Exhibit_C2_-_SCCCSB_Voluntary_Critical_Illness_Certificate.pdf

GC0614-CI

STANDARD INSURANCE COMPANY

A Stock Life Insurance Company 900 SW Fifth Avenue

Portland, Oregon 97204-1282

(503) 321-7000

GROUP CRITICAL ILLNESS INSURANCE CERTIFICATE

Policyholder: Superior Court of California, County of San Bernardino

Employer(s):

Superior Court of California, County of San Bernardino

Group Policy Number: 160283-C

Group Policy Effective Date: 01/01/2020

State of Issue: California

The Group Policy has been issued to the Policyholder. We certify that you will be insured as provided by the terms of the Group Policy. If your insurance is changed by an amendment to the Group Policy, we will provide the Policyholder or Employer with a revised Certificate or other notice that will be available to you.

Possession of this Certificate does not necessarily mean you are insured. You are insured only if you meet the requirements set out in this Certificate.

"You" and "your" mean the Member. "We", "us" and "our" mean Standard Insurance Company. Other defined terms appear with the initial letters capitalized. Section and provision headings, and references to them, appear in boldface type.

Your Certificate describes the insurance under the Group Policy. Please read your Certificate carefully.

YOU HAVE THE RIGHT TO REVIEW THIS CERTIFICATE AND RETURN IT WITHIN 30 DAYS FOR A FULL

PREMIUM REFUND.

THIS POLICY IS NOT IN LIEU OF AND DOES NOT AFFECT ANY REQUIREMENT FOR COVERAGE BY

WORKMENS’ COMPENSATION INSURANCE.

THIS CERTIFICATE IS ISSUED UNDER A LIMITED BENEFIT POLICY THAT PROVIDES CRITICAL ILLNESS INSURANCE BENEFITS. IT IS NOT A SUBSTITUTE FOR ESSENTIAL HEALTH BENEFITS OR MINIMUM

ESSENTIAL COVERAGE AS DEFINED IN FEDERAL LAW. IT DOES NOT PROVIDE COVERAGE FOR

HOSPITAL, SURGICAL OR MAJOR MEDICAL EXPENSES.

THIS CERTIFICATE IS NOT A MEDICARE SUPPLEMENT POLICY. IF YOU ARE ELIGIBLE FOR MEDICARE, REVIEW THE “GUIDE TO HEALTH INSURANCE FOR PEOPLE WITH MEDICARE” AVAILABLE FROM US.

THIS POLICY DOES NOT PAY BENEFITS FOR ANY SKIN MALIGNANCIES (SUCH AS BASAL CELL AND SQUAMOUS CELL CARCINOMAS,) PRE-MALIGNANT LESIONS, INTRAEPITHELIAL NEOPLASIA, BENIGN

TUMORS OR POLYPS UNDER THIS GROUP POLICY.

STANDARD INSURANCE COMPANY

By

TABLE OF CONTENTS

COVERAGE FEATURES

Employer(s)

Member

Class(es)

Eligibility Waiting Period

Premium Contributions

Coverage Amount

Amount Payable

Additional Benefits

Additional Features

ELIGIBILITY AND ENROLLMENT

Becoming Insured

When Your Insurance Becomes Effective

Evidence Of Insurability

Changes in Your Insurance

Active Work Requirement

When Your Insurance Ends

CHILD INSURANCE

When Child Insurance Becomes Effective

Changes in Child Insurance

When Child Insurance Ends

SPOUSE INSURANCE

Eligibility for Spouse Insurance

When Spouse Insurance Becomes Effective

Evidence Of Insurability

Changes in Spouse Insurance

When Spouse Insurance Ends

CRITICAL ILLNESS BENEFITS

Insuring Clause

Critical Illness Definitions

Child Diseases

Additional Benefits

EXCLUSIONS

General Exclusions

ADDITIONAL FEATURES

Reinstatement

Continuity of Coverage

Continuation of Insurance (Portability) for the Member

Continuation of Insurance (Portability) for the Spouse

CLAIMS AND BENEFIT PAYMENT

Notice of Claim

Filing a Claim

Time Limits on Filing Proof Of Loss

Proof Of Loss

Investigation of Claim

Notice of Decision on Claim

Review Procedure

Time of Payment

Payment of Benefits

Reimbursement

Unpaid Premium

GENERAL PROVISIONS

Assignment

Time Limits on Legal Actions

Incontestability of Insurance

Clerical Error

Agency

Misstatement of Age

Misstatement of Tobacco Use

DEFINITIONS

INDEX OF DEFINED TERMS

Active Work, Actively At Work, 6 Annual Enrollment Period, 4

Calendar Year, 18 Child, 24 Childhood, 24 Civil Union, 25

Dependent(s), 24 Domestic Partner, 25

Eligibility Waiting Period, 24 Employer, 24 Evidence Of Insurability, 24

Family Status Change, 4

Group Policy, 25 Guarantee Issue Amount, 1

Limb, 25

Malignant, 11

Physician, 25 Prior Plan, 25 Proof Of Loss, 21

Spouse, 25

War, 18

GC0614-CI 1

COVERAGE FEATURES

Employer(s)

Superior Court of California, County of San Bernardino

Member

You are a Member if you are all of the following:

A regular employee of the Employer working in the United States.

Actively At Work at least 40 hours per pay period.

A citizen or resident of the United States.

You are not a Member if you are:

� A temporary or seasonal employee.

� A full time member of the armed forces of any country.

� A leased employee.

� An independent contractor.

Class(es)

All Members

Eligibility Waiting Period

If you are a Member on the Group Policy Effective Date, you are eligible on that date.

If you become a Member after the Group Policy Effective Date, you are eligible on the first day following 14 days as a Member.

Premium Contributions

For you and your Child: Contributory

For your Spouse: Contributory

Contributory means you pay all or part of the premium for insurance.

Coverage Amount

The Coverage Amount is the amount of insurance under the Group Policy. The Guarantee Issue Amount is the amount of insurance you may apply for without submitting Evidence Of Insurability. Coverage Amounts requiring Evidence Of Insurability are not effective until approved by us.

For Member: The amount you elect and we approve: $10,000 or $20,000 or $30,000.

For Child(ren): 50% of your Coverage Amount.

For Spouse: The amount you elect and we approve: $5,000 or $10,000 or $15,000.

Not to exceed 50% of your Coverage Amount.

Guarantee Issue Amount

For Member: $30,000

GC0614-CI 2

For Spouse: $15,000

Amount Payable

Table of Critical Illness Benefits

The amount payable is the percentage of the Coverage Amount in effect on the date of the Critical Illness.

Subject to the Reoccurrence Benefit, only one Critical Illness is payable unless an initial diagnosis or recommendation, as required, for a different and subsequent Critical Illness is made at least 90 days after the preceding Critical Illness.

Cancer

Invasive Cancer 100% of Coverage Amount

Non-Invasive Cancer 25% of Coverage Amount

Coma 100% of Coverage Amount

End-Stage Renal (Kidney) Failure 100% of Coverage Amount

Loss of Sight 100% of Coverage Amount

Major Organ Failure 100% of Coverage Amount

Myocardial Infarction (Heart Attack) 100% of Coverage Amount

Occupational Hepatitis 100% of Coverage Amount

Paralysis (2 or more Limbs)

100% of Coverage Amount

Severe Coronary Artery Disease With a Recommendation of Bypass Surgery

25% of Coverage Amount

Severe Stroke 100% of Coverage Amount

Child Diseases 100% of Coverage Amount for Child

Reoccurrence Benefit 100% of Coverage Amount

If a Critical Illness Benefit is payable and there is a subsequent diagnosis or recommendation for the same Critical Illness, a Reoccurrence Benefit is payable if you and your Dependents meet both of the following:

� You and your Dependents have been continuously insured under the Group Policy between the initial and subsequent diagnosis or recommendation.

� You and your Dependents have served a 12 month Treatment Free Period during such continuous insurance.

A Reoccurrence Benefit is payable only once per each Critical Illness during your or your Dependent's lifetime.

Treatment Free Period means you or your Dependent have not done any of the following in connection with the Critical Illness:

� Consulted a physician or other licensed medical professional.

� Received medical treatment, services or advice.

� Undergone diagnostic procedures, including self-administered procedures.

� Taken prescribed drugs or medications.

GC0614-CI 3

Treatment Free Period does not include:

� Maintenance drug therapy (such as: ongoing antiplatelet regimens and statins; ongoing hormonal therapy, immunotherapy or chemoprevention therapy) that is intended to decrease the risk of Critical Illness reoccurrence.

� Routine follow-up visits with a Physician, including necessary tests (such as a stress treadmill) to verify whether or not a Critical Illness has reoccurred.

Additional Benefits

You may select the Health Maintenance Screening Benefit for you and your Dependents.

Health Maintenance Screening Benefit $50

Additional Features

Reinstatement

Continuity of Coverage

Continuation of Insurance (Portability) for the Member

Continuation of Insurance (Portability) for the Spouse

GC0614-CI 4

ELIGIBILITY AND ENROLLMENT

Becoming Insured

To become insured you must:

• Be a Member.

• Complete your Eligibility Waiting Period.

• Meet the requirements shown in When Your Insurance Becomes Effective and Active Work Requirement.

• Submit Evidence Of Insurability, if required.

When Your Insurance Becomes Effective

The Coverage Features states whether insurance is Contributory or Noncontributory. Subject to the Active Work Requirement, your insurance becomes effective as follows:

Insurance Subject to Evidence Of Insurability

Insurance subject to Evidence Of Insurability becomes effective on the later of:

� The first day of the calendar month coinciding with or next following the date we approve your Evidence Of Insurability.

� The January 1 next following the Annual Enrollment Period during which we approved your

Insurance Not Subject to Evidence Of Insurability

Contributory insurance

You must apply in writing for Contributory insurance and agree to pay premiums. Contributory insurance not subject to Evidence Of Insurability becomes effective on:

� The date you become eligible if you apply on or before that date.

� The date you apply if you apply within 31 days after you become eligible.

� The January 1 next following the Annual Enrollment Period if you apply during the Annual Enrollment Period.

� If you have a Family Status Change the later of:

� The date of the Family Status Change if you apply on or before the date of the Family Status Change.

� The date you apply if you apply within 31 days of the Family Status Change.

� The January 1 next following the Annual Enrollment Period if you apply for the Family Status Change during the Annual Enrollment Period.

Annual Enrollment Period means the period designated each year by your Employer when you may apply for insurance or change insurance elections.

Family Status Change means any of the following events:

� Your marriage or divorce or dissolution of your Civil Union or Domestic Partner relationship.

� The birth of your Child.

� The adoption of a Child by you.

� The death of your Dependent.

GC0614-CI 5

� The commencement or termination of your Spouse's employment.

� A change in employment from full-time to part-time by your Spouse.

� A loss of critical illness insurance through your Spouse’s employment.

Evidence Of Insurability

Evidence Of Insurability will be required as follows:

� For Contributory insurance if you apply more than 31 days after you become eligible.

