Document:

Exhibit

Exhibit 10.3

Group Personal Excess Liability Policy
CHUBB"

Coverage Summary

Name and address of Insured

NORTHROP GRUMMAN CORPORATION GROUP PERSONAL EXCESS PROGRAM 
2980 FAIRVIEW PARK DRIVE
FALLS CHURCH, VIRGINIA 22042

Producer No.:  0017806

Sponsoring Organization and Address

Northrop Grumman Corporation 2980 Fairview Park Drive
Falls Church, VA 22042

 

 
Chubb Group of Insurance Companies
PO BOX 1600,
Whitehouse Station, NJ 08889-1600

Policy Number:    ( 20)  7993-14-03

Issued by the stock insurance company indicated below, herein called the company.

FEDERAL INSURANCE COMPANY

Incorporated under the laws of INDIANA

Policy Period

From: JANUARY 01, 2019 To:  JANUARY 01, 2020
12:01 A.M. Standard Time at the Named lnsured's mailing address.

Premium

Amount
$160,553.00

Limit Of Liability
SEE ENDT    Each Occurrence
		
	SEE ENDT
	Excess Uninsured / Underinsured 

Motorists Protection Each Occurrence

 

Required Primary Underlying Insurance

Personal Liability (Homeowners) for personal injury and property damage in the minimum amount of $100,000 each occurrence.

Registered vehicles in the minimum amount of $250,000 / $500,000 bodily injury and $100,000 property damage; or $300,000 single limit each occurrence.

Group Personal Excess Liability Policy    continued

Form 10-02-0690 (Rev. B-07)    Declarations    Page 1

Required Primary Underlying Insurance
(continued)

Unregistered vehicles in the minimum amount of $300,000 bodily injury and property damage each occurrence.

Registered vehicles with less than four wheels and motorhomes in the minimum amount $250,000 I $500,000 bodily injury and $100,000 property damage; or $300,000 single limit each occurrence.

Watercraft less than 26 feet and 50 engine rated horsepower or less for bodily and property damage in the minimum amount of $300,000 each occurrence.

Watercraft 26 feet or longer or more than 50 engine rated horsepower for bodily injury and property damage in the minimum amount of $500,000 each occurrence.

Uninsured motorists/underinsured motorists protection in the minimum amount of $250,000 I $500,000 bodily injury and $100,000 property damage; or $300,000 single limit occurrence.

FAILURE TO COMPLY WITH THE REQUIRED PRIMARY UNDERLYING INSURANCE WILL RESULT IN A GAP IN COVERAGE.
-----------------------------------------------------------------------------·

Group Personal Excess Liability Policy    continued

Form 10-02-0690 (Rev. 8-07)    Declarations    Page 2

CHUBB·
 
Group Personal Excess Liability Policy

Coverage Summary

 

Effective Date    JANUARY 01, 2019

Policy Number 7993-14-03

Authorization
In Witness Whereof, the company issuing this policy has caused this policy to be signed by its authorized officers and signed by a duly authorized representative of the company.

FEDERAL INSURANCE COMPANY

President
 

 

Date                        
FEBRUARY 14, 2019    Authorized Representative

Producer's Name & Address

MARSH USA, INC (PHILADELPHIA) 
1717 ARCH STREET 1100
PHILADELPHIA, PA 19103-0000

Chubb. InsuredTM 

Group Personal Excess Liability Policy    last page
Form 10-02-0690 (Rev. 8-07)    Declarations    Page 3

Schedule of Forms

Policy Number:    ( 20  )    7993-14-03
		
	Insured:
	NORTHROP GRUMMAN CORPORATION GROUP PERSONAL EXCESS PROGRAM

Policy Period From:  JANUARY 01, 2019 to JANUARY 01, 2020

The following is a schedule of forms issued with the policy at inception:

Form Name    Form Number

	
			
	PRIVACY NOTICE - GROUP MASTER POLICY
	10-02-1058
	(10/ 16)

	IMPORTANT NOTICE - OFAC
	99-10-0796
	(09/04)

	COVERAGE SUMMARY/DECLARATIONS
	10-02-0690
	(08/07)

	GROUP PERSONAL EXCESS - CONTRACT/POLICY TERMS
	10-02-0691
	(07/16)

	NAMED INSURED ENDORSEMENT
	10-02-0692
	(08/96)

	UNDERLYING LIMITS ENDORSEMENT
	10-02-0692
	(08/96)

	ANNUAL PREMIUM ADJUSTMENT CLAUSE
	10-02-0692
	(08/96)

Last page
Page 1
Form 10-02-0414 (Ed. 9/93)

CHUBB.

GROUP PERSONAL EXCESS LIABILITY
POLICY

THIS PAGE INTENTIONALLY LEFT BLANK

CHUBB.
GROUP PERSONAL EXCESS LIABILITY POLICY

INTRODUCTION
This is your Chubb Group Personal Excess Liability Policy. Together with your Coverage Summary, it explains your coverages and other conditions of your insurance in detail.
This policy is a contract between you and us. READ YOUR POLICY CAREFULLY and keep it in a safe place.
Agreement
We agree to provide the insurance described in this policy in return for the premium paid by you or the Sponsoring Organization and your compliance with the policy conditions.
Definitions
In this policy, we use words in their plain English meaning. Words with special meanings are defined in the part of the policy where they are used. The few defined terms used throughout the policy are defined here:
You means the individual who is a member of the Defined Group shown as the Insured named in the Coverage Summary.
Spouse means a partner in marriage or a partner in a civil union recognized under state law and who lives with you.
We and us mean the insurance company named in the Coverage Summary.
Family member means your spouse or domestic partner or other relative who lives with you, or any other person under 25 in your care or your relative's care who lives with you.
Domestic partner means a person in a legal or personal relationship with you, who lives with you and shares a common domestic life with you, and meeting all of the benefits eligibility criteria as defined by the Sponsoring Organization.
Sponsoring Organization means the entity, corporation, partnership or sole proprietorship sponsoring and defining the criteria for qualification as an Insured.
Policy means your entire Group Personal Excess Liability Policy, including the Coverage Summary.
Coverage Summary means the most recent Coverage Summary we issued to you, including any endorsements.
Occurrence means an accident or offense to which this insurance applies and which begins within the policy period. Continuous or repeated exposure to substantially the same general conditions unless excluded is considered to be one occurrence.
Business means any employment, trade, occupation, profession, or farm operation including the raising or care of animals or any activities intended to realize a benefit or financial gain engaged in on a full-time, part-time or occasional basis.
Defined Group means those individuals meeting the criteria for qualification as an Insured as defined by the Sponsoring Organization and accepted by us.
Follow form means we cover damages to the extent they are both covered under the Required Primary Underlying Insurance and, not excluded under this policy. Also, the amount of coverage, defense coverages, cancellation and "other insurance" provisions of this policy supersede and replace the similar provisions contained in such other policies. When this policy is called upon to pay losses in excess of required primary underlying policies exhausted by payment of claims, we do not provide broader coverage than provided by such policies. When no primary underlying coverage exists, the extent of coverage provided on a follow form basis will be determined as if the required primary underlying insurance bad been purchased from us.
Covered person means:
		
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	you or a family member;

		
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	any person using a vehicle or watercraft covered under this policy with permission from you or a family member with respect to their legal responsibility arising out of its use;

		
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	any other person who is a covered person under your Required Primary Underlying Insurance;

		
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	any person or organization with respect to their legal responsibility for covered acts or omissions of you or a family member; or

		
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	any combination of the above.

Definitions
(continued)

Damages mean the sum that is paid or is payable to satisfy a claim settled by us or resolved by judicial procedure or by a compromise we agree to in writing.
Personal injury means the following injuries, and resulting death:
		
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	bodily injury;

		
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	shock, mental  anguish, or mental  injury;

		
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	false  arrest, false imprisonment,  or wrongful detention;

		
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	wrongful  entry or eviction;

		
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	malicious prosecution  or humiliation; and

		
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	libel, slander, defamation  of character, or invasion  of privacy.

Bodily injury means physical bodily harm, including sickness or disease that results from it, and required care, loss of services and resulting death.
Property damage means physical injury to or destruction of tangible property and the resulting loss of its use. Tangible property includes the cost of recreating or replacing stocks, bonds, deeds, mortgages, bank deposits, and similar instruments , but does not include the value represented by such instruments. Tangible property does not include the cost of recreating or replacing any software, data or other information  that is in electronic form.
Registered vehicle means any motorized land vehicle not described in "unregistered vehicle."
Unregistered  vehicle means:
		
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	any motorized land vehicle not designed for or required to be registered for use on public roads;

		
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	any motorized land vehicle which is in dead storage at your residence;

		
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	any motorized land vehicle used solely on and to service your residence premises;

		
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	any motorized land vehicle used to assist the disabled that is not designed for or required to be registered for use on public roads; or

		
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	golf carts.

GROUP PERSONAL EXCESS COVERAGE

This part of your Group Personal Excess Liability Policy provides you or a family member with liability coverage in excess of your underlying insurance anywhere in the world unless stated otherwise or an exclusion applies.
Payment for a Loss
Amount of coverage
The amount of coverage for liability is shown in the Coverage Summary. We will pay on your behalf up to that amount for covered damages from any one occurrence, regardless of how many claims, homes, vehicles, watercraft, or people are involved in the occurrence.
Any costs we pay for legal expenses (see Defense coverages) are in addition to the amount of coverage.
Underlying Insurance
We will pay only for covered damages in excess of all underlying insurance covering those damages, even if the underlying coverage is for more than the minimum amount.
"Underlying insurance" includes all liability coverage that applies to the covered damages, except for other insurance purchased in excess of this policy.
Required primary underlying insurance
Regardless of whatever other primary underlying insurance may be available in the event of a claim or loss, it is a condition of your policy that you and your family members must maintain in full effect primary underlying liability insurance of the types and  in at least the amounts set forth below unless a different amount is shown in your Coverage Summary, covering your personal liability and to the extent you or a family member have such liability exposures, all vehicles and watercraft you or your family members own, or rent for longer than 60 days, or have furnished for longer than 60 days, as follows:
Personal liability (homeowners) for personal injury and property damage in the minimum amount of $300,000 each occurrence.

CHUBB.    GROUP PERSONAL EXCESS LIABILITY POLICY

Payment for a Loss
(continued)
Registered vehicles in the minimum amount of:
		
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	$250,000/$500,000 bodily injury and $100,000 property damage;

		
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	$300,000/$300,000 bodily injury and $100,000 property damage; or

		
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	$300,000 single limit each occurrence.

Unregistered vehicles in the minimum amount of $300,000 bodily injury and property damage each occurrence. 
Registered vehicles with less than four wheels and motorhomes in the minimum amount of:
		
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	$250,000/$500,000 bodily injury and $100,000 property damage;

		
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	$300,000/$300,000 bodily injury and $100,000 property damage; or

		
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	$300,000 single limit each occurrence.

Watercraft less than 26 feet and 50 engine rated horsepower or less for bodily injury and property damage in the minimum amount of $300,000 each occurrence.
Watercraft 26 feet or longer or more than 50 engine rated horsepower for bodily injury and property damage in the minimum amount of $500,000 each occurrence.
Uninsured motorists/underinsured motorist protection in the minimum amounts of:
		
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	$250,000/$500,000 bodily injury and $100,000 property damage;

		
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	$300,000/$300,000 bodily injury and $100,000 property damage; or

		
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	$300,000 single limit each occurrence.

With respect to you and your family members residing outside of the United States, the required primary underlying insurance limits of liability shall be the same limits of liability as shown above, unless you and your family members reside in a country where the minimum required primary underlying insurance limits of liability are not available. In these countries, you and your family members must maintain in full effect primary underlying liability insurance limits equal to the maximum limits of liability available in that country for all coverages up to the minimum required primary underlying limits shown in the Coverage Summary under Required Primary Underlying Insurance.
Failure by you or your family members to comply with this condition, or failure of any of your primary underlying insurers due to insolvency or bankruptcy, shall not invalidate this policy. In the event of any such failure, we shall only be liable in excess of the foregoing minimum amounts and to no greater extent with respect to coverages, amounts and defense costs than we would have been had this failure not occurred.
You must also give notice of losses and otherwise cooperate and comply with the terms and conditions of such primary underlying insurance.
Group Personal Excess Liability Coverage
We cover damages a covered person is legally obligated to pay for personal injury or property damage, caused by an occurrence:
		
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	in excess of damages covered by the underlying insurance; or

		
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	from the first dollar of damage where no underlying insurance is required under this policy and no underlying insurance exists; or

		
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	from the first dollar of damage where underlying insurance is required under this policy but no coverage is provided by the underlying insurance for a particular occurrence;

unless stated otherwise or an exclusion applies. Exclusions to this coverage are described in Exclusions.
Excess uninsured motorists/underinsured motorist protection
This coverage is in effect only if excess uninsured motorists/underinsured motorists protection is shown in the Coverage Summary.

Group Personal Excess Liability Coverage
(continued)

We cover damages for bodily injury and property damage a covered person is legally entitled to receive from the owner or operator of an uninsured motorized/underinsured motorized land vehicle. We cover these damages in excess of the underlying insurance or the Required Primary Underlying Insurance, whichever is greater, if they are caused by an occurrence during the policy period, unless otherwise stated.

Amount of coverage. The maximum amount of excess uninsured motorists/underinsured motorists protection available for any one occurrence is the excess uninsured motorists/underinsured motorists protection amount shown in the Coverage Summary regardless of the number of vehicles covered by the Required Primary Underlying Insurance. We will not pay more than this amount in any one occurrence for covered damages regardless of how many claims, vehicles or people are involved in the occurrence. This coverage will follow form.

