Document vRJqnbmdG37rQDpEXxyM8MVR

3*U>WU.XVI LIT XHSUBANCT C3KZA1CC |,>gf 29, 19W .Croup Polley Mo.__8577-0 taouria* the Employees of bearing data of December l. io<?6 ud ractstcs - wmmw, ntc.__________ (Morels called the Employsr ) Is hereby amended, as to Bnployeea of Bavbeatos Division > follows: PLAINTIFF'S EXHIBIT MET-785 Xffsetlve January 1, 1969. ^ y substituting "lant dny of the cnlrndnr month In vhii?h t~nri nnti nn nr hla euijiloymcot occurs" for the wordo "date at tho termination oif hia eat>loy t`rZl ^ 8-egnd Trarranl,s of eub3?et)on (A) of Section...S_______ XI By substituting "last day of the calendar aoath In which such termination g* h-* girnlnvwent bv the rbwlovcr oeeurg. ' ___________ *OT the words "date of such termination of hie employment by the Employer," appearing ta the lsgt sentence of the first and eecond pom^-apha of subsection (A) of Section 5 of aaia Group Policy. * ' '*"' "* ' " ... XXX. By substituting "that say fisployee while Insured hereunder ahail here died," tor the words "that any Employee laeured hereuadsx ehall have died while aa Etployee of the Employer, aa defined la Section 1 hereof," appearing la Section 7 of eald Croup Policy. XV. By substituting "eessatloa of his Insurance" for "termination of his employ* eat" or "termination of the &sployee1s employment" wherever either appears la Section 6 of eald Group Polley sad la subseotioa 2 of Section 9 of said Oroup Policy. V. By substituting for item (l) of eubseetloa 1 of Seetloa 9 of said Croup Polley, the following1 "(i) the last day of tbo calendar month la which termination of the fisployee's employment oceurs, or". The foregoing amendment is to ho attached to aad made part of aald Group Policy, and la subject to the agreements and eovaaaata therein contained. Dated at 1 . *aa \ day of 19 v. (Witaaaa/ RACTESTCB MUmTOH. XHC. (Employer) Bv /% r/,< , (SPACE UUU PC* USX CP MEZBOFOLXTAS LZR ZXSUBAMC3 OQKMJB OHS) Dated et New York, N.Y. this 29th day of Tabruarr 19 72 MEZMOPOUXAM LXPE HHUIUIICS CCKPAfflf, (Registrar) Perm 0.8186-3 Oct. 1991 PfXalad la U.SJU AMSOMBIT MO. __ U2_ -*tj" JOEIROF|oOLEXItT,AH LX7% IH5URAJICE COKPAX! Oroup taller Ho* 3577-0 May 29, 19W rewritten bearing date of Deseaber 1, 1956 nod lamed to WffltSTCS - MAJK/VTTAN, IHC. (Herein called the bployer) iby asended effective January 1, 1969, aa to teployeea of Rnybeatoe Divlalon aa fellows: Z. By aubatitutlng "laat day of the calendar month in which termination of rlovgnt^ oeeure" for the worda "date of the termination of hla eaployaent" In -st parajgann of aubaectlon (A) of Section 5 Supplementary Agreeaent Toraa O.A.P.P.6179-1, >325 and O.S.F.6303. attached to aald Group Policy aa parte thereof. IX. By aubatitutlng "laat dav of the calendar month In which auch tcralnation of :lovnent oeeure'* for the worda "date of auch termination of hla aent by the toploycr." In the laat sentence of aubaectlon (A) of Section 5 of aald iMWrle>wMt foras C -A -P .0.617S-1. C.B.f .6^2*? and G.S.r.6303. The foregoing aaendaent la to be attached to and aade part of aald Oroup Policy, subject to the agreeaante and eovenanta therein contained. it (Witness) this day of 19. mrassToe - Mmmmw, iwc. (Employer) (snot warn rat ns or mbtsofolziah lot zhsumbcz ooraunr orly) at New York. N.Y. thla aoth day of rebeuare 19 72 KET8010LZXAH UTS XJSOBAflCS OOKWUfT, (RagietrarT i9g9g0lB- jMBQKBfT . 48 uo METROPOLITAN LIFE INSURANCE COMPANY Croup Policy We. 8577-G . May 29, 19^0 rewritten bearing date of Pccc.-nber 1, 1QS6 and inauring the fcglejyecj Of u fellows RAYBrSTCS-MANfrATV, V. INC. (Herein called the t:.pioyer) is hereby emended Effective April l, 1969. bv wMlnr to Section 6 of Sunni rorttC.6391-I-P.tC. ------------------------------------------------------------------------- , the following: "Expenses for actual visits for healing purposes node by a Christian Seianee practitioner who is listed as such in the Christian Science Journal current at the time of such visits shall be considered for benefits subject to the saae terms and limitations as if sueh expenses were charged by a physician. Expenses for professional nursing services of a Christian Sclenee nurse shall bs included on the seme basis, and subjsct to the saae tens and limi tations, as expenses for other nursing services provided that such nurse is listed in the Chrlstlen Sclenee Journal current at the time such cervices are provided as (i) having completed nurses training at a Christian Seisnes Bsaevolent Association Sanatorium, or (il) being a graduate of another nurses training eourss, or (ill) having had thrss consecutlvs yaars of Christian Seisnes nursing, including two years of training.* The foregoing amendment le to be attached to and made part of aaid Croup Policy, and la subjaet to the agreement# and covenants therein contained. Dated at this day of 19 ` ' (Witness? RAYBXSTOS-XASKATIAS, PC. (8MCS BELOV POft USE 07 WCmOPOUTAH LXfE INSURANCE COMPANY CHUT) Dated at He* York, W.Y. Wh av of Fabmory X9 72 METROPOLITAN LEW INSURANCE COMPANY, fa&JxcJz Amendment Wo.^ METROPOLITAN life INSURANCE (OviPAJVY ---------------May 29, 19^0 writtn Croup Policy No---- SSTlz2-------- bearing date of........... .December 1. 1956 injuring the Employees of --------------------------------------------------- ^JE9P--mwhaTM,, IK.it hereby amended ow*: t. Effective Harsh 31, 1969. by adding to Supplementary Agreement Porn G.B.P.6301, it the Croup Poliey, the following: 'Each Baployee who is actively at work on April 1, 1969 and each Baployee employed mbsequent to that date shall be excluded free eligibility for insurance hereunder ind the insurance hereunder, if any, on each such Baployee shall be autanatically lis continued on March 31, 1969. Each fispl^ee who la not actively at work on Vprll 1, 1969 shall be excluded fron eligibility for insurance hereunder and his .nsurance hereunder, if any, shall be automatically discontinued on the day JBBedlately preceding the date of his return to active work." 