Document Zg7O7Lkxe4jM7mpaQNqzdZOL

Ir <4 METROPOLITAN LIFE INSURANCE COMPANY Sr * Nay 29, 15*0 rewritten v/ffp/ Group Policy Noj85ZZ:$.-- ____ hearing date of..___ J^S00ba;r..l*-1956----- and insuring' the Employe: as foliowi: ( H<HI> enMnN the Knttitnftv) __________________________ is herebj. ^ Z. Effective May 31, 1967, by adding to Supplewatary Agratenet fora C.B.r.630 attaabed to said Croup Volley as a part thereof, the following: "Applicable to toployees of Manhattan Rubber Division at Keeoah, Wlseonsln... Each Saployae too la actively at work oa June 1, 1967 and each Eaployes eaployed aubseguest to that date shall be excluded from eligibility for iasuraaee hentader aad the iasuranoa heretaidar, if aay, oa each such Sopisyea shall be eutonatleally discontinued on Nay 31, 1967*" - II. Effective June 1, 1967, by extending the waning of the tera "toployee" la Suppleaentary Agreeacnt Poro G.B.P.6325, attached to said Croup Policy as a part thereof, to include oertaii. eaploy^e of Msnhettaa Rubber Division at Hoesah, Wisconsin. ZZZ. Effeetlva oa the date applicable to his Division set forth la the following table as to each toployee oa any such Division actively at work oa such date aad toployai eaployed subsequent to such applicable date, aad affective oa the data of his retun to active work as to aay such applicable date, by asking the following ehsages, aneept that such change shall not apply to aay psAod of hospital ooafiaeaaat ooenaaelag or aay surgical operation perforaed prior to the date such ohsagas bacons effective with Aspec ts an toployes: Table toalovees of Raybaatos Division PLAINTIFF'S EXHIBIT Naahattaa Rubber Division toployees at Passaic, Rev Jersey, topicyeas ebo are not aeebers of Naahattaa todge 1679 Xntanatioaal Association of Machinists MET-775 toployees to are aeabere of Naahattaa Lodge 1679 Zatanatioaal Aasoeiatloo toplnyess at Reeaah, tfieeoaaia Oeaeral Aabastos aad Bobber Divlaioe felted States Asbestos Division fehash Division Effective Date Oetober 10, 1966 Juan at, 1966 September 29, 1966 June 1, 1967 Pebrmry 13, 1967 June 1, 1967 ~~ Oetober 10, 1966 & 3J77-0 KJ 2- o A. By substituting for tbs table of aaountsof insurance in Schedule 2 Basle Insurance la tho Sobedule of Insurance and Bnployaes' Maxieua contributions, as aaeaded, la Section 6 of said Group Rlley, the following: "Schedule I. Baale Insurance dams Ufa Jncuranee lasuraaee for Death or Dlsaeabenaat by Accidental Means sployees of a class or mit spoelflad la Schedule A hereof, ex cept. such taployees at Meeaah, Vlseoasla $4,000.00 Mo Insuranos teployees at Beeasb, Vlseoasla 3,000.00 Bo Insurance Ssployees of United States Asbestos Divi sion vita basic weekly earnings, as detemlasd by the Employer,of: Less thaa 150 $50 but lass thsa $70 70 or aors 4,000.00 4,000.00 4,000.00 No Insurance No lasuraaee No lasuraaee hsployees of Oeneral Asbestos A Rubber Divi sion 4,000.00 Mo lasuraaee teployees of Baybastoa Division Mo Zasuraaeo Bo lasuraaee teployees of Wabash Dlvlsloa; Employees subject to the bargaining agreeeat with tho All lad Industrial Workers of American Local fl64 AFL-CXO 2,000.00 Bo lasuraaoa All othar teployees 4,000.00 Bo Zasuraaeo Ol othar teployaes 2,000.00 Mo Zaauraeee Accident aad Sealtb lasuraaoa (Weekly Benefit)* fasployses ea- ployed la Mev All other Tort State teployees $33.00 $23.00 55.00 $0.00 40.00 45.00 55.00 40.00 50.00 J3.00 43.00 43.00 23.00" AKCQMBtT BO 6577-0 3 B. By substituting for tb# eeeond paragraph of subsaetlaa (B) of Section 7, M ombdad/ of sold Group Miey, the following: "Applicable to all teploywss except Saployeea of the Uoltod State* Asbestos Division.