ACTIVE FULL TIME EMPLOYEE: 30 hours per week.

EARNINGS: Regular pay, not counting:

1. commissions; or

2. bonuses; or

3. overtime pay; or

4. any other pay or fringe benefits.

MAXIMUM BENEFITS

Survivors of Class 1 Employee Only
SURVIVOR INCOME BENEFITS
Amount of Insurance

Employee Only
AMOUNT OF LIFE INSURANCE

REDUCTION IN AMOUNT OF LIFE INSURANCE DUE TO AGE
On the Policy Anniversary Date which occurs on or next follows the date you attain age 70, your Amount of Life Insurance shown in the preceding table will be reduced by 50%.
A Covered Person’s Amount of Life Insurance will be reduced by his amount of personal life insurance in force, if any, issued in accordance with the Conversion Privilege described in this booklet.

SCHEDULE OF CONTINUATION
If your employment terminates due to one of the following reasons, your insurance may be continued up to the maximum period of time stated below as long as the Policyholder continues payment of premium. Such continuation will be at the Policyholder’s option, but must be according to a plan which applies to all employees in the same way.

Such continuation will also end on the first to occur of the dates stated in items 1-4 of the provision entitled “Termination Date of Insurance - Insured Persons Coverage” appearing in Section IV.

ADDITIONAL PROVISIONS

CHANGE IN BENEFITS
Changes in coverage due to a change in:

1. class;

2. Earnings; or

3. this Plan of Insurance,

will become effective on the date of such change, except that any increase in coverage will be subject to the Deferred Effective Date Provisions.
A retroactive change in your rate of Earnings will become effective on the date the change is determined in the rate of earnings.

STATUTORY PROVISIONS

The following provision is included to bring your booklet-certificate into conformity with Georgia state law.

Replacement of Prior Group Life Insurance

If you are a Prior Covered Person and you:

1. are eligible for Group Life Insurance under this Plan on the Plan Effective Date; and

2. are not able to meet the requirements of the Deferred Effective Date provision of this booklet;

the next two items will apply to you.

1. The Deferred Effective Date provision will not apply.

2. The Amount of Life Insurance of this booklet will not apply to you. Instead, your Amount of Life Insurance will equal:

1. your Amount of Life Insurance under the Prior Plan on the day before the Plan Effective Date;

2. less any Amount of Life Insurance in force due to a disability benefit extension under the Prior Plan.

The Deferred Effective Date provision in this booklet will apply to you on the first to occur of:

1. the date you meet the requirements of the Deferred Effective Date provision; or

2. the date your insurance terminates for a reason stated under the Termination of Insurance—Personal Coverage provision of this booklet.

“Prior Covered Person” means a person covered by the Prior Plan the day before the effective date of the Plan.
“Prior Plan” means a group life insurance plan sponsored by the Policyholder under which a Prior Covered Person was covered the day before the effective date of the Plan.

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Section II

DEFINITIONS

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Section III

DATES OF ELIGIBILITY AND COVERAGE

Insured Persons Coverage

Eligible Persons
All persons in the class or classes shown on the Plan of Insurance will be considered Eligible Persons.

When You are Eligible
You will be eligible for coverage on:

1. the Policy Effective Date, if you have completed the Eligibility Waiting Period; or

2. the date on which you satisfy the Eligibility Waiting Period.

See the Plan of Insurance for the Eligibility Waiting Period.

When You Are Insured - Non-contributory Insurance
Your coverage starts the date on which you become eligible.

When You Are Insured - Contributory Insurance
Your coverage starts on the earliest of these dates:

1. the date you are eligible, if you enroll on or before that date;

2. the date you enroll, if you enroll within 31 days after the date you become eligible; or

3. the date The Hartford approves evidence of insurability. Evidence is required if you enroll more than 31 days after the date you become eligible. Such evidence must be furnished at your own expense.

Deferred Effective Date
If you are absent from work due to disability on the date your insurance would otherwise have been effective or would have been increased, your effective date or the effective date of any increase will be deferred. Your insurance or any increase will not be effective until the date on which you return to work as an Active Full Time Employee.

Enrollment
To enroll for insurance, you must complete and sign a group insurance enrollment card which is acceptable to The Hartford and deliver it to the Policyholder.

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Section IV

TERMINATION

Termination Date of Insurance
Insured Persons Coverage

Your insurance will terminate on the earliest of:

1. the date the Policy terminates; or

2. the date premium is due for your insurance but not paid by the Policyholder; or

3. the last day of the period for which you make any required premium contribution, if you fail to make any further required contribution; or

4. the date you enter active full-time military duty, other than active duty for training purposes for 2 months or less, in the armed forces (land, water, air) of any country or international authority; or

5. the date on which your employment terminates. This means the date on which you cease to be an Active Full Time Employee in an eligible class.
   your employment terminates, your insurance may be continued up to the maximum period of time stated in the Plan of Insurance.

