General Provisions - Life Insurance/Accidental Death & Dismemberment Coverage

Notice and Proof of Claim

Written notice of a medical or health insurance claim must be given at least 45 days before the end of the calendar year which follows the calendar year in which the claim is incurred. However, in the event that medical or health insurance ends, notice of claim in writing must be given no later than 12 months after such claim was incurred. Written notice of any other type of accident and sickness claim must be given to the Company at its home office or an authorized claim office or to an agent. Notice should include the name of the insured individual and the policy number.

Loss, as used in this provision, means covered expenses incurred, disability or accidental death or dismemberment.

When the Company receives the notice of claim, it will send the claimant forms for filing proof of claim. If these forms are not given to the claimant within 15 days, the claimant will meet the proof of claim requirements by giving the Company a statement in writing of the nature and extent of the loss within the time limit stated in the paragraph below.

Positive proof of claim must be given to an authorized claim office of the Company, as follows:

1. For a medical or health insurance claim, before the end of the calendar year which follows the calendar year in which the loss is incurred. However, in the event that medical or health insurance of the insured individual ends, proof of claim must be given no later than 12 months after such loss was incurred;
2. For a continuing loss (except a medical or health insurance claim), within 90 days after the end of the policy month in which the loss begins and each following policy month during which the loss continues;
3. For other losses, within 90 days after the date of such loss.

Proper positive written notice and proof of loss must be given before the Company will be liable for any loss. If it was not reasonably possible to give notice and proof in writing in the time required, the Company shall not reduce or deny the claim for this reason of proof if filed as soon as reasonably possible.

Payment of Claim

All benefits, other than for accidental death, will be paid to the Employee, subject to any written assignment of benefits by the Employee, which is authorized by the policy and made on a form satisfactory to the Company. If the policy has an accidental death benefit, such benefit will be payable to the beneficiary named by the Employee or otherwise determined by the provisions of the policy.

Claims for all other benefits shall be paid as follows, subject to due proof of claim:

1. For a continuing loss, claims will be payable each two weeks during the time that the Company is liable, and any balance still unpaid at the end of such period will be paid as soon as due proof is received;
2. For other losses, claim will be paid as soon as due proof is received.

Physical Examination and Autopsy

The Company has the right to examine the person with respect to whom benefits are claimed as often as reasonably needed while the claim is pending. It may also have an autopsy made unless against the law.

Legal Actions

No action at law or in equity may be brought to recover on the policy before the end of 60 days after proof in writing of the loss has been given, as required by the policy. No such action may be brought after 3 years from the time written proof of loss is required to be given.

Facility of Payment

All benefits shall be paid as stated in the Payment of Claim section except that benefits not validly assigned will be paid as follows if:

1. The Employee dies, the Company may pay any unpaid benefits, except the benefits for accidental death, to the natural person(s), if any, who becomes entitled at the Employee's death to be paid any of such Employee's Life Insurance proceeds (except persons who are minors at the time of payment). If there is no such person, the unpaid benefits shall be paid to the estate of the Employee.
2. Any payee, in the opinion of the Company, is not able to give a valid receipt and discharge for any payment, and claim is not made by duly appointed guardian or committee, the Company may pay such benefits to any beneficiary named by the Employee under the Life Coverage of the policy. This beneficiary must be a living natural person, not be a minor at the time of payment or be named as fiduciary. If there is no named beneficiary alive, the Company may make such payment or any portion thereof to any person or institution who, in its opinion, has rendered services to or cared for such payee.
   
   The Company may pay all or any benefits for covered expenses to the hospital, other such institutions, or the person giving medical or dental care or supplies.
   
   Any payments made according to the above paragraphs will discharge the Company to the extent of any such payment. The Company shall not be bound to see the use of the money so paid.

Assignments and Claims of Creditors

The policy provides that the insured individual may make an absolute assignment and transfer of the ownership of the insurance on his life under the policy, but only as a gift. No consideration may be given. The Company will not be responsible for the validity of assignment. When the Company receives and acknowledges such assignment, it shall not be liable for any action, payment, or other settlement made before such receipt.

Incontestability

The Company cannot contest the policy, unless the premiums are not paid, after it has been in force for two years from the date of issue. Also, the Company cannot contest the insurance of an eligible person whose insurance has been in force for two years during his lifetime unless the premiums are not paid. No statement, made by any person insured under the policy, that relates to his insurability will be used to contest his insurance unless such statement is made in writing and signed by such person.

Misstatement of Age

If the age of an insured individual has been misstated, any amounts payable will be those the premium would have purchased at the correct age. Any such misstatement shall neither continue insurance ended by valid means or void insurance otherwise valid in force.

Sex and Number

When used in the policy, the masculine includes the feminine, the singular the plural, and the plural the singular.