Document:

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-008890Executive Long-Term Disability Insurance Policy

 Exhibit 10(ii) 
  
 DRAFT              
  

  

			
	

	 	 GROUP INSURANCE POLICY
 NON-PARTICIPATING

  

  
 POLICYHOLDER: Northrop Grumman Corporation 
  

POLICY NUMBER: 587628 001 
  
 POLICY EFFECTIVE DATE: July 1, 2003 
  
 POLICY ANNIVERSARY DATE: July 1 
  
 GOVERNING JURISDICTION: California 
  
 Unum Life Insurance Company of America (referred to as Unum) will provide benefits under this policy. Unum makes this promise subject to all of this policy’s
provisions. 
  
 The policyholder should read this policy carefully and contact
Unum promptly with any questions. This policy is delivered in and is governed by the laws of the governing jurisdiction and to the extent applicable by the Employee Retirement Income Security Act of 1974 (ERISA) and any amendments. This policy
consists of: 
  

	•	 	all policy provisions and any amendments and/or attachments issued; 

  

	•	 	employees’ signed applications; and 

  

	•	 	the certificate of coverage. 

  
 This policy may be changed in whole or in part. Only an officer or a registrar of Unum can approve a change. The approval must be in writing and endorsed on or attached to this policy. No other person, including an
agent, may change this policy or waive any part of it. 
  
 Signed for Unum at
Portland, Maine on the Policy Effective Date. 
  

			
	

	  	

		
	President	  	Secretary

  
 Unum Life Insurance
Company of America 
 2211 Congress Street 
 Portland, Maine 04122 
  
 Copyright 1993, Unum Life
Insurance Company of America 
  

			
	C.FP-1	  	C.FP-1 (7/1/2003)

 DRAFT              

 
 TABLE OF CONTENTS 
  

			
	BENEFITS AT A GLANCE	  	B@G-LTD-1
		
	LONG TERM DISABILITY PLAN	  	B@G-LTD-1
		
	CLAIM INFORMATION	  	LTD-CLM-1
		
	LONG TERM DISABILITY	  	LTD-CLM-1
		
	POLICYHOLDER PROVISIONS	  	EMPLOYER-1
		
	CERTIFICATE SECTION	  	CC.FP-1
		
	GENERAL PROVISIONS	  	EMPLOYEE-1
		
	LONG TERM DISABILITY	  	LTD-BEN-1
		
	BENEFIT INFORMATION	  	LTD-BEN-1
		
	OTHER BENEFIT FEATURES	  	LTD-OTR-1
		
	STATE REQUIREMENTS	  	STATE REQ-1
		
	OTHER SERVICES	  	SERVICES-1
		
	ERISA	  	ERISA-1
		
	GLOSSARY	  	GLOSSARY-1

  
 TOC-1 (7/1/2003)

 DRAFT              

 
 BENEFITS AT A GLANCE 
  
 LONG TERM DISABILITY PLAN 
  
 This long term disability plan provides financial protection for you by paying a portion of
your income while you are disabled. The amount you receive is based on the amount you earned before your disability began. In some cases, you can receive disability payments even if you work while you are disabled. 
  
 EMPLOYER’S ORIGINAL PLAN 
  
 EFFECTIVE DATE: July 1, 2003 
  
 POLICY NUMBER: 587628 001 
  
 ELIGIBLE GROUP(S): 
  
 All elected or appointed officers in active employment who are elected by the Board of Directors 
  
 MINIMUM HOURS REQUIREMENT: 
  
 Employees must be working at least 20 hours per week. 
  
 WAITING PERIOD: 
  
 For employees in an eligible group on or before July 1, 2003: None 
  
 For employees entering an eligible group after July 1, 2003: None

  
 WHO PAYS FOR THE COVERAGE: 
  
 Your Employer pays the cost of your coverage. 
  
 ELIMINATION PERIOD: 
  
 6 months 
  
 Benefits begin the day after the elimination period is completed. 
  
 MONTHLY BENEFIT: 
  
 65% of monthly earnings to a maximum benefit of $15,000 per month. 
  
 Your payment may be reduced by deductible sources of income and disability earnings. Some disabilities may not be covered
or may have limited coverage under this plan. 
  
 MAXIMUM PERIOD OF
PAYMENT: 
  

			
	 Age at Disability

	    	 Maximum Period of Payment

	 Less than age 60
	    	To age 65, but not less than 5 years
	 Age 60
	    	60 months
	 Age 61
	    	48 months
	 Age 62
	    	42 months
	 Age 63
	    	36 months
	 Age 64
	    	30 months
	 Age 65
	    	24 months
	 Age 66
	    	21 months
	 Age 67
	    	18 months
	 Age 68
	    	15 months
	 Age 69 and over
	    	12 months

  
 No premium payments are required for
your coverage while you are receiving payments under this plan. 
  
 B@G-LTD-1 (7/1/2003) 

 DRAFT              

 
 OTHER FEATURES: 
  
 Continuity of Coverage 
  
 Minimum Benefit 
  
 Pre-Existing: 3/12 
  
 Survivor Benefit 
  
 Work Life Assistance Program 
  
 The above items are only highlights of this plan. For a full description of your coverage, continue reading your certificate of coverage section. 
  
 B@G-LTD-2 (7/1/2003) 

 DRAFT              

 
 CLAIM INFORMATION 
  
 LONG TERM DISABILITY 
  
 WHEN DO YOU NOTIFY UNUM OF A CLAIM? 
  
 We encourage you to notify us of your claim as soon as possible, so that a
claim decision can be made in a timely manner. Written notice of a claim should be sent within 30 days after the date your disability begins. However, you must send Unum written proof of your claim no later than 90 days after your elimination
period. If it is not possible to give proof within 90 days, it must be given no later than 1 year after the time proof is otherwise required except in the absence of legal capacity. 
  
 The claim form is available from your Employer, or you can request a claim form from us. If you do not receive the form from
Unum within 15 days of your request, send Unum written proof of claim without waiting for the form. 
  
 You must notify us immediately when you return to work in any capacity. 
  
 HOW DO YOU FILE A CLAIM? 
  
 You and your Employer must fill out your own sections of the claim form and then give it to your attending physician. Your physician should fill out his
or her section of the form and send it directly to Unum. 
  
 WHAT
INFORMATION IS NEEDED AS PROOF OF YOUR CLAIM? 
  
 Your
proof of claim, provided at your expense, must show: 
  

	 	•	 	that you are under the regular care of a physician; 

  

	 	•	 	the appropriate documentation of your monthly earnings; 

  

	 	•	 	the date your disability began; 

  

	 	•	 	the cause of your disability; 

  

	 	•	 	the extent of your disability, including restrictions and limitations preventing you from performing your regular occupation; and 

  

	 	•	 	the name and address of any hospital or institution where you received treatment, including all attending physicians. 

  
 We may request that you send proof of continuing disability indicating that
you are under the regular care of a physician. This proof, provided at your expense, must be received within 45 days of a request by us. 
  
 In some cases, you will be required to give Unum authorization to obtain additional medical information and to provide non-medical information as part of
your proof of claim, or proof of continuing disability. Unum will deny your claim, or stop sending you payments, if the appropriate information is not submitted. 
  
 TO WHOM WILL UNUM MAKE PAYMENTS? 
  
 Unum will make payments to you. 
  
 LTD-CLM-1 (7/1/2003) 

 DRAFT              

 
 WHAT HAPPENS IF UNUM OVERPAYS YOUR CLAIM? 
  
 Unum has the right to recover any overpayments due to: 
  

	 	•	 	fraud; 

  

	 	•	 	any error Unum makes in processing a claim; and 

  

	 	•	 	your receipt of deductible sources of income. 

  
 You must reimburse us in full. We will determine the method by which the repayment is to be made. 
  
 Unum will not recover more money than the amount we paid you. 
  
 LTD-CLM-2 (7/1/2003) 

 DRAFT              

 
 POLICYHOLDER PROVISIONS 
  
 WHAT IS THE COST OF THIS INSURANCE? 
  
 LONG TERM DISABILITY 
  
 The initial premium for each plan is based on the initial rate(s)
shown in the Rate Information Amendment(s). 
  
 WAIVER OF
PREMIUM 
  
 Unum does not require premium payments for an
insured while he or she is receiving Long Term Disability payments under this plan. 
  
 INITIAL RATE GUARANTEE 
  
 Refer to the Rate Information Amendment(s). 
  
 WHEN IS PREMIUM DUE
FOR THIS POLICY? 
  
