Document VjGpE0MDVLvKk9YRKm6md1gpq

' Group Policy No. follows: 65T7-C bearing date of------------Oecmaer 1. X9_5damj insuring the Employees 0f (Htmi HIM the lapltrrr I , IfC._.------------ is herebv amended ! Effective My 1, 1968 by substituting for tits definition of the vord "Dependent", as amended, in Section 1 of Supplenentary Agreenent Form G.B.F.6301, attaened to said Group Policy as a part toereof, the following: "Applicable to Employees of Wanash Uivision. -- The tern 'Opendent' means (1) an &tployee's spouse, (2) any wintrried child of a male Employee, of a widowed feaale finployee, or of a female Employee whose husband is not eligible for insurance as an teployee, excluding in any ease: Any child wider 15 days of age and any child 19 years of age or elder. Any person eligible for insurance as an Employee. Any person residing outside the United States and Canada. Any person whose evidence of good health, furnished in accord ance with the provisions of Section 3 hereof, is not accepted by tne Insurance Company as satisfactory. Any person in the military or similar forces of any country or suodWision tnereof. The term 'child' includes any legally adopted child, ary step child wno resides in tne Employee's houscnold, and any child supported oolcly by tne Employee and permanently rcsJiiinr: In the household of whieh the Employee is tne head. Applicable to Employee of United States Asbestos Division.-- The term 'Dependent' means (1) an Dsployee's wife, (2) any unmarried child of a male Employee, of a widewad famalc Employee, or of a female Employee whose husband ia net eligible for insurance as an Employee, excluding in any ease: Any ehild under 15 days of ace and any child 19 years of age or older. Any person eligible for insurance as an Beployee. Any person residing outside the United States snd Csnada. Aqr person whose evidence of good health, furnished In neeordanee with the provisions of Section 3 hereof, Is net aceeptsd hy the Znsursnee Company as satisfaetory IdmtuNI*M After the date of an bplqree'e retirement, any person on whose accent the Employee was not insured hereistder on the dsy preceding the data of his retirement. Amendment > ._y_ the ten 'child* include* err legally adopted ehild, enr atepehlld who reside* in the Employee's household, end eny child supported solely toy the Employee end permanently residing in the household of which the Employes is the hesd. Applicable to All Bnalovees Zf an Employee is Insured hereunder on aeeount of a child prior to the child's nineteenth birthday end aakcs written reeucot on or prior to sueh birthday for eontlnuanee of sueh insurance after such birthday, or if any child is nineteen years of age or ewer on the date the Employee becomes insured hereunder on aeeount of his De pendents and the Employee makes written request for Insurance on aeeount of sueh ehlld on or prior to sueh dote, sueh ehlld shall, for the purposes of insurance hercunrter and subject to all terms snd conditions hereof, other than the prevision that the ehlld be under nineteen years of one, be considered a Dependent of the im- ployee for a period prior to the earliest of the following dates: (a) The date of sueh child's 23rd birthday. (b) The date of expiration of the last period for which the Employee made a contribution required on aeeount of the insurance with respect to sueh ehlld. (e) The date sueh ehlld enters the military or similar foreea of any country or subdivision thereof. (d) The date sueh ehlld enters full-time employment. (e) The date sueh ehlld becomes covered under any other plan of hospital or surgical operation insurance (ether than insurance on aeeount of accident)." ZZ. Effective on the date applicable to his Division ns set forth in the Table below, as to Employees, actively at work on that date and Employee# employed subsequent to that date, and effective on the date of Ms return to active work as to any Employee net actively at work on sueh applicable date, by making the following changes, exeept that (a) with respect to all fisployees, sueh ehsages shall net apply to (l) any parted of hospital confinement eoaaeneing prior to, or (11) any surgieal operation performed prior to, the date sueh ehanges beeems effective with respeet to the Employee sad (b) with rwspect to bployeea of Baybostea D1vistoo, sueh changes shall not apply to aay pregnancy axisting ao the data sueh changes beearn* effective with respeet to the Employee: Table Baybestos Division Vabash Division Manhattan Rubber Div. (Employees at leeaab, Wisconsin) All other Impleyess Date of Periston Korember 1, 196? Nay 1, I960 Juno 1, i960 November 1, 190? 