� For reinstatements, if required.

� If you were required to provide Evidence Of Insurability during a prior period of eligibility under the Group Policy and either:

� You did not provide Evidence Of Insurability; or

� We disapproved your Evidence Of Insurability.

� For any Coverage Amount in excess of the Guarantee Issue Amount.

Evidence Of Insurability will be waived to become insured for the Guarantee Issue Amount if:

� You have a Family Status Change; and you apply within 31 days of the Family Status Change.

However, we will not waive Evidence Of Insurability if you previously submitted Evidence Of Insurability and it was not approved by us.

Changes in Your Insurance

You may apply in writing for any increase in your insurance.

Evidence Of Insurability for Contributory insurance will be required as follows:

� For increases in Coverage Amounts.

� If you were required to provide Evidence Of Insurability during a prior period of eligibility under the Group Policy and either:

� You did not provide Evidence Of Insurability; or

Evidence Of Insurability will be waived in the following instances:

� For any increase in Coverage Amount not to exceed the Guarantee Issue Amount.

� You have a Family Status Change; and you apply for the increase up to the Guarantee Issue Amount within 31 days of the Family Status Change.

However, we will not waive Evidence Of Insurability if you previously submitted Evidence Of Insurability

Subject to the Active Work Requirement, increases in your insurance become effective as follows:

Increases Subject to Evidence Of Insurability

Increases subject to Evidence Of Insurability become effective on the later of:

� The first day of the calendar month coinciding with or next following the date we approve your Evidence Of Insurability.

� The January 1 next following the Annual Enrollment Period during which we approved your

� The date we approve your Evidence Of Insurability due to a Family Status Change.

Increases Not Subject to Evidence Of Insurability

GC0614-CI 6

Increases not subject to Evidence Of Insurability become effective on the later of:

� The January 1 next following the Annual Enrollment Period during which you apply for the increase.

� The date of your Family Status Change.

Decreases in Coverage Amounts become effective on:

� The first day of the calendar month coinciding with or next following the date the Policyholder or Employer receives your written request for the decrease.

Active Work Requirement

If you are incapable of Active Work because of sickness, injury, or pregnancy on the day before the scheduled effective date of your insurance or increase in Coverage Amount under the Group Policy, such insurance will not become effective until the day after you complete 1 full day(s) of Active Work as an eligible Member.

Active Work and Actively At Work mean performing the material duties of your own occupation at your Employer's usual place of business.

You will also meet the Active Work requirement if you meet all of the requirements shown below:

� You were absent from Active Work because of a regularly scheduled day off, holiday, or vacation day.

� You were Actively At Work on your last scheduled work day before the date of your absence.

� You were capable of Active Work on the day before the scheduled effective date of your insurance.

When Your Insurance Ends

Insurance ends automatically on the earliest of the following:

� For Contributory insurance, the date you notify the Policyholder or your Employer in writing that coverage is to be terminated.

� The date the last period ends for which the premium was paid for your insurance.

� The date the Group Policy terminates unless you continue your insurance under the Continuation of Insurance (Portability) for the Member provision.

� The first day of the calendar month following the date your employment terminates unless you continue your insurance under the Continuation of Insurance (Portability) for the Member provision.

� The date you reach age 80.

� The date you cease to be a Member. However, if you cease to be a Member because you are not working the required minimum number of hours, your insurance will be continued with payment of premium:

� During the first 60 days of a temporary or indefinite administrative leave of absence.

� During any other scheduled leave of absence approved by your Employer in advance and in writing and lasting not more than 60 days.

� During a leave of absence which is required by the federal or a state-mandated family or medical leave act or law.

CHILD INSURANCE

When Child Insurance Becomes Effective

GC0614-CI 7

Insurance for your Child becomes effective as follows:

• The date your insurance becomes effective if you have a Child on that date.

• The date you first acquire a Child, if you are insured on that date.

If you have more than one Child on the effective date, all are insured as of that date. While your insurance is in effect, each new Child becomes insured immediately.

A Member may not be insured as both a Member and a Child. A Child may not be insured by more than one Member.

Changes in Child Insurance

Increases or decreases resulting from changes in your Coverage Amounts will become effective for a Child on the effective date of your change.

When Child Insurance Ends

Your insurance for a Child ends automatically on the earliest of:

� The date your insurance ends unless the Child insurance is continued under the Continuation of Insurance (Portability) for the Member provision or Continuation of Insurance (Portability) for the Spouse provision.

� The date the Child insurance terminates under the Group Policy unless the Child insurance is continued under the Continuation of Insurance (Portability) for the Member provision or Continuation of Insurance (Portability) for the Spouse provision.

� The date a Child ceases to meet the definition of Child.

� The date the Group Policy terminates unless the Child insurance is continued under the Continuation of Insurance (Portability) for the Member provision.

SPOUSE INSURANCE

Eligibility for Spouse Insurance

You become eligible to insure your Spouse on the later of:

� The date you become eligible for insurance if you have a Spouse on that date.

� The date you acquire a Spouse, if you are insured on that date.

A Member may not be insured as both a Member and a Spouse.

When Spouse Insurance Becomes Effective

The Coverage Features states whether your Spouse insurance is Contributory or Noncontributory. You must apply in writing for Contributory Spouse insurance and agree to pay premiums.

Spouse Insurance Subject to Evidence Of Insurability

Spouse insurance subject to Evidence Of Insurability becomes effective on the later of:

� The first day of the calendar month coinciding with or next following the date we approve Evidence Of Insurability for your Spouse;

� The January 1 next following the Annual Enrollment Period during which we approved Evidence Of Insurability for your Spouse.

