Executive Accidental Death, Dismemberment and Plegia Insurance Policy



 Exhibit 10(hh) 
  
 CALIFORNIA LIFE AND HEALTH INSURANCE 
 GUARANTY ASSOCIATION ACT 
 SUMMARY DOCUMENT AND DISCLAIMER 
  
 Residents of California who purchase life and health insurance and annuities should know that
the insurance companies licensed in this state to write these types of insurance are members of the California Life and Health Insurance Guaranty Association. The purpose of this Association is to assure that policyholders will be protected, within
limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the Association will assess its other member insurance companies for the money to pay the claims of insured persons who
live in this state and, in some cases, to keep coverage in force. The valuable extra protection provided through the Association is not unlimited, as noted in the box below, and is not a substitute for consumers’ care in selecting well managed
and financially stable insurers. 
  
 The California Life and Health Insurance
Guaranty Association may not provide coverage for this insurance. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in the state. You should not rely on coverage by the Association
in selecting an insurance company or in selecting an insurance policy. 
  
 Coverage is NOT provided for your insurance or any portion of it that is not guaranteed by the Insurer or for which you have assumed the risk, such as a variable contract sold by prospectus. 
  
 Insurance companies or their agents are required by law to give or send you this notice.
However, insurance companies and their agents are prohibited by law from using the existence of the Association to induce you to purchase any kind of insurance policy. 
  
 If you have additional questions, you should first contact your insurer or agent and then may contact: 
  

					
	California Life and Health	 	OR	  	Consumer Service Division
	Insurance Guaranty Association	 	 	  	California Department of Insurance
	P.O. Box 17319	 	 	  	300 South Spring Street
	Beverly Hills, CA 90209-3319	 	 	  	Los Angeles, CA 90013

  
 Below is a brief summary of this
law’s coverages, exclusions and limits. This summary does not cover all provisions of the law; nor does it in any way change anyone’s rights or obligations under the Act or the rights or obligations of the Association. 
  
 COVERAGE 
  
 Generally, individuals will be protected by the California Life and Health Insurance Guaranty Association if they live in this state and
hold a life or health insurance contract, or an annuity, or if they are insured under a group insurance contract, issued by a member insurer. The beneficiaries, payees or assignees of insured persons are protected as well, even if they live in
another state. 







 EXCLUSIONS FROM COVERAGE 
  

However, persons holding such policies are not protected by this Association if: 
  

	•	 	their insurer was not authorized to do business in this state when it issued the policy or contract; 

  

	•	 	their policy was issued by a health care service plan (HMO), Blue Cross, Blue Shield, a charitable organization, a fraternal benefit society, a mandatory state pooling plan, a
mutual assessment company, an insurance exchange, or a grants and annuities society; 

  

	•	 	they are eligible for protection under the laws of another state. This may occur when the insolvent insurer was incorporated in another state whose Guaranty Association protects
insureds who live outside that state. 

  
 The Association also does
not provide coverage for: 
  

	•	 	unallocated annuity contracts; that is, contracts which are not issued to and owned by an individual and which guarantee rights to group contract holders, not individuals;


  

	•	 	employer and association plans to the extent they are self-funded or uninsured; 

  

	•	 	synthetic guaranteed interest contracts; 

  

	•	 	any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as a variable contract sold by prospectus;


  

	•	 	any policy of reinsurance unless an assumption certificate was issued; 

  

	•	 	interest rate yields that exceed an average rate; and 

  

	•	 	any portion of a contract that provides dividends or experience rating credits. 

  
 LIMITS ON AMOUNT OF COVERAGE 
  
 The Act limits the Association to pay benefits as follows: 
  
 Life and Annuity Benefits 
  

	•	 	80% of what the life insurance company would owe under a life policy or annuity contract up to 

  

	 	•	 	$100,000 in cash surrender values; 

  

	 	•	 	$100,000 in present value of annuities; or 

  

	 	•	 	$250,000 in life insurance death benefits. 

  

	•	 	A maximum of $250,000 for any one insured life no matter how many policies and contracts there were with the same company, even if the policies provided different types of
coverages. 

  
 Health Benefits 
  

	•	 	A maximum of $200,000 of the contractual obligations that the health insurance company would owe were it not insolvent. The maximum may increase or decrease annually based upon
changes in the health care cost component of the consumer price index. 

  
 PREMIUM SURCHARGE 
  
 Member insurers are required to recoup
assessments paid to the Association by way of a surcharge on premiums charged for health insurance policies to which the act applies. 







 Life Insurance Company of North America 
 1601 Chestnut Street, Philadelphia, Pennsylvania 19192-2235 
 A Stock Insurance Company 
  
 GROUP ACCIDENT POLICY 
  

			
	POLICYHOLDER:	    	Trustee of the Group Insurance Trust for Employers in the Manufacturing Industry
		
	POLICY NUMBER:	    	OK 980036
		
	POLICY EFFECTIVE DATE:	    	June 1, 2004
		
	POLICY ANNIVERSARY DATE:	    	July 1
		
	STATE OF ISSUE:	    	Delaware

  
 This Policy describes the terms and
conditions of insurance. This Policy goes into effect subject to its applicable terms and conditions at 12:01 AM on the Policy Effective Date shown above at the Policyholder’s address. The laws of the State of Issue shown above govern this
Policy. 
  
 We and the Policyholder agree to all of the terms of this Policy.

  
 THIS IS A GROUP ACCIDENT ONLY INSURANCE POLICY.

 IT DOES NOT PAY BENEFITS FOR LOSS CAUSED BY SICKNESS. 
  
 THIS IS A LIMITED POLICY. 
 PLEASE READ IT CAREFULLY. 
  

			
	

	  	


	Susan L. Cooper, Secretary	  	Gregory H. Wolf, President

  

			
	Countersigned	 	  


	 	 	        Where Required By Law


 GA-00-1000.00 







 TABLE OF CONTENTS 
  

			
	 SECTION

	  	PAGE
NUMBER


	 SCHEDULE OF AFFILIATES
	  	1
		
	 SCHEDULE OF BENEFITS
	  	2
		
	 GENERAL DEFINITIONS
	  	13
		
	 ELIGIBILITY AND EFFECTIVE DATE PROVISIONS
	  	16
		
	 COMMON EXCLUSIONS
	  	17
		
	 CONVERSION PRIVILEGE
	  	18
		
	 CLAIM PROVISIONS
	  	19
		
	 ADMINISTRATIVE PROVISIONS
	  	21
		
	 GENERAL PROVISIONS
	  	22
		
	 ACCIDENTAL DEATH AND DISMEMBERMENT COVERAGE
	  	24
		
	 EXPOSURE AND DISAPPEARANCE COVERAGE
	  	25
		
	 HIJACKING AND AIR PIRACY COVERAGE
	  	25
		
	 OWNED AIRCRAFT COVERAGE
	  	25
		
	 PILOT COVERAGE
	  	25
		
	 WAR RISK COVERAGE
	  	26
		
	 BRAIN DAMAGE BENEFIT
	  	26
		
	 FELONIOUS ASSAULT AND VIOLENT CRIME BENEFIT
	  	26
		
	 HOME ALTERATION AND VEHICLE MODIFICATION BENEFIT
	  	27
		
	 REHABILITATION BENEFIT
	  	27
		
	 SEATBELT AND AIRBAG BENEFIT
	  	28
		
	 MODIFYING PROVISIONS AMENDMENT
	  	29

  
 GA-00-1000.00 







 SCHEDULE OF AFFILIATES 
  
 The following affiliates are covered under this Policy on the effective dates listed below. 
  

					
	 AFFILIATE NAME

	  	 LOCATION

	  	 EFFECTIVE DATE


	None	  	 	  	 

  
 GA-00-1000.00 
  

 1 








 SCHEDULE OF BENEFITS 
  
 This Policy is intended to be read in its entirety. In order to understand all the conditions, exclusions and limitations applicable to its benefits, please read
all the policy provisions carefully. 
  
 The Schedule of
Benefits provides a brief outline of the coverage and benefits provided by this Policy. Please read the Description of Coverages and Benefits Section for full details. 
  

			
	Subscriber:	  	Northrop Grumman Corporation
		
	Effective Date of Subscriber Participation:	  	June 1, 2004
		
	Minimum Participation Requirements:	  	 
	 Percentage
	  	Not applicable

  
 Covered Classes: 
  

			
	 Class 1
	  	All active, Full-time Employees of the Employer who are members of Executive Class 1, Executive Class 2, Executive Class 3 and Executive Class 4 as on file with the
Subscriber.
		
	 Class 2
	  	All active, Full-time Employees of the Employer excluding Employees who are members of Executive Classes 1, 2, 3, 4, 5, 6 and 8 as on file with the Subscriber.
		
	 Class 3
	  	All active, Full-time Employees of the Employer who are members of Executive Class 5: Non Vice Presidents whose Salary Grade is 49 and above, as on file with the Subscriber.
		
	 Class 4
	  	All active, Full-time Employees of the Employer who are members of Executive Class 6: Non Vice Presidents whose Salary Grade is below 49, as on file with the Subscriber.
		
	 Class 5
	  	All active, Full-time Employees of the Employer who are members of Executive Class 8: those designated by Logicon Human Resources, as on file with the Subscriber.

  

 2 








 SCHEDULE OF BENEFITS FOR CLASS 1 
  
 This Schedule of Benefits shows maximums, benefit periods and any limitations applicable to benefits provided in
this Policy for each Covered Person unless otherwise indicated. Principal Sum, when referred to in this Schedule, means the Employee’s Principal Sum in effect on the date of the Covered Accident causing the Covered Injury or Covered Loss unless
otherwise specified. 
  
