.56 Tm (any current or prospective employer, when appropriate; and) Tj ET Q q n 18 300.15 m 630 300.15 l 630 288.15 l 18 288.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 290.56 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 290.56 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 79.74 290.56 Tm (describes) Tj ET BT /F3 12 Tf 1 0 0 1 129.45 290.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 149.18 290.56 Tm (Program's) Tj ET BT /F3 12 Tf 1 0 0 1 202.4 290.56 Tm (goals;) Tj ET BT /F3 12 Tf 1 0 0 1 236.13 290.56 Tm (each) Tj ET BT /F3 12 Tf 1 0 0 1 263.17 290.56 Tm (party's) Tj ET BT /F3 12 Tf 1 0 0 1 299.72 290.56 Tm (responsibilities;) Tj ET BT /F3 12 Tf 1 0 0 1 380.78 290.56 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 403.17 290.56 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 422.89 290.56 Tm (times,) Tj ET BT /F3 12 Tf 1 0 0 1 456.95 290.56 Tm (dates) Tj ET BT /F3 12 Tf 1 0 0 1 486.67 290.56 Tm (and) Tj ET Q q n 45.35 288.15 m 657.35 288.15 l 657.35 276.15 l 45.35 276.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 278.56 Tm (costs of the rehabilitation services.) Tj ET Q q n 18 276.15 m 630 276.15 l 630 264.15 l 18 264.15 l h W n Q q n 0 264.15 m 612 264.15 l 612 252.15 l 0 252.15 l h W n Q Q q Q Q endstream endobj 31 0 obj <>>>>> endobj 162 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 744 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 56.48 2.41 Tm (PRIOR INSURANCE CREDIT UPON TRANSFER OF INSURANCE CARRIERS) Tj ET Q Q q Q q 1 0 0 1 36 36 cm q n 0 48 m 612 48 l 612 36 l 0 36 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 216.68 38.41 Tm (Prior Insurance Credit) Tj ET Q q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-15 99) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 265 14.41 Tm (29) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 84 cm q n 0 646.2 m 612 646.2 l 612 634.2 l 0 634.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 636.61 Tm (To) Tj ET BT /F3 12 Tf 1 0 0 1 16.62 636.61 Tm (prevent) Tj ET BT /F3 12 Tf 1 0 0 1 55.89 636.61 Tm (loss) Tj ET BT /F3 12 Tf 1 0 0 1 77.85 636.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 91.14 636.61 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 137.73 636.61 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 155.01 636.61 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 169.63 636.61 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 221.57 636.61 Tm (because) Tj ET BT /F3 12 Tf 1 0 0 1 262.83 636.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 276.12 636.61 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 284.73 636.61 Tm (transfer) Tj ET BT /F3 12 Tf 1 0 0 1 324.67 636.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 337.95 636.61 Tm (insurance) Tj ET BT /F3 12 Tf 1 0 0 1 387.22 636.61 Tm (carriers,) Tj ET BT /F3 12 Tf 1 0 0 1 429.48 636.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 447.43 636.61 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 481.39 636.61 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 503.34 636.61 Tm (provide) Tj ET Q q n 0 634.2 m 612 634.2 l 612 622.2 l 0 622.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 624.61 Tm (Prior Insurance Credit for employees insured under the prior carrier's policy on its termination date as follows.) Tj ET Q q n 0 622.2 m 612 622.2 l 612 610.2 l 0 610.2 l h W n Q q n 0 610.2 m 612 610.2 l 612 598.2 l 0 598.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 600.61 Tm (FAILURE) Tj ET BT /F3 12 Tf 1 0 0 1 53.75 600.61 Tm (TO) Tj ET BT /F3 12 Tf 1 0 0 1 72.82 600.61 Tm (BE) Tj ET BT /F3 12 Tf 1 0 0 1 91.24 600.61 Tm (ACTIVELY-AT-WORK) Tj ET BT /F3 12 Tf 1 0 0 1 214.96 600.61 Tm (DUE) Tj ET BT /F3 12 Tf 1 0 0 1 242.7 600.61 Tm (TO) Tj ET BT /F3 12 Tf 1 0 0 1 261.77 600.61 Tm (INJURY) Tj ET BT /F3 12 Tf 1 0 0 1 307.52 600.61 Tm (OR) Tj ET BT /F3 12 Tf 1 0 0 1 327.27 600.61 Tm (SICKNESS.) Tj ET BT /F3 12 Tf 1 0 0 1 393.12 600.61 Tm (Subject) Tj ET BT /F3 12 Tf 1 0 0 1 432.19 600.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 444.61 600.61 Tm (premium) Tj ET BT /F3 12 Tf 1 0 0 1 491.01 600.61 Tm (payments,) Tj ET Q q n 0 598.2 m 612 598.2 l 612 586.2 l 0 586.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 588.61 Tm (the Policy will provide coverage to an Employee:) Tj ET Q q n 18 586.2 m 630 586.2 l 630 574.2 l 18 574.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 576.61 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 576.61 Tm (who was insured by the prior carrier's policy at the time of transfer; and) Tj ET Q q n 18 574.2 m 630 574.2 l 630 562.2 l 18 562.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 564.61 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 564.61 Tm (who was not Actively-At-Work due to Injury or Sickness on the Policy's Effective Date.) Tj ET Q q n 0 562.2 m 612 562.2 l 612 550.2 l 0 550.2 l h W n Q q n 0 550.2 m 612 550.2 l 612 538.2 l 0 538.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 540.61 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 22.69 540.61 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 70.03 540.61 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 92.73 540.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 108.1 540.61 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 130.13 540.61 Tm (provided) Tj ET BT /F3 12 Tf 1 0 0 1 176.82 540.61 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 192.85 540.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 211.55 540.61 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 238.91 540.61 Tm (carrier's) Tj ET BT /F3 12 Tf 1 0 0 1 281.08 540.61 Tm (policy,) Tj ET BT /F3 12 Tf 1 0 0 1 318.11 540.61 Tm (had) Tj ET BT /F3 12 Tf 1 0 0 1 339.47 540.61 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 350.18 540.61 Tm (remained) Tj ET BT /F3 12 Tf 1 0 0 1 398.85 540.61 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 412.22 540.61 Tm (force.) Tj ET BT /F3 12 Tf 1 0 0 1 447.94 540.61 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 470.63 540.61 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 521.33 540.61 Tm (will) Tj ET Q q n 0 538.2 m 612 538.2 l 612 526.2 l 0 526.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 528.61 Tm (pay:) Tj ET Q q n 18 526.2 m 630 526.2 l 630 514.2 l 18 514.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 516.61 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 516.61 Tm (the benefit that the prior carrier would have paid; minus) Tj ET Q q n 18 514.2 m 630 514.2 l 630 502.2 l 18 502.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 504.61 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 504.61 Tm (any amount for which the prior carrier is liable.) Tj ET Q q n 18 502.2 m 630 502.2 l 630 490.2 l 18 490.2 l h W n Q q n 0 490.2 m 612 490.2 l 612 478.2 l 0 478.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 480.61 Tm (DISABILITY) Tj ET BT /F3 12 Tf 1 0 0 1 70.91 480.61 Tm (DUE) Tj ET BT /F3 12 Tf 1 0 0 1 99.16 480.61 Tm (TO) Tj ET BT /F3 12 Tf 1 0 0 1 118.74 480.61 Tm (A) Tj ET BT /F3 12 Tf 1 0 0 1 130.99 480.61 Tm (PRE-EXISTING) Tj ET BT /F3 12 Tf 1 0 0 1 215.9 480.61 Tm (CONDITION.) Tj ET BT /F3 12 Tf 1 0 0 1 292.73 480.61 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 336.3 480.61 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 360.55 480.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 375.46 480.61 Tm (payable) Tj ET BT /F3 12 Tf 1 0 0 1 416.36 480.61 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 433.94 480.61 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 442.85 480.61 Tm (Total) Tj ET BT /F3 12 Tf 1 0 0 1 471.76 480.61 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 522.67 480.61 Tm (due) Tj ET Q q n 0 478.2 m 612 478.2 l 612 466.2 l 0 466.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 468.61 Tm (to a Pre-Existing Condition for an Employee who:) Tj ET Q q n 18 466.2 m 630 466.2 l 630 454.2 l 18 454.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 456.61 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 456.61 Tm (was insured by the prior carrier's policy at the time of transfer; and) Tj ET Q q n 18 454.2 m 630 454.2 l 630 442.2 l 18 442.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 444.61 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 444.61 Tm (was Actively-At-Work and insured under the Policy on the Policy's Effective Date.) Tj ET Q q n 0 442.2 m 612 442.2 l 612 430.2 l 0 430.2 l h W n Q q n 0 430.2 m 612 430.2 l 612 418.2 l 0 418.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 420.61 Tm (The benefits will be determined as follows:) Tj ET Q q n 18 418.2 m 630 418.2 l 630 406.2 l 18 406.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 408.61 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 408.61 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 70.2 408.61 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 123.41 408.61 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 148.63 408.61 Tm (apply) Tj ET BT /F3 12 Tf 1 0 0 1 181.83 408.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 203.04 408.61 Tm (Policy's) Tj ET BT /F3 12 Tf 1 0 0 1 247.09 408.61 Tm (Pre-Existing) Tj ET BT /F3 12 Tf 1 0 0 1 313.63 408.61 Tm (Condition) Tj ET BT /F3 12 Tf 1 0 0 1 368.18 408.61 Tm (Exclusion.) Tj ET BT /F3 12 Tf 1 0 0 1 432.27 408.61 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 446.81 408.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 468.01 408.61 Tm (Insured) Tj ET Q q n 45 406.2 m 657 406.2 l 657 394.2 l 45 394.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 396.61 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 97.34 396.61 Tm (qualifies) Tj ET BT /F3 12 Tf 1 0 0 1 142.35 396.61 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 160.03 396.61 Tm (benefits,) Tj ET BT /F3 12 Tf 1 0 0 1 204.71 396.61 Tm (such) Tj ET BT /F3 12 Tf 1 0 0 1 230.39 396.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 270.07 396.61 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 322.41 396.61 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 344.77 396.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 359.78 396.61 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 384.13 396.61 Tm (according) Tj ET BT /F3 12 Tf 1 0 0 1 435.13 396.61 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 448.15 396.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 466.5 396.61 Tm (Policy's) Tj ET Q q n 45 394.2 m 657 394.2 l 657 382.2 l 45 382.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 384.61 Tm (benefit schedule.) Tj ET Q q n 18 382.2 m 630 382.2 l 630 370.2 l 18 370.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 372.61 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 372.61 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 57.08 372.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 75.49 372.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 115.22 372.61 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 167.61 372.61 Tm (cannot) Tj ET BT /F3 12 Tf 1 0 0 1 203.34 372.61 Tm (satisfy) Tj ET BT /F3 12 Tf 1 0 0 1 238.41 372.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 256.81 372.61 Tm (Policy's) Tj ET BT /F3 12 Tf 1 0 0 1 298.05 372.61 Tm (Pre-Existing) Tj ET BT /F3 12 Tf 1 0 0 1 361.79 372.61 Tm (Condition) Tj ET BT /F3 12 Tf 1 0 0 1 413.54 372.61 Tm (Exclusion,) Tj ET BT /F3 12 Tf 1 0 0 1 468.27 372.61 Tm (but) Tj ET BT /F3 12 Tf 1 0 0 1 487.35 372.61 Tm (can) Tj ET Q q n 45.35 370.2 m 657.35 370.2 l 657.35 358.2 l 45.35 358.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 360.61 Tm (satisfy) Tj ET BT /F3 12 Tf 1 0 0 1 84.38 360.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 106.73 360.61 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 137.75 360.61 Tm (carrier's) Tj ET BT /F3 12 Tf 1 0 0 1 183.58 360.61 Tm (pre-existing) Tj ET BT /F3 12 Tf 1 0 0 1 248.59 360.61 Tm (condition) Tj ET BT /F3 12 Tf 1 0 0 1 301.62 360.61 Tm (exclusion) Tj ET BT /F3 12 Tf 1 0 0 1 355.3 360.61 Tm (giving) Tj ET BT /F3 12 Tf 1 0 0 1 393.67 360.61 Tm (consideration) Tj ET BT /F3 12 Tf 1 0 0 1 466.01 360.61 Tm (towards) Tj ET Q q n 45.35 358.2 m 657.35 358.2 l 657.35 346.2 l 45.35 346.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 348.61 Tm (continuous) Tj ET BT /F3 12 Tf 1 0 0 1 102.64 348.61 Tm (time) Tj ET BT /F3 12 Tf 1 0 0 1 128.6 348.61 Tm (insured) Tj ET BT /F3 12 Tf 1 0 0 1 168.56 348.61 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 200.51 348.61 Tm (both) Tj ET BT /F3 12 Tf 1 0 0 1 226.48 348.61 Tm (policies;) Tj ET BT /F3 12 Tf 1 0 0 1 271.76 348.61 Tm (then) Tj ET BT /F3 12 Tf 1 0 0 1 297.05 348.61 Tm (he) Tj ET BT /F3 12 Tf 1 0 0 1 313.01 348.61 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 327.64 348.61 Tm (she) Tj ET BT /F3 12 Tf 1 0 0 1 348.26 348.61 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 371.56 348.61 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 387.52 348.61 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 412.81 348.61 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 426.77 348.61 Tm (accord) Tj ET BT /F3 12 Tf 1 0 0 1 463.38 348.61 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 348.61 Tm (the) Tj ET Q q n 45.35 346.2 m 657.35 346.2 l 657.35 334.2 l 45.35 334.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 336.61 Tm (benefit schedule and all other terms, conditions and limitations of:) Tj ET Q q n 45 334.2 m 657 334.2 l 657 322.2 l 45 322.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 324.61 Tm (\(a\)) Tj ET BT /F3 12 Tf 1 0 0 1 72 324.61 Tm (the Policy without applying the Pre-Existing Condition Exclusion; or) Tj ET Q q n 45 322.2 m 657 322.2 l 657 310.2 l 45 310.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 312.61 Tm (\(b\)) Tj ET BT /F3 12 Tf 1 0 0 1 72 312.61 Tm (the prior carrier's policy;) Tj ET Q q n 45 310.2 m 657 310.2 l 657 298.2 l 45 298.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 300.61 Tm (whichever is less.) Tj ET Q q n 18 298.2 m 630 298.2 l 630 286.2 l 18 286.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 288.61 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 288.61 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 57.35 288.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 76.01 288.61 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 116.01 288.61 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 168.66 288.61 Tm (cannot) Tj ET BT /F3 12 Tf 1 0 0 1 204.65 288.61 Tm (satisfy) Tj ET BT /F3 12 Tf 1 0 0 1 239.99 288.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 258.65 288.61 Tm (Pre-Existing) Tj ET BT /F3 12 Tf 1 0 0 1 322.65 288.61 Tm (Condition) Tj ET BT /F3 12 Tf 1 0 0 1 374.67 288.61 Tm (Exclusion) Tj ET BT /F3 12 Tf 1 0 0 1 426.66 288.61 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 440.67 288.61 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 459.33 288.61 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 494 288.61 Tm (or) Tj ET Q q n 45.35 286.2 m 657.35 286.2 l 657.35 274.2 l 45.35 274.2 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 276.61 Tm (that of the prior carrier, no benefit will be paid.) Tj ET Q q n 0 274.2 m 612 274.2 l 612 256.2 l 0 256.2 l h W n Q Q q Q Q endstream endobj 32 0 obj <>>>>> endobj 163 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 758.4 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 191 2.41 Tm (FAMILY INCOME BENEFIT) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 60 m 550.8 60 l 550.8 48 l 0 48 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 196.5 50.41 Tm (Three) Tj ET BT /F3 12 Tf 1 0 0 1 227.48 50.41 Tm (Month Survivor Benefit) Tj ET Q q n 177.85 48 m 361.45 48 l 361.45 36 l 177.85 36 l h W n Q q n 183.6 48 m 550.8 48 l 550.8 36 l 183.6 36 l h W n Q q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-16 94 PA) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 264.65 14.41 Tm (30) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 503.74 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 81.6 cm q n 0 660.6 m 612 660.6 l 612 648.6 l 0 648.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 651.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 23.4 651.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 74.81 651.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 98.23 651.01 Tm (pay) Tj ET BT /F3 12 Tf 1 0 0 1 120.3 651.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 130.38 651.01 Tm (lump) Tj ET BT /F3 12 Tf 1 0 0 1 159.79 651.01 Tm (sum) Tj ET BT /F3 12 Tf 1 0 0 1 184.54 651.01 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 222.61 651.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 236.69 651.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 256.1 651.01 Tm (Eligible) Tj ET BT /F3 12 Tf 1 0 0 1 298.84 651.01 Tm (Survivor) Tj ET BT /F3 12 Tf 1 0 0 1 345.58 651.01 Tm (when) Tj ET BT /F3 12 Tf 1 0 0 1 376.32 651.01 Tm (proof) Tj ET BT /F3 12 Tf 1 0 0 1 407.06 651.01 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 419.81 651.01 Tm (received) Tj ET BT /F3 12 Tf 1 0 0 1 465.2 651.01 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 487.94 651.01 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 504.01 651.01 Tm (Insured) Tj ET Q q n 0 648.6 m 612 648.6 l 612 636.6 l 0 636.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 639.01 Tm (Employee died:) Tj ET Q q n 18 636.6 m 630 636.6 l 630 624.6 l 18 624.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 627.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 627.01 Tm (after Disability had continued for 180 or more consecutive days; and) Tj ET Q q n 18 624.6 m 630 624.6 l 630 612.6 l 18 612.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 615.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 615.01 Tm (while receiving a Monthly Benefit.) Tj ET Q q n 0 612.6 m 612 612.6 l 612 600.6 l 0 600.6 l h W n Q q n 0 600.6 m 612 600.6 l 612 588.6 l 0 588.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 591.01 Tm (The benefit will be equal to three times the Insured Employee's Last Monthly Benefit.) Tj ET Q q n 0 588.6 m 612 588.6 l 612 576.6 l 0 576.6 l h W n Q q n 0 576.6 m 612 576.6 l 612 564.6 l 0 564.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 567.01 Tm ("Last Monthly Benefit" means the gross Monthly Benefit which) Tj ET 1 0 0 rg BT /F3 12 Tf 1 0 0 1 307.75 567.01 Tm (:) Tj ET Q q n 18 564.6 m 630 564.6 l 630 552.6 l 18 552.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 555.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 555.01 Tm (was payable to the Insured Employee immediately prior to death; or) Tj ET Q q n 18 552.6 m 630 552.6 l 630 540.6 l 18 540.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 543.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 543.01 Tm (would) Tj ET BT /F3 12 Tf 1 0 0 1 79.04 543.01 Tm (have) Tj ET BT /F3 12 Tf 1 0 0 1 105.39 543.01 Tm (been) Tj ET BT /F3 12 Tf 1 0 0 1 131.73 543.01 Tm (payable) Tj ET BT /F3 12 Tf 1 0 0 1 172.74 543.