Uninsured motorists/underinsured motorists protection arbitration
If we and a covered person disagree whether that person is legally entitled to recover damages from the owner or operator of an uninsured motor vehicle/underinsured motor vehicle, or do not agree as to the amount of damages, either party may make a written demand for arbitration. In this event, each party will select an arbitrator. The two arbitrators will select a third. If they cannot agree on a third arbitrator within 45 days, either may request that the arbitration be submitted to the American Arbitration Association. When the covered person's recovery exceeds the minimum limit specified in the applicable jurisdiction's financial responsibility law, each party will pay the expenses it incurs, and bear the expenses of the third arbitrator equally. Otherwise, we will bear all the expenses of the arbitration.
Unless both parties agree otherwise, arbitration will take place in the county and state in which the covered person lives. Local rules of law as to procedure and evidence will apply. A decision agreed to by two arbitrators will be binding unless the recovery amount for bodily injury exceeds the minimum limit specified by the applicable jurisdiction's financial responsibility law. If the amount exceeds that limit, either party may demand the right to a trial. This demand must be made within 60 days of the arbitrator's decision. If this demand is not made, the amount of damages agreed to by the arbitrators will be binding.
Uninsured/underinsured liability coverage
This coverage is in effect only if excess uninsured motorists/underinsured motorists protection is shown in the Coverage Summary.
We cover up to a maximum of $1 million for bodily injury and personal injury you or a family member are legally entitled to receive from an uninsured or underinsured negligent person caused by an occurrence, unless stated otherwise or an exclusion applies. We will not pay more than this amount for covered damages from any one occurrence, regardless of how many claims or people are involved in the occurrence. This coverage is excess over the total of any other collectible insurance that covers damages from the occurrence.

All the exclusions under the Group Personal Excess Liability Coverage are applicable to this Uninsured/underinsured liability coverage, and where used, the definition of you or a family member is extended to include negligent person. This coverage also does not apply to damages from an occurrence arising out of any business activities; any activities involving business property or the sale or transfer of property; or the ownership, maintenance, use, loading, unloading, or towing of any motor vehicle, watercraft, or aircraft. In addition, this coverage does not apply to damages from an occurrence arising from any employment related harassment, termination, demotion, breach of an oral or written employment contract or agreement or violation of any state or federal wrongful employment practices act or similar law.

We also do not cover any fines, penalties, taxes, punitive, exemplary or multiplied damages, or any claim or suit seeking non­ monetary relief, including but not limited to, injunctive relief, declaratory relief or other equitable remedies.

"Negligent person" means an identifiable natural person by legal name who is not a family member, and who is legally responsible for damages sustained by you or a family member caused by an occurrence.
Duplication of coverage. We will not make a duplicate payment for any portion of damages for which payment has been made by or on behalf of persons who may be legally responsible, or otherwise covered by any other collectible insurance. Nor will we pay for any portion of damages if you or a family member is entitled to receive payment for the same portion of damages under any workers' compensation law, disability benefits law or similar law.

CHUBB·        

 
GROUP PERSONAL EXCESS LIABILITY POLICY

Group Personal Excess Liability Coverage
(continued)

Defense coverages
We will defend a covered person against any suit seeking covered damages for personal injury or property damage that is either:
		
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	not covered by any underlying insurance; or

		
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	covered by an underlying policy. This will apply to each Defense Coverage as it has been exhausted by payment of claims.

We provide this defense at our expense, with counsel of our choice, even if the suit is groundless, false, or fraudulent. We may investigate, negotiate, and settle any such claim or suit at our discretion.
As part of our investigation, defense, negotiation, or settlement, we will pay:
		
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	all premiums on appeal bonds required in any suit we defend;

		
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	all premiums on bonds to release attachments for any amount up to the amount of coverage (but we are not obligated to apply for or furnish any bond);

		
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	all expenses incurred by us;

		
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	all costs taxed against a covered person;

		
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	all interest accruing after a judgment is entered in a suit we defend on only that part of the judgment we are responsible for paying. We will not pay interest accruing after we have paid the judgment up to the amount of coverage;

		
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	all prejudgment interest awarded against a covered person on that part of the judgment we pay or offer to pay.

We will not pay any prejudgment interest based on that period of time after we make an offer to pay the amount of coverage;
		
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	all earnings lost by each covered person at our request, up to $25,000;

		
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	other reasonable expenses incurred by a covered person at our request; and

		
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	the cost of bail bonds required of a covered person because of a covered loss.

In jurisdictions where we may be prevented by local law from carrying out these Defense Coverages, we will pay only those defense expenses that we agree in writing to pay and that are incurred by you.
Extra Coverages
In addition to covering damages and defense costs, we also provide other related coverages. These coverages are in addition to the amount of coverage for damages and defense costs unless stated otherwise.

Shadow defense coverage
If we are defending you or a family member in a suit seeking covered damages, we will pay reasonable expenses you or a family member incur up to $10,000 or the amount shown in the Coverage Summary for a law firm of your choice to review and monitor the defense. However any recommendation by your persona attorney is not binding on us. We will pay these costs provided that you obtain prior approval from us before incurring any fees or expenses.

Identity fraud
We will pay for your or a family member's identity fraud expenses, up to a maximum of $25,000, for each identity fraud occurrence.

"Identity fraud" means the act of knowingly transferring or using, without lawful authority, your or a family member's means of identity which constitutes a violation of federal law or a crime under any applicable state or local law.
"Identity fraud occurrence" means any act or series of acts of identity fraud by a person or group commencing in the policy period.
"Identity fraud expenses" means:
		
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	the costs for notarizing affidavits or similar documents for law enforcement agencies, financial institutions or similar credit grantors, and credit agencies;

		
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	the costs for sending certified mail to law enforcement agencies, financial institutions or similar credit grantors, and credit agencies;

Extra Coverages
(continued)

		
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	the loan application fees for reapplying for loan(s) due to the rejection of the original application because the lender received incorrect credit information;

		
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	the telephone expenses for calls to businesses, law enforcement agencies, financial institutions or similar credit grantors, and credit agencies;

		
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	earnings lost by you or a family member as a result of time off from work to complete fraud affidavits, meet with law

enforcement agencies, credit agencies, merchants, or legal counsel;
		
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	the reasonable attorney fees incurred with prior notice to us for:

		
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	the defense of you or a family member against any suit(s) by businesses or their collection agencies;

		
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	the removal of any criminal or civil judgements wrongly entered against you or a family member;

		
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	any challenge to the information in your or a family member's consumer credit report; and

		
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	the reasonable fees incurred  with prior notice to us by an identity fraud mitigation entity to:

		
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	provide services for the activities described above;

		
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	restore accounts or credit standing with financial institutions or similar credit grantors and credit agencies; and

		
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	monitor for up to one year the effectiveness of the fraud mitigation and to detect additional identity fraud activity after the  first identify fraud occurrence.

However, such monitoring must begin no later than one year after you or a family member first report an identity fraud occurrence to us.

However, "identity fraud expenses" does not include expenses incurred due to any fraudulent, dishonest or criminal act by a covered person or any person acting with a covered person, or by any authorized representative of a covered person, whether acting alone or in collusion with others.

"Identity fraud mitigation entity" means a company that principally provides professional, specialized  services  to  counter identity fraud for individuals or groups of individuals, or a financial institution  that provides similar services.

In addition to the duties described in Policy Terms, Liability Conditions, Your duties after a loss, you shall notify an applicable law enforcement agency.

Kidnap expenses
We will pay up to a maximum of $100,000 for kidnap expenses you or a family member incurs solely and directly as a result of a kidnap and ransom occurrence. In addition, we also will pay up to $25,000 to any person for information not otherwise available leading to the arrest and conviction of any person(s) who kidnaps you, a family member or a covered relative. The following are not eligible to receive this reward payment:
		
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	you or a family member; or

		
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	a covered relative who witnessed the occurrence.

"Kidnap and ransom occurrence" means the actual or alleged wrongful taking of:
		
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	you;

		
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	one or more family members; or

		
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	one or more covered relatives while visiting or legally traveling with you or a family member;

from anywhere in the world except those places listed on the United States State Department Bureau of Consular Affairs Travel Warnings list at the time of the occurrence. The occurrence must include a demand for ransom payment which would be paid by you or a family member in exchange for the release of the kidnapped person(s).
"Kidnap expenses" means the reasonable costs for:
		
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	a professional negotiator;

		
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	a professional security consultant;

		
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	professional security guard services;

		
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	a professional public relations consultant;

		
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	travel, meals, lodging and phone expenses incurred by you or a family member;

		
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	advertising, communications and recording equipment;

		
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	related medical, cosmetic, psychiatric and dental expenses incurred by a kidnapped person within 12 months from that person's release;

		
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	attorneys fees;

		
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	a professional forensic analyst;

		
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	earnings lost by you or a family member, up to $25,000.

CHUBB"    GROUP PERSONAL EXCESS LIABILITY POLICY

Extra Coverages
(continued)

However, "kidnap expenses" does not include expenses incurred due to any kidnap and ransom occurrence caused by:
		
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	you or a family member;

		
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	a covered relative;

		
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	any guardian, or former guardian of you, a family member or covered relative;

		
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	any estranged spouse or domestic partner, or former spouse or domestic partner of you or a family member;

		
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	any person unrelated to you or a family member who lives with you or a family member or has ever lived with you or a family member for 6 or more months, other than a domestic employee, residential staff, or a person employed by you or a family  member for farm work; or

		
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	a civil authority,

or any person acting on behalf of any of the above, whether acting alone or in collusion with others.

"Covered relative" means the following relatives of you, or a spouse or domestic partner who lives with you, or any family member:
		
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	children, their children or other descendents of theirs;

		
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	parents, grandparents or other ancestors of theirs; or

		
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	siblings,  their children or other descendents of theirs;

who do not live with you, including spouses or domestic partners of all of the above. Parents, grandparents and other ancestors include adoptive parents, stepparents and stepgrandparents.

Reputational injury. If we are defending you or a family member in a suit seeking covered damages, we will pay reasonable and necessary fees or expenses that you or a family member incur for services provided by a reputation management firm to minimize potential injury to the reputation of you or a family member solely as a result of personal injury or property damage, caused by an occurrence if:
		
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	the reputational injury is reported to us as soon as reasonably possible but not later than 30 days after the personal injury or property damage occurrence;  and

		
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	you obtain approval of the reputation management firm from us before incurring any fees or expenses, unless stated otherwise or an exclusion applies. There is no deductible for this coverage.

A Reputation management firm means a professional public relations consulting firm, a professional security consulting firm or a professional media management consulting firm.
The maximum amount of coverage for Reputational injury available for any one occurrence is $25,000 or the amount shown in the Coverage Summary. We will not pay more than this amount in any one occurrence for covered damages regardless of how many claims or people are involved in the occurrence.
The maximum annual amount of coverage for Reputational injury shown in the Coverage Summary is the most we will pay for the sum of all covered damages you or a family member incur during the policy period regardless of the number of claims, people, or occurrences.
This coverage does not apply to loss caused by a wrongful employment act covered by Employment Practices Liability Insurance.

Exclusions
These exclusions apply to your Group Personal Excess Liability Coverage, unless stated otherwise.
Aircraft. We do not cover any damages arising out of the ownership, maintenance, use, loading, unloading, or towing of any aircraft, except aircraft chartered with crew by you. We do not cover any property damages to aircraft rented to, owned by, or in  the care, custody or control of a covered person.

Hovercraft. We do not cover any damages arising out of the ownership, maintenance, use, loading, unloading or towing of any hovercraft. We do not cover any property damages to hovercraft rented to, owned by, or in the care, custody or control of  a covered person.

Exclusions
(continued)
Motorized land vehicle racing or track usage. We do not cover any damages arising out of the ownership, maintenance or use of any motorized land vehicle:
		
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	during any instruction, practice, preparation for, or participation in, any competitive, prearranged or organized racing,

speed contest, rally, gymkhana, sports event, stunting activity, or timed event of any kind; or
		
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	on a racetrack, test track or other course of any kind.

Watercraft and aircraft racing or track usage. We do not cover any damages arising out of the ownership, maintenance or use of any watercraft or aircraft during any instruction, practice, preparation for, or participation in, any competitive, prearranged or organized racing, speed contest, rally, sports event, stunting activity or timed event of any kind. This exclusion does not apply to you or a family member for sailboat racing even if the sailboat is equipped with an auxiliary motor.
Motorized land vehicle-related jobs. We do not cover any damages arising out of the ownership, maintenance, or use of a motorized land vehicle by any person who is employed or otherwise engaged in the business of selling, repairing, servicing, storing, parking, testing, or delivering motorized land vehicles. This exclusion does not apply to you, a family member, or your employee or an employee of a family member for damages arising out of the ownership, maintenance or use of a motorized land vehicle owned by, rented to, or furnished to you or a family member.

Watercraft related jobs. We do not cover any damages arising out of the ownership, maintenance, or use of a watercraft by any person who is engaged by or employed by, or is operating a marina, boat repair yard, shipyard, yacht club, boat sales agency, boat service station, or other similar organization. This exclusion does not apply to damages arising out of the ownership, maintenance, or use of a watercraft by you, a family member, or your or a family member's captain or full time paid crew member maintaining or using this watercraft with permission from you or a family member.

Motorized land vehicle and watercraft loading. We do not cover any person or organization, other than you or a family member or your or a family member's employees, with respect to the loading or unloading of motorized land vehicles or watercraft.
Workers' compensation or disability, We do not cover any damages a covered person is legally:
		
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	required to provide; or

•voluntarily provides under any:
		
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	workers'  compensation;

		
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	disability benefits;

		
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	unemployment  compensation; or

		
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	other similar laws.

But we do provide coverage in excess over any other insurance for damages you or a family member is legally required to pay for bodily injury to a domestic employee of a residence covered under the Required Primary Underlying Insurance which are not compensable under workers' compensation, unless another exclusion applies.
Director's liability. We do not cover any damages for any covered person's actions or failure to act as an officer or member of a board of directors of any corporation or organization. However, we do cover such damages if you are or a family member is an officer or member of a board of directors of a:
		
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	homeowner, condominium or cooperative association; or

•not for profit corporation or organization for which he or she is not compensated; unless another exclusion applies.
Damage to covered person's property. We do not cover any person for property damage to property owned by any covered person.
Damage to property in your care. We do not cover any person for property damage to property rented to, occupied by, used by, or in the care of any covered person, to the extent that the covered person is required by contract to provide insurance. But we do cover such damages for loss caused by fire, smoke, or explosion unless another exclusion applies.
Wrongful employment act. We do not cover any damages arising out of a wrongful employment act. A wrongful employment act means any employment discrimination, sexual harassment, or wrongful termination of any residential staff actually or allegedly committed or attempted by a covered person while acting in the capacity as an employer, that violates applicable employment law of any federal, state, or local statute, regulation, ordinance, or common law of the United States of America, its territories or possessions, or Puerto Rico.