 Eligibility Waiting Period 
  
 The Eligibility Waiting Period is the period of time the Employee must be in a Covered Class
to be eligible for coverage. 
  

			
	For Employees hired on or before the Policy Effective Date:	  	None
	For Employees hired after the Policy Effective Date:	  	None

  
 Time Period for Loss:

  

			
	 Any Covered Loss must occur within:
	 	365 days of the Covered Accident

  
 BASIC ACCIDENTAL
DEATH AND DISMEMBERMENT BENEFITS 
  

			
	 Employee Principal Sum:
	 	6 times the Employee’s Annual Compensation, subject to a maximum of $1,000,000

  
 SCHEDULE OF
COVERED LOSSES 
  

			
	 Covered Loss

	 	 Benefit


	 Loss of Life
	 	100% of the Principal Sum
	 Loss of Two or More Hands or Feet
	 	100% of the Principal Sum
	 Loss of Sight of Both Eyes
	 	100% of the Principal Sum
	 Loss of One Hand or One Foot and Sight in One Eye
	 	100% of the Principal Sum
	 Loss of Speech and Hearing (in both ears)
	 	100% of the Principal Sum
	 Quadriplegia
	 	100% of the Principal Sum
	 Paraplegia
	 	75% of the Principal Sum
	 Hemiplegia
	 	50% of the Principal Sum
	 Coma
	 	 
	         Monthly Benefit
	 	1% of the Principal Sum
	                 Number of Monthly Benefits
	 	11
	                 When Payable
	 	At the end of each month during which the
	 	 	 Covered Person remains comatose

	         Lump Sum Benefit
	 	100% of the Principal Sum
	                 When Payable
	 	Beginning of the 12th month
	 Loss of One Hand or Foot
	 	75% of the Principal Sum
	 Loss of Sight in One Eye
	 	60% of the Principal Sum
	 Loss of Speech
	 	85% of the Principal Sum
	 Loss of Hearing (in both ears)
	 	85% of the Principal Sum
	 Severance and Reattachment of One Hand or Foot
	 	25% of the Principal Sum
	 Loss of Thumb and Index Finger of the Same Hand
	 	25% of the Principal Sum

  
 ADDITIONAL ACCIDENTAL DEATH AND
DISMEMBERMENT COVERAGES 
  
 Accidental Death and Dismemberment benefits
are provided under the following coverages. Any benefits payable under them are as shown in the Schedule of Covered Losses and are not paid in addition to any other Accidental Death and Dismemberment benefits. 
  

			
	EXPOSURE AND DISAPPEARANCE COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.
		
	HIJACKING AND AIR PIRACY COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.

  

 3 









			
	OWNED AIRCRAFT COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.
		
	PILOT COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.
		
	WAR RISK COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.

  
 ADDITIONAL ACCIDENT BENEFITS

  
 Any benefits payable under these Additional Accident Benefits
shown below are paid in addition to any other Accidental Death and Dismemberment benefits payable. 
  

			
	BRAIN DAMAGE BENEFIT	 	100% of the Principal Sum
	
	FELONIOUS ASSAULT AND VIOLENT CRIME BENEFIT
		
	 Accidental Death and Dismemberment Benefit
	 	10% multiplied by the percentage of the Principal Sum applicable to the Covered Loss, as shown in the Schedule of Covered Losses, subject to a minimum of $100 and a maximum of
$10,000
	
	 HOME ALTERATION AND VEHICLE MODIFICATION
 BENEFIT
  

	 Benefit
	 	10% of the Principal Sum subject to a maximum of $25,000
		
	REHABILITATION BENEFIT	 	 
		
	 Benefit per Covered Accident
	 	20% multiplied by the percentage of the Principal Sum applicable to the Covered Loss, subject to a minimum of $4,500 and a maximum of $18,000
		
	SEATBELT AND AIRBAG BENEFIT	 	 
		
	 Seatbelt Benefit
	 	20% of the Principal Sum subject to a Maximum Benefit of $25,000
	 Airbag Benefit
	 	10% of the Principal Sum subject to a Maximum Benefit of $10,000

  
 INITIAL PREMIUM RATES

  

			
	 Premium Rate:
	 	Basic Insurance
	 	 	 Employee Rate:    $0.017 per $1000

		
	 Mode of Premium Payment:
	 	Monthly
		
	 Contributions:
	 	The cost of the coverage is paid by the Employer
		
	 Premium Due Dates:
	 	The Policy Effective Date and the first day of each succeeding modal period

  
 Premium rates are subject to change in
accordance with the Changes in Premium Rates section contained in the Administrative Provisions section of this Policy. 
  
 GA-00-1100.00 
  

 4 








 SCHEDULE OF BENEFITS FOR CLASS 2 
  
 This Schedule of Benefits shows maximums, benefit periods and any limitations applicable to benefits provided in
this Policy for each Covered Person unless otherwise indicated. Principal Sum, when referred to in this Schedule, means the Employee’s Principal Sum in effect on the date of the Covered Accident causing the Covered Injury or Covered Loss unless
otherwise specified. 
  
 Eligibility Waiting Period 
  
 The Eligibility Waiting Period is the period of time the Employee must be in a Covered Class
to be eligible for coverage. 
  

			
	For Employees hired on or before the Policy Effective Date:	  	None
	For Employees hired after the Policy Effective Date:	  	None

  
 Time Period for Loss:

  

			
	 Any Covered Loss must occur within:
	 	365 days of the Covered Accident

  
 BASIC ACCIDENTAL
DEATH AND DISMEMBERMENT BENEFITS 
  

			
	 Employee Principal Sum:
	 	1 times the Employee’s Annual Compensation, subject to a minimum of $50,000 and a maximum of $1,000,000

  
 SCHEDULE OF
COVERED LOSSES 
  

			
	 Covered Loss

	 	 Benefit


	 Loss of Life
	 	100% of the Principal Sum
	 Loss of Two or More Hands or Feet
	 	100% of the Principal Sum
	 Loss of Sight of Both Eyes
	 	100% of the Principal Sum
	 Loss of One Hand or One Foot and Sight in One Eye
	 	100% of the Principal Sum
	 Loss of Speech and Hearing (in both ears)
	 	100% of the Principal Sum
	 Quadriplegia
	 	100% of the Principal Sum
	 Paraplegia
	 	75% of the Principal Sum
	 Hemiplegia
	 	50% of the Principal Sum
	 Coma
	 	 
	         Monthly Benefit
	 	1% of the Principal Sum
	                 Number of Monthly Benefits
	 	11
	                 When Payable
	 	At the end of each month during which the Covered Person remains comatose
	         Lump Sum Benefit
	 	100% of the Principal Sum
	                 When Payable
	 	Beginning of the 12th month
	 Loss of One Hand or Foot
	 	75% of the Principal Sum
	 Loss of Sight in One Eye
	 	60% of the Principal Sum
	 Loss of Speech
	 	85% of the Principal Sum
	 Loss of Hearing (in both ears)
	 	85% of the Principal Sum
	 Severance and Reattachment of One Hand or Foot
	 	25% of the Principal Sum
	 Loss of Thumb and Index Finger of the Same Hand
	 	25% of the Principal Sum

  
 ADDITIONAL ACCIDENTAL DEATH AND
DISMEMBERMENT COVERAGES 
  
 Accidental Death and Dismemberment benefits
are provided under the following coverages. Any benefits payable under them are as shown in the Schedule of Covered Losses and are not paid in addition to any other Accidental Death and Dismemberment benefits. 
  

			
	EXPOSURE AND DISAPPEARANCE COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.
		
	HIJACKING AND AIR PIRACY COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.

  

 5 









			
	OWNED AIRCRAFT COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.
		
	PILOT COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.
		
	WAR RISK COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.

  
 ADDITIONAL ACCIDENT BENEFITS

  
 Any benefits payable under these Additional Accident Benefits
shown below are paid in addition to any other Accidental Death and Dismemberment benefits payable. 
  

			
	BRAIN DAMAGE BENEFIT	 	100% of the Principal Sum
	
	FELONIOUS ASSAULT AND VIOLENT CRIME BENEFIT
		
	 Accidental Death and Dismemberment Benefit
	 	10% multiplied by the percentage of the Principal Sum applicable to the Covered Loss, as shown in the Schedule of Covered Losses, subject to a minimum of $100 and a maximum of
$10,000
		
	HOME ALTERATION AND VEHICLE MODIFICATION BENEFIT	 	 
		
	 Benefit
	 	10% of the Principal Sum subject to a maximum of $25,000
		
	REHABILITATION BENEFIT	 	 
		
	 Benefit per Covered Accident
	 	20% multiplied by the percentage of the Principal Sum applicable to the Covered Loss, subject to a minimum of $4,500 and a maximum of $18,000
		
	SEATBELT AND AIRBAG BENEFIT	 	 
		
	 Seatbelt Benefit
	 	20% of the Principal Sum subject to a Maximum Benefit of $25,000
	 Airbag Benefit
	 	10% of the Principal Sum subject to a Maximum Benefit of $10,000

  
 INITIAL PREMIUM RATES

  

			
	 Premium Rate:
	 	Basic Insurance
	 	 	 Employee Rate:    $0.017 per $1000

		
	 Mode of Premium Payment:
	 	Monthly
		
	 Contributions:
	 	The cost of the coverage is paid by the Employer
		
	 Premium Due Dates:
	 	The Policy Effective Date and the first day of each succeeding modal period

  
 Premium rates are subject to change in
accordance with the Changes in Premium Rates section contained in the Administrative Provisions section of this Policy. 
  
