54-I7 - Life Contract Rider 0.pdf

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

LGC-10024/TX 1/12 1

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

Incorporation Provision

Beneficiary Companion, Travel Assistance and Identity Theft Resolution Services Policy Rider

Rider Number: 001 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.

Noninsurance Benefits We may agree with the Policyholder to offer or provide to you the value-added benefits and services listed below.

We have arranged for a third party service provider to give access to you to the services which relate to the line of insurance coverage the Policyholder has purchased. While we have arranged for this access, the third party service provider is liable to you for the provision of such services. We are not responsible for the provision of such services nor are we liable for the failure of the provision of the same. Further, we are not liable to you for the negligent provision of such services by this third party service provider. If you wish to initiate a complaint or are requesting an appeal, please contact the vendor by calling 1-877-823-5807 and you will be guided through the complaint resolution process by the vendor. Please note that if the vendor fails to provide or continue to provide the services listed below, then no services are available, since we are not responsible for providing these services.

Beneficiary Companion services:

• Issue of a Beneficiary Companion Guidebook

• Access to Beneficiary Assistance Coordinators any time, any day of the week

• Assistance if a deceased's identity is stolen

Dedicated Beneficiary Assistance Coordinators are available 24/7 to:

• Answer any questions

• Offer guidance on how to obtain death certificate copies

• Manage notifications, including:

• Social Security Administration

• Credit reporting agencies

• Credit card companies/financial institutions

• Third-party vendors

• Government agencies

Travel Assistance services:

• Help finding physicians, dentists and medical facilities.

• Free transportation under medical supervision to a hospital/treatment facility.

• Replacement of medication or eyeglasses.

• Monitoring during a medical emergency to determine if care is appropriate, or if evacuation is required.

• Arrangement for your traveling companion’s return home if previously made arrangements are lost due to your medical emergency.

• Free transportation home for dependent children under the age of 16 who were traveling with you and are left unattended because of your hospitalization. A qualified escort will be arranged if necessary.

• Free round-trip transportation for one immediate family member or friend to visit you if you are traveling alone and are likely to be hospitalized for seven consecutive days.

Identity Theft Resolution services:

• Assistance completing an ID theft affidavit to submit to the proper authorities, credit bureaus and creditors.

• Help replacing credit, debit and membership cards.

• A credit report review with the beneficiary.

• Suppression of the deceased’s credit report or an offer to freeze/close the account with credit bureaus.

• Full-service resolution assistance if the deceased’s identity is stolen, including affidavit assistance, credit bureau and fraud department notification, help filing a police report, and creditor follow-up.

LGC-10024/TX 1/12 2

To obtain these benefits, contact Europ Assistance at 1-877-823-5807. You may obtain a complete description of these services in the additional materials given to you by the Policyholder.

As an insured employee, you and your family members have access to these programs at no additional charge.

Termination of these services will occur if your coverage under the group policy terminates for any reason, or in the event that the Policyholder chooses to discontinue these services.

The effective date of these changes is January 1, 2019 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 amendment.

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.