CenturyLink Disability Plan Long -Term Disability (LTD ... · Administrator (the insurer, The Standard) for the Plan. Whenever you have a q uestion or concern regarding LTD benefits

LTD SPD. CenturyLink US Employees

CenturyLink Disability PlanLong-Term Disability (LTD) Benefit

SUMMARY PLAN DESCRIPTIONFor CenturyLink US EmployeesSupplement to Your Standard Insurance Company Certificate of Coverage and Summary Plan Description

CenturyLink, Inc.Effective January 1, 2020

LTD SPD. CenturyLink US Employees 2 2020

Table of ContentsIntroduction....................................................................................................................................3Reservation of Company Rights...................................................................................................3How to Use this Document............................................................................................................3This is an Important Document.....................................................................................................3Whose Benefits are Explained in this SPD? ................................................................................3General Plan Information ..............................................................................................................4To Contact the Plan .......................................................................................................................4Inform the Plan of Changes...........................................................................................................4A Word About Your Privacy ..........................................................................................................4Plan Determinations are Not Health Care Advice ........................................................................4Conversion Rights When Coverage Ends....................................................................................5Loss of Eligibility due to Falsification; Reimbursement Required .............................................5General Administrative Information .............................................................................................5Interpretation of the Plan and Claims Fiduciary ..........................................................................5Plan Fiduciary ................................................................................................................................6Type of Administration of the Plan ...............................................................................................6Funding ..........................................................................................................................................6Circumstances That May Affect Your Plan Benefits ...................................................................6Time Limitation on Civil Actions...................................................................................................6Clerical Error ..................................................................................................................................7Records and Information and Your Obligation to Furnish Information .....................................7Interpretation of the Plan...............................................................................................................7


IntroductionCenturyLink, Inc. (hereinafter the “Company”) is pleased to provide you with this Supplement to your Certificate of Coverage and Summary Plan Description, and related Summaries of Material Modification, if any (collectively, the “SPD”). This Supplement presents an overview of the administration of your

Long-Term Disability (LTD) benefits under the CenturyLink Disability Plan (the “Disability Plan”). The Plan was established by the Company to provide Short and Long-Term Disability coverage and this document supplements the information about the insured Long-Term Disability Plan benefits that are available.

Reservation of Company Rights The Company reserves the right to amend or terminate the Plan, and all or any of the benefits available under the Plan, including participant contribution obligations, if any, with respect to all participant classes, retired or otherwise without prior notice to or consultation with any participant, subject to applicable laws and collective bargaining agreements. In the event of any discrepancy between this Supplement, the SPD and the official Plan document, the Plan document shall govern.

How to Use this Document We encourage you to read this Supplement. With respect to the LTD benefits you may be eligible for, you will need to read this Supplement in connection with the SPD and Certificate of Coverage prepared by The Standard Insurance Company, the Plan’s third-party administrator. Many sections of this Supplement are related to the LTD SPD located on HRConnect at: https://insidelink.corp.intranet/HR/Pages/DisabilityLeaveManagement-LongTermDisability.aspx.

This Supplement and the SPD must be read together to fully understand your rights and benefits under the Plan.

This is an Important Document This Supplement and the SPD are provided to explain how the Plan works. Together, they describe your benefits and rights as well as your obligations under the Plan. It is important for you to understand that because this is only a summary; it cannot cover all of the details of the Plan or how the rules will apply to every person in every situation. All of the specific rules governing the Plan are contained in the Plan document. You, your dependents and beneficiaries and your lawyer (or other legal representative) may examine the Plan document and other documents relating to the Plan during regular business hours or by appointment at a mutually convenient time in the office of the Plan Administrator.

We encourage you to read the Supplement and the SPD, in their entirety. Many sections of the SPD are related to other sections of the document. You may not have all of the information you need by reading just one section. You should keep this Supplement and the SPD in a safe place so you can refer to each, as needed, from time to time. If you should have questions after reading these documents, please contact the Claims Administrator or the Plan Administrator.

Whose Benefits are Explained in this SPD? In general, the Plan provides Long-Term Disability coverage to Non-Represented and Represented employees who are determined to be “disabled” (as defined by the Plan) and eligible for LTD benefits.

https://insidelink.corp.intranet/HR/Pages/DisabilityLeaveManagement-LongTermDisability.aspx


General Plan Information The SPD provides general Plan information including, but not limited to, the following:

• Eligibility • When Coverage Begins • When Coverage Ends • Questions, Complaints, How to File a Claim and an Appeal • The Plan’s Right to Recover Overpaid Benefits • Coordination of Benefits • Your ERISA Rights • Glossary of Defined Terms

To Contact the PlanThroughout this Supplement you will find statements that encourage you to contact the Claims Administrator (the insurer, The Standard) for the Plan. Whenever you have a question or concern regarding LTD benefits or a claim, please call the Standard first:

• If it is to initiate an LTD claim telephonically and it has not been completed (assigned to an analyst), call 855-290-9480.

• If the claim is complete and has been assigned to an analyst, or you have general questions regarding LTD, call 800-368-1135.

• If it is to initiate an LTD claim under the State of New York Policy, call 855-290-9476.

If the Claims Administrator is unable to answer your questions or provide you with the information you seek, contact the CenturyLink Service Center at 1-800-729-7526 (PLAN).

Inform the Plan of Changes You must notify the Plan of a change in your address or telephone number as well as notifying the Plan of other changes to your name and/or marital status. To do this, you must contact the CenturyLink Service Center as soon as possible at 1-800-729-7526 (PLAN).

A Word About Your Privacy In determining benefits and eligibility, the Plan will use confidential or personal health information. Please keep in mind it is very important for you to follow the Plan’s procedures, as summarized in the SPD, in order to obtain Plan benefits and to help keep your personal health information private and protected. For example, contacting someone at the Company other than the claims administrator or Plan Administrator (or their duly authorized delegates), in order to try to get a benefit claim issue resolved, is not following the Plan’s procedures. If you do not follow the Plan’s procedures for claiming a benefit or resolving an issue involving Plan benefits, there is no guarantee the Plan benefits for which you may be eligible will be paid to you on a timely basis, or paid at all, and there can be no guarantee that your personal health information will remain private and protected.

Plan Determinations are Not Health Care AdvicePlease keep in mind the sole purpose of the Plan is to provide for the payment of disability benefits and may provide you with eligibility to other Company-sponsored benefits (such as health or life insurance benefits); not to guide or direct the course of treatment of any employee or eligible dependent. A determination by the Claims Administrator that a particular course of treatment is not helpful in determining your eligibility for LTD benefits, does not mean the recommended course of treatments, services or procedures should not be provided to the individual or that they should not be provided in the setting or facility proposed.


Only you and your healthcare provider can decide what is the right health care decision for you. Decisions by the Plan Administrator or Claims Administrator are solely decisions with respect to Plan LTD benefits and do not constitute health care recommendations or advice.

Conversion Rights When Coverage Ends There are no individual conversion rights to this insurance benefit.

Loss of Eligibility due to Falsification; Reimbursement Required Coverage for a participant may be terminated based on enrollment or eligibility information received which was falsely provided. NOTE: If a participant's coverage for LTD benefits is terminated, the termination of coverage may relate back to the effective date of benefits based on the circumstances. The Plan will seek to be made whole by the participant for amounts improperly paid on behalf of the participant (and any dependents) for LTD benefits paid. Your loss of LTD benefits may impact your eligibility for other Company-sponsored benefits, such as health, life insurance or disability pension benefits.

General Administrative InformationPlan Name: CenturyLink Disability Plan, a group disability plan

Plan Sponsor: CenturyLink, Inc. 931 14th Street, 9th Floor Denver CO 80202

Telephone: (800)729-7526

Employer Identification Number: 72-0651161

Plan Number: 513

Agent for Service of Legal Process: Process in legal actions with respect to the provisions of the Plan should be directed to:

Plan Administrator: c/o Associate General Counsel-Litigation 214 East 24th Street Vancouver, WA 98663

or to the Plan Sponsor’s agent for service of legal process: The Corporation Company (CT Corp) 931 14th Street, 9th Floor Denver, Colorado 80202

Interpretation of the Plan and Claims Fiduciary The LTD claims administrator is the claims fiduciary, for purposes of the federal law known as “ERISA” which governs disability plans such as this. The LTD claims administrator has been delegated the sole and exclusive discretion to:

• Interpret benefits covered under the Plan • Interpret the other terms, conditions, limitations and exclusions under the Plan • Making factual determinations, finding and determining all facts related to benefits • Decide all disputes and questions related to benefits


The LTD claims administrator may delegate this discretionary authority to other persons or entities that provide services in regard to the administration of this benefit.

Plan Fiduciary The named fiduciary of the Plan is the CenturyLink Employee Benefits Committee. The Company has designated the claims administrator (the insurer, The Standard) as a claims fiduciary for purposes of all claims arising under this benefit.

Type of Administration of the Plan The Company provides certain administrative services in connection with the Plan and uses the services of third-party administrators for benefits available under the Plan. The LTD benefit is fully insured by The Standard.

FundingThe LTD benefits under the Plan are currently fully insured and paid by The Standard.

Circumstances That May Affect Your Plan Benefits Under certain circumstances all or a portion of your benefits under the Plan may be denied, reduced, suspended, terminated or otherwise affected. Many of these circumstances have been specifically addressed in the SPD. Such circumstances, in general, include:

• You are no longer in an eligible class of participants • The Plan is changed, amended or terminated or the contract with The Standard amended or

terminated • You attain the maximum benefit available under the Plan • You misrepresent or falsify any information required under the Plan; you will not be permitted

to benefit under the Plan from your own misrepresentation • You have been overpaid a benefit and the Plan seeks recovery of the overpayment • If you are entitled to receive benefits from the Plan for injuries caused by a third-party, the

Plan has the right to obtain restitution, or by other equitable means, to a repayment of the LTD benefits paid under the Plan from any part of payments received from such party, your insurance carrier or by any other party, including an individual or corporate entity

• Your coverage under the Plan is terminated for one of a variety of reasons, for example, failure to submit required documentation timely or, if applicable, to pay a premium.

Time Limitation on Civil Actions You cannot bring any legal proceeding or action against the Plan, the Plan Administrator, Claims Administrator or the Company unless you first complete all the steps in the claims and appeals procedure – the reviews process described in the SPD.

After completing that process, you can bring any legal proceedings or action against the Plan or us or the claims administrator within 12 months or 1 year of the date the claims administrator notified you of the final decision on your appeal, unless otherwise specified in an applicable insurance policy. No person has the right to file a civil action, proceeding or lawsuit against the Plan or any person acting with respect to the Plan, including, but not limited to, the Company, any participating company, the CenturyLink Employee Benefits Committee or any other fiduciary, or any third party service provider, after the last day of the 12th month following the later of (a) the 60th day after receipt by the claimant of written notification of the Adverse Benefit Determination or (b) the date on which the Adverse Benefit Determination on appeal was issued with respect to such Plan benefit claim.


Clerical ErrorIf a clerical error or other mistake occurs, however occurring, that error does not create a right to LTD benefits. Clerical errors include, but are not limited to, providing misinformation on eligibility or benefit coverages or entitlements or relating to information transmittal and/or communications, perfunctory or ministerial in nature, involving claims processing, recordkeeping. Although every effort is and will be made to administer the Plan in a fully accurate manner, any inadvertent error, misstatement or omission will be disregarded and the actual Plan provisions will be controlling. A clerical error will not void coverage to which a Participant is entitled under the terms of the Plan, nor will it continue coverage that should have ended under the terms of the Plan. When an error is found, it will be corrected or adjusted appropriately as soon as practicable. Interest shall not be payable with respect to a benefit corrected or adjusted. It is your responsibility to confirm the accuracy of statements made by the Plan or our designees, including the claims administrator(s), in accordance with the terms of the SPD and other Plan documents.

Records and Information and Your Obligation to Furnish Information At times, the Plan or the Claims Administrator may need information from you. You agree to furnish the Plan and/or the Claims Administrator with all information and proofs that are reasonably required regarding any matters pertaining to the Plan. If you do not provide this information when requested, it may delay or result in the denial of your claim.

By accepting LTD benefits under the Plan, you authorize and direct any person that has provided services to you, to furnish the Plan or the claims administrator with all information or copies of records relating to the services provided to you. The Plan or the claims administrator has the right to request this information at any reasonable time. This applies to all Participants.

The Plan agrees that such information and records will be considered confidential. The Company and the Claims Administrator have the right to release any and all records which are necessary to implement and administer the terms of the Plans, for appropriate medical review or quality assessment, or as we are required by law or regulation.

Interpretation of the PlanThe Plan Administrator has authority to control and manage the operation and administration of the Plan. However, the Plan Administrator has delegated to the Claims Administrator, The Standard, its discretionary authority to make all final determinations regarding claims and appeals for benefits under the Plan. This discretionary authority includes, but is not limited to, the determination of eligibility for benefits, based upon enrollment information, and the amount of any benefits due, and to construe the terms of the policy insuring the benefits for the Plan.

Any decision made by the group sponsored life insurance carrier in the exercise of this authority, including review of denials of benefit, is conclusive and binding on all parties. Any court reviewing the group sponsored life insurance carrier’s determinations shall uphold such determination unless the claimant proves the determinations are arbitrary and capricious.

STANDARD INSURANCE COMPANYA Stock Life In s u ra n ce Com pa n y

900 SW Fifth Aven u ePort la n d , Oregon 97204 -1282

(503) 321 -7000

CERTIFICATE AND SUMMARY PLAN DESCRIPTION

GROUP LONG TERM DISABILITY INSURANCE

Policyh older : Cen tu ryLin k

Policy Nu m ber : 64 3 38 8-H

Effect ive Da te: J a n u a ry 1 , 2 0 19

Th e Grou p Policy h a s been is s u ed to th e Policyh old er . We cer t ify th a t you will be in s u red a s p rovided by th e term s of you r Em ployer 's covera ge u n der th e Grou p Policy. If th e term s of th is Cer t ifica te a n d Su m m a ry Pla n Des cr ip t ion d iffer from th e term s of you r Em ployer 's covera ge u n d er th e Grou p Policy, th e la t ter will govern . If you r covera ge is ch a n ged by a n a m en d m en t to th e Grou p Policy, we will p rovide th e Em ployer with a revis ed Cer t ifica te a n d Su m m a ry Pla n Des cr ip t ion or oth er n ot ice to be given to you . In th e even t of a p rem iu m in crea s e, th e Policyh older will be given 1 80 da ys p r ior n ot ice.

Pos s es s ion of th is Cer t ifica te a n d Su m m a ry Pla n Des cr ip t ion d oes n ot n eces s a r ily m ea n you a re in s u red . You a re in s u red on ly if you m eet th e r equ irem en ts s et ou t in th is Cer t ifica te a n d Su m m a ry Pla n Des cr ip t ion .

"You " a n d "you r" m ea n th e Mem ber . "We", "u s " a n d "ou r" m ea n Sta n d a rd In s u ra n ce Com pa n y. Oth er defin ed term s a pp ea r with th e in it ia l let ter s ca p ita lized . Sect ion h ea d in gs , a n d referen ces to th em , a p pea r in b oldfa ce type.