 GA-00-1100.00 
  

 6 








 SCHEDULE OF BENEFITS FOR CLASS 3 
  
 This Schedule of Benefits shows maximums, benefit periods and any limitations applicable to benefits provided in
this Policy for each Covered Person unless otherwise indicated. Principal Sum, when referred to in this Schedule, means the Employee’s Principal Sum in effect on the date of the Covered Accident causing the Covered Injury or Covered Loss unless
otherwise specified. 
  
 Eligibility Waiting Period 
  
 The Eligibility Waiting Period is the period of time the Employee must be in a Covered Class
to be eligible for coverage. 
  

			
	 For Employees hired on or before the Policy Effective Date:
	  	 None

	 For Employees hired after the Policy Effective Date:
	  	 None


  
 Time Period for Loss:

  

			
	Any Covered Loss must occur within:	 	365 days of the Covered Accident

  
 BASIC ACCIDENTAL
DEATH AND DISMEMBERMENT BENEFITS 
  

			
	 Employee Principal Sum:
	 	4 times the Employee’s Annual Compensation, subject to a maximum of $1,000,000

  
 SCHEDULE OF
COVERED LOSSES 
  

			
	 Covered Loss

	 	 Benefit


	 Loss of Life
	 	100% of the Principal Sum
	 Loss of Two or More Hands or Feet
	 	100% of the Principal Sum
	 Loss of Sight of Both Eyes
	 	100% of the Principal Sum
	 Loss of One Hand or One Foot and Sight in One Eye
	 	100% of the Principal Sum
	 Loss of Speech and Hearing (in both ears)
	 	100% of the Principal Sum
	 Quadriplegia
	 	100% of the Principal Sum
	 Paraplegia
	 	75% of the Principal Sum
	 Hemiplegia
	 	50% of the Principal Sum
	 Coma
	 	 
	         Monthly Benefit
	 	1% of the Principal Sum
	                 Number of Monthly Benefits
	 	11
	                 When Payable
	 	At the end of each month during which the Covered Person remains comatose
	         Lump Sum Benefit
	 	100% of the Principal Sum
	                 When Payable
	 	Beginning of the 12th month
	 Loss of One Hand or Foot
	 	75% of the Principal Sum
	 Loss of Sight in One Eye
	 	60% of the Principal Sum
	 Loss of Speech
	 	85% of the Principal Sum
	 Loss of Hearing (in both ears)
	 	85% of the Principal Sum
	 Severance and Reattachment of One Hand or Foot
	 	25% of the Principal Sum
	 Loss of Thumb and Index Finger of the Same Hand
	 	25% of the Principal Sum

  
 ADDITIONAL ACCIDENTAL DEATH AND
DISMEMBERMENT COVERAGES 
  
 Accidental Death and Dismemberment benefits
are provided under the following coverages. Any benefits payable under them are as shown in the Schedule of Covered Losses and are not paid in addition to any other Accidental Death and Dismemberment benefits. 
  

			
	EXPOSURE AND DISAPPEARANCE COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.
		
	HIJACKING AND AIR PIRACY COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.

  

 7 









			
	OWNED AIRCRAFT COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.
		
	PILOT COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.
		
	WAR RISK COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.

  
 ADDITIONAL ACCIDENT BENEFITS

  
 Any benefits payable under these Additional Accident Benefits
shown below are paid in addition to any other Accidental Death and Dismemberment benefits payable. 
  

			
	BRAIN DAMAGE BENEFIT	 	100% of the Principal Sum
	
	 FELONIOUS ASSAULT AND VIOLENT CRIME BENEFIT
  

	 Accidental Death and Dismemberment Benefit
	 	10% multiplied by the percentage of the Principal Sum applicable to the Covered Loss, as shown in the Schedule of Covered Losses, subject to a minimum of $100 and a maximum of
$10,000
	
	 HOME ALTERATION AND VEHICLE MODIFICATION
 BENEFIT
  

	 Benefit
	 	10% of the Principal Sum subject to a maximum of $25,000
		
	REHABILITATION BENEFIT	 	 
		
	 Benefit per Covered Accident
	 	20% multiplied by the percentage of the Principal Sum applicable to the Covered Loss, subject to a minimum of $4,500 and a maximum of $18,000
		
	 SEATBELT AND AIRBAG BENEFIT
  
	 	 
	 Seatbelt Benefit
	 	20% of the Principal Sum subject to a Maximum Benefit of $25,000
	 Airbag Benefit
	 	10% of the Principal Sum subject to a Maximum Benefit of $10,000

  
 INITIAL PREMIUM RATES

  

			
	 Premium Rate:
	 	Basic Insurance
	 	 	 Employee Rate:    $0.017 per $1000

		
	 Mode of Premium Payment:
	 	Monthly
		
	 Contributions:
	 	The cost of the coverage is paid by the Employer
		
	 Premium Due Dates:
	 	The Policy Effective Date and the first day of each succeeding modal period

  
 Premium rates are subject to change in
accordance with the Changes in Premium Rates section contained in the Administrative Provisions section of this Policy. 
  
 GA-00-1100.00 
  

 8 








 SCHEDULE OF BENEFITS FOR CLASS 4 
  
 This Schedule of Benefits shows maximums, benefit periods and any limitations applicable to benefits provided in
this Policy for each Covered Person unless otherwise indicated. Principal Sum, when referred to in this Schedule, means the Employee’s Principal Sum in effect on the date of the Covered Accident causing the Covered Injury or Covered Loss unless
otherwise specified. 
  
 Eligibility Waiting Period 
  
 The Eligibility Waiting Period is the period of time the Employee must be in a Covered Class
to be eligible for coverage. 
  

			
	For Employees hired on or before the Policy Effective Date:	  	None
	For Employees hired after the Policy Effective Date:	  	None

  
 Time Period for Loss:


			
		
	Any Covered Loss must occur within:	 	365 days of the Covered Accident

  
 BASIC ACCIDENTAL
DEATH AND DISMEMBERMENT BENEFITS 
  

			
	 Employee Principal Sum:
	 	The greater of $100,000 or 1 times the Employee’s Annual Compensation, subject to a maximum of $1,000,000

  
 SCHEDULE OF
COVERED LOSSES 
  

			
	 Covered Loss

	 	 Benefit


	 Loss of Life
	 	100% of the Principal Sum
	 Loss of Two or More Hands or Feet
	 	100% of the Principal Sum
	 Loss of Sight of Both Eyes
	 	100% of the Principal Sum
	 Loss of One Hand or One Foot and Sight in One Eye
	 	100% of the Principal Sum
	 Loss of Speech and Hearing (in both ears)
	 	100% of the Principal Sum
	 Quadriplegia
	 	100% of the Principal Sum
	 Paraplegia
	 	75% of the Principal Sum
	 Hemiplegia
	 	50% of the Principal Sum
	 Coma
	 	 
	         Monthly Benefit
	 	1% of the Principal Sum
	                 Number of Monthly Benefits
	 	11
	                 When Payable
	 	At the end of each month during which the Covered Person remains comatose
	         Lump Sum Benefit
	 	100% of the Principal Sum
	                 When Payable
	 	Beginning of the 12th month
	 Loss of One Hand or Foot
	 	75% of the Principal Sum
	 Loss of Sight in One Eye
	 	60% of the Principal Sum
	 Loss of Speech
	 	85% of the Principal Sum
	 Loss of Hearing (in both ears)
	 	85% of the Principal Sum
	 Severance and Reattachment of One Hand or Foot
	 	25% of the Principal Sum
	 Loss of Thumb and Index Finger of the Same Hand
	 	25% of the Principal Sum

  
 ADDITIONAL ACCIDENTAL DEATH AND
DISMEMBERMENT COVERAGES 
  
 Accidental Death and Dismemberment benefits
are provided under the following coverages. Any benefits payable under them are as shown in the Schedule of Covered Losses and are not paid in addition to any other Accidental Death and Dismemberment benefits. 
  

			
	EXPOSURE AND DISAPPEARANCE COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.
		
	HIJACKING AND AIR PIRACY COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.

  

 9 









			
	OWNED AIRCRAFT COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.
		
	PILOT COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.
		
	WAR RISK COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.

  
 ADDITIONAL ACCIDENT BENEFITS

  
 Any benefits payable under these Additional Accident Benefits
shown below are paid in addition to any other Accidental Death and Dismemberment benefits payable. 
  

			
	BRAIN DAMAGE BENEFIT	 	100% of the Principal Sum
	
	 FELONIOUS ASSAULT AND VIOLENT CRIME BENEFIT
  

	 Accidental Death and Dismemberment Benefit
	 	10% multiplied by the percentage of the Principal Sum applicable to the Covered Loss, as shown in the Schedule of Covered Losses, subject to a minimum of $100 and a maximum of
$10,000
	
	 HOME ALTERATION AND VEHICLE MODIFICATION
 BENEFIT

		
	 Benefit
	 	10% of the Principal Sum subject to a maximum of $25,000
		
	 REHABILITATION BENEFIT
  
	 	 
	 Benefit per Covered Accident
	 	20% multiplied by the percentage of the Principal Sum applicable to the Covered Loss, subject to a minimum of $4,500 and a maximum of $18,000
		
	SEATBELT AND AIRBAG BENEFIT	 	 
		
	 Seatbelt Benefit
	 	20% of the Principal Sum subject to a Maximum Benefit of $25,000
	 Airbag Benefit
	 	10% of the Principal Sum subject to a Maximum Benefit of $10,000

  
 INITIAL PREMIUM RATES

  

			
	 Premium Rate:
	 	Basic Insurance
	 	 	 Employee Rate:    $0.017 per $1000

		
	 Mode of Premium Payment:
	 	Monthly
		
	 Contributions:
	 	The cost of the coverage is paid by the Employer
		
	 Premium Due Dates:
	 	The Policy Effective Date and the first day of each succeeding modal period

  
 Premium rates are subject to change in
accordance with the Changes in Premium Rates section contained in the Administrative Provisions section of this Policy. 
  