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 185.77 543.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 204.12 543.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 243.8 543.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 296.15 543.01 Tm (had) Tj ET BT /F3 12 Tf 1 0 0 1 317.17 543.01 Tm (he) Tj ET BT /F3 12 Tf 1 0 0 1 332.19 543.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 345.87 543.01 Tm (she) Tj ET BT /F3 12 Tf 1 0 0 1 365.56 543.01 Tm (survived) Tj ET BT /F3 12 Tf 1 0 0 1 410.58 543.01 Tm (until) Tj ET BT /F3 12 Tf 1 0 0 1 436.28 543.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 454.63 543.01 Tm (end) Tj ET BT /F3 12 Tf 1 0 0 1 475.65 543.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 543.01 Tm (the) Tj ET Q q n 45.35 540.6 m 657.35 540.6 l 657.35 528.6 l 45.35 528.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 531.01 Tm (30-day benefit period in which death occurred.) Tj ET Q q n 0 528.6 m 612 528.6 l 612 516.6 l 0 516.6 l h W n Q q n 0 516.6 m 612 516.6 l 612 504.6 l 0 504.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 507.01 Tm (Any reductions for Other Income Benefits, or for earnings from Partial Disability Employment, will not apply.) Tj ET Q q n 0 504.6 m 612 504.6 l 612 492.6 l 0 492.6 l h W n Q q n 0 492.6 m 612 492.6 l 612 480.6 l 0 480.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 483.01 Tm ("Eligible Survivor" means the Insured Employee's:) Tj ET Q q n 18 480.6 m 630 480.6 l 630 468.6 l 18 468.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 471.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 471.01 Tm (surviving spouse; or, if none) Tj ET Q q n 18 468.6 m 630 468.6 l 630 456.6 l 18 456.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 459.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 459.01 Tm (surviving children who are under age) Tj ET BT /F3 12 Tf 1 0 0 1 227.29 459.01 Tm (25 on the Insured Employee's date of death.) Tj ET Q q n 0 456.6 m 612 456.6 l 612 444.6 l 0 444.6 l h W n Q q n 0 444.6 m 612 444.6 l 612 432.6 l 0 432.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 435.01 Tm (If payment becomes due to the Insured Employee's surviving children; then payment will be made:) Tj ET Q q n 18 432.6 m 630 432.6 l 630 420.6 l 18 420.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 423.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 423.01 Tm (in equal shares to the children; or their legal or court appointed guardian, if any; or) Tj ET Q q n 18 420.6 m 630 420.6 l 630 408.6 l 18 408.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 411.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45 411.01 Tm (to the Insured Employee's estate on the children's behalf.) Tj ET Q q n 0 408.6 m 612 408.6 l 612 396.6 l 0 396.6 l h W n Q q n 0 396.6 m 612 396.6 l 612 384.6 l 0 384.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 387.01 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 24.87 387.01 Tm (payment) Tj ET BT /F3 12 Tf 1 0 0 1 69.73 387.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 91.94 387.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 106.81 387.01 Tm (valid) Tj ET BT /F3 12 Tf 1 0 0 1 134.34 387.01 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 155.21 387.01 Tm (effective) Tj ET BT /F3 12 Tf 1 0 0 1 200.71 387.01 Tm (against) Tj ET BT /F3 12 Tf 1 0 0 1 238.24 387.01 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 253.77 387.01 Tm (claims) Tj ET BT /F3 12 Tf 1 0 0 1 288.64 387.01 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 304.18 387.01 Tm (others) Tj ET BT /F3 12 Tf 1 0 0 1 337.04 387.01 Tm (representing,) Tj ET BT /F3 12 Tf 1 0 0 1 402.89 387.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 416.43 387.01 Tm (claiming) Tj ET BT /F3 12 Tf 1 0 0 1 461.95 387.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 474.83 387.01 Tm (represent,) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 387.01 Tm (the) Tj ET Q q n 0 384.6 m 612 384.6 l 612 372.6 l 0 372.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 375.01 Tm (children.) Tj ET Q q n 0 372.6 m 612 372.6 l 612 354.6 l 0 354.6 l h W n Q Q q Q Q endstream endobj 33 0 obj <>>>>> endobj 164 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 758.4 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 159.31 2.41 Tm (RETIREMENT PROTECTION BENEFIT) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-36-RT) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 265 14.41 Tm (31) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 684.6 m 612 684.6 l 612 672.6 l 0 672.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 675.01 Tm (EFFECTIVE DATE.) Tj ET BT /F3 12 Tf 1 0 0 1 114.02 675.01 Tm (The Retirement Protection Benefit will take effect on the later of:) Tj ET Q q n 18 672.6 m 630 672.6 l 630 660.6 l 18 660.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 663.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 663.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 63.29 663.01 Tm (effective) Tj ET BT /F3 12 Tf 1 0 0 1 108.54 663.01 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 131.81 663.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 145.08 663.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 163.02 663.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 202.29 663.01 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 261.06 663.01 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 307.64 663.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 324.91 663.01 Tm (Long) Tj ET BT /F3 12 Tf 1 0 0 1 353.53 663.01 Tm (Term) Tj ET BT /F3 12 Tf 1 0 0 1 382.79 663.01 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 433.41 663.01 Tm (Benefits) Tj ET BT /F3 12 Tf 1 0 0 1 476.68 663.01 Tm (under) Tj ET Q q n 45.35 660.6 m 657.35 660.6 l 657.35 648.6 l 45.35 648.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 651.01 Tm (the Policy; or) Tj ET Q q n 18 648.6 m 630 648.6 l 630 636.6 l 18 636.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 639.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 639.01 Tm (the effective date of this provision, if it is added later by amending the Policy.) Tj ET Q q n 0 636.6 m 612 636.6 l 612 624.6 l 0 624.6 l h W n Q q n 0 624.6 m 612 624.6 l 612 612.6 l 0 612.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 615.01 Tm (BENEFIT.) Tj ET BT /F3 12 Tf 1 0 0 1 61.68 615.01 Tm (The Company will pay a monthly Retirement Protection Benefit while an Insured Employee:) Tj ET Q q n 18 612.6 m 630 612.6 l 630 600.6 l 18 600.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 603.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 603.01 Tm (is Totally Disabled or Partially Disabled; and) Tj ET Q q n 18 600.6 m 630 600.6 l 630 588.6 l 18 588.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 591.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 591.01 Tm (receives a Total Disability or Partial Disability Monthly Benefit under the Policy.) Tj ET Q q n 0 588.6 m 612 588.6 l 612 576.6 l 0 576.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 579.01 Tm (To) Tj ET BT /F3 12 Tf 1 0 0 1 16.98 579.01 Tm (qualify,) Tj ET BT /F3 12 Tf 1 0 0 1 57.63 579.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 75.94 579.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 115.58 579.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 167.89 579.01 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 194.88 579.01 Tm (have) Tj ET BT /F3 12 Tf 1 0 0 1 221.19 579.01 Tm (been) Tj ET BT /F3 12 Tf 1 0 0 1 247.49 579.01 Tm (contributing) Tj ET BT /F3 12 Tf 1 0 0 1 309.81 579.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 322.79 579.01 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 337.78 579.01 Tm (Employer) Tj ET BT /F3 12 Tf 1 0 0 1 388.75 579.01 Tm (Sponsored) Tj ET BT /F3 12 Tf 1 0 0 1 443.07 579.01 Tm (Qualified) Tj ET BT /F3 12 Tf 1 0 0 1 492.04 579.01 Tm (Plan) Tj ET BT /F3 12 Tf 1 0 0 1 517.03 579.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 534.67 579.01 Tm (a) Tj ET Q q n 0 576.6 m 612 576.6 l 612 564.6 l 0 564.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 567.01 Tm (minimum of three consecutive months prior to the date of Total or Partial Disability.) Tj ET Q q n 0 564.6 m 612 564.6 l 612 552.6 l 0 552.6 l h W n Q q n 0 552.6 m 612 552.6 l 612 540.6 l 0 540.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 543.01 Tm (AMOUNT.) Tj ET BT /F3 12 Tf 1 0 0 1 65.47 543.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 88.03 543.01 Tm (monthly) Tj ET BT /F3 12 Tf 1 0 0 1 131.94 543.01 Tm (Retirement) Tj ET BT /F3 12 Tf 1 0 0 1 189.16 543.01 Tm (Protection) Tj ET BT /F3 12 Tf 1 0 0 1 242.39 543.01 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 281.61 543.01 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 321.51 543.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 344.09 543.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 359.32 543.01 Tm (based) Tj ET BT /F3 12 Tf 1 0 0 1 390.54 543.01 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 406.45 543.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 415.68 543.01 Tm (percentage) Tj ET BT /F3 12 Tf 1 0 0 1 471.55 543.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 485.45 543.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 504.01 543.01 Tm (Insured) Tj ET Q q n 0 540.6 m 612 540.6 l 612 528.6 l 0 528.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 531.01 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 62.17 531.01 Tm (Basic) Tj ET BT /F3 12 Tf 1 0 0 1 95.52 531.01 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 143.54 531.01 Tm (Earnings.) Tj ET BT /F3 12 Tf 1 0 0 1 202.57 531.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 227.92 531.01 Tm (Retirement) Tj ET BT /F3 12 Tf 1 0 0 1 287.92 531.01 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 329.93 531.01 Tm (Percentage) Tj ET BT /F3 12 Tf 1 0 0 1 389.25 531.01 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 403.94 531.01 Tm (shown) Tj ET BT /F3 12 Tf 1 0 0 1 441.96 531.01 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 457.98 531.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 479.33 531.01 Tm (Schedule) Tj ET BT /F3 12 Tf 1 0 0 1 530 531.01 Tm (of) Tj ET Q q n 0 528.6 m 612 528.6 l 612 516.6 l 0 516.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 519.01 Tm (Insurance.) Tj ET Q q n 0 516.6 m 612 516.6 l 612 504.6 l 0 504.6 l h W n Q q n 0 504.6 m 612 504.6 l 612 492.6 l 0 492.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 495.01 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 12.2 495.01 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 27.74 495.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 67.94 495.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 120.8 495.01 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 133.02 495.01 Tm (Totally) Tj ET BT /F3 12 Tf 1 0 0 1 171.89 495.01 Tm (Disabled,) Tj ET BT /F3 12 Tf 1 0 0 1 221.76 495.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 240.63 495.01 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 278.15 495.01 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 318.36 495.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 341.24 495.01 Tm (equal) Tj ET BT /F3 12 Tf 1 0 0 1 371.44 495.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 390.31 495.01 Tm (Retirement) Tj ET BT /F3 12 Tf 1 0 0 1 447.83 495.01 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 487.37 495.01 Tm (Percentage) Tj ET Q q n 0 492.6 m 612 492.6 l 612 480.6 l 0 480.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 483.01 Tm (multiplied by the Insured Employee's Basic Monthly Earnings.) Tj ET Q q n 0 480.6 m 612 480.6 l 612 468.6 l 0 468.6 l h W n Q q n 0 468.6 m 612 468.6 l 612 456.6 l 0 456.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 459.01 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 11.8 459.01 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 26.94 459.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 66.74 459.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 119.2 459.01 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 131.02 459.01 Tm (Partially) Tj ET BT /F3 12 Tf 1 0 0 1 175.49 459.01 Tm (Disabled,) Tj ET BT /F3 12 Tf 1 0 0 1 224.96 459.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 243.43 459.01 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 280.55 459.01 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 320.36 459.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 342.84 459.01 Tm (equal) Tj ET BT /F3 12 Tf 1 0 0 1 372.64 459.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 391.11 459.01 Tm (Retirement) Tj ET BT /F3 12 Tf 1 0 0 1 448.23 459.01 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 487.37 459.01 Tm (Percentage) Tj ET Q q n 0 456.6 m 612 456.6 l 612 444.6 l 0 444.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 447.01 Tm (multiplied) Tj ET BT /F3 12 Tf 1 0 0 1 52.66 447.01 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 67.99 447.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 85.98 447.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 125.3 447.01 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 184.11 447.01 Tm (Basic) Tj ET BT /F3 12 Tf 1 0 0 1 214.11 447.01 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 258.77 447.01 Tm (Earnings) Tj ET BT /F3 12 Tf 1 0 0 1 304.76 447.01 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 325.42 447.01 Tm (then) Tj ET BT /F3 12 Tf 1 0 0 1 349.41 447.01 Tm (pro-rated) Tj ET BT /F3 12 Tf 1 0 0 1 396.71 447.01 Tm (based) Tj ET BT /F3 12 Tf 1 0 0 1 427.37 447.01 Tm (upon) Tj ET BT /F3 12 Tf 1 0 0 1 454.7 447.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 472.69 447.01 Tm (amount) Tj ET BT /F3 12 Tf 1 0 0 1 512.01 447.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 447.01 Tm (the) Tj ET Q q n 0 444.6 m 612 444.6 l 612 432.6 l 0 432.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 435.01 Tm (Partial Disability Benefit the Insured Employee receives for that month.) Tj ET Q q n 0 432.6 m 612 432.6 l 612 420.6 l 0 420.6 l h W n Q q n 0 420.6 m 612 420.6 l 612 408.6 l 0 408.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 411.01 Tm (PAYMENT OPTIONS.) Tj ET BT /F3 12 Tf 1 0 0 1 126.67 411.01 Tm (The Insured Employee may choose to have the benefit paid:) Tj ET Q q n 18 408.6 m 630 408.6 l 630 396.6 l 18 396.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 399.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 399.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 58.91 399.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 77.8 399.01 Tm (Employer) Tj ET BT /F3 12 Tf 1 0 0 1 129.35 399.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 147.57 399.01 Tm (deposit) Tj ET BT /F3 12 Tf 1 0 0 1 186.46 399.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 200.02 399.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 218.91 399.01 Tm (Employer) Tj ET BT /F3 12 Tf 1 0 0 1 270.46 399.01 Tm (Sponsored) Tj ET BT /F3 12 Tf 1 0 0 1 325.36 399.01 Tm (Qualified) Tj ET BT /F3 12 Tf 1 0 0 1 374.9 399.01 Tm (Plan) Tj ET BT /F3 12 Tf 1 0 0 1 400.46 399.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 418.68 399.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 437.57 399.01 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 475.12 399.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 399.01 Tm (the) Tj ET Q q n 45.35 396.6 m 657.35 396.6 l 657.35 384.6 l 45.35 384.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 387.01 Tm (Insured Employee, provided the Insured Employee is eligible to contribute to the plan;) Tj ET Q q n 18 384.6 m 630 384.6 l 630 372.6 l 18 372.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 375.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 375.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 57.98 375.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 66.6 375.01 Tm (non-qualified) Tj ET BT /F3 12 Tf 1 0 0 1 134.54 375.01 Tm (annuity) Tj ET BT /F3 12 Tf 1 0 0 1 173.83 375.01 Tm (then) Tj ET BT /F3 12 Tf 1 0 0 1 197.78 375.01 Tm (issued) Tj ET BT /F3 12 Tf 1 0 0 1 231.08 375.01 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 246.37 375.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 264.33 375.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 314.29 375.01 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 326.24 375.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 344.2 375.01 Tm (time) Tj ET BT /F3 12 Tf 1 0 0 1 368.82 375.01 Tm (application) Tj ET BT /F3 12 Tf 1 0 0 1 425.43 375.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 442.72 375.01 Tm (such) Tj ET BT /F3 12 Tf 1 0 0 1 468.01 375.01 Tm (annuity) Tj ET Q q n 45.35 372.6 m 657.35 372.6 l 657.35 360.6 l 45.35 360.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 363.01 Tm (is made; or) Tj ET Q q n 18 360.6 m 630 360.6 l 630 348.6 l 18 348.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 351.01 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 351.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 57.82 351.01 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 72.27 351.01 Tm (annuity) Tj ET BT /F3 12 Tf 1 0 0 1 111.4 351.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 124.52 351.01 Tm (trust) Tj ET BT /F3 12 Tf 1 0 0 1 148.99 351.01 Tm (designated) Tj ET BT /F3 12 Tf 1 0 0 1 203.44 351.01 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 218.57 351.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 236.36 351.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 275.48 351.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 327.26 351.01 Tm (upon) Tj ET BT /F3 12 Tf 1 0 0 1 354.39 351.01 Tm (making) Tj ET BT /F3 12 Tf 1 0 0 1 393.51 351.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 401.97 351.01 Tm (written) Tj ET BT /F3 12 Tf 1 0 0 1 439.09 351.01 Tm (request) Tj ET BT /F3 12 Tf 1 0 0 1 476.88 351.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 489.34 351.01 Tm (the) Tj ET Q q n 45.35 348.6 m 657.35 348.6 l 657.35 336.6 l 45.35 336.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 339.01 Tm (Company.) Tj ET Q q n 0 336.6 m 612 336.6 l 612 324.6 l 0 324.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 327.01 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 13.09 327.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 32.85 327.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 73.93 327.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 127.68 327.01 Tm (chooses) Tj ET BT /F3 12 Tf 1 0 0 1 170.77 327.01 Tm (Option) Tj ET BT /F3 12 Tf 1 0 0 1 209.2 327.01 Tm (1) Tj ET BT /F3 12 Tf 1 0 0 1 220.3 327.01 Tm (above,) Tj ET BT /F3 12 Tf 1 0 0 1 257.05 327.