R2007-197 AUTHORIZING GROUP TERM LIFE INSURANCE COVERAGE

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FAMILY AND MEDICAL LEAVE OF ABSENCE EXTENSION We will allow the Insured's coverage, and that of any Insured Dependents, to continue for up to twelve (12) weeks in a twelve (12) month period, if the Insured is eligible for, and you have approved, a Family and Medical Leave of Absence under the terms of the Family and Medical Leave Act of 1993 for any of the following reasons: (1) To provide care after the birth of a son or daughter; or (2) To provide care for a son or daughter upon legal adoption; or (3) To provide care after the placement of a foster child in the Insured's home; or (4) To provide care to a spouse, son, daughter, or parent due to serious illness; or (5) To take care of his/her own serious health condition as explained below. � If the Insured, due to his/her own serious health condition, meets the definition of Total Disability in this Policy, he/she will be considered Totally Disabled and eligible for Waiver of Premium benefits according to the Waiver of Premium in Event of Total Disability provision. If the Insured, due to his/her own serious health condition, is on a Family and Medical Leave of Absence, but not eligible for Waiver of Premium benefits under this Policy, insurance coverage will be continued under this extension. The Insured will not qualify for the Family and Medical Leave of Absence Extension unless we have received proof from you, in a form satisfactory to us, that the Insured has been granted a leave under the terms of the Family and Medical Leave Act of 1993. Such proof: (1) must outline the terms of the Insured's leave; and (2) give the date the leave began; and (3) the date it is expected to end; and (4) must be received by us within thirty-one (31) days after a claim for benefits has been filed with us. If you grant the Insured a Family and Medical Leave of Absence, the following applies to the Insured who has been granted the leave: (1) While the Insured is on an approved Family and Medical Leave of Absence, the required premium must be paid according to the terms specified in this Policy to keep the insurance in force. (2) Coverage will terminate for any Insured or any Insured Dependents, if the Insured does not return to work as scheduled according to the terms of his/her agreement with you; however, the Insured is eligible to convert his/her coverage under the Conversion Privilege. In no case will coverage be extended under this benefit beyond twelve (12) weeks in a twelve (12) month period. Insurance will not be terminated for an Insured who becomes Totally Disabled during the period of the leave and who is eligible for Waiver of Premium benefits, if any, according to the terms of this Policy. (3) This extension is not available if the Insured converts his/her coverage under the Conversion Privilege. (4) While the Insured is on an approved Family and Medical Leave of Absence, he/she will be considered Actively at Work in all instances unless such leave is due to his/her own illness, injury, or disability. Changes such as revisions to coverage because of age, class or salary changes will apply during the leave except that increases in , amount of insurance, whether automatic or subject to election, are not effective for an Insured who is not Actively , at Work until such time as he/she retums to Active Work for one full day. , ' All other terms and conditions of this Policy will remain in force while an Insured is on an approved Family and Medical I Leave of Absence. LRS-6422-69 Ed. 01/99 Page 14.0