--Par all diaabllltlas eomencing os or after tb* bployee's 60th birthday aad vlthla any twelve eoaaaeutlv* eoatha, a total of oot wore than twenty-six week* benaflta ahall be paid la the eaaa of aa toploye* aeployed la New fork State or at Waboah Division aad la the eaae of aay ether teployee, a total of aot eora thaa thirteen mil benefit* ahall be paid." C. By substituting for the Schedule of Zaauraaee aad Deploy***1 Maxima Contributions, aa aaendsd, la Section 6 of raid Supplementary Agreement Pont C.8.P.6301, the following: "Schedule of laauraace aad Bsployee*' Maximuo Poatrlbutloae Claaa i Baployeea of Ublted State* Aaboatoa Division oapltal ficpaoae Zaauraaee Maxlaua Bally Benefit Dependent personal Zaauraaea laauraace (Bach Dependent) 624.00* $24.00* AH other Dsployees 14.00 14.00 *626.00 coMeaclag oa April 1, 1968 provided the Ibployes la tbea actively at werk, othervlee oa tbe date of hla retun to active work. She amount toleb aa Deploy** my coatribute to tbe coat of tb* la- a urease ________ __ _ eball aot exceed tbe prealue' charged for tb* aaouat* of bl* la- S. By substituting for the elrth paragraph of Sectloa 7, aa aacaded, of aald Bupplematary AgreesestPore C.B.P.63OI, tb* follovlag: Applicable to Deployeee of the United State* Aabectoa Dlvlalon retired on or subsequent to January 1. 19o0 (l) under the Nnalon Phan of the Dsploycr or (11) at age US or olaer with at least lb rcarc or aore of contmuoua service.--The combined total paymat of hospital Bxpeaee Xaeuraace benefits, Supplemfifry Boapltal Benefit* for fbyslelaas' Attendance, aad Surgleal Operation Zasunao* benefits oa acoouat of all periods of hospital QOBflaoeoat of tb* Deploys* or a Depeadeat comeaciag, aad dll surgleal operations performed upon the Deploy** or upon a Depeadeat, oa sad after tbe date tb* Ssployu* Is retired, shall aot, la tbe aggregate, exeeed tbe meat specifled for snob class la tbs tabls bale*. AMBQKEB? BO. V? 8577-0 4 Table Class finployoea retired prior to March 1, 1963 teployees retired oa March 1, 1963 but prior to April 1, 1964 Anount zopioyee $3,645.00 3,785.00 Bach Dependent $3,645.00 3,785.00 fispleyoea retired oa or subsequent to April 1, 1964 but prior to April 1, 1967 fiaployooa retired 00 or subsequent to April 1, 1967 but prior to April 1, 1968 fisployoea retired oa or subsequent to April 1, 1968 2,145.00 v 4,325.00 v,.r 4,505.00 2,145.00 4,325.00 4,505.00 X. By substituting for the definition of tha ten "Bnployee" la Booties 1 of aold Buppleaentary Agreesent Ton G.B.F.6325, th* following: "The ten'Baployee' moo* o full-tlae eaployee 160 la directly employed mad coapenssted for services by tba Manhattan Bubbor Division, tha Ooneral Aabeatoa and Rubber Siviaion or the JUybeatoa SIviaion of the feployer." F. By aubatltutlng for the definition of the ton "Dapendant" la Soetloa 1 of aold Buppleaentary Agreement Fore G.B.F.6325, the following: Applicable to Baployees of Manhattan Bubbor Division.