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 276.81 327.01 Tm (Employer) Tj ET BT /F3 12 Tf 1 0 0 1 329.23 327.01 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 342.33 327.01 Tm (responsible) Tj ET BT /F3 12 Tf 1 0 0 1 402.08 327.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 421.17 327.01 Tm (determining) Tj ET BT /F3 12 Tf 1 0 0 1 484.25 327.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 504.01 327.01 Tm (Insured) Tj ET Q q n 0 324.6 m 612 324.6 l 612 312.6 l 0 312.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 315.01 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 59.3 315.01 Tm (eligibility) Tj ET BT /F3 12 Tf 1 0 0 1 109.78 315.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 122.94 315.01 Tm (contribute) Tj ET BT /F3 12 Tf 1 0 0 1 175.4 315.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 188.56 315.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 207.03 315.01 Tm (Employer) Tj ET BT /F3 12 Tf 1 0 0 1 258.17 315.01 Tm (Sponsored) Tj ET BT /F3 12 Tf 1 0 0 1 312.66 315.01 Tm (Qualified) Tj ET BT /F3 12 Tf 1 0 0 1 361.79 315.01 Tm (Plan.) Tj ET BT /F3 12 Tf 1 0 0 1 393.76 315.01 Tm (When) Tj ET BT /F3 12 Tf 1 0 0 1 426.23 315.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 444.71 315.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 484.52 315.01 Tm (Employee's) Tj ET Q q n 0 312.6 m 612 312.6 l 612 300.6 l 0 300.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 303.01 Tm (eligibility) Tj ET BT /F3 12 Tf 1 0 0 1 49.74 303.01 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 80.14 303.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 97.88 303.01 Tm (Employer) Tj ET BT /F3 12 Tf 1 0 0 1 148.28 303.01 Tm (Sponsored) Tj ET BT /F3 12 Tf 1 0 0 1 202.02 303.01 Tm (Qualified) Tj ET BT /F3 12 Tf 1 0 0 1 250.42 303.01 Tm (Plan) Tj ET BT /F3 12 Tf 1 0 0 1 274.83 303.01 Tm (ends) Tj ET BT /F3 12 Tf 1 0 0 1 299.9 303.01 Tm (while) Tj ET BT /F3 12 Tf 1 0 0 1 329.64 303.01 Tm (still) Tj ET BT /F3 12 Tf 1 0 0 1 350.73 303.01 Tm (receiving) Tj ET BT /F3 12 Tf 1 0 0 1 398.45 303.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 406.85 303.01 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 457.26 303.01 Tm (Monthly) Tj ET BT /F3 12 Tf 1 0 0 1 501.68 303.01 Tm (Benefit,) Tj ET Q q n 0 300.6 m 612 300.6 l 612 288.6 l 0 288.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 291.01 Tm (he or she may choose one of the remaining options above by making a written request to the Company.) Tj ET Q q n 0 288.6 m 612 288.6 l 612 276.6 l 0 276.6 l h W n Q q n 0 276.6 m 612 276.6 l 612 264.6 l 0 264.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 267.01 Tm (The Insured Employee should consult with a tax advisor before choosing any payment option.) Tj ET Q q n 0 264.6 m 612 264.6 l 612 252.6 l 0 252.6 l h W n Q q n 0 252.6 m 612 252.6 l 612 240.6 l 0 240.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 243.01 Tm (DURATION.) Tj ET BT /F3 12 Tf 1 0 0 1 74.34 243.01 Tm (This Retirement Protection Benefit will cease on the earliest of:) Tj ET Q q n 18 240.6 m 630 240.6 l 630 228.6 l 18 228.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 231.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 231.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 63.78 231.01 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 87.54 231.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 105.97 231.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 145.73 231.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 198.15 231.01 Tm (ceases) Tj ET BT /F3 12 Tf 1 0 0 1 232.57 231.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 245.67 231.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 260.77 231.01 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 275.87 231.01 Tm (eligible) Tj ET BT /F3 12 Tf 1 0 0 1 315.63 231.01 Tm (participant) Tj ET BT /F3 12 Tf 1 0 0 1 370.71 231.01 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 383.81 231.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 402.24 231.01 Tm (Employer) Tj ET BT /F3 12 Tf 1 0 0 1 453.33 231.01 Tm (Sponsored) Tj ET Q q n 45.35 228.6 m 657.35 228.6 l 657.35 216.6 l 45.35 216.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 219.01 Tm (Qualified) Tj ET BT /F3 12 Tf 1 0 0 1 96.67 219.01 Tm (Plan) Tj ET BT /F3 12 Tf 1 0 0 1 124.01 219.01 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 147.34 219.01 Tm (does) Tj ET BT /F3 12 Tf 1 0 0 1 175.35 219.01 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 196.68 219.01 Tm (have) Tj ET BT /F3 12 Tf 1 0 0 1 225.34 219.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 236.67 219.01 Tm (non-qualified) Tj ET BT /F3 12 Tf 1 0 0 1 307.33 219.01 Tm (annuity) Tj ET BT /F3 12 Tf 1 0 0 1 349.33 219.01 Tm (issued) Tj ET BT /F3 12 Tf 1 0 0 1 385.33 219.01 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 403.34 219.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 424 219.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 476.67 219.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 492.67 219.01 Tm (an) Tj ET Q q n 45.35 216.6 m 657.35 216.6 l 657.35 204.6 l 45.35 204.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 207.01 Tm (alternate annuity or trust in which payments may be applied;) Tj ET Q q n 18 204.6 m 630 204.6 l 630 192.6 l 18 192.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 195.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 195.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 64.15 195.01 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 88.28 195.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 107.07 195.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 147.2 195.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 199.99 195.01 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 212.13 195.01 Tm (no) Tj ET BT /F3 12 Tf 1 0 0 1 228.27 195.01 Tm (longer) Tj ET BT /F3 12 Tf 1 0 0 1 263.07 195.01 Tm (entitled) Tj ET BT /F3 12 Tf 1 0 0 1 303.2 195.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 316.67 195.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 326.14 195.01 Tm (Total) Tj ET BT /F3 12 Tf 1 0 0 1 355.6 195.01 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 407.07 195.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 421.21 195.01 Tm (Partial) Tj ET BT /F3 12 Tf 1 0 0 1 456.67 195.01 Tm (Disability) Tj ET Q q n 45.35 192.6 m 657.35 192.6 l 657.35 180.6 l 45.35 180.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 183.01 Tm (Monthly Benefit under the Policy;) Tj ET Q q n 18 180.6 m 630 180.6 l 630 168.6 l 18 168.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 171.01 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 171.01 Tm (the date the Maximum Benefit Period under the Policy ends; or) Tj ET Q q n 18 168.6 m 630 168.6 l 630 156.6 l 18 156.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 159.01 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 159.01 Tm (the date the Insured Employee dies.) Tj ET Q q n 0 156.6 m 612 156.6 l 612 144.6 l 0 144.6 l h W n Q q n 0 144.6 m 612 144.6 l 612 132.6 l 0 132.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 135.01 Tm (EXCLUSIONS AND LIMITATIONS) Tj ET Q q n 0 132.6 m 612 132.6 l 612 120.6 l 0 120.6 l h W n Q q n 0 120.6 m 612 120.6 l 612 108.6 l 0 108.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 111.01 Tm (Prior) Tj ET BT /F2 12 Tf 1 0 0 1 30.38 111.01 Tm (Disability.) Tj ET BT /F3 12 Tf 1 0 0 1 88.84 111.01 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 113.24 111.01 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 149.62 111.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 171.35 111.01 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 189.74 111.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 204.13 111.01 Tm (payable) Tj ET BT /F3 12 Tf 1 0 0 1 244.5 111.01 Tm (during) Tj ET BT /F3 12 Tf 1 0 0 1 278.89 111.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 287.28 111.01 Tm (period) Tj ET BT /F3 12 Tf 1 0 0 1 321 111.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 334.06 111.01 Tm (Total) Tj ET BT /F3 12 Tf 1 0 0 1 362.44 111.01 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 412.84 111.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 425.9 111.01 Tm (Partial) Tj ET BT /F3 12 Tf 1 0 0 1 460.28 111.01 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 510.67 111.01 Tm (which) Tj ET Q q n 0 108.6 m 612 108.6 l 612 96.6 l 0 96.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 99.01 Tm (begins) Tj ET BT /F3 12 Tf 1 0 0 1 34.67 99.01 Tm (before) Tj ET BT /F3 12 Tf 1 0 0 1 68.65 99.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 86.65 99.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 125.98 99.01 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 184.8 99.01 Tm (effective) Tj ET BT /F3 12 Tf 1 0 0 1 230.1 99.01 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 253.42 99.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 266.76 99.01 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 313.4 99.01 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 344.06 99.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 362.06 99.01 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 396.06 99.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 409.4 99.01 Tm (before) Tj ET BT /F3 12 Tf 1 0 0 1 443.38 99.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 461.38 99.01 Tm (effective) Tj ET BT /F3 12 Tf 1 0 0 1 506.68 99.01 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 530 99.01 Tm (of) Tj ET Q q n 0 96.6 m 612 96.6 l 612 84.6 l 0 84.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 87.01 Tm (this Retirement Protection Benefit provision, if added later by amending the Policy.) Tj ET Q q n 0 84.6 m 612 84.6 l 612 72.6 l 0 72.6 l h W n Q q n 0 72.6 m 612 72.6 l 612 60.6 l 0 60.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 63.01 Tm (Pre-Existing) Tj ET BT /F2 12 Tf 1 0 0 1 69.62 63.01 Tm (Condition) Tj ET BT /F2 12 Tf 1 0 0 1 126.6 63.01 Tm (Limitation) Tj ET BT /F2 12 Tf 1 0 0 1 181.26 63.01 Tm (.) Tj ET BT /F3 12 Tf 1 0 0 1 195.52 63.01 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 222.48 63.01 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 261.42 63.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 285.72 63.01 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 306.68 63.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 323.63 63.01 Tm (payable) Tj ET BT /F3 12 Tf 1 0 0 1 366.57 63.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 386.19 63.01 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 409.14 63.01 Tm (Total) Tj ET BT /F3 12 Tf 1 0 0 1 440.09 63.01 Tm (Disability) Tj ET BT /F3 12 Tf 1 0 0 1 493.05 63.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 508.68 63.01 Tm (Partial) Tj ET Q q n 0 60.6 m 612 60.6 l 612 48.6 l 0 48.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 51.01 Tm (Disability which:) Tj ET Q q n 18 48.6 m 630 48.6 l 630 36.6 l 18 36.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 39.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 39.01 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 58.31 39.01 Tm (caused) Tj ET BT /F3 12 Tf 1 0 0 1 95.92 39.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 110.88 39.01 Tm (contributed) Tj ET BT /F3 12 Tf 1 0 0 1 170.49 39.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 184.78 39.01 Tm (by,) Tj ET BT /F3 12 Tf 1 0 0 1 204.74 39.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 219.7 39.01 Tm (results) Tj ET BT /F3 12 Tf 1 0 0 1 255.99 39.01 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 284.27 39.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 294.56 39.01 Tm (Pre-Existing) Tj ET BT /F3 12 Tf 1 0 0 1 359.51 39.01 Tm (Condition) Tj ET BT /F3 12 Tf 1 0 0 1 412.48 39.01 Tm (\(as) Tj ET BT /F3 12 Tf 1 0 0 1 431.43 39.01 Tm (defined) Tj ET BT /F3 12 Tf 1 0 0 1 472.37 39.01 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 486.66 39.01 Tm (this) Tj ET Q q n 45.35 36.6 m 657.35 36.6 l 657.35 24.6 l 45.35 24.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 27.01 Tm (provision\); and) Tj ET Q q n 18 24.6 m 630 24.6 l 630 12.6 l 18 12.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 15.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 15.01 Tm (begins in the first) Tj ET BT /F3 12 Tf 1 0 0 1 132 15.01 Tm (12) Tj ET BT /F3 12 Tf 1 0 0 1 147 15.01 Tm (months after the Insured Employee's effective date under this provision.) Tj ET Q q n 18 12.6 m 630 12.6 l 630 0.597 l 18 0.597 l h W n Q Q q Q Q endstream endobj 34 0 obj <>>>>> endobj 165 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 734.4 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 159.31 26.41 Tm (RETIREMENT PROTECTION BENEFIT) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 239 14.41 Tm (\(Continued\)) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-36-RT) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 265 14.41 Tm (32) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 676.8 m 612 676.8 l 612 664.8 l 0 664.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 667.21 Tm (Prior) Tj ET BT /F2 12 Tf 1 0 0 1 31.35 667.21 Tm (Insurance) Tj ET BT /F2 12 Tf 1 0 0 1 86.72 667.21 Tm (Credit.) Tj ET BT /F3 12 Tf 1 0 0 1 131.1 667.21 Tm (Prior) Tj ET BT /F3 12 Tf 1 0 0 1 159.13 667.21 Tm (Insurance) Tj ET BT /F3 12 Tf 1 0 0 1 209.8 667.21 Tm (Credit) Tj ET BT /F3 12 Tf 1 0 0 1 243.83 667.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 266.52 667.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 281.88 667.21 Tm (applied) Tj ET BT /F3 12 Tf 1 0 0 1 321.23 667.21 Tm (toward) Tj ET BT /F3 12 Tf 1 0 0 1 358.59 667.21 Tm (satisfying) Tj ET BT /F3 12 Tf 1 0 0 1 409.28 667.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 427.97 667.21 Tm (Pre-Existing) Tj ET BT /F3 12 Tf 1 0 0 1 491.99 667.21 Tm (Condition) Tj ET Q q n 0 664.8 m 612 664.8 l 612 652.8 l 0 652.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 655.21 Tm (Limitation) Tj ET BT /F3 12 Tf 1 0 0 1 56.38 655.21 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 89.43 655.21 Tm (this) Tj ET BT /F3 12 Tf 1 0 0 1 112.49 655.21 Tm (Retirement) Tj ET BT /F3 12 Tf 1 0 0 1 171.53 655.21 Tm (Protection) Tj ET BT /F3 12 Tf 1 0 0 1 226.57 655.21 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 267.62 655.21 Tm (provision) Tj ET BT /F3 12 Tf 1 0 0 1 318.67 655.21 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 331.73 655.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 342.78 655.21 Tm (similar) Tj ET BT /F3 12 Tf 1 0 0 1 381.83 655.21 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 420.87 655.21 Tm (was) Tj ET BT /F3 12 Tf 1 0 0 1 445.25 655.21 Tm (included) Tj ET BT /F3 12 Tf 1 0 0 1 492.3 655.21 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 655.21 Tm (the) Tj ET Q q n 0 652.8 m 612 652.8 l 612 640.8 l 0 640.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 643.21 Tm (Employer's) Tj ET BT /F3 12 Tf 1 0 0 1 57.76 643.21 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 84.69 643.21 Tm (group) Tj ET BT /F3 12 Tf 1 0 0 1 116.29 643.21 Tm (long) Tj ET BT /F3 12 Tf 1 0 0 1 141.23 643.21 Tm (term) Tj ET BT /F3 12 Tf 1 0 0 1 166.83 643.21 Tm (disability) Tj ET BT /F3 12 Tf 1 0 0 1 215.1 643.21 Tm (plan) Tj ET BT /F3 12 Tf 1 0 0 1 239.37 643.21 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 252.31 643.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 285.24 643.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 303.51 643.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 343.1 643.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 395.36 643.21 Tm (was) Tj ET BT /F3 12 Tf 1 0 0 1 417.63 643.21 Tm (covered) Tj ET BT /F3 12 Tf 1 0 0 1 459.21 643.21 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 474.82 643.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 493.08 643.21 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 516.67 643.21 Tm (prior) Tj ET Q q n 0 640.8 m 612 640.8 l 612 628.8 l 0 628.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 631.21 Tm (to the effective date of this provision.) Tj ET Q q n 0 628.8 m 612 628.8 l 612 616.8 l 0 616.8 l h W n Q q n 0 616.8 m 612 616.8 l 612 604.8 l 0 604.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 607.21 Tm (DEFINITIONS, as used in this provision.) Tj ET Q q n 0 604.8 m 612 604.8 l 612 592.8 l 0 592.8 l h W n Q q n 0 592.8 m 612 592.8 l 612 580.8 l 0 580.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 583.21 Tm ("Employer) Tj ET BT /F2 12 Tf 1 0 0 1 60.59 583.21 Tm (Sponsored) Tj ET BT /F2 12 Tf 1 0 0 1 117.88 583.21 Tm (Qualified) Tj ET BT /F2 12 Tf 1 0 0 1 169.15 583.21 Tm (Plan") Tj ET BT /F3 12 Tf 1 0 0 1 202.42 583.21 Tm (includes,) Tj ET BT /F3 12 Tf 1 0 0 1 248.68 583.21 Tm (but) Tj ET BT /F3 12 Tf 1 0 0 1 267.29 583.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 278.56 583.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 297.16 583.21 Tm (limited) Tj ET BT /F3 12 Tf 1 0 0 1 334.43 583.21 Tm (to,) Tj ET BT /F3 12 Tf 1 0 0 1 350.03 583.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 358.63 583.21 Tm (401\(k\),) Tj ET BT /F3 12 Tf 1 0 0 1 396.89 583.21 Tm (403\(b\),) Tj ET BT /F3 12 Tf 1 0 0 1 435.15 583.21 Tm (457,) Tj ET BT /F3 12 Tf 1 0 0 1 459.42 583.21 Tm (Money) Tj ET BT /F3 12 Tf 1 0 0 1 496.68 583.21 Tm (Purchase) Tj ET Q q n 0 580.8 m 612 580.8 l 612 568.8 l 0 568.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 571.21 Tm (Plan,) Tj ET BT /F3 12 Tf 1 0 0 1 27.6 571.21 Tm (Profit) Tj ET BT /F3 12 Tf 1 0 0 1 58.2 571.21 Tm (Sharing) Tj ET BT /F3 12 Tf 1 0 0 1 98.8 571.21 Tm (Plan,) Tj ET BT /F3 12 Tf 1 0 0 1 126.4 571.21 Tm (ESOP,) Tj ET BT /F3 12 Tf 1 0 0 1 162.02 571.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 175.28 571.21 Tm (Stock) Tj ET BT /F3 12 Tf 1 0 0 1 205.88 571.21 Tm (Plan.) Tj ET BT /F3 12 Tf 1 0 0 1 236.75 571.21 Tm (It) Tj ET BT /F3 12 Tf 1 0 0 1 247.35 571.21 Tm (does) Tj ET BT /F3 12 Tf 1 0 0 1 272.61 571.21 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 291.22 571.21 Tm (include) Tj ET BT /F3 12 Tf 1 0 0 1 329.8 571.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 344.4 571.21 Tm (individual) Tj ET BT /F3 12 Tf 1 0 0 1 396.33 571.21 Tm (retirement) Tj ET BT /F3 12 Tf 1 0 0 1 448.9 571.21 Tm (account) Tj ET BT /F3 12 Tf 1 0 0 1 489.48 571.21 Tm (\(IRA\)) Tj ET BT /F3 12 Tf 1 0 0 1 521.41 571.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 534.67 571.21 Tm (a) Tj ET Q q n 0 568.8 m 612 568.8 l 612 556.8 l 0 556.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 559.21 Tm (non-qualified plan of deferred compensation.) Tj ET Q q n 0 556.8 m 612 556.8 l 612 544.8 l 0 544.8 l h W n Q q n 0 544.8 m 612 544.8 l 612 532.8 l 0 532.