War Memorial Nurses Association

Short Term

Disability Policy

                        P BOOKLETCERTIFICATE

                              EMBERS OF

NON UNION MEMBERS HIRED AFTER 8/1/07 OR

NURSES

ASSOCIATION(MNA)UNION MEMBERS

Group Short Term Disability Insurance

Print Date: 11/02/2007

Your insurance has been designed to provide financial help for you when a covered loss occurs. This plan has chosen

benefits provided by a Group Policy issued by Us, Principal Life Insurance Company. To the extent that benefits are

provided by the Group Policy, the administration and payment of claims will be done by Us as an insurer.

Members rights and benefits are determined by the provisions of the Group Policy. This booklet briefly describes those

rights and benefits. It outlines what you must do to be insured. It explains how to file claims. It is your certificate while

you are insured.

The effective date of your insurance is as shown on your enrollment card.

THIS BOOKLET REPLACES ANY PRIOR BOOKLET THAT YOU MAY HAVE RECEIVED. If you have any

questions about this new booklet, please contact your employer. In the event of future plan changes, you will be provided

with a new bookletcertificate

or a bookletcertificate

rider.

If you have an electronic booklet, paper copies of this bookletcertificate

are also available. Please contact your

Policyholder if you would like to request a paper copy.

PLEASE READ YOUR BOOKLET CAREFULLY. We suggest that you start with a review of the terms listed in the

DEFINITIONS Section (at the back of the booklet). The meanings of these terms will help you understand the insurance.

The group insurance policy and your coverage under the Group Policy may be discontinued or altered by the Policyholder

or Us at any time without your consent.

We reserve complete discretion to construe or interpret the provisions of this group insurance, to determine eligibility for

benefits, and to determine the type and extent of benefits, if any, to be provided. Our decisions in such matters will be

controlling, binding, and final as between Us and persons covered by this group insurance, subject to the Claim

Procedures shown on page GH 866 of this booklet.

The insurance provided in this booklet is subject to the laws of the state of

.

PRINCIPAL LIFE

INSURANCE COMPANY

503920001

GH850

1

TABLE OF CONTENTS

SHORT TERM DISABILITY INSURANCE SUMMARY GH 852

HOW TO BE INSURED

Eligibility and Individual Incontestability GH 854

Effective Dates GH 855

Termination, Continuation, and Reinstatement GH 856

DESCRIPTION OF BENEFITS

Benefit Qualification GH 857

Benefits Payable GH 858

Rehabilitation Services and Benefits GH 859

Weekly Payment Limit GH 862

Benefit Payment Period and Recurring Disability GH 863

Limitations GH 864

CLAIM PROCEDURES GH 866

GRIEVANCE PROCEDURES GH 866 GP

STATEMENT OF RIGHTS GH 150

DEFINITIONS GH 867

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SHORT TERM DISABILITY INSURANCE SUMMARY

(Nonoccupational)

Minimum Hours Requirement Employees must be working at least 0 hours a week

Who Pays for Coverage You are not required to pay a part of the premium for

insurance under the Group Policy.

Elimination Period A Benefit Payment Period will begin on the:

1st day for Disability Due to Injury

4th day for Disability Due to Sickness

Benefits will begin on the earlier of completion of an Elimination Period or on the first day of Hospitalization if you

are Hospitalized for any Disability

Primary Benefit 70% of Predisability Earnings

Maximum Weekly Benefit $1,000

Minimum Weekly Benefit $15

Maximum Benefit Payment Period 13 weeks

Rehabilitation Services and Benefits

Rehabilitation Services

Predisability Intervention Services

Included

Included

Other Coverage Features

Proportionate Benefit if Working Included

NOTE:

Benefits may be reduced by other sources of income and disability earnings.

Some disabilities may not be covered or may be limited under this insurance.

This summary provides only highlights of the Group Policy. The entire Group Policy determines all rights, benefits,

exclusions and limitations of the insurance described above.

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HOW TO BE INSURED

SHORT TERM DISABILITY INSURANCE

Eligibility and Individual Incontestability

Eligibility

You will be eligible for insurance on the later of:

a. October 1, 2007; or

b. the first of the Insurance Month coinciding with or next following the date you complete 60 consecutive days of

employment with the Policyholder as a Member.

Member

Any NON UNION PERSON HIRED AFTER 8/1/07 OR

NURSES ASSOCIATION (MNA)

PERSON, residing in the

, who is a

citizen or is legally working in the

, who is a

fulltime

employee of the Policyholder and who regularly works at least *20 hours a week. Work must be at the

Policyholder's usual place or places of business, at an alternative worksite at the direction of the Policyholder, or at

another place to which the employee must travel to perform his or her regular duties. This excludes any person who

is scheduled to work for the Policyholder on a seasonal, temporary, contracted, or parttime

basis. A person is

considered to be residing in the

if his or her main home or permanent address is in the

or

if the person is in the

for six months or more during any 12month

period.

For MNA Union Members: *24

Individual Incontestability

All statements made by any person insured will be representations and not warranties. In the absence of fraud, these

statements may not be used to contest the insured person's coverage unless:

a. the insurance has been in force for less than two years during the insured person's lifetime; and

b. the statement is in Written form Signed by the insured person; and

c. a copy of the form which contains the statement is given to the insured person or the insured person's beneficiary

at the time insurance is contested.

However, the above will not preclude the assertion at any time of defenses based upon the person's not being eligible for

insurance under the Group Policy or upon other provisions of the Group Policy.

In addition, if a person's age is misstated, We may, at any time, adjust premiums and benefits to reflect the correct age.

We may, at any time, terminate a Member's eligibility under the Group Policy, in Writing and with 31day

notice:

a. if the individual submits any claim that contains false or fraudulent elements under state or federal law;

b. upon finding in a civil or criminal

elements under state or federal law;

case that a Member has submitted claims that contain false or fraudulent

c. when a Member has submitted a claim which, in good faith judgement and investigation, a Membeshould have known, contains false or fraudulent elements under state or federal law.

r knew or

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HOW TO BE INSURED

SHORT TERM DISABILITY INSURANCE

Effective Dates

Actively at Work

Your effective date for Short Term Disability Insurance will be as explained in this booklet, if you are Actively at Work

on that date. If you are not Actively at Work on the date insurance would otherwise be effective, such insurance will not

be in force until the day of return to Active Work.