 GA-00-1100.00 
  

 10 








 SCHEDULE OF BENEFITS FOR CLASS 5 
  
 This Schedule of Benefits shows maximums, benefit periods and any limitations applicable to benefits provided in
this Policy for each Covered Person unless otherwise indicated. Principal Sum, when referred to in this Schedule, means the Employee’s Principal Sum in effect on the date of the Covered Accident causing the Covered Injury or Covered Loss unless
otherwise specified. 
  
 Eligibility Waiting Period 
  
 The Eligibility Waiting Period is the period of time the Employee must be in a Covered Class
to be eligible for coverage. 
  

			
	For Employees hired on or before the Policy Effective Date:	  	None
	For Employees hired after the Policy Effective Date:	  	None

  
 Time Period for Loss:

  

			
	 Any Covered Loss must occur within:
	 	365 days of the Covered Accident

  
 BASIC ACCIDENTAL
DEATH AND DISMEMBERMENT BENEFITS 
  

			
	 Employee Principal Sum:
	 	4 times the Employee’s Annual Compensation, subject to a maximum of $1,000,000

  
 SCHEDULE OF
COVERED LOSSES 
  

			
	 Covered Loss

	 	 Benefit


	 Loss of Life
	 	100% of the Principal Sum
	 Loss of Two or More Hands or Feet
	 	100% of the Principal Sum
	 Loss of Sight of Both Eyes
	 	100% of the Principal Sum
	 Loss of One Hand or One Foot and Sight in One Eye
	 	100% of the Principal Sum
	 Loss of Speech and Hearing (in both ears)
	 	100% of the Principal Sum
	 Quadriplegia
	 	100% of the Principal Sum
	 Paraplegia
	 	75% of the Principal Sum
	 Hemiplegia
	 	50% of the Principal Sum
	 Coma
	 	 
	         Monthly Benefit
	 	1% of the Principal Sum
	                 Number of Monthly Benefits
	 	11
	                 When Payable
	 	At the end of each month during which the Covered Person remains comatose
	         Lump Sum Benefit
	 	100% of the Principal Sum
	                 When Payable
	 	Beginning of the 12th month
	 Loss of One Hand or Foot
	 	75% of the Principal Sum
	 Loss of Sight in One Eye
	 	60% of the Principal Sum
	 Loss of Speech
	 	85% of the Principal Sum
	 Loss of Hearing (in both ears)
	 	85% of the Principal Sum
	 Severance and Reattachment of One Hand or Foot
	 	25% of the Principal Sum
	 Loss of Thumb and Index Finger of the Same Hand
	 	25% of the Principal Sum

  
 ADDITIONAL ACCIDENTAL DEATH AND
DISMEMBERMENT COVERAGES 
  
 Accidental Death and Dismemberment benefits
are provided under the following coverages. Any benefits payable under them are as shown in the Schedule of Covered Losses and are not paid in addition to any other Accidental Death and Dismemberment benefits. 
  

			
	EXPOSURE AND DISAPPEARANCE COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.
		
	HIJACKING AND AIR PIRACY COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.

  

 11 









			
	OWNED AIRCRAFT COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.
		
	PILOT COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.
		
	WAR RISK COVERAGE	 	Principal Sum multiplied by the percentage applicable to the Covered Loss, as shown in the Schedule of Covered Losses.

  
 ADDITIONAL ACCIDENT BENEFITS

  
 Any benefits payable under these Additional Accident Benefits
shown below are paid in addition to any other Accidental Death and Dismemberment benefits payable. 
  

			
	BRAIN DAMAGE BENEFIT	 	100% of the Principal Sum
	
	 FELONIOUS ASSAULT AND VIOLENT CRIME BENEFIT
  

	 Accidental Death and Dismemberment Benefit
	 	10% multiplied by the percentage of the Principal Sum applicable to the Covered Loss, as shown in the Schedule of Covered Losses, subject to a minimum of $100 and a maximum of
$10,000
	
	 HOME ALTERATION AND VEHICLE MODIFICATION
 BENEFIT
  

	 Benefit
	 	10% of the Principal Sum subject to a maximum of $25,000
		
	REHABILITATION BENEFIT	 	 
		
	 Benefit per Covered Accident
	 	20% multiplied by the percentage of the Principal Sum applicable to the Covered Loss, subject to a minimum of $4,500 and a maximum of $18,000
		
	SEATBELT AND AIRBAG BENEFIT	 	 
		
	 Seatbelt Benefit
	 	20% of the Principal Sum subject to a Maximum Benefit of $25,000
	 Airbag Benefit
	 	10% of the Principal Sum subject to a Maximum Benefit of $10,000

  
 INITIAL PREMIUM RATES

  

			
	 Premium Rate:
	 	Basic Insurance
	 	 	 Employee Rate:    $0.017 per $1000

		
	 Mode of Premium Payment:
	 	Monthly
		
	 Contributions:
	 	The cost of the coverage is paid by the Employer
		
	 Premium Due Dates:
	 	The Policy Effective Date and the first day of each succeeding modal period

  
 Premium rates are subject to change in
accordance with the Changes in Premium Rates section contained in the Administrative Provisions section of this Policy. 
  
 GA-00-1100.00 
  

 12 








 GENERAL DEFINITIONS 
  
 Please note that certain words used in this Policy have specific meanings. The words defined below and capitalized within the text of this Policy have the meanings set
forth below. 
  

					
	Active Service	  	An Employee will be considered in Active Service with his Employer on any day that is either of the following:
			
	 	  	1.	  	one of the Employer’s scheduled work days on which the Employee is performing his regular duties on a full-time basis, either at one of the Employer’s usual places of business or at
some other location to which the Employer’s business requires the Employee to travel;
			
	 	  	2.	  	a scheduled holiday, vacation day or period of Employer-approved paid leave of absence, other than sick leave, only if the Employee was in Active Service on the preceding scheduled
workday.
		
	Age	  	A Covered Person’s Age, for purposes of initial premium calculations, is his Age attained on the date coverage becomes effective for him under this Policy. Thereafter, it is his
Age attained on his last birthday.
		
	Aircraft	  	A vehicle which:
			
	 	  	1.	  	has a valid certificate of airworthiness; and
			
	 	  	2.	  	is being flown by a pilot with a valid license to operate the Aircraft.
		
	Annual Compensation	  	An Employee’s gross straight-time pay for regularly scheduled hours for a seven-day week, excluding bonuses, overtime, incentive compensation allowances, benefit dollars or
other types of special compensation or as determined by the Subscriber and/or its subsidiaries.
		
	Covered Accident	  	A sudden, unforeseeable, external event that results, directly and independently of all other causes, in a Covered Injury or Covered Loss and meets all of the following
conditions:
			
	 	  	1.	  	occurs while the Covered Person is insured under this Policy;
			
	 	  	2.	  	is not contributed to by disease, Sickness, mental or bodily infirmity;
			
	 	  	3.	  	is not otherwise excluded under the terms of this Policy.
		
	Covered Injury	  	Any bodily harm that results directly and independently of all other causes from a Covered Accident.
		
	Covered Loss	  	A loss that is all of the following:
			
	 	  	1.	  	the result, directly and independently of all other causes, of a Covered Accident;
			
	 	  	2.	  	one of the Covered Losses specified in the Schedule of Covered Losses;
			
	 	  	3.	  	suffered by the Covered Person within the applicable time period specified in the Schedule of Benefits.
		
	Covered Person	  	An eligible person, as defined in the Schedule of Benefits, for whom an enrollment form has been accepted by Us and required premium has been paid when due and for whom
coverage under this Policy remains in force.
		
	Employee	  	For eligibility purposes, an Employee of the Employer who is in one of the Covered Classes.
		
	Employer	  	The Subscriber and any affiliates, subsidiaries or divisions shown in the Schedule of Covered Affiliates and which are covered under this Policy on the date of issue or
subsequently agreed to by Us.
		
	He, His, Him	  	Refers to any individual, male or female.

  

 13 









					
	Hospital	  	An institution that meets all of the following:
			
	 	  	1.	  	it is licensed as a Hospital pursuant to applicable law;
			
	 	  	2.	  	it is primarily and continuously engaged in providing medical care and treatment to sick and injured persons;
			
	 	  	3.	  	it is managed under the supervision of a staff of medical doctors;
			
	 	  	4.	  	it provides 24-hour nursing services by or under the supervision of a graduate registered nurse (R.N.);
			
	 	  	5.	  	it has medical, diagnostic and treatment facilities, with major surgical facilities on its premises, or available on a prearranged basis;
			
	 	  	6.	  	it charges for its services.
		
	 	  	The term Hospital does not include a clinic, facility, or unit of a Hospital for:
			
	 	  	1.	  	rehabilitation, convalescent, custodial, educational or nursing care;
			
	 	  	2.	  	the aged, drug addicts or alcoholics;
			
	 	  	3.	  	a Veteran’s Administration Hospital or Federal Government Hospital unless the Covered Person incurs an expense.
		
	Inpatient	  	A Covered Person who is confined for at least one full day’s Hospital room and board. The requirement that a person be charged for room and board does not apply to confinement
in a Veteran’s Administration Hospital or Federal Government Hospital and in such case, the term ‘Inpatient’ shall mean a Covered Person who is required to be confined for a period of at least a full day as determined by the
Hospital.
		