 Premium Due Dates: Premium due dates
are based on the Premium Due Dates shown in the Rate Information Amendment(s). 
  
 The Policyholder must send all premiums to Unum on or before their respective due date. The premium must be paid in United States dollars. 
  
 WHEN ARE INCREASES OR DECREASES IN PREMIUM DUE? 
  
 Premium increases or decreases which take effect during a policy month are adjusted and due on the next premium due date
following the change. Changes will not be pro-rated daily. 
  
 If
premiums are paid on other than a monthly basis, premiums for increases and decreases will result in a monthly pro-rated adjustment on the next premium due date. 
  
 Unum will only adjust premium for the current policy year and the prior policy year. In the case of fraud, premium
adjustments will be made for all policy years. 
  
 WHAT INFORMATION DOES
UNUM REQUIRE FROM THE POLICYHOLDER? 
  
 The Policyholder
must provide Unum with the following on a regular basis: 
  

	 	•	information about employees: 

  

	 	•	who are eligible to become insured; 

  

	 	•	whose amounts of coverage change; and/or 

  

	 	•	whose coverage ends; 

  

	 	•	occupational information and any other information that may be required to manage a claim; and 

  

	 	•	any other information that may be reasonably required. 

  
 Policyholder records that, in Unum’s opinion, have a bearing on this policy will be available for review by Unum at any reasonable time. 

 
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 Clerical error or omission by Unum will not: 
  

	 	•	 	prevent an employee from receiving coverage; 

  

	 	•	 	affect the amount of an insured’s coverage; or 

  

	 	•	 	cause an employee’s coverage to begin or continue when the coverage would not otherwise be effective. 

  
 WHO CAN CANCEL THIS POLICY OR A PLAN UNDER THIS POLICY?

  
 This policy or a plan under this policy can be cancelled:

  

	 	•	 	by Unum; or 

  

	 	•	 	by the Policyholder. 

  
 Unum may cancel or offer to modify this policy or a plan if: 
  

	 	•	 	there is less than 75% participation of those eligible employees who pay all or part of their premium for a plan; or 

  

	 	•	 	there is less than 100% participation of those eligible employees for a Policyholder paid plan; 

  

	 	•	 	the Policyholder does not promptly provide Unum with information that is reasonably required; 

  

	 	•	 	the Policyholder fails to perform any of its obligations that relate to this policy; 

  

	 	•	 	fewer than 10 employees are insured under a plan; 

  

	 	•	 	the Policyholder fails to pay any premium within the 60 day grace period. 

  
 If Unum cancels this policy or a plan for reasons other than the Policyholder’s failure to pay premium, a written
notice will be delivered to the Policyholder at least 120 days prior to the cancellation date. 
  
 If the premium is not paid during the grace period, the policy or plan will terminate automatically at the end of the grace period. The Policyholder is
liable for premium for coverage during the grace period. The Policyholder must pay Unum all premium due for the full period each plan is in force. 
  
 The Policyholder may cancel this policy or a plan by written notice delivered to Unum at least 120 days prior to the cancellation date. When both the
Policyholder and Unum agree, this policy or a plan can be cancelled on an earlier date. If Unum or the Policyholder cancels this policy or a plan, coverage will end at 12:00 midnight on the last day of coverage. 
  
 If this policy or a plan is cancelled, the cancellation will not affect a
payable claim. 
  
 WHAT HAPPENS TO AN EMPLOYEE’S COVERAGE
UNDER THIS POLICY WHILE HE OR SHE IS ON A FAMILY AND MEDICAL LEAVE OF ABSENCE? 
  
 We will continue the employee’s coverage in accordance with the policyholder’s Human Resource policy on family and medical leaves of absence if premium payments continue and the policyholder approved the
employee’s leave in writing. 
  
 Coverage will be continued
until the end of the month in which the leave begins, plus 4 months. 
  
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 If the policyholder’s Human Resource policy doesn’t provide for
continuation of an employee’s coverage during a family and medical leave of absence, the employee’s coverage will be reinstated when he or she returns to active employment. 
  
 We will not: 
  

	 	•	 	apply a new waiting period; 

  

	 	•	 	apply a new pre-existing conditions exclusion; or 

  

	 	•	 	require evidence of insurability. 

  
 DIVISIONS, SUBSIDIARIES OR AFFILIATED COMPANIES INCLUDE: 
  
 NAME/LOCATION (CITY AND STATE) 
  
 Refer to the contract file correspondence for a listing of names and locations approved by Unum. 
  
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 CERTIFICATE SECTION 
  
 Unum Life Insurance Company of America (referred to as Unum) welcomes you as a client.

  
 This is your certificate of coverage as long as you are eligible for coverage
and you become insured. You will want to read it carefully and keep it in a safe place. 
  
 Unum has written your certificate of coverage in plain English. However, a few terms and provisions are written as required by insurance law. If you have any questions about any of the terms and provisions, please consult Unum’s claims
paying office. Unum will assist you in any way to help you understand your benefits. 
  
 If the terms and provisions of the certificate of coverage (issued to you) are different from the policy (issued to the policyholder), the policy will govern. Your coverage may be cancelled or changed in whole or in part under the terms and
provisions of the policy. 
  
 The policy is delivered in and is governed by the
laws of the governing jurisdiction and to the extent applicable by the Employee Retirement Income Security Act of 1974 (ERISA) and any amendments. When making a benefit determination under the policy, Unum has discretionary authority to determine
your eligibility for benefits and to interpret the terms and provisions of the policy. 
  
 For purposes of effective dates and ending dates under the group policy, all days begin at 12:01 a.m. and end at 12:00 midnight at the Policyholder’s address. 
  
 Unum Life Insurance Company of America 
 2211 Congress Street 
 Portland, Maine 04122 
  
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GENERAL PROVISIONS 
  
 WHAT IS THE CERTIFICATE OF COVERAGE? 
  
 This certificate of coverage is a written statement prepared by Unum and may include attachments. It tells you: 
  

	 	•	 	the coverage for which you may be entitled; 

  

	 	•	 	to whom Unum will make a payment; and 

  

	 	•	 	the limitations, exclusions and requirements that apply within a plan. 

  
 WHEN ARE YOU ELIGIBLE FOR COVERAGE? 
  
 If you are working for your Employer in an eligible group, the date you are eligible for coverage is the later of: 
  

	 	•	 	the plan effective date; or 

  

	 	•	 	the day after you complete your waiting period. 

  
 WHEN DOES YOUR COVERAGE BEGIN? 
  
 When your Employer pays 100% of the cost of your coverage under a plan, you will be covered at 12:01 a.m. on the date you are eligible for coverage.

  
 WHAT IF YOU ARE ABSENT FROM WORK ON THE DATE YOUR COVERAGE WOULD
NORMALLY BEGIN? 
  
 If you are absent from work
due to injury, sickness or temporary leave of absence, your coverage will begin on the date you return to active employment. 
  
 ONCE YOUR COVERAGE BEGINS, WHAT HAPPENS IF YOU ARE TEMPORARILY NOT WORKING? 
  
 If you are on a leave of absence, and if premium is paid, you will be covered through the end of the month that
immediately follows the month in which your leave of absence begins. 
  
 WHEN WILL CHANGES TO YOUR COVERAGE TAKE EFFECT? 
  
 Once your coverage begins, any increased or additional coverage will take effect immediately if you are in active employment or if you are on a covered leave of absence. If you are not in active employment due to
injury or sickness, any increased or additional coverage will begin on the date you return to active employment. 
  
 Any decrease in coverage will take effect immediately but will not affect a payable claim that occurs prior to the decrease. 
  
 WHEN DOES YOUR COVERAGE END? 
  
 Your coverage under the policy or a plan ends on the earliest of:

  

	 	•	 	the date the policy or a plan is cancelled; 

  

	 	•	 	the date you no longer are in an eligible group; 

  
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	 	•	 	the date your eligible group is no longer covered; 

  

	 	•	 	the last day of the period for which you made any required contributions; or 

  

	 	•	 	the last day you are in active employment except as provided under the covered leave of absence provision. 

  
 Unum will provide coverage for a payable claim which occurs while you are
covered under the policy or plan. 
  
 WHAT ARE THE TIME LIMITS FOR
LEGAL PROCEEDINGS? 
  
 You can start legal action
regarding your claim 60 days after proof of claim has been given and up to 3 years from the time proof of claim is required, unless otherwise provided under federal law. 
  