GROUP PERSONAL EXCESS LIABILITY POLICY
CHUBB·

Exclusions
(continued)

Employment discrimination as it relates solely to a wrongful employment act means a violation of applicable employment discrimination law protecting any residential staff based on his or her race, color, religion, creed, age, sex, disability, national origin or other status according to any federal, state, or local statute, regulation, ordinance, or common law of the United States of America, its territories or possessions, or Puerto Rico.

Sexual harassment as it relates solely to a wrongful employment act means unwelcome sexual advances, requests for sexual favors, or other conduct of a sexual nature that:
		
	•
	is made a condition of employment of any residential staff;

		
	•
	is used as a basis for employment decisions;

		
	•
	interferes with performance of any residential staffs duties; or

		
	•
	creates an intimidating, hostile, or offensive working environment.

Wrongful termination as it relates solely to a wrongful employment act means:
		
	•
	the actual or constructive termination of employment of any residential staff by you or a family member in violation of applicable employment law; or

		
	•
	breach of duty and care when you or a family member terminates an employment relationship with any residential staff.

Residential staff as it relates solely to a wrongful employment act means your or a family member's employee who is:
		
	•
	employed by you or a family member, or through a firm under an agreement with you or a family member, to perform duties related only to a covered person's domestic, personal, or business pursuits covered under this part of your policy;

		
	•
	compensated for labor or services directed by you or a family member; and

		
	•
	employed regularly to work 15 or more hours per week.

Residential staff includes a temporary worker. Residential staff does not include an independent contractor or any covered person.

Temporary worker as it relates solely to a wrongful employment act means your or a family member's employee who is:
		
	•
	employed by you or a family member, or through a firm under an agreement with you or a family member, to perform duties related only to a covered person's domestic, personal, or business pursuits covered under this part of your policy;

		
	•
	compensated for labor or services directed by you or a family member; and

		
	•
	employed to work 15 or more hours per week to substitute for any residential staff on leave or to meet seasonal or short- term workload demands for 30 consecutive days or longer during a 6 month period.

Temporary worker does not include an independent contractor or any covered person.

Discrimination. We do not cover any damages arising out of discrimination due to age, race, color, sex, creed, national origin, or any other discrimination.

Intentional acts. We do not cover any damages arising out of a willful, malicious, fraudulent or dishonest act or any act intended by any covered person to cause personal injury or property damage, even if the injury or damage is of a different degree or type than actually intended or expected. But we do cover such damages if the act was intended to protect people or property unless another exclusion applies. An intentional act is one whose consequences could have been foreseen by a reasonable person.

Molestation, misconduct or abuse. We do not cover any damages arising out of any actual, alleged or threatened:
		
	•
	sexual molestation;

		
	•
	sexual misconduct or harassment; or

		
	•
	abuse.

Nonpermissive use. We do not cover any person who uses a motorized land vehicle or watercraft without permission from you or a family member.

Exclusions
(continued)

Business pursuits. We do not cover any damages arising out of a covered person's business pursuits, investment or other for-profit activities, for the account of a covered person or others, or business property except on a follow form basis.
But we do cover damages arising out of volunteer work for an organized charitable, religious or community group, an incidental business away from home, incidental business at home, incidental business property, incidental farming, or residence premises conditional business liability unless another exclusion applies. We also cover damages arising out of your or a family member's ownership, maintenance, or use of a private passenger motor vehicle in business activities other than selling, repairing, servicing, storing, parking, testing, or delivering motorized land vehicles.
Unless stated otherwise in your Coverage Summary:
"Incidental business away from home" is a self-employed sales activity, or a self-employed business activity normally undertaken by person under the age of 18 such as newspaper delivery, babysitting, caddying, and lawn care. Either of these activities must:
		
	•
	not yield gross revenues in excess of $15,000 in any year;

		
	•
	have no employees subject to worker's compensation or other similar disability laws;

		
	•
	conform to local, state, and federal laws.

"Incidental business at home" is a business activity, other than farming, conducted on your residence premises which must:
		
	•
	not yield gross revenues in excess of $15,000, in any year, except for the business activity of managing one's own personal investments;

		
	•
	have no employees subject to worker's compensation or other similar disability laws;

		
	•
	conform to local, state, and federal laws.

"Incidental business property" is limited to the rental or holding for rental, to be used as a residence, of a condominium or cooperative unit owned by you or a family member, an apartment unit rented to you or a family member, a one or two family dwelling owned by you or a family member, or a three or four family dwelling owned and occupied by you or a family member. We provide this coverage only for premises covered under the Required Primary Underlying Insurance unless the rental or holding for rental is for:
		
	•
	a residence of yours or a family member's that is occasionally rented and that is used exclusively as a residence; or

		
	•
	part of a residence of yours or a family member's by one or two roomers or boarders; or

		
	•
	part of a residence of yours or a family member's as an office, school, studio, or private garage.

"Incidental farming" is a farming activity which meets all of the following requirements:
		
	•
	is incidental to your or a family member's use of the premises as a residence;

		
	•
	does not involve employment of others for more than 1,500 hours of farm work during the policy period;

		
	•
	does not produce more than $25,000 in gross annual revenue from agricultural operations;

		
	•
	and with respect to the raising or care of animals:

		
	•
	does not produce more than $50,000 in gross annual revenues;

		
	•
	does not involve more than 25 sales transactions during the policy period;

		
	•
	does not involve the sale of more than 50 animals during the policy period.

"Residence premises conditional business liability" is limited to business or professional activities when legally conducted by you or a family member at your residence. We provide coverage only for personal injury or property damage arising out of the physical condition of that residence if:
		
	•
	you or a family member do not have any employees involved in your business or professional activities who are subject to workers' compensation or other similar disability laws; or, if you or a family member are a doctor or dentist, you do not have more than two employees subject to such laws;

		
	•
	you or a family member do not earn annual gross revenues in excess of $5,000, if you or a family member are a home day care provider.

We do not cover damages or consequences resulting from business or professional care or services performed or not performed.

CHUBB.    GROUP PERSONAL EXCESS LIABILITY POLICY

Exclusions
(continued)

The following additional exclusion applies only to "incidental farming" as described under the exclusion, Business pursuits.
Contamination. We do not cover any actual or alleged damages arising out of the discharge, dispersal, seepage, migration or release or escape of pollutants. Nor do we cover any cost or expense arising out of any request, demand or order to:
		
	•
	extract pollutants from land or water;

		
	•
	remove, restore or replace polluted or contaminated land or water; or

		
	•
	test for, monitor, clean up, remove, contain, treat, detoxify or neutralize pollutants, or in any way respond to or assess the effects of pollutants.

However, this exclusion does not apply if the discharge, dispersal, seepage, migration, release or escape is sudden and accidental. A "pollutant" is any solid, liquid, gaseous or thermal irritant or contaminant, including smoke (except smoke from a hostile fire), vapor, soot, fumes, acids, alkalis, chemicals and waste. A "contaminant" is an impurity resulting from the mixture of or contact of a substance with a foreign substance. "Waste" includes materials to be disposed of, recycled, reconditioned or reclaimed.

Financial guarantees. We do not cover any damages for any covered person's financial guarantee of the financial performance of any covered person, other individual or organization.

Professional services. We do not cover any damages for any covered person's performing or failure to perform professional services, or for professional services for which any covered person is legally responsible or licensed.

Acts of war. We do not cover any damages caused directly or indirectly by war, undeclared war, civil war, insurrection, rebellion, revolution, warlike acts by military forces or personnel, the destruction or seizure of property for a military purpose, or the consequences of any of these actions.

Contractual liability. We do not cover any assessments charged against a covered person as a member of a homeowners, condominium or cooperative association. We also do not cover any damages arising from contracts or agreements made in connection with any covered person's business. Nor do we cover any liability for unwritten contracts, or contracts in which the liability of others is assumed after a covered loss.

Covered person's or dependent's personal injury. We do not cover any damages for personal injury for any covered person or their dependents where the ultimate beneficiary is the offending party or defendant. We also do not cover any damages for personal injury for which you can be held legally liable, in any way, to a family member, your spouse or domestic partner or for which a family member, your spouse or domestic partner can be held legally liable, in any way, to you.
However, we do cover damages for bodily injury arising out of the use of a motorized land vehicle for which you can be held legally liable to a family member, your spouse or domestic partner or for which a family member, your spouse or domestic partner can be held legally liable to you to the extent that coverage is provided under this policy. This coverage applies only to the extent such damages are covered by primary underlying insurance and exceed the limits of insurance required for that motorized land vehicle under the Required Primary Underlying Insurance provisions of this policy.

Liability for dependent care. We do not cover any damages for personal injury for which a covered person's only legal liability is by virtue of a contract or other responsibility for a dependent's care.

Illness. We do not cover personal injury or property damage resulting from any illness, sickness or disease transmitted intentionally or unintentionally by a covered person to anyone, or any consequence resulting from that illness, sickness or disease. We also do not cover any damages for personal injury resulting from the fear of contracting any illness, sickness or disease, or any consequence resulting from the fear of contracting any illness, sickness or disease.

Fungi and mold. We do not cover any actual or alleged damages or medical expenses arising out of mold, the fear of mold, or any consequences resulting from mold or the fear of mold. "Mold" means fungi, mold, mold spores, mycotoxins, and the scents and other byproducts of any of these.

Exclusions
(continued)
Nuclear or radiation hazard. We do not cover any damages caused directly or indirectly by nuclear reaction, radiation, or radioactive contamination, regardless of how it was caused.

POLICY TERMS
This part of your Group Personal Excess Liability Policy explains the conditions that apply to your policy.
General Conditions
These conditions apply to your policy in general, and to each coverage provided in the policy.
Policy period
The effective dates of your policy are shown in the Coverage Summary. Those dates begin at 12:01 a.m. standard time at the mailing address shown.
All coverages on this policy apply only to occurrences that take place while this policy is in effect.
Transfer of rights
If we make a payment under this policy, we will assume any recovery rights a covered person has in connection with that loss, to the extent we have paid for the loss.
All of your rights of recovery will become our rights to the extent of any payment we make under this policy. A covered person will do everything necessary to secure such rights; and do nothing after a loss to prejudice such rights. However, you may waive any rights of recovery from another person or organization for a covered loss in writing before the loss occurs.
Concealment or fraud
We do not provide coverage if you or any covered person has intentionally concealed or misrepresented any material fact relating to this policy before or after a loss.
Application of coverage
Coverage applies separately to each covered person. However, this provision does not increase the amount of coverage for any one occurrence.
Assignment
You cannot transfer your interest in this policy to anyone else unless we agree in writing to the transfer.
Policy changes
This policy can be changed only by a written amendment we issue.
Bankruptcy or insolvency
We will meet all our obligations under this policy regardless of whether you, your estate, or anyone else or their estate becomes bankrupt or insolvent.
In case of death
In the event of your death, coverage will be provided until the end of the policy period or policy anniversary date, whichever occurs first, for any surviving member of your household who is a covered person at the time of death. We will also cover your legal representative or any person having proper temporary custody of your property.
Liberalization
We may extend or broaden the coverage provided by this policy. If we do this during the policy period or within 60 days before it begins, without increasing the premium, then the extended or broadened coverage will apply to occurrences after the effective date of the extended or broadened coverage.
Conforming to state law
If any provision of this policy conflict with any applicable laws of the state you live in, this policy is amended to conform to those laws.
Conforming to trade sanction laws
This policy does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing insurance.

CHUBB.    GROUP PERSONAL EXCESS LIABILITY POLICY

Liability Conditions
These conditions apply to all liability coverages in this policy.

Other Insurance
This insurance is excess over any other insurance except for those policies that

		
	•
	are written specifically to cover excess over the amount of coverage that applies in this policy; and

		
	•
	schedule this policy as underlying insurance.

Your duties after a loss
In case of an accident or occurrence, the covered person shall perform the following duties that apply:

Notification. You must notify us or your agent or broker as soon as possible.

Assistance. You must provide us with all available information. This includes any suit papers or other documents which help us in the event that we defend you.

Cooperation. You must cooperate with us fully in any legal defense. This may include any association by us with the covered person in defense of a claim reasonably likely to involve us.

Examination.  A person making a claim under this policy must submit as often as we reasonably require:
		
	•
	to physical exams by physicians we select, which we will pay for; and

•    to examination under oath and subscribe the same; and authorize us to obtain:
		
	•
	medical reports; and

		
	•
	other pertinent records.

Appeals
If a covered person, or any primary insurer, does not appeal a judgment for covered damages, we may choose to do so. We will then become responsible for all expenses, taxable costs, and interest arising out of the appeal. However, the amount of coverage for damages will not be increased.

Special Conditions
In the event of conflict with any other conditions of your policy, these conditions supersede.
Legal action against us
You agree not to bring action against us unless you have first complied with all conditions of this policy.
You also agree not to bring any action against us until the amount of damages you are legally obligated to pay has been finally determined after an actual trial or appeal, if any, or by a written agreement between you, us and the claimant. No person or organization has any right under this policy to bring us into any action to determine the liability of a covered  person.

Notice of cancellation and coverage termination conditions
The Sponsoring Organization may cancel this policy by returning it to us or notifying us in writing at any time subject to the following:
		
	•
	the Sponsoring Organization must notify us in advance of the requested cancellation date; and

		
	•
	the Sponsoring Organization must provide proof of notification to each member of the Defined Group covered under this policy.

We may cancel this policy or any part of it subject to the following conditions.  Our right to cancel applies to each coverage or limit in this policy. In the event we cancel this policy, we are under no obligation to provide you with an opportunity to purchase equivalent coverage.

Special Conditions
(continued)

Within 60 days. When this policy or any part of it has been in effect for less than 60 days, we may cancel with 30 days notice for any reason.
Non payment of premium. We may cancel this policy or any part of it with 10 days notice if the Sponsoring Organization or you fail to pay the premium by the due date, regardless of whether the premium is payable to us, to our agent, or under any financial credit.