	Nurse	  	A licensed graduate Registered Nurse (R.N.), a licensed practical Nurse (L.P.N.) or a licensed vocational Nurse (L.V.N.) and who is not:
			
	 	  	1.	  	employed or retained by the Subscriber;
			
	 	  	2.	  	living in the Covered Person’s household; or
			
	 	  	3.	  	a parent, sibling, spouse or child of the Covered Person.
		
	Outpatient	  	A Covered Person who receives treatment, services and supplies while not an Inpatient in a Hospital.
		
	Permanently Totally Disabled	  	An Covered Person who is Totally Disabled and is expected to remain Totally Disabled, as certified by a Physician, for the rest of his life.
		
	Prior Plan	  	The plan of insurance providing similar benefits, sponsored by the Employer in effect immediately prior to this Policy’s Effective Date.
		
	Physician	  	A licensed health care provider practicing within the scope of his license and rendering care and treatment to a Covered Person that is appropriate for the condition and locality and
who is not:
			
	 	  	1.	  	employed or retained by the Subscriber;
			
	 	  	2.	  	living in the Covered Person’s household;
			
	 	  	3.	  	a parent, sibling, spouse or child of the Covered Person.
		
	Sickness	  	A physical or mental illness.
		
	Spouse	  	The Employee’s lawful spouse.
		
	Subscriber	  	Any participating organization that subscribes to the trust to which this Policy is issued.

  

 14 









					
	 Totally Disabled or
 Total Disability
	  	 Totally Disabled or Total Disability means either:
  

	  	 1.      
	  	inability of the Covered Person who is currently employed to do any type of work for which he is or may become qualified by reason of education, training or experience; or
			
	 	  	 2.      
	  	inability of the Covered Person who is not currently employed to perform all of the activities of daily living including eating, transferring, dressing, toileting, bathing, and continence,
without human supervision or assistance.
		
	We, Us, Our	  	Life Insurance Company of North America.

  
 GA-00-1200.00 
  

 15 








 ELIGIBILITY AND EFFECTIVE DATE PROVISIONS 
  
 Subscriber Effective Date 
  
 Accident Insurance Benefits become effective for each Subscriber in consideration of the Subscriber’s application, Subscription Agreement and payment of the initial
premium when due. Insurance coverage for the Subscriber becomes effective on the Effective Date of Subscriber Participation as long as the Minimum Participation Requirement shown in the Schedule of Benefits has been satisfied. 
  
 Eligibility 
  
 An Employee becomes eligible for insurance under this Policy on the date he meets all of the requirements of one of the Covered Classes and
completes any Eligibility Waiting Period, as shown in the Schedule of Benefits. 
  
 Effective Date for Individuals 
  
 Insurance becomes effective
for an eligible Employee, subject to the Deferred Effective Date provision below, on the latest of the following dates: 
  

	1.	the effective date of this Policy; 

  

	2.	the date the Employee becomes eligible. 

  
 DEFERRED EFFECTIVE DATE 
  
 Active Service 
  
 The effective date of
insurance will be deferred for any Employee who is not in Active Service on the date coverage would otherwise become effective. Coverage will become effective on the later of the date he returns to Active Service and the date coverage would
otherwise have become effective. 
  
 Effective Date of Changes 

 
 Any increase or decrease in the amount of insurance for the Covered Person resulting
from: 
  

	1.	a change in benefits provided by this Policy; or 

  

	2.	a change in the Employee’s Covered Class will take effect on the date of such change. 

  
 Increases will take effect subject to any Active Service requirement. 
  
 TERMINATION OF INSURANCE 
  
 The insurance on a Covered Person will end on the earliest date below: 
  

	1.	the date this Policy or insurance for a Covered Class is terminated; 

  

	2.	the next premium due date after the date the Covered Person is no longer in a Covered Class or satisfies eligibility requirements under this Policy; 

  

	3.	the last day of the last period for which premium is paid. 

  
 Termination will not affect a claim for a Covered Loss or Covered Injury that is the result, directly and independently of all other causes, of a Covered Accident that
occurs while coverage was in effect. 
  
 Continuation for Family, Medical,
Educational or Personal Leave 
  
 Insurance for an Employee may be continued
until the earliest of the following dates if: (a) an Employee is on an Employer-approved Family Leave, Medical Leave, Educational or Personal Leave; and (b) required premium contributions are paid when due. 
  

	1.	for an Employer-approved Family Leave: four months after the end of the month in which the leave begins; 

  

	2.	for an Employer-approved Medical Leave: twenty-four months after the end of the month in which the leave begins; 

  

	3.	for an Employer-approved Educational Leave: one month after the end of the month in which the leave begins; 

  

	4.	for an Employer-approved Personal Leave: one month after the end of the month in which the leave begins. 

  
 GA-00-1300.00 
  

 16 








 COMMON EXCLUSIONS 
  
 In addition to any benefit-specific exclusions, benefits will not be paid for any Covered Injury or Covered Loss which, directly or indirectly, in whole or in part, is
caused by or results from any of the following unless coverage is specifically provided for by name in the Description of Benefits Section: 
  

	1.	intentionally self-inflicted Injury, suicide or any attempt thereat while sane or insane; 

  

	2.	commission or attempt to commit a felony or an assault; 

  

	3.	declared or undeclared war or act of war; 

  

	4.	flight in, boarding or alighting from an Aircraft or any craft designed to fly above the Earth’s surface, except as: 

  

	 	a.	a fare-paying passenger on a regularly scheduled commercial or charter airline; 

  

	 	b.	a passenger in a non-scheduled, private Aircraft used for pleasure purposes with no commercial intent during the flight; 

  

	 	c.	a passenger in a military Aircraft flown by the Air Mobility Command or its foreign equivalent; 

  

	5.	Sickness, disease, bodily or mental infirmity, bacterial or viral infection or medical or surgical treatment thereof, except for any bacterial infection resulting from an accidental
external cut or wound or accidental ingestion of contaminated food; 

  

	6.	travel in any Aircraft owned, leased or controlled by the Subscriber, or any of its subsidiaries or affiliates. An Aircraft will be deemed to be ‘controlled’ by the
Subscriber if the Aircraft may be used as the Subscriber wishes for more than 10 straight days, or more than 15 days in any year; 

  

	7.	a Covered Accident that occurs while engaged in the activities of active duty service in the military, navy or air force of any country or international organization. Covered
Accidents that occur while engaged in Reserve or National Guard training are not excluded until training extends beyond 31 days; 

  

	8.	voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage;


  

	9.	the Covered Person’s intoxication as determined according to the laws of the jurisdiction in which the Covered Accident occurred. 

  
 GA-00-1400.00 
  

 17 








 CONVERSION PRIVILEGE 
  
 If the Covered Person’s insurance or any portion of it ends for any of the following reasons: 
  

	a.	employment or membership ends; 

  

	b.	eligibility ends (except for age); 

  
 the Covered Person may have Us issue converted accident insurance on an individual policy or an individual certificate under a designated group policy. The Covered Person
may apply for an amount of coverage that is: 
  

	a.	in $1,000 increments; 

  

	b.	not less than $25,000, regardless of the amount of insurance under the group policy; and 

  

	c.	not more than the amount of insurance he had under the group policy, except as provided above, up to a maximum amount of $250,000. 

  
 The Covered Person must be under age 70 to get a converted policy. 
  
 If the Covered Person’s insurance or any portion of it ends for non-payment of premium,
he may not convert. 
  
 The converted policy or certificate will cover accidental
death and dismemberment. The policy or certificate will not contain disability or other additional benefits. The Covered Person need not show Us that he is insurable. 
  
 If the Covered Person has converted his group coverage and later becomes insured under the same group plan as before, he may not convert a
second time unless he provides, at his own expense, proof of insurability or proof the prior converted policy is no longer in force. 
  
 The Covered Person must apply for the individual policy within 31 days after his coverage under this Group Policy ends and pay the required premium, based on Our table of
rates for such policies, his Age and class of risk. If the Covered Person has assigned ownership of his group coverage, the owner/assignee must apply for the individual policy. 
  
 If the Covered Person dies during this 31-day period as the result of an accident that would have been covered under this Group Policy, We
will pay as a claim under this Group Policy the amount of insurance that the Covered Person was entitled to convert. It does not matter whether the Covered Person applied for the individual policy or certificate. If such policy or certificate is
issued, it will be in exchange for any other benefits under this Group Policy. 
  
 The individual policy or certificate will take effect on the day following the date coverage under the Group Policy ended; or, if later, the date application is made. 
  
 Exclusions 
  
 The converted policy may exclude the hazards or conditions that apply to the Covered Person’s group coverage at the time it ends. We will reduce payment under the
converted policy by the amount of any benefits paid under the group policy if both cover the same loss. 
  
 GA-01-1500.00 
  

 18 








 CLAIM PROVISIONS 
  
 Notice of Claim 
  
 Written or authorized electronic/telephonic notice of claim must be given to Us within 31 days after a Covered Loss occurs or begins or as soon as reasonably possible. If written or authorized electronic/telephonic
notice is not given in that time, the claim will not be invalidated or reduced if it is shown that written or authorized electronic/telephonic notice was given as soon as was reasonably possible. Notice can be given to Us at Our Home Office in
Philadelphia, Pennsylvania, such other place as We may designate for the purpose, or to Our authorized agent. Notice should include the Subscriber’s name and policy number and the Covered Person’s name, address, policy and certificate
number. 
  
 Claim Forms 
  
 We will send claim forms for filing proof of loss when We receive notice of a claim. If such
forms are not sent within 15 days after We receive notice, the proof requirements will be met by submitting, within the time fixed in this Policy for filing proof of loss, written or authorized electronic proof of the nature and extent of the loss
for which the claim is made. 
  
