Disclosures, Terms, and Exclusions

$10,000 Group Term Life

Suicide Exclusion

If a Covered Person dies as the result of suicide or any attempt at suicide, while sane or insane within two years of his Effective Date of coverage, the insurance company will be liable only for an amount equal to the Premium paid.

Accidental Death Benefit Exclusions

If, within 90 days from the date of an Accident which occurs while coverage is in force, Injury from such Accident results in a loss covered by this benefit, We will pay the benefit in the amount set opposite such loss, as shown on the Schedule of Benefits. If more than one such loss is sustained as the result of one Accident, We will pay only one amount, the largest to which the Covered Person is entitled.

This benefit is subject to all the terms, conditions and exclusions of this Certificate.

Exclusions: No benefits are payable for any loss caused by:

• Suicide or intentionally self-inflicted Injury while sane or insane.
• War or any act of war, declared or undeclared.
• Travel, or flight in or descent from any kind of aircraft unless as a fare paying passenger on a regularly scheduled flight.
• As a passenger on an official flight of the Military Airlift Command of the United States or similar air transport services of other countries.
• Infections, except infections which occur simultaneously with or through a cut or wound sustained as the direct result of an Injury, independent of any other cause; and
• The non-accidental ingestion of a contaminated substance.
• Intoxication as defined in the jurisdiction where the accident occurred.
• Being under the influence of any drug unless administered and taken as prescribed by a Doctor.
• Participation in an attempt to commit an assault or felony, or participation in a riot.
• Voluntary gas inhalation or poison voluntarily taken, administered or inhaled.
• Riding or driving as a professional in any kind of race for prize money or profit.

$5,000 Group Term Life

Suicide Exclusion

If a Covered Person dies as the result of suicide or any attempt at suicide, while sane or insane within two years of his Effective Date of coverage, the insurance company will be liable only for an amount equal to the Premium paid.

Accidental Death Benefit Exclusions

If, within 90 days from the date of an Accident which occurs while coverage is in force, Injury from such Accident results in a loss covered by this benefit, We will pay the benefit in the amount set opposite such loss, as shown on the Schedule of Benefits. If more than one such loss is sustained as the result of one Accident, We will pay only one amount, the largest to which the Covered Person is entitled.

This benefit is subject to all the terms, conditions and exclusions of this Certificate.

Exclusions: No benefits are payable for any loss caused by:

• Suicide or intentionally self-inflicted Injury while sane or insane.
• War or any act of war, declared or undeclared.
• Travel, or flight in or descent from any kind of aircraft unless as a fare paying passenger on a regularly scheduledflight.
• As a passenger on an official flight of the Military Airlift Command of the United States or similar air transport servicesof other countries.
• Infections, except infections which occur simultaneously with or through a cut or wound sustained as the direct resultof an Injury, independent of any other cause; and
• The non-accidental ingestion of a contaminated substance.
• Intoxication as defined in the jurisdiction where the accident occurred.
• Being under the influence of any drug unless administered and taken as prescribed by a Doctor.
• Participation in an attempt to commit an assault or felony, or participation in a riot.
• Voluntary gas inhalation or poison voluntarily taken, administered or inhaled.
• Riding or driving as a professional in any kind of race for prize money or profit.

Group Accident Only Insurance

The following rates apply for coverage underwritten by Guarantee Trust Life Insurance Company as part of your membership in the AmeriBenefit Plan. The rates by plan are: Group Accident Only AME $10,000 with $250 deductible, AD&D $5,000, CI $10,000 and DI $150 90 Elimination days/26 weeks maximum: Individual = $25.01, Individual + Spouse = $49.15, Individual + Child(ren) = $31.51, Family = $58.44 per month.

The following rates apply for coverage underwritten by Guarantee Trust Life Insurance Company as part of your membership in the AmeriBenefit Plan. The rates by plan are: Group Accident Only $10,000 AME with $250 deductible, AD&D $5,000, and DI $150 90 Elimination days/26 weeks maximum: Individual = $6.45, Individual + Spouse = $12.03, Individual + Child(ren) = $9.24, Family = $17.61 per month.