 HOW CAN STATEMENTS MADE IN YOUR APPLICATION FOR THIS COVERAGE BE USED? 
  
 Unum considers any statements you or your Employer make in a signed
application for coverage a representation and not a warranty. If any of the statements you or your Employer make are not complete and/or not true at the time they are made, we can: 
  

	 	•	 	reduce or deny any claim; or 

  

	 	•	 	cancel your coverage from the original effective date. 

  
 We will use only statements made in a signed application as a basis for doing this. 
  
 If the Employer gives us information about you that is incorrect, we will: 
  

	 	•	 	use the facts to decide whether you have coverage under the plan and in what amounts; and 

  

	 	•	 	make a fair adjustment of the premium. 

  
 HOW WILL UNUM HANDLE INSURANCE FRAUD? 
  
 Unum wants to ensure you and your Employer do not incur additional insurance costs as a result of the undermining effects of insurance fraud. Unum
promises to focus on all means necessary to support fraud detection, investigation, and prosecution. 
  
 Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties. 

 
 In addition, submission of false information in connection with the claim
form may also constitute a crime under federal laws. Unum will pursue any appropriate legal remedies in the event of insurance fraud, including prosecuting under federal mail fraud, federal wire fraud, and/or the federal Racketeer Influenced and
Corrupt Organizations Act statutes. Any false statements made herein may be reported to state and federal tax and regulatory authorities as is appropriate. 
  
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 DOES THE POLICY REPLACE OR AFFECT ANY WORKERS’ COMPENSATION OR STATE
DISABILITY INSURANCE? 
  
 The policy does not
replace or affect the requirements for coverage by any workers’ compensation or state disability insurance. 
  
 DOES YOUR EMPLOYER ACT AS YOUR AGENT OR UNUM’S AGENT? 
  
 For purposes of the policy, your Employer acts on its own behalf or as your agent. Under no circumstances will your Employer
be deemed the agent of Unum. 
  
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LONG TERM DISABILITY 
  
 BENEFIT INFORMATION 
  
 HOW DOES UNUM DEFINE DISABILITY? 
  
 You are disabled when Unum determines that: 
  

	 	•	 	you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury; and

  

	 	•	 	you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury. 

  
 After 24 months of payments, you are disabled when Unum determines that due to the same sickness or injury, you are unable
to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience. 
  
 The loss of a professional or occupational license or certification does not, in itself, constitute disability. 
  
 We may require you to be examined by a physician, other medical practitioner
and/or vocational expert of our choice. Unum will pay for this examination. We can require an examination as often as it is reasonable to do so. We may also require you to be interviewed by an authorized Unum Representative. 
  
 HOW LONG MUST YOU BE DISABLED BEFORE YOU ARE ELIGIBLE TO RECEIVE
BENEFITS? 
  
 You must be continuously disabled
through your elimination period. Unum will treat your disability as continuous if your disability stops for 30 days or less during the elimination period. The days that you are not disabled will not count toward your elimination period.

  
 Your elimination period is 6 months. 
  
 CAN YOU SATISFY YOUR ELIMINATION PERIOD IF YOU ARE WORKING?

  
 Yes. If you are working while you are disabled, the days
you are disabled will count toward your elimination period. 
  
 WHEN
WILL YOU BEGIN TO RECEIVE PAYMENTS? 
  
 You will
begin to receive payments when we approve your claim, providing the elimination period has been met. We will send you a payment monthly for any period for which Unum is liable. 
  
 HOW MUCH WILL UNUM PAY YOU IF YOU ARE DISABLED? 
  
 We will follow this process to figure your payment: 
  

	 	1.	Multiply your monthly earnings by 65%. 

  

	 	2.	The maximum monthly benefit is $15,000. 

  

	 	3.	Compare the answer from Item 1 with the maximum monthly benefit. The lesser of these two amounts is your gross disability payment. 

  
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	 	4.	Subtract from your gross disability payment any deductible sources of income. 

  
 The amount figured in Item 4 is your monthly payment. 
  
 WHAT ARE YOUR MONTHLY EARNINGS? 
  
 “Monthly Earnings” means your gross monthly income from your Employer in effect just prior to your date of disability. It includes your total
income before taxes. It is prior to any deductions made for pre-tax contributions to a qualified deferred compensation plan, Section 125 plan, or flexible spending account. It does not include income received from commissions, bonuses, overtime pay,
any other extra compensation, or income received from sources other than your Employer. 
  
 WHAT WILL WE USE FOR MONTHLY EARNINGS IF YOU BECOME DISABLED DURING A COVERED LEAVE OF ABSENCE? 
  
 If you become disabled while you are on a covered leave of absence, we will use your monthly earnings from your Employer in effect just prior to the date
your absence begins. 
  
 HOW MUCH WILL UNUM PAY YOU IF YOU ARE DISABLED AND
WORKING? 
  
 We will send you the monthly payment if you
are disabled and your monthly disability earnings, if any, are less than 20% of your indexed monthly earnings, due to the same sickness or injury. 
  
 If you are disabled and your monthly disability earnings are 20% or more of your indexed monthly earnings, due to the same sickness or injury, Unum will
figure your payment as follows: 
  
 During the first 12 months of
payments, while working, your monthly payment will not be reduced as long as disability earnings plus the gross disability payment does not exceed 100% of indexed monthly earnings. 
  

	 	1.	Add your monthly disability earnings to your gross disability payment. 

  

	 	2.	Compare the answer in Item 1 to your indexed monthly earnings. 

  
 If the answer from Item 1 is less than or equal to 100% of your indexed monthly earnings, Unum will not further reduce your monthly payment. 

 
 If the answer from Item 1 is more than 100% of your indexed monthly
earnings, Unum will subtract the amount over 100% from your monthly payment. 
  
 After 12 months of payments, while working, you will receive payments based on the percentage of income you are losing due to your disability. 
  

	 	1.	Subtract your disability earnings from your indexed monthly earnings. 

  

	 	2.	Divide the answer in Item 1 by your indexed monthly earnings. This is your percentage of lost earnings. 

  

	 	3.	Multiply your monthly payment by the answer in Item 2. 

  
 This is the amount Unum will pay you each month. 
  
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 During the first 24 months of disability payments, if your monthly
disability earnings exceed 80% of your indexed monthly earnings, Unum will stop sending you payments and your claim will end. 
  
 Beyond 24 months of disability payments, if your monthly disability earnings exceed 60% of your indexed monthly earnings, Unum will stop sending you
payments and your claim will end. 
  
 Unum may require you to
send proof of your monthly disability earnings at least quarterly. We will adjust your payment based on your quarterly disability earnings. 
  
 As part of your proof of disability earnings, we can require that you send us appropriate financial records which we believe are necessary to substantiate
your income. 
  
 After the elimination period, if you are
disabled for less than 1 month, we will send you 1/30 of your payment for each day of disability. 
  
 HOW CAN WE PROTECT YOU IF YOUR DISABILITY EARNINGS FLUCTUATE? 
  
 If your disability earnings routinely fluctuate widely from month to month, Unum may average your disability earnings over the most recent 3 months to
determine if your claim should continue. 
  
 If Unum averages
your disability earnings, we will not terminate your claim unless: 
  

	 	•	 	During the first 24 months of disability payments, the average of your disability earnings from the last 3 months exceeds 80% of indexed monthly earnings; or

  

	 	•	 	Beyond 24 months of disability payments, the average of your disability earnings from the last 3 months exceeds 60% of indexed monthly earnings. 

  
 We will not pay you for any month during which disability earnings exceed
the amount allowable under the plan. 
  
 WHAT ARE DEDUCTIBLE SOURCES OF
INCOME? 
  
 Unum will subtract from your gross disability
payment the following deductible sources of income: 
  

	 	1.	The amount that you receive or are entitled to receive under: 

  

	 	•	 	a workers’ compensation law. 

  

	 	•	 	an occupational disease law. 

  

	 	•	 	any other act or law with similar intent. 

  

	 	2.	The amount that you receive or are entitled to receive as disability income payments under any: 

  

	 	•	 	state compulsory benefit act or law. 

  

	 	•	 	other group insurance plan. 

  

	 	•	 	governmental retirement system as a result of your job with your Employer. 

  
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	 	3.	The amount that you receive or are entitled to receive as disability payments or the amount you receive as retirement payments under: 

  

	 	•	 	the United States Social Security Act. 

  

	 	•	 	the Canada Pension Plan. 

  

	 	•	 	the Quebec Pension Plan. 

  

	 	•	 	any similar plan or act. 