Spouse insurance will not become effective if you were required to submit Evidence Of Insurability and either:

GC0614-CI 8

� You did not submit Evidence Of Insurability.

Spouse Insurance Not Subject to Evidence Of Insurability

Contributory Spouse insurance becomes effective on:

� The date your insurance becomes effective if you apply on or before that date to insure your Spouse.

� The date you apply to insure your Spouse.

� If you have a Family Status Change, the later of:

� The date of the Family Status Change if you apply on or before the date of the Family Status Change.

� The date you apply, if you apply within 31 days of the Family Status Change.

Evidence Of Insurability

Evidence Of Insurability will be required for your Spouse as follows:

� For Contributory insurance if you apply more than 31 days after you become eligible for Spouse insurance.

� For reinstatements, if required.

� If Evidence Of Insurability was required for your Spouse during a prior period of eligibility under the Group Policy and either:

� Evidence Of Insurability was not provided for your Spouse; or

� We disapproved Evidence Of Insurability for your Spouse.

� For any Coverage Amount in excess of the Spouse Guarantee Issue Amount.

Evidence Of Insurability will be waived to become insured for the Guarantee Issue Amount if:

� You have a Family Status Change; and you apply within 31 days of the Family Status Change.

However, we will not waive Evidence Of Insurability if you previously submitted Evidence Of Insurability

Changes in Spouse Insurance

You may apply in writing for any increase in your Spouse insurance.

Evidence Of Insurability for Contributory insurance will be required as follows:

� For increases in Coverage Amounts.

� If Evidence Of Insurability was required for your Spouse during a prior period of eligibility under the Group Policy and either:

� Evidence Of Insurability was not provided for your Spouse; or

� We disapproved Evidence Of Insurability for your Spouse.

GC0614-CI 9

Evidence Of Insurability will be waived in the following instances:

� For any increase in your Spouse’s Coverage Amount not to exceed the Spouse Guarantee Issue Amount.

� For additional insurance due to a plan change.

� For any increase in Coverage Amount not to exceed the Guarantee Issue Amount if:

� You have a Family Status Change; and you apply within 31 days of the Family Status Change.

However, we will not waive Evidence Of Insurability if you previously submitted Evidence Of Insurability for your Spouse and it was not approved by us.

Increases in your Spouse’s insurance become effective as follows:

Spouse Insurance Increases Subject to Evidence Of Insurability

Increases in your Spouse’s insurance subject to Evidence Of Insurability become effective on the later of:

� The first day of the calendar month coinciding with or next following the date we approve Evidence Of Insurability for your Spouse.

� The January 1 next following the Annual Enrollment Period during which we approved Evidence Of Insurability for your Spouse.

� The date we approved Evidence Of Insurability for your Spouse due to a Family Status Change.

Spouse Insurance Increases Not Subject to Evidence Of Insurability

Increases in your Spouse’s insurance not subject to Evidence Of Insurability becomes effective on the latest of:

� The date you apply for the increase.

� The January 1 next following the Annual Enrollment Period during which you apply for the increase.

� The date of your Family Status Change.

Decreases in your Spouse’s Coverage Amounts become effective on:

� The first day of the calendar month coinciding with or next following the date the Policyholder or Employer receives your written request for the decrease.

When Spouse Insurance Ends

Your insurance for a Spouse ends automatically on the earliest of:

� The date your insurance ends unless Spouse insurance is continued under the Continuation of

Insurance (Portability) for the Member provision or Continuation of Insurance (Portability) for the Spouse provision.

� The date Spouse insurance terminates under the Group Policy, unless Spouse insurance is continued under the Continuation of Insurance (Portability) for the Member provision or Continuation of Insurance (Portability) for the Spouse provision.

� The date a Spouse ceases to meet the definition of Spouse.

� The date the last period ends for which the premium was paid for your Spouse insurance.

� The date the Group Policy terminates, unless Spouse insurance is continued under the Continuation of Insurance (Portability) for the Member provision.

� The date your Spouse reaches age 80.

GC0614-CI 10

CRITICAL ILLNESS BENEFITS

Insuring Clause

If you or your Dependent incur a Critical Illness or meet the requirements for the Additional Benefits while insured under the Group Policy, we will pay benefits according to the terms of the Group Policy after we receive Proof Of Loss. Benefits for Non-Invasive Cancer and Severe Coronary Artery Disease with Recommendation of Bypass Surgery are offered on a reduced basis. For any Critical Illness, if a pathological diagnosis is medically inappropriate, a clinical diagnosis will be accepted instead.

Critical Illness Definitions

Cancer:

We cover two categories of Cancer: Invasive Cancer and Non-Invasive Cancer. Each category of Cancer is defined below. Different benefit amounts are payable for each category as shown in the Table of Critical Illness Benefits. Non-Invasive Cancer may be covered at a lesser benefit amount than Invasive Cancer, see the Table of Critical Illness benefits for more information.

The diagnosis must:

• Be made while insured under the Group Policy.

• Be made by a Physician.

• Be based on pathological or clinical evidence.

Invasive Cancer means an initial diagnosis of any Malignant tumor or neoplasm with histological confirmation, characterized by the uncontrolled growth of Malignant cells and invasion of tissue beyond the initial tissue (invasive).

Invasive Cancer includes:

• Leukemia

• Lymphoma

• Sarcoma

• Malignant melanoma or other skin malignancies that have been histologically classified as having caused invasion beyond the epidermis with a Clark’s level III or greater, Breslow’s depth of 0.75mm or greater, or AJCC TNM stage II or greater are included.