'I. Effective April 1, 1969, as to Baployees of the United States Rubber Division actively at work on that date and such Employees employed subsequent to that date nd, with respect to any such Baployee not actively at work on that date, effective <a the date of his return to active work, and effective April 1, 1969 as to any ther Baployee, by making the following changes, exeept that aueh changes shall .ot apply to (1) any period of hospital confinement ecnaenelng prior to, (11} ny surgleal operation performed prior to, (ill) any medical expenses incurred prior o, or (lv) any pregnancy exiatlng an the date such ehangea become effective with eapeet to the Employee: By substituting for the last clast of Employees designated as HA11 Other Baployees" nd the amounts of insurance applicable thereto in the non-contributory Insurance parIon of Schedule IB and for the aecond class of Employees designated as "Bapltyees of altsd States Asbestos Division" and the amounts of Insurance applicable thereto in he Contributory Insurance portion of said Schedule IB in the Schedule of Insurance nd Employees Maximum Contributions In Section 6 of said Croup Policy, the following: Class Accidsat and Health Insurance __________ (Weekly Benefit} Baployees Employed All Other la New fork State Employees TSee"*ota 1) yCB-COTTRIBUTCRT nSURAWCg baployees of United Staten Asbestos Division Salaried teployeoe Hourly Baployees LI Other Baployees --"-- Ho Insurance CgHTRIHUTORT IWSURAJCE <65.00 lo laeuraace Bo Insurance" fepleyees of United States Asbestos Division Salaried Baployees Hourly Employees Ho Insurance <65.00" Amendment 85TT-G -2- B. By substituting for the Schedule of Insurance end fisployee' Ntzloua Contri bution* la Section 6, of Supplementary Agreement Fora G.S.P.6303 of said Croup Policy, the following: "Schedule of Insurance and Bffpl~vcca' Maximum Contribution* Class Hexlaua Benefit Dependent Surgical. Personal Surgical Operation Insurance Operation Insurance (Each Dependent) Employee* of Manhattan Rubber Division at Passaic, Rev Jersey, and Employees of Baybestos Dirision and United States Aabestor Division $600.00 $600.00 All Other teployees 500.00 500.00 Bo Bxployee of Manhattan Rubber D1vision, other than a retired fisployee, shall be required to contribute the cost of the insurance, ftie amount vhieh any other fiepleyee stay contribute to the cost of the insurance shall not exceed the premium charged for tbe amount of his insurance." C. By substituting for the Schedule of Insurance and ttsployee'a Maximum Contributions in Section 6 of Supplementary Agreement Porn C.6391-1-P.AD. of aaid Croup Policy, tbe following: "Schedule of Benefits and Bnployeee' Maximum Contributions Class Supplementary hospital Benefits for Wivsiclana' Attendance Pally Benefit Maximum Benefit (Deployee and (Employee and each Dependent) each Dependent) Employees of Manhattan Rubber 'Division at Passaic, Rev Jersey All Other ffeployeee $8.00 5.00 $1200.00 350.00 Bo Ztoployee of Manhattan Rubber Division, other than a retired fiepleyee, shall he re quired to contribute to the eoet of tbe Insurance. The amount whlefa any ether fiepleyee may contribute to tbe eoet of the insurance obeli not exceed the premium charged for the amount of bin lneursace." D. Hr substituting for the deflnltloe of the term "Dependent" in Section 1 of Supplement!*? Agreement Perm 6.6297 (hearing date of issue April 1, 196b) of the Croup Policy, the foLUwlag: "The tern 'Dependent' has the seme meaning herein as such term hem in the applle* able Bospltal Expense Insurance provisions of tbs Group Policy." AKZHDKEXT **0._ 8577-G -3- . By substituting for the table in the Schedule in subjection (C) of Section 5 of Supplmwntary Agreeaeat Form 0.8297 (bearing date of issue April 1, 0.961*) of the Croup Policy, the following: "Clast All Employee! Personal Insurance and Dependent Insurance (Ernlovee and Each Dependent) Basic Insured Deductible Maximum Benefit Maximum Proportion Amount For one Medical Aggregate Sec Note 1 Sec Note 2 Expenne Period Benefit ao; 2100 $10,000 $10,000" T. By substituting for the second itea in the list of Covered Medical Expenses in subsection (D) of Section 5 of said Suppleaentary Agreement Fora 0.8297 (bearing date of issue April 1, 1961) of the Croup Policy, the following: "Hospital rooa and board excluding for any day of confinement in private room accom aodations any charges in excess of the hospital's seat eomaon seal-private rooa rate. C. By substituting for the caption appearing at the bottom of Endorsement Fora C.9088-1, added to said Croup Policy June 21, 1966, the following: "Applicable to Employees of (1) Manhattan Rubber Division st Passaic, New Jersey, and (11) United States Asbestos Division.'' B. By adding to said Croup Policy, as a part thereof, the attached Suppleaentary Agree ment Fora G.3.F.6325, applicable to Employees of the Vabash Division and the United States .Asbestos Division. III. Effective April 30, 1969, by adding to each Suppleaentary Agreement attached to the Group Policy, as a part thereof, the following: "Applicable to Deploys#* enrolled under the Corporate-Field Prograa of the fisployee.