Effective Date for Noncontributory Insurance

Unless Proof of Good Health is required, insurance for which you contribute no part of premium will be in force on the

date you are eligible.

Effective Date for Contributory Insurance

If you are to contribute a part of premium, insurance must be requested in a form provided by Us. Unless Proof of Good

Health is required, the requested insurance will be in force on:

a.

the date you are eligible, if the request is made on or before that date; or

b.

the first of the Insurance Month coinciding with or next following the date of your request, if the request is made

within 31 days after the date you are eligible.

If the request is made more than 31 days after the date you are eligible, Proof of Good Health will be required before

insurance can be in force.

Effective Date When Proof of Good Health is Required

Insurance for which Proof of Good Health is required will be in force on the later of:

a.

the date insurance would have been effective if Proof of Good Health had not been required; or

b.

the first of the Insurance Month coinciding with or next following the date Proof of Good Health is approved by

Us.

Proof of Good Health Requirements

The type and form of required Proof of Good Health will be determined by Us. You must submit Proof of Good Health:

a.

If insurance for which you contribute a part of premium is requested more than 31 days after the date you are

eligible.

b.

If you have failed to provide required Proof of Good Health or have been refused insurance under the Group

Policy at any prior time.

c.

If you elect to terminate insurance and, more than 31 days later, request to be insured again.

d.

If, on the date you become eligible, fewer than ten Members are insured.

e.

If, on the date you become eligible for any increase or additional Benefit Payable amount, fewer than ten Members

are insured.

GH855 5

Effective Date for Benefit Changes Due to a Change in Weekly Earnings

Unless Proof of Good Health is required (see above), a change in Benefit Payable amount because of a change in your

Weekly Earnings will normally be effective on the March 1 that next follows the date of change. However, if you are not

Actively at Work on the date a Benefit Payable change would otherwise be effective, the Benefit Payable change will not

be in force until the date you return to Active Work.

Effective Date for Benefit Changes Due to a Change in Insurance Class

Unless Proof of Good Health is required (see above), a change in Benefit Payable amount because of a change in your

insurance class will normally be effective on the first of the Insurance Month coinciding with or next following the date

of change. However, if you are not Actively at Work on the date a Benefit Payable change would otherwise be effective,

the Benefit Payable change will not be in force until the date you return to Active Work.

Effective Date for Benefit Changes Change

by Policy Amendment or Endorsement

Unless Proof of Good Health is required (see above), a change in the amount of your Benefit Payable because of a

change in the Benefit Payable by amendment or endorsement to the Group Policy will be effective on the date of change.

However, if you are not Actively at Work on the date a Benefit Payable change would otherwise be effective, the Benefit

Payable change will not be in force until the date you return to Active Work.

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HOW TO BE INSURED

SHORT TERM DISABILITY INSURANCE

Termination, Continuation, and Reinstatement

Termination of Insurance

Your insurance will terminate on the earliest of:

a. the date the Group Policy is terminated; or

b. the end of the Insurance Month for which the last premium is paid for your insurance; or

c. for contributory insurance, the end of any Insurance Month if requested by you before that date; or

d. the end of the Insurance Month in which you cease to be a Member as defined; or

e. the end of the Insurance Month in which you cease to be in a class for which Member Insurance is provided; or

f. the end of the Insurance Month in which you cease Active Work except as provided below.

Termination of insurance for any reason described above will not affect your rights to benefits, if any, for a Disability

that begins while your insurance is in force under the Group Policy. You are considered to be continuously Disabled if

you are Disabled from one condition and, while still Disabled from that condition, incur another condition that causes

Disability.

Continuation

You may qualify to have your insurance continued under one or more of the continuation provisions below. If you

qualify for continuation under more than one provision, the longest period of continuation will be applied, and all periods

of continuation will run concurrently.

Continuation and Reinstatement Sickness,

Injury, or Pregnancy

If you cease Active Work due to sickness, injury, or pregnancy, your insurance can be continued subject to payment of

premium, until the earliest of:

a. the date insurance would otherwise terminate as provided in items a. through e. above; or

b. the end of the Insurance Month in which you recover; or

c. the date 95 days after Active Work ends.

If a Benefit Payment Period is established, your insurance will be reinstated if you return to Active Work for the

Policyholder within six months of the date the Benefit Payment Period ends. Your reinstated insurance will be in force on

the date of return to Active Work.

If you do not qualify to have a Benefit Payment Period begin, insurance will be reinstated if you return to Active Work

for the Policyholder within six months of the date insurance ceased. Your reinstated insurance will be in force on the date

of return to Active Work.

Proof of Good Health will be required to place in force any Benefit Payable that would have been subject to Proof of

Good Health had you remained continuously insured.

Continuation and Reinstatement Layoff

or Leave of Absence

GH856

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If you cease Active Work due to layoff or leave of absence, your insurance can be continued, subject to premium

payment, until the earlier of:

a. the date insurance would otherwise terminate as provided in items a. through e. above; or

b. the end of the Insurance Month in which Active Work ends.

Your insurance will be reinstated if you return to Active Work for the Policyholder within six months of the date

insurance ceased. Your reinstated insurance will be in force on the date of return to Active Work.

A longer reinstatement period may be allowed for an approved leave of absence taken in accordance with the provisions

of the federal law regarding Uniform Services Employment and Reemployment Rights Act of 1994 (USERRA).

Proof of Good Health will be required to place in force any Benefit Payable that would have been subject to Proof of

Good Health had you remained continuously insured.

Continuation and Reinstatement Family

and Medical Leave Act (FMLA)

If you cease Active Work due to an approved leave of absence under FMLA, the Policyholder may choose to continue

your insurance, subject to premium payment, until the date 12 weeks after the end of the Insurance Month in which

Active Work ends.

Your terminated insurance may be reinstated in accordance with the provisions of FMLA.

GH856

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DESCRIPTION OF BENEFITS

Benefit Qualification

You will qualify for Disability benefit, if all of the following apply:

a. You are Disabled under the terms of the Group Policy.

b. Your Disability begins while you are insured under the Group Policy.

c. Your Disability is not subject to any of the Limitations listed in this booklet.

d. An Elimination Period is completed.

e. A Benefit Payment Period is established.

f. You are under the Regular and Appropriate Care of a Physician.

g. The claim requirements listed in the CLAIM PROCEDURES Section are satisfied.