Misrepresentation. We may cancel this policy or any part of it with 30 days notice if the coverage was obtained through misrepresentation, fraudulent statements, or omissions or concealment of a fact that is relevant to the acceptance of the risk or to the hazard we assumed.

Increase in hazard. We may cancel this policy or any part of it with 30 days notice if there has been a substantial change in the risk which increases the chance of loss after insurance coverage has been issued or renewed, including but not limited to an increase in exposure due to rules, legislation, or court decision.

Procedure. To cancel this policy or any part of it, we must notify you in writing. This notice will be mailed to the Sponsoring Organization at the mailing address shown in the Coverage Summary and we will obtain a certificate of mailing. This notice will include the date the cancellation is to take effect.

Termination. Should an individual for any reason no longer qualify as a member of the Defined Group, coverage will cease sixty
(60) days from the date that individual no longer qualifies as a member of the Defined Group, or the policy expiration or cancellation date, whichever comes first.

Refund. In the event of cancellation by the Sponsoring Organization or us, we will refund any unearned premium on the effective date of cancellation, or as soon as possible afterwards to the Sponsoring Organization. The unearned premium will be computed short rate for the unexpired term of the policy.

CHUBB"
 

ENDORSEMENT
 
GROUP EXCESS LIABILITY POLICY

Policy Period Effective Date Policy Number
 
JANUARY 01, 2019

JANUARY 01, 2019

( 20 )  7993-14-03
 
to    JANUARY 01, 2020

Insured
 
NORTHROP GRUMMAN CORPORATION GROUP PERSONAL EXCESS PROGRAM

		
	Name of Company 
	FEDERAL INSURANCE COMPANY

		
	Date Issued
	FEBRUARY 14, 2019

All Vice Presidents, Non Officers designated by the company and Designated Retirees of Northrop Grumman Corporation

$20,000,000  Limit of Liability
$ 5,000,000  UM/UIM Protection Limit
$15,000,000  Limit of Liability
$ 5,000,000  UM/UIM Protection Limit
$15,000,000  Limit of Liability
$ 3,000,000  UM/UIM Protection Limit
$15,000,000  Limit of Liability
$ 2,000,000  UM/UIM Protection Limit
$10,000,000  Limit of Liability
$ 5,000,000  UM/UIM Protection Limit
$10,000,000  Limit of Liability
$ 3,000,000  UM/UIM Protection Limit

$10,000,000   Limit of Liability
$ 2,000,000     UM/UIM Protection Limit
$ 5,000,000   Limit of Liability
$ 2,000,000    UM/UIM Protection Limit

ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED.

Authorized Representative

GROUP EXCESS LIABILITY POLICY

ENDORSEMENT

		
	Policy Period 
	JANUARY 01, 2019 to    JANUARY 01, 2020

		
	Effective Date 
	JANUARY 01, 2019

		
	Policy Number
	(20 ) 7993-14-03

 

Insured    NORTHROP GRUMMAN CORPORATION
GROUP PERSONAL EXCESS PROGRAM
 

		
	Name of Company 
	FEDERAL INSURANCE COMPANY

		
	Date Issued
	FEBRUARY 14, 2019

UNDERLYING LIMITS ENDORSEMENT
IT IS HEREBY UNDERSTOOD AND AGREED THAT THE REQUIRED PRIMARY UNDERLYING LIABILITY INSURANCE LIMITS ARE AMENDED TO:
Personal Liability (Homeowners) for personal injury and property damage in the minimum amount of $100,000 each occurrence.
Registered vehicles in the minimum amount of:
$250,000/$500,000 bodily injury and $100,000 property damage;
$300,000/$300,000 bodily injury and $100,000 property damage; or
$300,000 single limit each occurrence.
Unregistered vehicles in the minimum amount of $300,000 bodily injury and property damage each occurrence.
Registered vehicles with less than four wheels and motorhomes in the minimum amount of:
$250,000/$500,000 bodily injury and $100,000 property damage;
$300,000/$300,000 bodily injury and $100,000 property damage; or
$300,000 single limit each occurrence.
Watercraft less than 26 feet and 50 engine rated horsepower or less for bodily injury and property damage in the minimum amount of $300,000 each occurrence.

Watercraft 26 feet or longer or more than 50 engine rated horsepower for bodily injury and property damage in the minimum amount of
$500,000 each occurrence.
Uninsured motorists /underinsured motorist protection in the minimum amount of:
$250,000/$500,000 bodily injury and $100,000 property damage;
$300,000/$300,000 bodily injury and $100,000 property damage; or

$300,000 single limit each occurrence.
FAILURE TO COMPLY WITH THE REQUIRED PRIMARY UNDERLYING INSURANCE WILL RESULT IN A GAP IN COVERAGE.---

ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED.

Authorized Representative                    

GROUP EXCESS LIABILITY POLICY

ENDORSEMENT

		
	Policy Period 
	JANUARY 01, 2019 to    JANUARY 01, 2020

		
	Effective Date
	JANUARY 01, 2019

 

		
	Policy Number 
	(  20 )   7993-14-03

		
	Insured
	NORTHROP GRUMMAN CORPORATION

GROUP PERSONAL EXCESS PROGRAM

 

 

		
	Name of Company 
	FEDERAL INSURANCE COMPANY

		
	Date Issued
	FEBRUARY 14, 2019

 

ANNUAL PREMIUM ADJUSTMENT CLAUSE
It is agreed that this policy is written with a deposit premium to be adjusted on either each policy anniversary or at policy expiration.    The premium will be adjusted on the basis of the difference between the total number of participants at inception and the actual number of participants at each policy anniversary. This difference is to be multiplied by fifty percent (50%) of the annual rate per participant, resulting in either an additional or return premium.

ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED.

Authorized RepresentativeExhibit

Exhibit 10.4

YOUR BENEFIT PLAN

Northrop Grumman Corporation

All Actively at Work Employees Participating
In One of The Following Executive Classes:

Class I – Chief Executive Officer (CEO)

Class II – Elected Officers Who Are Direct Reports To
The Chief Executive Officer (CEO)

Class III – Elected Officers Who Are Non-Direct Reports To
The Chief Executive Officer (CEO)

Class IV – All Other Vice Presidents of The
Northrop Grumman Corporation

Class V – Chairman

Basic Life Insurance

Accidental Death and Dismemberment Insurance

Certificate Date: January 1, 2019

 

Northrop Grumman Corporation
2980 Fairview Park Drive
Falls Church, VA  22042

TO OUR ‍EMPLOYEES:

All of us appreciate the protection and security insurance provides.

This certificate describes the benefits that are available to you. We urge you to read it carefully.

Northrop Grumman Corporation

 

Metropolitan Life Insurance Company
200 Park Avenue, New York, New York 10166

CERTIFICATE OF INSURANCE

Metropolitan Life Insurance Company (“MetLife”), a stock company, certifies that You ‍are insured for the benefits described in this certificate, subject to the provisions of this certificate.  This certificate is issued to You under the Group Policy and it includes the terms and provisions of the Group Policy that describe Your insurance.  PLEASE READ THIS CERTIFICATE CAREFULLY. 

This certificate is part of the Group Policy. The Group Policy is a ‍contract between MetLife and the Policyholder and may be changed or ended without Your consent or notice to You.

	
		
	Policyholder:
	Northrop Grumman Corporation

	
		
	Group Policy Number:

	91360-2-G

	Type of Insurance:
	Term Life ‍& Accidental Death and Dismemberment ‍‍‍‍‍‍Insurance‍‍‍‍‍‍‍

	
		
	MetLife Toll Free Number(s):
	 

	For Claim Information
	FOR LIFE CLAIMS: 1-800-638-6420‍

	
	
	PLEASE AFFIX THE STICKER
SHOWING THE EMPLOYEE'S
NAME AND EFFECTIVE DATE
IN THIS SPACE. ‍

THIS CERTIFICATE ONLY DESCRIBES TERM LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT ‍‍‍‍‍‍INSURANCE‍‍‍. ‍

THE BENEFITS OF THE POLICY PROVIDING YOUR COVERAGE ARE GOVERNED PRIMARILY BY THE LAW OF A STATE OTHER THAN FLORIDA. 

THE GROUP INSURANCE POLICY PROVIDING COVERAGE UNDER THIS CERTIFICATE WAS ISSUED IN A JURISDICTION OTHER THAN MARYLAND AND MAY NOT PROVIDE ALL THE BENEFITS REQUIRED BY MARYLAND LAW.

WE ARE REQUIRED BY STATE LAW TO INCLUDE THE NOTICE(S) WHICH APPEAR ON THIS PAGE AND IN THE NOTICE(S) SECTION WHICH FOLLOWS THIS PAGE.  PLEASE READ THE(SE) NOTICE(S) CAREFULLY. 

GCERT2000    
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‍

 

IMPORTANT NOTICE

To obtain information or make a complaint:

You may call MetLife’s toll free telephone number for information or to make a complaint at:

1-800-638-6420‍

You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights, or complaints at:

1-800-252-3439

You may write the Texas Department of Insurance:
P.O. Box 149104 
Austin, TX  78714-9104 
Fax: (512) 490-1007
Web: www.tdi.texas.gov

Email: ConsumerProtection@tdi.texas.gov

PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim, you should contact MetLife first.  If the dispute is not resolved, you may contact the Texas Department of Insurance.

ATTACH THIS NOTICE TO YOUR CERTIFICATE: This notice is for information only and does not become a part or condition of the attached document.

 

AVISO IMPORTANTE

 
Para obtener información o para presentar una queja:

Usted puede llamar al número de teléfono gratuito de MetLife's para obtener información o para presentar una queja al:

1-800-638-6420‍

Usted puede comunicarse con el Departamento de Seguros de Texas para obtener información sobre compañías, coberturas, derechos, o quejas al:

1-800-252-3439

Usted puede escribir al Departamento de Seguros de Texas a:
P.O. Box 149104 
Austin, TX 78714-9104 
Fax: (512) 490-1007
Sitio Web: www.tdi.texas.gov

Email: ConsumerProtection@tdi.texas.gov

DISPUTAS POR PRIMAS DE SEGUROS O RECLAMACIONES: Si tiene una disputa relacionada con su prima de seguro o con una reclamación, usted debe comunicarse con MetLife primero.  Si la disputa no es resuelta, usted puede comunicarse con el Departamento de Seguros de Texas.

ADJUNTE ESTE AVISO A SU CERTIFICADO: 
Este aviso es solamente para propósitos informativos y no se convierte en parte o en condición del documento adjunto.

GCERT2000    For Texas Residents
notice/tx 11/14‍                                            2
‍

 

NOTICE FOR RESIDENTS OF WASHINGTON

LIFE INSURANCE: ACCELERATED BENEFIT OPTION (ABO)

The Life Insurance accelerated benefit does not and is not intended to qualify as long-term care under Washington state law. Washington state law prevents this accelerated life benefit from being marketed or sold as long-term care.

GCERT2000
notice/wa/abo    3    

 

NOTICE FOR RESIDENTS OF ALL STATES

LIFE INSURANCE BENEFITS WILL BE REDUCED IF AN ACCELERATED‍ BENEFIT IS PAID

DISCLOSURE:  The Life Insurance accelerated‍ benefit offered under this certificate is intended to qualify for favorable tax treatment under the Internal Revenue Code of 1986.  If this benefit qualifies for such favorable tax treatment, the benefit will be excludable from Your income and not subject to federal taxation.  Tax laws relating to accelerated‍ benefits are complex.  You are advised to consult with a qualified tax advisor about circumstances under which You could receive an accelerated‍ benefit excludable from income under federal law.

DISCLOSURE:  Receipt of an accelerated‍ benefit may affect Your, Your Spouse’s‍ or Your family’s eligibility for public assistance programs such as Medical Assistance (Medicaid), Aid to Families with Dependent Children (AFDC), Supplementary Social Security Income (SSI), and drug assistance programs.  You are advised to consult with a qualified tax advisor and with social service agencies concerning how receipt of such payment will affect Your, Your Spouse’s‍ and Your family’s eligibility for public assistance.

GCERT2000
notice/abo/nw    4    

 

NOTICE FOR RESIDENTS OF ARKANSAS
If You have a question concerning Your coverage or a claim, first contact the Policyholder or group account administrator.  If, after doing so, You still have a concern, You may call the toll free telephone number shown on the Certificate Face Page.

If You are still concerned after contacting both the Policyholder and MetLife, You should feel free to contact:

Arkansas Insurance Department
Consumer Services Division
1200 West Third Street
Little Rock, Arkansas 72201
(501) 371-2640 or (800) 852-5494

GCERT2000
notice/ar                                            5
‍

 

NOTICE FOR RESIDENTS OF CALIFORNIA

IMPORTANT NOTICE

TO OBTAIN ADDITIONAL INFORMATION, OR TO MAKE A COMPLAINT, CONTACT THE POLICYHOLDER OR METLIFE AT:

METROPOLITAN LIFE INSURANCE COMPANY
ATTN: CONSUMER RELATIONS DEPARTMENT
500 SCHOOLHOUSE ROAD
JOHNSTOWN, PA 15904

1-800-438-6388

IF, AFTER CONTACTING THE POLICYHOLDER AND/OR METLIFE, YOU FEEL THAT A SATISFACTORY SOLUTION HAS NOT BEEN REACHED, YOU MAY FILE A COMPLAINT WITH THE CALIFORNIA DEPARTMENT OF INSURANCE DEPARTMENT AT:

DEPARTMENT OF INSURANCE
CONSUMER SERVICES
300 SOUTH SPRING STREET
LOS ANGELES, CA 90013

WEBSITE: http://www.insurance.ca.gov/

1-800-927-4357 (within California)
1-213-897-8921 (outside California)

GCERT2000    6
notice/ca
‍

 

NOTICE FOR RESIDENTS OF GEORGIA

IMPORTANT NOTICE

The laws of the state of Georgia prohibit insurers from unfairly discriminating against any person based upon his or her status as a victim of family violence.