-- Each fisployee who is actively at work ea May 1, 1969 (herein referred to as the Revision Date) and each Deployed employed subsequent to that date shall be excluded from eligi bility for insurance hereunder end the insurance hereunder. If any, ea each such Employee shall be automatically discontinued on the dsy immediately preceding aueh Revision Date. Each Employee who is mot actively at work on such Revision Date shall be excluded from eligibility for iaeuremee hereunder and his insurance hereunder, if any, shall he auto matically discontinued an the day immediately preceding the date of his subsequent return to active uorh.M AMENDMENT BO. 50 3 8577-0 - I* - IV. Effective May 1, 1969, u to Employees actively at work on that date and Employees employed subsequent to that date and with respect to any Employee not actively at work oo that date, effective on the date of his return to active work, by making the following chanr.es, except that such changes shall not apnly to (1) any period of hospital confinement eonmeneinr prior to, (11) any surgical operation performed prior to, (ill) any medical expenses incurred prior to, or Civ) any pregnancy existing on, the date such changes become effective vlth respect to the Employee: A. By substituting for Section 2, as aaended, of said Croup Policy, the following: "Section 2. Eligibility of Employees.--Each Employee eligible for insurance hereunder prior to May 1, 1969 is eligible for insurance hereunder in accordance with the provisions hereof as such provisions existed prior to that date. Each other Bnployee shall be eli gible for Insurance hereunder on the later of (1) May 1, 1969, and (li) the day lnaeliately following the date of eonoletion of three months of continuous service." 3. By substituting "All Salaried Employees, other than Salaried Eeployees enrolled under the Corporate-field Program of the Employer" for the first class of Eaployees designated es "All Salaried Employees" in the Hon-Contributory Insurance portion of Schedule IA in the Schedule of Insurance and Employees' Maximum Contributions in Seetlon 6 of ssld 3roup Policy. By substituting for the first class of Employees designated as "All Salaried Employees", md the amounts of insurance applicable thereto in the Contributory Insurance portion of aid Schedule ZA of aald Section 6 of said Group Policy, the following: CONTSIBUTOST INSURANCE Claes life Insurance Insurance for Death or Dismemberment by Accidental Means All Salaried Jtaployees enrolled under the Corporate-Pisld Program She amount of Life In- The amount of Insurance for Death surance shall be an or Dismemberment by Accidental amount equal to the >- Means shall be an amount equal to ployec's bade annual the Employee's basic annual earnings earnings, as determined as determined by the Employer, subject by the Employer, subject to a maximum amount of Insurance for to a amount of Death or Dismembensent by Accidental life Insurance of Meaae of $200,000. If such amount $200,000. If such of Insurance far Death or Dismeaber- amouat of Lift Insurance meat by Accidental Means Is sot s is not a multiple of multiple of $1,000, it shall be ad- 21 ,000, it shall be ad- justed to the next higher mutiple Justed to the next higher of $1,000. multiple ef $1,000. U. ether Salaried fisployees le Insurance So laeuraaee AKEKDKOfT SO. 50 J5T7-0 -5- i. By addin* as the next to the lest class of Employees In said Contributory Insurance onion of Schedule IA, the following: Class Employee* enrolled under the Corporate-Field Program Life Insurance 51,000.00 Insurance for Death or Dismemberment bv Accidental Means Ho Insurance" * By substituting for the third class of ISsployeea and the aaounts of insurance appliable thereto in the Contributory Insurance portion of Schedule IS of eaid Section 6 f said Croup Policy, the following: CONTRIBUTORY IH5URANC2 Class Accident and Health Insurance (Weekly Benefit) Employees Enployed All Other in Nev York State Employees ^ployees of Raybestos Dirlsion and Employees snrolled under the Corporate-Field Progran, '1th basic weekly earning*, as determined >y the Baployer, of: >esa than $60 150 but leaa than $ 86 BS but less than 96 96 but lest than 101 .01 but leas than 112 .12 but less than 120 -20 or more < m ea - - - -- m $50.00 55.00 60.00 65.00 70.00 75.00 60.00" By substituting for Item 7 under the heading "All other Retired Employees" in the :hedule of Insurance and Employee'a Maximum Contributions in said Saetlen 6 of said oup Policy, the following: . As to any Hourly deploy** who la eitrollad under the Corporate-Field Program of tha Employer (a) retired on or after Hey 2, 1969 but trior to November 17, 1969.-- 53,000.00, and (b) retired on or after November 17, 1969.--SI,500.00." . As to any other iteployee, except a 3alarled Employee retired on or after January 2, 1969.--the amount of hie Basic Life Insurance hereunder on the day preceding the date of his retirement.H By to uid 0roup Bailey, an parts thereof, the attached Supplementary Agreement ras 6.B.F.6325, G.S.F.6303, G.6391-2-P.*D., G.8065-7 and G.8297, and the Supplemental dera G.9331, G.9333, and 0.9331 (each boaring date of Issue May 1, 1969) applicable to ployees who are enrolled la the Corporate-Field Program. AMSSSHERT HO. 50 8577-5 o a- E. By substituting for the first das* of Employees designated as "asployees of Manhattan Rubber Division" in the Non-Contributory Insurance portion of Schedule IB of aaid Section 6 of aaid Group Policy, the following: Class Accident t Health Insurance (Weekly Benefit) Ssployees employed All other in New York State Emnloyees "Employees of Manhattan Rubber Division Located at: Heenah. Wisconsin Passaic Rev Jersey No Insurance No Insurance $60.00 No Insurance Employees of General Asbestos end Rubber Division No Insurance k0.00 Salaried Employees of United States Asbestos Division No Insurance 65.00 All other finployees No Insurance ITo Insurance 7. As to periods of disability eosstenelng on or after that date, by substituting the following for the part of the schedule of insurance setting forth amounts of Weekly Benefit applicable to Employe*s employed in the State of Rev fork: "Class Weekly Benefit Emnloyees endowed In Rev York State Employees of Haahattan Rubber Division: at Seeaab, Wisconsin at Passaic, New Jersey Employee* of Rsybestoe Division All other a^loyoes in lev fork State $33*00 an amount equal to 50i of the Eanloyee 'e basic 'feebly eaminrs, as determined by the Employer, with a martman Weekly Benefit of $65.00 and a minimum Weekly Benefit of $20.00 $50.00 30.00" AKHKMSRT 0. 