An Elimination Period will start on the date you become Disabled. The Elimination Period will be completed and a

Benefit Payment Period established on the:

a. 1st day if the Disability is Due to Injury; or

b. 4th day if the Disability is Due to Sickness; or

c. first day of Hospitalization if you are Hospitalized for any Disability.

Disability; Disabled

You will be considered Disabled if, solely and directly because of sickness, injury, or pregnancy, one of the following

applies:

a.

You cannot perform the majority of the Substantial and Material Duties of your Own Occupation.

b.

You are performing the duties of your Own Occupation on a Modified Basis or any occupation and are unable

to earn more than 80% of your Predisability Earnings.

The loss of a professional or occupational license or certification does not, in itself, constitute a Disability.

Benefit Payment Period

The period of time during which benefits are payable.

Elimination Period

The period of time you must be Disabled before benefits begin to accrue. An Elimination Period starts on the date

you are Disabled and must be satisfied for each period of Disability.

Modified Basis

You will be considered working on a Modified Basis if you are working to your full medical and vocational capacity

on a parttime

basis.

GH857 9

Own Occupation

The occupation you are routinely performing for the Policyholder when your Disability begins.

Substantial and Material Duties

The essential tasks generally required by employers from those engaged in a particular occupation that cannot be

modified or omitted. If a Member routinely works on average 40 hours or more per week, The Principal will consider

the Member able to perform the Substantial and Material Duties of an occupation if he or she is working, or has the

capacity to work, 40 hours per week.

GH 857 10

DESCRIPTION OF BENEFITS

Benefits Payable

If you are not working during a period of Disability

Your Benefit Payable for each full week of a Benefit Payment Period will be your Primary Benefit less Other Income

Sources.

If you are working during a period of Disability

Your work incentive Benefit Payable for each full week of a Benefit Payment Period will be the lesser of:

a.

Your Primary Benefit less Other Income Sources, multiplied by your Income Loss Percentage; or

b.

100% of Predisability Earnings less Other Income Sources, less Current Earnings from your Own Occupation or

any occupation.

You must work to your full medical and vocational capacity. If you choose not to work to full capacity, benefits will be

paid as if you are working to full capacity.

Primary Benefit

70% of your Predisability Earnings. The Primary Benefit will not exceed the Maximum Weekly Benefit of $1,000.

Predisability Earnings

Your Weekly Earnings in effect prior to the date Disability begins.

Income Loss Percentage

Your Income Loss is equal to:

a. your Predisability Earnings less any Current Earnings from your Own Occupation or any occupation; divided by

b. your Predisability Earnings.

Current Earnings

Your Weekly Earnings for each week you are Disabled. While Disabled, your Weekly Earnings may result from

working for the Policyholder or any other employer.

Weekly Earnings

For Members with no ownership interest in the business entity of the Policyholder:

On any date, your basic weekly (or weekly equivalent) wage then in force, as established by the Policyholder. Basic

wage does not include commissions, bonuses, tips, differential pay, housing and/or car allowance, or overtime pay.

Basic wage does include any deferred earnings under a qualified deferred compensation plan, such as contributions to

Internal Revenue Code Section 401(k), 403(b), or 457 deferred compensation arrangements, and any amount of

voluntary earnings reduction under a qualified Section 125 Cafeteria Plan.

GH 858

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For Members with ownership interest in the business entity of the Policyholder, such as an owner of a sole

proprietorship, a partner in a partnership, a shareholder of a corporation or subchapter Scorporation,

or a member of

a limited liability company or limited liability partnership, Weekly Earnings on any date are based on an average of

the following earnings as reported for Federal Income Tax purposes for the last two calendar year(s), assuming the

owner meets all eligibility requirements:

a.

Your share (based on ownership or contractual agreement) of the gross revenue or income earned by the

Policyholder, including income earned by you and others under your supervision or direction; less

b.

Your share (based on ownership or contractual agreement) of the usual and customary unreimbursed business

expenses of the Policyholder which are incurred on a regular basis, are essential to the established business operation

of the Policyholder, are deductible for Federal Income Tax purposes, and do not exceed the expenses before

Disability began; plus

c.

The salary, benefits, and other forms of compensation which are payable to you, and any contributions to a pension

or profit sharing plan made on your behalf by the Policyholder.

Weekly Earnings do not include any form of unearned income such as dividends, rent, interest, capital gains, income

received from any form of deferred compensation, retirement, pension plan, income from royalties, or disability

benefits.

Other Income Sources

The weekly equivalent of:

a. all disability payments for the month that you and your Dependents receive (or would have received if complete and

timely application had been made) under the Federal Social Security Act, Railroad Retirement Act, or any similar act

of any federal, state, provincial, municipal, or other governmental agency; and

b. if you have reached Social Security Normal Retirement Age or older, all retirement payments for the month that you

and your Dependents receive or would have received if complete and timely application had been made) under the

Federal Social Security Act, Railroad Retirement Act, or any similar act of any federal, state, provincial, municipal,

or other governmental agency; and

c. if you are less than Social Security Normal Retirement Age, all retirement payments for the month that you and your

Dependents receive under the Federal Social Security Act, Railroad Retirement Act, or any similar act of any

federal, state, provincial, municipal, or other governmental agency; and

d. all payments for the month that you receive from a permanent or temporary award or settlement under a Worker's

Compensation Act, or other similar law, whether or not liability is admitted. Payments that are specifically set out in

an award or settlement as medical benefits, rehabilitation benefits, income benefits for fatal injuries or income

benefits for scheduled injuries involving loss or loss of use of specific body members will not be considered an Other

Income Source; and

e. all payments for the month that you receive (or would have received if complete and timely application had been

made) under a policy that provides benefits for loss of time from work, if the Policyholder pays a part of the cost or

makes payroll deductions for that coverage; and

f. all payments for the month that you receive or are eligible to receive under another group disability insurance policy;

and

g all payments for the month that you receive under any state disability plan; and

h. all sick pay, salary continuance payments, personal time off, or severance pay, for the month that you receive from

the Policyholder; and

GH 858

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i. all retirement payments attributable to employer contributions and all disability payments attributable to employer

contributions for the month that you receive under a pension plan sponsored by the Policyholder. A pension plan is a

defined benefit plan or defined contribution plan providing disability or retirement benefits for employees. A pension

plan does not include a profit sharing plan, a thrift savings plan, a nonqualified deferred compensation plan, a plan

under Internal Revenue Code Section 401(k) or 457, an Individual Retirement Account (IRA), a Tax Deferred

Sheltered Annuity (TSA) under Internal Revenue Code Section 403(b), a stock ownership plan, or a Keogh (HR10)

plan with respect to partners; and

j. all payments for the month that you receive for loss of income under nofault

auto laws. Supplemental disability

benefits purchased under a nofault

law will not be counted; and

k. all renewal commissions for the month that you receive from the Policyholder.