GC405 -LTD

Table o f Cont e nt s

COVERAGE FEATURES ................................................................ ............................... 1GENERAL POLICY INFORMATION ................................ ................................ .......... 1SCHEDULE OF INSURANCE ................................ .................................................. 2PREMIUM CONTRIBUTIONS ................................ .................................................. 4ERISA SUMMARY PLAN DESCRIPTION INFORMATION ................................ .......... 5

INSURING CLAUSE ................................ ................................ ................................ ..... 6BECOMING INSURED ................................................................ ................................ . 6WHEN YOUR INSURANCE BECOMES EFFECTIVE ...................................................... 6ACTIVE WORK PROVISIONS ................................ ....................................................... 7CONTINUITY OF COVERAGE ................................ ....................................................... 7WHEN YOUR INSURANCE ENDS ................................ ................................................. 8WAIVER OF PREMIUM ................................................................ ................................ 8REINSTATEMENT OF INSURANCE ................................ ................................ .............. 9DEFINITION OF DISABILITY ................................ ........................................................ 9RETURN TO WORK PROVISIONS ................................ ............................................... 10REASONABLE ACCOMMODATION EXPENSE BENEFIT ................................ ............. 12REHABILITATION PLAN PROVISION ................................ ................................ .......... 12TEMPORARY RECOVERY ................................................................ .......................... 13WHEN LTD BENEFITS END ................................................................ ....................... 13PREDISABILITY EARNINGS ................................................................ ....................... 13DEDUCTIBLE INCOME ................................................................ ............................. 14EXCEPTIONS TO DEDUCTIBLE INCOME ................................ ................................ .. 16RULES FOR DEDUCTIBLE INCOME ................................ ................................ .......... 16SUBROGATION ................................ ................................ ................................ ......... 17BENEFITS AFTER INSURANCE ENDS OR IS CHANGED ................................ ............ 17EFFECT OF NEW DISABILITY ................................ ................................................... 17DISABILITIES EXCLUDED FROM COVERAGE ................................ ........................... 18DISABILITIES SUBJ ECT TO LIMITED PAY PERIODS .................................................. 19LIMITATIONS ................................ ................................ ................................ ............ 20CLAIMS ................................ ................................ ..................................................... 21ALLOCATION OF AUTHORITY ................................ ................................................... 23TIME LIMITS ON LEGAL ACTIONS ................................ ................................ ............. 23INCONTESTABILITY PROVISIONS ................................ ................................ ............. 24CLERICAL ERROR, AGENCY, AND MISSTATEMENT .................................................. 24TERMINATION OR AMENDMENT OF THE GROUP POLICY................................ ......... 25DEFINITIONS ................................ ................................ ................................ ............ 25ERISA INFORMATION AND NOTICE OF RIGHTS ................................ ........................ 26

Inde x o f De fine d Te rm s

Act ive Work , Act ively At Work , 7 Allowa ble Per iod s , 13 An y Occu pa t ion , 10 An y Occu pa t ion Per iod , 3

Ben efit Wa it in g Per iod , 3 , 25

Ch ild , 1 2 Cla s s Defin it ion , 1 Con tr ib u tory, 2 5 CPI-W , 25

Dedu ct ib le In com e, 1 4 Dis a b led , 9

Em ployer , 25 Em ployer (s ), 1 Eviden ce Of In s u ra b ility, 7

Fa m ily Ca re Expen s es , 1 2 Fa m ily Mem ber , 12

Grou p Policy, 25 Grou p Policy Effect ive Da te, 1 Grou p Policy Nu m ber , 1

Hos p ita l, 2 0

Ind exed Pred is ability Ea rn ings , 2 5 In ju ry , 25

L.L.C. Ow ner-Em ploy ee , 25 LTD Benefit, 25

Ma ter ia l Du t ies , 1 0 Maxim um Benefit Period , 25 Ma xim u m LTD Ben efit , 3 Mem ber , 6 Men ta l Dis order , 19 Min im u m LTD Ben efit , 3

Non con tr ib u tory, 2 6

Oth er Lim ited Con dit ion s , 19 Own Occu pa t ion , 10 Own Occu pa t ion Per iod , 3

Phy s ica l Dis eas e , 26 Ph ys icia n , 26 Policyh older , 1 Pred is a b ility Ea rn in gs , 14 Preexis t in g Con dit ion , 1 8 Pregn a n cy, 2 6 Prior Pla n , 26

Rea s on a ble Accom m oda t ion Expen s e Ben efit , 12

Reh a bilita t ion Pla n , 1 2

Socia l Secu r ity Norm a l Ret irem en t Age (SSNRA), 4

Su b s ta n ce Ab u s e, 19

Tem p ora ry Recovery, 13

Wa r , 18 Work Ea rn in gs , 1 1

10/ 0 9 / 2 0 18 - 1 - 64 3 38 8-H

COVERAGE FEATURES

Th is s ect ion con ta in s m a n y of th e fea tu res of you r lon g term d is a b ility (LTD) in s u ra n ce. Oth er p rovis ion s , in clu d in g exclu s ion s , lim ita t ion s , a n d Ded u ct ib le In com e, a p p ea r in o th er s ect ion s . Plea s e refer to th e text of ea ch s ect ion for fu ll deta ils . Th e Ta ble of Con ten ts a n d th e In dex of Defin ed Term s h elp loca te s ect ion s a n d defin it ion s .

GENERAL POLICY INFORMATION

Grou p Policy Nu m ber : 64 3 38 8-H

Policyh older : Cen tu ryLin k

Em ployer (s ): Cen tu ryLin k a n d Affilia ted or Su bs id ia ry Com pa n ies

Grou p Policy Effect ive Da te: J a n u a ry 1 , 2 0 19

Policy Is s u ed in : Lou is ia n a

Mem ber m ea n s a cit izen or res id en t of th e Un ited Sta tes (in clu d in g US Ter r itor ies ) or Ca n a da a n d on e of th e followin g:

1 . A regu la r fu ll-t im e em ployee of th e Em ployer wh o is Act ively At Work a t lea s t 30 h ou rs a week; or

2 . A regu la r fu ll-t im e Qwes t Repres en ted em ployee of th e Em ployer wh o wa s h ired , reh ired or t ra n s fer red on or a fter J a n u a ry 1 , 2 0 18 a n d wh o is Act ively At Work a t lea s t 30 h ou rs a week; or

3 . A regu la r fu ll-t im e em ployee of th e Em ployer wh o is Act ively At Work a t lea s t 3 0 h ou rs a week ou ts ide of th e Un ited Sta tes ; or

4 . A regu la r Qwes t Repres en ted Fu ll-t im e Em ployee, Pa r t -t im e Em ployee, or Term Em ployee, of th e Em ployer wh o wa s h ired pr ior to J a n u a ry 1 , 20 1 8 a n d wh o is Act ively At Work for a t lea s t 21 h ou rs a week .

For p u rp os es of th e Mem ber d efin it ion , Act ively At Wor k will in clu de r egu la r ly s ch ed u led da ys off, h olid a ys , or va ca t ion d a ys , s o lon g a s th e p ers on is ca p a b le of Act ive Work on th os e da ys .

Mem ber does n ot in clu de a tem p ora ry em ployee, a fu ll-t im e m em ber of th e a rm ed forces of a n y cou n try (u n les s you r Em ployer in d ica tes oth erwis e), a lea s ed em ployee a s defin ed in 41 4n of th e In tern a l Reven u e Cod e, a n in depen den t con t ra ctor , a n occa s ion a l or in ciden ta l em ployee or a n on -em ployee con s u lta n t .

Cla s s Defin it ion :

Cla s s 1 : Cen tu ryLin k Non -Repres en ted Mem bers a n d Qwes t Repres en ted Reta il/ Ou ts ide Sa les Repres en ta t ives , Cen tu ryLin k Repres en ted Mem bers a s defin ed in th eir collect ive b a rga in in g a greem en t

Cla s s 2 : Qwes t Repres en ted Em ployees h ired pr ior to J a n u a ry 1 , 2 01 8

Cla s s 3 : Qwes t Repres en ted Em p loyees wh o a re h ired , reh ired or t ra n s fer red on or a fter J a n u a ry 1 , 2 0 18

10/ 0 9 / 2 0 18 - 2 - 64 3 38 8-H

SCHEDULE OF INSURANCE

Eligib ility Wa it in g Per iod : You a re eligib le on th e la t ter of (A) th e Grou p Policy Effect ive Da te, a n d (B) on e of th e followin g:

Pla n 1 : Th e fir s t da y followin g 36 5 da ys a s a Mem ber

Pla n 2 : Th e J a n u a ry 1 followin g 3 65 da ys a s a Mem ber

Eligib ility Wa it in g Per iod m ea n s th e per iod you m u s t b e a Mem b er before you b ecom e eligib le for in s u ra n ce.

NOTE for All Cla s s es : If you a re a Mem ber u n der th e Grou p Policy , bu t h a ve n ot yet becom e eligib le for in s u ra n ce, you r Eligib ility Wa it in g Per iod will con t in u e to a ccru e a s if you a re Act ively a t Work wh ile:

a ) You a re n ot Act ively a t Work d u e to a n Em ployer a pproved Lea ve of Abs en ce; or

b ) You a re n ot Act ively a t Work d u e to a n on -th e-job in ju ry or illn es s .

NOTE: If you cea s e to b e a Mem ber d u e to a red u ct ion in workforce, a n d if you b ecom e a Mem ber a ga in with in 1 2 m on th s from th e d a te of you r term in a t ion , you r Eligib ility Wa it in g Per iod will a p p ly a s follows :

1 . If you were reh ired a n d h a d n ot p reviou s ly m et you r in it ia l E ligib ility Wa it in g Per iod , you r Eligib ility Wa it in g Per iod will be redu ced by a n y con t in u ou s per iod a s a Mem b er of th e Em ployer im m edia tely p r ior to th e da te you beca m e a Mem b er .

2 . You r Preexis t in g Con dit ion exclu s ion per iod a s s h own in th e Dis abilit ie s Exc lude d From Cove rage s ect ion will be redu ced by th e p r ior con t in u ou s p er iod a s a Mem ber of th e Em ployer im m edia tely p r ior to becom in g a m em b er u n der th e Grou p Policy.

3 . Eviden ce of In s u ra b ility will n ot a pp ly to you r Pla n 2 (Su p plem en ta l) LTD Ben efit if you a p ply with in 30 d a ys a fter you b ecom e eligib le.

4 . Th e a m ou n t of you r Pla n 1 (Ba s ic) or Pla n 2 (Su p plem en ta l) LTD Ben efit will be th e s a m e a m ou n t of in s u ra n ce th a t you h a d in effect on th e da te of you r term in a t io n du e to a redu ct ion in workforce con t in gen t on you r ea rn in gs bein g th e s a m e.

An n u a l En rollm en t Per iod :

Eviden ce of In s u ra b ility (m edica l eviden ce) will n ot be requ ired if you a p ply for Pla n 2 LTD In s u ra n ce du r in g you r Em ployer ’s An n u a l En rollm en t Per iod im m edia tely followin g th e da te you becom e eligib le. If you a p ply du r in g th is t im e per iod , you r Pla n 2 LTD In s u ra n ce will becom e effect ive on th e J a n u a ry 1 n ext followin g th e An n u a l En rollm en t Per iod d u r in g wh ich you a p ply.

If you d o n ot elect to becom e in s u red u n d er Pla n 2 LTD (Su p plem en ta l) in s u ra n ce d u r in g you r fir s t a n n u a l en rollm en t a fter you becom e eligib le, a n d la ter a pp ly, Eviden ce of In s u ra b ility requ irem en t s will a pp ly.

An n u a l En rollm en t Per iod m ea n s th e per iod d es ign a ted ea ch yea r by you r Em plo yer wh en you m a y ch a n ge in s u ra n ce elect ion s a n d is s u b ject to th e Ac t ive Wo rk Provis io ns .

Plea s e s ee item A.2 .b a n d item C. of th e Whe n Ins uran c e Be c om e s Effe c t ive s ect ion for m ore in form a t ion on Eviden ce of In s u ra b ility requ irem en ts .

NOTE: If you cea s e to b e a Mem ber d u e to a red u ct ion in workforce, a n d if you becom e a Mem ber a ga in with in 1 2 m on th s from th e da te of you r term in a t ion , th e a m ou n t of you r Pla n 1 (Ba s ic) or Pla n 2 (Su pplem en ta l) LTD Ben efit will be th e s a m e a m ou n t of in s u ra n ce th a t you h a d in e ffect on th e da te of you r term in a t ion d u e to a redu ct ion in workforce con t in gen t on you r ea rn in gs bein g th e s a m e. See Whe n Your Ins uran c e Be c om e s Effe c t ive s ect ion .

10/ 0 9 / 2 0 18 - 3 - 64 3 38 8-H

Own Occu pa t ion Per iod : Th e fir s t 24 m on th s for wh ich LTD Ben efit s a re pa id .

An y Occu pa t ion Per iod : From th e en d of th e Own Occu p a t ion Per iod to th e en d of th e Ma xim u m Ben efit Per iod .

LTD Ben efit :

You m ay be in s ure d un de r e it he r Plan 1 or Plan 2 , but n ot bot h . Yo u will be in s ure d un de r Plan 1 un le s s you are ins ure d un de r Plan 2 . If y o u c e as e paying for pre m ium s fo r Plan 2 , you will auto m at ic ally be ins ure d unde r Plan 1 .

Pla n 1 (Ba s ic): 50% of th e fir s t $2 4 ,0 0 0 of you r Pred is a b ility Ea rn in gs , redu ced by Ded u ct ib le In com e.

Pla n 2 (Su p plem en ta l): 65% of th e fir s t $3 8 ,4 6 2 of you r Pred is a b ility Ea rn in gs , redu ced by Ded u ct ib le In com e.

Ma xim u m :

Pla n 1 (Ba s ic): $1 2 ,0 0 0 before red u ct ion by Dedu ct ib le In com e.

Pla n 2 (Su p plem en ta l): $2 5 ,0 0 0 before red u ct ion by Dedu ct ib le In com e.

Min im u m : $1 0 0 or 1 0% of you r LTD Ben efit before red u ct ion by Dedu ct ib le In com e, wh ich ever is grea ter .

Ben efit Wa it in g Per iod : Clas s 1 and 3 : Th e lon ger of:

a ) 18 2 d a ys / 26 Week s

b ) Th rou gh th e d a te for wh ich STD or Su pp lem en ta l Worker ’s Com p Pa ym en t (SWCP) b en efit s a re p a id to you u n d er you r Em ployer 's Dis a b ility Pla n ; or

c) th e da te STD Ben efit s a re exh a u s ted

Clas s 2 : In n o ca s e will LTD Ben efit s be p a id to you wh ile you a re eligib le to receive Sh or t Term Dis a b ilit y ben efit s u n d er you r Em ployer ’s Sh or t Term Dis a b ility Pla n .

As a pp lica b le, you r Ben efit Wa it in g Per iod is a s follows :

a ) 27 0 d a ys / 39 week s ; or b ) 12 m on th s in a n y con s ecu t ive 1 8 m on th per iod

rega rd les s of th e n u m ber or len gth of th e cla im s , b u t n ot to exceed th e STD Ma xim u m Ben efit Per iod of 9 m on th s for a n y on e cla im ; or

c) th e da te STD Ben efit s a re exh a u s ted

Note: If you tem pora r ily recover from you r Dis a b ility a n d th en becom e Dis a b led a ga in from a d ifferen t ca u s e or ca u s es , you r STD Ben efit s m a y be exten d ed for a m a xim u m of 1 2 m on th s with in a n y 18 m on th p er iod .

