SCHEDULE OF INSURANCE
Schedule of Insurance
The Schedule(s) of Insurance for Group Insurance Policy GL-207759 listed below:
e = Basic Life Insurance
e Accidental Death, Dismemberment and Loss of Sight Benefit
e Supplemental Life Insurance
are shown in Booklet-certificate(s) 207759(GL)4.17, 207759(GL)5.12, 207759(GL)6.5, 207759(GL)7.3,
20775HGL)8.3, 207759(GL)9.3, 207759(GL)10.4, 207759(GL)11.3, 207759(GL)12.3, 207759(GL)13.3,
207759(GL) 14.3, 207759(GL)15.3, 207759 GL)16.3, 207759(GL)17.3, 207759(GL) 18.3, 207759(GL)19.3,
207759(GL)20.2, 207759(GL)21.3, 207759(GL)22.2, 207759(GL)23.2, 207759(GL)24.2 and 207759(GL)1.18.
The Schedule(s) of Insurance will control the:
e benefit amounts and maximum limits;
e eligibility and effective date rules; and
e other schedule amounts and limits,
which apply to the employees of the Policyholder.
GR-11383-HLA(G3.1) PI-3.21