-- The ten 'Dependent' attai (l)an Biployoe'a spouse, (2) any unmarried child of a sale finployee, of a widowed female JDapioyoo or of a fosale fiaployoe whose huabaad la oot eligible for laauraaeo aa aa fiaployoe, excluding la oay caeo: Aay child under 15 daya of age aad oay child 19 yeare of ape or elder. Aay porooe for laauraaeo aa aa Jfeployee. Aay person meldlac outside the Uhltod Statoa aad Caaada. Aay peraoo those evidence of food health, furnished la necordaaee with the provlalona of Soetloa 3 hereof, la oot aeeepted by the Xaeuraace Ooapeay aa aatlafaetory. Aay peraoo la the allltary or slallar foreea of aay eooatry or eubdlviaioo thereof. After the date of aa toployoe'a retlraaent, aay poreea oa those aeeoat the fiaployoe ooa not Insured heniader aa the day pneedlas the date of bla retlnoeat. AMCXSNEBT BO. *V.7 8577-0 5 Ths tan 'child' Ideludes aay legally adapted child, any stopchild too resides la the Bsployee'* household, sad any child supported solely by the Bsployee and peraaaently residing la ths household of tolcb the Beployce Is the head. If aa Bsployee Is Insured herounder oa account of a child prior to the child's nineteenth birthday and sokes written request on or prior to such birthday for continuance of such insurance after such birthday , or if aay child is nineteen years of age or over oa the date the teployee beeoaes insured hereunder on account of his De pendents and tha Bsployee aakes written request for insurance on account of such child on or prior to such data, such child shall, for the purposes of Insurance hereunder end tubjeet to all tens and conditions hereof, other then the provision thet the child be under nineteen years of age, be considersd a Dapeadant of the bployee- for a period prior to the earlleat of the following dates: (a) The date of such child's 22nd birthday. (b) The date of aspiration of the last period for toieb the Bsployee Bade e contribution required on secouat of the insurance with respect to such child. (c) The date sueh child eeeses to be e full-tlae student at aa approved school, as determined by the Bsployer. (d) The date such ehild enters full-tlae employment. (e) The date such child becooes covered under eay other plan of hospital or surgical operation insurance (other then Insurance on account of accident). If aa Bsployee le insured hersunoar on secouat of a child on the dey lanediatcly preceding such child*e Uniting age end if sueh ehild is then incapable of self-sustaining eaploymeat by reason of aantal retardation or physleal handicap and is ehlafly dependent upon sueh Bsployee for support and maintenance, the requirement that the child be under his limiting age to qualify as a Dependent will not apply to such child toils he remains so incapacitate! and dependent upon the toployae, provided that, open request from the Insurance Company, due proof of such incapacity and depeadaney and that such incapacity and depsndsney have been continuous sines the child's attainment of sueh limiting ate is submitted by ths B^loyae to the Insurance Coaapny and further pro vided the Bsployee makes aay contribution required by the toplayer on account nt the instamaee with respect to sueh child. TBs Insurance Company may require the Bsployee to furnish proof at aay time that aay such Dapeadant remains so incapacitated and dependent.* AMBOKEKT XO. -v ? / 8577-0 6 Applicable to faployves of Ocaaral Aibtitoi and lubber Division---Baa ton "Dependent* auu (1) an loployve's spouse, (2) any unmarried child of a aalo teployve, of e vldoved female taployvs, or of a feasls bployoe idaoaa husband is not eligible for Insuraaoe as an feployme, ^ Uy Any child oodor 15 days of as* and any child 19 years of acre or alder. Any person eligible for Insurance as an feployoe. Any person residing outside the United States and Canada. Any person ifcose evidence of good health furnished la aeeordenoe vlth the provisions of Seetlon 3 hereof, is not accepted by the Xaamnee Company as satisfactory. Any person in the allltary or aIdler foroes of any country or subdivision thereof. the tors 'child' Includes