NOTE: If any sick pay, salary continuance payments, personal time off, severance pay, or loss of time from work

payments specified above are attributable to individual disability insurance policies, the payments will not

be considered an Other Income Source.

Any retirement payments you receive under the Federal Social Security Act or a pension plan which you

had been receiving in addition to your Weekly Earnings prior to a claim for Disability, will not be

considered an Other Income Source.

Military or Veterans Administration disability or retirement payments will not be considered an Other

Income Source.

After the initial deduction for each of the Other Income Sources, benefits will not be further reduced due to

any cost of living increases payable under the above stated sources.

Withdrawal of pension plan benefits by you for the purpose of placing the benefits in a subsequent pension

plan or a deferred compensation plan will not be considered an Other Income Source unless you withdraw

pension benefits from the subsequent pension plan or defined compensation plan due to disability or

retirement.

If any income specified above is payable in a monthly payment, the weekly equivalent will be calculated by

multiplying the monthly benefit by 12 and dividing by 52.

Minimum Weekly Benefit

In no event will the weekly Benefit Payable be less than $15 for each full week of a Benefit Payment Period, except that

We will have the right to reduce the Minimum Weekly Benefit by any prior benefit overpayment. The Benefit Payable

for each day of any part of a Benefit Payment Period that is less than a full week will be the weekly benefit divided by

seven.

GH 858 13

DESCRIPTION OF BENEFITS

Rehabilitation Services and Benefits

Rehabilitation Services and Benefits

While you are Disabled and covered under the Group Policy, you may qualify to participate in a Rehabilitation Plan and

receive Rehabilitation Services and Benefits. We will work with you, the employer, and your Physician(s), and others as

appropriate, to develop an individualized Rehabilitation Plan intended to assist you in returning to work.

Rehabilitation Plan

An individualized Written agreement between you and Us, developed with your assistance, the assistance of an

employer, and your Physician(s). The Rehabilitation Plan may include medical, psychological, or vocational services

and benefits, which are provided with the intent to restore your ability to perform your Own Occupation or any

occupation which you are or could reasonably become qualified by education, training, or experience.

Rehabilitation Services

While you are Disabled under the terms of the Group Policy, you may qualify for Rehabilitation Services. If you, the

Policyholder and The Principal agree in Writing on a Rehabilitation Plan in advance, We may pay a portion of reasonable

expenses. The goal of the plan will be to return you to work.

Any rehabilitation assistance must be approved in advance by The Principal and outlined in a Rehabilitation Plan. The

Benefit Payable as described in the booklet (subject to the terms and conditions of the Group Policy) will continue, unless

modified by the Rehabilitation Plan. Rehabilitation assistance may include, but is not limited to:

a. coordination of medical services;

b. vocational and employment assessment;

c. purchasing adaptive equipment;

d. business/financial planning;

e. retraining for a new occupation;

f. education expenses.

We will periodically review the Rehabilitation Plan and your progress and We will continue to pay for the agreed upon

expenses as long as We determine that the Rehabilitation Plan is providing the necessary action to return you to work.

We may require you to participate in an individualized Rehabilitation Plan at Our expense. If you refuse to participate in

or do not comply with the Rehabilitation Plan without good cause, all benefits will cease to be payable. As used in this

section, "good cause" means a medical reason preventing implementation of the Rehabilitation Plan.

Predisability Intervention Services

Rehabilitation Services may be offered if you have not yet become Disabled under the terms of the Group Policy,

provided you have a condition which has the potential of resulting in the inability to perform the Substantial and Material

Duties of your Own Occupation.

GH 859 14

DESCRIPTION OF BENEFITS

Weekly Payment Limit

In no event will the sum of the amounts payable for:

a. Benefits Payable as described in this booklet; and

b. income from Other Income Sources; and

c. Current Earnings from your Own Occupation or any occupation; and

d. payments attributable to individual disability insurance policies;

exceed 100% of Predisability Earnings. In the event your total income from all sources listed above exceeds 100% of

Predisability Earnings, the benefits as described in this booklet will be reduced by the amount in excess of 100% of

Predisability Earnings.

GH 862 15

DESCRIPTION OF BENEFITS

Benefit Payment Period and Recurring Disability

Benefit Payment Period

Benefits are payable until the date 13 weeks after the date the Benefit Payment Period begins.

However, in no event, will benefits continue beyond:

a.

the date of your death; or

b.

the date your Disability ends, unless a Recurring Disability exists as explained in this booklet; or

c.

the date you fail to provide any required proof of Disability; or

d.

the date you fail to submit to any required medical examination or evaluation; or

e.

the date you fail to report any required Current Earnings information; or

f.

the date you fail to report income from Other Income Sources; or

g.

the date ten days after receipt of notice from Us if you fail to pursue Social Security Benefits or benefits under a

Workers' Compensation Act or similar law as described in this booklet; or

h.

the date you cease to be under the Regular and Appropriate Care of a Physician; or

i.

the date you refuse to participate in or do not comply with a Rehabilitation Plan.

Recurring Disability

A Recurring Disability will exist under the Group Policy if:

a.

after you have completed an Elimination Period and during a Benefit Payment Period, you cease to be Disabled;

and

b.

you then return to Active Work; and

c.

while insured under the Group Policy, but before completing 30 continuous days of Active Work, you are again

Disabled; and

d.

your current Disability and the Disability for which you completed the Elimination Period result from the same or

a related cause.

A Recurring Disability will be treated as if the initial Disability had not ended, except that no benefits will be payable for

the time between Disabilities. You will not be required to complete a new Elimination Period for a Recurring Disability

and a new Benefit Payment Period will not be established. Benefits will be payable from the first day of each Recurring

Disability, but only for the remainder, if any, of the Benefit Payment Period established for the initial Disability.

GH 8631

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DESCRIPTION OF BENEFITS

Limitations

No benefits will be paid for any Disability that:

a.

results from willful selfinjury,

while sane or insane; or

b.

results from war or act of war; or

c.

results from participation in an assault or felony; or

d.

is a new Disability that begins after a prior Benefit Payment Period has ended and you have not returned to Active

Work; or

e.

is a continuation of a Disability for which a Benefit Payment Period has ended and you have not returned to

Active Work (except as provided for a Recurring Disability in this booklet); or

f.

results from a sickness or injury arising out of or in the course of employment for wage or profit.

GH 8641

17

CLAIM PROCEDURES

Notice of Claim

Written notice of claim must be given to Us within 20 days after the date of loss for which claim is being made. Failure

to give notice within the time specified will not invalidate or reduce any claim if notice is given as soon as reasonably

possible.

Claim Forms

Claim forms and other information needed to provide proof of Disability must be filed with Us in order to obtain

payment of benefits. The Policyholder will provide appropriate claim forms to assist you in filing claims. If the forms are

not provided within 15 days after We receive notice of claim, you will be considered to have complied with the

requirements of the Group Policy regarding proof of Disability upon submitting, within the time specified below for filing

proof of Disability, Written proof covering the occurrence, character and extent of the loss.

Proof of Disability

Claim forms and other information needed to prove Disability should be filed promptly. Written proof that Disability

exists and has been continuous must be sent to Us within 90 days after the date you complete an Elimination Period.

Proof required includes the date, nature, and extent of the loss. Further proof that Disability has not ended must be sent

when requested by Us. We may request additional information to substantiate your loss or require a Signed unaltered

authorization to obtain that information from the provider. We reserve the right to determine when these conditions are

met. Your failure to comply with such request could result in declination of the claim. For purposes of satisfying the

claims processing requirements of the Employee Retirement Income Security Act (ERISA), receipt of claim will be

considered to be met when the Elimination Period has been completed and the appropriate claim form is received by Us.

Proof of Disability while outside the

If during a period of Disability, you are residing or staying outside the

, the following will apply:

a.

Any evidence you submit for your claim will be required to be translated by the U.S. Embassy and contain the

U.S. Embassy seal.

b.

You may be required to return to the

at a frequency We deem necessary to substantiate your claim

for Disability. All expenses incurred by you for returning to the

will be your responsibility.

c.

You must notify Us in advance of any return to the

and your change of address.

Your failure to comply with such request could result in declination of the claim. For purposes of satisfying the claims

processing requirements of the Employee Retirement Income Security Act (ERISA), receipt of claim will be considered to

be met when the Elimination Period has been completed and the appropriate claim form is received by Us.

Payment, Denial, and Review

ERISA permits up to 45 days from receipt of claim for processing the claim. If a claim cannot be processed due to

incomplete information, We will send a Written explanation prior to the expiration of the 45 days. A claimant is then

allowed up to 45 days to provide all additional information requested. We are permitted two 30day

extensions for

processing an incomplete claim. Written notification will be sent to a claimant regarding the extension.

In actual practice, benefits under the Group Policy will be payable sooner, provided We receive complete and proper

proof of Disability. Further, if a claim is not payable or cannot be processed, We will submit a detailed explanation of

the basis for its denial.

GH 866

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A claimant may request an appeal of a claim denial by Written request to Us within 180 days of the receipt of notice of

the denial. We will make a full and fair review of the claim. We may require additional information to make the review.

We will notify a claimant in Writing of the appeal decision within 45 days after receipt of the appeal request. If the

appeal cannot be processed within the 45 day period because We did not receive the requested additional information, We

are permitted a 45day

extension for the review. Written notification will be sent to a claimant regarding the extension.

After exhaustion of the formal appeal process, the claimant may request an additional appeal. However, this appeal is

voluntary and does not need to be filed before asserting rights to legal action.

For purposes of this section, "claimant" means Member.

Report of Payments from Other Income Sources

When asked, you must give Us:

a.

a report of all payments from Other Income Sources; and

b.

proof of application for all such income for which you and your Dependents are eligible; and

c.

proof that any application for such income has been rejected.

Lump Sum Payments from Other Income Sources

If any income from Other Income Sources are payable in a lump sum (except as described below), the lump sum will be

deemed to be paid in weekly amounts prorated over the time stated. If no such time is stated, the lump sum will be

prorated weekly over your expected life span. We will determine the expected life span.

Lump Sum Payments under:

a.

a retirement plan will be deemed to be paid in the weekly amount which:

(1)

is provided by the standard annuity option under the plan as identified by the Policyholder; or

(2)

is prorated under a standard annuity table over your expected life span (if the plan does not have a standard

annuity option);

b.

a Workers' Compensation Act or other similar law (which includes benefits paid under an award or settlement)

will be deemed to be paid weekly:

(1)

at the rate stated in the award or settlement; or

(2)

at the rate paid to the lump sum (if no rate is stated in the award or settlement); or

(3)

at the maximum rate set by the law (if no rate is stated and you did not receive a periodic award).

Social Security Estimates

Until exact amounts are known, We may estimate the Social Security benefits for which you and your Dependents are

eligible and may include those estimates in your Other Income Sources.

If it is reasonable that you would be entitled to disability benefits under the Federal Social Security Act, We will require

that you:

a.

apply for disability benefits within ten days after receipt of Written notice from Us requesting you to apply for

such benefits; and

b.

give satisfactory proof within 30 days after receipt of Written notice from Us that you have applied for these

benefits within the tenday

period; and

c.

request reconsideration of the application for Social Security benefits if the original application is denied, and

appeal any denial or reconsideration if an appeal appears reasonable.

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Workers' Compensation Estimates

Until exact amounts are known, We may estimate the Workers' Compensation benefits for which you are eligible and

may include those estimates in your Other Income Sources.

If it is reasonable that you would be entitled to benefits under a Workers' Compensation Act or a similar law, We will

require that you:

a.

apply for benefits within ten days after receipt of Written notice from Us requesting you to apply for such benefits;

and

b.

give satisfactory proof within 30 days after receipt of Written notice from Us that you have applied for these

benefits within the tenday

period.

Payments for Less Than a Full Week

The Benefit Payable for each day of any part of a Benefit Payment Period that is less than a full week will be the weekly

benefit divided by seven.

Right to Recover Overpayments

If an overpayment of benefits occurs under the Group Policy, We will have the option to:

a.

reduce or withhold any future benefits We determine to be due, including the Minimum Weekly Benefit; or

b.

recover the overpayment directly from you; or

c.

take any other legal action.

Facility of Payment

Benefits under the Group Policy will be payable at the end of each week of a Benefit Payment Period, provided complete

and proper proof of Disability has been received by Us. We will have the option to issue Benefits Payable in a lump sum

amount.

Any unpaid balance that remains after a Benefit Payment Period ceases will be immediately payable.

We will normally pay benefits directly to you. However, in the special instances listed below, payment will be as

indicated. All payments so made will discharge Us to the full extent of those payments.

a.

If payment amounts remain due upon your death, those amounts may, at Our option, be paid to your spouse, child,

parent or estate.

b.

If We believe a person is not legally able to give a valid receipt for a benefit payment, and no guardian has been

appointed, We may pay whoever has assumed the care and support of the person. Any payment due a minor will

be at the rate of not more than $50 a week.

Medical Examinations and Evaluations

We may require you to be examined by a Physician or undergo an evaluation, at reasonable intervals, during the course

of a claim. We will pay for those examinations and evaluations and will choose the Physician or evaluator to perform

them. Failure to attend a medical examination or cooperate with the Physician may be cause for suspension or denial of

your benefits. Failure to attend an evaluation or to cooperate with the evaluator may also be cause for suspension or

denial of your benefits. If you fail to attend an examination or evaluation, any charges incurred for not attending an

appointment as scheduled may be your responsibility.

Legal Action

GH 866

20

Legal action to recover benefits under the Group Policy may not be started earlier than 90 days after proof of Disability

is filed and before the appeal procedures have been exhausted. Further, no legal action may be started later than three

years after that proof is required to be filed.

Time Limits

All time limits listed in this section will be adjusted as required by law.

GH 866 21

GRIEVANCE PROCEDURES

Applicability

You or a designated representative may file a Grievance if you are dissatisfied with any action We may have taken. A

letter can be sent to the local service center.

As used in the Group Policy, Grievance means a Written complaint submitted by you or a designated representative

concerning the payment of benefits.

Grievance Review

Upon receipt of a Grievance, The Principal will provide the claimant with the name, address, and telephone number of a

person designated to coordinate the Grievance review. Written notification of the determination will be provided to you

not later than 45 calendar days after a Grievance is submitted in Writing by you unless We require an extension of time

to obtain additional information to make a determination. The extension will not exceed 45 days from the end of the

initial period unless the initial period is extended due to your or your designated representative's failure to submit

information necessary to make a determination. If the extension is due to your or your designated representative's failure

to submit information, the time period for making a determination will not begin until you or your designated

representative respond to the request for additional information.

GH 866 GP (MI) 22

STATEMENT OF RIGHTS

Federal law requires that this section be included in your booklet:

As a participant in this plan you are entitled to certain rights and protections under the Employee Retirement Income

Security Act of 1974 (ERISA).

ERISA provides that all plan participants shall be entitled to:

Receive Information About Your Plan and Benefits

Examine,

without charge, at the plan administrator's office and at other specified locations, such as worksites

and union halls, all documents governing the plan, including insurance contracts and collective bargaining

agreements, and a copy of the latest annual report (Form 5500 Series) filed by the plan with the

Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security

Administration.

Obtain,

upon written request to the plan administrator, copies of documents governing the operation of the

plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual

report (Form 5500 Series) and updated summary plan description. The administrator may make a reasonable

charge for the copies.

Receive

a summary of the plan's annual financial report. The plan administrator is required by law to

furnish each participant with a copy of this summary annual report.

Prudent Actions by Plan Fiduciaries

In addition to creating rights for plan participants ERISA imposes duties upon the people who are responsible for the

operation of the employee benefit plan. The people who operate your plan, called "fiduciaries" of the plan, have a duty to

do so prudently and in the interest of you and other plan participants and beneficiaries. No one, including your employer,

your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from

obtaining a welfare benefit or exercising your rights under ERISA.

Enforce Your Rights

If your claim for a welfare benefit is denied or ignored, in whole or in part, you have a right to know why this was done,

to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time

schedules.

Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of plan

documents or the latest annual report from the plan and do not receive them within 30 days, you may file suit in a

Federal court. In such a case, the court may require the plan administrator to provide the materials and pay you up to

$110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of

the administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a

state or Federal court. In addition, if you disagree with the plan's decision or lack thereof concerning the qualified status

of a domestic relations order or a medical child support order, you may file suit in Federal court. If it should happen that

plan fiduciaries misuse the plan's money, or if you are discriminated against for asserting your rights, you may seek

assistance from the U.S. Department of Labor, or you may file suit in a Federal court. The court will decide who should

pay court costs and legal fees. If you are successful the court may order the person you have sued to pay these costs and

fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.

Assistance with Your Questions

If you have any questions about your plan, you should contact the plan administrator. If you have any questions about

this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the plan

GH 1501

23

administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of

Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits

Security Administration,

Department of Labor,

. You may

also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of

the Employee Benefits Security Administration.

GH 1501

24

DEFINITIONS

Several words and phrases used to describe your insurance are capitalized whenever they are used in this booklet. These

words and phrases have special meanings as explained in this section.

Active Work; Actively at Work

You are considered Actively at Work if you are able and available for active performance of all your regular duties. Short

term absence because of a regularly scheduled day off, holiday, vacation day, jury duty, funeral leave, or personal time

off is considered Active Work provided you are able and available for active performance of all of your regular duties

and were working the day immediately prior to the date of his or her absence.

Benefit Payment Period

The period of time during which benefits are payable.