The following rates apply for coverage underwritten by Guarantee Trust Life Insurance Company as part of your membership in the AmeriBenefit Plan. The rates by plan are: Group Accident Only $5,000 AME with $250 deductible, AD&D $5,000, CI $5,000 and DI $150 90 Elimination days/26 weeks maximum: Individual = $12.81, Individual + Spouse = $25.62, Individual + Child(ren) = $16.43, Family = $31.01 per month.

Group Accident Insurance Exclusions

The Policy does not provide benefits for:

• Treatment, services or supplies which:
  • Are not Medically Necessary;
  • Are not prescribed by a Doctor as necessary to treat an Injury;
  • Are determined to be Experimental/Investigational in nature;
  • Are received without charge or legal obligation to pay;
  • Are received from persons employed or retained by any Family Member, unless otherwise specified; or
  • Are not specifically listed as Covered Charges in the Policy.
• Injury by acts of war, whether declared or not.
• Injury received while traveling or flying by air, except as a fare-paying passenger and not as a pilot or crew member, on a regularly scheduled commercial airline.
• Injury covered by Worker’s Compensation, Employer Liability law or Occupational Disease Act or Law.
• Dental treatment, except as specifically stated.
• Injury sustained while committing or attempting to commit a felony.
• Prescription Drugs except as specifically stated.
• Suicide or attempted suicide while sane or insane.
• Intentionally self-inflicted Injury.
• Loss resulting from being legally intoxicated or under the influence of alcohol as defined by the laws of the state or jurisdiction in which the Injury occurs.
• Loss resulting from being under the influence of any drugs or narcotic unless administered on the advice of a Doctor.
• Injury sustained while participating in or practicing for any professional, intercollegiate or sports activity, except as specifically provided.
• Injury which occurs while a Covered Person is on active duty service in any armed forces. Reserve or National Guard active duty for training is not excluded unless it extends beyond 31 days.
• Injury sustained flying in an ultra-light, hang gliding, parachuting or bungee-cord jumping, by flight in a space craft or any craft designed for navigation above or beyond the earth’s atmosphere.
• Injury sustained while driving or riding on vehicles for off-road use including but not limited to all-terrain vehicles (ATV’s).
• Injury sustained where a Covered Person is the operator and does not possess a current and valid motor vehicle operator’s license, except in a Driver’s Education Program.
• Treatment in any Veteran’s Administration or federal Hospital, except if there is a legal obligation to pay.
• Cosmetic surgery, except for reconstructive surgery on an injured part of the body.
• Covered Charges incurred outside of the United States or its possessions
• Competing in motor sports races or competitions;
• Competing in water sports races or competitions;
• Testing cars/trucks on any racetrack or speedway;
• Handling, storing or transporting explosives;
• Scaling up cliffs or mountain walls;
• Spelunking (exploring caves);
• Handling or working with dangerous animals.
• Injury sustained while water skiing or surfboarding;
• Injury sustained while snow skiing or snowboarding;
• Injury sustained while roller blading or skateboarding;
• Injury sustained while participating in a rodeo.
• Reinjury or complications of an Injury caused or contributed to by a condition that existed before the Accident.
• Repetitive motion injuries, strains, hernia, tendonitis, bursitis and heat exhaustion not related to a specific Injury.

Cancer Lump Sum Benefit Rider and Limited Specified Disease Benefit Rider (CHS) Exclusions

Pre-Existing Condition Limitation

Pre-Existing Condition is not eligible for benefits unless the Diagnosis occurs after this Rider Effective Date and the Waiting Period, if any, has expired. We will not pay benefits for a Pre‐Existing Condition that is Diagnosed within the Pre-Existing Period stated in the Schedule of Benefits.

A Pre-Existing Condition is not covered unless the loss begins after the Benefit Eligibility Period for Pre-Existing Conditions has elapsed as stated in the Schedule of Benefits.