30 ) 8577-C 9 C. By substituting for Items b, 5, ai 6 voder the beading "AH other Retired Employee*" ia tbe Schedule of Insurance sad Employee's Maximum Contribution* in said Section 5 of said Croup Policy, the following: "b. As to any Employee of Manhattan Rubber Division who is (Da Salaried Employee, other than a Salaried Employee on the Main Office Payroll, retired on or sub sequent to October 28, 1955 but prior to January 2, 1969, (iD subject to tbe Bargaining Agreement between Manhattan Rubber Works Independent Union, Ine. retired on or subsequent to October 28, 1955 but prior to June 25, 1970, (iii) a member of Manhattan Lodce 1679, International Asaoeiatloa of Machinists retired on or subsequent to November 25, 1955 but prior to October 1, 1970, or (iv) a Main Office Payroll Employee retired on or subsequent to January 1, 1956 (but prior to Jnnunry 2, 1'X`O in the en.-ic of n :;/vlarle<l Employee on the Main Office Payroll). -- 50^ of the amount of his Jiuaie life Innuraaee hereunder on the day receding the date of hln retirement. 5. As to any Employee of the Manhattan Rubber Division at Passaic who it (1) subject to tbe Bargaining Agreement with Manhattan Rubber Workers, In dependent Union, Inc., retired on or subsequent to June 25, 1970, or (11) a member of Manhattan Dodge 1679, International Association of Machinists, retired on or subsequent to October 1, 1970 -~32.500.00. 6. As to any Employee of United States Asbestos Divisions retired on or sub sequent to April 1, 196^. -- $3,000.00. 7. As to any other Emsloyee, except a Salaried Employee retired on or after January 2, 1969, -- the amount of his Bnaie Life Insurance hereunder on the day preceding the date of his retirement." H. By substituting for the heading to the first definition of the tern Dependent in Section 1 of Supplementary Agreement Form G.B.F.6325, (bearing date of issue December 1, 1956) tbe folloving: "Applicable to Employees of Manhattan Rubber Division at Nsenah, Wisconsin." Z. By-adding Immediately folloving said definition of the term Dependent In said Section 1 of maid Supplementary Agreement Form C.B.F.6325, the following: "Applicable to Employees of Manhattan Rubber Division at Pasaaie, Hew Jersey-- The term 'Dependent* means (1) an Employee'a spouse, (2) any unmarried child of a mala E^loyee, of a widowed female Employee, or of a female *ployee whose husband la not eligible for Insurance as an Employee, excluding in any ease: Any ehllA under 15 days ef sgs and say child 22 years of age or older. Any person eligible for insurance as an Employee. Any person maiding outside tbe United States and Canada. Any person is the military or similar forces of any country or subdivision thereof. Any child ip' years of age or older who (a) is not a full-time student, or (b) Is ia full-time employment. She term 'child' includes say legally adopted child, any stepchild mho resides in tbe tapleyee's household, aad any child supported solely by the Employee and permansntly residing ia tbe household of which the Employee is the head. AMENDMENT mo. 5 0377-0 . - 10 If an Employee la insured hereunder on account of a child on the day imediately preceding such child'* nineteenth birthday (herein referred to as the Uniting Age) and if such child is then incapable of self-sustaining employment by reason of aental retardation or physical handicap and is chiefly dependent upon such Employee for support and maintenance, the requirement that the ehild be under uch Uniting Age to qualify as a Dependent vili not aptly to such child vhile be remains ao incapacitated and dependent upon the Employee, provided that, upon request from the Insurance Company, due proof of such incapacity and dependency and that such incapacity and dependency have been continuous since the child's attainment of such Uniting Age is submitted by the Employee to the Insurance Company and further provided the Employee mahes any contribution required by the Brployer on account of the Insurance vith respect to such ehild. Hie Insurance Company may require the Employee to fumiah proof at any time that any such Depandent remains so incapacitated and dependent. J. By eubatituting for the first class of Employees designated as "Employees of the Manhattan Rubber Division at Passaic, Rev Jersey" and the amount of Daily Benefit applicable thereto in the Schedule of Insurance and Employees Maximus Contributions in Section 6, as amended, of Supplementary Agreement form C.B.F.6325, the following: Class "Employees of the Manhattan Rubber Division at Passaic, Rev Jersey Daily Benefit Employee and Each Dependent For any day of hospital confinement, the actual amount charged by tn-. hospital for room and board for such day, axeluding, in ease of private room accomodations, any eharges over the hospital's most comon semi-private room rate. X. By substituting for item (b) under the beading "Maximum Payment" in item (3) of the first paragraph of Section 7, as amended, of said Supplementary Agreement Form G.3.F.&325, the following: "(b) Applicable to Employees of Manhattan Rubber at Taanule, Hew Jersey ana their Dependents .--$2,000" : By substituting for the Schedule of Insurance and Employees' Maximum Contributions In Section 6, as amended, of Supplementary Agreement Form G.S.F.6303 attached to said Group Policy aa a pert thereof, toe following: "Schedule of Insurance and Employees1 Maximum Contributions Clans Maximum Benefit Dependant Surgical Personal Surgical Operation Insurance Operation Insurance (Each Dependent) Employees of the Manhattan Rubber nt Passaic, Bee Jersey at Reeaah, Wisconsin $760.00* 500.00 $780.00* 500.00 Employees of General Asbestos and Rubber Division or Employees of Wabash Division All other Employees AKEXDXERT 0. 50 500.00 600.00 500.00 600.00 V 8577-0 n- 2it Mxlaua Benefit on and after Jure 25, 1971 hall be $900.00, provided the toplcyee la actively at work oa aueh date, otberviae os the date of bla return to active work, and shall not apply to any surgical operation performed prior to June 25, 1,71. Bo Employee of the Manhattan Rubber Division, other than a retired Employee, shall be required to contribute to the eoat of the insurance. 'Ihe amount which any other Employee may contribute to the cost of the inauranee anall not exceed the premium charged for the eaounte of hia inauranee." M. By substituting for the fifth paragraph of Section 7. aj amended, of aald Supplementary Agreement Term C.S.F.6303, the following: "Anpllcable to Employees of the United States Aabeatoa Division and Passaic Division and Dependents of such Employees --ho payment snail be made hereunder for any sur gical operation vnien la caused by pregnancy or resulting childbirth or compli cations ." 5. By adding to aald Section 7, as amended, of said Supplementary Agreement Form G.S.F.6303, the following: "Applicable to Employees of the Manhattan Rubber Division at Faasale, Mew Jeraev.-- Zf the Employee or a Dependent of the Employee receives treatment by a physician legally licensed to practice medicine an a result of (1) injury not arising out of or in the eourse of any employment for wage or profit, or (11) eevere sickness which, in either case, could have Jeopardized such person'* life, and such treatment is received within 2E hours of such injury or the onset of such severe sickness, and provided no benefits are otherwise payable under the Group Polley for cuch treatment, the Insurance Company will pay to the Employee an amount equal to the actual fee charged by the phyaleiaa for such treatment up to a maximum of $25.00 per incident." O. By adding to Section 9 of aald Supplementary Agreement Form G.S.F.6303, the attached Section -9, setting forth the schedule of surgical operations and maximum payments therefor based on Maximum Surgical Operation Expense Insurance benefits of $780 and $900, applicable to eertaln Employees whose Maximum Surgical Operation Expense Insurance benefit is $780, and $900, respectively. P. By substituting for the Maximum Bally Benefit specified la aald Section B-l of said Supplemental Rider Fen G.9331, the following: Class Maximum Dally Benefit Employee and each Dependent "All Employees For any day of hospital confinement, the actual amount charged by the hospital far room and hoard for such day, excluding, la the eaae af private room accommodations, say charges ever the hospital's most common semi-pri vate room rate." AMEBOMEST NO 50 8577-0 - 12 * By eubetituting for the list of Covered Services end Areunt of Benefit applicable thereto appearing la Seetion B-2 of eaid Supplemental Rider Form G.9331. the following: Covered Servicee "1. Room end board sad Special Hospital Service* received during the first 60 days of hospital confinement la a Spell of Illness. Amount of Benefit The actual amount charged by the hospital but not acre than $52 for such services received during the entire period, excluding, for each day in private room accommodation*, the amount by which the charge for room and board exceeds the Maximum Daily Benefit. 2. Room and board and Special Hospital For each day: the actual amount Service* received during the ol*t charged by the hospital for such ser through 90th day of hospital confine- vices but not more than $13- sent in a Spell of Illness. 3. Services received during the 91st through 120th dsy of hospital confine ment in s Spell of Illness a. Room and board for each day. b. Special Hospital Service*. The aetual amount charged by the hosoitoi for such day but not more than the Maximum Dally Benefit. The actual amount charred by the hospital for *ueh services. k. The first three pints of blood during a Spell of Zllness. The aetual amount charged." R. By substituting for the paragraph relating to the benefit for Covered Medical Services received by an Employee or a Dependent in a calendar year appearing In Seetion S-2 of said Supplemental Rider Form G.9333, the following: "The benefit for Covered Medical Services received by an Employee or a Dependent in a calendar year is (a) the aetual amount charged for such services, to a of 250, plus (b) if the Employee or Dependent undergoes any surgical operation, 202 of the --xlrnia payment for such operation (or for more than one operation, 202 of the maximum payment for the combination of operations) determined in accordance with the Schedule of Surgical Operations baned upon a maximum benefit of 1780* appearing in Supplementary Agreement Form G.S.F.6303. 