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<br />DEPENDENTS LIFE INSURANCE <br /> <br />A. Insuring Clause <br />If your Dependent dies while insured for Dependents Life Insurance, we will pay benefits according to the <br />terms of the Group Policy after we receive satisfacto:ry Proof Of Loss. <br /> <br />B. Amount Of Dependents Life Insurance <br />See the Coverage Features for the amount of your Dependents Life Insurance. <br /> <br />C. Changes in Dependents Life Insurance <br />A change in your Dependents Life Insurance will become effective on the first day of the calendar month <br />coinciding with or next following the date of change in factors shown in the Coverage Features. Insurance <br />which exceeds any Guarantee Issue Amount shown in the Coverage Features will become effective on the <br />date we approve your Dependent's Evidence Of Insurability. <br /> <br />D. DefinitioDS For Dependents Life Insurance <br />Dependent means your Spouse or Child. Dependent does not include a person who is afull-time member of the <br />armed forces of any country. <br /> <br />Child means your unmarried child from live birth through age 20 (through age 24 if a registered student in full <br />time attendance at an accredited educational institution). Child includes a stepchild living in your home and <br />an adopted child. . <br /> <br />Disabled Child means your unmarried child who, on and after the date on which Dependents Life Insurance <br />would end because of the child's age, is continuously: <br /> <br />1. Incapable of self-sustaining employment because of mental retardation or physical handicap; and <br /> <br />2. Chiefly dependent upon you for support and maintenance, or institutionalized because of mental <br />retardation or physical handicap. <br /> <br />Disabled Child includes your unmarried child over age 20 (or over age 24 and a registered student in full-time <br />attendance at an accredited educational institution) who: <br /> <br />a. On the day before the effective date of your Employer's coverage under the Group Policy was insured <br />under the Prior Plan; and <br /> <br />b. On and after the effective date of your Employer's coverage under the Group Policy continuously meets <br />the requirements of 1 and 2 above. <br /> <br />You must give us proof of Disabled Child status on our forms and within 31 days after a) the date on which <br />insurance would otherwise end because of the Child's age or b) the effective date of your Employer's coverage <br />under the Group Policy if your child is a Disabled Child on that date. At reasonable intervals thereafter, we <br />may require further proof, and have your Disabled Child PYl'1m;ned at our expense. <br /> <br />E. Becoming Insured For Dependents Life Insurance <br />1. Eligibility <br /> <br />You become eligible to insure your Dependents on the later of: <br /> <br />a. The date your Life Insurance becomes effective; and <br /> <br />b. The date you first acquire a Dependent. <br /> <br />2. Effective Date <br /> <br />The Coverage Features states whether your Dependents Life Insurance is Contributory or <br />Noncontributory. <br /> <br />a. Noncontributory Dependents Life Insurance <br /> <br />Subject to the Active Work Provisions, Noncontributory Dependents Life Insurance becomes <br />effective on the date you become eligible to insure your Dependents. <br /> <br />b. Contributory Dependents Life Insurance <br /> <br />Printed 4196 Revised 4/96 <br /> <br />-9- <br /> <br />SAMPLE U.AD&D, DU. Sup. U <br />