Your Group Insurance Plan (1982)

The ***Your Group Insurance Plan document*** was a document distributed to employees of Pizza Time Theatre, Inc., as an informational sheet on the Pizza Time Theatre insurance plan.

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### Cover

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Your Group Insurance Plan

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### Notice

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IMPORTANT When you receive your "Certificate of Coverage - Form P" confirming that you are insured, peel the tape slowly from the back of it. Then attach in this space.

This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy/policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policy/policies described herein is subject to all the terms, exclusions and conditions of such policies.

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### Page 1: SCHEDULE OF BENEFITS

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EMPLOYEE

LIFE (Based on Annual Earnings)
Less than $20,000 ................................................ (1)
$20,000 and Over ................................................ (2)

ACCIDENTAL DEATH, DISMEMBERMANT
AND LOSS OF SIGHT - (Full Amount of Insurance)
Same as Life Benefits

EMPLOYEE and DEPENDANTS ..............................$   100
ADDITIONAL ACCIDENT     ..............................$   500
DENTAL ...............................................$ 1,500
MAJOR MEDICAL   .............................. (3) $1,000,000
HOME HEALTH CARE
Maximum Payment per Visit.............................$    40

(1)   100% of annual earnings with a maximum of $150,000.

(2)   150% of annual earnings with a maximum of $150,000.

(3) $25,000 maximum with respect to charges in connection with mental illness(es) or functional nervous disorder(s) of any type or cause.

Your Life and Accidental Death, Dismemberment, and Loss of Sight benefits reduce 50% at age 70.

Changes in amounts of benefits due to a change in earnings will be made immediately on the date a change in earnings becomes effective.

Life and Accidental Death, Dismemberment and Loss of Sight benefits cover you on and off the job. All other benefits cover you only for accidents and sicknesses originating off the job. No benefits are provided for charges which you are not legally obligated to pay, such as for U. S. Government Hospital confinement and services, nor for claims to which you or your dependents are entitled to Worker's Compensation benefits.

NOTE: "Illness" or "Sickness" means a bodily disorder or disease, pregnancy, mental infirmity or bodily injury. All bodily injuries sustained by an individual in a single accident, or all illnesses or sicknesses which are due to the same or related cause or causes, will be considered one illness or sickness.

Pregnancy benefits are payable at the same basis as any other illness.

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### Page 2: DESCRIPTION OF BENEFITS

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LIFE, ACCIDENATAL DEATH, DISMEMBERMENT AND LOSS OF SIGHT INSURANCE

LIFE INSURANCE
Life Insurance benefits are payable as a result of death from any cause.

You may change your beneficiary without the beneficiary's consent by giving written notice to The Lincoln National Life Insurance Company, (hereinafter also called The Lincoln) through your Employer. The change will become effective as of the date you signed the notice.

An absolute assignment of all the incidents of ownership of group life insurance under the policy, as evidenced by this certificate will not be permitted. Collateral assignments, by whatever named called, will not be permitted.

TBD

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