GCERT2000        
notice/ga                    7
‍

NOTICE FOR RESIDENTS OF IDAHO

If You have a question concerning Your coverage or a claim, You may call the toll free telephone number shown on the Certificate Face Page.

If You are still concerned after contacting ‍MetLife, You should feel free to contact:

Idaho Department of Insurance
Consumer Affairs
700 West State Street, 3rd Floor
PO Box 83720
Boise, Idaho 83720-0043
1-800-721-3272 (for calls placed within Idaho) or 208-334-4250 or www.DOI.Idaho.gov

GCERT2000
notice/id                                            8
‍

NOTICE FOR RESIDENTS OF ILLINOIS

IMPORTANT NOTICE

To make a complaint to MetLife, You may write to:

MetLife 
200 Park Avenue
New York, New York 10166

The address of the Illinois Department of Insurance is:

Illinois Department of Insurance
Public Services Division
Springfield, Illinois 62767

GCERT2000
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‍

NOTICE FOR RESIDENTS OF INDIANA

Questions regarding your policy or coverage should be directed to: 

Metropolitan Life Insurance Company
1-800-438-6388

If you (a) need the assistance of the government agency that regulates insurance; or (b) have a complaint you have been unable to resolve with your insurer you may contact the Department of Insurance by mail, telephone or email: 

State of Indiana Department of Insurance
Consumer Services Division
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204

Consumer Hotline: (800) 622-4461; (317) 232-2395

Complaint can be filed electronically at www.in.gov/idoi

GCERT2000
notice/in                                            10
‍

NOTICE FOR MASSACHUSETTS RESIDENTS
 
CONTINUATION OF ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D)‍‍‍‍ INSURANCE

		
	1.
	If Your AD&D‍‍‍‍ Insurance ends due to a Plant Closing or Covered Partial Closing, such insurance will be continued for 90 days after the date it ends.

		
	2.
	If Your AD&D‍‍‍‍ Insurance ends because:

		
	•
	You cease to be in an Eligible Class; or

		
	•
	Your employment terminates;

for any reason other than a Plant Closing or Covered Partial Closing, such insurance will continue for 31 days after the date it ends.

Continuation of Your AD&D‍‍‍‍ Insurance under the CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT subsection will end before the end of continuation periods shown above if You become covered for similar benefits under another plan.

Plant Closing and Covered Partial Closing have the meaning set forth in Massachusetts Annotated Laws, Chapter 151A, Section 71A.

 

GCERT2000
notice/ma    11
‍

NOTICE FOR RESIDENTS OF MINNESOTA

This is a life insurance policy which pays accelerated death benefits at your option under conditions specified in the policy.  This policy is not a long-term care policy meeting the requirements of sections M.S.62A.46 to 62A.56 or chapter 62S.

GCERT2000
notice/mn    12

.

NOTICE FOR RESIDENTS OF MISSOURI

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE

EXCLUSIONS

If You reside in Missouri the exclusion for "suicide or attempted suicide" is as follows:
"suicide or attempted suicide while sane"

GCERT2000
notice/mo    13

 

NOTICE FOR RESIDENTS OF TEXAS

THE INSURANCE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE.  YOU SHOULD CONSULT YOUR EMPLOYER TO DETERMINE WHETHER YOUR EMPLOYER IS A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM.

GCERT2000
notice/tx/wc                                            14
‍

 

NOTICE FOR RESIDENTS OF TEXAS

LIFE INSURANCE: ACCELERATED‍ BENEFIT OPTION (ABO)

The laws of the state of Texas mandate that the terms "Terminally Ill" and "Terminal Illness" when used in the LIFE INSURANCE: ACCELERATED‍ BENEFIT OPTION (ABO) FOR YOU provision means that due to injury or sickness, You are expected to die within 24 months of the date You request payment of an Accelerated‍ Benefit. 

GCERT2000
notice/tx/abo    15    

NOTICE FOR RESIDENTS OF UTAH

Notice of Protection Provided by
Utah Life and Health Insurance Guaranty Association

This notice provides a brief summary of the Utah Life and Health Insurance Guaranty Association ("the Association") and the protection it provides for policyholders. This safety net was created under Utah law, which determines who and what is covered and the amounts of coverage.

The Association was established to provide protection in the unlikely event that your life, health, or annuity insurance company becomes financially unable to meet its obligations and is taken over by its insurance regulatory agency. If this should happen, the Association will typically arrange to continue coverage and pay claims, in accordance with Utah law, with funding from assessments paid by other insurance companies.

The basic protections provided by the Association are:
		
	•
	Life Insurance

o $500,000 in death benefits
o $200,000 in cash surrender or withdrawal values
		
	•
	Health Insurance

o $500,000 in hospital, medical and surgical insurance benefits
o $500,000 in long-term care insurance benefits
o $500,000 in disability income insurance benefits
o $500,000 in other types of health insurance benefits
		
	•
	Annuities

o $250,000 in withdrawal and cash values

The maximum amount of protection for each individual, regardless of the number of policies or contracts, is $500,000. Special rules may apply with regard to hospital, medical and surgical insurance benefits.

Note: Certain policies and contracts may not be covered or fully covered. For example, coverage does not extend to any portion of a policy or contract that the insurer does not guarantee, such as certain investment additions to the account value of a variable life insurance policy or a variable annuity contract.  Coverage is conditioned on residency in this state and there are substantial limitations and exclusions. For a complete description of coverage, consult Utah Code, Title 3 lA, Chapter 28.

Insurance companies and agents are prohibited by Utah law to use the existence of the Association or its coverage to encourage you to purchase insurance. When selecting an insurance company, you should not rely on Association coverage. If there is any inconsistency between Utah law and this notice, Utah law will control.

To learn more about the above protections, as well as protections relating to group contracts or retirement plans, please visit the Association's website at www.utlifega.org or contact:

Utah Life and Health Insurance Guaranty Assoc.     Utah Insurance Department
60 East South Temple, Suite 500    3110 State Office Building
Salt Lake City UT 84111    Salt Lake City UT 84114-6901
(801) 320-9955    (801) 538-3800

A written complaint about misuse of this Notice or the improper use of the existence of the Association may be filed with the Utah Insurance Department at the above address.

16
GTY-NOTICE-UT-0710
‍

    

NOTICE FOR RESIDENTS OF VIRGINIA

IMPORTANT INFORMATION REGARDING YOUR INSURANCE

In the event You need to contact someone about this insurance for any reason please contact Your agent.  If no agent was involved in the sale of this insurance, or if You have additional questions You may contact the insurance company issuing this insurance at the following address and telephone number:

MetLife
200 Park Avenue
New York, New York 10166
Attn: Corporate Consumer Relations Department

To phone in a claim related question, You may call Claims Customer Service at:
1-800-275-4638

If You have been unable to contact or obtain satisfaction from the company or the agent, You may contact the Virginia State Corporation Commission’s Bureau of Insurance at:

The Office of the Managed Care Ombudsman
Bureau of Insurance
P.O. Box 1157
Richmond, VA 23218
1-877-310-6560 - toll-free
1-804-371-9944 - fax
www.scc.virginia.gov - web address
ombudsman@scc.virginia.gov - email

GCERT2000
notice/va    17    
‍

   

NOTICE FOR RESIDENTS OF WISCONSIN

KEEP THIS NOTICE WITH YOUR INSURANCE PAPERS

PROBLEMS WITH YOUR INSURANCE? - If You are having problems with Your insurance company or agent, do not hesitate to contact the insurance company or agent to resolve Your problem.

MetLife
Attn: Corporate Consumer Relations Department
200 Park Avenue
New York, New York 10166
1-800-438-6388

You can also contact the OFFICE OF THE COMMISSIONER OF INSURANCE, a state agency which enforces Wisconsin’s insurance laws, and file a complaint.  You can contact the OFFICE OF THE COMMISSIONER OF INSURANCE by contacting:

Office of the Commissioner of Insurance
Complaints Department
P.O. Box 7873
Madison, WI 53707-7873
1-800-236-8517 outside of Madison or 608-266-0103 in Madison.

GCERT2000
notice/wi    18    
‍

TABLE OF CONTENTS

Section    Page

CERTIFICATE FACE PAGE    1
NOTICES    2
SCHEDULE OF BENEFITS    21
DEFINITIONS    25
ELIGIBILITY PROVISIONS: INSURANCE FOR YOU    28
Eligible Classes    28
Date You Are Eligible for Insurance    28
Enrollment Process    28
Date Your Insurance Takes Effect    28
Date Your Insurance Ends    29
CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT    30
For Family And Medical Leave    30
At Your Option: Portability    30
At Your Option: Continuation Of Your Life Insurance and Accidental Death and Dismemberment 
Insurance During A Labor Dispute    32
At The Policyholder's Option    33
EVIDENCE OF INSURABILITY    34
LIFE INSURANCE: FOR YOU    35
LIFE INSURANCE: ACCELERATED‍ BENEFIT OPTION (ABO) FOR YOU    36
LIFE INSURANCE: CONVERSION OPTION FOR YOU    38
ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE    40
ADDITIONAL BENEFIT: SEAT BELT USE    42
ADDITIONAL BENEFIT: AIR BAG USE    43
ADDITIONAL BENEFIT: SURVIVING SPOUSE‍    44
ADDITIONAL BENEFIT: HOSPITAL CONFINEMENT    45
ADDITIONAL BENEFIT: REHABILITATIVE PHYSICAL THERAPY    46
FILING A CLAIM: CLAIMS FOR LIFE INSURANCE BENEFITS    47
FILING A CLAIM: CLAIMS FOR ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS    48
GENERAL PROVISIONS    49
Assignment    49
Beneficiary    49

GCERT2000
toc    19
‍

TABLE OF CONTENTS (continued)

Section    Page

Entire Contract    49
Incontestability: Statements Made by You    49
Misstatement of Age    50
Conformity with Law    50
Physical Exams    50
Autopsy‍    50

GCERT2000
toc    20
‍

SCHEDULE OF BENEFITS

This schedule shows the benefits that are available under the Group Policy. You‍ will only be insured for the benefits:

		
	•
	for which You‍ become and remain eligible;

		
	•
	which You elect, if subject to election; and 

		
	•
	which are in effect.

	
		
	BENEFIT
	BENEFIT AMOUNTS AND HIGHLIGHTS

How We Will Pay Benefits 

Unless the Beneficiary requests payment by check, when the Certificate states that We will pay benefits in "one sum" or a "single sum", We may pay the full benefit amount: 

		
	•
	by check; 

		
	•
	by establishing an account that earns interest and provides the Beneficiary with immediate access to the full benefit amount; or 

		
	•
	by any other method that provides the Beneficiary with immediate access to the full benefit amount. 

Other modes of payment may be available upon request.  For details, call Our toll free number shown on the Certificate Face Page.

Life Insurance For You

Basic Life Insurance is‍ Portability Eligible Insurance

	
				
	For Class I – V Active Employees   
	An amount equal to 3 times Your Basic Annual Earnings‍‍, rounded to the next higher ‍‍$1,000‍

	 

	Maximum‍ Life Benefit   
	

	$2,000,000

	 

	Accelerated‍ Benefit Option   
	Up to 80% of Your Basic Life amount not to exceed $500,000
‍

Accidental Death and Dismemberment Insurance (AD&D) For You

Full Amount for ‍AD&D

Accidental Death and Dismemberment Insurance for You is‍ Portability Eligible Insurance

‍‍GCERT2000
sch    21

SCHEDULE OF BENEFITS (continued)

	
			
	For Class I – V Active Employees   

	An amount equal to 6 times Your Basic Annual Earnings‍, rounded to the next higher ‍‍$1,000‍

	Minimum Accidental Death and Dismemberment Full Amount   
	

$1,000

	 

	Maximum Accidental Death and Dismemberment Full Amount   
	

$1,000,000

	 

Additional Benefits: ‍

	
		
	Seat Belt Benefit   
	Yes

	
		
	Air Bag Use Benefit   
	Yes

	
		
	Surviving Spouse‍ Benefit   
	Yes

	
		
	Hospital Confinement Benefit   
	Yes

	
		
	Rehabilitative Physical Therapy Benefit   
	Yes

Schedule of Covered Losses for Accidental Death and Dismemberment Insurance

All amounts listed are stated as percentages of the Full Amount.

Covered Losses

	
				
	Loss of life   
	100%
	 
	 

	Loss of a hand permanently severed at or above 
the wrist but below the elbow   
	

75%
	 
	 

	Loss of a foot permanently severed at or above 
the ankle but below the knee   
	

75%
	 
	 

	Loss of an arm permanently severed at or above the elbow   
	75%
	 
	 

	Loss of a leg permanently severed at or above the knee   
	75%
	 
	 

	Loss of sight in one eye   
	60%
	 
	 

	Loss of two or more hands or feet........................................
	100%
	 
	 

	Loss of sight in both eyes....................................................
	100%

	 
	 

Loss of sight means permanent and uncorrectable loss of sight in the eye.  Visual acuity must be 20/200 or worse in the eye or the field of vision must be less than 20 degrees.

	
		
	Loss of any combination of hand, foot, or sight of one eye, as defined above   
	

100%

	Loss of the thumb and index finger of same hand   
	25%

‍‍GCERT2000
sch    22

SCHEDULE OF BENEFITS (continued)

Loss of thumb and index finger of same hand means that the thumb and index finger are permanently severed through or above the third joint from the tip of the index finger and the second joint from the tip of the thumb.

	
		
	Loss of speech and loss of hearing   
	100%

	Loss of speech or loss of hearing   
	85%

Loss of speech means the entire and irrecoverable loss of speech that continues for 6 consecutive months following the accidental injury. 

Loss of hearing means the entire and irrecoverable loss of hearing in both ears that continues for 6 consecutive months following the accidental injury.
    
	
		
	Paralysis of both arms and both legs   
	100%

	Paralysis of both legs   
	75%

	Paralysis of the arm and leg on either side of the body   
	50%

	Paralysis of one arm or leg   
	25%

Paralysis means loss of use of a limb, without severance. A Physician must determine the paralysis to be permanent, complete and irreversible.