 Claimant Cooperation Provision 

 
 Failure of a claimant to cooperate with Us in the administration of the claim may result
in termination of the claim. Such cooperation includes, but is not limited to, providing any information or documents needed to determine whether benefits are payable or the actual benefit amount due. 
  
 Proof of Loss 
  
 Written or authorized electronic proof of loss satisfactory to Us must be given to Us at Our office, within 90 days of the loss for which
claim is made. If (a) benefits are payable as periodic payments and (b) each payment is contingent upon continuing loss, then proof of loss must be submitted within 90 days after the termination of each period for which We are liable. If written or
authorized electronic notice is not given within that time, no claim will be invalidated or reduced if it is shown that such notice was given as soon as reasonably possible. In any case, written or authorized electronic proof must be given not more
than two years after the time it is otherwise required, except if proof is not given solely due to the lack of legal capacity. 
  
 Time of Payment of Claims 
  
 We will pay benefits due under this Policy for any loss other than a loss for which this Policy provides any periodic payment immediately upon receipt of due written or
authorized electronic proof of such loss. Subject to due written or authorized electronic proof of loss, all accrued benefits for loss for which this Policy provides periodic payment will be paid monthly unless otherwise specified in the benefits
descriptions and any balance remaining unpaid at the termination of liability will be paid immediately upon receipt of proof satisfactory to Us. 
  
 Payment of Claims 
  
 All benefits will be paid in United States currency. Benefits for loss of life will be payable in accordance with the Beneficiary provision and these Claim Provisions. All other proceeds payable under this Policy,
unless otherwise stated, will be payable to the covered Employee or to his estate. 
  
 If We are to pay benefits to the estate or to a person who is incapable of giving a valid release, We may pay $1,000 to a relative by blood or marriage whom We believe is equitably entitled. Any payment made by Us in good faith pursuant to
this provision will fully discharge Us to the extent of such payment and release Us from all liability. 
  
 Payment of Claims to Foreign Employees 
  
 The Subscriber may, in a fiduciary capacity, receive and hold any benefits payable to covered Employees whose place of employment is other than: 
  

	1.	the United States of America; 

  

	2.	Puerto Rico; or 

  

	3.	the Dominion of Canada. 

  
 We will not be responsible for the application or disposition by the Subscriber of any such benefits paid. Our payments to the Subscriber will constitute a full discharge of Our liability for those payments under this
Policy. 
  

 19 








 Physical Examination and Autopsy 
  
 We, at Our own expense, have the right and opportunity to examine the Covered Person when and as often as We may reasonably require while a
claim is pending and to make an autopsy in case of death where it is not forbidden by law. 
  
 Legal Actions 
  
 No action at law or in
equity may be brought to recover under this Policy less than 60 days after written or authorized electronic proof of loss has been furnished as required by this Policy. No such action will be brought more than three years after the time such written
proof of loss must be furnished. 
  
 Beneficiary 
  
 The beneficiary is the person or persons the Employee names or changes on a form executed by
him and satisfactory to Us. This form may be in writing or by any electronic means agreed upon between Us and the Subscriber. Consent of the beneficiary is not required to affect any changes, unless the beneficiary has been designated as an
irrevocable beneficiary, or to make any assignment of rights or benefits permitted by this Policy. 
  
 A beneficiary designation or change will become effective on the date the Employee executes it. However, We will not be liable for any action taken or payment made before We record notice of the change at our Home
Office. 
  
 If more than one person is named as beneficiary, the interests of each
will be equal unless the Employee has specified otherwise. The share of any beneficiary who does not survive the Covered Person will pass equally to any surviving beneficiaries unless otherwise specified. 
  
 If there is no named beneficiary or surviving beneficiary, or if the Employee dies while
benefits are payable to him, We may make direct payment to the first surviving class of the following classes of persons: 
  

	1.	Spouse; 

  

	2.	Child or Children; 

  

	3.	Mother or father; 

  

	4.	Sisters or brothers; 

  

	5.	Estate of the Covered Person. 

  
 Recovery of Overpayment 
  
 If benefits are overpaid, We have the right to recover the amount overpaid by either of the following methods. 
  

	1.	A request for lump sum payment of the overpaid amount. 

  

	2.	A reduction of any amounts payable under this Policy. 

  
 If there is an overpayment due when the Covered Person dies, We may recover the overpayment from the Covered Person’s estate. 
  
 GA-00-1600.00 
  

 20 








 ADMINISTRATIVE PROVISIONS 
  

Premiums 
  
 All premium rates are expressed in, and all premiums are payable in, United States currency. The premiums for this Policy will be based on the rates set forth in the Schedule of Benefits, the plan and amounts
of insurance in effect. If a Covered Person’s insurance amounts are reduced due to age, premium will be based on the amounts of insurance in force on the day before the reduction took place. 
  
 Changes in Premium Rates 
  
 We may change the premium rates from time to time with at least 31 days advance written
notice to the Subscriber. No change in rates will be made until 25 months after the Policy Effective Date. An increase in rates will not be made more often than once in a 12-month period. However, We reserve the right to change rates at any time if
any of the following events take place: 
  

	1.	the terms of this Policy change; 

  

	2.	the terms of the Subscriber’s participation change; 

  

	3.	a division, subsidiary, affiliated company or eligible class is added or deleted from this Policy; 

  

	4.	there is a change in the factors bearing on the risk assumed; 

  

	5.	any federal or state law or regulation is amended to the extent it affects Our benefit obligation. 

  
 Payment of Premium 
  
 The first premium is due on the Subscriber’s effective date of participation under this Policy. Thereafter, premiums are due on the Premium Due Dates agreed upon
between Us and the Subscriber. If any premium is not paid when due, the Subscriber’s participation under this Policy will be terminated as of the Premium Due Date on which premium was not paid. 
  
 Grace Period 
  
 A Grace Period of 60 days will be granted to each Subscriber for payment of required premiums under this Policy. A Subscriber’s
participation under this Policy will remain in effect during the Grace Period. The Subscriber is liable to Us for any unpaid premium for the time its participation under this Policy was in force. 
  
 GA-00-1700.00 
  

 21 








 GENERAL PROVISIONS 
  
 Entire Contract; Changes 
  
 This Policy, including the endorsements, amendments and any attached papers constitutes the entire contract of insurance. No change in this Policy will be valid until
approved by one of Our executive officers and endorsed on or attached to this Policy. No agent has authority to change this Policy or to waive any of its provisions. 
  
 Subscriber Participation Under This Policy 
  

An organization may elect to participate under this Policy by submitting a signed Subscriber participation agreement to the Policyholder. No participation by an
organization is in effect until approved by Us. 
  
 Misstatement of Fact

  
 If the Covered Person has misstated any fact, all amounts payable under
this Policy will be such as the premium paid would have purchased had such fact been correctly stated. 
  
 Certificates 
  
 Where required by law, We
will provide a certificate of insurance for delivery to the Covered Person. Each certificate will list the benefits, conditions and limits of this Policy. It will state to whom benefits will be paid. 
  
 30 Day Right To Examine Certificate 
  
 If a Covered Person does not like the Certificate for any reason, it may be returned to Us
within 30 days after receipt. We will return any premium that has been paid and the Certificate will be void as if it had never been issued. 
  
 Multiple Certificates 
  
 The Covered Person may have in force only one certificate at a time under this Policy. If at any time the Covered Person has been issued more than one certificate, then only the largest shall be in effect. We will
refund premiums paid for the others for any period of time that more than one certificate was issued. 
  
 Assignment 
  
 We will be bound by an
assignment of a Covered Person’s insurance under this Policy only when the original assignment or a certified copy of the assignment, signed by the Covered Person and any irrevocable beneficiary, is filed with Us. The assignee may exercise all
rights and receive all benefits assigned only while the assignment remains in effect and insurance under this Policy and the Covered Person’s certificate remains in force. 
  
 Incontestability 
  

	1.	Of This Policy or Participation Under This Policy 

  
 All statements made by the Subscriber to obtain this Policy or to participate under this Policy are considered representations and not warranties. No statement will be
used to deny or reduce benefits or be used as a defense to a claim, or to deny the validity of this Policy or of participation under this Policy unless a copy of the instrument containing the statement is, or has been, furnished to the Subscriber.

  
 After two years from the Policy Effective Date, no such statement will cause
this Policy to be contested except for fraud. 
  

	2.	Of A Covered Person’s Insurance 

  
 All statements made by a Covered Person are considered representations and not warranties. No statement will be used to deny or reduce benefits or be used as a defense to
a claim, unless a copy of the instrument containing the statement is, or has been, furnished to the claimant. 
  
 After two years from the Covered Person’s effective date of insurance, or from the effective date of increased benefits, no such statement will cause insurance or the increased benefits to be contested except for
fraud or lack of eligibility for insurance. 
  
 In the event of death or
incapacity, the beneficiary or representative shall be given a copy. 
  

 22 








 Reporting Requirements 
  

At Our request, the Subscriber or its authorized agent must report to Us the names of persons insured under the Policy as of any specified date and any additional
information required by Us. 
  
 Policy Termination 
  
 We may terminate coverage on or after the first anniversary of the policy effective date.
The Subscriber may terminate coverage on any premium due date. Written or authorized electronic notice must be given at least 31 days prior to such premium due date. 
  
 Termination will not affect a claim for a Covered Loss that is the result, directly and independently of all other causes, of a Covered
Accident that occurs while coverage was in effect. 
  