Current Earnings

Your Weekly Earnings for each week you are Disabled. While Disabled, your Weekly Earnings may result from working

for the Policyholder or any other employer.

Dependent

Any person who qualifies for benefits as a dependent under the Federal Social Security Act as a result of your Disability

or retirement, whether or not residing in your home.

Disability; Disabled

You will be considered Disabled if, solely and directly because of sickness, injury, or pregnancy, one of the following

applies:

a.

You cannot perform the majority of the Substantial and Material Duties of your Own Occupation.

b.

You are performing the duties of your Own Occupation on a Modified Basis or any occupation and are unable to

earn more than 80% of your Predisability Earnings.

The loss of a professional or occupational license or certification does not, in itself, constitute a Disability.

Disability Due to Injury

A Disability that:

a.

occurs solely and directly because of an accidental injury; and

b. begins within 30 days of the accident.

An accidental injury means an injury that results solely from external, violent, and accidental means.

Disability Due to Sickness

A Disability that:

a.

occurs directly or indirectly because of disease, a Mental Health Condition, alcohol, drug or chemical abuse,

dependency, or addiction; or

GH 8671

25

b.

is not a Disability Due to Injury as defined in this booklet.

Elimination Period

The period of time you must be Disabled before benefits begin to accrue. An Elimination Period starts on the date you

are Disabled and must be satisfied for each period of Disability.

Generally Accepted

Treatment, service or medication that:

a.

has been accepted as the standard of practice according to the prevailing opinion among experts as shown by (or

in) articles published in authoritative, peerreviewed

medical, and scientific literature; and

b.

is in general use in the medical community; and

c.

is not under continued scientific testing or research as a therapy for the particular sickness or injury which is the

subject of the claim.

Group Policy

The policy of group insurance issued to the Policyholder by Us which describes benefits and provisions for insured

Members.

Hospital

An institution that is licensed as a Hospital by the proper authority of the state in which it is located, but not including

any institution, or part thereof, that is used primarily as a clinic, convalescent home, rest home, home for the aged,

nursing home, custodial care facility, or training center.

Hospitalization; Hospitalized

The period of time you are confined:

a.

in a Hospital as a registered bed patient (for any cause); or

b.

in a licensed birthing center for obstetrical delivery; or

c.

while undergoing outpatient surgery at a Hospital or freestanding ambulatory surgery center that requires the

services of an anesthesiologist, for other than local or digital anesthesia.

Income Loss Percentage

Your Income Loss Percentage is equal to:

a.

your Predisability Earnings less any Current Earnings from your Own Occupation or any occupation; divided by

b.

your Predisability Earnings.

Insurance Month

Calendar month.

Maximum Weekly Benefit

$1,000

Member

Any NON UNION PERSON HIRED AFTER 8/1/07 OR

NURSES ASSOCIATION (MNA)

PERSON, residing in the

, who is a

citizen or is legally working in the

, who is a

fulltime

employee of the Policyholder and who regularly works at least *20 hours a week. Work must be at the

Policyholder's usual place or places of business, at an alternative worksite at the direction of the Policyholder, or at

another place to which the employee must travel to perform his or her regular duties. This excludes any person who is

scheduled to work for the Policyholder on a seasonal, temporary, contracted, or parttime

basis. A person is considered to

be residing in the

if his or her main home or permanent address is in the

or if the person is

in the

for six months or more during any 12month

period.

For MNA Union Members; *24

Mental Health Condition

Any condition which is:

a.

manifested by a psychiatric disturbance including, but not limited to, a biologically or chemically based disorder;

and

b.

categorized in the current edition of American Psychiatric Associations Diagnostic and Statistical Manual of Mental

Disorders.

Conditions not considered a Mental Health Condition include:

a.

dementia; and

b.

organic brain syndrome; and

c.

delirium; and

d.

organic amnesia syndromes; and

e.

organic delusional or organic hallucinogenic syndromes.

Modified Basis

You will be considered working on a Modified Basis if you are working to your full medical and vocational capacity on

a parttime

basis.

Other Income Sources

The Weekly equivalent of:

a.

all disability payments for the month that you and your Dependents receive (or would have received if complete

and timely application had been made) under the Federal Social Security Act, Railroad Retirement Act, or any

similar act of any federal, state, provincial, municipal, or other governmental agency; and

b.

for a Member who has reached Social Security Normal Retirement Age or older, all retirement payments for the

month that you and your Dependents receive (or would have received if complete and timely application had been

made) under the Federal Social Security Act, Railroad Retirement Act, or any similar act of any federal, state,

provincial, municipal, or other governmental agency; and

c.

for a Member who is less than Social Security Normal Retirement Age, all retirement payments for the month that

you and your Dependents receive under the Federal Social Security Act, Railroad Retirement Act, or any similar

act of any federal, state, provincial, municipal, or other governmental agency; and

GH 8671

27

d.

all payments for the month that you receive from a permanent or temporary award or settlement under a Workers'

Compensation Act, or other similar law, whether or not liability is admitted. Payments that are specifically set out

in an award or settlement as medical benefits, rehabilitation benefits, income benefits for fatal injuries or income

benefits for scheduled injuries involving loss or loss of use of specific body members will not be considered an

Other Income Source; and

e.

all payments for the month that you receive (or would have received if complete and timely application had been

made) under a policy that provides benefits for loss of time from work, if the Policyholder pays a part of the cost

or makes payroll deductions for that coverage; and

f.

all payments for the month that you receive or are eligible to receive under another group disability insurance

policy; and

g.

all payments for the month that you receive under any state disability plan; and

h.

all sick pay, salary continuance payments, personal time off, or severance pay, for the month that you receive from

the Policyholder; and

i.

all retirement payments attributable to employer contributions and all disability payments attributable to employer

contributions for the month that you receive under a pension plan sponsored by the Policyholder. A pension plan is

a defined benefit plan or defined contribution plan providing disability or retirement benefits for employees. A

pension plan does not include a profit sharing plan, a thrift savings plan, a nonqualified deferred compensation

plan, a plan under Internal Revenue Code Section 401(k) or 457, an Individual Retirement Account (IRA), a Tax

Deferred Sheltered Annuity (TSA) under Internal Revenue Code Section 403(b), a stock ownership plan, or a

Keogh (HR10)

plan with respect to partners; and

j.

all payments for the month that you receive for loss of income under nofault

auto laws. Supplemental disability

benefits purchased under a nofault

auto law will not be counted; and

k.

all renewal commissions for the month that you receive from the Policyholder.