Invasive Cancer does not include:

• All cancers which are histologically classified as pre-malignant, or non-invasive having borderline malignancy, or having low malignant potential.

• Breast Cancer that has not spread to surrounding tissue and is histologically classified as T1N0M0 or equivalent (breast cancer that has not metastasized beyond the breast).

• Benign tumors or polyps or cancerous tumors that have not spread.

• Early prostate cancer that has not spread to surrounding tissue and that is histologically classified as T1N0M0 or equivalent staging (prostate cancer that has not metastasized beyond the prostate).

• Chronic lymphocytic leukemia that is histologically classified as Rai Stage 0 or Binet Stage A.

• Any skin cancer not previously incorporated in this definition, including:

• Cutaneous lymphoma.

• Melanoma that is histologically classified as Clark’s level I or II; Breslow’s depth of less than 0.75mm; or AJCC TNM stage 0 or I.

GC0614-CI 11

Non-invasive Cancer means an initial diagnosis of cancer in which the tumor or cells still lie within the tissue of origin without invading neighboring tissue or regional lymph nodes.

Non-invasive Cancer includes:

• Early prostate cancer that has not spread to surrounding tissue and is histologically classified as T1N0M0 or equivalent staging (prostate cancer that has not metastasized beyond the prostate).

• Breast Cancer that has not spread to surrounding tissue and is histologically classified as T1N0M0 or equivalent (breast cancer that has not metastasized beyond the breast).

• Non Malignant melanoma which is not invading the reticular (lower) dermis and that is histologically classified Clark’s level I or II, Breslow’s depth of less than 0.75mm, or AJCC TNM stage 0 or I.

Non-Invasive Cancer does not include lesser skin malignancies, as follows:

• Basal cell and squamous cell carcinomas.

• Pre-malignant lesions.

• Intraepithelial neoplasia.

• Benign tumors or polyps.

Malignant means a tumor that grows in an uncontrolled manner, has invaded surrounding tissue, and has spread (metastasize).

Coma means an initial diagnosis of a profound state of mental unconsciousness from which one cannot be aroused and there is no evidence of appropriate response to external stimulation, other than primitive avoidance reflexes, due to an accident or disease.

The diagnosis must:

� Be made while insured under the Group Policy.

� Be made by a Physician.

� Must last for at least 14 consecutive days resulting in neurological deficit with persisting clinical symptoms.

Coma which is medically induced or Coma as a result of drug or alcohol use is not included.

End-Stage Renal Failure means an initial diagnosis of chronic and end-stage irreversible failure of both kidneys to function, as a result of which the need for regular, at least weekly and for longer than 6 months, kidney dialysis or kidney transplant is recommended to sustain life.

The diagnosis and recommendation must:

• Be made while insured under the Group Policy.

� Be made by a board certified nephrologist.

Loss of Sight means an initial diagnosis of entire, uncorrectable, and irrecoverable loss of sight due to an accident or a disease.

The diagnosis must:

� Be made while insured under the Group Policy.

� Be made by a Physician.

� Be based on evidence of sight in the better eye being reduced to a best-corrected visual acuity of 20/200 (Snellen or E-Chart Acuity) and visual field restriction to 20° or less in both eyes.

� For a Child, occur after age 3.

GC0614-CI 12

Major Organ Failure means an initial diagnosis of irreversible failure of the heart, liver, lung, small intestine, or pancreas as a result of a disease and, for which a transplantation of the organ(s) or tissue from a suitable human donor is required.

� Be made while insured under the Group Policy.

• Be made by a Physician.

� Be based on clinical evidence of major organ failure of an organ(s) or tissue and requires that your or your Dependent’s condition meet the criteria for placement on the registry with the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) or its medically recognized successor organization.

If you or your Dependent do not meet the criteria for placement on the registry because your or your Dependent’s condition is too far advanced or you or your Dependent are too ill to proceed with a transplant, this requirement will not apply.

Myocardial Infarction is commonly known as a heart attack and means an episode of rapid onset of chest pain that required immediate medical attention and with an initial diagnosis of death of a portion of the heart muscle as a result of inadequate blood supply to the heart.

The diagnosis must:

• Be made while insured under the Group Policy.

• Be made by a Physician.

• Be based on new changes consistent with an evolving infarction on electrocardiogram (EKG) and concurrent with elevation of infarction specific enzymes, troponins or other biochemical markers accepted to be indicative of an acute Myocardial Infarction. In the event of death, an autopsy or death certificate indicating Myocardial Infarction as the cause will apply.

Myocardial Infarction does not include a heart attack that occurred during a medical procedure or due to alcohol or drug abuse. Other acute coronary syndromes, including but not limited to angina, are not included.

Occupational Hepatitis means an initial diagnosis of hepatitis, other than hepatitis A, that occurs as a result of a documented accidental exposure in the workplace to blood or other bodily fluids.

The diagnosis must:

� Be made while insured under the Group Policy.

� Be made by a Physician.

� Be based on blood testing. A blood test is required within 72 hours of the accidental exposure with the results showing as negative for hepatitis. A follow up blood test with the results showing as positive for hepatitis must occur 6 to 12 months after the accidental exposure.

� Be documented by an appropriate accident report at the workplace.

Occupational Hepatitis does not include hepatitis that occurs as a result of intravenous drug use, sexual transmission, or is determined not to be an accident.

Paralysis means an initial diagnosis of the irreversible loss of all motor function of two or more Limbs due to an accident or a disease.