1900, aa of June 25, 1971" 8. By a<M4"f to said Croup Volley aa a part thereof the attached Supplementary Agreement Ten 6.6552*18 (bearing date of leeue June 25, 1970) applicable to u^leyoes of the Manhattan Rubber Division t Paasalc, Sew Jersey. AKEHDWOC HO. 50 5577-0 - 13 - ITCH. Effective July 1, 1970, A. By substituting the division identification specified in Colunn B belov for the corresponding division indeatification specified in Column A belov vherever such iivislon iadeotificetion appears in said Group Policy: Coliaan A Column B Raybcstos Division Stratford Division Manhattan Rubber Division Passaie Division General Asbestos and Rubber Division North Charleston Division Vabash Division Crawfordsville Division United States Asbestos Division Marshville Division {Salaried Eaoloyees), Manheia Division and Fullerton Division i. By substituting for the definition of the tern "Employee" in Section 1 of Supplementary Agreement Form C.3.P.6325, (bearing date of issue December 1, 1956) the following: `The term 'Employee' means a full-time employee, other than an employee enrolled under :he Corporate-Field Program of the Employer, who is directly employed and compensated Tor services by the Employer at the Passaic Division, tbs Stratford Division, or the <crth Charleston Division." By substituting for the definition of tbs ten ''Bsployee" in Section 1 of Supplementary Agreement Form G.6065-7, (bearing date of issue June 25, 1970) the following: 'The ten 'Employee* means a full-time employee, other than an employee enrolled under :he Corporate-Field rngram of the Employer, who is directly employed and compensated Cor services by the Employer at the Passaic Division at Passaie, New Jersey." 3. ' By substituting for the definition of the ten "itaployee" in Section 1 of Supplementary Agreements Fon G.S.F.6303 and Form G.6391-1-P.ED., (each bearing date of issue December 1, 1956) the following: "The ten 'Eeployee' aeaae (!) a full-time employee, other then an employee enrolled under :he Corporate-Field Prows of the Isployer, who is directly employed end compensated Tot services by the S^iflyer at the Passaie Division, the Mtahein Division, the Fullerton >lvision, the North Division, the Stratford Division, or the Crsvfordsvllle division, end (11) a futt-tiae Salaried employee, other than an employee enrolled under ihe Corporate-Field Program of tho Ehrployer, who is directly employed and compensated for services by the Employer at the Marshville Division." AMESDKZET NO. 50 8577-0 - 11* - E. By substituting for the definition of the tent "Bcployee" in Section 1 of Supplementary Agreements Fora 0.8297 and Fora 0.8065-7. (bearinc date of issue Jloveaber 1, 1964 and October 10, 1966, respectively.) the follovin/;: "The ten 'Employee' means a full-time employee, other than an employee enrolled under the Corporate-Field Program of the fisployer, vho le directly employed and eompencated for service* by the Employer at the Stratford Division." F. By substituting for the definition of the tent "Qnplcyee" in Section 1 of Supplementary Abetment* Form 0.8297 and Fora 0.6065-7, (each bearing date of issue June 1, 1969) the following; "Trie term 'taployee' mean* a full-time employee, other than an emoloyee enrolled under the Corporate-Field Program of the Employer, who is directly employed and compensated for services by the Bnployer at the Passaic Division at Ueenah, Wisconsin." C. By substltutihg for the definition of the tera "Employee" in Oeetion 1 of Supplementary Agreements Fora G.8297 and Fora 0.8065-7, (bearinf date of issue April 1, 1964 and April 1, 1970, respectively) the following: "The tera 'Buployee' means (i) a full-time employee, other than an employee enrolled under the Corporate-Field Program of the Employer, vho is directly employed and compensated for services by the Employer at the Manheim Division or the Fullerton Division, and (ii) a full-tla* Salaried employee, other than an employee enrolled under the Corporate-Field Program of the Employer, vho is directly employed and compensated for services by the Employer at the Marshville Divisions." H. By substituting for the definition of the tera "Bsployee' in Section 1 of Supplementary Agreement Fora 0.8297, (bearing date of issue June 6, 1962) the folloviag; "The term 'Employee1 means a full-time employee, other then an employee enrolled under the Corporate-Field Program of the Employer, vho is directly employed end compensated for services by the Employer at the Cravfordsville Division." 2. By substituting for the definition of the tera "Employe*" in Seetion 1 of Supplementary Agreement Form G.6297, (bearing date of issue February 13, 1967) the following; "The term 'Employee* means a full-time emoloyee, other than an employee enrolled under the Corporate-Field Program of the Employer, who is directly employed and compensated for services by the Employer at the North Charleston Division." J. By substituting for the definition of the tera "Bsoloy**" in Section 1 of Supplementary Agreement Fora 5.8297* (bearing date of issue June 2$, 1968} the following: "The tera 'Employee' aeeaa a full-time employee, other than an employee enrolled under the Corporate-Field Program of the Employer, vho is directly employed end compensated for services by the Bplsytr at the Passaic Sivision at Paaaaic, lev Jersey." AMENDMENT M0. 50 8577-0 - 15 EC. Effective January X, 1971, A. By subetitutiag for the Schedule of Insurance and Sroloyees' Maximum Contribution* in Section 6 of aaid Supplementary Agreement font S.B.".6325 (bearing date of iaaue Hay 1, 1969) the following: "For any day of hospital confinement the actual amount charged by the hospital for roors and board for aueh day, eicludlnr any ch<vrrea over the lesser of (i) the hoepital'a seal-private roan rate and (11) 160.00" B. By substituting for the fourth paragraph in Section 7 of said Suppleneatary Agreement Fora G.B.I\6325 (bearing date of issue May 1, 1969). the following: "For all hospital confineaent which is caused by any one pregnancy or resulting childbirth or caaplleations, the total of the payaents for both Bally Benefits and all Special Hospital Services coablned shall not exceed*380.00, provided, bovever, that no payaent Of any hind shall be aade for such hospitaleonfinenent if the pregnancy existed on the effective date of the Hospital Expense Insurance hereunderon account of tne person so confined." C. By substituting for the table in the Schedule in subsection (C) of Section 5 of Suppleaentary Agreement Fora 