any legally adopted child, any stepchild idio realdea la tba Eoployaa 's household, and any ehlid supported solely by tbs fcploysa and penanently residing In the houssbold of Aleh the Bsployme Is the head. If an Bnployoe lo lncurod hereunder on eceount of a child on Ute day Immediately preceding uueh child'o lleltlug age and If such child la than laeapabla of self>euatalnlng employment by rceaoo of oentol retardation or physical handicap and is chiefly dependent upon such Zfeployee for support and malatenaaoe, the requlreasnt that the child be under his Uniting age to qualify as s Dependent vlll not apply to sueh child \fcile be reualne so Ineepeeltatad end dependent upon the Baplovee, provided .that, upon request from the Insurance Ooapany, due proof of such lneepeelty and dependency and that such lneepeelty end dependency have been continuous sines the child' attainment of such Uniting age Is submitted by the Btployee to the Insurance Company and further provided the teployve sakes any contribution required by the teployvr on eeeouot of the Insurance vlth respect to sueh child. She Znsurenoe Company say require the Bsployoe to funlab proof at any tine that any such Dependent remains so incapacitated and dependant. Applicable to feploymes of Baybestoa Division.--9w ton "Dependent* means (1) an Baployoe's spouse, (2) any unmarried child of a amis toployee, of a vldowd female Bepleyae, or of a female feployve tooee husband la net eligible for laouimaee as an taployme, oscludlng la any eaao: Amy Child 25 days of age and any ohlld 19 yoare of age or older. Any pence for laswoaee as an bployme. Amy portoo nsldlng outside the Halted States end Canada. Any pence booe ovldonoo of good health, furelshod In oooerdaaoe vlth the previsions of Seetlon 3 hereof, lo act accepted by the Xoeuraaoe Cempmay ms satisfactory. Any pence la the alUtary or almllar forces of aay country or eubdlvision tbonof. AMBQKEHT IQ. "V7 1 8577-0 7 After ttM date of on Baploywe's retirement, may person on whose aecotat tbe employee m not Insured benuader on the day pre ceding tbe dote of bis rstlreaent. toe tan# "child" Includes any MgaUy adopted child, sny stepchild too resides la tbe Bsployee's household, sad any child supported solely by tbe teployee end permanently residing la tbe household of toieh tbe Sepiayee Is tbe head. Zf ea finployee Is lasured hereunder on account of a child prior to tbe child's nineteenth birthday and Bakes written request on or prior to euefa blrtbdey for eoatlauaaee of such Insurance after sueb birthday, or If any child is nineteen years of age or over on the date tbe finplsyee becomes Insured bereiader oa account of bis Dependents and tbe Ssployoe makes written request for Insurance oa account of such child on or prior to sueb date, sueb child shall, for tbe purposes of Insurance bertuader and subject to ail terms and conditions hereof, other tban tbe provision that tbs child be lir nineteen years of age, be considered a Dependant of tbe toployme for a period prior to tbe earliest of tbe following dates: (a) Tbe date of sueb child's 23** birthday. * (b) Tbe date of expiration of tbe last period for toieh the bploywe made a contribution required oa account of tbe Insurance with respect to such child. (c) toe date such child is no longer principally dependent upon tbe Dsploywe for support. (d) ID* date sueb child enters full-time employment. (o) The date sueb child becomes covered under any other plan of hospital or surgical operation tnouranee (other than Insurance a account of aeeldaat). 6. By substituting for tbe definition of tbe term "Dependent" in Seetloa 1, me emended, of Supplementary Agreement Pens C.B.P.6303 and G.6391-2-P.AD., attached to said Croup Policy as parts thereof, tbe following: toe ten 'Dependent' has the same meaning In tbla Supplementary Agreement as sueb tan has la the applicable Xcspltal Expense Insurance provisions of toe Oroup Volley." K. By Mhetltutlng for the Sebedula of Zneuranoe and teployeas' Con tributions in Section 6, as emended, of said Supplementary Agreement form G.B.f.6325, the following: ANBQMBff BO. 6577-0 ST" "Bengal* or iksdrajcs akd BgLoytss1 wjoxjh cowiRnonows dm toploy*es of the NubttUB Rubber Division at Pas*ale,-Rev Jersey Dally Benefit (Bsployee and Bach Dependent) For aay day of hospital eonflneaeat, the actual aaotat charged by the hospital for rooa aad board up to tho hospital' charge for sealprivate rooa aeeoBodatlosi, but sot to exseed $26 per day teployes* of the JUybestos Division of the Msnhattaa Rubber Division at lleaaab, Wisconsin Jbsployees of the General Asbestos aad Rubber Division For aay day of hospital eonflaoaeat, the actual saouat charged by the hospital for rooa aad board for sueb day, but aot to exeeed: $2$ 22 go Deploy** of Manhattan Rubber Division other then e retired teployea, shall be required to eontribute to the eost of the insurance, tte aaount Uileh any other bployes aey contribute to the eost of the Insurance aball not exceed the premies charged for the eaouats of bis lasuranos." Z. By substituting for "120*", es aaeaded, appearing in ltea (1) in the first paragraph of Section 7 of said Supplsnantary Agreeoont For* C.B.F.6325, the follovlag: (l) 70 days la the ease of an toployee of (a) General Asbestos and Rubber Dlvlsloa (b) Raybesfeos Division aad (c) Manhattan Rubber Division employees at Reeaah, Wisconsin, aad (ll) 150 days la tbs ossa of aay other feployee of Manhattan *ubber Division" J. By substituting far ltea (2) la tho first paragraph of Section 7* as aaeaded, of said Bupplsmantary Agreement Fan G.B.F.6325, the faUowlag: "(2) far tte expeaaes charged for the following Special Boepltal Services received during such confinement prior to the ex piration of the maxisim period for toleh Sally Beaaflts aay be paid, provided that the total payaaat far all ouch axpaasas aball aot axeaed tbs aaxlaioi payasat specified: AXDQBSKI SO. 4.1 5577-0 U pedal Hospital Services Anesthetics (and the tratlon thereof} aad all otter special hospital services charged for by tte hospital ex cept eei-rice* of physicians or apodal avraaa aad aarvieaa aad i9pllaa sot ralatad to tba aall eal oara or traatnast of tba person confined Haadnum Payaeat (0 Applicable to Btployeea of General Aabeatoa aad Rubber Division aad their Depondcnta.-Twenty pines tba naxlnw Sally benefit. (b) Applicable to teployee* of Manhattan Rubber Division at Paacalc, New Jeraey aad tbelr Dependents.-piQO plus 755 of the excess of tbe expense* charged for aueh aarvieaa over $M0, , .but tte Ntzlaia peynaot not to exceed 2 200 (e) Applicable to Employed of Manhattan Rubber Division at Weenah, wiconln and their Dopcndanto.-riftcon tiaea tba aaxla Sally Benefit. (d) Applicable to Baployeea of RayPeatoa DlVlilon aad their Dependent*.*1200 plus of tbe axeaaa of tbe expanses charged for aueb aarvieaa over $200, but tbe Maxlata Total Payoent sot to exceed $2000. (3) Applicable to Baployoes of Manbattaa Rubber Division.