The diagnosis must:

� Be made while insured under the Group Policy.

� Be made by a Physician.

Severe Coronary Artery Disease with a Recommendation of Bypass Surgery means a narrowing or blockage of the arteries and vessels that provide oxygen and nutrients to the heart that result in an initial diagnosis of severe coronary artery disease which results in a Physician’s recommendation of bypass surgery. Severe

GC0614-CI 13

Coronary Artery Disease with a Recommendation of Bypass Surgery includes but is not limited to: open heart surgery to increase the flow of blood through the coronary arteries.

The diagnosis and recommendation must:

• Be made while insured under the Group Policy.

• Be made by a Physician.

• Be based on a clinical diagnosis.

Severe Coronary Artery Disease does not include: angioplasty, stenting, percutaneous coronary intervention, or laser procedures.

If a Physician has recommended bypass surgery but you are too ill to proceed with the recommended surgery, the requirement that bypass surgery be recommended will not apply.

Severe Stroke means an initial diagnosis of: a cerebrovascular accident or infarction (death) of brain tissue caused by hemorrhage, embolism or thrombosis producing measurable, neurological deficit, which is expected to be permanent.

The diagnosis must:

• Be made while insured under the Group Policy.

• Be made by a Physician assigning a Modified Rankin Scale score of 4 (moderately severe disability) or greater.

• Be based on objective clinical evidence of brain tissue damage using current neuroimaging tests, including but not limited to: Computed Tomography scan (CT); Magnetic Resonance Imaging (MRI);

Positron Emission Tomography scan (PET); arteriography; or angiography.

Severe Stroke does not include Transient Ischemic Attack (TIA) and traumatic injury to brain tissue or blood vessels. A transient ischemic attack (TIA) is an episode of temporary neurologic dysfunction caused by a restriction in blood supply to tissues of the brain, spinal cord, or eye that typically lasts less than an hour and not more than 24 hours and is not associated with acute tissue death.

Child Diseases

Means any of the following Critical Illnesses where an initial diagnosis is made while the Child is insured under the Group Policy or the initial diagnosis was made prior to birth and you were insured under the Group Policy and the Child became insured at birth:

Anal Atresia means a malformation of the anus and rectum.

The diagnosis must:

� Be made at birth with a physical examination, abdominal x-ray, ultrasound or Magnetic Resonance Imaging (MRI); or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero.

� Be made by a Physician.

� Include a recommendation for surgical intervention.

Anencephaly means an incomplete development of the brain, skull and scalp (neural tube defects).

The diagnosis must:

� Be made at birth with a physical examination; or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero via ultrasound, amniocentesis, or a serum folic acid test.

� Be made by a Physician.

Biliary Atresia means a blockage in the bile duct tubes inhibiting bile flow from the liver to the gallbladder.

GC0614-CI 14

� Be made by a diagnostic test, including but not limited to: abdominal x-ray; ultrasound; blood tests (to check total and direct bilirubin levels); Hepatobiliary iminodiacetic acid (HIDA) scan;

cholescintigraphy; liver biopsy; and x-ray of the bile ducts (cholangiogram); or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero.

� Be made by a Physician.

� Include a recommendation for surgical intervention.

Cerebral Palsy means a group of disorders affecting development of movement, muscle tone and posture causing activity limitation, attributed to an insult to the immature, developing brain, most often before birth.

The diagnosis must:

� Be made during Childhood.

� Be made by a Physician.

Cerebral Palsy does not include other similar conditions such as: degenerative nervous disorders, genetic diseases, muscle diseases, metabolic disorders, nervous system tumors, coagulation disorders, or other injuries or disorders which delay early development, but can be outgrown.

Cleft Lip means a physical split or separation of the two sides of the upper lip appearing as a narrow opening or gap in the skin of the upper lip where the separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.

The diagnosis must:

� Be made at birth with a physical examination; or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero via ultrasound or a sample of amniotic fluid (amniocentesis).

� Be made by a Physician.

� Include a recommendation for surgery to ensure the Child's ability to eat, speak, hear and breathe and to achieve a normal facial appearance.

A Critical Illness Benefit is not payable for a Cleft Lip if a Cleft Palate is payable.

Cleft Palate means a split or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front portion of the roof of the mouth), and/or the soft palate (the soft back portion of the roof of the mouth).

The diagnosis must:

� Be made at birth with a physical examination; or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero via ultrasound or a sample of amniotic fluid (amniocentesis).

� Be made by a Physician.

� Include a recommendation for surgery to ensure the child's ability to eat, speak, hear and breathe and to achieve a normal facial appearance.

Club Foot means a range of foot abnormalities in which the foot is twisted out of shape or position. The tissues connecting the muscles to the bone (tendons) are shorter than usual.

The diagnosis must:

� Be made at birth with a physical examination; or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero via ultrasound or a sample of amniotic fluid (amniocentesis).

� Be made by a Physician.

� Include a recommendation of corrective techniques such as the Ponseti method and French/Functional method, or corrective surgery.

Coarctation of the Aorta means the severe narrowing of the aorta, causing a decrease in blood flow to the lower part of the body.

GC0614-CI 15

� Be made at birth with a physical examination and diagnostic testing, including but not limited to: chest radiography; barium esophagography; cardiac catheterization or electrocardiography (ECG); or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero via a fetal echocardiography.

� Be made by a Physician.

Cystic Fibrosis means an inherited, life-threatening disorder that affects the cells that produce mucus, sweat and digestive juices that causes severe damage to the lungs and digestive system.