	
		
	Brain Damage   
	100%

        
Brain Damage means permanent and irreversible physical damage to the brain causing the complete inability to perform all the substantial and material functions and activities normal to everyday life.  Such damage must manifest itself within 30 days of the accidental injury, require a hospitalization of at least 5 days and persists for 12 consecutive months after the date of the accidental injury.

	
		
	Coma   
	1% monthly beginning on the 7th day of the Coma for 11 months, and then 100% in the 12th month for the duration of the Coma to a maximum of 12 months

        
Coma means a state of deep and total unconsciousness from which the comatose person cannot be aroused. Such state must begin within 30 days of the accidental injury and continue for 7 consecutive days.

‍‍GCERT2000
sch    23

SCHEDULE OF BENEFITS (continued)

Portability Eligible Life and AD&D Insurance
Life and AD&D Insurance For You:
Portability Eligible Life Insurance For You:

	
		
	Minimum Portability Eligible Life Insurance Amount   
	$10,000

	

Maximum Portability Eligible Life Insurance Amount   
	

The lesser of Your total Life Insurance in effect on the date You elect to Port or $2,000,000

Portability Eligible AD&D Insurance For You:

	
		
	Minimum Portability Eligible AD&D Insurance Amount   
	$10,000

	

Maximum Portability Eligible AD&D Insurance Amount   
	

The lesser of Your total AD&D Insurance in effect on the date You elect to Port or $2,000,000

If Your Portability Eligible Insurance ends due to the end of the Group Policy or the amendment of the Group Policy to end the Portability Eligible Insurance for an eligible class of which You are a member, the maximum amount of insurance that You may Port is the lesser of:

		
	•
	the amount of Your Portability Eligible Insurance that ends under the Group Policy less the amount of life and AD&D insurance for which You become eligible under any group policy issued to replace this Group Policy; or

		
	•
	$10,000. 

‍‍GCERT2000
sch    24

DEFINITIONS

As used in this certificate, the terms listed below will have the meanings set forth below.  When defined terms are used in this certificate, they will appear with initial capitalization.  The plural use of a term defined in the singular will share the same meaning. 

Actively at Work or Active Work means that You are performing all of the usual and customary duties of Your job.  This must be done at:

		
	•
	the Policyholder’s place of business;

		
	•
	an alternate place approved by the Policyholder; or

		
	•
	a place to which the Policyholder’s business requires You to travel.

You will be deemed to be Actively at Work during weekends or Policyholder approved vacations, ‍holidays or business closures if You were Actively at Work on the last scheduled work day preceding such time off.

Basic Annual Earnings means Your gross annual rate of pay as determined by Your Policyholder, excluding overtime and other extra pay. "Basic Annual Earnings" for You if You are a salesman includes commissions and/or bonuses which shall be averaged for the most recent 12 month period.

Beneficiary means the person(s) to whom ‍We will pay insurance‍ as determined in accordance with the ‍GENERAL PROVISIONS section.

Common Carrier means a government regulated entity that is in the business of transporting fare paying passengers.

The term does not include:

•    chartered or other privately arranged transportation;
•    taxis; or
•    limousines.

‍Domestic Partner‍ means each of two people, one of whom is an Employee of the Policyholder, who:

		
	•
	have registered as each other’s domestic partner, civil union partner or reciprocal beneficiary with a government agency where such registration is available; or

		
	•
	are of the same or opposite sex and have a mutually dependent relationship so that each has an insurable interest in the life of the other. Each person must be:

		
	1.
	18 years of age or older;

		
	2.
	unmarried;

		
	3.
	the sole domestic partner of the other person and have been so for the immediately preceding 6 months;

		
	4.
	sharing a primary residence with the other person and have been so for the immediately preceding 6 months; and

		
	5.
	not related to the other in a manner that would bar their marriage in the jurisdiction in which they reside.

GCERT2000
def    25
	
		
	as amended by GCR09-08 dp
	‍

‍

DEFINITIONS (continued)

A Domestic Partner declaration attesting to the relationship between the employee and the employee’s domestic partner must be completed and Signed by the Employee. The declaration must establish that each person has either a substantial interest in the other engendered by love and affection; or a lawful and substantial economic interest in the continued life, health or bodily safety of each other, as distinguished from an interest which would arise only by, or would be enhanced in value by, the death, disablement or injury of the other person.  

Hospital means a facility which is licensed as such in the jurisdiction in which it is located and:

		
	•
	provides a broad range of medical and surgical services on a 24 hour a day basis for injured and sick persons by or under the supervision of a staff of Physicians; and

		
	•
	provides a broad range of nursing care on a 24 hour a day basis by or under the direction of a registered professional nurse.

Noncontributory Insurance means insurance for which the Policyholder does not require You to pay any part of the premium.

Physician means:

		
	•
	a person licensed to practice medicine in the jurisdiction where such services are performed; or

		
	•
	any other person whose services, according to applicable law, must be treated as Physician’s services for purposes of the Group Policy.  Each such person must be licensed in the jurisdiction where he performs the service and must act within the scope of that license.  He must also be certified and/or registered if required by such jurisdiction.

The term does not include:

		
	•
	You;

		
	•
	Your Spouse‍; or

		
	•
	any member of Your immediate family including Your and/or Your Spouse’s‍:

		
	•
	parents;

		
	•
	children (natural, step or adopted);

		
	•
	siblings;

		
	•
	grandparents; or

		
	•
	grandchildren.

Proof means Written evidence satisfactory to Us that a person has satisfied the conditions and requirements for any benefit described in this certificate.  When a claim is made for any benefit described in this certificate, Proof must establish:

		
	•
	the nature and extent of the loss or condition;

		
	•
	Our obligation to pay the claim; and

		
	•
	the claimant’s right to receive payment.

Proof must be provided at the claimant's expense.

Signed means any symbol or method executed or adopted by a person with the present intention to authenticate a record, which is on or transmitted by paper or electronic media which is acceptable to Us and consistent with applicable law.

Spouse means Your lawful spouse.  Wherever the term "Spouse" appears in the certificate it shall, unless otherwise specified, be read to include Your Domestic Partner.  ‍‍‍

We, Us and Our mean MetLife.

Written or Writing means a record which is on or transmitted by paper or electronic media which is acceptable to Us and consistent with applicable law.

You and Your mean an employee who is insured under the Group Policy for the insurance described in this certificate.

GCERT2000
def    26
	
		
	as amended by GCR09-08 dp
	‍

‍

DEFINITIONS (continued)

GCERT2000
def    27
	
		
	as amended by GCR09-08 dp
	‍

‍

ELIGIBILITY PROVISIONS: INSURANCE FOR YOU

ELIGIBLE CLASS(ES) 

All Actively at Work employees of the Policyholder participating in one of the following executive  
classes:

Class I – Chief Executive Officer (CEO).

Class II – Elected Officers, who are direct reports to the Chief Executive Officer (CEO).

Class III – Elected Officers, who are non-direct reports to the Chief Executive Officer (CEO).

Class IV – All other Vice Presidents of the Northrop Grumman Corporation.

Class V – Chairman.

DATE YOU ARE ELIGIBLE FOR INSURANCE

You may only become eligible for the insurance available for Your eligible class as shown in the SCHEDULE OF BENEFITS.

If You are in an eligible class on January 1, 2019, You will be eligible for the insurance described in this certificate on that date.

If You enter an eligible class after January 1, 2019, You will be eligible for the insurance described in this certificate on the date You enter that class.

Previous Employment With The Policyholder

If You were employed by the Policyholder and insured by Us under a policy of group life insurance when Your employment ended, You will not be eligible for life insurance under this Group Policy if You are re-hired by the Policyholder within 2 years after such employment ended, unless You surrender:

		
	•
	any individual policy of life insurance to which You converted when Your employment ended; and

		
	•
	any certificate of insurance continued as ported insurance when such employment ended.

The cash value, if any, of such surrendered insurance will be paid to You.

ENROLLMENT PROCESS 

If You are eligible for insurance, You may enroll for such insurance by completing an enrollment form.‍‍‍

DATE YOUR INSURANCE‍ TAKES EFFECT

Rules for Noncontributory Insurance

When You complete the enrollment process for Noncontributory Insurance, such insurance will take effect on the date You become eligible, provided You are Actively at Work on that date.

If You are not Actively at Work on the date the Noncontributory Insurance would otherwise take effect, insurance will take effect on the day You resume Active Work.

GCERT2000     28
e/ee‍
‍

ELIGIBILITY PROVISIONS: INSURANCE FOR YOU (continued)

For Basic Life Insurance ‍

Increase in Insurance

An increase in insurance due to an increase in Your earnings will take effect on the ‍‍date of the increase in Your earnings.

If You are not Actively at Work on the date insurance would otherwise take effect, insurance will take effect on the day You resume Active Work.‍

Decrease in Insurance

A decrease in insurance due to a decrease in Your earnings will take effect on the ‍‍date of change.

For Basic Accidental Death and Dismemberment Insurance

Increase in Insurance

An increase in insurance due to an increase in Your earnings will take effect on the ‍‍date of the increase in Your earnings.

If You are not Actively at Work on the date insurance would otherwise take effect, insurance will take effect on the day You resume Active Work. 

Decrease in Insurance

A decrease in insurance due to a decrease in Your earnings will take effect on the ‍‍date of change.

DATE YOUR INSURANCE ENDS
 
Your insurance will end on the earliest of:

1.    the date the Group Policy ends; or
2.    the date insurance ends for Your class; or
		
	3.
	‍the end of the period for which the last premium has been paid for You; or

		
	4.
	the date Your employment ends; Your employment will end if You cease to be Actively at Work in any eligible class, except as stated in the section entitled CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT‍; or

		
	5.
	the date You retire in accordance with the Policyholder’s retirement plan.

‍‍‍‍‍‍‍‍‍‍Please refer to the section entitled LIFE INSURANCE: CONVERSION OPTION FOR YOU for information concerning the option to convert to an individual policy of life insurance if Your Life Insurance ends.

In certain cases insurance may be continued as stated in the section entitled CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT.

GCERT2000     29
e/ee‍
‍

CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT‍‍

FOR FAMILY AND MEDICAL LEAVE

Certain leaves of absence may qualify for continuation of insurance under the Family and Medical Leave Act of 1993 (FMLA), or other legally mandated leave of absence or similar laws.  Please contact the Policyholder for information regarding such legally mandated leave of absence laws.

AT YOUR OPTION: PORTABILITY

For Life and Accidental Death and Dismemberment Insurance

If Your Portability Eligible Insurance ‍‍ends for any of the reasons stated below, You have the option to continue that insurance under another group policy in accordance with the conditions and requirements of this section.  This is referred to as Porting.  Evidence of Your insurability will not be required.

For purposes of this subsection the term "Portability Eligible Insurance" refers to Your Life Insurance and Accidental Death and Dismemberment Insurance benefits for which the Portability Eligible Insurance is shown as available in the SCHEDULE OF BENEFITS.

When Porting is an Option

Porting may only be exercised by a request in Writing during the Request Period specified below.

If You choose not to Port, Life Insurance benefits may be converted in accordance with the section entitled LIFE INSURANCE: CONVERSION OPTION FOR YOU.

		
	1.
	You may choose to Port if Portability Eligible Insurance ends because:

		
	•
	You become retired from active service with the Employer; or

		
	•
	Your employment ends, due to a reason other than retirement; or

		
	•
	You cease to be in a class that is eligible for such insurance; or

		
	•
	the Policy is amended to end the Portability Eligible Insurance, unless such insurance is replaced by similar insurance under another group insurance policy issued to the Policyholder or its successor; or

		
	•
	this Policy has ended, unless such insurance is replaced by similar insurance under another group insurance policy issued to the Policyholder or its successor.

		
	2.
	You may choose to Port the reduced amount of insurance if Your Portability Eligible Insurance is reduced due to:

		
	•
	an amendment to the Plan which affects the amount of insurance for Your class.

If a request is made under this subsection, We will issue a new certificate of insurance which will explain the new insurance benefits. The insurance benefits under the new certificate may not be the same as those that ended under this Policy. 

A request under this subsection may be made, if on the date the Portability Eligible Insurance‍ ended, the following requirements are met:

		
	•
	the Group Policy is in effect; 

		
	•
	with respect to any amount of Portability Eligible Life Insurance‍ that is to be Ported, no application has been made to convert that amount of insurance to an individual policy of life insurance as provided in the section entitled LIFE INSURANCE: CONVERSION OPTION FOR YOU; and

		
	•
	the person making the request resides in a jurisdiction that permits this Portability feature.

Request Period

If written notice of the option to Port is given within 15 days before or after the date such insurance ends, the Request Period:

		
	•
	begins on the date the insurance ends, and 

		
	•
	expires 31 days after the date.

GCERT2000
coi-np‍‍    30

CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT‍‍ (continued)

If written notice of the option to Port is given more than 15 days after but within 91 days of the date such insurance ends, the Request Period:

		
	•
	begins on the date the insurance ends, and

		
	•
	expires 45 days after the date of the notice.

If written notice of the option to Port is not given within 91 days of the date such insurance ends, the Request Period:

		
	•
	begins on the date the insurance ends, and

		
	•
	expires at the end of such 91 day period.

Amount of the New Certificate

The amount of Ported Insurance for You‍ that may be continued is shown in the SCHEDULE OF BENEFITS. However, at the time of Porting You may change the amount of Portability Eligible Insurance in the following circumstances:

Your Increase in Amount

For Portability Eligible Life Insurance

At the time of Porting, You may increase the amount of Your Portability Eligible Life Insurance.  This may be done in increments of $25,000, up to a maximum ported amount of $2,000,000.  To be eligible for this increased amount, You must provide evidence of Your insurability satisfactory to us, at Your expense.  If We approve the increase, it will take effect on the date We state in Writing. 

For Portability Eligible Accidental Death and Dismemberment Insurance

At the time of Porting, You may increase the amount of Your Portability Eligible Accidental Death and Dismemberment Insurance. This may be done in increments of $25,000, up to a maximum ported amount of $2,000,000.  This increase will take effect on the date We state in Writing.

Your Decrease in Amount

If We receive a request to decrease an amount of insurance, any such decrease will take place on the date We state in Writing.