  
 We will not offset for any amount received by your spouse or dependents. 
  

	 	4.	The amount that you: 

  

	 	•	 	receive as disability payments under your Employer’s retirement plan. 

  

	 	•	 	voluntarily elect to receive as retirement payments under your Employer’s retirement plan. 

  

	 	•	 	receive as retirement payments when you reach the later of age 62 or normal retirement age, as defined in your Employer’s retirement plan. 

  
 Disability payments under a retirement plan will be those benefits which are
paid due to disability and do not reduce the retirement benefit which would have been paid if the disability had not occurred. 
  
 Retirement payments will be those benefits which are based on your Employer’s contribution to the retirement plan. Disability benefits which reduce
the retirement benefit under the plan will also be considered as a retirement benefit. 
  
 Regardless of how the retirement funds from the retirement plan are distributed, Unum will consider your and your Employer’s contributions to be distributed simultaneously throughout your lifetime. 
  
 Amounts received do not include amounts rolled over or transferred to any
eligible retirement plan. Unum will use the definition of eligible retirement plan as defined in Section 402 of the Internal Revenue Code including any future amendments which affect the definition. 
  

	 	5.	The amount that you receive under Title 46, United States Code Section 688 (The Jones Act). 

  

	 	6.	The amount that you receive under the mandatory portion of any “no fault” motor vehicle plan. 

  

	 	7.	The amount that you receive under a salary continuation or accumulated sick leave plan. 

  

	 	8.	The amount that you receive from a third party (after subtracting attorney’s fees) by judgment, settlement or otherwise. 

  
 With the exception of retirement payments, Unum will only subtract
deductible sources of income which are payable as a result of the same disability. 
  
 We will not reduce your payment by your Social Security retirement income if your disability begins after age 65 and you were already receiving Social Security retirement payments. 
  
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 WHAT ARE NOT DEDUCTIBLE SOURCES OF INCOME? 
  
 Unum will not subtract from your gross disability payment income you receive
from, but not limited to, the following: 
  

	 	•	 	401(k) plans 

  

	 	•	 	profit sharing plans 

  

	 	•	 	thrift plans 

  

	 	•	 	tax sheltered annuities 

  

	 	•	 	stock ownership plans 

  

	 	•	 	non-qualified plans of deferred compensation 

  

	 	•	 	pension plans for partners 

  

	 	•	 	military pension and disability income plans 

  

	 	•	 	credit disability insurance 

  

	 	•	 	franchise disability income plans 

  

	 	•	 	a retirement plan from another Employer 

  

	 	•	 	individual retirement accounts (IRA) 

  

	 	•	 	individual disability income plans 

  

	 	•	 	severance payments 

  
 WHAT IF SUBTRACTING DEDUCTIBLE SOURCES OF INCOME RESULTS IN A ZERO BENEFIT? (Minimum Benefit) 
  
 The minimum monthly payment is the greater of: 
  

	 	•	 	$100; or 

  

	 	•	 	10% of your gross disability payment. 

  
 Unum may apply this amount toward an outstanding overpayment. 
  
 WHAT HAPPENS WHEN YOU RECEIVE A COST OF LIVING INCREASE FROM DEDUCTIBLE SOURCES OF INCOME? 
  
 Once Unum has subtracted any deductible source of income from your gross disability payment, Unum will not further reduce
your payment due to a cost of living increase from that source. 
  
 WHAT IF
UNUM DETERMINES YOU MAY QUALIFY FOR DEDUCTIBLE INCOME BENEFITS? 
  
 When we determine that you may qualify for benefits under Item(s) 1, 2 and 3 in the deductible sources of income section, we will estimate your entitlement to these benefits. We can reduce your payment by the
estimated amounts if such benefits: 
  

	 	•	 	have not been awarded; and 

  

	 	•	 	have not been denied; or 

  

	 	•	 	have been denied and the denial is being appealed. 

  
 Your Long Term Disability payment will NOT be reduced by the estimated amount if you: 
  

	 	•	 	apply for the disability payments under Item(s) 1, 2 and 3 in the deductible sources of income section and appeal your denial to all administrative levels Unum feels are necessary;
and 

  
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	 	•	 	sign Unum’s payment option form. This form states that you promise to pay us any overpayment caused by an award. 

  
 If your payment has been reduced by an estimated amount, your payment will
be adjusted when we receive proof: 
  

	 	•	 	of the amount awarded; or 

  

	 	•	 	that benefits have been denied and all appeals Unum feels are necessary have been completed. In this case, a lump sum refund of the estimated amount will be made to you.

  
 If you receive a lump sum payment from any
deductible sources of income, the lump sum will be pro-rated on a monthly basis over the time period for which the sum was given. If no time period is stated, we will use a reasonable one. 
  
 HOW LONG WILL UNUM CONTINUE TO SEND YOU PAYMENTS? 
  
 Unum will send you a payment each month up to the maximum period of
payment. Your maximum period of payment is based on your age at disability as follows: 
  

			
	 Age at Disability

	    	 Maximum Period of Payment

	Less than age 60	    	To age 65, but not less than 5 years
	Age 60	    	60 months
	Age 61	    	48 months
	Age 62	    	42 months
	Age 63	    	36 months
	Age 64	    	30 months
	Age 65	    	24 months
	Age 66	    	21 months
	Age 67	    	18 months
	Age 68	    	15 months
	Age 69 and over	    	12 months

  
 WHEN WILL PAYMENTS STOP?

  
 We will stop sending you payments and your claim will
end on the earliest of the following: 
  

	 	•	 	during the first 24 months of payments, when you are able to work in your regular occupation on a part-time basis but you choose not to; 

  

	 	•	 	after 24 months of payments, when you are able to work in any gainful occupation on a part-time basis but you choose not to; 

  

	 	•	 	the end of the maximum period of payment; 

  

	 	•	 	the date you are no longer disabled under the terms of the plan; 

  

	 	•	 	the date you fail to submit proof of continuing disability; 

  

	 	•	 	the date your disability earnings exceed the amount allowable under the plan; 

  

	 	•	 	the date you die. 

  
 WHAT DISABILITIES HAVE A LIMITED PAY PERIOD UNDER YOUR PLAN? 
  
 Disabilities due to mental illness, alcoholism or drug abuse have a limited pay period up to 24 months. 
  
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 Unum will continue to send you payments beyond the 24 month period if you
meet one or both of these conditions: 
  

	 	1.	If you are confined to a hospital or institution at the end of the 24 month period, Unum will continue to send you payments during your confinement. 

 
 If you are still disabled when you are discharged, Unum will send you
payments for a recovery period of up to 90 days. 
  
 If you
become reconfined at any time during the recovery period and remain confined for at least 14 days in a row, Unum will send payments during that additional confinement and for one additional recovery period up to 90 more days. 
  

	 	2.	In addition to Item 1, if, after the 24 month period for which you have received payments, you continue to be disabled and subsequently become confined to a hospital or institution
for at least 14 days in a row, Unum will send payments during the length of the reconfinement. 

  
 Unum will not pay beyond the limited pay period as indicated above, or the maximum period of payment, whichever occurs first. 
  
 Unum will not apply the mental illness limitation to dementia if it is a
result of: 
  

	 	•	 	stroke; 

  

	 	•	 	trauma; 

  

	 	•	 	viral infection; 

  

	 	•	 	Alzheimer’s disease; or 

  

	 	•	 	other conditions not listed which are not usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs, or other similar methods
of treatment. 

  
 WHAT DISABILITIES ARE NOT COVERED UNDER YOUR
PLAN? 
  
 Your plan does not cover any disabilities
caused by, contributed to by, or resulting from your: 
  

	 	•	 	intentionally self-inflicted injuries. 

  

	 	•	 	active participation in a riot. 

  

	 	•	 	loss of a professional license, occupational license or certification. 

  

	 	•	 	commission of a crime for which you have been convicted under state or federal law. 

  

	 	•	 	pre-existing condition. 

  
 Your plan will not cover a disability due to war, declared or undeclared, or any act of war. 
  
 Unum will not pay a benefit for any period of disability during which you
are incarcerated. 
  
 WHAT IS A PRE-EXISTING CONDITION? 

 
 You have a pre-existing condition if: 
  

	 	•	 	you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date
of coverage; and 

  
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	 	•	 	the disability begins in the first 12 months after your effective date of coverage. 

  
 WHAT HAPPENS IF YOU RETURN TO WORK FULL TIME AND YOUR DISABILITY OCCURS AGAIN? 
  