 Reinstatement

  
 This Policy may be reinstated if it lapsed for nonpayment of premium.
Requirements for reinstatement are written application of the Subscriber satisfactory to Us and payment of all overdue premiums. Any premium accepted in connection with a reinstatement will be applied to a period for which premium was not previously
paid.  
  
 Clerical Error 
  
 A Covered Person’s insurance will not be affected by error or delay in keeping records
of insurance under this Policy. If such error or delay is found, We will adjust the premium fairly. 
  
 Conformity with Statutes 
  
 Any
provisions in conflict with the requirements of any state or federal law that apply to this Policy are automatically changed to satisfy the minimum requirements of such laws. 
  
 Policy Changes 
  
 We may agree with the Subscriber to modify a plan of benefits without the Covered Person’s consent. 
  
 Workers’ Compensation Insurance 
  
 This Policy is not in place of and does not affect any requirements for coverage under any Workers’ Compensation law. 
  
 Examination of the Policy 
  
 This Group Policy will be available for inspection at the Subscriber’s office during
regular business hours. 
  
 Examination of Records 
  
 We will be permitted to examine all of the Subscriber’s records relating to this Group
Policy. Examination may occur at any reasonable time while the Group Policy is in force; or it may occur: 
  

	1.	at any time for two years after the expiration of this Group Policy; or, if later, 

  

	2.	upon the final adjustment and settlement of all Group Policy claims. 

  
 The Subscriber is acting as an agent of the Covered Person for transactions relating to this insurance. The actions of the Subscriber will not be considered Our actions.

  
 GA-00-1800.00 
  

 23 








 DESCRIPTION OF COVERAGES AND BENEFITS 
  
 This Description of Coverages and Benefits Section describes the Accident Coverages and Benefits
provided by this Policy. Benefit amounts, benefit periods and any applicable aggregate and benefit maximums are shown in the Schedule of Benefits. Certain words capitalized in the text of these descriptions have
special meanings within this Policy and are defined in the General Definitions section. Please read these and the Common Exclusions sections in order to understand all of the
terms, conditions and limitations applicable to these coverages and benefits. 
  
 ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS 
  

					
	Covered Loss	  	We will pay the benefit for any one of the Covered Losses listed in the Schedule of Benefits, if the Covered Person suffers a Covered Loss resulting directly and
independently of all other causes from a Covered Accident within the applicable time period specified in the Schedule of Benefits.
		
	 	  	If the Covered Person sustains more than one Covered Loss as a result of the same Covered Accident, the maximum benefit that will be paid for all Covered Losses is the Principal
Sum. If the loss results in death, benefits will only be paid under the Loss of Life benefit provision. Any Loss of Life benefit will be reduced by any paid or payable Accidental Dismemberment benefit. However, if such Accidental Dismemberment
benefit equals or exceeds the Loss of Life benefit, no additional benefit will be paid.
			
	Definitions	  	 	    	Loss of a Hand or Foot means complete Severance through or above the wrist or ankle joint.
			
	 	  	 	    	Loss of Sight means the total, permanent loss of all vision in one eye which is irrecoverable by natural, surgical or artificial means.
			
	 	  	 	    	Loss of Speech means total and permanent loss of audible communication which is irrecoverable by natural, surgical or artificial means.
			
	 	  	 	    	Loss of Hearing means total and permanent loss of ability to hear any sound in both ears which is irrecoverable by natural, surgical or artificial means.
			
	 	  	 	    	Loss of a Thumb and Index Finger of the Same Hand means complete Severance through or above the metacarpophalangeal joints of the same hand (the joints between the fingers and the
hand).
			
	 	  	 	    	Paralysis or Paralyzed means total loss of use of a limb. A Physician must determine the loss of use to be complete and irreversible.
			
	 	  	 	    	Quadriplegia means total Paralysis of both upper and both lower limbs.
			
	 	  	 	    	Hemiplegia means total Paralysis of the upper and lower limbs on one side of the body.
			
	 	  	 	    	Paraplegia means total Paralysis of both lower limbs or both upper limbs.
			
	 	  	 	    	Coma means a profound state of unconsciousness which resulted directly and independently from all other causes from a Covered Accident, and from which the Covered Person is not likely
to be aroused through powerful stimulation. This condition must be diagnosed and treated regularly by a Physician. Coma does not mean any state of unconsciousness intentionally induced during the course of treatment of a Covered Injury unless the
state of unconsciousness results from the administration of anesthesia in preparation for surgical treatment of that Covered Accident.
			
	 	  	 	    	Severance means the complete and permanent separation and dismemberment of the part from the body.

  

 24 









					
		
	Exclusions	  	The exclusions that apply to this benefit are in the Common Exclusions section.

  
 GA-00-2100.00 
  
 ADDITIONAL ACCIDENTAL DEATH AND DISMEMBERMENT COVERAGES 
  
 Accidental Death and Dismemberment benefits are provided under the following coverages. Any
benefits payable under them are shown in the Schedule of Covered Losses and will not be paid in addition to any other Accidental Death and Dismemberment benefits payable. 
  
 EXPOSURE AND DISAPPEARANCE COVERAGE 
  
 Benefits for Accidental Death and Dismemberment, as shown in the Schedule of Covered Losses, will be payable if a Covered Person suffers a Covered Loss which
results directly and independently of all other causes from unavoidable exposure to the elements following a Covered Accident. 
  
 If the Covered Person disappears and is not found within one year from the date of the wrecking, sinking or disappearance of the conveyance in which the Covered Person
was riding in the course of a trip which would otherwise be covered under this Policy, it will be presumed that the Covered Person’s death resulted directly and independently of all other causes from a Covered Accident. 
  

					
	Exclusions	  	The exclusions that apply to this coverage are in the Common Exclusions Section.

  
 GA-00-2202.00 
  
 HIJACKING AND AIR PIRACY COVERAGE 
  
 Benefits for Accidental Death and Dismemberment, as shown in the Schedule of Covered
Losses, will be payable if the Covered Person suffers a Covered Loss resulting directly and independently of all other causes from a Covered Accident that occurs during the hijacking, air piracy, or unlawful seizure or attempted seizure of an
Aircraft. 
  

					
	Exclusions	  	The exclusions that apply to this coverage are in the Common Exclusions Section.

  
 GA-00-2203.00 
  
 OWNED AIRCRAFT COVERAGE 
  
 Benefits for Accidental Death and Dismemberment, as shown in the Schedule of Covered Losses, will be payable if the Covered Person
suffers a Covered Loss that results directly and independently of all other causes from a Covered Accident that occurs during travel or flight in, including getting in or out of, any Aircraft that is owned, leased, operated or controlled by the
Subscriber or any of its subsidiaries or affiliates. A record of eligible Aircraft will be maintained by the Subscriber and available for review by Us at any time during normal business hours. An Aircraft substituted for an eligible Aircraft will
also be eligible if it has no greater seating capacity and the original Aircraft is withdrawn from normal use due to breakdown, repair, servicing, loss or destruction. 
  

					
	Exclusions	  	The exclusions that apply to this coverage are in the Common Exclusions Section.

  
 GA-00-2205.00 
  
 PILOT COVERAGE 
  
 Benefits for Accidental Death and Dismemberment, as shown in the Schedule of Covered Losses, will be payable if the Covered Person
suffers a Covered Loss resulting directly and independently of all other causes from a Covered Accident that occurs while the Covered Person is flying as a licensed pilot or member of the crew of an Aircraft and meets all of the following
requirements: 
  

	1.	is flying as a pilot or member of the crew of an Aircraft for which he is qualified. 

  

	2.	is not giving or receiving flight instruction. 

  

					
	Exclusions	  	The exclusions that apply to this coverage are in the Common Exclusions Section.

  
 GA-00-2206.00 
  

 25 








 WAR RISK COVERAGE 
  
 Benefits for Accidental Death and Dismemberment as shown in the Schedule of Covered Losses, will be payable, subject to the following conditions and exclusions, if
a Covered Person suffers a Covered Loss that results directly and independently of all other causes from a Covered Accident that occurs during war or acts of war that occur worldwide. 
  
 The Subscriber may cancel this war risk coverage at any time by sending written notice to Us at Our home office address. Coverage will be
canceled upon receipt of notice or a date specified by the Subscriber. 
  
 We may
cancel this coverage at any time by providing written notice to the Subscriber at least 10 days prior to termination of this coverage. Any unearned premium will be promptly returned to the Subscriber. 
  

					
	Exclusions	  	This benefit does not provide coverage when a Covered Loss occurs:

  

	 	1.	in the United States and its territories and possessions; or 

  

	 	2.	in any nation of which the Covered Person is a citizen. 

  

					
	 	  	Other exclusions that apply to this coverage are in the Common Exclusions Section.

  
 GA-00-2208.00 
  
 ADDITIONAL ACCIDENT BENEFITS 
  
 Accidental Death and Dismemberment benefits are provided under the following Additional
Benefits. Any benefits payable under them will be paid in addition to any other Accidental Death and Dismemberment benefit payable. 
  
 BRAIN DAMAGE BENEFIT 
  
 We will pay the benefit shown in the Schedule of Benefits if a Covered Person suffers a Covered Injury that results directly and independently of all other causes from a Covered Accident and results in Brain
Damage. The benefit will be payable if all of the following conditions are met: 
  

	1.	Brain Damage begins within 60 days from the date of the Covered Accident; 

  

	2.	the Covered Person is hospitalized for treatment of Brain Damage at least seven days within the first 120 days following the Covered Accident; 

  

	3.	Brain Damage continues for 12 consecutive months; 

  

	4.	a Physician determines that as a result of Brain Damage, the Covered Person is Permanently Totally Disabled at the end of the 12 consecutive month period. 