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Ma xim u m Ben efit Per iod : Determ in ed by you r a ge wh en Dis a b ility begin s , a s follows :

Age Ma xim u m Ben efit Per iod

61 or you n ger ................................ ....... To a ge 6 5 , or to SSNRA, or 3 yea rs 6 m on th s , wh ich eve r is lon ges t .

62 ........................................................ To SSNRA, or 3 yea rs 6 m on th s , wh ich ever is lon ger . 63 ........................................................ To SSNRA, or 3 yea rs , wh ich ever is lon ger . 64 ........................................................ To SSNRA, or 2 yea rs 6 m on th s , wh ich ever is lon ger . 65 ........................................................ 2 yea rs 66 ........................................................ 1 yea r 9 m on th s 67 ........................................................ 1 yea r 6 m on th s 68 ........................................................ 1 yea r 3 m on th s 69 or old er ................................ ............ 1 yea r

Socia l Secu r ity Norm a l Ret irem en t Age (SSNRA) m ea n s you r n orm a l ret irem en t a ge u n der th e Federa l Socia l Secu r ity Act , a s a m en d ed .

It ’s im p or ta n t to u n d ers ta n d you n orm a l ret irem en t a ge. Here’s a lis t o f p os s ib le yea rs you were b orn followed by you r n orm a l ret irem en t a ge a ccord in g to th e Socia l Secu r ity Adm in is t ra t ion .

19 3 7 or ea r lier ................................ ...... 65 yea rs 19 3 8 ................................ ..................... 65 yea rs a n d 2 m on th s 19 3 9 ................................ ..................... 65 yea rs a n d 4 m on th s 19 4 0 ................................ ..................... 65 yea rs a n d 6 m on th s 19 4 1 ................................ ..................... 65 yea rs a n d 8 m on th s 19 4 2 ................................ ..................... 65 yea rs a n d 10 m on th s 19 4 3 th rou gh 1 9 54 ............................... 66 yea rs 19 5 5 ................................ ..................... 66 yea rs a n d 2 m on th s 19 5 6 ................................ ..................... 66 yea rs a n d 4 m on th s 19 5 7 ................................ ..................... 66 yea rs a n d 6 m on th s 19 5 8 ................................ ..................... 66 yea rs a n d 8 m on th s 19 5 9 ................................ ..................... 66 yea rs a n d 10 m on th s 19 6 0 or la ter ................................ ......... 67 yea rs

PREMIUM CONTRIBUTIONS

In s u ra n ce is :

Pla n 1 : Non con tr ib u tory

Pla n 2 : Con tr ib u tory: You a n d You r Em ployer s h a re th e cos t of covera ge. Em ployer con t r ibu t ion level determ in es th e ta xa b ility of th e ben efit a m ou n t .

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ERISA SUMMARY PLAN DESCRIPTION INFORMATION

Na m e of Pla n : Lon g Term Dis a b ility In s u ra n ce

Na m e, Ad dres s of Pla n Spon s or : Cen tu ryLin k 93 1 1 4 th S t reet , 9 th Floor Den ver , CO 8 0 20 2

Pla n Sp on s or Ta x ID Nu m ber : 72 -0 6 51 1 61 Pla n Nu m ber : 51 3

Typ e of Pla n : Grou p In s u ra n ce Pla n

Typ e of Adm in is t ra t ion : Con tra ct Adm in is t ra t ion

Na m e, Ad dres s , Ph on e Nu m b er of Pla n Adm in is t ra tor : Pla n Sp on s or (80 0) 7 2 9-75 2 6

Na m e, Ad dres s of Regis t ered Agen t for Service of Lega l Proces s : Pla n Adm in is t ra tor

If Lega l Proces s In volves Cla im s For Ben efit s Un der Th e Grou p Policy, Ad dit ion a l Not ifica t ion of Lega l Proces s Mu s t Be Sen t To: Sta n da rd In s u ra n ce Com pa n y 11 0 0 SW 6th Ave Por t la n d OR 9 7 20 4 -1 09 3

Sou rces of Con tr ib u t ion s : Em ployer / Mem ber

Fu n din g Mediu m : Sta n da rd In s u ra n ce Com pa n y - Fu lly In s u red

Pla n Fis ca l Yea r En d: Decem ber 3 1

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INSURING CLAUSE

If you becom e Dis a b led wh ile in s u red u n der th e Grou p Policy, we will p a y LTD Ben efit s a ccord in g to th e term s of th e Grou p Policy a fter we receive Proof Of Los s s a t is fa ctory to u s .

LT.IC.OT.1

BECOMING INSURED

To b ecom e in s u red you m u s t b e a Mem ber , com plete you r Eligib ility Wa it in g Per iod , a n d m eet th e requ irem en ts in Ac t ive Work Provis ion s a n d Whe n Your Ins uran c e Be c om e s Effe c t ive .

You a re a Mem ber if you a re a cit izen or res iden t of th e Un ited Sta tes (in clu d in g US Ter r itor ies ) or Ca n a da a n d on e of th e followin g:

1 . A regu la r fu ll-t im e em ployee of th e Em ployer wh o is Act ively At Work a t lea s t 30 h ou rs a week; or

2 . A regu la r fu ll-t im e Qwes t Repres en ted em ployee of th e Em p loyer wh o wa s h ired , reh ired or t ra n s fer red on or a fter J a n u a ry 1 , 2 0 18 a n d wh o is Act ively At Work a t lea s t 30 h ou rs a week; or

3 . A regu la r fu ll-t im e em ployee of th e Em ployer wh o is Act ively At Work a t lea s t 3 0 h ou rs a week ou ts ide of th e Un ited Sta tes ; or

4 . A regu la r Qwes t Repres en ted Fu ll-t im e Em ployee, Pa r t -t im e Em ployee, or Term Em ployee, of th e Em ployer wh o wa s h ired pr ior to J a n u a ry 1 , 20 1 8 a n d wh o is Act ively At Work for a t lea s t 21 h ou rs a week .

For p u rp os es of th e Mem ber d efin it ion , Act ively At Work will in clu de r egu la r ly s ch ed u led da ys off, h olid a ys , or va ca t ion d a ys , s o lon g a s th e p ers on is ca p a b le of Act ive Work on th os e da ys .

Mem ber does n ot in clu de a tem p ora ry em ployee, a fu ll-t im e m em ber of th e a rm ed forces of a n y cou n try (u n les s you r Em ployer in d ica tes oth erwis e), a lea s ed em ployee a s defin ed in 41 4n of th e In tern a l Reven u e Cod e, a n in depen den t con t ra ctor , a n occa s ion a l or in ciden ta l em ployee or a n on -em ployee con s u lta n t .

(VAR MBR DEF) LT.BI.OT.1 X

WHEN YOUR INSURANCE BECOMES EFFECTIVE

A. Wh en In s u ra n ce Becom es Effect ive

Su bject to th e Ac t ive Work Provis io ns , you r in s u ra n ce becom es effect ive a s follows :

1 . In s u ra n ce Su bject To Eviden ce Of In s u ra b ility

In s u ra n ce s u b ject to Eviden ce Of In s u ra b ility b ecom es effect ive on th e J a n u a ry 1 n ext followi n g th e An n u a l En rollm en t Per iod du r in g wh ich you a p ply or th e da te we a p p rove you r Eviden ce Of In s u ra b ility, wh ich ever is la ter .

2 . In s u ra n ce Not Su bject To Evid en ce of In s u ra b ilit y

Th e Cove rage Fe ature s s ta tes wh eth er in s u ra n ce is Con tr ib u tory or Non con tr ib u tory.

a . Non con tr ib u tory In s u ra n ce (Ba s ic)

Non con tr ib u tory in s u ra n ce n ot s u b ject to Eviden ce Of In s u ra b ility becom es effect ive on th e da te you b ecom e eligib le, u n les s you becom e in s u red for Con tr ib u tory in s u ra n ce.

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b . Con tr ib u tory In s u ra n ce (Su p plem en ta l)

You m u s t a p p ly in wr it in g for Con tr ibu tory in s u ra n ce a n d a gree to pa y pr em iu m s . You m a y on ly a p p ly d u r in g you r Em ployer ’s An n u a l En rollm en t Per iod .

Con tr ib u tory in s u ra n ce n ot s u b ject to Eviden ce Of In s u ra b ility becom es effect ive on th e J a n u a ry 1 n ext followin g th e An n u a l En rollm en t Per iod d u r in g wh ich you a p ply.

La te a p p lica t ion : Evid en ce Of In s u ra b ility is requ ired if you a p ply a fter th e fir s t An n u a l En rollm en t Per iod in wh ich you a re eligib le to a p p ly for Con tr ibu tory In s u ra n ce a n d will b ecom e effect ive a s s h own a bove in item A.1 .

B. Ta keover Provis ion s

If you were in s u red u n d er th e Pr ior Pla n on th e da y b efore th e effect ive da te of you r Em ployer 's covera ge u n der th e Grou p Policy, you r Eligib ilit y Wa it in g Per iod is wa ived on th e effect ive da te of you r Em ployer 's covera ge u n d er th e Grou p Policy.

C. Eviden ce Of In s u ra b ility Requ irem en t

Eviden ce Of In s u ra b ility s a t is fa ctory to u s is requ ired :

a . For la te a p p lica t ion for Con tr ibu tory in s u ra n ce.

b . For rein s ta tem en ts if requ ired .

Provid in g Eviden ce Of In s u ra b ility m ea n s you m u s t :

1 . Com plete a n d s ign ou r m edica l h is tory s ta tem en t elect ron ica lly or on pa per ;

2 . S ign ou r form a u th or izin g u s to ob ta in in form a t ion a bou t you r h ea lth ;

3 . Un dergo a ph ys ica l exa m in a t ion , if requ ired by u s , wh ich m a y in clu d e b lood tes t in g; a n d

4 . Provide a n y a d dit ion a l in form a t ion a bou t you r in s u ra b ility th a t we m a y rea s on a bly requ ire. (VAR EOI) LT.EF.OT.1 X

ACTIVE WORK PROVISIONS

A. Act ive Work Requ irem en t

You m u s t b e ca p a ble of Act ive Work on th e da y before th e s ch ed u led effect ive d a te of you r in s u ra n ce or you r in s u ra n ce will n ot becom e effect ive a s s ch edu led . If you a re in ca p a ble of Act ive Work beca u s e of Ph ys ica l Dis ea s e, In ju ry, Pregn a n cy or Men ta l Dis ord er on th e da y before th e s ch edu led effect ive da te of you r in s u ra n ce, you r in s u ra n ce will n ot becom e effect ive u n t il th e da y you com plete on e fu ll d a y of Act ive Work a s a n eligib le Mem ber .

Act ive Work a n d Act ively At Work m ea n per form in g with rea s on a ble con t in u ity th e Ma ter ia l Du t ies of you r Own Occu pa t ion a t you r Em ployer 's u s u a l p la ce of bu s in es s .

B. Ch a n ges In In s u ra n ce

Th is Act ive Work requ irem en t a ls o a p p lies to a n y in crea s e in you r in s u ra n ce, oth er th a n a n in crea s e in you r Pred is a b ility Ea rn in gs .

LT.AW.OT.1 X

CONTINUITY OF COVERAGE

If you r Dis a b ility is s u b ject to th e Preexis t in g Con dit ion Exclu s ion , LTD Ben efit s will be p a ya ble if:

1 . You were in s u red u n der th e Pr ior Pla n on th e da y before th e effect ive da te of you r Em ployer 's covera ge u n der th e Grou p Policy;

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2 . You beca m e in s u red u n d er th e Grou p Policy wh en you r in s u ra n ce u n der th e Pr ior Pla n cea s ed ;

3 . You were con t in u ou s ly in s u red u n d er th e Grou p Policy from th e effect ive da te of you r in s u ra n ce u n d er th e Grou p Policy th rou gh th e da te you beca m e Dis a b led from th e Preexis t in g Con dit ion ; a n d

4 . Ben efit s wou ld h a ve b een pa ya ble u n d er th e term s of th e Pr ior Pla n if it h a d rem a in ed in force, ta k in g in to a ccou n t th e p reexis t in g con dit ion exclu s ion , if a n y, of th e Pr ior Pla n .

For s u ch a Dis a b ility, th e a m ou n t of you r LTD Ben efit will be th e les s er of:

a . Th e m on th ly b en efit th a t wou ld h a ve b een pa ya ble u n d er th e term s of th e Pr ior Pla n if it h a d rem a in ed in force; or

b . Th e LTD Ben efit p a ya ble u n der th e term s of th e Grou p Policy, b u t with ou t a p p lica t ion of th e Preexis t in g Con dit ion Exclu s ion .

You r LTD Ben efit s for s u ch a Dis a b ility will en d on th e ea r lier of th e followin g da tes :

a . Th e da te ben efit s wou ld h a ve en ded u n d er th e term s of th e Pr ior Pla n if it h a d rem a in ed in force; or

b . Th e d a te LTD Ben efit s en d u n d er th e term s of th e Grou p Policy. (PX) LT.CC.OT.1

WHEN YOUR INSURANCE ENDS

You r in s u ra n ce en d s a u tom a t ica lly on th e ea r lies t of:

1 . Th e da te th e la s t per iod en d s for wh ich a p rem iu m con tr ib u t ion wa s m a de for you r in s u ra n ce, if a n y.

2 . Th e d a te th e Grou p Policy term in a tes .

3 . Th e la t ter of th e d a te you r em ploym en t term in a tes or th e la s t da y in wh ich prem iu m con tr ibu t ion s were m a d e.

4 . Th e da te you cea s e to be a Mem b er . However , you r in s u ra n ce will be con t in u ed du r in g th e followin g p er iods wh en you a re a b s en t from Act ive Work , u n les s it en ds u n der a n y of th e a b ove.

a . Du r in g a lea ve of a b s en ce if con t in u a t ion of you r in s u ra n ce u n der th e Grou p Policy is requ ired by a s ta te-m a n d a ted fa m ily or m edica l lea ve a ct or la w.

b . Du r in g a m ilita ry lea ve of a b s en ce provid in g a ) you a p ply in wr it in g to con t in u e you r in s u ra n ce a n d b) p rem iu m p a ym en ts con t in u e to be m a de.

c. Du r in g a n y oth er tem p ora ry lea ve of a b s en ce a p proved by you r Em ployer in a dva n ce a n d in wr it in g bu t n ot beyon d th e la s t d a y of th e ca len da r m on th followin g th e ca len da r m on th in wh ich th e lea ve of a bs en ce begin s , or th e lea ve per iod s h own in you r collect ive ba rga in in g a greem en t . A per iod of Dis a b ility is n ot a lea ve of a bs en ce.

d . Du r in g th e Ben efit Wa it in g Per iod . LT.EN.OT.1 X

WAIVER OF PREMIUM

We will wa ive pa ym en t of p rem iu m for you r in s u ra n ce wh ile LTD Ben efit s a re pa ya ble. LT.WP.OT.1

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REINSTATEMENT OF INSURANCE

If you r in s u ra n ce en ds , you m a y becom e in s u red a ga in a s a n ew Mem b er . However , th e followin g will a p p ly:

1 . If you cea s e to be a Mem ber beca u s e of a covered Dis a b ility, you r in s u ra n ce will en d ; h owever , if you becom e a Mem b er a ga in im m edia tely a fter LTD Ben efit s en d , th e Eligib ility Wa it in g Per iod will be wa ived (s u b ject to you r Em ployer ’s reh ire p rovis ion for Red u ct ion In Force em ployees ) a n d , with res pect to th e con dit ion (s ) for wh ich LTD Ben efit s were pa ya ble, th e Preexis t in g Con dit ion Exclu s ion will be a pp lied a s if you r in s u ra n ce h a d rem a in ed in effect d u r in g th a t p er iod of Dis a b ility.