The diagnosis must:

� Be made during Childhood based on appropriate diagnostic measures, including but not limited to, a sweat test with results of chloride concentrations greater than 60 mmol/L; or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero via diagnostic amniocentesis, chorionic villus biopsy or a blood or saliva sample.

� Be made by a Physician.

Diaphragmatic Hernia means an abnormal opening in the diaphragm allowing the abdominal organs (stomach, spleen, liver, and intestines) to appear in the chest cavity, impeding the lung tissue on the affected side to completely develop.

The diagnosis must:

� Be made at birth by physical examination with symptoms including, but not limited to: irregular chest movements; absent breath sounds on affected side; bowel sounds heard in the chest or abdomen feels less full on examination by touch (palpation); respiratory distress (retractions, cyanosis, grunting respirations); rapid heart rate (tachycardia); and chest x-ray; or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero via a fetal echocardiography.

� Be made by a Physician.

� Include a recommendation for surgical repair.

Down’s Syndrome means an extra full or partial copy of chromosome 21.

The diagnosis must:

� Be made during Childhood.

� Be made by a Physician.

Gastroschisis means a defect in the anterior abdominal wall through which the abdominal contents protrude (abdominal herniation).

The diagnosis must:

� Be made at birth with a physical examination; or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero via ultrasound or a sample of amniotic fluid (amniocentesis).

� Be made by a Physician.

� Include a recommendation for surgical intervention.

Hirschsprung's Disease means a disorder of the abdomen where part or all of the large intestine (colon) or antecedent parts of the gastrointestinal tract have no nerves and cannot function which creates an obstruction.

The diagnosis must:

� Be made at birth with a physical examination or diagnostic testing including but not limited to:

abdominal x-ray using a contrast dye (barium or other); anal manometry test; rectal biopsy; or barium enema; or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero via ultrasound.

� Include a recommendation for surgical intervention.

GC0614-CI 16

Hypoplastic Left Heart Syndrome means severely underdeveloped structures on the left side of the heart unable to support the circulation needed by the body’s organs.

The diagnosis must:

� Be made at birth with a physical examination or shortly thereafter with symptoms including, but not limited to: blue or purple tint to lips, skin and nails (cyanosis), difficulty breathing, difficulty feeding, and lethargy (sleepy or unresponsive) or via diagnostic testing including but not limited to:

electrocardiogram; chest x-ray; pulse, cardiac catheterization; or cardiac Magnetic Resonance Imaging (MRI); or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero via a fetal echocardiography.

� Include a recommendation of a heart transplantation with reconstruction via the Norwood (Stage I), Glenn (Stage II) and Fontan (Stage III) procedures or a hybrid procedure (combination of surgery and catheter-based treatment).

� Be made by a Physician.

Infantile Hypertrophic Pyloric Stenosis means a narrowing (stenosis) of the opening from the stomach to the first part of the small intestine (duodenum) due to enlargement (hypertrophy) of the muscle surrounding this opening (pylorus) resulting in violent projectile vomiting.

The diagnosis must:

� Be made at birth with a physical examination or diagnostic testing including, but not limited to: upper gastrointestinal series, abdominal ultrasound and/or blood tests; or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero via ultrasound or a sample of amniotic fluid (amniocentesis).

� Be made by a Physician.

� Include a recommendation for the surgical intervention of pyloromyotomy.

Muscular Dystrophy means a group of genetic diseases characterized by progressive weakness and degeneration of the skeletal or voluntary muscles that control movement.

The diagnosis must:

� Be made by a Physician.

� Be based on testing methods, including but not limited to: Electromyography; muscle biopsy; nerve conduction tests; or blood enzyme tests.

Omphalocele means the organs remained enclosed in visceral peritoneum (membrane) and protrude out of the navel.

The diagnosis must:

� Be made at birth with a physical examination; or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero via ultrasound.

� Be made by a Physician.

� Include a recommendation of surgical intervention.

Patent Ductus Arteriosis (PDA) means a persistent opening between two major blood vessels leading from the heart.

The diagnosis must:

� Be made at birth with a physical examination or diagnostic testing, including but not limited to:

echocardiogram; chest x-ray; electrocardiogram; cardiac catheterization; cardiac Computerized Tomography (CT); or Magnetic Resonance Imaging (MRI).

Spina Bifida Cystica with Myelomeningocele means a malformation of the vertebrae around the spinal cord.

GC0614-CI 17

� Be made at birth with a physical examination or a diagnostic test (Magnetic Resonance Image (MRI) or Computed Tomography (CT) scan); or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero via diagnostic prenatal tests: blood test (maternal serum quadruple or triple screen), high resolution fetal ultrasound, or amniocentesis.

� Be made by a Physician.

� Include a recommendation for surgical intervention.

Tetralogy of Fallot means four heart defects (a large ventricular septal defect (VSD, pulmonary infundibular stenosis, right ventricular hypertrophy, and an overriding aorta) with a recommendation of surgical repair.

The diagnosis must:

� Be made at birth with a physical examination or shortly thereafter with symptoms including, but not limited to: heart murmur; blue or purple tint to lips, skin and nails (cyanosis); difficulty in feeding;

failure to gain weight; retarded growth and physical development; dyspnea on exertion; clubbing of the fingers and toes; polycythemia; or "tet spells"; or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero.

� Be made by a Physician.

Transposition of the Great Arteries means a transposition of the pulmonary artery and aorta resulting in a cyanotic heart defect (decreased oxygen in the blood being pumped to the rest of the body).

