Document Bv8J0Vda6jZd2q02JVvOrN3zE

metropolWuv life insurance coiAAny Group Policy No-----5ZZl ollowi: --llMl> Uiilpul I. Effective December 31, 1968, by oddlag to the Contributory Insert of Mid Group Policy, the following; "Applicable to Officers and Department Heads.--Each Employee vbo Is actively at work on bis last regularly scheduled working day prior to January 1, 1969 and eaeh Employee employed subsequent to January 1, 1969 shall be excluded from eligibility for Addi- tlonal Insurance hereunder and the Additional Insurance hereunder. If any, on each such fiaployee shall be automatically discontinued on December 31, 1966. Eaeh Esployee who Is not actively at work on his last regularly scheduled working day prior to January 1, 1969 shall be excluded from eligibility for Additional Insurance hereunder and hie Additional Insurance hereunder. If any, shall be automatically discontinued on the earlier of: (a) the thirtieth duy following the date of his return to active work, provided he Is actively at work on the next succeeding day; If not then actively at work, on the day Immediately preceding the date of bis subsequent return to active work, or (b) the day Immediately preceding the effective date of bis Additional Insur ance hereunder subsequent to January 1, 1969* Applicable to all Employees.--Each Employee who Is actively at work on hlc last regularly scheduled working day prior to January 1, 1969 and each employee employed subsequent to January 1, 1969 shall be excluded free eligibility for Basic Insurance hereunder and the Basic Insurance hereunder, If any, on each such Employee shall be automatically discontinued on December 31, 1968. Each Employee who is not actively at work on his last regularly scheduled working day prior to January 1, 1969 shall be excluded from eligibility for Basic Insurance hereunder and his Basle Insurance hereunder, If any, shall be automatically discontinued on the day Immediately preceding the date of his return to active work." H. Effective January 1, 19j9, by substituting for the first sentence of subsection (1) of Section 6 of Supplementary Agreement Form 0.6065-7 end Supplementary Agreement Form 0.8297 bearing date of Issue November 1, 1964, attached to said Group Policy as parts thereof, the following: o"Tchceurlsa. s11 t day of the calendar month In which termination of the Enployec' employment ZH. Effective January 1, 1969 as to ibployees actively at work on thalr last regularly scheduled working Aay prior to January 1, 1969 and Employees employed subsequent to January 1, 1969 and effective on the effective date of his Insurance under said Group Policy subsequent to January 1, 1969 as to ary bployoe not actively at work on bis last regularly ecbadulad working day prior to January 1, 1969* A. By substituting for said Contributory `Insert of said Croup Policy tbs attached Combination Non-Contributory and Contributory Insert. liMnkiMnt W. b6 5577-0 -2 B. By adding to sold Group Policy Use attached Supplementary Agreement Ton SOD6175-1. C. By adding Immediately prior to Section 3 of Supplementary Agreement PonmO.B.P.6325j Q.S.P.6303 and G.6391*I-PfcD, attached to said Group Policy as parts thereof, the folloulag: BoWithstanding the provisions of Section 3 and Section k hereof to the contrary, as to each taployee of General Asbestos arM Rubber Division: (a) no employee shall be required to make vrlttea request for Personal Insurance in order to become insured hereunder for Personal Znsuranes only or for Personal Insurance and Dependent Insurance. (b) the Personal Insurance on any Snployee shall become effective on the date of his eligibility for eueb insurance provided be is actively at sorb on that date, and (c) no Bsployee nay contribute to the cost of his Personal Insurance hereunder." It is understood and agreed as to all Employees, axeept Salaried Employees, that, for tba purpose of determining effective dates of insurance under said Combination Bon-Contributory and Contributory Insert, the written requests for insurance under said Group Policy of Employees insured thereunder on December 31, 1968 shall be deemed to be vrlttea requests for insurance under said Combination Bon-Contributory and Contributory Insert. The foregoing amendment is to be attached to end made part of said Group Policy, sad is subject to the agreetnt* end covenants therein 00arained. tted an/Ar1 r, ir ,...... this-----------------:-----------------------day of---------- -----------------------------------19....... ^........ . _______________ _____________ ................................................................... sted B .................. (sracs below roe tin or metrofouta* un insuiunc* company only) Mev Yorkx M.Y.this___,,*S..day of.___________________7ebrwry .................................. 19 . . ^ JH_____ _ * metropolitan ufe insurance company. .J:-----ssssr---------- /------------------ , /Oast. faU*JxJt Met10a 1. BERMTICR OP VJ VOTO "PCT/jfTT" - fit* wort "zSp^oyee" aa used herein mb| XUll-tlM ffoliovtag 9leyt who Diviciaoa of Is directiy plqyed the teplayer: mad eospeaMted for ecrvleei by oac of tbe & Dlvlclonc Mnafaottoo Rubber United States Asbestos General Asbestos aal Rubber Jtaybestos Uabaab Scetloe 2. ZLXGXBXLZTr OT B4PL0MEES.-- AfiPllcable to Salaried Bnpleyeea.--Inch Dnployee who has eanpleted eae sooth of continuous "vice prior to January 1, 1969 is eligible for insurance bereunler 00 January 1, 1>9. Each fisployee who has not completed one sooth of continuous service prior to January 1, 1969 and each ISsployee employed subsequent to that date shall be eligible for laouronec hereunder on the day Immediately following the date of coo* wot 008 moaxii ot continuous service. An Cnployee age 65 or older >vt aot be eligible for Insurance for Seath or Dlaaeaberaent by Accidental Means. Applicable to all other &nployees.-Eacb Csployee who has completed three sooths of continuous service prior to January 1, 1969 is eligible for insurance hereunder on January l, 1969. Saeh Csployee who has not completed three sooths of continuous service prior to January 1, 1969 and each Csployee eoployed subsequent to that date 1 be eligible for Insurance hereunder on the day mediately following the date of completion of three sooths of continuous service. mien }. EFFECTIVE DATES OF INSURANCE.-- to active work if be ii not actively at work on the date of hit eligibility, ehall become effective, provided he it then actively et (a) AS TO NottCOKTSISUTOST IWSUSAMCS work, on the____________ _____.?-------------------- ----A **x ne Non-Contributory Insurance hereunder on any Employee become elective on the date of hit eligibility. provided .x __ _*___ x date of tuch request. Any Employee making such request after such thirty-first day and any Employee requesting reinstatement <5_________ _______________A...he it actively at work on the >f hit eligibility. The Non-Contributory Insurance on any of hit Contributory Insurenet hereunder after bit Contributory Insurance hereunder hat been discontinued in accordance with item (a) of Section S hereof, mutt furnish at hit own expense >ycc who it not actively at work on the date when hit Non* Evidence of Insurability satisfactory to the Insurance Company ibutory Insurance hereunder would otherwise become effee- before be may be insured for Contributory Insurance hereunder. tall become effective on the neat following-------- dW----------- Any such insurance shell become effective, provided such Em on which he it actively at work- ployee is then actively at work, on the-............--...... X-----------*XX----------------------------------------------------------- daw the Insurance Company accepts as taoifactory such evidence (>) At to CotmuturaaT IsmuMiecg Employee may become insured for Contributory Insurance ider only by making wrinsn request is the Employer on furnished by the Insurance Compeny. Tbs Contributory nee on any Employee who makes such request on ot before of Insurability. Tbe Contributory Insurance on any Employee not actively at work on the daw when bis Contributory Insurance hereunder would otherwise become effective shall become effective on the next following___________ &X------------------------------------- a* which he it actively * work. tc of hit eligibility shall brtoaa effective on the date of hie Uy. paOM*<aJ X - - -* -JS5---------------------------------------------------------- 2L * la actively at work on the daw of hie iry. The Contributory Insurance on any Employee who such request after the daw of hit eligibility end on or the thirty-first day following the dsw of his eligibility, or before the thiRyfitei day following the daw of his morn Smriea 4. EMPLOYEE'S CONTRIBUTIONS.--No Employee faceted hereunder shall be required to contribute to the coat of his Non Conrribumry Insurance hereunder. No Employee insured for Contributory Insurance hereunder (hell be required 10 contribute to the cast of such insurance more than the rrrtVmt-* amount specified in Section i hereof in accordance with such insurance in form hereunder on hit account. OLK. IM1-1-40 (2) mirmerw uojl Stctitm S. CESSATION OP INSURANCE--!*) A* to the e Jrwurtnce hereunder:--The Life Insurstice on enr Employee xred hereunder (hall autnmaticallr ceaw on the dere of the runsnon ol hie employment. Termmitton el employment, the purpoees ol Life iruurance hereunder, meant cessation etive work u in Employee as defined in Section 1 hereof, ept that (0 in cate of the abaence of an Employee from active work became of sickness, m;ury or reiirement.,,.P.n.J>.<IPO.ipn.... --.......--hu employment may, for the purpose* of hi* Life Insurance hereunder, be deemed to continue until terminated by'the Employer, or In the caae of either of the above exceptions, the Accident (nd* Health (tuuranct hereunder on auch Employee (hall utomsucally ceaae on the date of tuch termination of hu employment by the Employer, at evidenced to the Iruurance Company by the Emplnyer, whether by notification or by cessation of premium pay ment on account of auch Employee'* Accident and Health lnaurtnce hereunder. (a) The Contributory Iruurance on eny Employee inmred hereunder who ahall have notified the Employer that hu Con tributory Iruurance hereunder is in be discontinued ih*ll auto matically ceaae on the................... .dk.IrS.............................................. (h) in case of the abaence of an Employee from active work ------------------------ -such nonce of discontinuance is received by the because nf leave ol absence or temporary lay-off, hu em Employer. If any Employee fails to make any contribution when ployment may, for the purposes of hi* Life Insurance due, as required by the Empinyrr, to the coat of his Contributory hereunder, be deemed to continue until terminated by the Insurance hereunder, his Contriburnrr Insurance hereunder (halt Empl-vyer but to no ce*e beyond rhe..?.??P.i?R.^A.9!)...9X...l,e automatically cease on the dare of the expiration of the Isst period period neclfled.-QQ. the roverce tide hereof for which he made such contribution. fPil9yinjS..Sfe.A*.-JuCh leave of tbwnct or lay-off commenced. (c) The Accident and Health Insurance on any disabled Em ployee insured hereunder shall automatically cease on the dstc of expiration of the maximum number of weeks for which Weekly Benefits are payable hereunder an account of such Employee's the case of either of the above exceptions, the Life Iruurance eundcr un such Employee shall automatically cease on the date such termination of his employment by the Employer, aa disability. The Accident and Health Insurance hereunder on any auch Employee (hall be reinstated only if and when he returns to active work for the Employer on full time. fenced to the Insurance Company by the Employer, whether notification or by cessation of premium payment on account tacit Employee's Life insurance hereunder. (ft) In any event all insurance hereunder shat) automatically cease upon the discontinuance nf this Policy. As'to the Accident and Health Insurance hereunder:--The Section 6. AMOUNT OF INSURANCE.--The amount of in surance hereunder on any Employee shall be in accordance with dcnt and Health Insurance on any Employee insured heft the schedule set forth on the next page and any increase ier shall automatically cease on the data of the termination of .EJi________________ m the amount of such insurance, m accord- employment, except that an Employee's Accident and Health irarc: hereunder shall continue during any period for which anct with said schedule, shall become affective, provided the Employee m then actively at work, on the....F*dyR.?3Li*$....., is entitled to receive Weekly Benefits hereunder. Termination mpioymem, for the purpaaw of Accident and Health Incure hereunder, means carnation of active work at an Employee .m*. --------- &M.9,.(94,BU5.V.lJga-rSXtrjg.-flMRj--------------------- ; lehned in Section 1 hereof, coop* that U such Employee is not then actively at work, auch change in the (i) in ease of the ehacnea of an Employee hum active work because of sickness or injury, his employment may. fee t'te purposes of hia Accident and Health Insurance here under, he deemed to continue until terminated by the Employer, or (it) in case of the abaence of an Employee from active work h-cause of temporary layoff, fua employment may, fee the purpmea nf hie Accident end Health Insurance hereunder, hr deemed hi oautnwe until tcrnumtcd by the Employer hut In no caae beyund thc..SS&.4Ti)3^.(L-9.t.~ a. --------- amount of maursne* dial! become affective on the next following dax------------------------------------------------------------------- on which ho is activehr at work_ffUteJffJ&*.-IUl...`ttlR_C*.tS_Cf. *nir amount OfJU^-Ifljtras-^X-Ir>\ga.RCg_Xai:------ Oosth or PisiwnrbcrBgnV'by Accident*!. HeansL-xrgatcr than t^j.OTKl, to the additional,. provUletX^-foUpW' iw the Bchcilula, antitill "Provldona Applicable to Uiy Innitranco j>ndInpurtmce for BSftth.StT. 01 fuw.-aiuvrm.-nt by Aceiduntal Muaae In. (baouaty. (Iotdl..,AdQ\int of Saalc. gnd... Additional..lnauraace.):."............................................. ....... d --* layoff commenced. WNATmst Motwcnsmuitumay asm rosrrxmt/mar imskkt Cla> Ol.H 1931--MO ties 5 (A) (U) (Continued) to *ay Bsployw of United Butti Aabeato* Oivieloa - six aoatb* to asy other taployee - tvo aoatbe tloo 6. (Continued) aeb preceding calendar quarter an to iinployeee at Manhela, Penneylvanln, and, la the cate toy other fisployee, oa the date of change in the fisployee'e earning* or elaae. OO