-- y-Qr Codaultatloa Service*, except ataff eoaaultatloaa required by hospital rule* or regulations, but only i&lla tba teployae or Dependant la a boepltallted bad-patient, for a condition requiring apaelal skill or knowledge, aa aaalataaee In dlagnoala or troatnent to tba pbyalelan In charge of tbe ease. Fayneot ahall be United to $50 for aedleal, surgical or obeterteal bedside oonaultatlon during aaeb period of continuous boapitalitation. X. By aubstltutlng for the third, fourth, fifth and sixth paragraphs of .Sactloo 7, aa aaaadad, of said Supplaaentaxy Aguecant ran G.B.P.6325, tte following: "Applicable to Baployeea of General Aabeatoa and Rubber Division aad Dependent* of uch Duploycoa. --For all heopltal conflnaaant tdaleb la caused bypragnasey or reaulting childbirth or ecnplleatlooa, tte total of the peyoaata for room and board and all Special nospltal Services contained aball not axeead $330 provided, hovevar that no payaeat of any bind aball be ache for such hospital aonflnenent if tte pregoaney existed on the affective data of tba Bospltal Sxpaaaa Znauranea teretndar on account of tte parson so confined. Applicable to fcrployocc of Raybestoa Division.-- for all boapltal cooflxtauest of aa tepioyeo Ubleh is caused by pregoaacy er rasuiting cblldbirtb or aooplieatlOM tba sb of tte payneote for Daily Baaaflta aball not exceed $175 and tte total ef tte paynaata far ipeeial Boapltal Sarvlaas (including delivery .room) aball not exceed $100. fur all boapltal eooflsaaaot ef a Dependent ifeleh la caused by pragnaney or raaulting cblldbirtb or ooapllcctlonc, tte total of tte paynenta for $ .rooa aad board aad all Apaelal Boapltal Bervioss contained aball not exceed 250 AMBCDKEKT HO. V? 8577-0 T 10 Re payment of any kind shall be made for may hospital confinement wuMd by pregnancy or resulting childbirth or complications if the pregnancy existed on the effective date of tbe Bospltal fccpensa Insurance on account of tbe person so confined. Applicable to Bsploymes of Manhattan Rubber Division employed in Hassle, Rev Jersey. Tot all hospital eosflaesent of an Employee caused by any one pregnancy or resulting childbirth or complications, the Sally benefits shall not exceed $1>iO.OO and the sun of the payaenta on acooust Of all Special Hospital Services (including Delivery Room) shall not exceed $100.00; provided,however, that do peyiecnt of any hind shall be made for such hospital eonflneaent if the pregnancy existed on the effective date of the Seployee's Bospltal Expense Insurance. Tot all hospital eonflneaent of a Dependent eauned by any one pregnaney or resulting childbirth or complications, the total of pay ments for both Dally Benefit and all Special Bospltal Services combined shall not exceed $200.00 on account of such Dependent; provided, how ever, that no payment of any kind shall b# made for such confinement If the pregnaney existed of the effective date of the Hployee's Bospltal ftepease Insurance on account of such Dependent. Applicable to Snployees of Manhattan Rubber Division at Neenah, Wisconsin.. Ro payment of any kind shall be made for. hospital eonflneaent of an employee or a Dependent which Is eeused by pregnaney or resulting child birth or complications. Applicable to Employees of Manhattan Rubber Division at Passaic, Raw Jersey retired on or subsequent to January 1, lVo2.--The combined total payment of hospital Bepease Insurance benefits, Supplementary Bospltal Benefits for Ibyslelaae' Attendance, and Surgical Operation Insurance benefits on account of all periods of hospital confinement of tba Employ*# or a Dependent oommenelag, and all surgical operation performed upon the toployee or upon a Dependent, on and after tbe date tbe Aiploymo 1* retired, shell not, la the aggregate, exceed the amount specified for such unit la the table below. Table ttolt. Hplojee Amount Bach Dependent Ssploymes retired on or subseq uent to January 1, 1962 but prior to December 23, 1963 85,180 85,180 Employees rstlrsd on or subseq uent to December 23, 1963 but prior to July 1, 1966 feploymes retired on or subseq uent to July 1, 1966 5,7*0 8,250 5,7*0 8,250" AMERXHERT 10. ^3 l fi5T7-0 - 11 L. >7 subetituting for its* (1) of Section 6, as snead-td, of Mid upplaaantary Agreement Pore O.6391-Z-P.ID., the following: "(1) toe aaount of such supplementary benefit* shall not exceed the (renter of (a) the applicable aeount aat forth in the schedule below times the nuabcr of days for which Hospital Expense Insurance Daily Benefits are paid for such hospital eonflaeannt, ex cluding any days on or after the day os which any surgical 0paratios la performed for Alch surgical benefits are pay able leader the Croup Policy and Mleh an dua to the bodily injury or disease tftieh resulted in the operation/ op to the applicable aaxlaixi set forth la said schedule, or (b) the applicable aaount act forth in the schedule below time* the number of days for i*leb Hospital topense Insuranea Daily Bsncfita are paid for such hospital eoafineeent, up to the applicable aaxlaus set forth la said schedule, lass the aaount of any surgical benefits payable uader the Croup Policy on account of o surgical eporatioe parfonwd during such period of hospital eoafineeent." H. By substituting for ltaa (3), as aaended, of Section 6 of aald Suppleaentary Agraeaant Pen C.639i-Z-p.se., the following: *(3) Applicable to (1) toployees of the Ublted States Asbestos Division retired on or subsequent to January 1/ i960 (a) under the Pension Plan of the toployer or (b) at age 65 or older with at least 15 years or sore of oontiauou* service, and (11) Dsployeas of Manhattan Rubber Division at Passaic, tow Jersey retired on or subsequent to January 1, 1962 the combined total payeent of Hospital topenso Insurance benefits, Suppleeentary lospital Benefits for Ihyaleiaas' Attendance, and Surgleal Operation Insuranea banafit* on account of all pariode of hospital aonfinaasat of the to* ployee or a Dependant eeoMnelng, and all surgleal operations performed upon the toployee or upon a Dspandant, on and after tba data tba toployee is retired shall not in the aggregate txoaed tba aaount specified for snob aolt in the table Mm. AMPCMgTT HO V? 8577-0 - 12 - Ta'ole Unit Manhattan Rubber Dlvlaloa Sipleyeee retired 00 or eubaequsnt to January 1, 1962 but prior to Beeanber 23, 1963 teployee! retired oa or eubaequest to Deeaaber 23, 1963 but prior to July 1, 1966 Beployeee retired oa or aubeequeat to July 1, 1966 Itoltad Statei Aabeatos Olvliloa Boployeea retired prior to Marsh 1, 1963 teployee* retired oa March 1, 1963 but prior to April 1, 19&* teployed retired oa or aubeequeat to April 1, 196i but prior to April 1, 1967 Beployeee retired oa or aubeequeat to April 1, 1967 but prior to April 1, 1968 teployee* retired oa or subeeqiueat to April 1, 1968 Aao isit tealoyee' Sect Dependent $5,160.00 5,71*0.00 6,520.00 3,61*5.00 3,785.00 2,11*5.00 4,325.00 4,505.00 $5,180.00 5,740.00 8,520.00 3,645.00 3,785 .00 2,1U5.00 4,325.00 4,505.00 B. By eubetltutia* for the Schedule of Benefit* la Beetles 6 of eald Auppleaeatary Acreeaeat Toro 0.6391-l-P.Afi. t the following: AWOMBT BD. V? 8577-0 13 "Schedule of Benefits and Drployees1 Haxlarua Contributions cimi Suppleaentaiy lospital Benefit* for Physicians' A*f*"<- Maxima Dally Benefit Daily Benefit (Bnployee *ad (Bsployee and each Dependest) each Dependent) Bnployees of Masbettea lubber Diviaioa at: Passaic, Mev Jersey Meeoah, Wisconsin $6.00 5.00 $1200.00 350.00 toployees of General Asbestos and lubber Division 5.00 350.00 toployees of laybestos Division 4.00 260.00 toploysea of United States Asbestos Division 4.00 260.00 All other toployees 4.00 124.00 Ho Deploys# of Maabatten lubber Division, other than a retired B> ployes, shall be required to contribute to the eost of the lnsuranee,the aaoust which any other fisployee say contribute to the cost of the insurance shall not exceed the prealus charged for the aaount of bis insurance." 0. By substituting for the Schedule of Insurance and teployees' Maxima Contributions in Section 6, as aaended, of said Suppleacntary Agreenent Torn G.S.P.6303, the following: "soanoic or msomicE aid iMPLoras' maximum cowiaunons Class Maxima Benefit Dependent Surgical Personal Surgieal Operation Znsuraacd Operation Insurance (Bach Dependent) topicyess of the Manhattan Bobber Ddvlsloa at: Passaic, Mew Jersey Beenah, Wlscooaia $600.00 500.00 $600.00 500.00 Beployses of united States Asbestos Division 500.00 500.00 All other topinyses 245.00 245.00 AKSOKSn 10,*_2 577-0 - 15 ttllt Naabattaa Rubber DlYlaion feployeee retired oa or eubae* quant to January 1, 1962 but prior to Deeeaber 23, 1963 Beployeea retired on or eubae. quant to Oeeeaber 23, 1963 but prior to July 1, 1966 laployeea retired oa or aubae* queat to July 1, 1966 Aaauat Employee Been Denendeat 85,180.00 5,740.00 8,250.00 95,180.00 5,740.00 8,250.00 Halted Statea Aebeetoa Sinaloa toployee* retired prior to Mareb 1, 1963 feployeee retired oa March 1, 1963 but prior to April 1, 196k Baployeee retired on or aubae* queat to April 1, 196b but prior to April 1, 1967 Baployeea retired oa or aubee* queat to April 1, 1967 but prior to April 1, 1968 3,645.00 3,785.00 2,145.00 4,325.00 3,645.00 3,785.00 2,145.00 4,325.00 ftaployeea retired oa or eubeequeat queat to April ,1* 1968 4,505.00 4,505.00 B* By adding to flection 9 the Attached Seetlaa* 9 eettia* forth the sebedulee of eurgieal opezmtleoe asd oaxlatB peyneata therefor baaed ea a Maxima flungieal Operotloo feepenae Benefit of (1) $600 ea aeeeuat of oertala feployeea aad Bepeadeata aad (id) $500 ea aeeeuat ef eortala ether teployeee aad Depeadoat#. AKBCKEKT BO. V ? 8577-0 . 16 . 8. By adding aa a beading to Supploaontory Agmust Ton 0.6552-16,attached to said Qroup Policy aa a part thereof, tba folloving: "Applicable to Jtoployoes of Ualtod Stataa /Ubtiui Plvlaloa" T. By eubetltutlag far tba definition of tba ton "Dependent" la Suppleaatary Agraaaaat Ton 0.0297, attached ,, aald Oroup Tolley aa a part thereof, tba folloviag: *&a ton 'Dependent* baa tba aaao Maolag la tbla Supplaaeatary Agree* aat aa such ton baa la tba applicable loaltb fccpenee laauraaoa arovlsloas of tba Oroup Policy." . n TJ. By adding to said Oroup Policy aa parta tbaraof tba attaeted Supplenatary Agmwt Tona 0.6552-16, 0.0065-7* 0.0297 aad Bpdonaoaat TOnaC.9060-1. The fortgoing amendment is to be attached to end made part of aaid Group Policy, end ie aabjcct to the agree tad covenant* therein contained. -ty^6-.ft^>^..te______? U da* ^ ...........day of........ 'r'.y/T, *'v tV.________ __ ___ -19 AU . ts'.U.'.vv'....... ___ junzs^^fut^^ sc....... (SfAct asLow rot uat or wcraorouTAN un iwnaunct company only) ...........y.cT.. **T..............day of...........<*. ...19 C-.i: MKTKOPOtJTAN IJKK !NSUKANC COMPANY, Aorodneat - *^3 JtQgZt- tffU*btcJz Srrrtttry