 If you have a recurrent disability, Unum will treat your disability
as part of your prior claim and you will not have to complete another elimination period if: 
  

	 	•	 	you were continuously insured under the plan for the period between your prior claim and your recurrent disability; and 

  

	 	•	 	your recurrent disability occurs within 6 months of the end of your prior claim. 

  
 Your recurrent disability will be subject to the same terms of this plan as your prior claim. 
  
 Any disability which occurs after 6 months from the date your prior claim
ended will be treated as a new claim. The new claim will be subject to all of the policy provisions. 
  
 If you become entitled to payments under any other group long term disability plan, you will not be eligible for payments under the Unum plan. 

 
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LONG TERM DISABILITY 
  
 OTHER BENEFIT FEATURES 
  
 WHAT BENEFITS WILL BE PROVIDED TO YOUR FAMILY IF YOU DIE? (Survivor Benefit) 
  
 When Unum receives proof that you have died, we will pay your eligible survivor a lump sum benefit equal to 3 months
of your gross disability payment if, on the date of your death: 
  

	 	•	 	your disability had continued for 180 or more consecutive days; and 

  

	 	•	 	you were receiving or were entitled to receive payments under the plan. 

  
 If you have no eligible survivors, payment will be made to your estate, unless there is none. In this case, no payment will be made. 
  
 However, we will first apply the survivor benefit to any overpayment which
may exist on your claim. 
  
 WHAT IF YOU ARE NOT IN ACTIVE EMPLOYMENT WHEN
YOUR EMPLOYER CHANGES INSURANCE CARRIERS TO UNUM? (Continuity of Coverage) 
  
 When the plan becomes effective, Unum will provide coverage for you if: 
  

	 	•	 	you are not in active employment because of a sickness or injury; and 

  

	 	•	 	you were covered by the prior policy. 

  
 Your coverage is subject to payment of premium. 
  
 Your payment will be limited to the amount that would have been paid by the prior carrier. Unum will reduce your payment by any amount for which your
prior carrier is liable. 
  
 WHAT IF YOU HAVE A DISABILITY DUE TO A
PRE-EXISTING CONDITION WHEN YOUR EMPLOYER CHANGES INSURANCE CARRIERS TO UNUM? (Continuity of Coverage) 
  
 Unum may send a payment if your disability results from a pre-existing condition if, you were: 
  

	 	•	 	in active employment and insured under the plan on its effective date; and 

  

	 	•	 	insured by the prior policy at the time of change. 

  
 In order to receive a payment you must satisfy the pre-existing condition provision under: 
  

	 	1.	the Unum plan; or 

  

	 	2.	the prior carrier’s plan, if benefits would have been paid had that policy remained in force. 

  
 If you do not satisfy Item 1 or 2 above, Unum will not make any payments. 
  
 LTD-OTR-1 (7/1/2003) 

 DRAFT              

 
 If you satisfy Item 1, we will determine your payments according to the
Unum plan provisions. 
  
 If you only satisfy Item 2, we will
administer your claim according to the Unum plan provisions. However, your payment will be the lesser of: 
  

	 	a.	the monthly benefit that would have been payable under the terms of the prior plan if it had remained inforce; or 

  

	 	b.	the monthly payment under the Unum plan. 

  
 Your benefits will end on the earlier of the following dates: 
  

	 	1.	the end of the maximum benefit period under the plan; or 

  

	 	2.	the date benefits would have ended under the prior plan if it had remained in force. 

  
 LTD-OTR-2 (7/1/2003) 

 DRAFT              

 
 STATE REQUIREMENTS 
  
 CALIFORNIA 
 CONTACT NOTICE 
  
 GENERAL QUESTIONS: If you have any general questions about your insurance, you may contact the Insurance Company by: 
  
 CALLING: 
  
 1-800-421-0344 (Customer Information Call Center) 
  
 -OR- 
  
 WRITING TO: 
  
 Unum Life Insurance Company of
America 
 2211 Congress Street 
 Portland, Maine 04122 
  
 COMPLAINTS: If a complaint arises about your
insurance, you may contact the Insurance Company by: 
  
 CALLING: 
  
 (Compliance Center Complaint Line)

 Toll free: 1-800-321-3889, Option 2 
 Direct: 207-575-7568 
  
 -OR- 
  
 WRITING TO: 
  
 Deborah J. Jewett, Manager, Customer Relations 
 Unum Life Insurance Company of America 
 2211
Congress Street 
 Portland, Maine 04122 
  
 WHEN CALLING OR WRITING TO THE INSURANCE COMPANY, PLEASE PROVIDE YOUR INSURANCE POLICY NUMBER. 
  
 If the Policy or Certificate of Coverage was issued or delivered by an agent or broker, please contact your agent or broker for assistance.

  
 You also can contact the California Department of Insurance. However, the
California Department of Insurance should be contacted only after discussions with the Insurance Company or its agent or other representative, or both, have failed to produce a satisfactory resolution to the problem. 
  
 Department of Insurance 
 Consumer Communications Bureau 
 300 South
Spring Street - South Tower 
 Los Angeles, California 90013 
 Toll Free Hotline Telephone Number: 1-800-927-4357 
 Local Telephone Number: 213-897-8921 
 Fax: 213-736-2562 
 Office Hours: 8:00 a.m. -
5:00 p.m. 
  
 STATE REQ-1 (7/1/2003) 

 DRAFT              

 
 This form is for contact information only, and it is not to be considered a condition for
the Policy. 
  
 STATE REQ-2 (7/1/2003) 

 DRAFT              

 
 OTHER SERVICES 
  
 These services are also available from us as part of your Unum Long Term Disability plan.

  
 IS THERE A WORK LIFE ASSISTANCE PROGRAM AVAILABLE WITH THE PLAN?

  
 We do provide you and your dependents access to a
work life assistance program designed to assist you with problems of daily living. 
  
 You can call and request assistance for virtually any personal or professional issue, from helping find a day care or transportation for an elderly parent, to researching possible colleges for a child, to helping to
deal with the stress of the workplace. This work life program is available for everyday issues as well as crisis support. 
  
 This service is also available to your Employer. 
  
 This program can be accessed by a 1-800 telephone number available 24 hours a day, 7 days a week or online through a website. 
  
 Information about this program can be obtained through your plan
administrator. 
  
 HOW CAN UNUM HELP YOUR EMPLOYER IDENTIFY AND PROVIDE
WORKSITE MODIFICATION? 
  
 A worksite modification might
be what is needed to allow you to perform the material and substantial duties of your regular occupation with your Employer. One of our designated professionals will assist you and your Employer to identify a modification we agree is likely to help
you remain at work or return to work. This agreement will be in writing and must be signed by you, your Employer and Unum. 
  
 When this occurs, Unum will reimburse your Employer for the cost of the modification, up to the greater of: 
  

	 	•	 	$1,000; or 

  

	 	•	 	the equivalent of 2 months of your monthly benefit. 

  
 This benefit is available to you on a one time only basis. 
  
 HOW CAN UNUM’S REHABILITATION SERVICE HELP YOU RETURN TO WORK? 
  
 Unum has a vocational rehabilitation program available to assist you to return to work. This program is offered as a
service, and is voluntary on your part and on Unum’s part. 
  
 In addition to referrals made to the rehabilitation program by our claims paying personnel, you may request to have your claim file reviewed by one of Unum’s rehabilitation professionals. As your file is reviewed, medical and
vocational information will be analyzed to determine if rehabilitation services might help you return to gainful employment. 
  
 Once the initial review is completed, Unum may elect to offer you a return-to-work program. The return-to-work program may include, but is not limited to,
the following services: 
  

	 	•	 	coordination with your Employer to assist you to return to work; 

  
 SERVICES-1 (7/1/2003) 

 DRAFT              

 

	 	•	 	evaluation of adaptive equipment to allow you to return to work; 

  

	 	•	 	vocational evaluation to determine how your disability may impact your employment options; 

  

	 	•	 	job placement services; 

  

	 	•	 	resume preparation; 

  

	 	•	 	job seeking skills training; or 

  

	 	•	 	retraining for a new occupation. 

  
 HOW CAN UNUM’S SOCIAL SECURITY CLAIMANT ADVOCACY PROGRAM ASSIST YOU WITH OBTAINING SOCIAL SECURITY DISABILITY BENEFITS? 
  
 In order to be eligible for assistance from Unum’s Social Security
claimant advocacy program, you must be receiving monthly payments from us. Unum can provide expert advice regarding your claim and assist you with your application or appeal. 
  
 Receiving Social Security benefits may enable: 
  

	 	•	 	you to receive Medicare after 24 months of disability payments; 

  

	 	•	 	you to protect your retirement benefits; and 

  

	 	•	 	your family to be eligible for Social Security benefits. 

  
 We can assist you in obtaining Social Security disability benefits by: 
  

	 	•	 	helping you find appropriate legal representation; 

  

	 	•	 	obtaining medical and vocational evidence; and 

  

	 	•	 	reimbursing pre-approved case management expenses. 

  
 SERVICES-2 (7/1/2003) 

 DRAFT              

 
 ERISA 
  
 Additional Summary Plan Description Information 
  
 Name of Plan: 
  
 Northrop Grumman Corporation Group Benefits Plan; sponsor Northrop Grumman Corporation 
  
 Name and Address of Employer: 
  
 Northrop Grumman Corporation 
 1840 Century
Park East 
 CC-3, Dept. 161 
 Los
Angeles, California 
 90067-2199 
  
 Plan Identification Number: 
  

	 	a.	Employer IRS Identification #: 95-4840775 

  

	 	b.	Plan #: 501 

  
 Type of Welfare Plan: 
  
 Disability 
  
 Type of Administration: 
  
 The Plan is administered by the Plan Administrator. Benefits are
administered by the insurer and provided in accordance with the insurance policy issued to the Plan. 
  
 ERISA Plan Year Ends: 
  
 December 31 
  
 Plan Administrator, Name, Address, and Telephone
Number: 
  
 Northrop Grumman Corporation 
 1840 Century Park East 
 CC-3, Dept. 161

 Los Angeles, California 
 90067-2199 
 (310) 201-3076 
  
 Northrop Grumman Corporation is the Plan Administrator and named fiduciary of the Plan, with authority to delegate its duties. The Plan Administrator may
designate Trustees of the Plan, in which case the Administrator will advise you separately of the name, title and address of each Trustee. 
  
 Agent for Service of Legal Process on the Plan: 
  
 Northrop Grumman Corporation 
 1840 Century
Park East 
 CC-3, Dept. 161 
 Los
Angeles, California 
 90067-2199 
  
 Service of legal process may also be made upon the Plan Administrator, and any Trustee of the Plan. 
  
 ERISA-1 (7/1/2003) 

 DRAFT              

 
 Funding and Contributions: 
  
 The Plan is funded as an insured plan under policy number 587628 001, issued
by Unum Life Insurance Company of America, 2211 Congress Street, Portland, Maine 04122. Contributions to the Plan are made as stated under “WHO PAYS FOR THE COVERAGE” in the Certificate of Coverage. 
  
 EMPLOYER’S RIGHT TO AMEND THE PLAN 
  
 The Employer reserves the right, in its sole and absolute discretion, to
amend, modify, or terminate, in whole or in part, any or all of the provisions of this Plan (including any related documents and underlying policies), at any time and for any reason or no reason. Any amendment, modification, or termination must be
in writing and endorsed on or attached to the Plan. 
  
 EMPLOYER’S RIGHT
TO REQUEST POLICY CHANGE 
  
 The Employer can request a
policy change. Only an officer or registrar of Unum can approve a change. The change must be in writing and endorsed on or attached to the policy. 
  
 CANCELLING THE POLICY OR A PLAN UNDER THE POLICY 
  
 The policy or a plan under the policy can be cancelled: 
  

	 	•	 	by Unum; or 

  

	 	•	 	by the Policyholder. 

  
 Unum may cancel or offer to modify the policy or a plan if: 
  

	 	•	 	there is less than 75% participation of those eligible employees who pay all or part of their premium for a plan; or 

  

	 	•	 	there is less than 100% participation of those eligible employees for a Policyholder paid plan; 

  

	 	•	 	the Policyholder does not promptly provide Unum with information that is reasonably required; 

  

	 	•	 	the Policyholder fails to perform any of its obligations that relate to the policy; 

  

	 	•	 	fewer than 10 employees are insured under a plan; 

  

	 	•	 	the Policyholder fails to pay any premium within the 60 day grace period. 

  
 If Unum cancels the policy or a plan for reasons other than the Policyholder’s failure to pay premium, a written notice will be delivered to the
Policyholder at least 120 days prior to the cancellation date. 
  
 If the premium is not paid during the grace period, the policy or plan will terminate automatically at the end of the grace period. The Policyholder is liable for premium for coverage during the grace period. The Policyholder must pay Unum
all premium due for the full period each plan is in force. 
  
 The Policyholder may cancel the policy or a plan by written notice delivered to Unum at least 120 days prior to the cancellation date. When both the Policyholder and Unum agree, the policy or a plan can be cancelled on an earlier date. If
Unum or the Policyholder cancels the policy or a plan, coverage will end at 12:00 midnight on the last day of coverage. 
  
 ERISA-2 (7/1/2003) 

 DRAFT              

 
 If the policy or a plan is cancelled, the cancellation will not affect a
payable claim. 
  
 HOW TO FILE A CLAIM 
  
 If you wish to file a claim for benefits, you should follow the claim
procedures described in your group insurance certificate. Unum must receive a completed claim form. The form must be completed by you, your authorized representative, your attending physician and your Employer. If you or your authorized
representative has any questions about what to do, you or your authorized representative should contact Unum directly. 
  
 CLAIMS PROCEDURES 
  
 Unum will give you notice of the decision no later than 45 days after the claim is filed. This time period may be extended twice by 30 days if Unum both
determines that such an extension is necessary due to matters beyond the control of the Plan and notifies you of the circumstances requiring the extension of time and the date by which Unum expects to render a decision. If such an extension is
necessary due to your failure to submit the information necessary to decide the claim, the notice of extension will specifically describe the required information, and you will be afforded at least 45 days within which to provide the specified
information. If you deliver the requested information within the time specified, any 30 day extension period will begin after you have provided that information. If you fail to deliver the requested information within the time specified, Unum may
decide your claim without that information. 
  
 If your claim for
benefits is wholly or partially denied, the notice of adverse benefit determination under the Plan will: 
  

	 	•	 	state the specific reason(s) for the determination; 

  

	 	•	 	reference specific Plan provision(s) on which the determination is based; 

  

	 	•	 	describe additional material or information necessary to complete the claim and why such information is necessary; 

  

	 	•	 	describe Plan procedures and time limits for appealing the determination, and your right to obtain information about those procedures and the right to sue in federal court; and

  

	 	•	 	disclose any internal rule, guidelines, protocol or similar criterion relied on in making the adverse determination (or state that such information will be provided free of charge
upon request). 

  
 Notice of the determination may
be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements. 
  
 ERISA-3 (7/1/2003) 

 DRAFT
                 
  
 APPEAL PROCEDURES 
  
 You
have 180 days from the receipt of notice of an adverse benefit determination to file an appeal. Requests for appeals should be sent to the address specified in the claim denial. A decision on review will be made not later than 45 days following
receipt of the written request for review. If Unum determines that special circumstances require an extension of time for a decision on review, the review period may be extended by an additional 45 days (90 days in total). Unum will notify you in
writing if an additional 45 day extension is needed. 
  
 If an
extension is necessary due to your failure to submit the information necessary to decide the appeal, the notice of extension will specifically describe the required information, and you will be afforded at least 45 days to provide the specified
information. If you deliver the requested information within the time specified, the 45 day extension of the appeal period will begin after you have provided that information. If you fail to deliver the requested information within the time
specified, Unum may decide your appeal without that information. 
  
 You will have the opportunity to submit written comments, documents, or other information in support of your appeal. You will have access to all relevant documents as defined by applicable U.S. Department of Labor regulations. The review of
the adverse benefit determination will take into account all new information, whether or not presented or available at the initial determination. No deference will be afforded to the initial determination. 
  
 The review will be conducted by Unum and will be made by a person different
from the person who made the initial determination and such person will not be the original decision maker’s subordinate. In the case of a claim denied on the grounds of a medical judgment, Unum will consult with a health professional with
appropriate training and experience. The health care professional who is consulted on appeal will not be the individual who was consulted during the initial determination or a subordinate. If the advice of a medical or vocational expert was obtained
by the Plan in connection with the denial of your claim, Unum will provide you with the names of each such expert, regardless of whether the advice was relied upon. 
  
