Common use of ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT Clause in Contracts

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT. If, as the result of an accident, you suffer any of the losses listed below within 365 days of the accident, payment will be made as indicated. The principal amount of your accidental death and dismemberment insurance is an amount equal to the amount of your group life insurance. LOSS OF: • Life Principal amount of insurance (Paid to your beneficiary) LOSS OF: • Both hands • Both feet • The sight of both eyes • One hand and one foot • One hand and the sight of one eye • One foot and the sight of one eye • Paraplegia, or • Use of both hands for a continuous period of 12 months following the accident Principal amount of insurance (Paid to you) LOSS OF: • Use of one arm for a continuous period of 12 months following the accident Three-quarters of the principal amount of insurance (Paid to you) LOSS OF: • One hand • One foot, or • The sight of one eye Two-thirds of the principal amount of insurance (Paid to you) LOSS OF: • Use of one hand for a continuous period of 12 months following the accident One-half of the principle amount of insurance (Paid to you) LOSS OF: Thumb and index finger of either hand One-third of the principle amount of insurance (Paid to you) The total benefit payable for one loss shall not exceed the principal amount except that the amount payable for any of the above losses shall be doubled if the loss is sustained:

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT. If, as the result of an accident, you suffer any of the losses listed below within 365 days of the accident, payment will be made as indicated. The principal amount of your accidental death and dismemberment insurance is an amount equal to the amount of your group life insurance. LOSS OF: •  Life Principal amount of insurance (Paid to your beneficiary) LOSS OF: •  Both hands •  Both feet •  The sight of both eyes •  One hand and one foot •  One hand and the sight of one eye •  One foot and the sight of one eye • Principal amount of insurance (Paid to you)  Paraplegia, or •  Use of both hands for a continuous period of 12 months following the accident Principal amount of insurance (Paid to you) LOSS OF: •  Use of one arm for a continuous period of 12 months following the accident Three-quarters of the principal amount of insurance (Paid to you) LOSS OF: •  One hand •  One foot, or •  The sight of one eye Two-thirds of the principal amount of insurance (Paid to you) LOSS OF: •  Use of one hand for a continuous period of 12 months following the accident One-half of the principle amount of insurance (Paid to you) LOSS OF: Thumb and index finger of either hand One-third of the principle amount of insurance (Paid to you) The total benefit payable for one loss shall not exceed the principal amount except that the amount payable for any of the above losses shall be doubled if the loss is sustained:

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT. If, as the result of an accident, you suffer any of the losses listed below within 365 days of the accident, payment will be made as indicated. The principal amount of your accidental death and dismemberment insurance is an amount equal to the amount of your group life insurance. LOSS OF: • Life Principal amount of insurance (Paid to your beneficiary) LOSS OF: • Both hands • Both feet • The sight of both eyes • One hand and one foot • One hand and the sight of one eye • One foot and the sight of one eye • Paraplegia, or • Use of both ofboth hands for a continuous period of 12 months following the accident Principal amount of insurance (Paid to you) LOSS OF: • Use of one arm for a continuous period of 12 months following the accident Three-quarters of the principal amount of insurance (Paid to you) LOSS OF: • One hand • One foot, or • The sight of one eye Two-thirds of the principal amount of insurance (Paid to you) LOSS OF: • Use of one hand for a continuous period of 12 months following the accident One-half of the principle amount of insurance (Paid to you) LOSS OF: Thumb and index finger of either hand One-third of the principle amount of insurance (Paid to you) The total benefit payable for one loss shall not exceed the principal amount except that the amount payable for any of the above losses shall be doubled if the loss is sustained:

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT. If, as the result of an accident, you suffer any of the losses listed below within 365 days of the accident, payment will be made as indicated. The principal amount of your accidental death and dismemberment insurance is an amount equal to the amount of your group life insurance. LOSS OF: •  Life Principal amount of insurance (Paid to your beneficiary) LOSS OF: •  Both hands •  Both feet •  The sight of both eyes •  One hand and one foot •  One hand and the sight of one eye •  One foot and the sight of one eye •  Paraplegia, or •  Use of both hands for a continuous period of 12 months following the accident Principal amount of insurance (Paid to you) LOSS OF: •  Use of one arm for a continuous period of 12 months following the accident Three-quarters of the principal amount of insurance (Paid to you) LOSS OF: •  One hand •  One foot, or •  The sight of one eye Two-thirds of the principal amount of insurance (Paid to you) LOSS OF: •  Use of one hand for a continuous period of 12 months following the accident One-half of the principle amount of insurance (Paid to you) LOSS OF: Thumb and index finger of either hand One-third of the principle amount of insurance (Paid to you) The total benefit payable for one loss shall not exceed the principal amount except that the amount payable for any of the above losses shall be doubled if the loss is sustained: