United Teachers of Monroe

Group Life

Schedule of Benefits

590 Employees

Miscellaneous Provisions

1. Life proposal includes Waiver of Premium to age 65.

2. Standard Actively-at-Work Provision will apply (30 hours per week).

3. Written notification of a sold case must be submitted within 15 days of the proposed effective date.

4. Includes 24 Hour AD&D Coverage.

5. Coverage is to be effective May 1, 2008.

6. The Non-Medical Maximum for this group is $5,000.

7. *Rates guaranteed for 24 months.

8. This proposal is valid through June 26, 2008.

9. This proposal is contingent on compliance with Lafayette Life's Electronic Administration System.

10. This is a non-contributory plan.

11. This proposal assumes that all participants are residing and performing the duties of their occupation in the U.S.A.

*The rates are guaranteed to the rate guarantee date listed above, assuming there are none of the following benefit structure changes: no more than a 20% change in enrollment, there is no addition/deletion of a unit, there is no lapse in the report of monthly census changes, or there is no payment of monthly premium other than as billed. A rate guarantee does not otherwise alter or amend the terms or conditions of the policy. The rate guarantee is good only as long as the policy is in force.

This quote shows a summary of proposed benefits, rates and miscellaneous provisions. It is not part of the group policy or a legal contract with Lafayette Life Insurance Company.