2 AXQtOKQtT ID. W < A. By aubstitutia* far the table of aaeuats of luvuet la Schedule i huie Insurance la the Schedule of Znsurfece end Employmi ' "<--iu Contributions, as amended, la Seetlon 6 of cold Qreup Polley, the following: "Schedule Z. Bcelc Insurance Class Life Insurance Insurance for Death or Disnenbement by Accidental Mesas Accident end Health Insurance (Weekly Benefit)*_______ Employee en- ployed in Rev All ether York State Employees Employees of a elaas or unit specified in Schedule A hereof, ex cept such Employees at Veeaah, Viseoasia $k,000.00 Ho Insurance $33.00 $28.00 Employees at Heeaah, Wisconsin finployees of United States Asbestos Divi sion vlth basic veefcly earnings, as detexsiaed by the Employer, of: 3,000.00 Re Insurance ----- 55.00 Less thaa $50 $50 but less thaa $70 70 or more k,000.00 k,000.00 k,000.00 No Insurance Ro Insurance Ho Insurance -- k0.00 k5.00 55.00 Employees of General Asbestos A Rubber Divi sion k,000.00 He Insurance kO.OO fismloyees of Faybestos Division vlth basic veehly earnings, as determined by the Employer, of: Less thaa $80 $80 but less than $88 88 but less thaa 96 96 but less than 10k 10k but less then 112 112 but less than 120 120 or more Be Insurance Be Insurance Be Insurance Be laeuraaee Bo Insurance Bo Insurance Be Insurance No Insurance He Insurance He Insurance Re Insurance He Insurance He Insurance He Insurance mz 50.00 55.00 60.00 65.00 70.00 75.00 80.00 AHOOMER BO. W Clams Enpleyees ef Wahash Divlaion: bployees subject to the bargaining agreenent with the Allied Industrial Workers ef America local #166 AP1-CT0 All ether tapleyees All ether taployees Life ^nsuyaaee - $3,000.00 6,000.00 2,000.00 insurance for Death or Disaanbenent by Accidental Means Aecioeat ana health (Weekly Benefit^ lev fork All ethn f No Insurance No Insurance 80 Insurance -- $33.00 $30.00 50.00 28.00" 8. By substituting for the typewritten verting appearing In itea (ii), a* amende of subsection (8) of Section 7 of said Croup Policy, the following: "thirteen weeks in the ease of an Employee ef Manhattan Rubber y Division at Neenah, Wisconsin, and in the ease ef any ether Employee, twenty-six". C.By substituting for the seeond paragraph, as amended, ef subseetlen (8) ef aid Section 7, ef said Croup Policy, the relieving: "Applicable to teployees ef Manhattan Rubber Division at heenah, Wisconsin.--for all disabilities cesnenelng on or after the Enployec's 60th birthday and within any twelve consecutive aosths, a total ef net more than thirteen weeks benefits shall be paid. D. By substituting for the Schedule ef Insurance and ifcployees' Maxima Contri butions, as aended, la Section 6 ef said Supplaaentary Agreement Pen G.B.P.6301, the felloelng: "Schedule ef Instance and arployees' Maxima Contributions <3. ana Hospital Expense Insurance Maxima Daily benefit Dependent Personal Insurance Insurance (Bach Dependent Dpltjess of Daltad States Asbestos Division $26.00 $26.00 kpleyns ef Wabash Division 26.00* 26.00* $26.00 ruananrtni en Nay 1, 1969 provided the Ehploye* is then activsly at work, other wise en the date nr bis mum to active work. She Mount which an tanleyee nay eoatribute to the eeat ef the In surance shall ant txeeed the prssiua share** the aenuats #f his in surance." AMENDMENT NO. W 9577-0 5 E. By substituting for the Type of Service and Maximur. Total Payment there for, u aieaded. in the first ParaGraph of Section 7 of said Supplementary Agreement Form G.B.r.6301, the following: Troe of Service "Room and Board Maximum Total Payment An amount equal to the Maximus Daily Benefit for each day of sueh hospital confinement, but not to exceed seventy tines the Maxinun Daily Benefit The following Special Hospital Services received nrior to the date the Ihsployee becomes en titled to the Haxinun Total Payment specified above on account of expenses eftarced for Roan and Board, namely, anes thetics (and tne administration thereof) and all other special hospital servlets emerged for by the hospital except services of physielans or special nurses and services and supplies not related to the smdieal care and trestaeat of the person confined. AnnHcnblc to Kmnlnyccs of the United States Asbestos HI vision and their Dependents Twenty tines the Maximum Dally Benefit. Applicable to Employees of the Wabash Division and their Dependents .--Tan tines the Maximum Daily Benefit." F. By substitutin'-, for tne tnird throurn the last paragraphs of said Seeticc 7 of said Suppienentary Agreement Form G.B.F.C301, the following: "Applicable to awployccs of tne Wabash Division .