Long Term Disability - Fortis

February 1, 2004 - January 31, 2005

Information provided is in summary format.  Any difference between the summary provided and actual contract will be settled in favor of the contract.

Eligibility Class

Each full-time employee who is at active work, and who is working in the United States of America, except any temporary or seasonal worker

Percentage Paid

60%

$5,000

Qualifying Period

2 months

Maximum Benefit Period

See your booklet for the Maximum Benefit Schedule

Definition of Disability

An injury, sickness, or pregnancy which requires that you be under the regular care and attendance of a doctor, and prevents you from performing at least one of the material duties of your regular occupation

Own Occupation Period

36 months

An injury, sickness, pregnancy, symptom or physical finding, or any related injury, sickness, pregnancy, symptom or physical finding for which you consulted with or received advice from a licensed medical or dental practitioner; or received medical or dental care, treatment, or services, including taking drugs, medicine, insulin, or similar substances during the 3 months that end on the day before you became insured under the Long Term Disability insurance policy.

12 months

No

Survivor Benefit

Included

Mental & Nervous

Included

Your Employer pays 100% of the cost