NOTE:

If any sick pay, salary continuance payments, personal time off, severance pay, or loss of time from work

payments specified above are attributable to individual disability insurance policies, the payments will not be

considered an Other Income Source.

Any retirement payments you receive under the Federal Social Security Act or a pension plan which you had been

receiving in addition to your Weekly Earnings prior to a claim for Disability, will not be considered an Other

Income Source.

Military or Veterans Administration disability or retirement payments will not be considered an Other Income

Source.

After the initial deduction for each of the Other Income Sources, benefits will not be further reduced due to any

cost of living increases payable under the above stated sources.

Withdrawal of pension plan benefits by you for the purpose of placing the benefits in a subsequent pension plan or

a deferred compensation plan will not be considered an Other Income Source unless you withdraw pension benefits

from the subsequent pension plan or defined compensation plan due to disability or retirement.

If any income specified above is payable in a monthly payment, the weekly equivalent will be calculated by

multiplying the monthly benefit by 12 and dividing by 52.

Own Occupation

The occupation you are routinely performing for the Policyholder when your Disability begins.

GH 8671

28

Physician

a.

a licensed Doctor of Medicine (M.D.) or Osteopathy (D.O.); or

b.

any other licensed health care practitioner that state law requires be recognized as a Physician under the Group

Policy.

The term Physician does not include you, one of your employees, your business or professional partner or associate, any

person who has a financial affiliation or business interest with you, anyone related to you by blood or marriage, or

anyone living in your household.

Policyholder

.

Predisability Earnings

Your Weekly Earnings in effect prior to the date Disability begins.

Primary Benefit

70% of your Predisability Earnings. The Primary Benefit will not exceed the Maximum Weekly Benefit of $1,000.

Proof of Good Health

Written evidence that a person is insurable under Our underwriting standards. This proof must be provided in a form

satisfactory to Us.

Regular and Appropriate Care

You will be considered to be receiving Regular and Appropriate Care if you:

a.

are evaluated in person by a Physician; and

b.

receive treatment appropriate for the condition causing the Disability; and

c.

undergo evaluations and treatment that is provided by a Physician whose specialty is appropriate for the condition

causing the Disability; and

d.

undergo evaluations and treatment at a frequency intended to return you to full time work; and

e.

pursue reasonable treatment options or recommendations to achieve maximum medical improvement.

We may require you to have your Physician provide a Written evaluation and treatment plan for the condition causing the

Disability, which meets Generally Accepted medical standards and is satisfactory to Us.

We may waive, in Writing to you, the Regular and Appropriate Care requirement if it is determined by Us that continued

care would be of no benefit to you.

Rehabilitation Plan

An individualized Written agreement between you and Us, developed with your assistance, the assistance of an employer,

and your Physician(s). The Rehabilitation Plan may include medical, psychological, or vocational services and benefits,

which are provided with the intent to restore your ability to perform your Own Occupation or any occupation which you

are or could reasonably become qualified by education, training, or experience.

Signed or Signature

GH 8671

29

Any symbol or method executed or adopted by a person with the present intention to authenticate a record, and which is

on or transmitted by paper or electronic media, and which is consistent with applicable law and is agreed to by Us.

Social Security

Retirement Age (SSNRA)

Social Security

Retirement Age as defined by the Social Security Administration on the date Disabled.

Year of Birth

Retirement Age

Before 1938 65

1938 65 and 2 months

1939 65 and 4 months

1940 65 and 6 months

1941 65 and 8 months

1942 65 and 10 months

19431954

66

1955 66 and 2 months

1956 66 and 4 months

1957 66 and 6 months

1958 66 and 8 months

1959 66 and 10 months

After 1959 67

Substantial and Material Duties

The essential tasks generally required by employers from those engaged in a particular occupation that cannot be modified

or omitted. If a Member routinely works on average 40 hours or more per week, The Principal will consider the Member

able to perform the Substantial and Material Duties of an occupation if he or she is working, or has the capacity to work,

40 hours per week.

Weekly Earnings

For Members with no ownership interest in the business entity of the Policyholder:

On any date, your basic weekly (or weekly equivalent) wage then in force, as established by the Policyholder. Basic wage

does not include commissions, bonuses, tips, differential pay, housing and/or car allowance, or overtime pay. Basic wage

does include any deferred earnings under a qualified deferred compensation plan, such as contributions to Internal

Revenue Code Section 401(k), 403(b), or 457 deferred compensation arrangements, and any amount of voluntary earnings

reduction under a qualified Section 125 Cafeteria Plan.

For Members with ownership interest in the business entity of the Policyholder, such as an owner of a sole proprietorship,

a partner in a partnership, a shareholder of a corporation or subchapter Scorporation,

or a member of a limited liability

company or limited liability partnership, Weekly Earnings on any date are based on an average of the following earnings

as reported for Federal Income Tax purposes for the last two calendar year(s), assuming the owner meets all eligibility

requirements:

a.

Your share (based on ownership or contractual agreement) of the gross revenue or income earned by the

Policyholder, including income earned by you and others under your supervision or direction; less

b.

Your share (based on ownership or contractual agreement) of the usual and customary unreimbursed business

expenses of the Policyholder which are incurred on a regular basis, are essential to the established business

operation of the Policyholder, are deductible for Federal Income Tax purposes, and do not exceed the expenses

before Disability began; plus

c.

The salary, benefits, and other forms of compensation which are payable to you, and any contributions to a pension

or profit sharing plan made on your behalf by the Policyholder.

Weekly Earnings do not include any form of unearned income such as dividends, rent, interest, capital gains, income

received from any form of deferred compensation, retirement, pension plan, income from royalties, or disability benefits.

We, Us, and Our

Principal Life Insurance Company,

.

Written or Writing

A record which is on or transmitted by paper or electronic media, and which is consistent with applicable law.

Plan Arranged By

W H A FINANCIAL SOLUTIONS INC

WI

537259038

Principal Life Insurance Company

503920002