AZ SAMPLE, the Insured Policynumber06-600-950970

UoPLifeandAccidentInsuranceCompany 1

Phoenix, AZ 85383

AZ SAMPLE, the Insured PolicyNumber06-600-950970

Disability IncomePolicy

NON-CANCELLABLE AND GUARANTEED RENBIABLE TO AGE65,NO CHANGE INPREMIUMRATES. As

longasthepremiumispaidontime,MecannotchangeYourPolicyoritspremiumrate untilYour65thbirthday.

RENEMALOPTIONAFTERYOUREACHAGE65.SUBJECT TO CHANGE INPREMIUMRATES. Youmay

continueYourPolicyforaTotalDisabilitybenefitwithalimitedbenefitperiod

whileYouareactivelyandregularlyemployedam1n1mumof30hoursperweek. isno agelimit. ThisoptionisexplainedinPart4.

There

YourRightToCancel.IfyouarenotsatisfiedwithYourPolicy,Youmaycancelit. ReturnthePolicytoUsorYourauthorizedrepresentativethroughwhomitwaspur chasedbymidnightofthetenthdayafterthedateYoureceiveit. Ifyoureturnthe Policybymail,itmustbeproperlyaddressed,postageprepaid,andpostmarkedno laterthanmidnightofthattenthday.WithintendaysafterwereceivethePolicy,Wewillrefund anypremiumyouhavepaid.ThePolicywillbeconsideredtohaveneverbeenissued.

ReadYourPolicyCarefully.Itisalegalcontract.

Signed,

President

andChiefExecutiveOfficer

VicePresident, CorporateSecretary and Assistant General Counsel

POLICY SCHEDULE

Insured -AZSAMPLE

EffectiveDate-October25,2007

Policy Number- 06-600-9540970 FirstRenewalDate-October2,5 RenewalTerm-TwelveMonths

2008

------Summary of Premium------

Hon-Tobacco User

AnnualPremiumforDisabilityBenefits / $931.29
Annual Premium for Additional Benefits / $167.30
Total AnnualPremium / $1,098.59
YourAnnualPremium / $1,098.59
OtherPremium Paying Methods:

$571.27 Semi-Annual

$285.63Quarterly

$95.03Monthly(InsurematicBankDraft)

------a-b-l-e-o-f TotalDisabilityBenefits------

Elimination Period

90Days

MaximumBenefitPeriods ForTotalDisability

ToAge65

Total DisabilityMonthly Amount

$3,500.00

TheMaximumBenefitPeriodsforTotalDisabilitymaychangeduetoYourageatTotal Disability.PleaseseetheMaximumBenefitPeriodsforTotalDisabilitysectionof thePolicySchedule.

MaximumBenefitPeriodforMentalDisorders:24MonthsoverthelifeofYourPolicy

BenefitsforMentalDisorderswillbepayablefortheMaximum BenefitPeriodfor MentalDisordersnottoexceedtheMaximumBenefitPeriodsforTotalDisability.

BenefitspayablebeyondtheMaximumBenefitPeriodforMentalDisordersforahospital conffinementduetoaDisabilityfromMentalDisorderswillinnoeventexceedthe MaximumBenefitPeriodsforTotalDisability.

YourOccupationPeriod:24Months

<PolicyScheduleiscontinuedonnextpage . )

POLICYSCHEDULE<continued)

------MaximumBenefitPeriodsforTotalDisability------

ToAge65:BeforeAge61ToAge65

AtAge61butbeforeAge6248Months

AtAge62butbeforeAge6342Months

AtAge63butbeforeAge6436Months

AtAge64butbeforeAge6530MonthsAtorafterAge65butbeforeAge7524Months AtorafterAge75 12Months

------Residual Disability Benefits------

Maximum BenefitPeriodFor

Work IncentivePeriod

3 Months

Residual Disability 24Months

------L-ifetimeContinuationOption------

EliminationPeriodBenefitAmountfor

LongTermCarePolicy

Lifetime Maximum Benefit Amount for

LongTermCarePolicy

90Days$3,000permonth$108,000

------TableofAdditionalBenefits------

Annual Premium

Description

Priorto Age65

FixedCostofLivingAdjustmentOption Rider EffectiveDate:

October25,2007

$167.30

INTRODUCTION

ThisPolicyisalegalcontractbetweenYouandUs.Itisissuedinconsideration ofthepayment,inadvance,ofthepremiumandofYourstatementsandrepresentations intheapplication<s>. Acopyoftheapplication(s)isattachedandispartofYour Policy.Omissionsandmisstatementsintheapplication(s)couldcauseanotherwise validclaimtobedeniedorYourPolicytoberescinded.

WeagreetopaybenefitssubjecttoalloftheprovisionscontainedinYourPolicy. Youagreetodoallthatwouldbereasonablyexpectedtomitigateanyloss.Lossmust beginwhileYourPolicyisinforce.

PART 1-DEFINITIONS

THEFOLLOWINGWORDSHAVESPECIALHEANINGS. THEYAREIHPORTANTINDESCRIBINGYOUR RIGHTSANDOURRIGHTSUNDERTHEPOLICY.REFERBACKTOTHESEMEANINGSASYOUREADYOUR POLICY.

AnyOccupationmeansAnyOccupationforwhichYouarereasonablyfittedbasedoned ucation, training orexperience.

ConcurrentDisabilitymeansaDisabilitythatiscausedbymorethanoneInjuryand/or Sickness.

ContestmeansthatWequestionthevalidityofcoverageunderYourPolicybyletter toYou.ThiscontestiseffectiveonthedateWemailtheletterandrefundthe premiumtoYou.

CPI-UmeanstheConsumerPriceIndexforallUrbanConsumers. Itispublishedbythe UnitedStatesDepartmentofLabor.Ifthisindexisdiscontinuedorifthemethod ofcomputingismateriallychanged,Wemaychooseanotherindex.Wewillchoosean indexthat,inOuropinion,wouldmostaccuratelyreflecttherateofchangeinthe costoflivingintheUnitedStates.CPI-UwillthenmeantheindexWechoose.

CPI-UChangemeanstheresultofacomputationwewillmakeasofeachReviewDate. WewilldividetheCPI-UforthemostrecentIndexMonthbytheCPI-UfortheIndex MonthpriortothemostrecentIndexMonth.

CPI-UFactormeanstheresultoftheCPI-UChangeasofthecurrentReviewDate multipliedbytheCPI-UChangeforeachpriorReviewDateoccurringsincetheDisa bilitybegan.TheCPI-UFactorasofthefirstReviewDatewillequaltheCPI-UChange asofthatReviewDate.TheCPI-UFactorisdeterminedasofeachReviewDatewhile Disabilitycontinues.

DisabilityorDisabledmeansthatYouareTotallyDisabledorResiduallyDisabled. DisabilitymuststartwhilethisPolicyisinforce.ADisabilitybeginswithan EliminationPeriodandhasamaximumbenefitperiodappliedtoit.

EffectiveDatemeansthedatethatthePolicybecomeseffective. Itisshowninthe PolicySchedule.

EliminationPeriodmeansthenumberofdaysthatmustelapseinaDisabilitybefore benefitsbecomepayable.ThenumberofdaysisshowninthePolicySchedule.These daysneednotbeconsecutive;theycanbeaccumulatedduringaDisabilitytosatisfy anEliminationPeriod.Benefitsarenotpayable,nordotheyaccrue,duringan EliminationPeriod.

Hospitalmeansaninstitutionlegallyoperatingasafacilitythat:

ismainlyengagedinprovidingin-patientmedical care fordiagnosisandtreatmentofInjuryorSickness,androutinelymakesachargeforsuchcare;
issupervisedbyastaffofPhysiciansonthepremises;and
providesonthepremises24hournursingservicesbyregisteredgraduatenurses. InnoeventwillHospitalincludeanyinstitution:

1.whichisrunmainlyasarest,nursingorconvalescenthome;

2.inwhichanypartismainlyforthecareoftheaged;or

3.whichisengagedintheschoolingofitspatients.

IndexMonthmeansthecalendarmonthfourmonthspriortothecalendarmonthinwhich aReviewDateoccurs.ThefirstIndexMonthforanyDisabilitywillbethecalendar monthfourmonthspriortothemonththatYourDisabilitybegan.

InjuryorInjuriesmeansaccidentalbodilyinjurythatoccursaftertheEffectiveDate andwhileYourPolicyisinforce.

Insuredisnamed'inthePolicyScheduleandistheownerofthisPolicy.

LossofEarningsforanymonthmeans YourPriorEarningsminusYourMonthly Earnings inthemonthforwhichabenefit isclaimed. Thisdifferencewillbeconsidereda LossofEarningstotheextent itisduetotheInjuryorSicknessthatcausedthe Disability.TheLossofEarningsmustbeatleast20¾ofPriorEarnings.

MaximumBenefitPeriodforMentalDisordersisthelongestperiodoftimeforwhich WewillpaybenefitsforlosscontributedtoorcausedbyMentalDisorders. Itis showninthePolicySchedule

MaximumBenefitPeriodfarResidualDisabilityisthelongestperiodoftimeforwhich WewillpaybenefitsduringaResidualDisability.ItisshowninthePolicySchedule.

MaximumBenefitPeriodforTotalDisabilityisthelongestperiodoftimeforwhich WewillpaybenefitsduringaTotalDisability.ItisshowninthePolicySchedule.

MentalDisordersmeansanydisorder(exceptdementiaresultingfromstroke,trauma, infectionsordegenerativediseasessuchasAlzheimer'sdisease)classifiedinthe DiagnosticandStatisticalManualofMentalDisorders(DSM),publishedbytheAmerican PsychiatricAssociation,mostcurrentasofthestartofaDisability.Suchdisorders include,butarenotlimitedtopsychotic,emotionalorbehavioraldisorders,or disordersrelatabletostressortosubstanceabuseordependency.IftheDSMis discontinuedorreplaced,thesedisorderswillbethoseclassifiedinthediagnostic manualtheninusebytheAmericanPsychiatricAssociationasofthestartofaDis ability.

MonthlyEarningsmeansyoursalary,wages,comissions,bonuses,feesandincome earnedforservicesperformed.Ifyouownanyportionofabusinessorprofession, itmeans:

1.Yourshareofincomeearnedbythatbusinessorprofession;

2.lessYourshareofbusinessexpensesthataredeductibleforFederalincometax purposes;

3.plusyoursalaryandanycontributionstoapensionorprofitsharingplanmade onYourbehalf.

MonthlyEarningsdoesnotinclude:

1.incomefromdeferredcompensationplans,disabilityincomepoliciesorretire mentplans;or

2.incomenotderivedfromYourvocationalactivities.

Wewillalloweitherthecashoraccrualaccountingmethod,butduringaDisability, thesamemethodmustbeusedwhendetermining LossofEarnings.

Physicianmeansapersonwhoislicensedbylaw,andisactingwithinthescopeof thelicense,totreatInjuriesorSicknessthatresultsinaDisability. APhysician cannotbeYouoranyonerelatedtoYoubybloodormarriage,abusinessorprofessional partner,oranypersonwhohasafinancialaffiliationorbusinessinterestwithYou. APhysicianmustbealicensedpsychiatristoralicenseddoctorallevelpsychologist ifaDisabilityisduetoaMentalDisorderthatisclassifiedintheDiagnosticand StatisticalManualofMentalDisorders(DSH),oritssuccessor,publishedbythe AmericanPsychiatricAssociationasofthebeginningofaDisability.

Physician'sCaremeanstheregularandpersonalcareofaPhysicianasfrequentlyas ismedicallyrequiredaccordingtostandardmedicalpractice,andwhich,underpre vailingmedicalstandards,isappropriatefortheconditioncausingtheDisability.