2 . If you r in s u ra n ce en d s beca u s e you fa il to m a ke a requ ired prem iu m con tr ib u t ion , you m u s t p rovide Eviden ce Of In s u ra b ility to becom e in s u red a ga in .

3 . If you r in s u ra n ce en d s beca u s e you a re on a federa l or s ta te -m a n da ted fa m ily or m edica l lea ve of a bs en ce, a n d you becom e a Mem ber a ga in im m edia tely followin g th e per iod a llowed , you r in s u ra n ce will be rein s ta ted pu rs u a n t to th e federa l or s ta te -m a n da ted fa m ily or m edica l lea ve a ct or la w.

4 . Th e Preexis t in g Con dit ion s Exclu s ion will be a p p lied a s if in s u ra n ce h a d rem a in e d in effect in th e followin g in s ta n ces :

a . If you b ecom e in s u red a ga in with in 12 m on th s .

b . If requ ired by federa l or s ta te-m a n d a ted fa m ily or m edica l lea ve a ct or la w a n d you becom e in s u red a ga in im m edia tely followin g th e per iod a llowed u n der th e fa m ily o r m edica l lea ve a ct or la w.

5 . In n o even t will in s u ra n ce be ret roa ct ive. LT.RE.OT.1

DEFINITION OF DISABILITY

You a re Dis a b led if you m eet th e followin g d efin it ion s d u r in g th e per iods th ey a pp ly:

A. Own Occu pa t ion Defin it ion Of Dis a b ility.

B. An y Occu pa t ion Defin it ion Of Dis a b ility.

A. Own Occu pa t ion Defin it ion Of Dis a b ility

Du r in g th e Ben efit Wa it in g Per iod a n d th e Own Occu pa t ion Per iod you a re requ ired to be Dis a b led on ly from you r Own Occu p a t ion .

You a re Dis a b led from you r Own Occu p a t ion if, a s a res u lt of Ph ys ica l Dis ea s e, In ju ry, Pregn a n cy or Men ta l Dis order :

1 . You a re u n a b le to per form with rea s on a ble con t in u ity th e Ma ter ia l Du t ies of you r Own Occu pa t ion ; a n d

2 . You s u ffer a los s of a t lea s t 2 0% in you r In d exed Pred is a b ility Ea rn in gs wh en work in g in you r Own Occu pa t ion .

Note: You a re n ot Dis a b led m erely beca u s e you r r igh t to per form you r Own Occu pa t ion is res t r icted , in clu d in g a res t r ict ion or los s of licen s e.

Du r in g th e Own Occu p a t ion Per iod you m a y work in a n oth er occu pa t ion wh ile you m eet th e Own Occu pa t ion Defin it ion Of Dis a b ility. However , you will n o lon ger be Dis a b led wh en you r Work Ea rn in gs from a n oth er occu pa t ion exceed 8 0% of you r In d exed Pred is a b ility Ea rn in gs . You r Work Ea rn in gs m a y be Dedu ct ib le In com e. See Re turn To Work Provis io ns a n d De duc t ible Inc om e .

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Own Occu pa t ion m ea n s a n y em ploym en t , bu s in es s , t ra de, p rofes s ion , ca llin g or voca t ion th a t in volves Ma ter ia l Du t ies of th e s a m e gen era l ch a ra cter a s th e occu pa t ion you a re regu la r ly per form in g for you r Em ployer wh en Dis a b ility b egin s . In determ in in g you r Own Occu p a t io n , we a re n ot lim ited to lookin g a t th e wa y you p er form you r job for you r Em ployer , bu t we m a y a ls o look a t th e wa y th e occu pa t ion is gen era lly per form ed in th e n a t ion a l econ om y. If you r Own Occu p a t ion in volves th e ren der in g of p rofes s ion a l s ervices a n d you a re requ ired to h a ve a p rofes s ion a l or occu pa t ion a l licen s e in order to work , you r Own Occu pa t ion is a s b roa d a s th e s cop e of you r licen s e.

Ma ter ia l Du t ies m ea n s th e es s en t ia l ta s ks , fu n ct ion s a n d opera t ion s , a n d th e s k ills , a b il it ies , kn owledge, t ra in in g a n d exp er ien ce, gen era lly requ ired by Em ployers from th os e en ga ged in a pa r t icu la r occu pa t ion th a t ca n n ot be rea s on a bly m odified or om it ted . In n o even t will we con s id er work in g a n a vera ge of m ore th a n 40 h ou rs per week to be a Ma ter ia l Du ty.

B. An y Occu pa t ion Defin it ion Of Dis a b ility

Du r in g th e An y Occu p a t ion Per iod you a re requ ir ed to b e Dis a b led from a ll occu p a t ion s .

You a re Dis a b led from a ll occu pa t ion s if, a s a res u lt of Ph ys ica l Dis ea s e, In ju ry, Pregn a n cy or Men ta l Dis order , you a r e u n a b le to p er form with rea s on a ble con t in u ity th e Ma ter ia l Du t ies of An y Occu pa t ion .

An y Occu pa t ion m ea n s a n y occu p a t ion or em ploym en t wh ich you a re a b le to per form , wh eth er du e to edu ca t ion , t ra in in g, or exper ien ce, wh ich is a va ila b le a t on e or m ore loca t ion s in th e n a t ion a l econ om y a n d in wh ich you ca n be exp ected to ea rn a t lea s t 8 0% of you r Pred is a b ility Ea rn in gs with in twelve m on th s followin g you r retu rn to work , rega rd les s of wh eth er you a re work in g in th a t or a n y oth er occu pa t ion .

Ma ter ia l Du t ies m ea n s th e es s en t ia l ta s ks , fu n ct ion s a n d opera t ion s , a n d th e s k ills , a b ilit ies , kn owledge, t ra in in g a n d exp er ien ce, gen era lly requ ired by Em ployers from th os e en ga ged in a pa r t icu la r occu pa t ion th a t ca n n ot be rea s on a bly m odified or om it ted . In n o even t will we con s id er work in g a n a vera ge of m ore th a n 40 h ou rs per week to be a Ma ter ia l Du ty.

You r An y Occu pa t ion Per iod a n d Own Occu p a t ion Per iod a re s h own in th e Cove rage Fe ature s . (OWN_ANY_WITH 4 0 ) LT.DD.LA.1

RETURN TO WORK PROVISIONS

A. Retu rn To Work Res p on s ib ility

Du r in g th e Own Occu pa t ion Per iod n o LTD Ben efit s will be pa id for a n y per iod wh en you a re a b le to work in you r Own Occu pa t ion a n d a b le to ea rn a t lea s t 2 0% of you r In dexed Pred is a b ility Ea rn in gs , bu t you elect n ot to work .

Du r in g th e An y Occu pa t ion Per iod n o LTD Ben efit s will b e p a id for a n y per iod wh en you a re a b le to work in An y Occu pa t ion a n d a b le to ea rn a t lea s t 20% of you r In dexed Pred is a b ility Ea rn in gs , b u t you elect n ot to work .

B. Retu rn To Work In cen t ive

You m a y s erve you r Ben efit Wa it in g Per iod wh ile work in g if you m eet th e Own Occu p a t ion Defin it ion Of Dis a b ility.

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You a re eligib le for th e Retu rn To Work In cen t ive on th e fir s t da y you work a fter th e Ben efit Wa it in g Per iod if LTD Ben efit s a re pa ya ble on th a t da te. Th e Retu rn To Work In cen t ive ch a n ges 12 m on th s a fter th a t da te, a s follows :

1 . Du r in g th e fir s t 1 2 m on th s , you r Work Ea rn in gs will be Dedu ct ib le In com e a s determ in ed in a ., b . a n d c:

a . Determ in e th e a m ou n t of you r LTD Ben efit a s if th ere were n o Ded u ct ib le In com e, a n d a d d you r Work Ea rn in gs to th a t a m ou n t .

b . Determ in e 10 0% of you r In dexed Pred is a b ility Ea rn in gs .

c. If a . is grea ter th a n b ., th e d ifferen ce will be Ded u ct ib le In com e.

2 . After th os e fir s t 12 m on th s , 50% of you r Work Ea rn in gs will be Dedu ct ib le In com e.

C. Work Ea rn in gs Defin it ion

Work Ea rn in gs m ea n s you r gros s m on th ly ea rn in gs from work you per form wh ile Dis a b led , p lu s th e ea rn in gs you cou ld receive if you worked a s m u ch a s you a re a b le to, con s ider in g you r Dis a b ility, in work th a t is rea s on a bly a va ila b le :

a . In you r Own Occu pa t ion du r in g th e Own Occu pa t ion Per iod ; a n d

b . In An y Occu pa t ion d u r in g th e An y Occu p a t ion Per iod .

Work Ea rn in gs in clu d es ea rn in gs from you r Em ployer , a n y oth er Em plo yer , or s elf-em ploym en t , a n d a n y s ick pa y, va ca t ion pa y, a n n u a l or pers on a l lea ve p a y or oth er s a la ry con t in u a t ion ea rn ed or a ccru ed wh ile work in g.

Ea rn in gs from work you per form will be in clu ded in Work Ea rn in gs wh en you h a ve th e r igh t to receive th em . If you a re pa id in a lu m p s u m or on a b a s is oth er th a n m on th ly, we will p rora te you r Work Ea rn in gs over th e per iod of t im e to wh ich th ey a p p ly. If n o p er iod of t im e is s ta ted , we will u s e a rea s on a ble on e.

In determ in in g you r Work Ea rn in gs we:

1 . Will u s e th e fin a n cia l a ccou n t in g m eth od you u s e for in com e ta x p u rpos es , if you u s e th a t m eth od on a con s is ten t ba s is .

2 . Will n ot be lim ited to th e ta xa b le in com e you rep or t to th e In tern a l Reven u e Service.

3 . Ma y ign ore expen s es u n der s ect ion 1 79 of th e IRC a s a d ed u ct ion from you r gros s ea rn in gs .

4 . Ma y ign ore deprecia t ion a s a ded u ct ion from you r gros s ea rn in gs .

5 . Ma y a d ju s t th e fin a n cia l in form a t ion you give u s in order to clea r ly reflect you r Work Ea rn in gs .

If we determ in e th a t you r ea rn in gs va ry s u b s ta n t ia lly from m on th to m on th , we m a y d eterm in e you r Work Ea rn in gs by a vera gin g you r ea rn in gs over th e m os t recen t th ree -m on th per iod . Du r in g th e Own Occu pa t ion Per iod you will n o lon ger be Dis a b led wh en you r a vera ge Work Ea rn in gs over th e la s t th ree m on th s exceed 8 0% of you r In dexed Pred is a b ility Ea rn in gs . Du r in g th e An y Occu pa t ion Per iod you will n o lon ger b e Dis a b led wh en you r a vera ge Work Ea rn in gs over th e la s t th ree m on th s exceed 8 0 % of you r Pred is a b ility Ea rn in gs .

D. Fa m ily Ca re Expen s es Adju s tm en t

If you m u s t pa y Fa m ily Ca re Expen s es in ord er to work , we will red u ce th e a m ou n t of th e Work Ea rn in gs u s ed in determ in in g you r Ded u ct ib le In com e, s u b ject to th e followin g:

1 . You r Work Ea rn in gs will be red u ced by th e fir s t $3 5 0 per Fa m ily Mem ber of th e m on th ly Fa m ily Ca re Expen s es you pa y, b u t n ot to exceed a tota l of $5 0 0 for a ll Fa m ily Mem bers .

2 . Th e Work Ea rn in gs a n d th e Fa m ily Ca re Exp en s es m u s t b e for th e s a m e p er iod .

3 . You m u s t give u s s a t is fa ctory proof of th e F a m ily Ca re Expen s es you pa y.

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4 . Th e Work Ea rn in gs red u ct ion by Fa m ily Ca re Expen s es will en d 12 m on th s a fter it begin s .

Fa m ily Ca re Expen s es m ea n s th e a m ou n t you pa y to a licen s ed ca re p rovid er for th e ca re of you r Fa m ily wh ich is n eces s a ry in order for you to work .

Fa m ily Mem ber m ea n s :

1 . You r Ch ild ; or

2 . You r s p ou s e, pa ren t , gra n dp a ren t , s ib lin g, or oth er clos e fa m ily m em b er res id in g in you r h om e wh o is :

a . Con t in u ou s ly in ca pa ble of s elf-s u s ta in in g em ploym en t beca u s e of m en ta l reta rda t ion or ph ys ica l h a n dica p ; a n d

b . Ch iefly depen den t u p on you for s u p p or t a n d m a in ten a n ce.

Ch ild m ea n s :

1 . You r ch ild res id in g in you r h om e (in clu d in g you r s tep ch ild a n d a n a d opted ch ild ), from live b ir th th rou gh a ge 1 5 ; or

2 . You r ch ild , a ge 1 6 or older , res id in g in you r h om e (in clu d in g you r s tep ch ild a n d a n a d opted ch ild ) wh o is :

a . Con t in u ou s ly in ca pa ble of s elf-s u s ta in in g em ploym en t beca u s e of m en ta l reta rda t ion or ph ys ica l h a n dica p ; a n d

b . Ch iefly depen den t u p on you for s u p p or t a n d m a in ten a n ce. (FAMILY CR) LT.RW.LA.1 X

REASONABLE ACCOMMODATION EXPENSE BENEFIT

If you retu rn to work in a n y occu pa t ion for a n y Em ployer , n ot in clu d in g s elf-em ploym en t , a s a res u lt of a rea s on a ble a ccom m oda t ion m a de by s u ch Em ployer , we will pa y th a t Em ployer a Rea s on a ble Accom m oda t ion Expen s e Ben efit of u p to $2 5 ,0 0 0 , bu t n ot to exceed th e exp en s es in cu r red .

Th e Rea s on a ble Accom m oda t ion Exp en s e Ben efit is pa ya ble on ly if th e rea s on a ble a ccom m oda t ion is a p proved by u s in wr it in g pr ior to it s im plem en ta t ion .

LT.RA.OT.1

REHABILITATION PLAN PROVISION

Wh ile you a re Dis a b led you m a y qu a lify to pa r t icipa te in a Reh a bilita t ion Pla n . Reh a bili ta t ion Pla n m ea n s a wr it ten p la n , p rogra m or cou r s e of voca t ion a l t ra in in g or ed u ca t ion th a t is in ten ded to p rep a re you to retu rn to work .

To pa r t icip a te in a Reh a bilita t ion Pla n you m u s t a pp ly on ou r form s or in a let ter to u s . Th e term s , con dit ion s a n d ob ject ives of th e p la n m u s t be a ccep ted by you a n d a p p roved by u s in a dva n ce. We h a ve th e s ole d is cret ion to a p prove you r Reh a bilita t ion Pla n .