0.8297 (bearing date of Issue May 1, 1969) of the Croup Policy the following: Personal Insurance and Dependent Insurance (Kanloyee and Each Dependent) Basle Insured Deductible Maximan Beneflt Maximum Proportion Amount For One Medical Aggregate See Mote 1 See Hote 2 Expense Period Benefit 80S 0100 *15.000 *15,000" D. By extending the application of Endorsement Fora 0.9088-1(added to said Croup Policy February 13, 1967) to include Bsployees who are enrolled la the CorporateField Program and by eubatltutisg for the caption appearing at the bottom of the first page of said Eadorasmeat Fens C.9066-1, the following: "Applicable to All Employees other than Espleyees of the Passaic Division at Passaic, Mew Jersey." E. By substituting far the amount of Maximum Dally Benefit appearing in Seetlon B-l of Croup Supplemental Haepltal Expense Insurance Rider Fora C.9J31 (bearing effective date May 1, 1969). the follmving: Claaa Maximum Daily Benefit Employee Dependent All "For say day of hospital confinement the actual amount charged by the hospital for room and board for aueh day, excluding any charges over the lesser of (1) the hospital' seed-private room rate and (11) *60.00." 50 amendment no. 6577-C - lfi - X. Effective January 1, 1971, as to Employees of Stratford Oivis ion, by aching the following changes, except that auch changes (hall not apply to (1} any period of hoapital confinement eesaenelng prior to, (ii) any surgical operation performed prior to, or (Hi) any pregnancy existing on, the date such chances become effective vith respect to the Employee: X. By substituting for the definition of the term "Dependent" applicable to Employees of Stratford Division, in Section 2 of said Suppleaentary Agreement form G.B.f.6325 dated December 1, 1956 the following: "Applicable to fisployeea of Stratford Division.-- The term 'Dependent' means (1) an Employee's spouse, (2) any unmarried child of a male Employee, of a widowed female Eaployee, or of a female Employee whose husband Is not eligible for insurance as an Employee, excluding in any eaae: Any ehild under 15 days of age and any child 23 years of age or elder, except that a ehlld under 15 days of age shall be a Dependent from the earlier of (a) the day the child's mother leaves the hospital, and (b) the day the Bsployee incurs aedlesl ex penses on account of the child as a result of severe medical or surgical complications. Any person eligible for insurance as an Eaployee. Any person residing outside the United States and Canada. Any person in the military or similar force* of any country or subdivision thereof. Any child 19 years of age or older who is not a full-time student at an approved school, as determined by the Employer. , Any ehlld 19 years of age or older who is in full-time employment. Any person whose evidence of good health, furnished in accordance vith the provisions of Section 3 hereof, as to any Contributory Insurance hereunder is not accepted by the Insurance Company as satisfactory. She ten 'child* includes any legally adopted ehild, any stepchild who resides in -the Employee's household and say ehild supported solely by the Bsployee and permanently residing in the household of which the Bsployee is the head. Zf an Baployee ie insured hereundsr on account of a ehild en the day imedlately pre ceding auch child's 19th birthday (herein referred to as the Limiting Age) end if such ehild le then ineapahle of self-eustainiuc employment by reason of mental retardation or physical handicap ail la ehiafly demandant unon such Emnloyee for support and main tenance, tha requirement that the ehild be under such Limiting Age to qualify as a De pendent will sot apply e amah child whila ha remains so incapacitated sad dependent upon tha Bsployee, provided that, upon request from the Insurance Company, due proof of auch incapacity and dependency and that each incapacity and dependency have been continuous sines tha child's attainment of such Limiting Age is submitted by the Bsployee to the Zosuranee Company. B Insurance Cos^any say require the bployee to furnish proof at any tins that any such Dependant remains ae incapacitated and de pendant. " AMOTMOT KQ. 50 8. By substituting for the Schedule of Insurance and Employees' Maximum Contributions in Section 6, aa amended, of said Supplementary A^eement Fora G.B.F.6325 dated Deeeaber 1. 1956 the following: Dally Benefit "Cleat (Bnplovee and Each Dependent) Employees of the Passaic Pi via ion at Passaic, New Jersey For any day of hospital confine ment , the actual amount charged by the hospital for room and board for eueh day, excluding in the ease of private room accomodations, any charges over the hospital's asst eossnon semi-private room rate. iinployeea of the Pasoaic Division at Neenah, Wiaconain For any day of hospital confine ment , the actual amount charged by the hospital for room and board up to the boseital'a charge for semiprivate room aceoemodations but not to exceed: $3i<.oo Employeea of the Stratford Division fiaployeea of the North Charleston Division 60.00 22.00 lo teployee of the Passaic Division, other than a retired fiaployee, shall be required to contribute to the cost of the insurance. The amount which any other Employee may contribute to the eost of the insurance snail not axceed the premium charged for the amounts of his insurance." By substituting for tht typewritten wording appearing in item (1) in the first soragraph of Section 7, as amended, of said Supplementary Agreement Fora 0.B.F.6325 dated December 1, 1956 the following: "(1) 150 days la the ease of an Oaployee of Passaic Division at Passaic, New Jersey, ar an fieployee of Stratford Division, and (11) in the esse of any other Employee, 70". ). By substituting for itsa (2) of the first paragraph of said Ssetlon 