Premiums for the New Certificate

All premium payments must be made directly to Us.  When We issue the new certificate, We will also provide a schedule of premiums and payment instructions.

You are not required to provide evidence of insurability to Port Your existing amount of Portability Eligible Life and Accidental Death and Dismemberment Insurance. However, to qualify for a lower premium rate, You may give us, at Your expense, evidence of Your insurability satisfactory to Us.  If We determine that the evidence satisfies Us, We will notify You that the lower premium rates will apply to You.

GCERT2000
coi-np‍‍    31

CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT‍‍ (continued)

Right to Convert Life Insurance Amounts Not Ported

Any amount of Life Insurance not Ported under this subsection may be converted under the section entitled LIFE INSURANCE: CONVERSION OPTION FOR YOU.

If You Die Within 31 Days of the Date Portability Eligible Life Insurance Ends

If You die within 31 days of the date Portability Eligible Life Insurance ends and an application to Port is not received by Us during such period, We will determine whether Your life insurance qualifies for payment.  This determination will be made in accordance with the section entitled LIFE INSURANCE: CONVERSION OPTION FOR YOU. 

AT YOUR OPTION: CONTINUATION OF YOUR LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE DURING A LABOR DISPUTE

You may elect to continue Life Insurance for You and ‍Accidental Death and Dismemberment Insurance for You, ‍‍‍‍ if You cease to be Actively at Work as the result of a labor dispute. Such insurance will continue for up to 6 months if the following conditions are met:

		
	•
	at least 75% of the employees eligible to continue insurance elect to continue this insurance for such time period; and

		
	•
	You pay the required premium for such insurance.

If continued, Life Insurance for You and ‍Accidental Death and Dismemberment Insurance for You, ‍‍‍‍ will end if: 

		
	•
	premium payment is required and You fail to pay premiums for such insurance;

		
	•
	the number of employees who elect to continue such insurance falls below 75% of all employees eligible to continue this insurance for such time period; or

		
	•
	You cease to be eligible to continue Life Insurance for You and ‍Accidental Death and Dismemberment Insurance for You, ‍‍‍‍ under this section and You do not immediately resume Active Work in a class that is eligible for such insurance.

GCERT2000
coi-np‍‍    32

CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT‍‍ (continued)

AT THE POLICYHOLDER’S OPTION

The Policyholder has elected to continue insurance by paying premiums for employees who‍ cease Active Work in an eligible class for any of the reasons specified below: ‍

		
	1.
	if You cease Active Work due to injury or sickness, up to 24 months; 

		
	2.
	if You cease Active Work due to part-time work, for a period in accordance with the Policyholder's general practice for an employee in Your job class; 

		
	3.
	if You cease Active Work due to strike, for a period in accordance with the Policyholder's general practice for an employee in Your job class;

		
	4.
	if You cease Active Work due to any other Policyholder approved leave of absence, up to 1 month following the end of the month in which the leave began. 

The Policyholder's general practice for employees in a job class determines which employees with the above types of absences are to be considered as still insured and for how long among persons in like situations.

At the end of any of the continuation periods listed above, Your insurance will be affected as follows:

		
	•
	if You resume Active Work in an eligible class at this time, You will continue to be insured under the Group Policy;

		
	•
	if You do not resume Active Work in an eligible class at this time, Your employment will be considered to end and Your insurance will end in accordance with the DATE YOUR INSURANCE ENDS subsection of the section entitled ELIGIBILITY PROVISIONS: INSURANCE FOR YOU.

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EVIDENCE OF INSURABILITY

No evidence of insurability is required for the insurance described in this certificate.

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LIFE INSURANCE: FOR YOU

If You die, Proof of Your death must be sent to Us. When We receive such Proof with the claim, We will review the claim and, if We approve it, will pay the Beneficiary the Life Insurance in effect on the date of Your death. 

PAYMENT OPTIONS

We will pay the Life Insurance in one sum.  Other modes of payment may be available upon request.  For details, call Our toll free number shown on the Certificate Face Page.

GCERT2000
l/ee    35

LIFE INSURANCE: ACCELERATED‍ BENEFIT OPTION (ABO) FOR YOU

For purposes of this section, the term “ABO Eligible Life Insurance” refers to each of Your Life Insurance benefits for which the Accelerated‍ Benefit Option is shown as available in the SCHEDULE OF BENEFITS.

If You become Terminally Ill, You or Your legal representative have the option to request Us to pay ABO Eligible Life Insurance before Your death.  This is called an accelerated‍ benefit.  The request must be made while ABO Eligible Life Insurance is in effect. ‍

Terminally Ill or Terminal Illness means that due to injury or sickness, You are expected to die within 6 months.

Requirements For Payment of an Accelerated‍ Benefit

Subject to the conditions and requirements of this section, We will pay an accelerated‍ benefit to You or Your legal representative if:

		
	•
	the amount of each ABO Eligible Life Insurance benefit to be accelerated equals or exceeds $10,000; and

		
	•
	the ABO Eligible Life Insurance to be accelerated has not been assigned; and

		
	•
	We have received Proof that You are Terminally Ill.

We will only pay an accelerated‍ benefit for each ABO Eligible Life Insurance benefit once.‍‍

Proof of Your Terminal Illness

We will require the following Proof of Your Terminal Illness:

		
	•
	a completed accelerated‍ benefit claim form; ‍

		
	•
	a signed Physician’s certification‍ that You are Terminally Ill; and

		
	•
	an examination by a Physician of Our choice, at Our expense, if We request it.‍

You or Your legal representative should contact Us to obtain a claim form and information regarding the accelerated‍ benefit.

Upon Our receipt of Your request to accelerate‍ benefits, We will send You a letter with information about the accelerated‍ benefit payment You requested. Our letter will describe the amount of the accelerated‍ benefits We will pay and the amount of Life Insurance remaining after the accelerated‍ benefit is paid.

Accelerated‍ Benefit Amount

We will pay an accelerated‍ benefit up to the percentage shown in the SCHEDULE OF BENEFITS for each ABO Eligible Life Insurance benefit in effect for You, subject to the following:

Maximum Accelerated‍ Benefit Amount. The maximum amount We will pay for each ABO Eligible Life Insurance benefit is shown in the SCHEDULE OF BENEFITS.

Scheduled Reduction of an ABO Eligible Life Insurance Benefit.  If an ABO Eligible Life Insurance benefit is scheduled to reduce within the 6 month period after the date You or Your legal representative request an accelerated‍ benefit, We will calculate the accelerated‍ benefit using the amount of such ABO Eligible Life Insurance that will be in effect immediately after the reduction(s) scheduled for such period.

Scheduled End of an ABO Eligible Life Insurance Benefit.  If an ABO Eligible Life Insurance benefit is scheduled to end‍ within 6 months after the date You or Your legal representative request an accelerated‍ benefit, We will not pay an accelerated‍ benefit for such ABO Eligible Life Insurance benefit.

Previous Conversion of an ABO Eligible Life Insurance Benefit.  We will not pay an accelerated‍ benefit for any amount of ABO Eligible Life Insurance which You previously converted under the section entitled LIFE INSURANCE: CONVERSION OPTION FOR YOU.

We will pay the accelerated‍ benefit in one sum unless You or Your legal representative select another payment mode.‍

GCERT2000‍
abo/ee    36

LIFE INSURANCE: ACCELERATED‍ BENEFIT OPTION (ABO) FOR YOU (continued)

Effect of Payment of an Accelerated‍ Benefit  

On Contribution for Your Life Insurance.  After We pay the accelerated benefit, any future contributions for Life Insurance You are required to pay will be waived.

On Your Life Insurance at Your death. The amount of Life Insurance that We will pay at Your death will be decreased by the amount of the accelerated‍ benefit paid by Us.

On Your Life Insurance at conversion.  The amount to which You are entitled to convert under the section entitled LIFE INSURANCE: CONVERSION OPTION FOR YOU will be decreased by the amount of the accelerated‍ benefit paid by Us.

On Your Accidental Death and Dismemberment Insurance.  Payment of an accelerated‍ benefit will not affect Your Accidental Death and Dismemberment Insurance.

Date Your Option to Accelerate‍ Benefits Ends 

The accelerated‍ benefit option will end on the earliest of:

		
	•
	the date the ABO Eligible Life Insurance ends;‍

		
	•
	the date You or Your legal representative assign all ABO Eligible Life Insurance; or

		
	•
	the date You or Your legal representative have accelerated all ABO Eligible Life Insurance benefits.

GCERT2000‍
abo/ee    37

LIFE INSURANCE: CONVERSION OPTION FOR YOU

If Your life insurance ends or is reduced for any of the reasons stated below, You have the option to buy an individual policy of life insurance (“new policy”) from Us during the Application Period in accordance with the conditions and requirements of this section.  This is referred to as the “option to convert”.  Evidence of Your insurability will not be required.

When You Will Have the Option to Convert

You will have the option to convert when: 

A.    Your life insurance ends because:
		
	•
	You cease to be in an eligible class;

		
	•
	Your employment ends; 

		
	•
	this Group Policy ends, provided You have been insured for life insurance for at least 5 continuous years‍; or

		
	•
	this Group Policy is amended to end all life insurance for an eligible class of which You are a member, provided You have been insured‍ for at least 5 continuous years‍; or

B.    Your life insurance is reduced:
		
	•
	on or after the date You attain age 65‍;

		
	•
	because You change from one eligible class to another; or

		
	•
	due to an amendment of this Group Policy.

If You opt not to convert a reduction in the amount of Your life insurance as described above, You will not have the option to convert that amount at a later date.

A reduction in the amount of Your life insurance as a result of the payment of an accelerated‍ benefit will not give rise to a right to convert under this section.

Application Period

If You opt to convert Your life insurance for any of the reasons stated above, We must receive a completed conversion application form from You within the Application Period described below.  

If You are given Written notice of the option to convert within 15 days before or after the date Your life insurance ends or is reduced, the Application Period begins on the date that such life insurance ends or is reduced and expires 31 days after such date.  

If You are given Written notice of the option to convert more than 15 days after the date Your life insurance ends or is reduced, the Application Period begins on the date such life insurance ends or is reduced and expires 25 days from the date of such notice.  In no event will the Application Period exceed 91 days from the date Your life insurance ends or is reduced.

Option Conditions

The option to convert is subject to the following:

		
	A.
	Our receipt within the Application Period of: 

		
	•
	Your Written application for the new policy; and 

		
	•
	the premium due for such new policy;

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co/l/ee 07/09    38
‍

LIFE INSURANCE: CONVERSION OPTION FOR YOU (continued)

		
	B.
	the premium rates for the new policy will be based on:

		
	•
	Our rates then in use;

		
	•
	the form and amount of insurance for which you apply;

		
	•
	Your class of risk; and

		
	•
	Your age;

		
	C.
	the new policy may be on any form then customarily offered by Us excluding term insurance;

		
	D.
	the new policy will be issued without an accidental death and dismemberment benefit,‍ an accelerated‍ benefit option, a waiver of premium benefit or any other rider or additional benefit; and

		
	E.
	the new policy will take effect on the 32nd day after the date Your life insurance ends or is reduced; this will be the case regardless of the duration of the Application Period.

Maximum Amount of the New Policy

If Your Life Insurance ends due to the end of this Group Policy or the amendment of this Group Policy to end all life insurance for an eligible class of which You are a member, the maximum amount of insurance that You may elect for the new policy is the lesser of:

		
	•
	the amount of Your life insurance that ends under this Group Policy less the amount of life insurance for which You become eligible under any group policy within 31 days after the date insurance ends under this Group Policy; or

		
	•
	$10,000.

If Your life insurance ends or is reduced due to the Policyholder’s organizational restructuring, the maximum amount of insurance that You may elect for the new policy is the amount of Your life insurance that ends under this Group Policy less the amount of life insurance for which You become eligible under any other group policy within 31 days after the date insurance ends under this Group Policy.

If Your life insurance ends or is reduced for any other reason, the maximum amount of insurance that You may elect for the new policy is the amount of Your life insurance which ends under this Group Policy.

ADDITIONAL PROVISIONS IF YOU DIE ‍ 

If You Die Within 31 Days After Your Life Insurance Ends Or Is Reduced

If You die within 31 days after Your life insurance ends or is reduced by an amount You are entitled to convert, Proof of Your death must be sent to Us.  When We receive such Proof with the claim, We will review the claim and if We approve it will pay the Beneficiary.  The amount We will pay is the amount You were entitled to convert.

The amount You were entitled to convert will not be paid as insurance under both a new individual conversion policy and the Group Policy.

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co/l/ee 07/09    39
‍

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE

If You ‍sustain an accidental injury that is the Direct and Sole Cause of a Covered Loss described in the SCHEDULE OF BENEFITS, Proof of the accidental injury and Covered Loss must be sent to Us. When We receive such Proof We will review the claim‍‍ and, if We approve it, will pay the insurance in effect on the date of the injury‍‍‍.

Direct and Sole Cause means that the Covered Loss occurs within 12 months of the date of the accidental injury and was a direct result of the accidental injury, independent of other causes. 

We will deem a loss to be the direct result of an accidental injury if it results from unavoidable exposure to the elements and such exposure was a direct result of an accident.  

PRESUMPTION OF DEATH

You ‍will be presumed to have died as a result of an accidental injury if:

		
	•
	the aircraft or other vehicle in which You ‍were traveling disappears, sinks, or is wrecked; and

		
	•
	the body of the person who has disappeared is not found within 1 year‍ of:

		
	•
	the date the aircraft or other vehicle was scheduled to have arrived at its destination, if traveling in an aircraft or other vehicle operated by a Common Carrier; or 

		
	•
	the date the person is reported missing to the authorities, if traveling in any other aircraft or other vehicle.

EXCLUSIONS (See notice page for residents of Missouri)

We will not pay benefits under this section for any loss caused or contributed to by:

		
	1.
	physical or mental illness or infirmity, or the diagnosis or treatment of such illness or infirmity;

		
	2.
	infection, other than infection occurring in an external accidental wound‍;

		
	3.
	suicide or attempted suicide‍‍;

		
	4.
	intentionally self-inflicted injury‍‍;

		
	5.
	service in the armed forces of any country or international authority. However, service in reserve forces does not constitute service in the armed forces, unless in connection with such reserve service an individual is on active military duty as determined by the applicable military authority other than weekend or summer training.  For purposes of this provision reserve forces are defined as reserve forces of any branch of the military of the United States or of any other country or international authority, including but not limited to the National Guard of the United States or the national guard of any other country;

		
	6.
	any incident related to travel in an aircraft or device:

•as a pilot or crew member of an Aircraft for which You are not qualified;
•flight student or flight instructor except in the course of Your job for the Policyholder;
		
	•
	for parachuting or otherwise exiting from the aircraft while the aircraft is in flight except for the purpose of self-preservation;

		
	•
	travel in an aircraft for the purpose of parachuting or otherwise exiting from such aircraft while it is in flight;

•for testing or experimental purposes;
•by or for any military authority; or
•for travel or designed for travel beyond the earth’s atmosphere;
		
	7.
	committing or attempting to commit a felony‍‍;

GCERT2000
add‍    40

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE (continued)

		
	8.
	the voluntary intake or use by any means of:

		
	•
	any drug, medication or sedative, unless it is:

		
	•
	taken or used as prescribed by a Physician; or 

		
	•
	an "over the counter" drug, medication or sedative taken as directed;

		
	•
	alcohol in combination with any ‍drug, medication, or sedative‍‍; or

		
	•
	poison, gas, or fumes; or

		
	9.
	war, whether declared or undeclared; or act of war‍, insurrection, rebellion or riot‍.

Exclusion for Intoxication

We will not pay benefits under this section for any loss if the injured party is intoxicated at the time of the incident and is the operator of a vehicle or other device involved in the incident.

Intoxicated means that the injured person’s‍‍ blood alcohol level met or exceeded the level that creates a legal presumption of intoxication under the laws of the jurisdiction in which the incident occurred.

BENEFIT PAYMENT

For loss of Your life, We will pay benefits to Your Beneficiary.

For any other loss sustained by You‍ We will pay benefits to You.

If You ‍sustain more than one Covered Loss due to an accidental injury, the amount We will pay, on behalf of any such injured person, will not exceed the Full Amount.

We will pay benefits in one sum. Other modes of payment may be available upon request. For details call Our toll free number shown on the Certificate Face Page.

APPLICABILITY OF PROVISIONS 

The provisions set forth in this ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE section apply to all Accidental Death and Dismemberment Insurance – Additional Benefit sections included in this certificate except as may otherwise be provided in such Additional Benefit sections.

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add‍    41

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE (continued)

ADDITIONAL BENEFIT: SEAT BELT USE

If You ‍die as a result of an accidental injury, We will pay this additional Seat Belt Use benefit if:

		
	1.
	We pay a benefit for loss of life under the ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE section;

		
	2.
	this benefit is in effect on the date of the injury; and

		
	3.
	We receive Proof that the deceased person:

		
	•
	was in an accident while driving or riding as a passenger in a Passenger Car;

		
	•
	was wearing a Seat Belt which was properly fastened at the time of the accident; and

		
	•
	died as a result of injuries sustained in the accident.

A police officer investigating the accident must certify that the Seat Belt was properly fastened.  A copy of such certification must be submitted to Us with the claim for benefits.

Passenger Car means any validly registered four-wheel private passenger car, four-wheel drive vehicle, sports-utility vehicle, pick-up truck or mini-van. It does not include any commercially licensed car, any private car being used for commercial purposes, or any vehicle used for recreational or professional racing.

Seat Belt means any restraint device that:

		
	•
	meets published United States Government safety standards;

		
	•
	is properly installed by the car manufacturer; and

		
	•
	is not altered after the installation.

The term includes any child restraint device that meets the requirements of state law.

BENEFIT AMOUNT

The Seat Belt Use benefit is an additional benefit equal to 20% of the Full Amount shown in the SCHEDULE OF BENEFITS. However, the amount We will pay for this benefit will not be less than $500 or more than $25,000.

BENEFIT PAYMENT

For loss of Your life, We will pay benefits to Your Beneficiary.

GCERT2000‍
‍add/seatbelt    42

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE (continued)

ADDITIONAL BENEFIT: AIR BAG USE

If You ‍die as a result of an accidental injury, We will pay this additional benefit if:

		
	1.
	We pay a benefit for loss of life under the ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE section;

		
	2.
	this benefit is in effect on the date of the injury; and

		
	3.
	We receive Proof that the deceased person:

		
	•
	was in an accident while driving or riding as a passenger in a Passenger Car equipped with an Air Bag(s);

		
	•
	was riding in a seat protected by an Air Bag;

		
	•
	was wearing a Seat Belt which was properly fastened at the time of the accident; and

		
	•
	died as a result of injuries sustained in the accident.

A police officer investigating the accident must certify that the Seat Belt was properly fastened and that the Passenger Car in which the deceased was traveling was equipped with Air Bags. A copy of such certification must be submitted to Us with the claim for benefits.

Passenger Car means any validly registered four-wheel private passenger car, four-wheel drive vehicle, sports-utility vehicle, pick-up truck or mini-van. It does not include any commercially licensed car, any private car being used for commercial purposes, or any vehicle used for recreational or professional racing.

Seat Belt means any restraint device that:

		
	•
	meets published United States government safety standards;

		
	•
	is properly installed by the car manufacturer; and

		
	•
	is not altered after the installation.

The term includes any child restraint device that meets the requirements of state law.

Air Bag means an inflatable restraint device that:

		
	•
	meets published United States government safety standards;

		
	•
	is properly installed by the car manufacturer; and

		
	•
	is not altered after the installation.

BENEFIT AMOUNT

The Air Bag Use Benefit is an additional benefit equal to 10% of the Full Amount shown in the SCHEDULE OF BENEFITS. However, the amount We will pay for this benefit will not be less than $250 or more than $10,000.

BENEFIT PAYMENT

For loss of Your life, We will pay benefits to Your Beneficiary.

‍

GCERT2000‍
‍add/airbag    43

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE (continued)

ADDITIONAL BENEFIT: SURVIVING SPOUSE‍

If You die as a result of an accidental injury, We will pay this benefit if:
		
	1.
	We pay a benefit for loss of Your life under the  ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE section; 

		
	2.
	We receive Proof that the death was a result of an injury sustained in an accident;‍

		
	3.
	this benefit is in effect on the date of the injury; and

		
	4.
	You have a surviving Spouse‍ who has survived You by at least 48 hours.

BENEFIT AMOUNT

We will pay an additional amount equal to 2% of the Full Amount of insurance under the ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE for each of the 12 months immediately following the date of Your death.

If this benefit is in effect on the date of death and there is no Spouse‍ who could qualify for payment, We will pay $1,000 to Your Beneficiary in one sum.

BENEFIT PAYMENT

For loss of Your life We will pay this benefit to Your Spouse‍.

If Your Spouse dies before all monthly payments have been made, We will pay any remaining amount to the Spouse’s estate in one sum.

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‍

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE (continued)

ADDITIONAL BENEFIT: HOSPITAL CONFINEMENT

Subject to the provisions of the ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE, We will pay this additional benefit if:

		
	1.
	We receive Proof that You‍ are confined in a Hospital as a result of an accidental injury which is the direct cause of such confinement independent of other causes; and

		
	2.
	this benefit is in effect on the date of the injury.

BENEFIT AMOUNT

We will pay an amount for each full month of Hospital Confinement equal to the lesser of:

		
	•
	5% of the Full Amount shown in the SCHEDULE OF BENEFITS; and

		
	•
	$1,000.

We will pay this benefit on a monthly basis beginning on the 7th day of confinement, for up to 12 months of continuous confinement. This benefit will be paid on a pro-rata basis for any partial month of confinement.

We will only pay benefits for one period of continuous confinement for any accidental injury. That period will be the first period of confinement that qualifies for payment.

BENEFIT PAYMENT

Benefit payments will be made monthly. Payment will be made to You.

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ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE (continued)

ADDITIONAL BENEFIT: REHABILITATIVE PHYSICAL THERAPY

We will pay this additional benefit if:

		
	1.
	We pay a benefit for a loss resulting from an accidental injury to You‍, under the ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE section;

		
	2.
	We receive Proof that rehabilitative physical therapy has been prescribed within 90 days of the Covered Loss by the attending Physician as necessary to treat a physical condition resulting from the Covered Loss; and

		
	3.
	this benefit is in effect on the date of the injury.

Such rehabilitative physical therapy must be provided within 1 year of the prescription by a Physician or therapist licensed to provide the therapy in the jurisdiction where such services are performed.

BENEFIT AMOUNT

We will pay an amount equal to the least of:

		
	•
	the actual charges incurred for such Rehabilitative Physical Therapy;

		
	•
	20% of the Full Amount shown in the SCHEDULE OF BENEFITS; or

		
	•
	$18,000.

BENEFIT PAYMENT

We will pay this benefit quarterly when We receive Proof that charges for Rehabilitative Physical Therapy have been paid. Payment will be made to You.

GCERT2000
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FILING A CLAIM

CLAIMS FOR LIFE INSURANCE BENEFITS

When there has been the death of an insured person, notify ‍Us by calling 1-800-638-6420‍‍.‍ This notice should be given to ‍Us‍ as soon as is reasonably possible after the death.  The claim form will be sent to the beneficiary or beneficiaries of record.

The beneficiary or beneficiaries should complete the claim form and send it and Proof of the death to Us as instructed on the claim form. 

When We receive the claim form and Proof, We will review the claim and, if We approve it, We will pay benefits subject to the terms and provisions of this certificate and the Group Policy‍.‍

GCERT2000
life/claim 07/09    47
‍

FILING A CLAIM

CLAIMS FOR ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS

When there has been a Covered Loss, notify ‍Us by calling 1-800-638-6420. This notice should be given to Us as soon as is reasonably possible but in any case within 20 days of the Covered Loss.  The claim form will be sent to You or the beneficiary or beneficiaries of record.

The claim form should be completed and sent along with Proof of the Covered Loss to Us as instructed on the claim form. If You or the beneficiary have not received a claim form within 15 days of giving notice of the claim, Proof may be sent using any form sufficient to provide Us with the required Proof.

The claimant must give us Proof no later than 90 days after the date of the Covered Loss.‍

If notice of claim or Proof is not given within the time limits described in this section, the delay will not cause a claim to be denied or reduced if such notice or Proof are given as soon as is reasonably possible. 

When We receive the claim form and Proof, We will review the claim and, if We approve it, We will pay benefits ‍subject to the terms and provisions of this certificate and the Group Policy‍‍‍‍. ‍‍‍

Time Limit on Legal Actions.  A legal action on a claim may only be brought against Us during a certain period.  This period begins 60 days after the date Proof is filed and ends 3 years after the date such Proof is required.

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add/claim 07/09    48
‍

GENERAL PROVISIONS

Assignment

The rights and benefits under the Group Policy are not assignable prior to a claim for benefits, except as required by law.  We are not responsible for the validity of an assignment.

Beneficiary 

You may designate a Beneficiary in Your application or enrollment form. You may change Your Beneficiary at any time.  To do so, You must send a Signed and dated, Written request to the Policyholder using a form satisfactory to Us. Your Written request to change the Beneficiary must be sent to the Policyholder within 30 days of the date You Sign such request. 

You do not need the Beneficiary’s consent to make a change.  When We receive the change, it will take effect as of the date You Signed it.  The change will not apply to any payment made in good faith by Us before the change request was recorded.

If two or more Beneficiaries are designated and their shares are not specified, they will share the insurance equally.

If there is no Beneficiary designated or no surviving designated Beneficiary at Your death, We will determine the Beneficiary according to the following order:

		
	1.
	Your Spouse or Domestic Partner; 

		
	2.
	Your child(ren), if there is no surviving Spouse or Domestic Partner; or 

		
	3.
	Your estate, if there is no surviving child.

  
Any payment made in good faith will discharge our liability to the extent of such payment.

If a Beneficiary or a payee is a minor or incompetent to receive payment, We will pay that person's guardian.

Entire Contract

Your insurance is provided under a contract of group insurance with the Policyholder.  The entire contract with the Policyholder is made up of the following:

		
	1.
	the Group Policy and its Exhibits, which include the certificate(s);

		
	2.
	the Policyholder's application‍; and

		
	3.
	any amendments and/or endorsements to the Group Policy.

Incontestability:  Statements Made by You‍

Any statement made by You‍‍ will be considered a representation and not a warranty.  We will not use such statement to avoid insurance, reduce benefits or defend a claim unless the following requirements are met:

		
	1.
	the statement is in a Written application or enrollment form;

		
	2.
	You have Signed the application or enrollment form; and

		
	3.
	a copy of the application or enrollment form has been given to You or Your Beneficiary‍.

For Life Insurance

We will not use Your statements which relate to insurability to contest‍‍ insurance after it has been in force for 2 years during Your life‍.  In addition, We will not use such statements to contest an increase or benefit addition to such insurance after the increase or benefit has been in force for 2 years during Your life.

49
GCERT2000
gp 10/04 ‍
‍
‍

GENERAL PROVISIONS (continued)

For Accidental Death and Dismemberment Insurance

We will not use Your statements which relate to insurability to contest ‍‍Accidental Death and Dismemberment Insurance after it has been in force for 2 years during Your life, unless the statement is fraudulent.  In addition, We will not use such statements to contest an increase or benefit addition to such insurance after the increase or benefit has been in force for 2 years during Your life, unless the statement is fraudulent.

Misstatement of Age

If Your‍ age is misstated, the correct age will be used to determine if insurance is in effect and, as appropriate, We will adjust the benefits and/or premiums.

Conformity with Law

If the terms and provisions of this certificate do not conform to any applicable law, this certificate shall be interpreted to so conform.   

Physical Exams

If a claim is submitted for insurance benefits other than life insurance benefits, We have the right to ask the insured to be examined by a Physician(s) of Our choice as often as is reasonably necessary to process the claim.  We will pay the cost of such exam.

Autopsy‍

We have the right to make a reasonable request for an autopsy where permitted by law.  Any such request will set forth the reasons We are requesting the autopsy.‍

50
GCERT2000
gp 10/04 ‍
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