Wh ile you a re pa r t icip a t in g in a n a p proved Reh a bilita t ion Pla n , you r LTD Ben efit will b e in crea s ed b y th e les s er of $ 1 ,0 00 or 10% of you r LTD Ben efit before redu ct ion by Ded u ct ib le In com e. You r LTD Ben efit m a y exceed th e Ma xim u m LTD Ben efit a s s h own in th e Cove rage Fe ature s a s a res u lt of th is in crea s e.

An a p proved Reh a bilita t ion Pla n m a y in clu de ou r pa ym en t of s om e or a ll of th e exp en s es you in cu r in con n ect ion with th e p la n , in clu d in g:

a . Tra in in g a n d ed u ca t ion exp en s es .

b . Fa m ily ca re expen s es .

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c. J ob -rela ted expen s es .

d . J ob s ea rch exp en s es . LT.RH.OT.1 X

TEMPORARY RECOVERY

You m a y tem p ora r ily recover from you r Dis a b ility a n d th en becom e Dis a b led a ga in from th e s a m e ca u s e or ca u s es with ou t h a vin g to s erve a n ew Ben efit Wa it in g Per iod . Tem p ora ry Recovery m ea n s you cea s e to be Dis a b led for n o lon ger th a n th e a p p lica b le Allowa ble Per iod . See De fin it io n Of Dis abilit y .

A. Allowa ble Per iod s

1 . Du r in g th e Ben efit Wa it in g Per iod : a tota l of 18 2 da ys of recovery.

2 . Du r in g th e Ma xim u m Ben efit Per iod : 1 8 0 da ys for ea ch per iod of recovery.

B. Effect Of Tem p ora ry Recovery

If you r Tem p ora ry Recovery does n ot exceed th e Allowa ble Per iod s , th e followin g will a p p ly.

1 . Th e Pred is a b ility Ea rn in gs u s ed to d eterm in e you r LTD Ben efit will n ot ch a n ge.

2 . Th e per iod of Tem pora ry Recovery will n ot cou n t towa rd you r Ben efit Wa it in g Per iod , you r Ma xim u m Ben efit Per iod or you r Own Occu p a t ion Per iod .

3 . No LTD Ben efit s will be pa ya ble for th e per iod of Tem p ora ry Recovery.

4 . No LTD Ben efit s will be pa ya ble a fter ben efit s becom e pa ya ble to you u n der a n y oth er d is a b ility in s u ra n ce p la n u n d er wh ich you becom e in s u red d u r in g you r p er iod of Tem p ora ry Recovery.

5 . Except a s s ta ted a b ove, th e p rovis ion s of th e Grou p Policy will b e a pp lied a s if th ere h a d been n o in ter ru p t ion of you r Dis a b ility.

LT.TR.OT.1

WHEN LTD BENEFITS END

You r LTD Ben efit s en d a u tom a t ica lly on th e ea r lies t of:

1 . Th e d a te you a re n o lon ger Dis a b led .

2 . Th e d a te you r Ma xim u m Ben efit Per iod en ds .

3 . Th e d a te you d ie.

4 . Th e d a te ben efit s becom e pa ya ble u n der a n y oth er grou p LTD p la n u n d er wh ich you becom e in s u red th rou gh em ploym en t du r in g a p er iod of Tem p ora ry Recovery.

5 . Th e d a te you fa il to p rovide proof of con t in u ed Dis a b ility a n d en t it lem en t to LTD Ben efit s . LT.BE.OT.1

PREDISABILITY EARNINGS

You r Pred is a b ility Ea rn in gs will be ba s ed on you r ea rn in gs in effect on you r la s t fu ll d a y of Act ive Work a s rep or ted to u s by you r Em ployer ; h owever , th is does n ot m ea n you r W-2 ea rn in gs . An y s u bs equ en t ch a n ge in you r ea rn in gs a fter th a t la s t fu ll d a y of Act ive Wor k will n ot a ffect you r Pred is a b ility Ea rn in gs .

For Lega cy Qwes t Ba rga in in g Reta il/ Ou ts ide Sa les Repres en ta t ives : Pred is a b ility Ea rn in gs m ea n s a n a m ou n t equ a l to th e Avera ge Hou r ly Ra te, a s defin ed in th e levera ged com pen s a t ion p la n , on you r la s t fu ll da y of Act ive Work .

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All oth er Mem bers : Pred is a b ility Ea rn in gs m ea n s you r m on th ly ra te of ea rn in gs a s repor ted to u s by you r Em ployer , in clu d in g bu t n ot lim ited to th e followin g:

1 . Con tr ib u t ion s you m a ke th rou gh a s a la ry red u ct ion a greem en t with you r Em ployer to:

a . An In tern a l Reven u e Cod e (IRC) Sect ion 40 1(k ), 403(b), 4 0 8(k), 4 0 8(p), or 45 7 defer red com pen s a t ion a r ra n gem en t ; or

b . An execu t ive n on qu a lified defer red com p en s a t ion a r ra n gem en t .

2 . Com m is s ion s (if a pp lica b le).

3 . Ta rget in cen t ive pa y (if a pp lica b le).

4 . Over t im e pa y, (a s p rovid ed in th e levera ged com p en s a t ion p la n on ly).

5 . Am ou n ts con t r ib u ted to you r fr in ge ben efit s a ccord in g to a s a la ry redu ct ion a greem en t u n der n IRC Sect ion 1 25 p la n .

Pred is a b ility Ea rn in gs does n ot in clu de:

1 . Bon u s es , excep t a s defin ed u n der ta rget in cen t ive pa y a b ove.

2 . Over t im e pa y, excep t a s oth erwis e p rovided in th e levera ged com pen s a t ion p la n .

3 . Sh ift d ifferen t ia l pa y

4 . S tock op t ion s or s tock b on u s es .

5 . Im p u ted in com e a n d reb a tes .

6 . You r Em ployer 's con t r ib u t ion s on you r beh a lf t o a n y defer red com p en s a t ion a r ra n gem en t or pen s ion p la n .

7 . An y oth er ext ra com pen s a t ion .

If you a re pa id on a n a n n u a l con t ra ct b a s is , you r m on th ly ra te of ea rn in gs is on e -twelfth (1 / 12 th ) of you r a n n u a l con t ra ct s a la ry.

If you a re pa id h ou r ly, you r m on th ly ra te of ea rn in gs is b a s ed on you r h ou r ly pa y ra te m u lt ip lied by th e n u m ber of h ou rs you a re regu la r ly s ch ed u led to work per m on th , b u t n ot m ore th a n 1 73 h ou rs . If you d o n ot h a ve regu la r work h ou rs , you r m on th ly ra te of ea rn in gs is ba s ed on th e a vera ge n u m b er of h ou rs you worked per m on th d u r in g th e p reced in g 1 2 ca len da r m on th s (or du r in g you r per iod of em ploym en t if les s th a n 12 m on th s ), b u t n ot m ore th a n 17 3 h ou rs .

(REG WITH COM_NO STOCK) LT.PD.OT.1 X

DEDUCTIBLE INCOME

Su bject to Exc e pt io ns To De duc t ible In c o m e , Ded u ct ib le In com e m ea n s :

1 . S ick p a y, a n n u a l or p ers on a l lea ve p a y, s evera n ce pa y, va ca t ion p a y, pers on a l p a id d a ys , or a n y oth er s a la ry con t in u a t ion (in clu d in g don a ted a m ou n ts ) pa id to you by you r Em ployer , if it exceed s th e a m ou n t fou n d in a ., b ., a n d c.

a . Determ in e th e a m ou n t of you r LTD Ben efit a s if th ere were n o Ded u ct ib le In com e, a n d a d d you r s ick p a y or oth er s a la ry con t in u a t ion to th a t a m ou n t .

b . Determ in e 10 0% of you r In dexed Pred is a b ility Ea rn in gs .

c. If a . is grea ter th a n b ., th e d ifferen ce will be Ded u ct ib le In com e.

2 . You r Work Ea rn in gs , a s des cr ibed in th e Re turn To Wo rk Provis io ns .

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3 . An y a m ou n t you receive or a re eligib le to receive beca u s e of you r d is a b ilit y, in clu d in g a m ou n ts for pa r t ia l or tota l d is a b ility, wh eth er perm a n en t , tem p ora ry, or voca t ion a l, u n d er a n y of th e followin g:

a . A work ers ' com pen s a t ion la w;

b . Th e J on es Act ;

c. Ma r it im e Doctr in e of Ma in ten a n ce, Wa ges , or Cu re;

d . Lon gs h orem en 's a n d Ha rbor Worker 's Act ; or

e. An y s im ila r a ct or la w.

4 . An y a m ou n t you receive or a re eligib le to receive beca u s e of you r d is a b ilit y or ret irem en t u n der :

a . Th e Federa l Socia l Secu r ity Act ;

b . Th e Ca n a da Pen s ion Pla n ;

c. Th e Qu ebec Pen s ion Pla n ;

d . Th e Ra ilroa d Ret irem en t Act ; or

e. An y s im ila r p la n or a ct .

Pr im a ry offs et on ly: Pr im a ry ben efit s (th e ben efit a wa rded to you ) a r e Ded u ct ib le In com e, b u t depen den ts b en efit s a re n ot .

5 . An y a m ou n t you receive or a re eligib le to receive beca u s e of you r d is a b ility u n d er a n y s ta te d is a b ility in com e b en efit la w or s im ila r la w.

6 . An y a m ou n t you receive or a re eligib le to receive beca u s e of you r d is a b ility u n der a n oth er grou p in s u ra n ce covera ge.

7 . An y d is a b ility or ret irem en t ben efit s you receive or a re eligib le to receive u n der you r Em ployer ’s ret irem en t p la n , in clu d in g a p la n a r ra n ged or m a in ta in ed by a u n ion for th e ben efit s of it s m em bers .

8 . An y d is a b ility ben efit s received or eligib le to receive a s a r ota t ion a l em p loyee u n der th e Bellcore pen s ion p la n .

9 . An y d is a b ility or ret irem en t ben efit s you receive or a re eligib le to receive u n der you r Em ployer 's ret irem en t p la n in clu d in g a n y lu m p s u m pa ym en ts .

10 . An y ea rn in gs or com pen s a t ion in clu ded in Pred is a b ility Ea rn in gs wh ich you receive or a re eligib le to receive wh ile LTD Ben efit s a re pa ya ble.

11 . An y a m ou n t you receive or a re eligib le to receive u n der a n y u n em ploym en t com pen s a t ion la w or s im ila r a ct or la w.

12 . An y a m ou n t you receive or a re eligib le to receive from or on beh a lf of a th ird pa r ty b eca u s e of you r d is a b ility, wh eth er by ju dgem en t , s et t lem en t or oth er m eth od . If you n ot ify u s before filin g s u it or s et t lin g you r cla im a ga in s t s u ch th ird pa r ty, th e a m ou n t u s ed a s Ded u ct ib le In com e will b e redu ced by a p ro ra ta s h a re of you r cos ts of recovery, in clu d in g rea s on a ble a t torn ey fees .

13 . An y a m ou n t you receive by com prom is e, s et t lem en t , or o th er m eth od a s a res u lt of a cla im for a n y of th e a bove, wh eth er d is pu ted or u n dis p u ted .

(NO OTHR OFFST_PRIV_WITH 3 RD) LT.DI.OT.1 X

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EXCEPTIONS TO DEDUCTIBLE INCOME

Dedu ct ib le In com e d oes n ot in clu de:

1 . An y cos t of livin g in crea s e in a n y Dedu ct ib le In com e oth er th a n Work Ea rn in gs , if th e in crea s e becom es effect ive wh ile you a re Dis a b led a n d wh ile you a re eligib le for th e Dedu ct ib le In com e.

2 . Reim b u rs em en t for h os p ita l, m edica l, or s u rgica l expen s e.

3 . Rea s on a ble a t torn eys fees in cu r red in con n ect ion with a cla im for Ded u ct ib le In com e.

4 . Ben efit s from a n y in d ivid u a l d is a b ility in s u ra n ce policy.

5 . Ea r ly ret irem en t ben efit s u n der th e Federa l Socia l Secu r ity Act wh ich a re n ot a ctu a lly received .

6 . Grou p cred it or m or tga ge d is a b ility in s u ra n ce b en efit s .

7 . Accelera ted dea th ben efit s pa id u n d er a life in s u ra n ce p olicy.

8 . An y Ben efit s you receive a s a res u lt of m ilita ry s ervice with th e Un ited Sta tes .

9 . Ben efit s from th e followin g:

a . Profit s h a r in g p la n .

b . Th r ift or s a vin gs p la n .

c. Defer red com pen s a t ion p la n .

d . Pla n u n der IRC Sect ion 40 1(k), 40 8(k), 40 8(p), or 45 7 .

e. In d ivid u a l Ret irem en t Accou n t (IRA).

f. Ta x Sh eltered An n u ity (TSA) u n der IRC Sect ion 4 03(b).

g. S tock own ers h ip p la n .

h . Keogh (HR-1 0) p la n . (PRIV_NO OTHR OFFST) LT.ED.OT.1 X

RULES FOR DEDUCTIBLE INCOME

A. Mon th ly Equ iva len ts

Ea ch m on th we will determ in e you r LTD Ben efit u s in g th e Ded u ct ib le In com e for th e s a m e m on th ly per iod , even if you a ctu a lly receive th e Ded u ct ib le In com e in a n oth er m on th .

If you a re pa id Dedu ct ib le In com e in a lu m p s u m or by a m eth od oth er th a n m on th ly, we will determ in e you r LTD Ben efit u s in g a p rora ted a m ou n t . We will u s e th e p er iod of t im e to wh ich th e Dedu ct ib le In com e a pplies . If n o per iod of t im e is s ta ted , we will u s e a rea s on a ble on e .

B. You r Du ty To Pu rs u e Dedu ct ib le In com e

You m u s t pu rs u e Dedu ct ib le In com e for wh ich you m a y be eligib le. We m a y a s k for wr it ten docu m en ta t ion of you r p u rs u it of Ded u ct ib le In com e. You m u s t p rovid e it with in 60 da ys a fter we m a il you ou r requ es t . Oth er wis e, we m a y redu ce you r LTD Ben efit s by th e a m ou n t we es t im a te you wou ld b e eligib le to receive u pon proper p u rs u it of th e Dedu ct ib le In com e.

C. Pen din g Ded u ct ib le In com e

We will n ot d ed u ct pen din g Dedu ct ib le In com e u n t il it becom es pa ya ble. You m u s t n ot ify u s of th e a m ou n t of th e Ded u ct ib le In com e wh en it is a p proved . You m u s t repa y u s for th e res u lt in g overpa ym en t of you r cla im .

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D. Overpa ym en t Of Cla im

We will n ot ify you of th e a m ou n t of a n y overpa ym en t of you r cla im u n der a n y grou p d is a b ility in s u ra n ce p olicy is s u ed by u s . You m u s t im m edia tely repa y u s . You will n ot receive a n y LTD Ben efit s u n t il we h a ve b een repa id in fu ll. In th e m ea n t im e, a n y LTD Ben efit s pa id , in clu d in g th e Min im u m LTD Ben efit , will be a p p lied to red u ce th e a m ou n t of th e overpa ym en t . We m a y ch a rge you in teres t a t th e lega l ra te for a n y overpa ym en t wh ich is n ot repa id with in 3 0 da ys a fter we fir s t m a il you n ot ice of th e a m ou n t of th e overp a ym en t .