We will not pay benefits for:

1. A Positive Diagnosis of Cancer before the Effective Date of the Covered Person’s coverage under the Policy;
2. Any loss due to injury, disease or incapacity, unless related to or attributable to Cancer as defined;
3. Any Cancer when advice or treatment is received during the Waiting Period or prior to the Effective Date, and such advice or treatment results in a Positive Diagnosis of Cancer. If tissue is extracted during the Waiting Period or prior to the Effective Date, and results in a Positive Diagnosis of Cancer, this will not be a covered condition. For the purposes of this Rider, the date of a Positive Diagnosis of Cancer will be considered to be the earlier of the date of clinical diagnosis or the date the specimen used to diagnose Cancer is taken. If a Positive Diagnosis of Cancer is made and/or Cancer is treated within the Waiting Period, OR if medical advice is given within the Waiting Period which leads to the subsequent Positive Diagnosis of Cancer after the Waiting Period, the Insured has the option to cancel the Policy and receive a refund of all premiums paid on this Rider.

We will not pay benefits for claims resulting, whether directly or indirectly, from diseases that are related to, or are resulting from any of the following:

1. Any disease if the Covered Person was previously Diagnosed during the 12 months before the Rider Effective Date.
2. Any disease first Diagnosed within the Waiting Period, as shown in the Schedule, immediately following the Rider Effective Date.
3. Arrhythmia resulting in a Heart Attack that occurs in association with use of an illegal drug or controlled substance, except when administered in accordance with the advice of the Covered Person’s Doctor.
4. Any amount in excess of any Maximum Benefit for Covered Conditions.
5. Diseases or conditions that do not meet the definition of a Covered Condition in this Rider.
6. Suicide or attempted suicide.

Coronary Artery Bypass Surgery, Heart Attack, or Stroke or Transient Ischemic Attack as defined in this Rider Exclusions

Pre-Existing Condition: A Pre-Existing Condition is a condition for which: (a) Medical advice or treatment was recommended by, or received from a Doctor, within the Pre-Existing Period shown in the Schedule; or (b) symptoms existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment within the Pre-Existing Period before the Effective Date of the Covered Person’s coverage. Treatment includes being prescribed or taking prescription drugs or medicines.

A Pre-Existing Condition is not covered unless the loss begins after the Benefit Eligibility for Pre-Existing Conditions has elapsed.

Pre-Existing Codition Limitation A Pre-Existing Condition is not eligible for benefits unless the Diagnosis occurs after this Rider Effective Date and the Waiting Period, if any, has expired. We will not pay benefits for a Pre‐Existing Condition that is Diagnosed within the Pre-Existing Period stated in the Schedule of Benefits.

A Pre-Existing Condition is not covered unless the loss begins after the Benefit Eligibility Period for Pre-Existing Conditions has elapsed, as stated in the Schedule of Benefits.

Waiting Period means the number of days, if any, after this Rider’s Effective Date before We will pay benefits for loss due to a Covered Condition. If the Diagnosis of a Covered Condition is made during the Rider Waiting Period, the Covered Person has the option to cancel this Rider and receive a refund of all premiums paid.

We will not pay benefits for claims resulting, whether directly or indirectly, from diseases that are related to, or are resulting from any of the following:

1. Any disease if the Covered Person was previously Diagnosed during the 12 months before the Rider Effective Date.
2. Any disease first Diagnosed within the Waiting Period, as shown in the Schedule, immediately following the Rider Effective Date.
3. Arrhythmia resulting in a Heart Attack that occurs in association with use of an illegal drug or controlled substance, except when administered in accordance with the advice of the Covered Person’s Doctor.
4. Any amount in excess of any Maximum Benefit for Covered Conditions.
5. Diseases or conditions that do not meet the definition of a Covered Condition in this Rider.
6. Suicide or attempted suicide.

General Disclosures

Guarantee Trust Life Insurance Company and AmeriBenefit Plan, Coverdell, SAS insurance development and Arthur J. Gallagher are separate legal entities and have sole financial responsibility for their own products. Or in some cases: Guarantee Trust Life Insurance Company and AmeriBenefit Plan, Coverdell, SAS insurance development and Arthur J. Gallagher are separate legal entities.

Guarantee Trust Life Insurance Company (GTL) provides the Group Accident Only insurance. GTL does not provide nor is affiliated with the discount programs provided as a part of membership in AmeriBenefit Plan.

Exclusions and limitations may vary by state. For complete details of coverage, please refer to the certificate.

You have the option of downloading your certificate electronically. If you choose to do so, you are consenting to accept electronic delivery of your certificate. You also have the right at any time to receive a hard copy of your certificate. If you choose this option, please call 1-(833) 469-4228.