--For all hospital confinement of an Employee vnieh is caused by any one preenancy or re sulting childbirth or conplications, the total of the payments for expenses eharced for Uoom and Board shall not exceed ten times the Maxinun Daily Benefit in force on oceotnt of the Employee; and the total of the payments for expenses charged for all Special Hospital Services (including delivary soon) shall not exceed $100.00, prevised, however, that no payment of any kind shall be mads for such confinement if the pregnancy existed on tbs effective date of the Employee's Hospital Ex pense Insurance herewder. Applicable to Dependents of Employees of the Wabash Division.-- For oil hospital eoafiasaent of a Dependent which la eauaed by any one pregaaaqr or resulting childbirth or conplieatlana, the total of the payments hereunder for expenses charged for ell types of services (including delivery room) received during sueh confinement shall not exceed ten times the Daily Benefit in force on account of such Dependent, provided, however, that no payment of say kind shell be mode for such eoefinement if tbs pregnancy existed on the effective date of the Has pits! Expense Insurance herewder on accewt of such Dependent. AKdfEKUrT BO. *-f*t 85TT-C -6- Applicable to hrmloyees of the United S^tcr. Asacstos Division and Dependents af such Employees .--i*o tnyaent of mnv xinA a Bade Hereunder for any Hospital confinement which is caused by preg nancy or resulting eaildbirth or complications. Applicable to fcamloyecs of the United States Asbestos Division retired on or subsequent to January 1. i960 (i) under the Pension Plan of the Bnploycr or (ii) at a/rc 65 or older with at least 15 years of acre of continuous service-The embined total psyment of Hospital Expense Insurance benefits. Supplementary Hospital Benefits for Physi cians' Attendance, and Surgical Operation Insurance benefits on account of all periods of hospital confinement of the Employee or a Dependent coalescing, and all surgical operations performed upon the ftapleyee or upon a Dependent, oa and after the date the E^loyee is retired, shall not, in the aggregate, exceed the amount apeeified for such class in the table below. Tabic Class Deployeaa retired prior to March 1, 1963 Smployeea retired on March 1, 1963 but prior to April 1, 1961 Dsployees retired oa or subsequent to April 1, 196U Amount HanlOYee Each Denendent #3.61*5.00 #3,61*5.00 3,785.00 3,785.00 -2,il>5.00 2,11*5.00 Arm 11 cable to nJl rtunloy^r^. --hcncfltr. hereunder are net payable for any serviecu wuich. In nccorunnec vltii lnwu or rcftulationr. of any government arc or any be ootained without eor.t or at a rcaueed eeot to a person covered hereunder, exeept as proridea by tnc following ocntenec. Zf a charge la Bade to any such person which he is legally required to pay, any benefits hereunder will be eeoputed la aeeordsnee with the provisions hereof, taking Into aeeount only such charge. 'Any government' includes the Federal, State, Provincial or loeal government or any pollIleal subdiviaoe thereof, of the United States or Canada." 6. *r substituting for the Schedule of Zasuroaeo aod Z^loyees ' Maxi sun Contri butions is Section 6, ao oeaded, of Supplementary Agreement Form 6.B.F.6325 ettaehed to said Qrcnv Foliar ao a part thereof, the following: AMfeUHurr So. W 8577-C -7- "Schedule at Insurance end anployeea' Maximum Contribution* C1*j Daily Benefit (employee end Each Dependent) bploytci of the Manhattan Rubber Division et Passale, Mew Jersey toployeee of the Mennetten Rubber Urieloo et Neeneh, Vie eons in For any day of hospital con finement , the actual amount charged by the hospital for room and board up to tne hospital's charge for semiprivate room accommodations, but aot to exceed: $28.00 per day 27.00 per day For any day of hospital con finement , the actual amount charged by the hospital' for room and board for such day, but not to exceed: Itaployees of Raybestos Division 30.00 per day Ibplojrtei of the Gencrel Asbestos end Rubber Division 22.00 per day Me finployee of Manhattan Rubber Division other them a retired cbiployee, shall be required to contribute to the eost of the insurance. The amount which may other Steployee may contribute to the cost of the insurance shall aot exceed the prcaita charged for the aswuota of his insurance.11 H. Ry substituting for item (2) in the first paragraph of Ssetlen 7* as amended, of said Supplementary Agreement Form G.b.F.6323, the following: "(2) for the expenses charged far the following Special Hospital Services received during sues confinement prior to the ex piration of the maxisum period for which Daily Benefits may Be paid, provided that the total payment for all such ex penses shall aot exceed the maximum payment specified: