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JAN -14 -98 WED 12:19 PM CFG INSURANCE SERVICES FAX N0, 612 945 9477 P. 04/09 <br />BENEFTES AT A GLANCE <br />—� JAM at DISAt3ILITY PLAN i I <br />This long tern disability plan provides financial protection • for you by paying iooitlon of y r i <br />while you are Jlaabkd. The amoaM1ttz 9ad10 le based on me timnunt pa earned MR • V <br />dSaaM�IN begun. In some cases,yQaQan'receive des/allltypayments •ven4ye* workwit e y <br />danhhd �} 1 <br />EFFECRY January 1,1598- �-- .-' <br />ENIIPLOYEI�Si OR L PLAN <br />POLICY NUMBER; 522838 001 <br />EUOIMLE GROUP(6): <br />M Employees In active employment <br />MINIMUM HOURS REQUIREMENT: <br />Employees must be working al bast <br />WAXrn p.EHIQac� <br />40 fours per week. <br />coma <br />r <br />are <br />Foremplaysea in an eligible•group on or before January 1,1998: 161..,,s ---� <br />Far empioydes dMdOnpens igjE group after 4anuaFv 1, 1998: First •Hie mont#r co <br />dart with or text loilowing the dyou enter an eligib 0 group <br />EI ptMtATtbN : ! k <br />Benefits begin the day after the elimination period is completed. <br />MONTHLY BENOIT: <br />60% of monthly eamings to a maximum benefit of 55,000 per month. �y <br />Sompayment ig iiie am ay not beeccovereedd may have limited coveraggedundeerr title plan. <br />MAXIMUM PUBOD OF PAYMET: <br />01- <br />a <br />ran ag <br />Aga 61 <br />VI SS <br />Ago Aga 64 1 <br />arias <br />Age 69 and over <br />u r • <br />- .0 nn <br />o age <br />,S0 months hs <br />/ / 48 Moni Montt <br />b months <br />,_r.21 N ondta <br />21 nits <br />18 mantas ..--- <br />16 months <br />12 months <br />ne <br />5 yearn <br />No premium payments are required for your coverage while you are receiving payments under this <br />sea <br />BSG LTQ -1 (1/1/1998) <br />um sax, IZt%Ntf* YcS tQ tc as •c1 '10 <br />Page 61 <br />T <br />