BENEFITS
Survivor Income Benefit

1. Survivor Income Benefits and to Whom Payable
If you die while insured under the policy, and if, on the first day of the calendar month following the date of your death, you are survived by an Eligible Survivor or Survivors, The Hartford will pay, upon receipt of due proof of your death, a Monthly Benefit in an amount determined in accordance with the following item 2, but not beyond the period stated in the following item 3.
Survivor Income Benefits are payable to your Class A Survivors. If there is no Class A Survivor, Benefits will be payable in equal shares to the Class B Survivors, if any.
Benefits are payable with respect to Class B Survivors who have reached the age of majority will be paid to such persons. Benefits payable with respect to minor Class B Survivors will be paid to the guardian or guardians of such persons.

2. Amount of Monthly Benefit
The Amount of Monthly Benefit shall be equal to the sum of the benefit amounts payable with respect to a Class A Survivor and up to 2 Class B Survivors, if any, and shall be determined by obtaining an amount in accordance with the Plan of Insurance and reducing the obtained amount by any benefits paid or payable by the Federal Social Security Act. However, in no event shall the sum of the benefit amounts payable in accordance with the schedule described in the Plan of Insurance exceed the Maximum Monthly Benefit stated in the Plan of Insurance.

3. Duration of Benefits
The Monthly benefits will be payable until the earliest to occur of the following dates:

1. the date on which there is no Eligible Survivor;

2. the date on which a Class A Survivor, if any, attains age 62;

3. the date on which a Class A Survivor, if any, remarries; except that if there are any Class B Survivors on the date specified in item (b) or (C) above, benefits will continue to be payable to them until they are no longer Eligible Survivors.

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Section V

BENEFITS

Life Insurance

Death Benefit and to Whom Payable
When The Hartford receives due proof of your death, the Amount of Life Insurance on your life will be paid.
Payment will be made in a lump sum to the beneficiary or beneficiaries named in writing by you, provided the names are on file with the Policyholder.

1. If more than one beneficiary is named, each will be paid an equal share.

2. If any named beneficiary dies before you, his share will be divided equally among the named beneficiaries who survive you.

3. If no beneficiary is named, or if no named beneficiary survives you, The Hartford will pay the executors or administrators of your estate. However, The Hartford may, at its option, pay your surviving relatives in the following order:

1. all to your surviving spouse; or

2. if your spouse does not survive you, in equal shares to your surviving children; or

3. if no child survives you, in equal shares to your surviving parents.

Subject to the terms of the next paragraph, installment payments may be chosen in lieu of a lump sum.
If a beneficiary is a minor who does not have a legal guardian, The Hartford may, until such a guardian is appointed, pay the person it deems to be caring for and supporting him. Such payment will be in monthly installments of not more than $50.
No assignment of interest under the Policy shall be binding on The Hartford until and unless:

1. the original; or

2. a true copy,

is received by The Hartford at its home office in Hartford, Connecticut. No person may assign benefits under the Policy. The Hartford has no responsibility for the validity or effect of any assignment. Any payment made in accordance with the preceding provisions, shall release The Hartford from further liability for the amount paid.

Optional Method of Settlement
You may elect in writing to have all or part of your insurance paid in installments upon your death. If you do not so elect, any beneficiary may make such election after you die. The first payment will be made when The Hartford receives due proof of your death. Installments may be elected accordin9 to the table below, but no method of payment may be elected which yields installments of less than

TABLE OF INSTALLMENTS

In addition to each installment after the first, the payee will receive interest. The rate of interest per year will be:

1. at least 2 1/2%, and

2. any amount over 2 1/2% which The Hartford declares for that year on funds remaining with The Hartford.

If any installments are left unpaid when the payee last entitled to receive them dies, The Hartford will:

1. sum the remaining installments; then

2. compute the sum at 2 1/2% per year; then

3. pay the resulting amount to the executors or administrators of such payee’s estate.

If the payee is:

1. a corporation; or

2. a partnership; or

3. an association; or

4. an assignee; or

5. a trust,

then no Optional Method of Settlement is available without consent of The Hartford.
Any reasonable arrangement for payment can be made if both you and The Hartford agree to it.

Facility of Payment
If there is no named beneficiary, The Hartford may pay up to $250 of your insurance to any party it deems to be entitled to such payment because of your burial expense. The Hartford will be released from further liability for any amount so paid.

Change of Beneficiary
You may change your beneficiary at any time by:

1. making such change in writing on a form acceptable to The Hartford; and

2. filing the form with the Policyholder.

After such written notice is received, the change will take effect as of the date you signed it, even if you have since died. However, The Hartford will not be liable for further payment of any amounts paid before it receives such written notice of change.

Conversion Privilege
If your insurance terminates because:

1. your employment ends; or

2. you are no longer in an eligible class;

then you may convert your life insurance to a personal life insurance policy.
To convert your life insurance, you must, within 31 days of the termination of your group life insurance:

1. make written application to The Hartford; and

2. pay the premium required for personal life insurance for your age and class of risk.

If you do so, The Hartford will issue to you a personal life insurance policy. Such policy will:

1. be issued without evidence of insurability; and

2. be on one of the life insurance policy forms, except term insurance, then customarily issued by The Hartford; and

3. be for the same amount for which you were last insured under this group Policy; and

4. contain no disability or supplementary benefits; and

5. be effective on the 32nd day after your group life insurance terminates.