 
 The benefit will be paid in one lump sum at the beginning of the 13th month following the
date of the Covered Accident if Brain Damage continues longer than 12 consecutive months. The amount payable will not exceed the Accidental Death and Dismemberment Principal Sum for the Covered Person whose Covered Accident is the basis of the
claim. 
  

					
	Definition	  	For purposes of this benefit:

  
 Brain Damage
means physical damage to the brain that results directly and independently of all other causes from a Covered Accident and causes the Covered Person to be Permanently Totally Disabled. 
  

					
	Exclusions	  	The exclusions that apply to this benefit are in the Common Exclusions Section.

  
 GA-00-2217.00 
  
 FELONIOUS ASSAULT AND VIOLENT CRIME BENEFIT 
  
 We will pay the amount shown in the Schedule of Benefits, subject to the following
conditions and exclusions, when the Covered Employee suffers a Covered Loss resulting directly and independently of all other causes from a Covered Accident that occurs during a violent crime or felonious assault as described below. A police report
detailing the felonious assault or violent crime must be provided before any benefits will be paid. 
  
 To qualify for benefit payment, the Covered Accident must occur during any of the following: 
  

	1.	actual or attempted robbery or holdup; 

  

	2.	actual or attempted kidnapping; 

  

	3.	any other type of intentional assault that is a crime classified as a felony by the governing statute or common law in the state where the felony occurred. 


 

 26 









					
	Definition	  	For purposes of this benefit:

  
 Family Member
means the Covered Person’s parent, step-parent, Spouse or former Spouse, son, daughter, brother, sister, mother-in-law, father-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, aunt, uncle, cousins, grandparent, grandchild
and stepchild. 
  
 Fellow Employee means a person
employed by the same Employer as the Covered Person or by an Employer that is an affiliated or subsidiary corporation. It shall also include any person who was so employed, but whose employment was terminated not more than 45 days prior to the date
on which the defined violent crime/felonious assault was committed. 
  
 Member of the Same Household means a person who maintains residence at the same address as the Covered Person. 
  

					
	Exclusions	  	Benefits will not be paid for treatment of any Covered Injury sustained or Covered Loss incurred during any:

  

	 	1.	violent crime or felonious assault committed by the Covered Person; or 

  

	 	2.	felonious assault or violent crime committed upon the Covered Person by a Fellow Employee, Family Member, or Member of the Same Household. 

  

					
	 	  	Other exclusions that apply to this benefit are in the Common Exclusions Section.

  
 GA-00-2234.00 
  
 HOME ALTERATION AND VEHICLE MODIFICATION BENEFIT 
  
 We will pay the Home Alteration and Vehicle Modification Benefit shown in the Schedule of
Benefits, subject to the following conditions and exclusions, when the Covered Person suffers a Covered Loss, other than a Loss of Life, resulting directly and independently of all other causes from a Covered Accident. 
  
 This benefit will be payable if all of the following conditions are met: 
  

	1.	prior to the date of the Covered Accident causing such Covered Loss, the Covered Person did not require the use of any adaptive devices or adaptation of residence and/or vehicle;


  

	2.	as a direct result of such Covered Loss, the Covered Person now requires such adaptive devices or adaptation of residence and/or vehicle to maintain an independent lifestyle;


  

	3.	the Covered Person requires home alteration or vehicle modification within one year of the date of the Covered Accident. 

  

					
	Exclusions	  	The exclusions that apply to this benefit are in the Common Exclusions Section.

  
 GA-00-2236.00 
  
 REHABILITATION BENEFIT 
  
 We will pay the Rehabilitation Benefit shown in the Schedule of Benefits, subject to the following conditions and exclusions, when
the Covered Person requires Rehabilitation after sustaining a Covered Loss resulting directly and independently of all other causes from a Covered Accident. 
  
 The Covered Person must require Rehabilitation within two years after the date of the Covered Loss. 
  

					
	Definition	  	For purposes of this benefit:

  
 Rehabilitation means medical services, supplies, or treatment, or Hospital confinement (or part of a Hospital confinement) that satisfies all of the following conditions: 
  

	 	1.	are essential for physical rehabilitation required due to the Covered Person’s Covered Loss; 

  

	 	2.	meet generally accepted standards of medical practice; 

  

	 	3.	are performed under the care, supervision or order of a Physician; 

  

	 	4.	prepare the Covered Person to return to his or any other occupation. 

  

					
	Exclusions	  	The exclusions that apply to this benefit are in the Common Exclusions Section.

  
 GA-00-2248.00 
  

 27 








 SEATBELT AND AIRBAG BENEFIT 
  
 We will pay the benefit shown in the Schedule of Benefits, subject to the conditions and exclusions described below, when the Covered
Person dies directly and independently of all other causes from a Covered Accident while wearing a seatbelt and operating or riding as a passenger in an Automobile. An additional benefit is provided if the Covered Person was also positioned in a
seat protected by a properly-functioning and properly deployed Supplemental Restraint System (Airbag). 
  
 Verification of proper use of the seatbelt at the time of the Covered Accident and that the Supplemental Restraint System properly inflated upon impact must be a part of an official police report of the Covered
Accident or be certified, in writing, by the investigating officer(s) and submitted with the Covered Person’s claim to Us. 
  

					
	Definitions	  	For purposes of this benefit:
		
	 	  	Supplemental Restraint System means an airbag that inflates upon impact for added protection to the head and chest areas.
		
	 	  	Automobile means a self-propelled, private passenger motor vehicle with four or more wheels which is a type both designed and required to be licensed for use on the highway
of any state or country. Automobile includes, but is not limited to, a sedan, station wagon, sport utility vehicle, or a motor vehicle of the pickup, van, camper, or motor-home type. Automobile does not include a mobile home or any motor vehicle
which is used in mass or public transit.

  

					
	Exclusions	  	The exclusions that apply to this benefit are in the Common Exclusions Section.

  
 GA-00-2251.00 
  

 28 








 Life Insurance Company of North America 
 1601 Chestnut Street 
 Philadelphia, Pennsylvania 19192-2235 
  
 MODIFYING PROVISIONS AMENDMENT 
  

							
	 Subscriber:
	  	Northrop Grumman Corporation	  	Policy No.:	  	OK 980036

  
 Amendment Effective Date:
June 1, 2004 
  
 This amendment is attached to and made part of the Policy
specified above and the Certificates issued under it. Its provisions are intended to conform them to the laws and regulations of the state of California and apply only to residents of California insured under this policy. 
  
 Subscriber and We hereby agree that the Policy and any Certificates delivered under the Group
Policy are amended as follows: 
  

	1.	Under the Common Exclusions section, exclusion number 2, pertaining to the commission of a felony, is replaced with the following. 

  

	 	2.	commission or attempt to commit a felony or an assault, or to which a contributing cause of such commission or attempt was the Covered Person’s being engaged in an illegal
occupation; 

  

	2.	Under Accidental Death and Dismemberment Benefits in the Description of Coverages and Benefits Section, the definition of Loss of a Thumb and Index Finger of the Same Hand or
Four Fingers of the Same Hand is replaced with the following. 

  
 Loss of a Thumb and Index Finger of the Same Hand means complete Severance of at least one whole phalanx of the same hand. 
  
 Except for the above, this amendment does not change the Policy in any way. 
  

	
	 Signed for the

	Life Insurance Company of North America
	
	


	 President



  

 29 








 LIFE INSURANCE COMPANY OF NORTH AMERICA 
 Philadelphia, PA 19192-2235 
  
 We, TRUSTEE OF THE GROUP INSURANCE TRUST FOR EMPLOYERS IN THE MANUFACTURING INDUSTRY, whose main office address is Wilmington, Delaware hereby apply on behalf of Northrop Grumman Corporation to the Life Insurance Company of North America
for Group Policy No. OK 980036. 
  
 We approve and accept the terms of this Group
Policy. 
  
 This application is to be signed in duplicate. One part is to be
attached to the Group Policy; the other part is to be returned to the Life Insurance Company of North America. 
  

					
	 	    	TRUSTEE OF THE GROUP INSURANCE TRUST
	 	    	FOR EMPLOYERS IN THE MANUFACTURING INDUSTRY
	 	    	(Full or Corporate Name of Applicant)
			
	 Signed at:

	    	 By:
	 	  


	 	    	 	 	(Signature and Title)
	 On:

	    	 Witness
	 	  


	 	    	         (To be signed by Licensed Resident Agent where required by law)

	
	(This Copy Is To Remain Attached To The Group Policy)

  
 TL-008890 
  
 LIFE INSURANCE COMPANY OF NORTH AMERICA 
 Philadelphia, PA 19192-2235 
  
 We, TRUSTEE OF THE GROUP INSURANCE TRUST FOR EMPLOYERS IN THE MANUFACTURING INDUSTRY, whose main office address is Wilmington, Delaware hereby apply on behalf of Northrop
Grumman Corporation to the Life Insurance Company of North America for Group Policy No. OK 980036. 
  
 We approve and accept the terms of this Group Policy. 
  
 This application is to be signed in duplicate. One part is to be attached to the Group Policy; the other part is to be returned to the Life Insurance Company of North America. 
  

					
	 	    	TRUSTEE OF THE GROUP INSURANCE TRUST
	 	    	FOR EMPLOYERS IN THE MANUFACTURING INDUSTRY
	 	    	 (Full or Corporate Name of Applicant)
  

	 Signed at:

	    	By:	 	  


	 	    	 	 	(Signature and Title)
	 On:

	    	Witness	 	  


	 	    	        (To be signed by Licensed Resident Agent where required by law)
	
	(This Copy Is To Be Returned To the Life Insurance Company of North America)

  
 TL-008890