LT.RU.OT.1

SUBROGATION

If LTD Ben efit s a re p a id or pa ya ble to you u n der th e Grou p Policy a s th e res u lt of a n y a ct or om is s ion of a th ird pa r ty, we will be s u broga ted to a ll r igh ts of recovery you m a y h a ve in res pect to s u ch a ct or om is s ion , to th e exten t th a t LTD Ben efit s were pa id . You m u s t execu te a n d deliver to u s s u ch in s t ru m en ts a n d pa pers a s m a y b e requ ired a n d do wh a tever els e is n eed ed to s ecu re s u ch r igh ts . You m u s t a void d oin g a n yth in g th a t wou ld preju d ice ou r r igh ts of s u broga t ion .

If you n ot ify u s b efore filin g s u it or s et t lin g you r cla im a ga in s t s u ch th ird pa r ty, th e a m ou n t to wh ich we a re s u broga ted will b e red u ced by a p ro ra ta s h a re of you r cos ts of recovery, in clu d in g rea s on a ble a t torn ey fees . If s u it or a ct ion is filed , we m a y r ecord a n ot ice of p a ym en ts of LTD Ben efit s , a n d s u ch n ot ice s h a ll con s t itu te a lien on a n y ju dgem en t recovered .

If you or you r lega l repres en ta t ive fa il to b r in g s u it or a ct ion prom pt ly a ga in s t s u ch th ird pa r ty, we m a y in s t itu te s u ch s u it or a ct ion in ou r n a m e or in you r n a m e. We a r e en t it led to reta in from a n y ju dgem en t recovered th e a m ou n t of LTD Ben efit s pa id or to be pa id to you or on you r beh a lf, togeth er with ou r cos ts of recovery, in clu d in g a t torn ey fees . Th e rem a in der of s u ch recovery, if a n y, s h a ll be pa id to you or a s th e cou r t m a y d irect .

LT.SG.LA.1

BENEFITS AFTER INSURANCE ENDS OR IS CHANGED

Du rin g ea ch per iod of con t in u ou s Dis a b ility, we will pa y LTD Ben efit s a ccord in g to th e term s of th e Grou p Policy in effect on th e d a te you b ecom e Dis a b led . You r r igh t to receive LTD Ben efit s will n ot b e a ffected by:

1 . An y a m en dm en t to th e Grou p Policy th a t is effect ive a fter you b ecom e Dis a b led .

2 . Term in a t ion of th e Grou p Policy a fter you becom e Dis a b led . LT.BA.OT.1

EFFECT OF NEW DISABILITY

If a per iod of Dis a b ility is exten ded by a n ew ca u s e wh ile LTD Ben efit s a re pa ya ble, LTD Ben efit s will con t in u e wh ile you rem a in Dis a b led . However , 1 a n d 2 a p p ly.

1 . LTD Ben efit s will n ot con t in u e beyon d th e en d of th e or igin a l Ma xim u m Ben efit Per iod .

2 . Th e Dis abilit ie s Exc lude d From Cove rage , Dis abilit ie s Subje c t To Lim ite d Pay Pe riods , a n d Lim itat io ns s ect ion s will a pp ly to th e n ew ca u s e of Dis a b ility.

LT.ND.OT.1

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DISABILITIES EXCLUDED FROM COVERAGE

A. Wa r

You a re n ot covered for a Dis a b ility ca u s ed or con t r ibu ted to by Wa r or a n y a ct of Wa r . Wa r m ea n s decla red or u n decla red wa r , wh eth er civil or in tern a t ion a l, a n d a n y s u bs ta n t ia l a rm ed co n flict between orga n ized forces of a m ilita ry n a tu re.

B. In ten t ion a lly Self-In flicted In ju ry

You a re n ot covered for a Dis a b ility ca u s ed or con t r ib u ted to by a n in ten t ion a lly s elf-in flicted In ju ry, wh ile s a n e or in s a n e.

C. Preexis t in g Con dit ion

A s epa ra te Preexis t in g Con dit ion exclu s ion a pp lies to Pla n 1 a n d Pla n 2 . However , if you ch a n ge you r Pla n s elect ion from Pla n 1 to Pla n 2 a n d b en efit s a re n ot pa ya ble u n der Pla n 2 b eca u s e of th e Preexis t in g Con dit ion exclu s ion , you r cla im will be a dm in is tered a s if you h a d n ot ch a n ged you r Pla n s elect ion .

1 . Defin it ion

A s epa ra te Preexis t in g Con dit ion exclu s ion a p p lies to Pla n 1 a n d Pla n 2 .

Preexis t in g Con dit ion m ea n s a m en ta l or ph ys ica l con dit ion wh eth er or n ot d ia gn os ed or m is d ia gn os ed :

a . For wh ich you h a ve don e or for wh ich a rea s on a bly pru d en t p ers on wou ld h a ve don e a n y of th e followin g:

i. Con s u lted a ph ys icia n or oth er licen s ed m edica l p rofes s ion a l;

ii. Received m edica l t rea tm en t , s ervices or a dvice;

iii. Un dergon e d ia gn os t ic p roced u res , in clu d in g s elf-a dm in is tered proced u res ;

iv. Ta ken pres cr ib ed dru gs or m edica t ion s ;

b . Wh ich , a s a res u lt of a n y m edica l exa m in a t ion , in clu d in g rou t in e exa m in a t ion , wa s d is covered or s u s pected ;

With res pect to Pla n 1 , a t a n y t im e d u r in g th e 3 6 5 -da y per iod ju s t before th e da te you r in s u ra n ce becom es effect ive u n d er th e Grou p Policy.

With res pect to Pla n 2 , a t a n y t im e du r in g th e 36 5 -da y per iod ju s t b efore you r in s u ra n ce becom es effect ive u n d er Pla n 2 .

2 . Exclu s ion

With res pect to Pla n 1 , you a re n ot covered for a Dis a b ility ca u s ed or con t r ib u ted to by a Preexis t in g Con dit ion or m edica l or s u rgica l t rea tm en t of a Preexis t in g Con dit ion u n les s , on th e da te you b ecom e Dis a b led , you :

a . Ha ve b een con t in u ou s ly in s u red u n der th e Grou p Policy for 1 2 m on th s a n d h a ve been Act ively At Work for a t lea s t on e fu ll d a y a fter th a t 12 m on th s ; or

b . Ha ve been con t in u ou s ly in s u red u n der th e Grou p Policy for a 12 -m on th Trea tm en t Free Per iod with ou t h a vin g don e a n y of th e followin g in con n ect ion with th e Preexis t in g Con dit ion :




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iv. Ta ken pres cr ib ed dru gs or m edica t ion s .

With res pect to Pla n 2 , you a re n ot covered for a Dis a b ility ca u s ed or con t r ib u ted to by a Preexis t in g Con dit ion or m edica l or s u rgica l t rea tm en t of a Preexis t in g Con dit ion u n les s , on th e da te you b ecom e Dis a b led , you :

a . Ha ve b een con t in u ou s ly in s u red u n d er Pla n 2 for 1 2 m on th s a n d h a ve been Act ively At Work for a t lea s t on e fu ll da y a fter th a t 12 m on th s ; or

b . Ha ve b een con t in u ou s ly in s u red u n d er Pla n 2 for a 1 2 -m on th Trea tm en t Free Per iod with ou t h a vin g d on e a n y of th e followin g in con n ect ion with th e Preexis t in g Co n dit ion :




iv. Ta ken pres cr ib ed dru gs or m edica t ion s .

D. Los s Of Licen s e Or Cer t ifica t ion

You a re n ot covered for a Dis a b ility ca u s ed or con t r ib u ted to by th e los s of you r p rofes s ion a l licen s e, occu p a t ion a l licen s e or cer t ifica t ion .

E . Violen t Or Cr im in a l Con du ct

You a re n ot covered for a Dis a b ility ca u s ed or con t r ibu ted to by you r com m it t in g or a t tem pt in g to com m it a n a s s a u lt or felon y, or a ct ively pa r t icipa t in g in a violen t d is ord er or r iot . Act ively pa r t icip a t in g d oes n ot in clu de bein g a t th e s cen e of a violen t d is ord er or r iot wh ile per form in g you r officia l d u t ies .

(WITH PRUDNT_TFP) LT.XD.OT.1

DISABILITIES SUBJ ECT TO LIMITED PAY PERIODS

A. Men ta l Dis orders , Su bs ta n ce Ab u s e a n d Oth er Lim ited Con dit ion s

Pa ym en t of LTD Ben efit s is lim ited to 12 m on th s du r in g you r en t ire lifet im e for a Dis a b ility ca u s ed or con t r ib u ted to by a n y on e or m ore of th e followin g, or m edica l or s u rgica l t rea tm en t of on e or m ore of th e followin g:

1 . Men ta l Dis orders ;

2 . Su b s ta n ce Ab u s e; or

3 . Oth er Lim ited Con dit ion s .

However , if you a re con fin ed in a Hos p ita l s olely beca u s e of a Men ta l Dis order a t th e en d of th e 1 2 m on th s , th is lim ita t ion will n ot a pp ly wh ile you a re con t in u ou s ly con fin ed .

Men ta l Dis order m ea n s a n y m en ta l, em ot ion a l, beh a viora l, p s ych ologica l, pers on a lity, cogn it ive, m ood or s t res s -rela ted a bn orm a lity, d is order , d is tu rba n ce, dys fu n ct ion or s yn drom e, rega rd les s of ca u s e (in clu d in g a n y b iologica l or b ioch em ica l d is ord er or im ba la n ce of th e b ra in ) or th e p res en ce of ph ys ica l s ym ptom s . Men ta l Dis order in clu des , bu t is n ot lim ited to, b ip ola r a ffect ive d is order , orga n ic b ra in s yn drom e, s ch izoph ren ia , p s ych ot ic illn es s , m a n ic depres s ive illn es s , depres s ion a n d depres s ive d is orders , a n xiety a n d a n xiety d is orders .

Su b s ta n ce Ab u s e m ea n s u s e of a lcoh ol, a lcoh olis m , u s e of a n y dru g, in clu d in g h a llu cin ogen s , or d ru g a dd ict ion .

Oth er Lim ited Con dit ion s m ea n s ch ron ic fa t igu e con dit ion s (s u ch a s ch ron ic fa t igu e s yn drom e, ch ron ic fa t igu e im m u n odeficien cy s yn drom e, p os t vira l s yn drom e, lim bic en ceph a lop a th y, Eps tein -Ba r r viru s in fect ion , h erpes viru s type 6 in fect ion , or m ya lgic en ceph a lom yelit is ), a n y a llergy or s en s it ivity to ch em ica ls or th e en viron m en t (s u ch a s en viron m en ta l a llergies , s ick bu ild in g

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s yn drom e, m u lt ip le ch em ica l s en s it ivity s yn drom e or ch ron ic toxic en ceph a lopa th y), ch ron ic p a in con dit ion s (s u ch a s fib rom ya lgia , r eflex s ym pa th et ic dys t roph y or m yofa s cia l pa in ), ca rpa l t u n n el or repet it ive m ot ion s yn drom e, tem p orom a n dibu la r join t d is order , or cra n iom a n dibu la r join t d is order .

However , Oth er Lim ited Con dit ion s does n ot in clu de n eopla s t ic d is ea s es , n eu rologic d is ea s es , en d ocr in e d is ea s es , h em a tologic d is ea s es , a s th m a , a llergy-in d u ced rea ct ive lu n g d is ea s e, tu m ors , m a lign a n cies , or va s cu la r m a lform a t ion s , d em yelin a t in g d is ea s es , or lu p u s .

Hos p ita l m ea n s a lega lly opera ted h os p ita l p rovid in g fu ll-t im e m edica l ca re a n d t rea tm en t u n der th e d irect ion of a fu ll-t im e s ta ff of licen s ed ph ys icia n s . Res t h om es , n u rs in g h om es , con va les cen t h om es , h om es for th e a ged , a n d fa cilit ies p r im a r ily a fford in g cu s tod ia l, ed u ca t ion a l, or reh a b ilita t ive ca re a re n ot Hos p ita ls .

B. Ru les For Dis a b ilit ies Su bject To Lim ited Pa y Per iod s

1 . If you a re Dis a b led a s a res u lt of a Men ta l Dis order or a n y Ph ys ica l Dis ea s e or In ju ry for wh ich pa ym en t of LTD Ben efit s is s u b ject to a lim ited p a y per iod , a n d a t th e s a m e t im e a re Dis a b led a s a res u lt of a Ph ys ica l Dis ea s e, In ju ry, or Pregn a n cy th a t is n ot s u b ject to s u ch lim ita t ion , LTD Ben efit s will be pa ya ble fir s t for con dit ion s th a t a re s u b ject to th e lim ita t ion .

2 . No LTD Ben efit s will be pa ya ble a fter th e en d of th e lim ited p a y per iod , u n les s on th a t da te you con t in u e to be Dis a b led a s a res u lt of a Ph ys ica l Dis ea s e, In ju ry, or Pregn a n cy for wh ich pa ym en t of LTD Ben efit s is n ot lim ited .

LT.LP.OT.1

LIMITATIONS

A. Ca re Of A Ph ys icia n

You m u s t be u n d er th e on goin g ca re of a Ph ys icia n in th e a ppropr ia te s pecia lty a s d eterm in ed b y u s du r in g th e Ben efit Wa it in g Per iod . No LTD Ben efit s will b e p a id for a n y per iod of Dis a b ility wh en you a re n ot u n d er th e on goin g ca re of a Ph ys icia n in th e a p propr ia t e s pecia lty a s determ in ed by u s .

B. Retu rn To Work Res p on s ib ility

Du r in g th e Own Occu p a t ion Per iod n o LTD Ben efit s will be pa id for a n y per iod of Dis a b ility wh en you a re a b le to work in you r Own Occu pa t ion a n d a b le to ea rn a t lea s t 2 0% of you r In dexed Pred is a b ility Ea rn in gs , bu t you elect n ot to work .

Du r in g th e An y Occu pa t ion Per iod , n o LTD Ben efit s will be pa id for a n y per iod of Dis a b ility wh en you a re a b le to work in An y Occu p a t ion a n d a b le to ea rn a t lea s t 20% of you r In dexed Pred is a b ility Ea rn in gs , bu t elect n ot to work .

C. Reh a bilita t ion Progra m

No LTD Ben efit s will be pa id for a n y per iod of Dis a b ility wh en you a re n ot pa r t icip a t in g in good fa ith in a p la n , p rogra m or cou rs e of m edica l t rea tm en t or voca t ion a l t ra in in g or ed u ca t ion a p proved by u s u n les s you r Dis a b ility p reven ts you from pa r t icip a t in g.

D. Foreign Res iden cy

Pa ym en t of LTD Ben efit s is lim ited to 1 2 m on th s for ea ch per iod of con t in u ou s Dis a b ility wh ile you res ide ou ts ide of th e Un ited Sta tes , a U.S Ter r itory or Ca n a da .

E . Im pr is on m en t

No LTD Ben efit s will be pa id for a n y per iod of Dis a b ility wh en you a re con fin ed for a n y rea s on in a pen a l or cor rect ion a l in s t itu t ion .

LT.LM.OT.1

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CLAIMS

A. Filin g A Cla im

Cla im s s h ou ld be filed on ou r form s . If we d o n ot p rovid e ou r form s with in 15 da ys a fter th ey a re requ es ted , you m a y s u bm it you r cla im in a let ter to u s . Th e let ter s h ou ld in clu de th e da te d is a b ility bega n , a n d th e ca u s e a n d n a tu re of th e d is a b ility.

B. Tim e Lim its On Filin g Proof Of Los s

You m u s t give u s Proof Of Los s with in 9 0 da ys a fter th e en d of th e Ben efit Wa it in g Per iod . If you ca n n ot do s o, you m u s t give it to u s a s s oon a s rea s on a bly p os s ib le, b u t n ot la ter th a n on e yea r a fter th a t 90 -da y p er iod . If Proof Of Los s is filed ou ts ide th es e t im e lim its , you r cla im will be den ied . Th es e lim its will n ot a pp ly wh ile you la ck lega l ca p a city.

C. Proof Of Los s

Proof Of Los s m ea n s wr it ten proof th a t you a re Dis a b led a n d en t it led to LTD Ben efit s . Proof Of Los s m u s t b e p rovid ed a t you r expen s e.

For cla im s of Dis a b ility du e to con dit ion s oth er th a n Men ta l Dis orders , we m a y requ ire p roof of ph ys ica l im p a irm en t th a t res u lt s from a n a tom ica l or ph ys iologica l a bn orm a lit ies wh ich a r e dem on s t ra b le by m edica lly a ccep ta b le clin ica l a n d la b ora tory d ia gn os t ic tech n iqu es .

D. Docu m en ta t ion

Com pleted cla im s s ta tem en ts , a s ign ed a u th or iza t ion for u s to ob ta in in form a t ion , a n d a n y oth er item s we m a y rea s on a bly requ ire in s u p por t of a cla im m u s t be s u bm it ted a t you r expen s e. If th e requ ired d ocu m en ta t ion is n ot p rovid ed with in 4 5 da ys a fter we m a il ou r re qu es t , you r cla im m a y be d en ied .

E . In ves t iga t ion Of Cla im

We m a y in ves t iga te you r cla im a t a n y t im e.

At ou r expen s e, we m a y h a ve you exa m in ed a t rea s on a ble in terva ls by s pecia lis t s of ou r ch oice. We m a y den y or s u s pen d LTD Ben efit s if you fa il to a t ten d a n exa m in a t ion or coopera te with th e exa m in er .

F. Tim e Of Pa ym en t

We will pa y LTD Ben efit s with in 30 da ys a fter you s a t is fy Proof Of Los s .

LTD Ben efit s will be p a id to you a t th e en d of ea ch m on th you qu a lify for th em . LTD Ben efit s rem a in in g u n pa id a t you r dea th will be pa id to you r es ta te.

We will eva lu a te you r cla im prom pt ly a fter you file it . With in 4 5 da ys a fter we receive you r cla im we will s en d you : (a ) a wr it ten decis ion on you r cla im ; or (b ) a n ot ice th a t we a re exten din g th e per iod to d ecide you r cla im for 30 d a ys . Before th e en d of th is exten s ion per iod we will s en d you : (a ) a wr it ten decis ion on you r cla im ; or (b ) a n ot ice th a t we a re exten din g th e per iod to d ecide you r cla im for a n a d d it ion a l 30 da ys . If a n exten s ion is du e to you r fa ilu re to p rovid e in form a t ion n eces s a ry to decide th e cla im , th e exten d ed t im e per iod for decid in g you r cla im will n ot begin u n t il you provide th e in form a t ion or oth erwis e res p on d .

If we exten d th e per iod to d ecide you r cla im , we will n ot ify you of th e followin g: (a ) th e rea s on s for th e exten s ion ; (b ) wh en we exp ect to decid e you r cla im ; (c) a n exp la n a t ion of th e s ta n da rds on wh ich en t it lem en t to ben efit s is ba s ed ; (d ) th e u n res olved is s u es p reven t in g a decis ion ; a n d (e) a n y a d dit ion a l in form a t ion we n eed to res olve th os e is s u es .

If we requ es t a d d it ion a l in form a t ion , you will h a ve 45 da ys to p rovid e th e in form a t ion . If you d o n ot p rovide th e requ es ted in form a t ion with in 4 5 da ys , we m a y decide you r cla im b a s ed on th e in form a t ion we h a ve received .

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If we den y a n y pa r t of you r cla im , you will receive a wr it ten n ot ice of den ia l con ta in in g:

a . Th e rea s on s for ou r decis ion .

b . Referen ce to th e pa r ts of th e Grou p Policy on wh ich ou r d ecis ion is b a s ed .

c. A copy of a n y in tern a l ru le or gu id elin e relied u p on in m a kin g ou r decis ion , or a s ta tem en t th a t n o s u ch ru le exis ts .

d . A des cr ip t ion of a n y a d dit ion a l in form a t ion n eed ed to s u pp or t you r cla im .

e. In form a t ion con cern in g you r r igh t to receive, free of ch a rge, cop ies of n on -pr ivileged docu m en ts a n d records releva n t to you r cla im .

f. In form a t ion con cern in g you r r igh t to a review of ou r d ecis ion .

g. In form a t ion con cern in g you r r igh t to b r in g a civil a ct ion for ben efit s u n der s ect ion 5 02(a ) of ERISA if you r cla im is den ied on review.

H. Review Procedu re

If a ll or pa r t of a cla im is den ied , you m a y requ es t a review. You m u s t requ es t a review in wr it in g with in 180 da ys a fter receivin g n ot ice of th e den ia l.

You m a y s en d u s wr it ten com m en ts or oth er item s to s u pp or t you r cla im . You m a y review a n d receive cop ies of a n y n on -pr ivileged in form a t ion th a t is releva n t to you r requ es t for review. Th ere will be n o ch a rge for s u ch copies . You m a y requ es t th e n a m es of m edica l or voca t ion a l exp er ts wh o provid ed a dvice to u s a b ou t you r cla im .

Th e p ers on con d u ct in g th e review will be s om eon e oth er th a n th e pers on wh o den ied th e cla im a n d will n ot b e s u b ord in a te to th a t p ers on . Th e pers on con du ct in g th e review will n ot give deferen ce to th e in it ia l den ia l d ecis ion . If th e den ia l wa s ba s ed on a m edica l ju dgem en t , th e pers on con d u ct in g th e review will con s u lt with a qu a lified h ea lth ca re p rofes s ion a l. Th is h ea lth ca re p rofes s ion a l will be s om eon e oth er th a n th e p ers on wh o m a de th e or igin a l m edica l ju dgem en t a n d will n ot b e s u bord in a te to th a t p ers on . Ou r review will in clu de a n y wr it ten com m en ts or oth er item s you s u bm it to s u p por t you r cla im .

We will review you r cla im prom pt ly a fter we receive you r requ es t . With in 45 d a ys a fter we receive you r requ es t for review we will s en d you : (a ) a wr it ten decis ion on review; or (b ) a n ot ice th a t we a re exten din g th e review p er iod for 4 5 da ys . If th e exten s ion is du e to you r fa ilu r e to p rovid e in form a t ion n eces s a ry to decide th e cla im on review, th e exten ded t im e per iod for review of you r cla im will n ot begin u n t il you provide th e in form a t ion or oth erwis e res pon d .

If we exten d th e review p er iod , we will n ot ify you of th e followin g : (a ) th e r ea s on s for th e exten s ion ; (b ) wh en we expect to d ecid e you r cla im on review; a n d (c) a n y a d dit ion a l in form a t ion we n eed to decide you r cla im .

If we requ es t a d d it ion a l in form a t ion , you will h a ve 45 da ys to p rovid e th e in form a t ion . If you d o n ot p rovide th e requ es ted in form a t ion with in 4 5 da ys , we m a y con clu d e ou r review of you r cla im ba s ed on th e in form a t ion we h a ve received .

Before we is s u e a decis ion on review, we will p rovide you , free of ch a rge, with a n y n ew eviden ce or ra t ion a le con s idered , relied u p on , or gen era ted b y u s in con n ect ion with th e cla im , a n d we wou ld provide s u ch n ew eviden ce or ra t ion a le s u fficien t ly in a dva n ce of th e decis ion d ea d lin e d a te to give you a rea s on a ble opp or tu n ity to res p on d pr ior to th a t da te.

If we den y a n y pa r t of you r cla im on review, you will receive a wr it ten n ot ice of den ia l con ta in in g:

a . Th e rea s on s for ou r decis ion .

b . Referen ce to th e pa r ts of th e Grou p Policy on wh ich ou r d ecis ion is b a s ed .

c. A copy of a n y in tern a l ru le or gu id elin e relied u p on in m a kin g ou r decis ion , or a s ta tem en t th a t n o s u ch ru les or gu id elin es exis t .

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d . In form a t ion con cern in g you r r igh t to receive, free of ch a rge, cop ies of n on -pr ivileged docu m en t s a n d records releva n t to you r cla im .

e. In form a t ion con cern in g you r r igh t t o b r in g a civil a ct ion for ben efit s u n d er s ect ion 5 02(a ) of ERISA. Th is in form a t ion will a ls o in clu de a des cr ip t ion of a n y a p plica b le con t ra ctu a l lim ita t ion s per iod th a t a pp lies to you r r igh t to b r in g s u ch a n a ct ion , in clu d in g th e ca len d a r da te on wh ich th e con t ra ctu a l lim ita t ion s per iod exp ires for th e cla im .

Th e Grou p Policy d oes n ot p rovid e volu n ta ry a ltern a t ive d is p u te res olu t ion op t ion s . However , you m a y con ta ct you r loca l U.S. Depa r tm en t of La b or Office a n d you r Sta te in s u ra n ce regu la tory a gen cy for a s s is ta n ce.

I. As s ign m en t

Th e r igh ts a n d b en efit s u n d er th e Grou p Policy a re n ot a s s ign a ble. (REV PRIV WRDG) LT.CL.LA.2 X

ALLOCATION OF AUTHORITY

Except for th os e fu n ct ion s wh ich th e Grou p Policy s p ecifica lly res erves to th e Policyh old er or Em ployer , we h a ve fu ll a n d exclu s ive a u th or ity to con t rol a n d m a n a ge th e Grou p Policy, to a dm in is ter cla im s , a n d to in terpret th e Grou p Policy a n d res olve a ll qu es t ion s a r is in g in th e a dm in is t ra t ion , in terpreta t ion , a n d a pplica t ion of th e Grou p Policy.

Ou r a u th or ity in clu des , bu t is n ot lim ited to:

1 . Th e r igh t to res olve a ll m a t ters wh en a review h a s been requ es ted ;

2 . Th e r igh t to es ta b lis h a n d en force ru les a n d proced u res for th e a dm in is t ra t ion of th e Grou p Policy a n d a n y cla im u n der it ;

3 . Th e r igh t to determ in e:

a . E ligib ility for in s u ra n ce;

b . En t it lem en t to ben efit s ;

c. Th e a m ou n t of ben efit s p a ya ble; a n d

d . Th e s u fficien cy a n d th e a m ou n t of in form a t ion we m a y rea s on a bly requ ire to determ in e a ., b ., or c., a bove.

Su bject to th e review proced u res of th e Grou p Polic y, a n y decis ion we m a k e in th e exercis e of ou r a u th or ity is con clu s ive. However , th is p rovis ion will n ot res t r ict a n y r igh t you m a y h a ve to file a la ws u it or con ta ct th e Lou is ia n a In s u ra n ce Com m is s ion er if you r cla im for ben efit s is d en ied .

LT.AL.LA.1

TIME LIMITS ON LEGAL ACTIONS

No a ct ion a t la w or in equ ity m a y b e brou gh t u n t il 60 da ys a fter you h a ve given u s Proof Of Los s . No s u ch a ct ion m a y be brou gh t m ore th a n th ree yea rs a fter th e ea r lier of:

1 . Th e d a te we receive Proof Of Los s ; a n d

2 . Th e t im e with in wh ich Proof Of Los s is requ ired to be given . LT.TL.OT.1

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INCONTESTABILITY PROVISIONS

A. In con tes ta b ility Of In s u ra n ce

An y s ta tem en t m a de to ob ta in in s u ra n ce or to in crea s e in s u ra n ce is a repres en ta t ion a n d n ot a wa r ra n ty.

No m is repres en ta t ion will be u s ed to redu ce or den y a cla im or con tes t th e va lid ity of in s u ra n ce u n les s :

1 . Th e in s u ra n ce wou ld n ot h a ve been a p proved if we h a d kn own th e t ru th ; a n d

2 . We h a ve given you or a n y oth er pers on cla im in g ben efit s a copy of th e s ign ed wr it ten in s t ru m en t wh ich con ta in s th e m is repres en ta t ion .

After in s u ra n ce h a s been in effect for two yea rs du r in g th e lifet im e of th e in s u red , we will n ot u s e a m is repres en ta t ion to red u ce or den y th e cla im , u n les s it wa s a fra u d u len t m is repres en ta t ion .

B. In con tes ta b ility Of Th e Grou p Policy

An y s ta tem en t m a d e by th e Policyh older or Em ployer to ob ta in th e Grou p Policy is a repres en ta t ion a n d n ot a wa r ra n ty.

No m is repres en ta t ion by th e Policyh older or you r Em ployer will b e u s ed to den y a cla im or to d en y th e va lid ity of th e Grou p Policy u n les s :

1 . Th e Grou p Policy wou ld n ot h a ve b een is s u ed if we h a d kn own th e t ru th ; a n d

2 . We h a ve given th e Policyh older or Em ployer a copy of a wr it ten in s t ru m en t s ign ed by th e Policyh older or Em ployer wh ich con ta in s th e m is repres en ta t ion .

Th e va lid ity of th e Grou p Policy will n ot be con tes ted a fter it h a s b een in force for two yea rs , excep t for n on pa ym en t of p rem iu m s or fra u d u len t m is repres en ta t ion s .

LT.IN.OT.1

CLERICAL ERROR, AGENCY, AND MISSTATEMENT

A. Cler ica l Er ror

Cler ica l er ror by th e Policyh older , you r Em ployer , or th eir res pect ive em p loyees or repres en ta t ives will n ot :

1 . Ca u s e a pers on to becom e in s u red .

2 . In va lida te in s u ra n ce u n d er th e Grou p Policy oth erwis e va lid ly in force.

3 . Con t in u e in s u ra n ce u n d er th e Grou p Policy oth erwis e va lid ly term in a ted .

B. Agen cy

Th e Policyh old er a n d you r Em ployer a ct on th eir own beh a lf a s you r a gen t , a n d n ot a s ou r a gen t . Th e Policyh older a n d you r Em ployer h a ve n o a u th or ity to a lter , expa n d or exten d ou r lia b ility or to wa ive, m odify or com prom is e a n y d efen s e or r igh t we m a y h a ve u n der th e Grou p Policy.

C. Mis s ta tem en t Of Age

If a p ers on 's a ge h a s b een m is s ta ted , we will m a k e a n equ ita b le a d ju s tm en t of p rem iu m s , ben efit s , or both . Th e a d ju s tm en t will be ba s ed on :

1 . Th e a m ou n t of in s u ra n ce ba s ed on th e cor rect a ge; a n d

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2 . Th e d ifferen ce between th e p rem iu m s p a id a n d th e p rem iu m s wh ich wou ld h a ve been p a id if th e a ge h a d b een cor rect ly s ta ted .

