Page 23 - Customer-Booklet_Texas
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Also, no benefits will be payable under the Rider for:
a. loss that begins prior to the Rider Effective Date;
b. Treatment for which no charges are made by the provider of same;
c. services which are primarily for rest care, convalescent care, or for rehabilitation; or
d. any injury or Sickness paid for under any state or federal Workers’ Compensation, Employers’

Liability Law, or similar law.

PRE-EXISTING CONDITION(S) The benefits of the Rider will not be payable during the first twelve
(12) months that coverage is in force with respect to an Insured Person for any loss caused by Pre-
Existing Condition(s). This twelve (12) month period is measured from the Rider Effective Date for
each Insured Person.

RETURN OF PREMIUM RIDER (Form # LY-ROP-D-FL)
In the event You die while the Rider is in force, a return of premium benefit may be payable to Your
named Beneficiary or estate. If the Rider is added to the policy after the policy was issued, only the
premium paid for the policy on or after the Rider Effective Date will be returned. The return of premium
benefit is Original Premium less Claims Paid.

The benefit provided by this Rider is payable only once during the entire time that the policy and this
Rider is in force.

If a payable claim is incurred on a date when the return of premium benefit would otherwise be
payable, regardless of whether it has been reported or adjudicated, We will:
a. Pay the claim, if it is payable upon the terms of the policy or Rider, and then reduce the return of

premium benefit by the sum of all Claims Paid; or
b. Pay the return of premium benefit, and then reduce the claim by the amount of the return of

premium benefit; or
c. Pay the return of premium benefit if the claim is not payable upon the terms of the Policy

or Rider.

7. YOUR TOTAL ANNUAL PREMIUM (at time of Application)

The modal premiums for the coverage(s) outlined above are: $______________
Lump Sum Heart and Stroke Insurance Policy $______________
Heart and Stroke Restoration Benefit Rider $______________
Lump Sum Cancer Rider $______________
Hospital and Intensive Care Unit Indemnity Benefit Rider $______________
Hospital Indemnity Benefit Rider $______________
Intensive Care Unit Indemnity Benefit Rider $______________
Return of Premium Rider

TOTAL $______________

8. VOLUNTARY ARBITRATION PROVISION – Your Policy contains a Voluntary Arbitration Provision which
may affect Your rights. Please read Your Policy and all attached Riders carefully.

LY-LSH-OC-B-FL 10 10/13
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