At your option, the personal life policy may be preceded by a single premium one year term life insurance policy, subject to the same conditions.
If you have been insured under the Group Insurance Policy for at least five years, and your insurance terminates because either The
Hartford or the Policyholder:

1. terminates the Group Insurance Policy; or

2. terminates insurance for your class;

then you may convert your life insurance to a personal life insurance policy, subject to:

1. the same conditions and limitations which apply to an Insured Person whose employment terminates; and

2. a limit of the lesser of:

1. the amount for which you were last insured under this Group Insurance Policy, reduced by any amount for which you are or become eligible under any other group life insurance policy within 31 days of termination of insurance; or

2. $2,000.

Such a policy will be effective on the 32nd day after your group life insurance terminates.
Any personal life insurance policy issued to you under this Conversion Privilege shall be in lieu of all other benefits provided by the Group Insurance Policy. However, you may exercise the rights under the Waiver of Premium provision, below, if:

1. all conditions of the Waiver of Premium provision are met; and

2. you surrender the personal policy to The Hartford; and

3. you disclaim all benefits under the personal policy except refund of premium.

Additional Death Benefit
If you die within the 31 day conversion period, The Hartford will, upon receipt of due proof of your death, pay the amount of life insurance you were entitled to convert.

Waiver of Premium
If you become Totally Disabled, as defined, while you are insured by the Group Insurance Policy, and if due proof of your Disability is furnished to The Hartford within one year after your last day of Active Full Time Work, then The Hartford will:

1. continue your insurance; and

2. waive premiums for your insurance.

However, your continued insurance shall be subject to any reductions provided by any part of the Group Insurance Policy.

Total Disability Defined
“Total Disability” means:

1. a Disability caused by accidental bodily injury or sickness, which

2. has existed continuously for at least nine months; and

3. which prevents you from doing any work for which you are or could become qualified by:

1. education; or

2. training; or

3. experience.

Exercise of Conversion Privilege
If you choose to convert your insurance under the Group Insurance
Policy to a personal life policy, then the Waiver of Premium provisions will no longer apply unless:

1. within twelve months after your last day of Active Full Time work, you surrender the personal life policy; and

2. no claim was made under the personal policy other than for return of premium.

Examinations
The Hartford will have the right

1. to require satisfactory proof of continuance of Total Disability; and

2. to examine you as follows:

1. at reasonable intervals during the first two years after receiving proof of Total Disability; and

2. not more than once a year after that.

If you fail to submit any proof of Total Disability required by The Hartford, or refuse to be examined as required by The Hartford, then premiums will no longer be waived.

Termination of Total Disability
If you:

1. are no longer Totally Disabled; and

2. return to work in a class of persons eligible for this insurance; then premiums will no longer be waived as of the date your Total Disability ceases.

If you:

1. are no longer Totally Disabled; but

2. do not return to work within an eligible class;

then premiums will no longer be waived as of the date your Total Disability ceases. However, if you are not eligible for any other group life insurance, then you are entitled to the Conversion Privilege. You may convert the amount of life insurance in force for you on the date your Total Disability ceases.

Termination of Waiver of Premium
If you become Totally Disabled before age 60, the Waiver of Premium will cease on the date you attain age 65. If you become Totally Disabled after age 60, the Waiver of Premium will cease five years after the date your Disability begins.
You will be entitled to the Conversion Privilege as of that date. You may convert no more than the amount of life insurance that was in force for you on the date the Waiver of Premium stopped.

Termination of Policy
Termination of the Group Insurance Policy will not affect any insurance in force under the terms of these provisions.

Extended Insurance Benefit
If, while insured under the Group Insurance Policy, you become Totally Disabled because of accidental bodily injury or sickness which prevents you from doing any work for which you are or could become qualified by:

1. education; or

2. training; or

3. experience;

and if:

1. you die while you are Totally Disabled; and

2. your death occurs within one year after your last day of Active Full Time work; and

3. you were continuously Disabled from your last day of Active Full Time work until the time you died; and

4. you were qualified for the Waiver of Premium or would have become qualified; and

5. proof of items (1) through (4) above is furnished to The Hartford within one year of your death;

then The Hartford will pay to the beneficiary the Amount of Life Insurance which would have been in force for you if your insurance had not terminated. Any such payment will fully discharge The Hartford’s liability for your insurance.

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Section VI

GENERAL PROVISIONS

Incontestability
Except for non-payment of premium, the Group Insurance Policy can not be contested after two years from the Policy’s Effective Date. No statement made by a Covered Person relating to his or her insurability will be used to contest the insurance for which the statement was made after the insurance has been in force for two years during the Covered Person’s lifetime. In order to be used, the statement must be in writing and signed by the Covered Person.

CLAIMS
If you die, your beneficiary will be furnished a claim form. The completed claim form and a certified copy of your death certificate should be sent to The Hartford. When the required claim papers are received and approved by The Hartford, the Amount of Life Insurance on your life will be paid.

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