 A notice that your request on appeal is denied will contain the following information: 
  

	 	•	 	the specific reason(s) for the determination; 

  

	 	•	 	a reference to the specific Plan provision(s) on which the determination is based; 

  

	 	•	 	a statement disclosing any internal rule, guidelines, protocol or similar criterion relied on in making the adverse determination (or a statement that such information will be
provided free of charge upon request); 

  

	 	•	 	a statement describing your right to bring a civil suit under federal law; 

  

	 	•	 	the statement that you are entitled to receive upon request, and without charge, reasonable access to or copies of all documents, records or other information relevant to the
determination; and 

  

	 	•	 	the statement that “You or your plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact
your local U.S. Department of Labor Office and your State insurance regulatory agency”. 

  
 ERISA-4 (7/1/2003) 

 DRAFT              

 
 Notice of the determination may be provided in written or electronic form.
Electronic notices will be provided in a form that complies with any applicable legal requirements. 
  
 Unless there are special circumstances, this administrative appeal process must be completed before you begin any legal action regarding your claim.

  
 YOUR RIGHTS UNDER ERISA 
  
 As a participant in this Plan you are entitled to certain rights and
protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all Plan participants shall be entitled to: 
  
 Receive Information About Your Plan and Benefits 
  
 Examine, without charge, at the Plan Administrator’s office and at other specified locations, all documents governing the Plan, including insurance
contracts, and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration. 
  
 Obtain, upon written request to the Plan Administrator, copies of documents
governing the operation of the Plan, including insurance contracts, and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The Plan Administrator may make a reasonable charge for the copies. 
  
 Receive a summary of the Plan’s annual financial report. The Plan
Administrator is required by law to furnish each participant with a copy of this summary annual report. 
  
 Prudent Actions by Plan Fiduciaries 
  
 In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit
plan. The people who operate your Plan, called “fiduciaries” of the Plan, have a duty to do so prudently and in the interest of you and other Plan participants and beneficiaries. No one, including your Employer or any other person, may
fire you or otherwise discriminate against you in any way to prevent you from obtaining a benefit or exercising your rights under ERISA. 
  
 Enforce Your Rights 
  
 If your claim for a benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating
to the decision without charge, and to appeal any denial, all within certain time schedules. 
  
 Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of plan documents or the latest annual report from the Plan and do not receive them within 30 days, you may
file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the
control of the Plan Administrator. 
  
 ERISA-5 (7/1/2003)

 DRAFT              

 
 If you have a claim for benefits that is denied or ignored, in whole or in
part, you may file suit in a state or federal court. If it should happen that Plan fiduciaries misuse the Plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or
you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these
costs and fees, if, for example, it finds your claim is frivolous. 
  
 Assistance with Your Questions 
  
 If you have
any questions about your Plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan Administrator, you should
contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S.
Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security
Administration. 
  
 DISCRETIONARY ACTS 
  
 In exercising its discretionary powers under the Plan, the Plan
Administrator, and any designee (which shall include Unum as a claims fiduciary) will have the broadest discretion permissible under ERISA and any other applicable laws, and its decisions will constitute final review of your claim by the Plan.
Benefits under this Plan will be paid only if the Plan Administrator or its designee (including Unum), decides in its discretion that the applicant is entitled to them. 
  
 ERISA-6 (7/1/2003) 

 DRAFT              

 
 GLOSSARY 
  
 ACTIVE EMPLOYMENT means you are working for your Employer for earnings
that are paid regularly and that you are performing the material and substantial duties of your regular occupation. You must be working at least the minimum number of hours as described under Eligible Group(s) in each plan. 
  
 Your work site must be: 
  

	 	•	 	your Employer’s usual place of business; 

  

	 	•	 	an alternative work site at the direction of your Employer, including your home; or 

	 	•	 	a location to which your job requires you to travel. 

  
 Normal vacation is considered active employment. 
  
 Temporary and seasonal workers are excluded from coverage. 
  
 DEDUCTIBLE SOURCES OF INCOME means income from deductible sources listed in the plan which you receive or are entitled to receive while you are
disabled. This income will be subtracted from your gross disability payment. 
  
 DISABILITY EARNINGS means the earnings which you receive while you are disabled and working, plus the earnings you could receive if you were working to your maximum capacity. 
  
 DOMESTIC PARTNER means an adult of the same or opposite sex who has
an emotional, physical and financial relationship with you, similar to that of a spouse; as evidenced by the following facts: 
  

	 	•	 	you and your domestic partner share financial responsibility for a joint household and intend to continue an exclusive relationship indefinitely; 

  

	 	•	 	you and your domestic partner each are at least eighteen (18) years of age; 

  

	 	•	 	you and your domestic partner are both mentally competent to enter into a binding contract; 

  

	 	•	 	you and your domestic partner share a residence and have done so for at least 12 months; 

  

	 	•	 	neither you nor your domestic partner are married to, or legally separated from anyone else; 

  

	 	•	 	you and your domestic partner are not related to one another by blood closer than would bar marriage; and 

  

	 	•	 	neither you nor your domestic partner is a domestic partner of anyone else. 

  
 ELIGIBLE SURVIVOR means your spouse or domestic partner if living; otherwise your children under age 25. 
  
 ELIMINATION PERIOD means a period of continuous disability which must
be satisfied before you are eligible to receive benefits from Unum. 
  
 EMPLOYEE means a citizen or permanent resident of the United States or Canada who is in active employment in the United States with the Employer unless an exception is applied for and approved in writing by Unum. 
  
 EMPLOYER means the Policyholder, and includes any division,
subsidiary or affiliated company named in the policy. 
  
 GLOSSARY-1 (7/1/2003) 

 DRAFT              

 
 GAINFUL OCCUPATION means an occupation that is or can be expected
to provide you with an income at least equal to 60% of your indexed monthly earnings within 12 months of your return to work. 
  
 GRACE PERIOD means the period of time following the premium due date during which premium payment may be made. 
  
 GROSS DISABILITY PAYMENT means the benefit amount before Unum
subtracts deductible sources of income and disability earnings. 
  
 HOSPITAL OR INSTITUTION means an accredited facility licensed to provide care and treatment for the condition causing your disability. 
  
 INDEXED MONTHLY EARNINGS means your monthly earnings adjusted on each anniversary of benefit payments by the lesser of 10% or the current annual
percentage increase in the Consumer Price Index. Your indexed monthly earnings may increase or remain the same, but will never decrease. 
  
 The Consumer Price Index (CPI-W) is published by the U.S. Department of Labor. Unum reserves the right to use some other similar measurement if the
Department of Labor changes or stops publishing the CPI-W. 
  
 Indexing is only used to determine your percentage of lost earnings while you are disabled and working. 
  
 INJURY means a bodily injury that is the direct result of an accident and not related to any other cause. Disability must begin while you are
covered under the plan. 
  
 INSURED means any person
covered under a plan. 
  
 LAW, PLAN OR ACT means the
original enactments of the law, plan or act and all amendments. 
  
 LEAVE OF ABSENCE means you are temporarily absent from active employment for a period of time that has been agreed to in advance in writing by your Employer. 
  
 Your normal vacation time or any period of disability is not considered a leave of absence. 
  
 LIMITED means what you cannot or are unable to do. 
  
 MATERIAL AND SUBSTANTIAL DUTIES means duties that: 
  

	 	•	 	are normally required for the performance of your regular occupation; and 

  

	 	•	 	cannot be reasonably omitted or modified. 

  
 MAXIMUM CAPACITY means, based on your restrictions and limitations: 
  

	 	•	 	during the first 24 months of disability, the greatest extent of work you are able to do in your regular occupation, that is reasonably available. 

  

	 	•	 	beyond 24 months of disability, the greatest extent of work you are able to do in any occupation, that is reasonably available, for which you are reasonably fitted by education,
training or experience. 

  
 GLOSSARY-2 (7/1/2003)

 DRAFT              

 
 MAXIMUM PERIOD OF PAYMENT means the longest period of time Unum
will make payments to you for any one period of disability. 
  
 MENTAL ILLNESS means a psychiatric or psychological condition regardless of cause such as schizophrenia, depression, manic depressive or bipolar illness, anxiety, personality disorders and/or adjustment disorders or other conditions.
These conditions are usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs, or other similar methods of treatment. 
  
 MONTHLY BENEFIT means the total benefit amount for which an employee is insured under this plan subject to the
maximum benefit. 
  
 MONTHLY EARNINGS means your gross
monthly income from your Employer as defined in the plan. 
  
 MONTHLY PAYMENT means your payment after any deductible sources of income have been subtracted from your gross disability payment. 
  
