Document YGmnxdZmJymjbQn73xqVoKean

o-/ 1 Effective April 1, 1969 Suppleaentary Agreement For G.B.T.6325 attached to Group Policy So. 8577 It endorsed to eliminate aubaectlon (B) of Section 5. /<' ' ( -------- %. v.J'fV.-. (Regiatrar) METSOPOUTAK LITE ISSUSAHCE CQKPAJ7, /toBSCt. UtUrnba*. iMtum oo Effective m of lta date of issue, this Supplenentaiy Acr*uat la hereby endorsed u fallova : Z. To delate the lest par*rraph in the section thereof anti tied "IHSURIltG C1AUSE". ZZ. To substitute for the taction thereof entitled "aonci: ASD PROOF OF CUIMJ", the following "PATMEHT OF CLAZM.--All benefita provided herein shell be paid to the Esployee u they accrue upon receipt of vrlttea proof covering the occurrence, character, and extent of the event for which dale is aade." C. 21 -- t (Registrar) Fom 0.8031 METROPOIZTAH UTX IHSURAWCI COMPAQ, I Stcno* 5. CESSATION OF INSURANCE.--(a) The Ptnorul Hospital Expense Insurance and Depend ent Hocprnl Expense Insurance on any Employee Insured hereunder (hall automatically cease on the date of the termination of hi* employment. the Person*! Hospital Eapenae Inaurane* hereunder on such Employee is then in force. (c) If any Employee tnaured hereunder for only Personal Hospital Expense Insurance shall notify the Employer that his Personal Hospital Expense Insurance Termination of employment, for the purpeaet of hereunder Is to be discontinued, such insurance shall the Hospital Expense Insurance hereunder, mean* automatically cease on the.____dx.te cessation of active work at an Employee as defined in Section 1 hereof, except that (I) in case of the a baence of an Employee from active work because of sickness or injury, his employ ment may, for the purposes of his Hospital Expense Insurance hereunder, be deemed to such notice of discontinuance is received by the Em ployer. If any Employee insured hereunder for both Personal Hospital Expense Insurance and Dependent Hospital Expense Insurance shall notify the Employer that cither (i) hit Personal Hospital Expense Insurance continue until terminated by the Employer, or hereunder, or (li) hi* Personal Hospital Expense Insur (U) In case of the absence of an Employee from active ance and Dependent Hospital Eapenae Insurance here I work because of temporary layoff, his employ- under is to be discontinued, then both his Personal 3 mem may, for the purpoecs of his Hotpital Hospital Expense Insurance and Dependent Hospital Expense Insurance hereunder, be deemed to con Expense Insurance hereunder shall automatically cease tinue until terminated by the Employer but in no case beyond the...... X..................... _..X.._....... on the.......... .4*?.... ....... ....... .................................... _____ x............ .......... x____ _______ X_____ ...................... .......... --..............................juch nodes of discontinuance ia received ^y the Employer. If any ______ X.------------------- Xsuch tey-off commenced Employee insured hereunder for both Personal Hotpital Expense Insurance and Dependent Hospital Expanse Insurance shall notify the Employer that only his Dependem Hospital Expense Insurance hereunder ia to bt discontinued, his____X.... ........... X..............*x..... ____ X.... ......._*,,................_______ Dependent Hospital Expense Insurant* hereunder shall automatically ecase on the............. 4***......................... ....... ..... ..................... In the case of either of the foregoing exceptions, the Personal Hospital Eapenae Insurance and Dependent Hospital Expense Insurance hereunder on such Em ployee shall auromancaily ccaac on the date of such termination of hi* employment by the Employer, at evidenced to the Insurance Company by the Employer, whether by notification or by emiation of premium payment on account of such Employee's insurance hereunder. (a) The Personal Hospital Expense Insurance here under on any Employee shall automatically cease on the date of expiration of the maximum number of days for which Daily Benefits am payable hereunder on eecouat of the hospital caotfamnaac of such Employee. Tha Personal Hospital Sapmwa insurance betaunder on any such Employee mar be tatnetatad anly if and when ha return* to active stark far die Employer on full time. An Employee's Dependent Hoepfeal Expense Insur ance hereunder with respect to any Dtpcraienr shall automatically caaae on tha date of expiration of tha auximum- number of day* for which Daily Benefit* am payable hereunder on account of the hospital confine* mem of euch Dependent. The Employee's Dependent Hospital Expense Insurance hereunder orkh respect to such Dependent may be reinstated only after the termination of such hospital confinement and upon recovery foam tha bodily biiury or afchnat which caused such hospital confinement, and only peeaided Form O.BJ. 4323 1M2 'rarxrpio in u.s.a. ..................................-...................................... such notice of discontinuance ia received by the Employer. Failure of any Employee to make contribution when due. as required by the Employer, to the com of either hit Personal Hotpital Expense Insurance hereunder or hia Dependent Hospital Expense Insurance hereunder shall have the same efiect as notice to the Employer, within the mcaninc of the preceding paragraph, that the insurance for which such Employee has foiled to make contribution ia to bt discontinued. (o) An Employee's Dependent Hospital Expense Insurance hereunder emh rmpect to any Dependent shall automatically caaae on the day immediately pre ceding the data such person teasea to be a Dependent of such Employee, as defined in Section 1 hereof. () In any event all insurance hereunder shall automatically cease Immediately upon the dbconimu* anee of this Supplementary Agreement or of said Croup Policy. .XgL?w;_jaHt.jiHjpgg..flf..thg jrotKlona-af ..WMfC.i4.qa. (A) Of this gtetloo..tha-amt Jflanwav ttf aa ttolay-- wba ia .ratdraA, jfo*U-bo , , ... .......fltwfi-UuioatlPiw until trmdnotatl byTeoatlpued OBrtrtrMAlAal^___