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 535.21 Tm (") Tj ET BT /F2 12 Tf 1 0 0 1 4.9 535.21 Tm (Pre-Existing) Tj ET BT /F2 12 Tf 1 0 0 1 73.75 535.21 Tm (Condition") Tj ET BT /F3 12 Tf 1 0 0 1 136.63 535.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 172.15 535.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 182.34 535.21 Tm (Sickness) Tj ET BT /F3 12 Tf 1 0 0 1 229.21 535.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 244.07 535.21 Tm (Injury) Tj ET BT /F3 12 Tf 1 0 0 1 278.26 535.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 297.11 535.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 331.3 535.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 350.83 535.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 391.68 535.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 445.19 535.21 Tm (received) Tj ET BT /F3 12 Tf 1 0 0 1 490.69 535.21 Tm (Treatment) Tj ET Q q n 0 532.8 m 612 532.8 l 612 520.8 l 0 520.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 523.21 Tm (within) Tj ET BT /F3 12 Tf 1 0 0 1 36.71 523.21 Tm (3) Tj ET BT /F3 12 Tf 1 0 0 1 48.76 523.21 Tm (months) Tj ET BT /F3 12 Tf 1 0 0 1 90.14 523.21 Tm (prior) Tj ET BT /F3 12 Tf 1 0 0 1 119.51 523.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 134.89 523.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 155.6 523.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 197.63 523.21 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 259.16 523.21 Tm (effective) Tj ET BT /F3 12 Tf 1 0 0 1 307.17 523.21 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 333.2 523.21 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 366.57 523.21 Tm (this) Tj ET BT /F3 12 Tf 1 0 0 1 389.95 523.21 Tm (Retirement) Tj ET BT /F3 12 Tf 1 0 0 1 449.31 523.21 Tm (Protection) Tj ET BT /F3 12 Tf 1 0 0 1 504.68 523.21 Tm (Benefit) Tj ET Q q n 0 520.8 m 612 520.8 l 612 508.8 l 0 508.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 511.21 Tm (provision.) Tj ET Q q n 0 508.8 m 612 508.8 l 612 496.8 l 0 496.8 l h W n Q q n 0 496.8 m 612 496.8 l 612 484.8 l 0 484.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 487.21 Tm (") Tj ET BT /F2 12 Tf 1 0 0 1 4.9 487.21 Tm (Treatment) Tj ET BT /F3 12 Tf 1 0 0 1 59.54 487.21 Tm (") Tj ET BT /F3 12 Tf 1 0 0 1 67.53 487.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 101.28 487.21 Tm (consultation,) Tj ET BT /F3 12 Tf 1 0 0 1 166.03 487.21 Tm (care) Tj ET BT /F3 12 Tf 1 0 0 1 189.09 487.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 202.18 487.21 Tm (services) Tj ET BT /F3 12 Tf 1 0 0 1 243.92 487.21 Tm (provided) Tj ET BT /F3 12 Tf 1 0 0 1 289.67 487.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 304.76 487.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 313.17 487.21 Tm (Physician.) Tj ET BT /F3 12 Tf 1 0 0 1 369.02 487.21 Tm (It) Tj ET BT /F3 12 Tf 1 0 0 1 379.44 487.21 Tm (includes) Tj ET BT /F3 12 Tf 1 0 0 1 422.52 487.21 Tm (diagnostic) Tj ET BT /F3 12 Tf 1 0 0 1 474.94 487.21 Tm (measures) Tj ET BT /F3 12 Tf 1 0 0 1 522.67 487.21 Tm (and) Tj ET Q q n 0 484.8 m 612 484.8 l 612 472.8 l 0 472.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 475.21 Tm (the prescription, refill of prescription, or taking of any prescribed drugs or medicines.) Tj ET Q q n 0 472.8 m 612 472.8 l 612 460.8 l 0 460.8 l h W n Q q n 0 460.8 m 612 460.8 l 612 448.8 l 0 448.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 451.21 Tm (OTHER) Tj ET BT /F2 12 Tf 1 0 0 1 46.37 451.21 Tm (PROVISIONS.) Tj ET BT /F3 12 Tf 1 0 0 1 130.1 451.21 Tm (Unless) Tj ET BT /F3 12 Tf 1 0 0 1 165.79 451.21 Tm (stated) Tj ET BT /F3 12 Tf 1 0 0 1 196.81 451.21 Tm (otherwise,) Tj ET BT /F3 12 Tf 1 0 0 1 249.49 451.21 Tm (this) Tj ET BT /F3 12 Tf 1 0 0 1 269.85 451.21 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 306.19 451.21 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 327.89 451.21 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 342.24 451.21 Tm (subject) Tj ET BT /F3 12 Tf 1 0 0 1 379.25 451.21 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 391.61 451.21 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 406.63 451.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 424.32 451.21 Tm (Definitions,) Tj ET BT /F3 12 Tf 1 0 0 1 484.34 451.21 Tm (Exclusions,) Tj ET Q q n 0 448.8 m 612 448.8 l 612 436.8 l 0 436.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 439.21 Tm (Claims Procedures, Waiver of Premium and other provisions of the Policy.) Tj ET Q q n 0 436.8 m 612 436.8 l 612 424.8 l 0 424.8 l h W n Q Q q Q Q endstream endobj 35 0 obj <>>>>> endobj 166 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 758.4 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 170.15 2.41 Tm (FAMILY CARE EXPENSE BENEFIT) Tj ET Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-39-FC PA) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 264.65 14.41 Tm (33) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 503.74 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 684.6 m 612 684.6 l 612 672.6 l 0 672.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 675.01 Tm (BENEFIT.) Tj ET BT /F3 12 Tf 1 0 0 1 64.15 675.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 87.04 675.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 137.94 675.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 160.84 675.01 Tm (reimburse) Tj ET BT /F3 12 Tf 1 0 0 1 213.06 675.01 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 228.62 675.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 268.84 675.01 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 328.55 675.01 Tm (Family) Tj ET BT /F3 12 Tf 1 0 0 1 366.79 675.01 Tm (Care) Tj ET BT /F3 12 Tf 1 0 0 1 393.68 675.01 Tm (Expenses) Tj ET BT /F3 12 Tf 1 0 0 1 443.23 675.01 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 457.46 675.01 Tm (described) Tj ET BT /F3 12 Tf 1 0 0 1 507.67 675.01 Tm (below,) Tj ET Q q n 0 672.6 m 612 672.6 l 612 660.6 l 0 660.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 663.01 Tm (while he or she is:) Tj ET Q q n 18 660.6 m 630 660.6 l 630 648.6 l 18 648.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 651.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 651.01 Tm (receiving a Partial Disability Monthly Benefit under the Policy; or) Tj ET Q q n 18 648.6 m 630 648.6 l 630 636.6 l 18 636.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 639.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45 639.01 Tm (receiving a Total Disability Benefit under the Policy, and:) Tj ET Q q n 45 636.6 m 657 636.6 l 657 624.6 l 45 624.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 627.01 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72 627.01 Tm (is Terminally Ill;) Tj ET Q q n 45 624.6 m 657 624.6 l 657 612.6 l 45 612.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 615.01 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72 615.01 Tm (has suffered a Cognitive Impairment; or) Tj ET Q q n 45 612.6 m 657 612.6 l 657 600.6 l 45 600.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 603.01 Tm (c.) Tj ET BT /F3 12 Tf 1 0 0 1 72 603.01 Tm (has suffered a Loss of Activities of Daily Living.) Tj ET Q q n 0 600.6 m 612 600.6 l 612 588.6 l 0 588.6 l h W n Q q n 0 588.6 m 612 588.6 l 612 576.6 l 0 576.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 579.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 22.03 579.01 Tm (Family) Tj ET BT /F3 12 Tf 1 0 0 1 59.4 579.01 Tm (Care) Tj ET BT /F3 12 Tf 1 0 0 1 85.43 579.01 Tm (Expense) Tj ET BT /F3 12 Tf 1 0 0 1 129.45 579.01 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 168.15 579.01 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 179.52 579.01 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 203.56 579.01 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 216.26 579.01 Tm (addition) Tj ET BT /F3 12 Tf 1 0 0 1 258.96 579.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 271.67 579.01 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 287.04 579.01 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 315.07 579.01 Tm (Policy) Tj ET BT /F3 12 Tf 1 0 0 1 349.11 579.01 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 390.47 579.01 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 411.16 579.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 433.21 579.01 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 451.91 579.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 466.61 579.01 Tm (offset) Tj ET BT /F3 12 Tf 1 0 0 1 497.31 579.01 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 512.68 579.01 Tm (Other) Tj ET Q q n 0 576.6 m 612 576.6 l 612 564.6 l 0 564.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 567.01 Tm (Income Benefits.) Tj ET Q q n 0 564.6 m 612 564.6 l 612 552.6 l 0 552.6 l h W n Q q n 0 552.6 m 612 552.6 l 612 540.6 l 0 540.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 543.01 Tm (PROOF.) Tj ET BT /F3 12 Tf 1 0 0 1 52.88 543.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 75.48 543.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 115.42 543.01 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 168.01 543.01 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 195.29 543.01 Tm (submit) Tj ET BT /F3 12 Tf 1 0 0 1 231.91 543.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 245.19 543.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 263.79 543.01 Tm (Company) Tj ET BT /F3 12 Tf 1 0 0 1 314.4 543.01 Tm (satisfactory) Tj ET BT /F3 12 Tf 1 0 0 1 373.66 543.01 Tm (proof) Tj ET BT /F3 12 Tf 1 0 0 1 403.6 543.01 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 425.53 543.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 434.8 543.01 Tm (Family) Tj ET BT /F3 12 Tf 1 0 0 1 472.75 543.01 Tm (Care) Tj ET BT /F3 12 Tf 1 0 0 1 499.35 543.01 Tm (Expense) Tj ET Q q n 0 540.6 m 612 540.6 l 612 528.6 l 0 528.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 531.01 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 19.77 531.01 Tm (been) Tj ET BT /F3 12 Tf 1 0 0 1 46.21 531.01 Tm (incurred) Tj ET BT /F3 12 Tf 1 0 0 1 89.96 531.01 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 107.74 531.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 116.84 531.01 Tm (Dependent) Tj ET BT /F3 12 Tf 1 0 0 1 172.6 531.01 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 193.7 531.01 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 218.14 531.01 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 233.92 531.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 252.36 531.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 292.13 531.01 Tm (Employee.) Tj ET BT /F3 12 Tf 1 0 0 1 351.34 531.01 Tm (Proof) Tj ET BT /F3 12 Tf 1 0 0 1 381.78 531.01 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 408.9 531.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 424 531.01 Tm (submitted) Tj ET BT /F3 12 Tf 1 0 0 1 475.11 531.01 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 490.89 531.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 500 531.01 Tm (monthly) Tj ET Q q n 0 528.6 m 612 528.6 l 612 516.6 l 0 516.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 519.01 Tm (basis.) Tj ET BT /F3 12 Tf 1 0 0 1 33 519.01 Tm (Satisfactory proof is a signed receipt from the Dependent care provider showing:) Tj ET Q q n 18 516.6 m 630 516.6 l 630 504.6 l 18 504.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 507.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 507.01 Tm (Dependent name;) Tj ET Q q n 18 504.6 m 630 504.6 l 630 492.6 l 18 492.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 495.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45 495.01 Tm (Dependent age;) Tj ET Q q n 18 492.6 m 630 492.6 l 630 480.6 l 18 480.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 483.01 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45 483.01 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 55.79 483.01 Tm (Dependent) Tj ET BT /F3 12 Tf 1 0 0 1 111.23 483.01 Tm (age) Tj ET BT /F3 12 Tf 1 0 0 1 131.35 483.01 Tm (exceeds) Tj ET BT /F3 12 Tf 1 0 0 1 172.78 483.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 190.91 483.01 Tm (maximum) Tj ET BT /F3 12 Tf 1 0 0 1 243.03 483.01 Tm (shown) Tj ET BT /F3 12 Tf 1 0 0 1 277.83 483.01 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 290.62 483.01 Tm (definition) Tj ET BT /F3 12 Tf 1 0 0 1 340.74 483.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 354.2 483.01 Tm ("Dependent") Tj ET BT /F3 12 Tf 1 0 0 1 419.44 483.01 Tm (below,) Tj ET BT /F3 12 Tf 1 0 0 1 455.23 483.01 Tm (reason) Tj ET BT /F3 12 Tf 1 0 0 1 490.01 483.01 Tm (for) Tj ET Q q n 45 480.6 m 657 480.6 l 657 468.6 l 45 468.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 471.01 Tm (care;) Tj ET Q q n 18 468.6 m 630 468.6 l 630 456.6 l 18 456.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 459.01 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45 459.01 Tm (dates of care;) Tj ET Q q n 18 456.6 m 630 456.6 l 630 444.6 l 18 444.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 447.01 Tm (5.) Tj ET BT /F3 12 Tf 1 0 0 1 45 447.01 Tm (total charges for care;) Tj ET Q q n 18 444.6 m 630 444.6 l 630 432.6 l 18 432.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 435.01 Tm (6.) Tj ET BT /F3 12 Tf 1 0 0 1 45 435.01 Tm (total payments for care; and) Tj ET Q q n 18 432.6 m 630 432.6 l 630 420.6 l 18 420.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 423.01 Tm (7.) Tj ET BT /F3 12 Tf 1 0 0 1 45 423.01 Tm (provider) Tj ET BT /F3 12 Tf 1 0 0 1 98 423.01 Tm (name,) Tj ET BT /F3 12 Tf 1 0 0 1 139.34 423.01 Tm (address,) Tj ET BT /F3 12 Tf 1 0 0 1 190.68 423.01 Tm (telephone) Tj ET BT /F3 12 Tf 1 0 0 1 249.67 423.01 Tm (number,) Tj ET BT /F3 12 Tf 1 0 0 1 301.68 423.01 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 331.36 423.01 Tm (Federal) Tj ET BT /F3 12 Tf 1 0 0 1 379.69 423.01 Tm (Employer) Tj ET BT /F3 12 Tf 1 0 0 1 439.36 423.01 Tm (Identification) Tj ET Q q n 45 420.6 m 657 420.6 l 657 408.6 l 45 408.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 411.01 Tm (Number/Taxpayer Identification Number.) Tj ET Q q n 0 408.6 m 612 408.6 l 612 396.6 l 0 396.6 l h W n Q q n 0 396.6 m 612 396.6 l 612 384.6 l 0 384.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 387.01 Tm (AMOUNT.) Tj ET BT /F3 12 Tf 1 0 0 1 66.72 387.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 89.91 387.01 Tm (Family) Tj ET BT /F3 12 Tf 1 0 0 1 128.44 387.01 Tm (Care) Tj ET BT /F3 12 Tf 1 0 0 1 155.62 387.01 Tm (Expense) Tj ET BT /F3 12 Tf 1 0 0 1 200.8 387.01 Tm (Benefit) Tj ET BT /F3 12 Tf 1 0 0 1 240.65 387.01 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 263.85 387.01 Tm (equal) Tj ET BT /F3 12 Tf 1 0 0 1 294.36 387.01 Tm (actual) Tj ET BT /F3 12 Tf 1 0 0 1 327.54 387.01 Tm (Family) Tj ET BT /F3 12 Tf 1 0 0 1 366.07 387.01 Tm (Care) Tj ET BT /F3 12 Tf 1 0 0 1 393.25 387.01 Tm (Expenses) Tj ET BT /F3 12 Tf 1 0 0 1 443.1 387.01 Tm (paid) Tj ET BT /F3 12 Tf 1 0 0 1 468.29 387.01 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 484.82 387.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 504.01 387.01 Tm (Insured) Tj ET Q q n 0 384.6 m 612 384.6 l 612 372.6 l 0 372.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 375.01 Tm (Employee that are not reimbursable from other sources, up to $250 per month for each eligible Dependent.) Tj ET Q q n 0 372.6 m 612 372.6 l 612 360.6 l 0 360.6 l h W n Q q n 0 360.6 m 612 360.6 l 612 348.6 l 0 348.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 351.01 Tm (DURATION.) Tj ET BT /F3 12 Tf 1 0 0 1 74.34 351.01 Tm (The Family Care Expense Benefit will cease on the earliest of:) Tj ET Q q n 18 348.6 m 630 348.6 l 630 336.6 l 18 336.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 339.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 339.01 Tm (the date the Insured Employee's Total or Partial Disability Benefits under the Policy cease;) Tj ET Q q n 18 336.6 m 630 336.6 l 630 324.6 l 18 324.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 327.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45 327.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 63.16 327.01 Tm (date) Tj ET BT /F3 12 Tf 1 0 0 1 86.64 327.01 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 101.47 327.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 140.95 327.01 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 199.93 327.01 Tm (Dependents) Tj ET BT /F3 12 Tf 1 0 0 1 260.08 327.01 Tm (no) Tj ET BT /F3 12 Tf 1 0 0 1 275.58 327.01 Tm (longer) Tj ET BT /F3 12 Tf 1 0 0 1 309.73 327.01 Tm (meet) Tj ET BT /F3 12 Tf 1 0 0 1 336.55 327.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 354.71 327.01 Tm (definition) Tj ET BT /F3 12 Tf 1 0 0 1 404.86 327.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 418.35 327.01 Tm (Dependent) Tj ET BT /F3 12 Tf 1 0 0 1 473.83 327.01 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 486.66 327.01 Tm (this) Tj ET Q q n 45 324.6 m 657 324.6 l 657 312.6 l 45 312.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 315.01 Tm (provision; or) Tj ET Q q n 18 312.6 m 630 312.6 l 630 300.6 l 18 300.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 303.01 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45 303.01 Tm (the date the Company has made 12 monthly Family Care Expense Benefit payments.) Tj ET Q q n 18 300.6 m 630 300.6 l 630 288.6 l 18 288.6 l h W n Q q n 0 288.6 m 612 288.6 l 612 276.6 l 0 276.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 279.01 Tm (DEFINITIONS.) Tj ET Q q n 0 276.6 m 612 276.6 l 612 264.6 l 0 264.6 l h W n Q q n 0 264.6 m 612 264.6 l 612 252.6 l 0 252.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 255.01 Tm ("Child") Tj ET BT /F3 12 Tf 1 0 0 1 45.72 255.01 Tm (includes) Tj ET BT /F3 12 Tf 1 0 0 1 89.42 255.01 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 107.79 255.01 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 147.49 255.01 Tm (Employee's) Tj ET BT /F3 12 Tf 1 0 0 1 206.68 255.01 Tm (naturally) Tj ET BT /F3 12 Tf 1 0 0 1 253.05 255.01 Tm (born) Tj ET BT /F3 12 Tf 1 0 0 1 278.75 255.01 Tm (child,) Tj ET BT /F3 12 Tf 1 0 0 1 309.46 255.01 Tm (legally) Tj ET BT /F3 12 Tf 1 0 0 1 345.83 255.01 Tm (adopted) Tj ET BT /F3 12 Tf 1 0 0 1 387.52 255.01 Tm (child,) Tj ET BT /F3 12 Tf 1 0 0 1 418.23 255.01 Tm (stepchild,) Tj ET BT /F3 12 Tf 1 0 0 1 468.27 255.01 Tm (foster) Tj ET BT /F3 12 Tf 1 0 0 1 499.3 255.01 Tm (child,) Tj ET BT /F3 12 Tf 1 0 0 1 530 255.01 Tm (or) Tj ET Q q n 0 252.6 m 612 252.6 l 612 240.6 l 0 240.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 243.01 Tm (child for whom the Insured Employee is the legal guardian.) Tj ET Q q n 0 240.6 m 612 240.6 l 612 228.6 l 0 228.6 l h W n Q q n 0 228.6 m 612 228.6 l 612 216.6 l 0 216.6 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 219.01 Tm ("Cognitive Impairment") Tj ET BT /F3 12 Tf 1 0 0 1 127.65 219.01 Tm ( means that the Insured Employee or Dependent:) Tj ET Q q n 18 216.6 m 630 216.6 l 630 204.6 l 18 204.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 207.01 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 207.01 Tm (has suffered a permanent deterioration or loss of cognitive or intellectual capacity; and) Tj ET Q q n 18 204.6 m 630 204.6 l 630 192.6 l 18 192.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 195.01 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45.35 195.01 Tm (requires) Tj ET BT /F3 12 Tf 1 0 0 1 87.24 195.01 Tm (another) Tj ET BT /F3 12 Tf 1 0 0 1 126.47 195.01 Tm (person's) Tj ET BT /F3 12 Tf 1 0 0 1 168.53 195.01 Tm (active,) Tj ET BT /F3 12 Tf 1 0 0 1 203.42 195.01 Tm (hands-on) Tj ET BT /F3 12 Tf 1 0 0 1 250.66 195.01 Tm (help) Tj ET BT /F3 12 Tf 1 0 0 1 274.56 195.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 287.8 195.01 Tm (verbal) Tj ET BT /F3 12 Tf 1 0 0 1 321.02 195.01 Tm (cues) Tj ET BT /F3 12 Tf 1 0 0 1 345.59 195.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 358.17 195.01 Tm (prevent) Tj ET BT /F3 12 Tf 1 0 0 1 397.39 195.01 Tm (harm) Tj ET BT /F3 12 Tf 1 0 0 1 425.29 195.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 437.87 195.01 Tm (self) Tj ET BT /F3 12 Tf 1 0 0 1 458.44 195.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 471.67 195.01 Tm (others,) Tj ET Q q n 45.35 192.6 m 657.35 192.6 l 657.35 180.6 l 45.35 180.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 183.01 Tm (due to that impairment.) Tj ET Q q n 0 180.6 m 612 180.6 l 612 168.6 l 0 168.6 l h W n Q q n 0 168.6 m 612 168.6 l 612 156.6 l 0 156.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 159.01 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 22.07 159.01 Tm (impairment) Tj ET BT /F3 12 Tf 1 0 0 1 80.8 159.01 Tm (must) Tj ET BT /F3 12 Tf 1 0 0 1 107.55 159.01 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 122.28 159.01 Tm (diagnosed) Tj ET BT /F3 12 Tf 1 0 0 1 174.35 159.01 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 189.76 159.01 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 198.5 159.01 Tm (Physician,) Tj ET BT /F3 12 Tf 1 0 0 1 251.57 159.01 Tm (based) Tj ET BT /F3 12 Tf 1 0 0 1 282.31 159.01 Tm (upon) Tj ET BT /F3 12 Tf 1 0 0 1 309.72 159.01 Tm (clinical) Tj ET BT /F3 12 Tf 1 0 0 1 348.44 159.01 Tm (evidence) Tj ET BT /F3 12 Tf 1 0 0 1 394.49 159.01 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 415.23 159.01 Tm (reliable) Tj ET BT /F3 12 Tf 1 0 0 1 454.62 159.01 Tm (standardized) Tj ET BT /F3 12 Tf 1 0 0 1 518.67 159.01 Tm (tests) Tj ET Q q n 0 156.6 m 612 156.6 l 612 144.6 l 0 144.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 147.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 13.52 147.01 Tm (short) Tj ET BT /F3 12 Tf 1 0 0 1 41.05 147.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 54.57 147.01 Tm (long-term) Tj ET BT /F3 12 Tf 1 0 0 1 105.42 147.01 Tm (memory;) Tj ET BT /F3 12 Tf 1 0 0 1 152.27 147.01 Tm (orientation) Tj ET BT /F3 12 Tf 1 0 0 1 207.79 147.01 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 221.31 147.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 234.17 147.01 Tm (person,) Tj ET BT /F3 12 Tf 1 0 0 1 272.69 147.01 Tm (place) Tj ET BT /F3 12 Tf 1 0 0 1 301.53 147.01 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 322.38 147.01 Tm (time;) Tj ET BT /F3 12 Tf 1 0 0 1 350.57 147.01 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 371.43 147.01 Tm (deductive) Tj ET BT /F3 12 Tf 1 0 0 1 421.6 147.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 435.12 147.01 Tm (abstract) Tj ET BT /F3 12 Tf 1 0 0 1 475.96 147.01 Tm (reasoning.) Tj ET BT /F3 12 Tf 1 0 0 1 532.67 147.01 Tm (It) Tj ET Q q n 0 144.6 m 612 144.6 l 612 132.6 l 0 132.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 135.01 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 25.91 135.01 Tm (result) Tj ET BT /F3 12 Tf 1 0 0 1 57.81 135.01 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 86.39 135.01 Tm (moderate) Tj ET BT /F3 12 Tf 1 0 0 1 136.28 135.01 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 150.85 135.01 Tm (severe) Tj ET BT /F3 12 Tf 1 0 0 1 186.75 135.01 Tm (head) Tj ET BT /F3 12 Tf 1 0 0 1 214.65 135.01 Tm (trauma,) Tj ET BT /F3 12 Tf 1 0 0 1 256.21 135.01 Tm (stroke,) Tj ET BT /F3 12 Tf 1 0 0 1 293.78 135.01 Tm (Alzheimer's) Tj ET BT /F3 12 Tf 1 0 0 1 356.5 135.01 Tm (disease) Tj ET BT /F3 12 Tf 1 0 0 1 396.4 135.01 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 411.64 135.01 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 441.55 135.01 Tm (form) Tj ET BT /F3 12 Tf 1 0 0 1 470.12 135.01 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 485.36 135.01 Tm (irreversible) Tj ET Q q n 0 132.6 m 612 132.6 l 612 120.6 l 0 120.6 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 123.01 Tm (dementia.) Tj ET Q q n 0 120.6 m 612 120.6 l 612 108.6 l 0 108.6 l h W n Q Q q Q Q endstream endobj 36 0 obj <>>>>> endobj 167 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 734.4 cm q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 170.15 26.41 Tm (FAMILY CARE EXPENSE BENEFIT) Tj ET Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 239 14.41 Tm (\(Continued\)) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 36 m 183.6 36 l 183.6 24 l 0 24 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 26.41 Tm (GL3002-CERT-39-FC PA) Tj ET Q q n 183.6 36 m 367.2 36 l 367.2 24 l 183.6 24 l h W n Q q n 0 24 m 183.6 24 l 183.6 12 l 0 12 l h W n Q q n 183.6 24 m 367.2 24 l 367.2 12 l 183.6 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 264.65 14.41 Tm (34) Tj ET Q q n 367.2 24 m 550.8 24 l 550.8 12 l 367.2 12 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 503.74 14.41 Tm (07/01/21) Tj ET Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 57.6 cm q n 0 676.8 m 612 676.8 l 612 664.8 l 0 664.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 667.21 Tm ("Dependent") Tj ET BT /F3 12 Tf 1 0 0 1 68.66 667.21 Tm ( means the Insured Employee's:) Tj ET Q q n 18 664.8 m 630 664.8 l 630 652.8 l 18 652.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 655.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 655.21 Tm (legal spouse, who is:) Tj ET Q q n 45 652.8 m 657 652.8 l 657 640.8 l 45 640.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 643.21 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72 643.21 Tm (living with the Insured Employee; and) Tj ET Q q n 45 640.8 m 657 640.8 l 657 628.8 l 45 628.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 631.21 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72 631.21 Tm (Incapable of Independent Living due to a mental or physical condition;) Tj ET Q q n 18 628.8 m 630 628.8 l 630 616.8 l 18 616.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 619.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45 619.21 Tm (Child less than age 16;) Tj ET Q q n 18 616.8 m 630 616.8 l 630 604.8 l 18 604.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 607.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45 607.21 Tm (unmarried Child age 16 years or older, who is:) Tj ET Q q n 45 604.8 m 657 604.8 l 657 592.8 l 45 592.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 595.21 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72 595.21 Tm (living with the Insured Employee; and) Tj ET Q q n 45 592.8 m 657 592.8 l 657 580.8 l 45 580.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 583.21 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72 583.21 Tm (Incapable of Independent Living due to a mental or physical condition; or) Tj ET Q q n 18 580.8 m 630 580.8 l 630 568.8 l 18 568.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 571.21 Tm (4.) Tj ET BT /F3 12 Tf 1 0 0 1 45 571.21 Tm (parent or parent-in-law, who is:) Tj ET Q q n 45 568.8 m 657 568.8 l 657 556.8 l 45 556.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 559.21 Tm (a.) Tj ET BT /F3 12 Tf 1 0 0 1 72 559.21 Tm (living with the Insured Employee; and) Tj ET Q q n 45 556.8 m 657 556.8 l 657 544.8 l 45 544.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45 547.21 Tm (b.) Tj ET BT /F3 12 Tf 1 0 0 1 72 547.21 Tm (Incapable of Independent Living due to a mental or physical condition.) Tj ET Q q n 0 544.8 m 612 544.8 l 612 532.8 l 0 532.8 l h W n Q q n 0 532.8 m 612 532.8 l 612 520.8 l 0 520.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 523.21 Tm ("Family) Tj ET BT /F2 12 Tf 1 0 0 1 46.65 523.21 Tm (Care) Tj ET BT /F2 12 Tf 1 0 0 1 75.96 523.21 Tm (Expense") Tj ET BT /F3 12 Tf 1 0 0 1 129.29 523.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 163.94 523.21 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 179.26 523.21 Tm (expense) Tj ET BT /F3 12 Tf 1 0 0 1 221.9 523.21 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 239.89 523.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 258.54 523.21 Tm (care) Tj ET BT /F3 12 Tf 1 0 0 1 282.51 523.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 296.5 523.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 305.82 523.21 Tm (Dependent,) Tj ET BT /F3 12 Tf 1 0 0 1 364.79 523.21 Tm (charged) Tj ET BT /F3 12 Tf 1 0 0 1 406.76 523.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 422.75 523.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 432.07 523.21 Tm (licensed) Tj ET BT /F3 12 Tf 1 0 0 1 475.38 523.21 Tm (care) Tj ET BT /F3 12 Tf 1 0 0 1 499.35 523.21 Tm (provider) Tj ET Q q n 0 520.8 m 612 520.8 l 612 508.8 l 0 508.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 511.21 Tm (who:) Tj ET Q q n 18 508.8 m 630 508.8 l 630 496.8 l 18 496.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 499.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 499.21 Tm (is not a member of the Insured Employee's immediate family; and) Tj ET Q q n 18 496.8 m 630 496.8 l 630 484.8 l 18 484.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 487.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45 487.21 Tm (is not living in the Insured Employee's home.) Tj ET Q q n 18 484.8 m 630 484.8 l 630 472.8 l 18 472.8 l h W n Q q n 0 472.8 m 612 472.8 l 612 460.8 l 0 460.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 463.21 Tm ("Incapable of Independent Living") Tj ET BT /F3 12 Tf 1 0 0 1 181.03 463.21 Tm ( means the Dependent:) Tj ET Q q n 18 460.8 m 630 460.8 l 630 448.8 l 18 448.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 451.21 Tm (1.) Tj ET BT /F3 12 Tf 1 0 0 1 45 451.21 Tm (is Terminally Ill;) Tj ET Q q n 18 448.8 m 630 448.8 l 630 436.8 l 18 436.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 439.21 Tm (2.) Tj ET BT /F3 12 Tf 1 0 0 1 45 439.21 Tm (suffers a Cognitive Impairment; or) Tj ET Q q n 18 436.8 m 630 436.8 l 630 424.8 l 18 424.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 427.21 Tm (3.) Tj ET BT /F3 12 Tf 1 0 0 1 45 427.21 Tm (suffers a Loss of Activities of Daily Living.) Tj ET Q q n 0 424.8 m 612 424.8 l 612 412.8 l 0 412.8 l h W n Q q n 0 412.8 m 612 412.8 l 612 400.8 l 0 400.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 403.21 Tm ("Loss) Tj ET BT /F2 12 Tf 1 0 0 1 34.52 403.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 49.03 403.21 Tm (Activities) Tj ET BT /F2 12 Tf 1 0 0 1 101.53 403.21 Tm (of) Tj ET BT /F2 12 Tf 1 0 0 1 116.04 403.21 Tm (Daily) Tj ET BT /F2 12 Tf 1 0 0 1 147.89 403.21 Tm (Living") Tj ET BT /F3 12 Tf 1 0 0 1 192.42 403.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 227.59 403.21 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 250.1 403.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 269.27 403.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 309.78 403.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 362.94 403.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 377.45 403.21 Tm (Dependent) Tj ET BT /F3 12 Tf 1 0 0 1 433.95 403.21 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 454.46 403.21 Tm (lost) Tj ET BT /F3 12 Tf 1 0 0 1 476.31 403.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 495.49 403.21 Tm (ability) Tj ET BT /F3 12 Tf 1 0 0 1 530.67 403.21 Tm (to) Tj ET Q q n 0 400.8 m 612 400.8 l 612 388.8 l 0 388.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 391.21 Tm (safely) Tj ET BT /F3 12 Tf 1 0 0 1 33.16 391.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 55 391.21 Tm (completely) Tj ET BT /F3 12 Tf 1 0 0 1 112.82 391.21 Tm (perform) Tj ET BT /F2 12 Tf 1 0 0 1 155.97 391.21 Tm (two) Tj ET BT /F2 12 Tf 1 0 0 1 179.15 391.21 Tm (or) Tj ET BT /F2 12 Tf 1 0 0 1 194.98 391.21 Tm (more) Tj ET BT /F3 12 Tf 1 0 0 1 226.14 391.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 240.64 391.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 259.81 391.21 Tm (following) Tj ET BT /F3 12 Tf 1 0 0 1 310.98 391.21 Tm (six) Tj ET BT /F3 12 Tf 1 0 0 1 329.5 391.21 Tm (Activities) Tj ET BT /F3 12 Tf 1 0 0 1 380.66 391.21 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 395.17 391.21 Tm (Daily) Tj ET BT /F3 12 Tf 1 0 0 1 426.34 391.21 Tm (Living) Tj ET BT /F3 12 Tf 1 0 0 1 462.84 391.21 Tm (without) Tj ET BT /F3 12 Tf 1 0 0 1 504.02 391.21 Tm (another) Tj ET Q q n 0 388.8 m 612 388.8 l 612 376.8 l 0 376.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 379.21 Tm (person's active, hands-on help with all or most of the activity.) Tj ET Q q n 0 376.8 m 612 376.8 l 612 364.8 l 0 364.8 l h W n Q q n 0 364.8 m 612 364.8 l 612 352.8 l 0 352.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 355.21 Tm (The six Activities of Daily Living are:) Tj ET Q q n 18 352.8 m 630 352.8 l 630 340.8 l 18 340.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 343.21 Tm (1.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 343.21 Tm (Bathing) Tj ET BT /F3 12 Tf 1 0 0 1 86.03 343.21 Tm ( - washing self in a tub, in a shower or by sponge bath; with or without equipment.) Tj ET Q q n 18 340.8 m 630 340.8 l 630 328.8 l 18 328.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 331.21 Tm (2.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 331.21 Tm (Dressing) Tj ET BT /F3 12 Tf 1 0 0 1 93.83 331.21 Tm (-) Tj ET BT /F3 12 Tf 1 0 0 1 101.64 331.21 Tm (putting) Tj ET BT /F3 12 Tf 1 0 0 1 139.46 331.21 Tm (on,) Tj ET BT /F3 12 Tf 1 0 0 1 158.27 331.21 Tm (taking) Tj ET BT /F3 12 Tf 1 0 0 1 192.08 331.21 Tm (off,) Tj ET BT /F3 12 Tf 1 0 0 1 212.88 331.21 Tm (fastening) Tj ET BT /F3 12 Tf 1 0 0 1 260.68 331.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 274.49 331.21 Tm (unfastening) Tj ET BT /F3 12 Tf 1 0 0 1 334.29 331.21 Tm (garments,) Tj ET BT /F3 12 Tf 1 0 0 1 385.09 331.21 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 406.23 331.21 Tm (medically) Tj ET BT /F3 12 Tf 1 0 0 1 457.36 331.21 Tm (necessary) Tj ET Q q n 45.35 328.8 m 657.35 328.8 l 657.35 316.8 l 45.35 316.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 319.21 Tm (braces, or any artificial limbs normally worn.) Tj ET Q q n 18 316.8 m 630 316.8 l 630 304.8 l 18 304.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 307.2 Tm (3.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 307.2 Tm (Toileting) Tj ET BT /F3 12 Tf 1 0 0 1 91.35 307.2 Tm ( - getting to, from, on and off toilet and performing related personal hygiene.) Tj ET Q q n 18 304.8 m 630 304.8 l 630 292.8 l 18 292.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 295.2 Tm (4.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 295.2 Tm (Transferring) Tj ET BT /F3 12 Tf 1 0 0 1 115.55 295.2 Tm (-) Tj ET BT /F3 12 Tf 1 0 0 1 123.08 295.2 Tm (moving) Tj ET BT /F3 12 Tf 1 0 0 1 163.29 295.2 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 176.16 295.2 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 197.03 295.2 Tm (out) Tj ET BT /F3 12 Tf 1 0 0 1 215.9 295.2 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 229.44 295.2 Tm (bed,) Tj ET BT /F3 12 Tf 1 0 0 1 253.3 295.2 Tm (chair) Tj ET BT /F3 12 Tf 1 0 0 1 280.82 295.2 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 294.36 295.2 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 315.22 295.2 Tm (wheelchair;) Tj ET BT /F3 12 Tf 1 0 0 1 374.73 295.2 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 399.6 295.2 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 413.14 295.2 Tm (without) Tj ET BT /F3 12 Tf 1 0 0 1 453.35 295.2 Tm (equipment) Tj ET Q q n 45.35 292.8 m 657.35 292.8 l 657.35 280.8 l 45.35 280.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 283.2 Tm (such) Tj ET BT /F3 12 Tf 1 0 0 1 70.92 283.2 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 84.49 283.2 Tm (canes,) Tj ET BT /F3 12 Tf 1 0 0 1 117.72 283.2 Tm (walkers,) Tj ET BT /F3 12 Tf 1 0 0 1 161.61 283.2 Tm (crutches,) Tj ET BT /F3 12 Tf 1 0 0 1 208.17 283.2 Tm (grab) Tj ET BT /F3 12 Tf 1 0 0 1 233.06 283.2 Tm (bars,) Tj ET BT /F3 12 Tf 1 0 0 1 259.63 283.2 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 287.86 283.2 Tm (support) Tj ET BT /F3 12 Tf 1 0 0 1 327.44 283.2 Tm (devices,) Tj ET BT /F3 12 Tf 1 0 0 1 370 283.2 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 383.57 283.2 Tm (mechanical) Tj ET BT /F3 12 Tf 1 0 0 1 441.78 283.2 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 455.35 283.2 Tm (motorized) Tj ET Q q n 45.35 280.8 m 657.35 280.8 l 657.35 268.8 l 45.35 268.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 271.2 Tm (devices.) Tj ET Q q n 18 268.8 m 630 268.8 l 630 256.8 l 18 256.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 259.2 Tm (5.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 259.2 Tm (Continence) Tj ET BT /F2 12 Tf 1 0 0 1 108.14 259.2 Tm (-) Tj ET BT /F3 12 Tf 1 0 0 1 116.93 259.2 Tm (voluntarily) Tj ET BT /F3 12 Tf 1 0 0 1 174.39 259.2 Tm (maintaining) Tj ET BT /F3 12 Tf 1 0 0 1 236.51 259.2 Tm (control) Tj ET BT /F3 12 Tf 1 0 0 1 275.29 259.2 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 290.08 259.2 Tm (bladder) Tj ET BT /F3 12 Tf 1 0 0 1 330.86 259.2 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 352.98 259.2 Tm (bowel) Tj ET BT /F3 12 Tf 1 0 0 1 387.11 259.2 Tm (function;) Tj ET BT /F3 12 Tf 1 0 0 1 435.23 259.2 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 450.02 259.2 Tm (performing) Tj ET Q q n 45.35 256.8 m 657.35 256.8 l 657.35 244.8 l 45.35 244.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 247.21 Tm (related personal hygiene, including care of any catheter or colostomy bag, if not continent.) Tj ET Q q n 18 244.8 m 630 244.8 l 630 232.8 l 18 232.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 18 235.21 Tm (6.) Tj ET BT /F2 12 Tf 1 0 0 1 45.35 235.21 Tm (Eating) Tj ET BT /F3 12 Tf 1 0 0 1 82.49 235.21 Tm (-) Tj ET BT /F3 12 Tf 1 0 0 1 89.61 235.21 Tm (once) Tj ET BT /F3 12 Tf 1 0 0 1 115.39 235.21 Tm (food) Tj ET BT /F3 12 Tf 1 0 0 1 140.52 235.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 151.65 235.21 Tm (prepared) Tj ET BT /F3 12 Tf 1 0 0 1 196.75 235.21 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 217.2 235.21 Tm (made) Tj ET BT /F3 12 Tf 1 0 0 1 246.32 235.21 Tm (available,) Tj ET BT /F3 12 Tf 1 0 0 1 295.75 235.21 Tm (getting) Tj ET BT /F3 12 Tf 1 0 0 1 332.21 235.21 Tm (nourishment) Tj ET BT /F3 12 Tf 1 0 0 1 395.33 235.21 Tm (into) Tj ET BT /F3 12 Tf 1 0 0 1 417.13 235.21 Tm (one's) Tj ET BT /F3 12 Tf 1 0 0 1 444.42 235.21 Tm (body) Tj ET BT /F3 12 Tf 1 0 0 1 471.55 235.21 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 486.67 235.21 Tm (any) Tj ET Q q n 45.35 232.8 m 657.35 232.8 l 657.35 220.8 l 45.35 220.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 223.21 Tm (means.) Tj ET BT /F3 12 Tf 1 0 0 1 86.8 223.21 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 112.03 223.21 Tm (includes) Tj ET BT /F3 12 Tf 1 0 0 1 155.91 223.21 Tm (eating) Tj ET BT /F3 12 Tf 1 0 0 1 189.13 223.21 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 216.35 223.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 225.57 223.21 Tm (table,) Tj ET BT /F3 12 Tf 1 0 0 1 255.79 223.21 Tm (tray) Tj ET BT /F3 12 Tf 1 0 0 1 278.34 223.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 292.23 223.21 Tm (container) Tj ET BT /F3 12 Tf 1 0 0 1 340.77 223.21 Tm (\(such) Tj ET BT /F3 12 Tf 1 0 0 1 370.65 223.21 Tm (as) Tj ET BT /F3 12 Tf 1 0 0 1 384.55 223.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 393.77 223.21 Tm (bowl) Tj ET BT /F3 12 Tf 1 0 0 1 421.66 223.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 435.55 223.21 Tm (cup\);) Tj ET BT /F3 12 Tf 1 0 0 1 464.11 223.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 478 223.21 Tm (using) Tj ET Q q n 45.35 220.8 m 657.35 220.8 l 657.35 208.8 l 45.35 208.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 45.35 211.21 Tm (special equipment \(such as a feeding tube or intravenous tube\).) Tj ET Q q n 0 208.8 m 612 208.8 l 612 196.8 l 0 196.8 l h W n Q q n 0 196.8 m 612 196.8 l 612 184.8 l 0 184.8 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 187.21 Tm ("Terminally) Tj ET BT /F2 12 Tf 1 0 0 1 68.8 187.21 Tm (Ill") Tj ET BT /F3 12 Tf 1 0 0 1 91.61 187.21 Tm (means) Tj ET BT /F3 12 Tf 1 0 0 1 127.08 187.21 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 146.55 187.21 Tm (Insured) Tj ET BT /F3 12 Tf 1 0 0 1 187.34 187.21 Tm (Employee) Tj ET BT /F3 12 Tf 1 0 0 1 240.8 187.21 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 255.61 187.21 Tm (Dependent) Tj ET BT /F3 12 Tf 1 0 0 1 312.4 187.21 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 333.2 187.21 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 343.34 187.21 Tm (medical) Tj ET BT /F3 12 Tf 1 0 0 1 386.13 187.21 Tm (condition) Tj ET BT /F3 12 Tf 1 0 0 1 436.27 187.21 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 470.4 187.21 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 483.22 187.21 Tm (expected) Tj ET BT /F3 12 Tf 1 0 0 1 530.67 187.21 Tm (to) Tj ET Q q n 0 184.8 m 612 184.8 l 612 172.8 l 0 172.8 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 175.21 Tm (result in death in 6 months or less, despite appropriate medical treatment.) Tj ET Q q n 0 172.8 m 612 172.8 l 612 160.8 l 0 160.8 l h W n Q Q q Q Q endstream endobj 37 0 obj <>>>>> endobj 169 0 obj <> endobj 168 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 722.4 cm q n 0 48 m 612 48 l 612 36 l 0 36 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 151.32 38.41 Tm (NOTICE OF PROTECTION PROVIDED BY) Tj ET Q q n 0 36 m 612 36 l 612 24 l 0 24 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 48.3 26.41 Tm (PENNSYLVANIA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION) Tj ET 2 J 1.14 w [] 0 d 0 0 0 RG 48.87 24.53 m 491.13 24.53 l S 1 w [] 0 d Q q n 0 24 m 612 24 l 612 12 l 0 12 l h W n Q q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 37.15 m 183.6 37.15 l 183.6 25.15 l 0 25.15 l h W n Q q n 183.6 37.15 m 367.2 37.15 l 367.2 25.15 l 183.6 25.15 l h W n Q q n 367.2 37.15 m 550.8 37.15 l 550.8 25.15 l 367.2 25.15 l h W n Q q n 0 25.15 m 183.6 25.15 l 183.6 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 15.56 Tm (GAN-GRP-PA NOTICE-P/C) Tj ET Q q n 183.6 25.15 m 367.2 25.15 l 367.2 13.15 l 183.6 13.15 l h W n Q q n 367.2 25.15 m 550.8 25.15 l 550.8 13.15 l 367.2 13.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 512.67 15.56 Tm (11/20) Tj ET Q q n 0 13.15 m 183.6 13.15 l 183.6 1.15 l 0 1.15 l h W n Q q n 183.6 13.15 m 367.2 13.15 l 367.2 1.15 l 183.6 1.15 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 265 3.56 Tm (35) Tj ET Q q n 367.2 13.15 m 550.8 13.15 l 550.8 1.15 l 367.2 1.15 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 58.75 cm q n 0 649.85 m 612 649.85 l 612 637.85 l 0 637.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 640.26 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 24.72 640.26 Tm (notice) Tj ET BT /F3 12 Tf 1 0 0 1 57.43 640.26 Tm (provides) Tj ET BT /F3 12 Tf 1 0 0 1 102.15 640.26 Tm (a) Tj ET BT /F2 12 Tf 1 0 0 1 110.86 640.26 Tm (brief) Tj ET BT /F2 12 Tf 1 0 0 1 138.91 640.26 Tm (summary) Tj ET BT /F3 12 Tf 1 0 0 1 190.96 640.26 Tm (regarding) Tj ET BT /F3 12 Tf 1 0 0 1 240.33 640.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 258.38 640.26 Tm (protections) Tj ET BT /F3 12 Tf 1 0 0 1 315.09 640.26 Tm (provided) Tj ET BT /F3 12 Tf 1 0 0 1 361.14 640.26 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 373.86 640.26 Tm (policyholders) Tj ET BT /F3 12 Tf 1 0 0 1 442.57 640.26 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 457.96 640.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 476.01 640.26 Tm (Pennsylvania) Tj ET Q q n 0 637.85 m 612 637.85 l 612 625.85 l 0 625.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 628.26 Tm (Life) Tj ET BT /F3 12 Tf 1 0 0 1 26.59 628.26 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 50.51 628.26 Tm (Health) Tj ET BT /F3 12 Tf 1 0 0 1 89.1 628.26 Tm (Insurance) Tj ET BT /F3 12 Tf 1 0 0 1 142.33 628.26 Tm (Guaranty) Tj ET BT /F3 12 Tf 1 0 0 1 193.58 628.26 Tm (Association) Tj ET BT /F3 12 Tf 1 0 0 1 256.84 628.26 Tm (\(the) Tj ET BT /F3 12 Tf 1 0 0 1 287.42 628.26 Tm (Association\).) Tj ET BT /F3 12 Tf 1 0 0 1 363 628.26 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 390.94 628.26 Tm (protection) Tj ET BT /F3 12 Tf 1 0 0 1 446.18 628.26 Tm (was) Tj ET BT /F3 12 Tf 1 0 0 1 471.44 628.26 Tm (created) Tj ET BT /F3 12 Tf 1 0 0 1 512.68 628.26 Tm (under) Tj ET Q q n 0 625.85 m 612 625.85 l 612 613.85 l 0 613.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 616.26 Tm (Pennsylvania law, which determines who and what is covered and the amounts of coverage.) Tj ET Q q n 0 613.85 m 612 613.85 l 612 601.85 l 0 601.85 l h W n Q q n 0 601.85 m 612 601.85 l 612 589.85 l 0 589.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 592.26 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 22.5 592.26 Tm (Association) Tj ET BT /F3 12 Tf 1 0 0 1 83 592.26 Tm (was) Tj ET BT /F3 12 Tf 1 0 0 1 105.5 592.26 Tm (established) Tj ET BT /F3 12 Tf 1 0 0 1 162.66 592.26 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 175.84 592.26 Tm (provide) Tj ET BT /F3 12 Tf 1 0 0 1 216.34 592.26 Tm (protection) Tj ET BT /F3 12 Tf 1 0 0 1 268.83 592.26 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 282.01 592.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 300.51 592.26 Tm (unlikely) Tj ET BT /F3 12 Tf 1 0 0 1 343.68 592.26 Tm (event) Tj ET BT /F3 12 Tf 1 0 0 1 373.51 592.26 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 395.34 592.26 Tm (your) Tj ET BT /F3 12 Tf 1 0 0 1 421.18 592.26 Tm (member) Tj ET BT /F3 12 Tf 1 0 0 1 464.34 592.26 Tm (life,) Tj ET BT /F3 12 Tf 1 0 0 1 487.17 592.26 Tm (annuity,) Tj ET BT /F3 12 Tf 1 0 0 1 530 592.26 Tm (or) Tj ET Q q n 0 589.85 m 612 589.85 l 612 577.85 l 0 577.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 580.26 Tm (health) Tj ET BT /F3 12 Tf 1 0 0 1 32.36 580.26 Tm (insurance) Tj ET BT /F3 12 Tf 1 0 0 1 81.38 580.26 Tm (company,) Tj ET BT /F3 12 Tf 1 0 0 1 131.4 580.26 Tm (RANLI) Tj ET BT /F3 12 Tf 1 0 0 1 171.11 580.26 Tm (PPO,) Tj ET BT /F3 12 Tf 1 0 0 1 199.16 580.26 Tm (hospital) Tj ET BT /F3 12 Tf 1 0 0 1 240.2 580.26 Tm (plan) Tj ET BT /F3 12 Tf 1 0 0 1 263.9 580.26 Tm (corporation,) Tj ET BT /F3 12 Tf 1 0 0 1 325.25 580.26 Tm (professional) Tj ET BT /F3 12 Tf 1 0 0 1 386.94 580.26 Tm (health) Tj ET BT /F3 12 Tf 1 0 0 1 419.3 580.26 Tm (services) Tj ET BT /F3 12 Tf 1 0 0 1 460.99 580.26 Tm (plan) Tj ET BT /F3 12 Tf 1 0 0 1 484.69 580.26 Tm (corporation) Tj ET Q q n 0 577.85 m 612 577.85 l 612 565.85 l 0 565.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 568.26 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 13.46 568.26 Tm (health) Tj ET BT /F3 12 Tf 1 0 0 1 46.25 568.26 Tm (maintenance) Tj ET BT /F3 12 Tf 1 0 0 1 110.34 568.26 Tm (organization) Tj ET BT /F3 12 Tf 1 0 0 1 173.79 568.26 Tm (\(member) Tj ET BT /F3 12 Tf 1 0 0 1 220.56 568.26 Tm (insurer\)) Tj ET BT /F3 12 Tf 1 0 0 1 261.35 568.26 Tm (becomes) Tj ET BT /F3 12 Tf 1 0 0 1 306.79 568.26 Tm (financially) Tj ET BT /F3 12 Tf 1 0 0 1 361.57 568.26 Tm (unable) Tj ET BT /F3 12 Tf 1 0 0 1 397.02 568.26 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 409.82 568.26 Tm (meet) Tj ET BT /F3 12 Tf 1 0 0 1 436.61 568.26 Tm (its) Tj ET BT /F3 12 Tf 1 0 0 1 451.41 568.26 Tm (obligations.) Tj ET BT /F3 12 Tf 1 0 0 1 511.21 568.26 Tm (If) Tj ET BT /F3 12 Tf 1 0 0 1 522.66 568.26 Tm (this) Tj ET Q q n 0 565.85 m 612 565.85 l 612 553.85 l 0 553.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 556.26 Tm (should) Tj ET BT /F3 12 Tf 1 0 0 1 36.66 556.26 Tm (happen,) Tj ET BT /F3 12 Tf 1 0 0 1 78.96 556.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 98.28 556.26 Tm (Association) Tj ET BT /F3 12 Tf 1 0 0 1 159.59 556.26 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 182.91 556.26 Tm (typically) Tj ET BT /F3 12 Tf 1 0 0 1 229.55 556.26 Tm (arrange) Tj ET BT /F3 12 Tf 1 0 0 1 270.18 556.26 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 284.17 556.26 Tm (provide) Tj ET BT /F3 12 Tf 1 0 0 1 325.48 556.26 Tm (coverage,) Tj ET BT /F3 12 Tf 1 0 0 1 376.43 556.26 Tm (pay) Tj ET BT /F3 12 Tf 1 0 0 1 398.41 556.26 Tm (claims,) Tj ET BT /F3 12 Tf 1 0 0 1 437.39 556.26 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 452.04 556.26 Tm (otherwise) Tj ET BT /F3 12 Tf 1 0 0 1 503.34 556.26 Tm (provide) Tj ET Q q n 0 553.85 m 612 553.85 l 612 541.85 l 0 541.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 544.26 Tm (protection) Tj ET BT /F3 12 Tf 1 0 0 1 52.92 544.26 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 66.53 544.26 Tm (accordance) Tj ET BT /F3 12 Tf 1 0 0 1 124.75 544.26 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 150.36 544.26 Tm (Pennsylvania) Tj ET BT /F3 12 Tf 1 0 0 1 218.62 544.26 Tm (law.) Tj ET BT /F3 12 Tf 1 0 0 1 243.21 544.26 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 266.14 544.26 Tm (protection) Tj ET BT /F3 12 Tf 1 0 0 1 319.06 544.26 Tm (provided) Tj ET BT /F3 12 Tf 1 0 0 1 365.99 544.26 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 382.26 544.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 401.19 544.26 Tm (Association) Tj ET BT /F3 12 Tf 1 0 0 1 462.12 544.26 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 474.4 544.26 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 494 544.26 Tm (unlimited) Tj ET Q q n 0 541.85 m 612 541.85 l 612 529.85 l 0 529.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 532.26 Tm (and is not a substitute for consumers' care in selecting companies that are well managed and financially stable.) Tj ET Q q n 0 529.85 m 612 529.85 l 612 517.85 l 0 517.85 l h W n Q q n 0 517.85 m 612 517.85 l 612 505.85 l 0 505.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 508.26 Tm (Below) Tj ET BT /F3 12 Tf 1 0 0 1 35.21 508.26 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 47.1 508.26 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 56.31 508.26 Tm (brief) Tj ET BT /F3 12 Tf 1 0 0 1 82.84 508.26 Tm (summary) Tj ET BT /F3 12 Tf 1 0 0 1 131.38 508.26 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 145.26 508.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 163.8 508.26 Tm (coverages,) Tj ET BT /F3 12 Tf 1 0 0 1 218.65 508.26 Tm (exclusions) Tj ET BT /F3 12 Tf 1 0 0 1 273.19 508.26 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 294.4 508.26 Tm (limits) Tj ET BT /F3 12 Tf 1 0 0 1 325.62 508.26 Tm (provided) Tj ET BT /F3 12 Tf 1 0 0 1 372.16 508.26 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 388.04 508.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 406.58 508.26 Tm (Association.) Tj ET BT /F3 12 Tf 1 0 0 1 470.12 508.26 Tm (This) Tj ET BT /F3 12 Tf 1 0 0 1 495.34 508.26 Tm (summary) Tj ET Q q n 0 505.85 m 612 505.85 l 612 493.85 l 0 493.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 496.26 Tm (does) Tj ET BT /F3 12 Tf 1 0 0 1 26.33 496.26 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 45.99 496.26 Tm (cover) Tj ET BT /F3 12 Tf 1 0 0 1 76.97 496.26 Tm (all) Tj ET BT /F3 12 Tf 1 0 0 1 93.3 496.26 Tm (provisions) Tj ET BT /F3 12 Tf 1 0 0 1 147.63 496.26 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 161.96 496.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 180.95 496.26 Tm (law;) Tj ET BT /F3 12 Tf 1 0 0 1 205.94 496.26 Tm (nor) Tj ET BT /F3 12 Tf 1 0 0 1 226.27 496.26 Tm (does) Tj ET BT /F3 12 Tf 1 0 0 1 252.59 496.26 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 263.59 496.26 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 277.26 496.26 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 298.91 496.26 Tm (way) Tj ET BT /F3 12 Tf 1 0 0 1 323.24 496.26 Tm (change) Tj ET BT /F3 12 Tf 1 0 0 1 361.54 496.26 Tm (anyone's) Tj ET BT /F3 12 Tf 1 0 0 1 407.36 496.26 Tm (rights) Tj ET BT /F3 12 Tf 1 0 0 1 439.02 496.26 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 453.35 496.26 Tm (obligations) Tj ET BT /F3 12 Tf 1 0 0 1 511.01 496.26 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 496.26 Tm (the) Tj ET Q q n 0 493.85 m 612 493.85 l 612 481.85 l 0 481.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 484.26 Tm (rights or obligations of the Association.) Tj ET Q q n 0 481.85 m 612 481.85 l 612 469.85 l 0 469.85 l h W n Q q n 0 469.85 m 612 469.85 l 612 457.85 l 0 457.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 235.33 460.26 Tm (COVERAGE) Tj ET 2 J 1.14 w [] 0 d 0 0 0 RG 235.9 458.38 m 304.1 458.38 l S 1 w [] 0 d Q q n 0 457.85 m 612 457.85 l 612 445.85 l 0 445.85 l h W n Q q n 0 445.85 m 612 445.85 l 612 433.85 l 0 433.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 436.26 Tm (Persons Covered) Tj ET 2 J 1.14 w [] 0 d 0 0 0 RG 0.57 434.38 m 85.74 434.38 l S 1 w [] 0 d Q q n 0 433.85 m 612 433.85 l 612 421.85 l 0 421.85 l h W n Q q n 0 421.85 m 612 421.85 l 612 409.85 l 0 409.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 412.26 Tm (Generally,) Tj ET BT /F3 12 Tf 1 0 0 1 56.3 412.26 Tm (individuals) Tj ET BT /F3 12 Tf 1 0 0 1 115.62 412.26 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 140.27 412.26 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 157.59 412.26 Tm (protected) Tj ET BT /F3 12 Tf 1 0 0 1 208.22 412.26 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 226.21 412.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 246.86 412.26 Tm (Association) Tj ET BT /F3 12 Tf 1 0 0 1 309.5 412.26 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 322.82 412.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 343.47 412.26 Tm (member) Tj ET BT /F3 12 Tf 1 0 0 1 388.78 412.26 Tm (insurer) Tj ET BT /F3 12 Tf 1 0 0 1 428.09 412.26 Tm (was) Tj ET BT /F3 12 Tf 1 0 0 1 452.74 412.26 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 464.05 412.26 Tm (member) Tj ET BT /F3 12 Tf 1 0 0 1 509.36 412.26 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 412.26 Tm (the) Tj ET Q q n 0 409.85 m 612 409.85 l 612 397.85 l 0 397.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 400.26 Tm (Association) Tj ET BT /F3 12 Tf 1 0 0 1 60.08 400.26 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 80.81 400.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 98.89 400.26 Tm (individual) Tj ET BT /F3 12 Tf 1 0 0 1 150.97 400.26 Tm (lives) Tj ET BT /F3 12 Tf 1 0 0 1 177.05 400.26 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 189.79 400.26 Tm (Pennsylvania) Tj ET BT /F3 12 Tf 1 0 0 1 257.2 400.26 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 269.27 400.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 287.35 400.26 Tm (time) Tj ET BT /F3 12 Tf 1 0 0 1 312.09 400.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 330.16 400.26 Tm (member) Tj ET BT /F3 12 Tf 1 0 0 1 372.9 400.26 Tm (insurer) Tj ET BT /F3 12 Tf 1 0 0 1 409.63 400.26 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 421.05 400.26 Tm (determined) Tj ET BT /F3 12 Tf 1 0 0 1 478.44 400.26 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 493.86 400.26 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 502.6 400.26 Tm (court) Tj ET BT /F3 12 Tf 1 0 0 1 530.67 400.26 Tm (to) Tj ET Q q n 0 397.85 m 612 397.85 l 612 385.85 l 0 385.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 388.26 Tm (be insolvent. Coverage is also provided to policy beneficiaries, payees or assignees of such individuals.) Tj ET Q q n 0 385.85 m 612 385.85 l 612 373.85 l 0 373.85 l h W n Q q n 0 373.85 m 612 373.85 l 612 361.85 l 0 361.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 364.26 Tm (Amounts of Coverage) Tj ET 2 J 1.14 w [] 0 d 0 0 0 RG 0.57 362.38 m 110.74 362.38 l S 1 w [] 0 d Q q n 0 361.85 m 612 361.85 l 612 349.85 l 0 349.85 l h W n Q q n 0 349.85 m 612 349.85 l 612 337.85 l 0 337.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 340.26 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 22.88 340.26 Tm (basic) Tj ET BT /F3 12 Tf 1 0 0 1 51.75 340.26 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 99.27 340.26 Tm (protections) Tj ET BT /F3 12 Tf 1 0 0 1 156.81 340.26 Tm (provided) Tj ET BT /F3 12 Tf 1 0 0 1 203.68 340.26 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 219.9 340.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 238.78 340.26 Tm (Association) Tj ET BT /F3 12 Tf 1 0 0 1 299.66 340.26 Tm (per) Tj ET BT /F3 12 Tf 1 0 0 1 319.2 340.26 Tm (insured) Tj ET BT /F3 12 Tf 1 0 0 1 358.75 340.26 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 372.3 340.26 Tm (each) Tj ET BT /F3 12 Tf 1 0 0 1 398.5 340.26 Tm (insolvency) Tj ET BT /F3 12 Tf 1 0 0 1 454.71 340.26 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 473.57 340.26 Tm (limited) Tj ET BT /F3 12 Tf 1 0 0 1 511.79 340.26 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 340.26 Tm (the) Tj ET Q q n 0 337.85 m 612 337.85 l 612 325.85 l 0 325.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 328.26 Tm (aggregate) Tj ET BT /F3 12 Tf 1 0 0 1 52.37 328.26 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 67.44 328.26 Tm ($300,000) Tj ET BT /F3 12 Tf 1 0 0 1 118.18 328.26 Tm (\(or) Tj ET BT /F3 12 Tf 1 0 0 1 137.91 328.26 Tm ($500,000) Tj ET BT /F3 12 Tf 1 0 0 1 188.65 328.26 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 203.72 328.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 224.12 328.26 Tm (case) Tj ET BT /F3 12 Tf 1 0 0 1 250.51 328.26 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 266.24 328.26 Tm (health) Tj ET BT /F3 12 Tf 1 0 0 1 301.3 328.26 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 340.35 328.26 Tm (plans\),) Tj ET BT /F3 12 Tf 1 0 0 1 378.42 328.26 Tm (including) Tj ET BT /F3 12 Tf 1 0 0 1 429.48 328.26 Tm (specific) Tj ET BT /F3 12 Tf 1 0 0 1 472.53 328.26 Tm (limits) Tj ET BT /F3 12 Tf 1 0 0 1 505.61 328.26 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 328.26 Tm (the) Tj ET Q q n 0 325.85 m 612 325.85 l 612 313.85 l 0 313.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 316.26 Tm (following types of coverage but not in excess of the contractual obligations of the member insurer;) Tj ET Q q n 0 313.85 m 612 313.85 l 612 301.85 l 0 301.85 l h W n Q q n 0 301.85 m 612 301.85 l 612 289.85 l 0 289.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 292.26 Tm (Life insurance:) Tj ET Q q n 0 289.85 m 612 289.85 l 612 277.85 l 0 277.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 280.26 Tm (o Up to $300,000 in death benefits including up to $100,000 in net cash surrender or withdrawal value.) Tj ET Q q n 0 277.85 m 612 277.85 l 612 265.85 l 0 265.85 l h W n Q q n 0 265.85 m 612 265.85 l 612 253.85 l 0 253.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 256.26 Tm (Accident, accident and health, or health insurance \(including HMOs\):) Tj ET Q q n 18 253.85 m 630 253.85 l 630 241.85 l 18 241.85 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 244.26 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 244.26 Tm (Up to $500,000 for health benefit plans, with some exceptions.) Tj ET Q q n 18 241.85 m 630 241.85 l 630 229.85 l 18 229.85 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 232.26 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 232.26 Tm (Up to $300,000 for disability income benefits.) Tj ET Q q n 18 229.85 m 630 229.85 l 630 217.85 l 18 217.85 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 220.26 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 220.26 Tm (Up to $300,000 for long-term care insurance benefits.) Tj ET Q q n 18 217.85 m 630 217.85 l 630 205.85 l 18 205.85 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 208.26 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 208.26 Tm (Up to $100,000 for all other types of health insurance.) Tj ET Q q n 0 205.85 m 612 205.85 l 612 193.85 l 0 193.85 l h W n Q q n 0 193.85 m 612 193.85 l 612 181.85 l 0 181.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 0 184.26 Tm (Individual annuities) Tj ET Q q n 18 181.85 m 630 181.85 l 630 169.85 l 18 169.85 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 172.26 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 172.26 Tm (Up) Tj ET BT /F3 12 Tf 1 0 0 1 56.01 172.26 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 70.68 172.26 Tm ($250,000) Tj ET BT /F3 12 Tf 1 0 0 1 121.03 172.26 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 135.7 172.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 155.71 172.26 Tm (present) Tj ET BT /F3 12 Tf 1 0 0 1 195.7 172.26 Tm (value) Tj ET BT /F3 12 Tf 1 0 0 1 227.03 172.26 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 242.37 172.26 Tm (benefits,) Tj ET BT /F3 12 Tf 1 0 0 1 288.7 172.26 Tm (including) Tj ET BT /F3 12 Tf 1 0 0 1 339.37 172.26 Tm (cash) Tj ET BT /F3 12 Tf 1 0 0 1 366.03 172.26 Tm (surrender) Tj ET BT /F3 12 Tf 1 0 0 1 416.68 172.26 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 439.35 172.26 Tm (net) Tj ET BT /F3 12 Tf 1 0 0 1 459.35 172.26 Tm (cash) Tj ET BT /F3 12 Tf 1 0 0 1 486.02 172.26 Tm (withdrawal) Tj ET Q q n 36 169.85 m 648 169.85 l 648 157.85 l 36 157.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 36 160.26 Tm (values.) Tj ET Q q n 0 157.85 m 612 157.85 l 612 145.85 l 0 145.85 l h W n Q q n 0 145.85 m 612 145.85 l 612 133.85 l 0 133.85 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 117.65 136.26 Tm (LIMITATIONS AND EXCLUSIONS FROM COVERAGE) Tj ET 2 J 1.14 w [] 0 d 0 0 0 RG 118.22 134.38 m 421.78 134.38 l S 1 w [] 0 d Q q n 0 133.85 m 612 133.85 l 612 121.85 l 0 121.85 l h W n Q q n 0 121.85 m 612 121.85 l 612 109.85 l 0 109.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 112.26 Tm (The Association also does not provide coverage for:) Tj ET Q q n 0 109.85 m 612 109.85 l 612 97.85 l 0 97.85 l h W n Q q n 18 97.85 m 630 97.85 l 630 85.85 l 18 85.85 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 88.26 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 88.26 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 56.93 88.26 Tm (policy) Tj ET BT /F3 12 Tf 1 0 0 1 90.52 88.26 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 104.12 88.26 Tm (contract) Tj ET BT /F3 12 Tf 1 0 0 1 146.37 88.26 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 159.96 88.26 Tm (portion) Tj ET BT /F3 12 Tf 1 0 0 1 198.23 88.26 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 211.83 88.26 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 220.75 88.26 Tm (policy) Tj ET BT /F3 12 Tf 1 0 0 1 254.35 88.26 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 267.95 88.26 Tm (contract) Tj ET BT /F3 12 Tf 1 0 0 1 310.19 88.26 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 343.12 88.26 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 354.73 88.26 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 373.66 88.26 Tm (guaranteed) Tj ET BT /F3 12 Tf 1 0 0 1 429.9 88.26 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 445.5 88.26 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 463.76 88.26 Tm (member) Tj ET BT /F3 12 Tf 1 0 0 1 506.68 88.26 Tm (insurer) Tj ET Q q n 36 85.85 m 648 85.85 l 648 73.85 l 36 73.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 36 76.26 Tm (or for which the individual has assumed the risk, such as a variable contract sold by prospectus;) Tj ET Q q n 18 73.85 m 630 73.85 l 630 61.85 l 18 61.85 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 64.26 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 64.26 Tm (claims) Tj ET BT /F3 12 Tf 1 0 0 1 72.43 64.26 Tm (based) Tj ET BT /F3 12 Tf 1 0 0 1 104.86 64.26 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 121.97 64.26 Tm (marketing) Tj ET BT /F3 12 Tf 1 0 0 1 175.72 64.26 Tm (materials) Tj ET BT /F3 12 Tf 1 0 0 1 224.81 64.26 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 239.91 64.26 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 269.68 64.26 Tm (documents) Tj ET BT /F3 12 Tf 1 0 0 1 326.77 64.26 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 361.2 64.26 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 380.96 64.26 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 401.4 64.26 Tm (approved) Tj ET BT /F3 12 Tf 1 0 0 1 451.15 64.26 Tm (policy) Tj ET BT /F3 12 Tf 1 0 0 1 486.26 64.26 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 501.36 64.26 Tm (contract) Tj ET Q q n 36 61.85 m 648 61.85 l 648 49.85 l 36 49.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 36 52.26 Tm (forms,) Tj ET BT /F3 12 Tf 1 0 0 1 71.95 52.26 Tm (claims) Tj ET BT /F3 12 Tf 1 0 0 1 108.24 52.26 Tm (based) Tj ET BT /F3 12 Tf 1 0 0 1 140.52 52.26 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 157.48 52.26 Tm (misrepresentations) Tj ET BT /F3 12 Tf 1 0 0 1 252.41 52.26 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 267.37 52.26 Tm (policy) Tj ET BT /F3 12 Tf 1 0 0 1 302.32 52.26 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 317.27 52.26 Tm (contract) Tj ET BT /F3 12 Tf 1 0 0 1 360.88 52.26 Tm (benefits,) Tj ET BT /F3 12 Tf 1 0 0 1 406.82 52.26 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 429.1 52.26 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 458.72 52.26 Tm (extra-contractual) Tj ET Q q n 36 49.85 m 648 49.85 l 648 37.85 l 36 37.85 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 36 40.26 Tm (claims;) Tj ET Q q n 18 37.85 m 630 37.85 l 630 25.85 l 18 25.85 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 28.26 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 28.26 Tm (any policy of reinsurance \(unless an assumption certificate was issued\);) Tj ET Q q n 18 25.85 m 630 25.85 l 630 13.85 l 18 13.85 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 16.26 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 16.26 Tm (interest rate yields or increases based on an index that exceed an average rate specified by statute;) Tj ET Q Q q Q Q endstream endobj 38 0 obj <>>>>> endobj 175 0 obj <>/Border[0 0 0]/Rect[439.79 444 526.43 456]/Subtype/Link>> endobj 176 0 obj <>/Border[0 0 0]/Rect[252 324 362.3 336]/Subtype/Link>> endobj 177 0 obj <>stream q 0 0 612 792 re W n q 1 0 0 1 36 758.4 cm q n 0 12 m 612 12 l 612 0 l 0 0 l h W n Q Q q Q q 1 0 0 1 36 21.6 cm q n 0 37.15 m 183.6 37.15 l 183.6 25.15 l 0 25.15 l h W n Q q n 183.6 37.15 m 367.2 37.15 l 367.2 25.15 l 183.6 25.15 l h W n Q q n 367.2 37.15 m 550.8 37.15 l 550.8 25.15 l 367.2 25.15 l h W n Q q n 0 25.15 m 183.6 25.15 l 183.6 13.15 l 0 13.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 15.56 Tm (GAN-GRP-PA NOTICE-P/C) Tj ET Q q n 183.6 25.15 m 367.2 25.15 l 367.2 13.15 l 183.6 13.15 l h W n Q q n 367.2 25.15 m 550.8 25.15 l 550.8 13.15 l 367.2 13.15 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 512.67 15.56 Tm (11/20) Tj ET Q q n 0 13.15 m 183.6 13.15 l 183.6 1.15 l 0 1.15 l h W n Q q n 183.6 13.15 m 367.2 13.15 l 367.2 1.15 l 183.6 1.15 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 265 3.56 Tm (36) Tj ET Q q n 367.2 13.15 m 550.8 13.15 l 550.8 1.15 l 367.2 1.15 l h W n 0 0 0 rg BT /F3 10 Tf 1 0 0 1 504.44 3.56 Tm (07/01/21) Tj ET Q Q q Q q 1 0 0 1 36 58.75 cm q n 18 697.25 m 630 697.25 l 630 685.25 l 18 685.25 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 687.66 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 687.66 Tm (dividends,) Tj ET BT /F3 12 Tf 1 0 0 1 88.87 687.66 Tm (experience) Tj ET BT /F3 12 Tf 1 0 0 1 144.04 687.66 Tm (rating) Tj ET BT /F3 12 Tf 1 0 0 1 175.25 687.66 Tm (credits,) Tj ET BT /F3 12 Tf 1 0 0 1 213.44 687.66 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 226.65 687.66 Tm (credits) Tj ET BT /F3 12 Tf 1 0 0 1 261.84 687.66 Tm (given) Tj ET BT /F3 12 Tf 1 0 0 1 291.71 687.66 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 304.26 687.66 Tm (connection) Tj ET BT /F3 12 Tf 1 0 0 1 360.11 687.66 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 384.66 687.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 402.53 687.66 Tm (administration) Tj ET BT /F3 12 Tf 1 0 0 1 475.06 687.66 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 488.26 687.66 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 496.8 687.66 Tm (policy) Tj ET BT /F3 12 Tf 1 0 0 1 530 687.66 Tm (or) Tj ET Q q n 36 685.25 m 648 685.25 l 648 673.25 l 36 673.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 36 675.66 Tm (contract by a group contractholder;) Tj ET Q q n 18 673.25 m 630 673.25 l 630 661.25 l 18 661.25 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 663.66 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 663.66 Tm (employers') Tj ET BT /F3 12 Tf 1 0 0 1 92.5 663.66 Tm (plans) Tj ET BT /F3 12 Tf 1 0 0 1 122.19 663.66 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 144.54 663.66 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 163.54 663.66 Tm (self-funded) Tj ET BT /F3 12 Tf 1 0 0 1 222.54 663.66 Tm (\(that) Tj ET BT /F3 12 Tf 1 0 0 1 248.88 663.66 Tm (is,) Tj ET BT /F3 12 Tf 1 0 0 1 264.24 663.66 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 283.93 663.66 Tm (insured) Tj ET BT /F3 12 Tf 1 0 0 1 323.61 663.66 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 339.97 663.66 Tm (member) Tj ET BT /F3 12 Tf 1 0 0 1 383.64 663.66 Tm (insurer,) Tj ET BT /F3 12 Tf 1 0 0 1 424.32 663.66 Tm (even) Tj ET BT /F3 12 Tf 1 0 0 1 451.32 663.66 Tm (if) Tj ET BT /F3 12 Tf 1 0 0 1 463.01 663.66 Tm (member) Tj ET BT /F3 12 Tf 1 0 0 1 506.68 663.66 Tm (insurer) Tj ET Q q n 36 661.25 m 648 661.25 l 648 649.25 l 36 649.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 36 651.66 Tm (administers them\);) Tj ET Q q n 18 649.25 m 630 649.25 l 630 637.25 l 18 637.25 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 639.66 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 639.66 Tm (unallocated) Tj ET BT /F3 12 Tf 1 0 0 1 94.88 639.66 Tm (annuity) Tj ET BT /F3 12 Tf 1 0 0 1 134.45 639.66 Tm (contracts) Tj ET BT /F3 12 Tf 1 0 0 1 181.34 639.66 Tm (\(which) Tj ET BT /F3 12 Tf 1 0 0 1 218.23 639.66 Tm (give) Tj ET BT /F3 12 Tf 1 0 0 1 242.47 639.66 Tm (rights) Tj ET BT /F3 12 Tf 1 0 0 1 273.37 639.66 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 286.28 639.66 Tm (group) Tj ET BT /F3 12 Tf 1 0 0 1 317.85 639.66 Tm (contractholders,) Tj ET BT /F3 12 Tf 1 0 0 1 398.39 639.66 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 417.3 639.66 Tm (individuals\)) Tj ET BT /F3 12 Tf 1 0 0 1 478.2 639.66 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 506.43 639.66 Tm (than) Tj ET BT /F3 12 Tf 1 0 0 1 530.67 639.66 Tm (in) Tj ET Q q n 36 637.25 m 648 637.25 l 648 625.25 l 36 625.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 36 627.66 Tm (limited circumstances and amounts;) Tj ET Q q n 18 625.25 m 630 625.25 l 630 613.25 l 18 613.25 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 615.66 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 615.66 Tm (certain) Tj ET BT /F3 12 Tf 1 0 0 1 72.03 615.66 Tm (contracts) Tj ET BT /F3 12 Tf 1 0 0 1 118.73 615.66 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 151.44 615.66 Tm (establish) Tj ET BT /F3 12 Tf 1 0 0 1 196.82 615.66 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 238.19 615.66 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 253.58 615.66 Tm (reference) Tj ET BT /F3 12 Tf 1 0 0 1 301.58 615.66 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 314.3 615.66 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 323.01 615.66 Tm (portfolio) Tj ET BT /F3 12 Tf 1 0 0 1 368.39 615.66 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 381.77 615.66 Tm (assets) Tj ET BT /F3 12 Tf 1 0 0 1 413.16 615.66 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 431.87 615.66 Tm (owned) Tj ET BT /F3 12 Tf 1 0 0 1 467.25 615.66 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 482.64 615.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 500.68 615.66 Tm (member) Tj ET Q q n 36 613.25 m 648 613.25 l 648 601.25 l 36 601.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 36 603.66 Tm (insurer; or) Tj ET Q q n 18 601.25 m 630 601.25 l 630 589.25 l 18 589.25 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 591.66 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 591.66 Tm (policies) Tj ET BT /F3 12 Tf 1 0 0 1 77.4 591.66 Tm (providing) Tj ET BT /F3 12 Tf 1 0 0 1 128.14 591.66 Tm (health) Tj ET BT /F3 12 Tf 1 0 0 1 161.53 591.66 Tm (care) Tj ET BT /F3 12 Tf 1 0 0 1 185.58 591.66 Tm (benefits) Tj ET BT /F3 12 Tf 1 0 0 1 227.64 591.66 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 245.7 591.66 Tm (Medicare) Tj ET BT /F3 12 Tf 1 0 0 1 295.08 591.66 Tm (Parts) Tj ET BT /F3 12 Tf 1 0 0 1 323.16 591.66 Tm (C) Tj ET BT /F3 12 Tf 1 0 0 1 335.23 591.66 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 349.3 591.66 Tm (D) Tj ET BT /F3 12 Tf 1 0 0 1 362.04 591.66 Tm (coverage,) Tj ET BT /F3 12 Tf 1 0 0 1 412.42 591.66 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 430.48 591.66 Tm (Medicaid) Tj ET BT /F3 12 Tf 1 0 0 1 479.87 591.66 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 493.94 591.66 Tm (under) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 591.66 Tm (the) Tj ET Q q n 36 589.25 m 648 589.25 l 648 577.25 l 36 577.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 36 579.66 Tm (Pennsylvania program for Comprehensive Health Care for Uninsured Children.) Tj ET Q q n 0 577.25 m 612 577.25 l 612 565.25 l 0 565.25 l h W n Q q n 0 565.25 m 612 565.25 l 612 553.25 l 0 553.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 555.66 Tm (The following policies and persons are among those that are excluded from Association coverage:) Tj ET Q q n 36 553.25 m 648 553.25 l 648 541.25 l 36 541.25 l h W n Q q n 18 541.25 m 630 541.25 l 630 529.25 l 18 529.25 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 531.66 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 531.66 Tm (A) Tj ET BT /F3 12 Tf 1 0 0 1 47.97 531.66 Tm (policy) Tj ET BT /F3 12 Tf 1 0 0 1 81.26 531.66 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 94.56 531.66 Tm (contract) Tj ET BT /F3 12 Tf 1 0 0 1 136.51 531.66 Tm (issued) Tj ET BT /F3 12 Tf 1 0 0 1 169.81 531.66 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 185.11 531.66 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 199.74 531.66 Tm (insurer) Tj ET BT /F3 12 Tf 1 0 0 1 236.36 531.66 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 257.66 531.66 Tm (was) Tj ET BT /F3 12 Tf 1 0 0 1 279.62 531.66 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 298.26 531.66 Tm (authorized) Tj ET BT /F3 12 Tf 1 0 0 1 352.2 531.66 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 364.84 531.66 Tm (do) Tj ET BT /F3 12 Tf 1 0 0 1 380.14 531.66 Tm (business) Tj ET BT /F3 12 Tf 1 0 0 1 424.11 531.66 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 436.75 531.66 Tm (Pennsylvania) Tj ET BT /F3 12 Tf 1 0 0 1 504.04 531.66 Tm (when) Tj ET BT /F3 12 Tf 1 0 0 1 533.33 531.66 Tm (it) Tj ET Q q n 36 529.25 m 648 529.25 l 648 517.25 l 36 517.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 36 519.66 Tm (issued the policy or contract) Tj ET Q q n 18 517.25 m 630 517.25 l 630 505.25 l 18 505.25 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 507.66 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 507.66 Tm (If the person is provided coverage by the guaranty association of another state) Tj ET Q q n 18 505.25 m 630 505.25 l 630 493.25 l 18 493.25 l h W n 0 0 0 rg BT /F169 12 Tf 1 0 0 1 18 495.66 Tm (x) Tj ET BT /F3 12 Tf 1 0 0 1 36 495.66 Tm (A) Tj ET BT /F3 12 Tf 1 0 0 1 49.74 495.66 Tm (policy) Tj ET BT /F3 12 Tf 1 0 0 1 84.81 495.66 Tm (issued) Tj ET BT /F3 12 Tf 1 0 0 1 119.89 495.66 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 136.96 495.66 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 147.36 495.66 Tm (fraternal) Tj ET BT /F3 12 Tf 1 0 0 1 193.07 495.66 Tm (benefit) Tj ET BT /F3 12 Tf 1 0 0 1 231.47 495.66 Tm (society,) Tj ET BT /F3 12 Tf 1 0 0 1 273.53 495.66 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 283.93 495.66 Tm (mandatory) Tj ET BT /F3 12 Tf 1 0 0 1 340.32 495.66 Tm (state) Tj ET BT /F3 12 Tf 1 0 0 1 367.39 495.66 Tm (pooling) Tj ET BT /F3 12 Tf 1 0 0 1 409.13 495.66 Tm (plan,) Tj ET BT /F3 12 Tf 1 0 0 1 437.87 495.66 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 448.27 495.66 Tm (mutual) Tj ET BT /F3 12 Tf 1 0 0 1 486.67 495.66 Tm (assessment) Tj ET Q q n 36 493.25 m 648 493.25 l 648 481.25 l 36 481.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 36 483.66 Tm (company) Tj ET BT /F3 12 Tf 1 0 0 1 83.85 483.66 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 97.71 483.66 Tm (similar) Tj ET BT /F3 12 Tf 1 0 0 1 134.9 483.66 Tm (plan) Tj ET BT /F3 12 Tf 1 0 0 1 159.42 483.66 Tm (in) Tj ET BT /F3 12 Tf 1 0 0 1 172.61 483.66 Tm (which) Tj ET BT /F3 12 Tf 1 0 0 1 205.8 483.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 224.32 483.66 Tm (policyholder) Tj ET BT /F3 12 Tf 1 0 0 1 288.83 483.66 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 300.7 483.66 Tm (subject) Tj ET BT /F3 12 Tf 1 0 0 1 338.55 483.66 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 351.74 483.66 Tm (future) Tj ET BT /F3 12 Tf 1 0 0 1 384.26 483.66 Tm (assessments,) Tj ET BT /F3 12 Tf 1 0 0 1 449.12 483.66 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 462.97 483.66 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 478.83 483.66 Tm (an) Tj ET BT /F3 12 Tf 1 0 0 1 494.02 483.66 Tm (insurance) Tj ET Q q n 36 481.25 m 648 481.25 l 648 469.25 l 36 469.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 36 471.66 Tm (exchange) Tj ET Q q n 0 469.25 m 612 469.25 l 612 457.25 l 0 457.25 l h W n Q q n 0 457.25 m 612 457.25 l 612 445.25 l 0 445.25 l h W n 0 0 0 rg BT /F2 12 Tf 1 0 0 1 242.99 447.66 Tm (NOTICES) Tj ET 2 J 1.14 w [] 0 d 0 0 0 RG 243.56 445.78 m 296.44 445.78 l S 1 w [] 0 d Q q n 0 445.25 m 612 445.25 l 612 433.25 l 0 433.25 l h W n Q q n 0 433.25 m 612 433.25 l 612 421.25 l 0 421.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 423.66 Tm (Member) Tj ET BT /F3 12 Tf 1 0 0 1 44.38 423.66 Tm (insurers) Tj ET BT /F3 12 Tf 1 0 0 1 86.09 423.66 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 99.81 423.66 Tm (their) Tj ET BT /F3 12 Tf 1 0 0 1 125.53 423.66 Tm (agents) Tj ET BT /F3 12 Tf 1 0 0 1 159.91 423.66 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 178.28 423.66 Tm (required) Tj ET BT /F3 12 Tf 1 0 0 1 221.99 423.66 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 237.71 423.66 Tm (law) Tj ET BT /F3 12 Tf 1 0 0 1 258.76 423.66 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 271.82 423.66 Tm (give) Tj ET BT /F3 12 Tf 1 0 0 1 296.2 423.66 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 309.93 423.66 Tm (send) Tj ET BT /F3 12 Tf 1 0 0 1 335.65 423.66 Tm (you) Tj ET BT /F3 12 Tf 1 0 0 1 357.37 423.66 Tm (this) Tj ET BT /F3 12 Tf 1 0 0 1 378.43 423.66 Tm (notice,) Tj ET BT /F3 12 Tf 1 0 0 1 414.48 423.66 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 435.53 423.66 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 453.9 423.66 Tm (prohibited) Tj ET BT /F3 12 Tf 1 0 0 1 506.95 423.66 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 522.67 423.66 Tm (law) Tj ET Q q n 0 421.25 m 612 421.25 l 612 409.25 l 0 409.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 411.66 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 26.84 411.66 Tm (using) Tj ET BT /F3 12 Tf 1 0 0 1 56.35 411.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 74.52 411.66 Tm (existence) Tj ET BT /F3 12 Tf 1 0 0 1 122.67 411.66 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 136.17 411.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 154.34 411.66 Tm (Association) Tj ET BT /F3 12 Tf 1 0 0 1 214.51 411.66 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 227.36 411.66 Tm (induce) Tj ET BT /F3 12 Tf 1 0 0 1 262.85 411.66 Tm (you) Tj ET BT /F3 12 Tf 1 0 0 1 284.36 411.66 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 297.2 411.66 Tm (purchase) Tj ET BT /F3 12 Tf 1 0 0 1 343.36 411.66 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 364.19 411.66 Tm (kind) Tj ET BT /F3 12 Tf 1 0 0 1 389.04 411.66 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 402.54 411.66 Tm (insurance) Tj ET BT /F3 12 Tf 1 0 0 1 452.03 411.66 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 465.53 411.66 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 493.7 411.66 Tm (coverage.) Tj ET Q q n 0 409.25 m 612 409.25 l 612 397.25 l 0 397.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 399.66 Tm (Policyholders) Tj ET BT /F3 12 Tf 1 0 0 1 69.4 399.66 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 94.15 399.66 Tm (additional) Tj ET BT /F3 12 Tf 1 0 0 1 145.54 399.66 Tm (questions) Tj ET BT /F3 12 Tf 1 0 0 1 194.29 399.66 Tm (should) Tj ET BT /F3 12 Tf 1 0 0 1 229.7 399.66 Tm (first) Tj ET BT /F3 12 Tf 1 0 0 1 252.44 399.66 Tm (contact) Tj ET BT /F3 12 Tf 1 0 0 1 290.49 399.66 Tm (their) Tj ET BT /F3 12 Tf 1 0 0 1 315.89 399.66 Tm (member) Tj ET BT /F3 12 Tf 1 0 0 1 358.62 399.66 Tm (insurer) Tj ET BT /F3 12 Tf 1 0 0 1 395.35 399.66 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 408.75 399.66 Tm (agent.) Tj ET BT /F3 12 Tf 1 0 0 1 441.15 399.66 Tm (To) Tj ET BT /F3 12 Tf 1 0 0 1 457.88 399.66 Tm (learn) Tj ET BT /F3 12 Tf 1 0 0 1 485.28 399.66 Tm (more) Tj ET BT /F3 12 Tf 1 0 0 1 513.34 399.66 Tm (about) Tj ET Q q n 0 397.25 m 612 397.25 l 612 385.25 l 0 385.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 387.66 Tm (coverages) Tj ET BT /F3 12 Tf 1 0 0 1 52.6 387.66 Tm (provided) Tj ET BT /F3 12 Tf 1 0 0 1 99.88 387.66 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 116.51 387.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 135.79 387.66 Tm (Association,) Tj ET BT /F3 12 Tf 1 0 0 1 200.08 387.66 Tm (please) Tj ET BT /F3 12 Tf 1 0 0 1 234.69 387.66 Tm (visit) Tj ET BT /F3 12 Tf 1 0 0 1 259.99 387.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 279.27 387.66 Tm (Associations) Tj ET BT /F3 12 Tf 1 0 0 1 349.22 387.66 Tm (website) Tj ET BT /F3 12 Tf 1 0 0 1 390.51 387.66 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 403.79 387.66 Tm (www.palifega.org) Tj ET BT /F3 12 Tf 1 0 0 1 490.43 387.66 Tm (.) Tj ET BT /F3 12 Tf 1 0 0 1 498.06 387.66 Tm (You) Tj ET BT /F3 12 Tf 1 0 0 1 523.35 387.66 Tm (can) Tj ET Q q n 0 385.25 m 612 385.25 l 612 373.25 l 0 373.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 375.66 Tm (obtain) Tj ET BT /F3 12 Tf 1 0 0 1 33.44 375.66 Tm (additional) Tj ET BT /F3 12 Tf 1 0 0 1 84.87 375.66 Tm (information) Tj ET BT /F3 12 Tf 1 0 0 1 144.97 375.66 Tm (from) Tj ET BT /F3 12 Tf 1 0 0 1 171.75 375.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 189.85 375.66 Tm (Association) Tj ET BT /F3 12 Tf 1 0 0 1 249.96 375.66 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 265.4 375.66 Tm (contacting) Tj ET BT /F3 12 Tf 1 0 0 1 318.83 375.66 Tm (it) Tj ET BT /F3 12 Tf 1 0 0 1 328.94 375.66 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 341.05 375.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 359.15 375.66 Tm (address) Tj ET BT /F3 12 Tf 1 0 0 1 398.59 375.66 Tm (below.) Tj ET BT /F3 12 Tf 1 0 0 1 434.36 375.66 Tm (You) Tj ET BT /F3 12 Tf 1 0 0 1 458.47 375.66 Tm (may) Tj ET BT /F3 12 Tf 1 0 0 1 482.58 375.66 Tm (also) Tj ET BT /F3 12 Tf 1 0 0 1 505.35 375.66 Tm (contact) Tj ET Q q n 0 373.25 m 612 373.25 l 612 361.25 l 0 361.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 363.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 18.77 363.66 Tm (Pennsylvania) Tj ET BT /F3 12 Tf 1 0 0 1 86.88 363.66 Tm (Insurance) Tj ET BT /F3 12 Tf 1 0 0 1 137.63 363.66 Tm (Department) Tj ET BT /F3 12 Tf 1 0 0 1 198.39 363.66 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 211.83 363.66 Tm (file) Tj ET BT /F3 12 Tf 1 0 0 1 231.94 363.66 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 241.37 363.66 Tm (complaint) Tj ET BT /F3 12 Tf 1 0 0 1 293.48 363.66 Tm (with) Tj ET BT /F3 12 Tf 1 0 0 1 318.92 363.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 337.7 363.66 Tm (Pennsylvania) Tj ET BT /F3 12 Tf 1 0 0 1 405.8 363.66 Tm (Insurance) Tj ET BT /F3 12 Tf 1 0 0 1 456.55 363.66 Tm (Commissioner) Tj ET BT /F3 12 Tf 1 0 0 1 530.67 363.66 Tm (to) Tj ET Q q n 0 361.25 m 612 361.25 l 612 349.25 l 0 349.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 351.66 Tm (allege) Tj ET BT /F3 12 Tf 1 0 0 1 31.78 351.66 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 40.24 351.66 Tm (violation) Tj ET BT /F3 12 Tf 1 0 0 1 86.04 351.66 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 99.16 351.66 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 119.62 351.66 Tm (provisions) Tj ET BT /F3 12 Tf 1 0 0 1 172.76 351.66 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 185.89 351.66 Tm (Pennsylvania) Tj ET BT /F3 12 Tf 1 0 0 1 253.01 351.66 Tm (laws) Tj ET BT /F3 12 Tf 1 0 0 1 278.14 351.66 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 298.6 351.66 Tm (regulations) Tj ET BT /F3 12 Tf 1 0 0 1 355.06 351.66 Tm (relating) Tj ET BT /F3 12 Tf 1 0 0 1 394.84 351.66 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 407.31 351.66 Tm (insurance) Tj ET BT /F3 12 Tf 1 0 0 1 456.42 351.66 Tm (including) Tj ET BT /F3 12 Tf 1 0 0 1 504.88 351.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 522.67 351.66 Tm (law) Tj ET Q q n 0 349.25 m 612 349.25 l 612 337.25 l 0 337.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 339.66 Tm (establishing the Association:) Tj ET Q q n 0 337.25 m 612 337.25 l 612 325.25 l 0 325.25 l h W n Q q n 0 325.25 m 612 325.25 l 612 313.25 l 0 313.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 315.66 Tm (Pennsylvania Life and Health Insurance) Tj ET BT /F3 12 Tf 1 0 0 1 216 315.66 Tm (Pennsylvania Insurance Department) Tj ET Q q n 0 313.25 m 612 313.25 l 612 301.25 l 0 301.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 303.66 Tm (Guaranty Association) Tj ET BT /F3 12 Tf 1 0 0 1 216 303.66 Tm (1209 Strawberry Square) Tj ET Q q n 0 301.25 m 612 301.25 l 612 289.25 l 0 289.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 291.66 Tm (290 King of Prussia Road) Tj ET BT /F3 12 Tf 1 0 0 1 216 291.66 Tm (Harrisburg, PA 17120) Tj ET Q q n 0 289.25 m 612 289.25 l 612 277.25 l 0 277.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 279.66 Tm (Radnor Station Building 2, Suite 218) Tj ET BT /F3 12 Tf 1 0 0 1 216 279.66 Tm (1-877-881-6388) Tj ET Q q n 0 277.25 m 612 277.25 l 612 265.25 l 0 265.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 267.66 Tm (Radnor, PA 19087) Tj ET BT /F3 12 Tf 1 0 0 1 216 267.66 Tm (www.insurance.pa.gov) Tj ET Q q n 0 265.25 m 612 265.25 l 612 253.25 l 0 253.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 255.66 Tm (\(610\) 975-0572) Tj ET Q q n 0 253.25 m 612 253.25 l 612 241.25 l 0 241.25 l h W n Q q n 0 241.25 m 612 241.25 l 612 229.25 l 0 229.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 231.66 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 22.92 231.66 Tm (summary) Tj ET BT /F3 12 Tf 1 0 0 1 71.85 231.66 Tm (information) Tj ET BT /F3 12 Tf 1 0 0 1 132.77 231.66 Tm (provided) Tj ET BT /F3 12 Tf 1 0 0 1 179.69 231.66 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 195.95 231.66 Tm (this) Tj ET BT /F3 12 Tf 1 0 0 1 217.56 231.66 Tm (notice) Tj ET BT /F3 12 Tf 1 0 0 1 251.14 231.66 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 272.73 231.66 Tm (on) Tj ET BT /F3 12 Tf 1 0 0 1 289 231.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 307.92 231.66 Tm (Associations) Tj ET BT /F3 12 Tf 1 0 0 1 377.51 231.66 Tm (web) Tj ET BT /F3 12 Tf 1 0 0 1 401.77 231.66 Tm (site) Tj ET BT /F3 12 Tf 1 0 0 1 422.7 231.66 Tm (do) Tj ET BT /F3 12 Tf 1 0 0 1 438.96 231.66 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 458.56 231.66 Tm (limit) Tj ET BT /F3 12 Tf 1 0 0 1 485.5 231.66 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 499.76 231.66 Tm (alter) Tj ET BT /F3 12 Tf 1 0 0 1 525.34 231.66 Tm (the) Tj ET Q q n 0 229.25 m 612 229.25 l 612 217.25 l 0 217.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 219.66 Tm (more) Tj ET BT /F3 12 Tf 1 0 0 1 31.22 219.66 Tm (comprehensive) Tj ET BT /F3 12 Tf 1 0 0 1 110.43 219.66 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 134.32 219.66 Tm (detailed) Tj ET BT /F3 12 Tf 1 0 0 1 178.87 219.66 Tm (provisions) Tj ET BT /F3 12 Tf 1 0 0 1 235.44 219.66 Tm (of) Tj ET BT /F3 12 Tf 1 0 0 1 252 219.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 273.22 219.66 Tm (law) Tj ET BT /F3 12 Tf 1 0 0 1 297.12 219.66 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 321.01 219.66 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 342.22 219.66 Tm (subject) Tj ET BT /F3 12 Tf 1 0 0 1 382.78 219.66 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 398.68 219.66 Tm (change) Tj ET BT /F3 12 Tf 1 0 0 1 439.22 219.66 Tm (without) Tj ET BT /F3 12 Tf 1 0 0 1 482.46 219.66 Tm (notice.) Tj ET BT /F3 12 Tf 1 0 0 1 521.34 219.66 Tm (The) Tj ET Q q n 0 217.25 m 612 217.25 l 612 205.25 l 0 205.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 207.66 Tm (statements) Tj ET BT /F3 12 Tf 1 0 0 1 56.07 207.66 Tm (made) Tj ET BT /F3 12 Tf 1 0 0 1 87.47 207.66 Tm (herein) Tj ET BT /F3 12 Tf 1 0 0 1 122.87 207.66 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 142.94 207.66 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 162.34 207.66 Tm (information) Tj ET BT /F3 12 Tf 1 0 0 1 224.42 207.66 Tm (purposes) Tj ET BT /F3 12 Tf 1 0 0 1 272.49 207.66 Tm (only.) Tj ET BT /F3 12 Tf 1 0 0 1 302.24 207.66 Tm (The) Tj ET BT /F3 12 Tf 1 0 0 1 326.32 207.66 Tm (Association) Tj ET BT /F3 12 Tf 1 0 0 1 388.39 207.66 Tm (has) Tj ET BT /F3 12 Tf 1 0 0 1 409.8 207.66 Tm (not) Tj ET BT /F3 12 Tf 1 0 0 1 430.55 207.66 Tm (reviewed) Tj ET BT /F3 12 Tf 1 0 0 1 479.95 207.66 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 502.69 207.66 Tm (specific) Tj ET Q q n 0 205.25 m 612 205.25 l 612 193.25 l 0 193.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 195.66 Tm (policy,) Tj ET BT /F3 12 Tf 1 0 0 1 37.29 195.66 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 51.59 195.66 Tm (verified) Tj ET BT /F3 12 Tf 1 0 0 1 93.19 195.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 112.15 195.66 Tm (information) Tj ET BT /F3 12 Tf 1 0 0 1 173.1 195.66 Tm (provided) Tj ET BT /F3 12 Tf 1 0 0 1 220.06 195.66 Tm (regarding) Tj ET BT /F3 12 Tf 1 0 0 1 270.33 195.66 Tm (residency) Tj ET BT /F3 12 Tf 1 0 0 1 320.61 195.66 Tm (or) Tj ET BT /F3 12 Tf 1 0 0 1 334.9 195.66 Tm (other) Tj ET BT /F3 12 Tf 1 0 0 1 363.86 195.66 Tm (relevant) Tj ET BT /F3 12 Tf 1 0 0 1 406.79 195.66 Tm (factors.) Tj ET BT /F3 12 Tf 1 0 0 1 446.74 195.66 Tm (Moreover,) Tj ET BT /F3 12 Tf 1 0 0 1 501.35 195.66 Tm (whether) Tj ET Q q n 0 193.25 m 612 193.25 l 612 181.25 l 0 181.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 183.66 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 47.71 183.66 Tm (will) Tj ET BT /F3 12 Tf 1 0 0 1 70.78 183.66 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 86.51 183.66 Tm (provided) Tj ET BT /F3 12 Tf 1 0 0 1 133.57 183.66 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 147.3 183.66 Tm (any) Tj ET BT /F3 12 Tf 1 0 0 1 169.03 183.66 Tm (specific) Tj ET BT /F3 12 Tf 1 0 0 1 210.75 183.66 Tm (policyholder) Tj ET BT /F3 12 Tf 1 0 0 1 275.81 183.66 Tm (can) Tj ET BT /F3 12 Tf 1 0 0 1 296.86 183.66 Tm (only) Tj ET BT /F3 12 Tf 1 0 0 1 322.6 183.66 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 338.33 183.66 Tm (determined) Tj ET BT /F3 12 Tf 1 0 0 1 396.71 183.66 Tm (by) Tj ET BT /F3 12 Tf 1 0 0 1 413.11 183.66 Tm (reference) Tj ET BT /F3 12 Tf 1 0 0 1 462.14 183.66 Tm (to) Tj ET BT /F3 12 Tf 1 0 0 1 475.87 183.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 494.94 183.66 Tm (statute) Tj ET BT /F3 12 Tf 1 0 0 1 530.67 183.66 Tm (in) Tj ET Q q n 0 181.25 m 612 181.25 l 612 169.25 l 0 169.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 171.66 Tm (effect,) Tj ET BT /F3 12 Tf 1 0 0 1 35.59 171.66 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 49.54 171.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 69.48 171.66 Tm (earliest,) Tj ET BT /F3 12 Tf 1 0 0 1 112.41 171.66 Tm (at) Tj ET BT /F3 12 Tf 1 0 0 1 126.36 171.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 146.31 171.66 Tm (time) Tj ET BT /F3 12 Tf 1 0 0 1 172.92 171.66 Tm (that) Tj ET BT /F3 12 Tf 1 0 0 1 196.2 171.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 216.14 171.66 Tm (member) Tj ET BT /F3 12 Tf 1 0 0 1 260.75 171.66 Tm (insurer) Tj ET BT /F3 12 Tf 1 0 0 1 299.35 171.66 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 312.64 171.66 Tm (declared) Tj ET BT /F3 12 Tf 1 0 0 1 358.56 171.66 Tm (insolvent.) Tj ET BT /F3 12 Tf 1 0 0 1 410.85 171.66 Tm (No) Tj ET BT /F3 12 Tf 1 0 0 1 430.8 171.66 Tm (final) Tj ET BT /F3 12 Tf 1 0 0 1 458.07 171.66 Tm (determination) Tj ET BT /F3 12 Tf 1 0 0 1 530 171.66 Tm (of) Tj ET Q q n 0 169.25 m 612 169.25 l 612 157.25 l 0 157.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 159.66 Tm (coverage) Tj ET BT /F3 12 Tf 1 0 0 1 50.02 159.66 Tm (can) Tj ET BT /F3 12 Tf 1 0 0 1 73.4 159.66 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 91.44 159.66 Tm (made) Tj ET BT /F3 12 Tf 1 0 0 1 124.15 159.66 Tm (until) Tj ET BT /F3 12 Tf 1 0 0 1 152.88 159.66 Tm (a) Tj ET BT /F3 12 Tf 1 0 0 1 164.92 159.66 Tm (member) Tj ET BT /F3 12 Tf 1 0 0 1 210.96 159.66 Tm (insurer) Tj ET BT /F3 12 Tf 1 0 0 1 251 159.66 Tm (is) Tj ET BT /F3 12 Tf 1 0 0 1 265.73 159.66 Tm (declared) Tj ET BT /F3 12 Tf 1 0 0 1 313.08 159.66 Tm (insolvent) Tj ET BT /F3 12 Tf 1 0 0 1 363.81 159.66 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 387.85 159.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 409.23 159.66 Tm (specific) Tj ET BT /F3 12 Tf 1 0 0 1 453.27 159.66 Tm (factual) Tj ET BT /F3 12 Tf 1 0 0 1 492.63 159.66 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 516.68 159.66 Tm (legal) Tj ET Q q n 0 157.25 m 612 157.25 l 612 145.25 l 0 145.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 147.66 Tm (circumstances) Tj ET BT /F3 12 Tf 1 0 0 1 71.49 147.66 Tm (can) Tj ET BT /F3 12 Tf 1 0 0 1 91.67 147.66 Tm (be) Tj ET BT /F3 12 Tf 1 0 0 1 106.52 147.66 Tm (reviewed.) 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Tj ET BT /F3 12 Tf 1 0 0 1 189.29 135.66 Tm (Finally,) Tj ET BT /F3 12 Tf 1 0 0 1 231.67 135.66 Tm (this) Tj ET BT /F3 12 Tf 1 0 0 1 254.39 135.66 Tm (summary) Tj ET BT /F3 12 Tf 1 0 0 1 304.43 135.66 Tm (and) Tj ET BT /F3 12 Tf 1 0 0 1 327.14 135.66 Tm (the) Tj ET BT /F3 12 Tf 1 0 0 1 347.17 135.66 Tm (Associations) Tj ET BT /F3 12 Tf 1 0 0 1 417.88 135.66 Tm (web) Tj ET BT /F3 12 Tf 1 0 0 1 443.25 135.66 Tm (site) Tj ET BT /F3 12 Tf 1 0 0 1 465.29 135.66 Tm (are) Tj ET BT /F3 12 Tf 1 0 0 1 485.32 135.66 Tm (for) Tj ET BT /F3 12 Tf 1 0 0 1 504.69 135.66 Tm (general) Tj ET Q q n 0 133.25 m 612 133.25 l 612 121.25 l 0 121.25 l h W n 0 0 0 rg BT /F3 12 Tf 1 0 0 1 0 123.66 Tm (information purposes and should not be relied upon as legal advice.) 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0001018474 00000 n trailer <]>> %iText-5.5.13.1 startxref 1018636 %%EOF