TABLE OF CONTENTS Renewal Provisions Policy Schedule Page 1 3 Definitions Exclusions Premium and Reinstatement 8 9 •• Part 4 Age 65 11 • Part 5 Claims 12 Part The Contract Benefits 15 Recurrent and Concurrent Disability 16 A copy of Your application, added benefits You have purchased, and any added provisions are attached at the back of the Policy.
POLICY SCHEDULE <continued) --------------------Maximum Benefit Periods for Total To Age 65: Before Age 61 To Age 65 At Age 61 but before Age 62 48 Months At Age 62 but before Age 63 42 Months At Age 63 but before Age 64 36 Months At Age 64 but before Age 65 30 Months At or after Age 65 but before Age 75 24 Months At or after Age 75 12 Months ----------------------------Residual Disability Maximum Benefit Period For Work Incentive Period 3 Months Residual Disability 24 Months ---------------------------L-ifet im e Continuation Elimination Period Benefit Amount for Long Term Care Policy Lifetime Maximum Benefit Amount for Long Term Care Policy 90 Days $3,000 per month $108,000 ----------------------------Table of Additional Annual Premium Prior to Age 65 Fixed Cost of Living Adjustment Option Rider Effective Date: October 25, 2007 $167.30
PART 7 - BENEFITS Benefits for Total Disability If You are Totally Disabled, We will pay benefits as follows: Benefits start to accrue on the day of Total Disability following the nation Period. The Total Disability Monthly Amount will be paid for as long as Total Disability continues, but not beyond the Maximum Benefit Period for Total Disability. Benefits for Disability Resulting from a Mental Disorder If Your Disability is contributed to or caused by a Mental Disorder, We will pay benefits according to the provisions of this Policy, except as limited by the Maximum Benefit Period for Hental Diso rders. If, at the end of the Maximum Benefit Period for Hental Disorders, You are uously confined, due to a Disability from Hental Disorders, in a Hospital under the care of a Physician, We will waive the Maximum Benefit Period for Mental Disorders for the duration of Your hospital confinement for this Disability. Benef1ts for Residual Disability If You are Residually Disabled, We will pay benefits as follows: Benefits start to accrue on the day of Residual Disability following the ination Period or after Your Total Disability ends, if later. The Residual Disability Monthly Amount will be determined each month using the following formulas: During the Work Incentive Period, the following formula will be used: Prior Earnings minus(-) Monthly Earnings = Residual Disability Monthly Amount* *Residual Disability Monthly Amount cannot exceed the Total Disability Monthly Amount. After the Work Incentive Period, the following formula will be used: Loss of Earnings Prior Earnings X Total Disability Monthly Amount = Residual Disability Monthly Amount If the Loss of Earnings equals 75¾ or greater of Prior Earnings, We will deem the loss to be 100¾ of Prior Earnings. The Residual Disability Monthly Amount will .be paid for as long as Residual Disability continues, but not beyond the Maximum Benefit Period for Residual Disa bi lity. Residual Disability benefits will not be paid for any days for which Total