Executive Basic Life Insurance and Accidental Death and Dismemberment Insurance Policy dated January 1, 2019

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.

If Your AD&D‍‍‍‍ Insurance ends because:

You cease to be in an Eligible Class; or

Your employment terminates;

Life Insurance

Health Insurance

Annuities

for which You‍ become and remain eligible;

which You elect, if subject to election; and

which are in effect.

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.

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.

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.

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:

18 years of age or older;

unmarried;

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

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

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

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.

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.

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.

the nature and extent of the loss or condition;

Our obligation to pay the claim; and

the claimant’s right to receive payment.

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 end of the period for which the last premium has been paid for You; or

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

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

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.

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.

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.

begins on the date the insurance ends, and

expires 31 days after the date.

begins on the date the insurance ends, and

expires 45 days after the date of the notice.

begins on the date the insurance ends, and

expires at the end of such 91 day period.

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.

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.

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

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;

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;

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.

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.

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.

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.‍

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.

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

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.

Our receipt within the Application Period of:

Your Written application for the new policy; and

the premium due for such new policy;

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;

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

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

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

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.

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.

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

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

suicide or attempted suicide‍‍;

intentionally self-inflicted injury‍‍;

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;

any incident related to travel in an aircraft or device:

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;

committing or attempting to commit a felony‍‍;

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

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

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

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

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.

meets published United States Government safety standards;

is properly installed by the car manufacturer; and

is not altered after the installation.

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

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

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.

meets published United States government safety standards;

is properly installed by the car manufacturer; and

is not altered after the installation.

meets published United States government safety standards;

is properly installed by the car manufacturer; and

is not altered after the installation.

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

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

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

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

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

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

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

$1,000.

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

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

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

the actual charges incurred for such Rehabilitative Physical Therapy;

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

$18,000.

Your Spouse or Domestic Partner;

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

Your estate, if there is no surviving child.

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

the Policyholder's application‍; and

any amendments and/or endorsements to the Group Policy.

the statement is in a Written application or enrollment form;

You have Signed the application or enrollment form; and

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