 PART-TIME BASIS means the ability to work and earn 20% or more of your indexed monthly earnings. 
  
 PAYABLE CLAIM means a claim for which Unum is liable under the terms
of the policy. 
  
 PHYSICIAN means: 
  

	 	•	 	a person performing tasks that are within the limits of his or her medical license; and 

	 	•	 	a person who is licensed to practice medicine and prescribe and administer drugs or to perform surgery; or 

	 	•	 	a person with a doctoral degree in Psychology (Ph.D. or Psy.D.) whose primary practice is treating patients; or 

	 	•	 	a person who is a legally qualified medical practitioner according to the laws and regulations of the governing jurisdiction. 

  
 Unum will not recognize you, or your spouse, children, parents or siblings
as a physician for a claim that you send to us. 
  
 PLAN
means a line of coverage under the policy. 
  
 POLICYHOLDER means the Employer to whom the policy is issued. 
  
 PRE-EXISTING CONDITION means a condition for which you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines for your condition during
the given period of time as stated in the plan. 
  
 RECURRENT
DISABILITY means a disability which is: 
  

	 	•	 	caused by a worsening in your condition; and 

  

	 	•	 	due to the same cause(s) as your prior disability for which Unum made a Long Term Disability payment. 

  
 GLOSSARY-3 (7/1/2003) 

 DRAFT              

 
 REGULAR CARE means: 
  

	 	•	 	you personally visit a physician as frequently as is medically required, according to generally accepted medical standards, to effectively manage and treat your disabling
condition(s); and 

  

	 	•	 	you are receiving the most appropriate treatment and care which conforms with generally accepted medical standards, for your disabling condition(s) by a physician whose specialty or
experience is the most appropriate for your disabling condition(s), according to generally accepted medical standards. 

  
 REGULAR OCCUPATION means the occupation you are routinely performing when your disability begins. Unum will look at your occupation as it is
normally performed in the national economy, instead of how the work tasks are performed for a specific employer or at a specific location. 
  
 RETIREMENT PLAN means a defined contribution plan or defined benefit plan. These are plans which provide retirement benefits to employees and are
not funded entirely by employee contributions. Retirement Plan includes but is not limited to any plan which is part of any federal, state, county, municipal or association retirement system. 
  
 SALARY CONTINUATION OR ACCUMULATED SICK LEAVE means continued
payments to you by your Employer of all or part of your monthly earnings, after you become disabled as defined by the Policy. This continued payment must be part of an established plan maintained by your Employer for the benefit of all employees
covered under the Policy. Salary continuation or accumulated sick leave does not include compensation paid to you by your Employer for work you actually perform after your disability begins. Such compensation is considered disability earnings, and
would be taken into account in calculating your monthly payment. 
  
 SICKNESS means an illness or disease. Disability must begin while you are covered under the plan. 
  
 SURVIVOR, ELIGIBLE means your spouse, if living; otherwise your children under age 25 equally. 
  
 TOTAL COVERED PAYROLL means the total amount of monthly earnings for
which employees are insured under this plan. 
  
 WAITING
PERIOD means the continuous period of time (shown in each plan) that you must be in active employment in an eligible group before you are eligible for coverage under a plan. 
  
 WE, US and OUR means Unum Life Insurance Company of America. 
  
 YOU means an employee who is eligible for Unum coverage. 

 
 GLOSSARY-4 (7/1/2003) 

 DRAFT              

 
 UnumProvident’s Commitment to Privacy 
  
 UnumProvident understands your privacy is important. We value our
relationship with you and are committed to protecting the confidentiality of nonpublic personal information (NPI). This notice explains why we collect NPI, what we do with NPI and how we protect your privacy. 
  
 Collecting Information 
  
 We collect NPI about our customers to provide them with insurance products
and services. This may include telephone number, address, date of birth, occupation, income and health history. We may receive NPI from your applications and forms, medical providers, other insurers, employers, insurance support organizations, and
service providers. 
  
 Sharing Information 
  
 We share the types of NPI described above primarily with people who perform
insurance, business, and professional services for us, such as helping us pay claims and detect fraud. We may share NPI with medical providers for insurance and treatment purposes. We may share NPI with an insurance support organization. The
organization may retain the NPI and disclose it to others for whom it performs services. In certain cases, we may share NPI with group policyholders for reporting and auditing purposes. We may share NPI with parties to a proposed or final sale of
insurance business or for study purposes. We may also share NPI when otherwise required or permitted by law, such as sharing with governmental or other legal authorities. When legally necessary, we ask your permission before sharing NPI about
you. Our practices apply to our former, current and future customers. 
  
 Please be assured we do not share your health NPI to market any product or service. We also do not share any NPI to market non-financial products and services. For example, we do not sell your name to catalog
companies. 
  
 The law allows us to share NPI as described above
(except health information) with affiliates to market financial products and services. The law does not allow you to restrict these disclosures. We may also share with companies that help us market our insurance products and services, such as
vendors that provide mailing services to us. We may share with other financial institutions to jointly market financial products and services. When required by law, we ask your permission before we share NPI for marketing purposes.

  
 When other companies help us conduct business, we expect them
to follow applicable privacy laws. We do not authorize them to use or share NPI except when necessary to conduct the work they are performing for us or to meet regulatory or other governmental requirements. 
  
 UnumProvident companies, including insurers and insurance service providers,
may share NPI about you with each other. The NPI might not be directly related to our transaction or experience with you. It may include financial or other personal information such as employment history. Consistent with the Fair Credit Reporting
Act, we ask your permission before sharing NPI that is not directly related to our transaction or experience with you. 
  
 GLB-1 (7/1/2003) 

 DRAFT              

 
 Safeguarding Information 
  
 We have physical, electronic and procedural safeguards that protect the
confidentiality and security of NPI. We give access only to employees who need to know the NPI to provide insurance products or services to you. 
  
 Access to Information 
  
 You may request access to certain NPI we collect to provide you with insurance products and services. You must make your request in writing and send it to
the address below. The letter should include your full name, address, telephone number and policy number if we have issued a policy. If you request, we will send copies of the NPI to you. If the NPI includes health information, we may provide the
health information to you through a health care provider you designate. We will also send you information related to disclosures. We may charge a reasonable fee to cover our copying costs. 
  
 This section applies to NPI we collect to provide you with coverage. It does
not apply to NPI we collect in anticipation of a claim or civil or criminal proceeding. 
  
 Correction of Information 
  
 If you believe NPI we have about you is incorrect, please write to us. Your letter should include your full name, address, telephone number and policy number if we have issued a policy. Your letter should also explain why you believe the
NPI is inaccurate. If we agree with you, we will correct the NPI and notify you of the correction. We will also notify any person who may have received the incorrect NPI from us in the past two years if you ask us to contact that person. 

 
 If we disagree with you, we will tell you we are not going to make the
correction. We will give you the reason(s) for our refusal. We will also tell you that you may submit a statement to us. Your statement should include the NPI you believe is correct. It should also include the reason(s) why you disagree with our
decision not to correct the NPI in our files. We will file your statement with the disputed NPI. We will include your statement any time we disclose the disputed NPI. We will also give the statement to any person designated by you if we may have
disclosed the disputed NPI to that person in the past two years. 
  
 Coverage Decisions 
  
 If we decide not to issue
coverage to you, we will provide you with the specific reason(s) for our decision. We will also tell you how to access and correct certain NPI. 
  
 Contacting Us 
  
 For additional information about UnumProvident’s commitment to privacy, please visit www.unumprovident.com/privacy or
www.coloniallife.com or write to: Privacy Officer, UnumProvident Corporation, 2211 Congress Street, M347, Portland, Maine 04122. We reserve the right to modify this notice. We will provide you with a new notice if we make material changes to
our privacy practices. 
  
 UnumProvident Corporation is
providing this notice to you on behalf of the following insuring companies: Unum Life Insurance Company of America, First Unum Life Insurance Company, Provident Life and Accident Insurance Company, Provident Life and Casualty Insurance Company,
Colonial Life & Accident 
  
 GLB-2 (7/1/2003) 

 DRAFT              

 
 Insurance Company, The Paul Revere Life Insurance Company and The Paul
Revere Variable Annuity Insurance Company. 
  
 UnumProvident
is the marketing brand of, and refers specifically to, UnumProvident Corporation’s insuring subsidiaries. © 2003 UnumProvident Corporation. The name and logo combination is a service mark of UnumProvident Corporation. All rights reserved.

  
 GLB-3 (7/1/2003)

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