LT.CE.OT.1

TERMINATION OR AMENDMENT OF THE GROUP POLICY

Th e Grou p Policy m a y b e term in a ted by u s or th e Policyh older a ccord in g to it s term s . It will term in a te a u tom a t ica lly for n on pa ym en t of p rem iu m . Th e Policyh old er m a y term in a te th e Grou p Policy in wh ole, a n d m a y term in a te in s u ra n ce for a n y cla s s or grou p of Mem bers , a t a n y t im e by givin g u s wr it ten n ot ice.

Ben efit s u n der th e Grou p Policy a re lim ited to it s term s , in clu d in g a n y va lid a m en d m en t . No ch a n ge or a m en dm en t will be va lid u n les s it is a p proved in wr it in g by on e of ou r execu t ive officers a n d given to th e Policyh old er for a t ta ch m en t to th e Grou p Policy . If th e term s of th e cer t ifica te d iffer from th e Grou p Policy, th e term s s ta ted in th e Grou p Policy will govern . Th e Policyh old er , you r Em p loyer , a n d th eir res pect ive em ployees or repres en ta t ives h a ve n o r igh t or a u th or ity to ch a n ge or a m en d th e Grou p Policy or to wa ive a n y of it s te rm s or p rovis ion s with ou t ou r s ign ed wr it ten a pprova l.

We m a y ch a n ge th e Grou p Policy in wh ole or in pa r t wh en a n y ch a n ge or cla r ifica t ion in la w or govern m en ta l regu la t ion a ffects ou r ob liga t ion s u n der th e Grou p Policy, or with th e Policyh older 's con s en t .

An y s u ch ch a n ge or a m en dm en t of th e Grou p Policy m a y a p ply to cu r ren t or fu tu re Mem bers or to a n y s ep a ra te cla s s es or grou ps of Mem bers .

LT.TA.OT.1

DEFINITIONS

Benefit W aiting Period m ea n s th e p er iod you m u s t be con t in u ou s ly Dis a b led before LTD Ben efit s becom e pa ya ble. No LTD Ben efit s a re pa ya ble for th e Ben efit Wa it in g Per iod . See Cove rage Fe ature s .

Contribu tory m ea n s in s u ra n ce is elect ive a n d Mem bers pa y a ll or p a r t of th e p rem iu m for in s u ra n ce.

CPI-W m ea n s th e Con s u m er Pr ice In d ex for Urb a n Wa ge Ea rn ers a n d Cler ica l Workers pu blis h ed by th e Un ited Sta tes Depa r tm en t of La b or . If th e CPI-W is d is con t in u ed or ch a n ged , we m a y u s e a com pa ra b le in dex. Wh ere requ ired , we will ob ta in p r ior s ta te a p prova l of th e n ew in dex.

Em ploy er m ea n s a n Em p loyer (in clu d in g a p proved a ffilia tes a n d s u bs id ia r ies ) for wh ich covera ge u n der th e Grou p Policy is a p proved in wr it in g by u s .

Grou p Policy m ea n s th e grou p LTD in s u ra n ce policy is s u ed by u s to th e Policyh old er a n d id en t ified by th e Grou p Policy Nu m b er .

Ind exed Pred is ability Ea rn in gs m ea n s you r Pred is a b ility Ea rn in gs a d ju s t ed by th e ra te of in crea s e in th e CPI-W. Du r in g you r fir s t yea r of Dis a b ility, you r In dexed Pred is a b ility Ea rn in gs a re th e s a m e a s you r Pred is a b ility Ea rn in gs . Th erea fter , you r In dexed Pred is a b ility Ea rn in gs a re determ in ed on ea ch a n n ivers a ry of you r Dis a b ility by in crea s in g th e p reviou s yea r 's In dexed Pred is a b ilit y Ea rn in gs b y th e ra te of in crea s e in th e CPI-W for th e p r ior ca len da r yea r . Th e m a xim u m a d ju s tm en t in a n y yea r is 10%. You r In d exed Pred is a b ility Ea rn in gs will n ot decrea s e, even if th e CPI-W decrea s es .

In ju ry m ea n s a n in ju ry to th e body.

L.L.C. Ow ner-Em ploy ee m ea n s a n in d ividu a l wh o own s a n equ ity in teres t in a n Em ployer a n d is a ct ively em ployed in th e con du ct of th e Em ployer 's bu s in es s .

LTD Benefit m ea n s th e m on th ly ben efit pa ya ble to you u n der th e term s of th e Grou p Policy.

Maxim um Benefit Period m ea n s th e lon ges t p er iod for wh ich LTD Ben efit s a re pa ya ble for a n y on e per iod of con t in u ou s Dis a b ility, wh eth er from on e or m ore ca u s es . It begin s a t th e en d of th e Ben efit

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Wa it in g Per iod . No LTD Ben efit s a re pa ya ble a fter th e en d of th e Ma xim u m Ben efit Per iod , even if you a re s t ill Dis a b led . See Cove rage Fe ature s .

Noncon tribu tory m ea n s (a ) in s u ra n ce is n on elect ive a n d th e Policyh older or E m ployer pa y th e en t ire p rem iu m for in s u ra n ce; or (b ) th e Policyh old er or Em ployer requ ire a ll eligib le Mem b ers to h a ve in s u ra n ce a n d to pa y a ll or pa r t of th e p rem iu m for in s u ra n ce.

Phy s ica l Dis eas e m ea n s a ph ys ica l d is ea s e en t ity or p roces s th a t p rod u ces s t ru ctu ra l or fu n ct ion a l ch a n ges in th e b ody a s d ia gn os ed by a Ph ys icia n .

Phy s icia n m ea n s a licen s ed M.D. or D.O., a ct in g with in th e s cope of th e licen s e. Ph ys icia n does n ot in clu de you or you r s p ou s e, or th e b rot h er , s is ter , pa ren t , or ch ild of eith er you or you r s p ou s e.

Pregna ncy m ea n s you r p regn a n cy, ch ild b ir th , or rela ted m edica l con dit ion s , in clu d in g com plica t ion s of p regn a n cy.

Prior Pla n m ea n s

a . you r Em ployer 's grou p lon g t erm d is a b ility in s u ra n ce p la n in effect on th e da y before th e effect ive da te of you r Em ployer 's pa r t icipa t ion u n der th e Grou p Policy a n d wh ich is rep la ced by covera ge u n der th e Grou p Policy; or

b . you r Em ployer ’s grou p lon g term d is a b ility in s u ra n ce p olicy th a t you were in s u red u n d er on th e da y before you r in s u ra n ce u n der th e Grou p Policy b eca m e effect ive.

S upplem en ta l W ork ers ' Com pens a tion Pay m ent benefit (S W CP) m ea n s you r wa ge rep la cem en t for a p proved on -th e-job a cciden ts .

LT.DF.OT.1 X

ERISA INFORMATION AND NOTICE OF RIGHTS

Th e followin g in form a t ion a n d n ot ice of r igh ts a n d protect ion s is fu rn is h ed by th e Pla n Ad m in is t ra tor a s requ ired by th e Em ployee Ret irem en t In com e Secu r ity Act of 1 9 74 (ERISA).

A. Gen era l Pla n In form a t ion

Th e Gen era l Pla n In form a t ion requ ired by ERISA is s h own in th e Cove rage Fe ature s .

B. Sta tem en t Of You r Righ ts Un der ERISA

1 . Righ t To Exa m in e Pla n Docu m en ts

You h a ve th e r igh t to exa m in e a ll Pla n docu m en ts , in clu d in g a n y in s u ra n ce con t ra cts or collect ive b a rga in in g a greem en ts , a n d a copy of th e la tes t a n n u a l rep or t (Form 5 50 0 Ser ies ) filed with th e U.S. Dep a r tm en t of La b or a n d a va ila b le a t th e Pu blic Dis clos u re Room of th e Em ployee Ben efit s Secu r ity Ad m in is t ra t ion . Th es e d ocu m en ts m a y be exa m in ed free of ch a rge a t th e Pla n Ad m in is t ra tor 's office.

2 . Righ t To Obta in Copies Of Pla n Docu m en ts

You h a ve th e r igh t to ob ta in cop ies of a ll Pla n d ocu m en ts , in clu d in g a n y in s u ra n ce con t ra cts or collect ive b a rga in in g a greem en ts , a copy of th e la tes t a n n u a l repor t (Fo rm 55 0 0 Ser ies ), a n d u p da ted s u m m a ry p la n des cr ip t ion u p on wr it ten requ es t to th e Pla n Ad m in is t ra tor . Th e Pla n Ad m in is t ra tor m a y m a ke a rea s on a ble ch a rge for th es e cop ies .

3 . Righ t To Receive A Copy Of An n u a l Rep or t

Th e Pla n Ad m in is t ra tor m u s t give you a copy of th e Pla n 's s u m m a ry a n n u a l fin a n cia l rep or t , if th e Pla n wa s requ ired to file a n a n n u a l rep or t . Th ere will be n o ch a rge for th e repor t .

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4 . Righ t To Review Of Den ied Cla im s

If you r cla im for a Pla n b en efit is den ied or ign ored , in wh ole or in pa r t , you h a ve th e r igh t : a ) to kn ow wh y th is wa s d on e; b ) to ob ta in cop ies of docu m en ts rela t in g to th e decis ion , with ou t ch a rge; a n d c) to h a ve you r cla im reviewed a n d recon s idered , a ll with in cer ta in t im e s ch ed u les .

C. Obliga t ion s Of Fid u cia r ies

In a dd it ion to crea t in g r igh ts for p la n pa r t icip a n ts , ERISA im pos es d u t ies u pon th e people wh o a r e res p on s ib le for th e op era t ion of th e Pla n . Th e p eople wh o opera te th e Pla n , ca lled "fid u cia r ies '' of th e Pla n , h a ve a d u ty to d o s o pru den t ly a n d in th e in teres t of a ll Pla n p a r t icipa n ts a n d ben eficia r ies . No on e, in clu d in g you r em ployer , you r u n ion , or a n y oth er pers on , m a y fire you or oth erwis e d is cr im in a te a ga in s t you in a n y wa y to p reven t you from obta in in g a Pla n ben efit or exercis in g you r r igh ts u n der ERISA.

D. En forcin g ERISA Righ ts

Un der ERISA, th ere a re s teps you ca n ta k e to en force th e a b ove r igh ts . For in s ta n ce, if you requ es t Pla n d ocu m en ts or th e la tes t a n n u a l rep or t from th e Pla n a n d do n ot receive th em with in 30 da ys , you m a y file s u it in a Federa l cou r t . In s u ch a ca s e, th e cou r t m a y requ ire th e Pla n Ad m in is t ra tor to p rovid e th e m a ter ia ls a n d pa y you u p to $ 1 10 a da y u n t il you receive th e m a ter ia ls , u n les s th e m a ter ia ls were n ot s en t beca u s e of rea s on s beyon d th e con t rol of th e Pla n Adm in is t ra tor .

If you h a ve a cla im for b en efit s wh ich is d en ied or ign ored , in wh ole or in pa r t , you m a y file s u it in a s ta te or Fed era l cou r t . If it s h ou ld h a pp en th a t Pla n fidu cia r ies m is u s e th e Pla n 's m on ey, or if you a re d is cr im in a ted a ga in s t for a s s er t in g you r r igh ts , you m a y s eek a s s is ta n ce from th e U.S. Depa r tm en t of La b or , or you m a y file s u it in a Federa l cou r t . Th e cou r t will decid e wh o s h ou ld pa y cou r t cos ts a n d lega l fees . If you a re s u cces s fu l th e cou r t m a y order th e pers on you h a ve s u ed to pa y th es e cos ts a n d fees . If you los e, th e cou r t m a y ord er you to p a y th es e cos ts a n d fees , for exa m ple, if it fin ds you r cla im is fr ivolou s .

E . Ad dit ion a l Proced u res For Cla im s Ba s ed on Dis a b ility Determ in a t ion s Filed on or a fter Apr il 1 , 20 1 8

If we d en y a n y p a r t of you r cla im for a ben efit th a t relies on a d is a b ility determ in a t ion , you will receive a wr it ten n ot ice of d en ia l con ta in in g a copy of a n y in tern a l r u le or gu id elin e relied u p on in m a kin g th e decis ion , or a s ta tem en t th a t n o s u ch ru les or gu idelin es exis t . Th e n ot ice of de n ia l will a ls o in clu d e in form a t ion con cern in g you r r igh t to receive, free of ch a rge, cop ies of n on -pr ivileged docu m en ts a n d records releva n t to you r cla im .

If a ll or pa r t of a cla im is den ied , you m a y requ es t a review. Before we is s u e a decis ion on review for a ben efit th a t relies on a d is a b ility d ecis ion , we will p rovide you , free of ch a rge, with a n y n ew evid en ce or ra t ion a le con s idered , relied u p on , or gen era ted by u s in con n ect ion with th e cla im , a n d we will p rovid e s u ch n ew evid en ce or ra t ion a le s u ffic ien t ly in a d va n ce of th e decis ion dea d lin e d a te to give you a rea s on a ble op p or tu n ity to res p on d p r ior to th a t da te.

If ou r review res u lt s in a den ia l of a n y pa r t of you r cla im for a ben efit th a t relies on a d is a b ilit y decis ion , you r wr it ten n ot ice of den ia l will con ta in a copy of a n y in tern a l ru le or gu idelin e relied u p on in m a kin g th e d ecis ion , or a s ta tem en t th a t n o s u ch ru les or gu idelin es exis t . Th e n ot ice of den ia l will a ls o in clu de in form a t ion con cern in g you r r igh t t o b r in g a civil a ct ion for ben efit s u n d er s ect ion 5 02(a ) of ERISA a n d a d es cr ip t ion of a n y a p plica b le con t ra ctu a l lim ita t ion s p er iod th a t a p p lies to you r r igh t to b r in g s u ch a n a ct ion , in clu d in g th e ca len da r da te on wh ich th e con t ra ctu a l lim ita t ion s p er iod exp ires for th e cla im .

F. Pla n An d ERISA Qu es t ion s

If you h a ve a n y qu es t ion s a b ou t th e Pla n , you s h ou ld con ta ct th e Pla n Ad m in is t ra tor . If you h a ve a n y qu es t ion s a b ou t th is s ta tem en t or a b ou t you r r igh ts u n der ERISA, or if you n eed a s s is ta n ce in ob ta in in g d ocu m en ts from th e Pla n Adm in is t r a tor , you s h ou ld con ta ct th e n ea res t office of th e Em ployee Ben efit s Secu r ity Adm in is t ra t ion , U.S. Depa r tm en t of La bor , lis ted in you r teleph on e d irectory or th e Divis ion of Tech n ica l As s is t a n ce a n d In qu ir ies , Em ployee Ben efit s Secu r ity

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Ad m in is t ra t ion , U.S . Depa r tm en t of La b or , 2 0 0 Con s t itu t ion Aven u e N.W., Wa s h in gton , DC 20 2 10 . You m a y a ls o ob ta in cer ta in p u blica t ion s a b ou t you r r igh ts a n d res p on s ib ilit ies u n der ERISA by ca llin g th e pu blica t ion s h ot lin e of th e Em ployee Ben efit s Secu r ity Ad m in is t ra t ion .

(NON-DENT_WITHOUT T/ A REFS) ERISA.3

LA/ LTDC2 0 0 0

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