The diagnosis must:

� Be made at birth with a physical examination or shortly thereafter with symptoms including, but not limited to: blue or purple tint to lips, skin and nails (cyanosis), shortness of breath, clubbing of the fingers or toes and poor feeding or via diagnostic testing of at least one of the following: cardiac catheterization; chest x-ray; electrocardiography (ECG); echocardiogram and Pulse oximetry (to check blood oxygen level); or prior to birth while you are insured under the Group Policy with an initial diagnosis in utero via a fetal echocardiography.

Additional Benefits

Health Maintenance Screening Benefit

We will pay a Health Maintenance Screening Benefit if you or your Dependent meet all of the following requirements:

� A Health Maintenance Screening Procedure is performed.

Health Maintenance Screening Procedures are limited to the following:

� Abdominal aortic aneurysm ultrasound.

� Ankle Brachial Index (ABI) screening for peripheral vascular disease.

� Biopsies for cancer.

� Bone density screening.

� Breast ultrasound.

� Cancer antigen 125 blood test for ovarian cancer (CA 125).

� Cancer antigen 15-3 blood test for breast cancer (CA 15-3).

� Carcinoembryonic antigen blood test for colon cancer (CEA).

� Colonoscopy.

� Complete Blood Count (CBC).

GC0614-CI 18

� Comprehensive Metabolic Panel (CMP).

� Electrocardiogram (EKG).

� Hemocult stool analysis.

� Hemoglobin A1C.

� Human Papillomavirus (HPV) vaccination.

� Lipid panel.

� Mammography.

� Pap smears or thin prep pap test.

� Prostate specific antigen (PSA) test.

� Stress test on a bicycle or treadmill.

� Generally medically accepted cancer screening tests.

We will pay a Health Maintenance Screening Benefit for 1 day(s) per insured person per Calendar Year.

Calendar Year means the period from January 1 through December 31 of the same year.

EXCLUSIONS

General Exclusions

Benefits are not payable if Critical Illness is proximately caused by any of the following:

� War or act of War. War means declared or undeclared war, whether civil or international, and any substantial armed conflict between organized forces of a military nature.

� Attempted suicide or other intentionally self-inflicted injury, while sane or insane.

� Committing or attempting to commit a felony.

� Intoxicated or under the influence of any narcotic, unless administered on the advice of a Physician.

� Initial diagnosis outside of the United States.

� Cosmetic surgery. Cosmetic surgery means surgery that is performed to alter or reshape normal structures of the body in order to improve your or your Dependent’s appearance. This exclusion will not apply to a Critical Illness caused or contributed to by reconstructive surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease to do either of the following: (a) to improve function; (b) to create a normal appearance to the extent possible. Reconstructive surgery includes medically necessary dental or orthodontic services that are an integral part of reconstructive surgery for cleft palate procedures.This exclusion will not apply to a Critical Illness caused or contributed to by your or your Dependent’s donation of an organ or tissue.

ADDITIONAL FEATURES

Reinstatement

If your insurance ends, you may become insured again as a new Member. However, the following will apply:

� If your insurance ends because you cease to be a Member and if you become a Member again within 90 days, the Eligibility Waiting Period will be waived.

GC0614-CI 19

� If your insurance ends because you fail to make the required premium contribution, you and your Spouse must provide Evidence Of Insurability to become insured again.

� If you ceased to be a Member under the Group Policy and continued insurance under the Continuation of Insurance (Portability) for the Member provision and you become a Member again within 90 days, your insurance will be for the coverage and amount which you continued under the Continuation of Insurance (Portability) for the Member provision on the day before you become a new Member.

In no event will insurance be retroactive.

Continuity of Coverage

Waiver of Active Work Requirement

If you were insured under the Prior Plan on the day before the effective date of the Employer’s coverage under the Group Policy, you can become insured on the effective date of your Employer’s coverage without meeting the Active Work requirement. See the Active Work Requirement.

Continuation of Insurance (Portability) for the Member

Eligibility for the Member

You become eligible to continue your or your Dependent’s insurance on the date one of the following events occurs:

� Your employment terminates with your Employer.

� The Group Policy terminates.

� Your insurance ends because you are no longer a Member.

You are not eligible to continue insurance under this provision if:

� You are disabled.

� You are age 80 or older.

Application, Amount of Insurance, and Premium Payment

You must apply in writing and pay the first premium to us within 31 days after the date you become eligible. Your and your Dependent’s continued insurance will be the same insurance provided under the Group Policy on the day before you become eligible under this Continuation of Insurance (Portability) for the Member. You may decrease the insurance, but cannot increase the insurance.

You will be directly billed for all premiums due if you have applied for and been approved for continuation of coverage under this provision. If premium is not paid on or before the Premium Due Date stated below it may be paid during the Grace Period as stated below. Your or your Dependent’s insurance will remain in force during the Grace Period. You are liable for premium for insurance during the Grace Period.

The Premium Due Date is the first day of each calendar month.

The Grace Period is 60 days from the Premium Due Date.

When Insurance Ends

Insurance continued under this provision ends automatically on the earliest of:

� The date the last period ends for which you made the premium payment.

� The date you die, however your Spouse may apply to continue insurance under the Continuation of Insurance (Portability) for the Spouse provision below.

� The date you become a full-time member of the armed forces of any country.

� With respect to your Child’s insurance, the date the Child ceases to meet the definition of Child.

� The date you reach age 80, however, if your Spouse has not reached age 80, your Spouse may

GC0614-CI 20

apply for continuing insurance under the Continuation of Insurance (Portability) for the Spouse provision below.

� The date you are sentenced by a court for any reason to a penal or correctional…