7 of said Supplementary Agreement Form G.B.F.6325 dated Deeeaber 1, 1956 the following: '(2) for the expenses charged for the following'Special Hospital Services received hiring such confinement prior to the expiration of the maximum period for vhieh Gaily Benefits aey be paid, provided that the total payment for all sueh expenses ihall mot exeeed the marl was payment specified: Special Hospital Services !a)Aeesthesla, radiation therapy, and C-Ray laboratory and pathological seminations, whether such services ire billed by the hospital or a ?nysleian who utilises hospital wfulpmaat or services, and Cb) all other hospital services charred Oar by the hospital except services of afeyoieleas or epeclal nurses sad services nd supplies net related to the medical rare and treatment of the person confined. Maximum Payment Applicable to bployees sad tholr Dependents at: (a) Charleston Division--$110.00 (b) Passaic Division at Passaic--$2,000.00 (e) Passaic Division at Beesab--11,000.00 (d) Stratford Division--$2,000.00" AHUSDKarf 0. 30 8577-G - 18 - 2. By substituting for item (3) in the first paragraph of said Section 7 of said Supplementary Agreement Fora G.3.F.6325 dated December 1, 1956 the following: "(3) Applicable to Employees to the Passaic Division at Neenah and Employee* of Stratford Division.--For consultation Services, except staff consultation* re quired by hospital rules or regulations, but only vhile the Employee or Dependent is a hospitalised bed-patient, for a condition requiring special skill or knowledge, as assistance in diagnosis or treatment to the physician in charge of the case. Payment ahall be limited to *50 for medical, surgical or obsterieal bedside consultation during each period of continuous hospitalization.'1 F. By substituting for the fourth paragraph in said Section 7 of said Supplementary Agreement Fora G.B.F.6325 dated December 1, 1956 the following: "Applicable to Employee* of Stratford Division.--For all hospital confinement which la eaused by any one pregnancy or resulting childbirth or complications, the total of the payments for both Daily Benefits and all Special Hospital Services combined shall not exceed <360; provided, however, that no payment of any kind shall be made for such hospital confinement if the pregnancy existed on the effective date of the Hospital Expense Insurance hereunder an account of the person so confined." G. By substituting for the Schedule of Benefits and Employees' Maximum Contributions in Section 6, as amended of Supplementary Agreement Form G.6391-I-P.6D., the following; Class Supplementary Hospital Benefits for Physicians 1 Attendance Dally~Beaeflt Maximum Benefit (asployee and each Dependent) fBcploree and each Dependent) Employees of Passaic Division at Paaaalc and Employees of Stratford Division $6.00 $1,200.00 All other Employees S.00 350.00" U. Uy substituting for the asterisked wordier at the bottom of Pare I, an amended, of the Schedule of Surrie&l Operation.*! Applicable to Kmnloyee# whose Maximum Surgleal Operation Insurance Benefit is $600 in Section 9, os amended, of sold Supplementary Agreement Form G.S.F.6303, the following: "With reapeet to all Employees of Stratford Division, $125, $250, and $62.50, respectively." Z. By substituting far the schedule in subsection (C) of Section 5, ee --ended, of said Supple--ataxy Agreement fan 0.6297, dated November 1, 1961, the foil--lag: Class Xaaured Proportion See Bote 1 Basle Deductible Amount See Bote 2 Maxim-- Be--fit For om Marta-- Medical Aggregate ExpensePeriod lenefit . "All Implores* 80S $100.00 $15,000.00 $15,000,00" AMZXDHETC 10. 50 8577-G 19 It la understood and agreed that: 1. Any benefits paid or payable under the Medical Expense Insurance - Extended Coverage provisions of the Group Policy for Covered Medical Expenses incurred prior to the date the provisions relating to Maximus Aggregate*Benefit in the foregoing aaendaent become effective with respect to an Emoloyee or Dependent shall be taxen into consideration in determining benefits payable for expense* Incurred on or after such effective date. 2. If a Dependent of an ihrployee la confined in a honpltal or other institution for eare or treatment, or is confined at home under the care of a physician nr surgeon beeauoe of a disabling physical or mental sickness or injury on the date the provisions of the foregoing amendment become effective vlth re spect to the Employee, the changes made in the Medical Expense Insurance Extended Coverage provisions of the Group Policy by the foregoing aaendaent shall not become effective vlth respect to such Dependent until such Dependent is no longer confined In a hospital or otner institution or confined at home under the eare of a physician or surgeon. 3. If prior to the date the foregoing aaendaent become effective vlth respect to an Employee or Dependent, the Medical Expense Insurance - Extended Coverage on account of such Employee or Dependent ceased because benefits in an amount equal to the Maximus Aggregate Benefit previously in effeet vere paid or are payable vlth respect to his, the Insurance on aeeounl of such person shall not be reinstated until evidence of the Insurability of such person has been ac cepted ae satisfactory by the Insurance Company. The foregoing amendment is to be attached to and made part of said Group Policy, and is subject to the agreend covenants therein contained. .this----------------- :....................day of......... . ..................................... -19 i h<Mt, ,v. f _____;...... .. ................................... IUrBESTO5-*UMUroU, c. By t (STACK SKLOW PO* USE OP SSCTSOPOUTAN UPC INMMtANCK COMPANY >U) Nt X.this ...........29th ... day of Febrisir.' 19 n MKTHOHM.il l` - : (\CK COMPANY. Amendment He. 3JL "lUxJe srrrrtsry