51-I10 - Life Contract Rider 3.pdf

Symetra® is a registered service mark of Symetra Life Insurance Company.

LGC-13002 10/12

Symetra Life Insurance Company 777 108th Avenue NE, Suite 1200 Bellevue, Washington 98004-5135 (An insurance company)

Incorporation Provision

Occupational Death Benefit

Rider Number: 3 Policyholder: City of Burleson Policy Number: 01 017859 00

The following provision is hereby added to the above-referenced Group Policy and Certificate of Insurance. This Rider does not vary, waive, alter or extend any of the terms, conditions or provisions of The Policy.

Occupational Death Benefit: When is the Occupational Death Benefit payable?

If You suffer a Loss of life as the result of a Covered Occupational Death, We will pay an Occupational Death Benefit if Your death occurs:

1) within 365 days after the date You were last Actively at Work; and

2) while You were covered under The Policy.

Covered Occupational Death means a death caused by or resulting from an Injury sustained while You are Actively at Work as a Public Safety Officer, or in the case of a required period of work not coinciding with regular work hours, while in transit to or from work.

Public Safety Officer means an Active Employee whose primary job duties include controlling or reducing crime or juvenile delinquency, criminal law enforcement, or fire suppression. Public Safety Officer means police officers, firefighters, corrections officers, judicial officers, and officially recognized or designated volunteer firefighters, if they otherwise meet the definition of Public Safety Officer.

The Occupational Death Benefit will not be payable if Your death is caused or contributed by:

1) suicide or attempted suicide, whether sane or insane;

2) Injury sustained while committing or attempting to commit a felony; or

3) voluntary use or consumption of any poison, chemical compound or drug, including but not limited to prescription medications, unless as prescribed to You by or administered to You by a Physician.

The specific amounts for this Benefit are shown in the Schedule of Insurance.

The effective date of these changes is January 1, 2024, but will not be effective prior to an insured person’s effective date of coverage. All other terms and provisions of The Policy will apply other than as stated in this Rider.

The provisions found in the Certificate(s) of Insurance will control the benefit plan, period of coverage, exclusions, claims and other general policy provisions pertaining to state insurance law requirements.

In all other respects, The Policy and Certificate(s) of Insurance remain the same.

Symetra Life Insurance Company

By: Margaret Meister, President Instructions: Retain a copy with your Policy.