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<br />COVERAGE FEATURES <br /> <br />This section contains many of the features of your group life insurance. Other provisions, including exclusions and <br />limitations, appear in other sections. Please refer to the text of each section for full details. The Table of Contents <br />and the Index of Defined Terms help locate sections and definitions. <br /> <br />GENERAL POLICY INFORMATION <br /> <br />Group Policy Number: <br /> <br />Type of Insurance Provided: <br />Life Insurance: <br />Accidental Death And <br />Dismemberment (AD&D) <br />Insurance: <br />Supplemental Life <br />Insurance: <br />Dependents Life <br />Insurance: <br /> <br />SAMPLE - LI, AD&D, DLI, Sup. LI <br /> <br />Yes <br /> <br />Yes <br /> <br />Yes <br /> <br />Yes <br /> <br />Policyowner: <br />Employer(s): <br /> <br />ABC Company <br />ABC Company <br />XYZ Affiliate <br />June 1, 1995 <br />Oregon <br /> <br />Group Policy Effective Date: <br />Policy Issued In: <br /> <br />BECOMING INSURED <br /> <br />To become insured for Life Insurance you must: (a) Be a Member; (b) Complete your Eligibility Waiting Period; and <br />(c) Meet the requirements in Life Insurance and Active Work Provisions. The requirements for becoming <br />insured for coverages other than Life Insurance are set out in the text. <br /> <br />Definition of Member: You are a Member if you are: <br />1. .An active employee of the Employer; and <br />2. Regularly working at least 30 hours each week. <br />You are not a. Member if you are: <br />1. A temporary or seasonal employee; or <br />2. A full time member of the armed forces of any country. <br /> <br />Class Definition: <br /> <br />None <br /> <br />Eligibility Waiting Period: <br /> <br />You are eligible on the later of: <br />1. The Group Policy Effective Date; and <br />2. The first day of the calendar month coinciding with or next <br />following 30 consecutive days as a Member. <br /> <br />Printed 4196 Revised 4196 <br /> <br />-1- <br /> <br />SAMPLE U, AD&D, DU, Sup, U <br />