PolicymeansthelegalcontractbetweenYouandUs. Thepolicy,anyapplication(s), thePolicySchedule(s)andanyattachedpapersthatwecallriders,amendments,or endorsementsmakeuptheentirecontractbetweenYouandUs.

Pre-existingConditionmeansasicknessorphysicalconditionforwhichpriortothe EffectiveDate:

1.symptomsexistedthatwouldcauseanordinarilyprudentpersontoseekadvice ortreatmentfromaPhysician;or

2.adviceortreatmentwasrecommendedbyorreceivedfromaPhysician.

Prior EarningsmeansthegreaterofYourMonthlyEarnings:

1.forthe12monthsjustpriortotheDisabilityforwhichclaimismade;or

2.forthefiscalyearwiththehigherearningsofthelasttwofiscalyearsprior totheDisabilityforwhichclaimismade.

StartingasofthefirstReviewDate,MewillmakeaninflationadjustmenttoYour PriorEarnings. MewillmultiplyYourPriorearningsbytheCPI-UFactor. Theresult willbeuseduntilthenextReviewDatetocomputeResidualDisabilityBenefitamounts payable. Theinflationadjustmentincreasewillbeatleast2¾ofYourPriorEarnings

amount.Innoeventwilltheinflationadjustmentincreasebemorethan10¾ofYour PriorEarningsamount.

RecurrentD;sab;1;tymeansaDisabilitythatoccurswithinsixmonthsaftertheend ofapreviousDisabilitythatisduetothesameorrelatedcause.s

ResidualDisabilityorResiduallyDisabledmeansthatYouarenotTotallyDisabled, butduetoInjuryorSickness:

Youareunabletoperformoneormoreofthematerialandsubstantialduties ofYourOccupation;orYouareunabletoperformthemforaslongasnormally requiredtoperformthem;and
YouarereceivingPhysician'sCare. WewillwaivethisrequirementifWere ceivewrittenproofacceptabletoUsthatfurthercarewouldbeofnobenefit toYou.

AftertheendoftheEliminationPeriod,ResidualDisabilityorResiduallyDisabled alsomeans:

YouincuraLossofEarningswhHeYouareengagedinYourOccupationorAny Occupation.

ReviewDatemeanseachanniversaryofthestartofaDisability.

RiderEffectiveDatemeansthedatethattheRiderbecomeseffective. Itisshown inthePolicySchedule.

SicknessmeanssicknessordiseasethatfirstmanifestsitselfaftertheEffective DateandwhileYourPolicyisinforce.ItincludesDisabilityfromsurgeryperformed toimproveYourappearanceorpreventdisfigurementortotransplantpartofYourbody to someoneelse.

TotalDisabilityorTotallyDisabledmeansthatbecauseofInjuriesorSickness:

YouareunabletoperformthematerialandsubstantialdutiesofYourOccupa tion;and
YouarenotengagedinanyotheroccupationforwhichYouarefittedbyeduca tion,trainingandexperience;and
YouarereceivingPhysician'sCare. WewillwaivethisrequirementifWere ceivewrittenproofacceptabletoUsthatfurtherPhysician'sCarewouldbeof nobenefittoYou.

AftertheendoftheYourOccupationPeriod,thenTotalDisabilityalso means:

YouareunabletoperformthematerialandsubstantialdutiesofAnyOccupation.

TotalDisabilityMonthlyAmountisshowninthePolicySchedule.

Me,Our,andUsrefertoTheProvidentLifeandAccidentInsuranceCompanyandits affi1 iates.

MorkIncentivePeriod forResidualDisability isshown inthePolicySchedule.

You,YourandYourselfrefertotheInsurednamedinthePolicySchedule.

YourOccupationmeanstheoccupationoroccupations,asperformedinthenational economy,ratherthanasperformedforaspecificemployerorinaspecificlocation, inwhichYouareregularlyengagedatthetimeYoubecomeDisabled.

YourOccupationPeriodisshowninthePolicySchedule.

PART2-EXCLUSIONS

Exclusions

WewillnotpaybenefitsforaDisability contributedtoorcausedby:

waroractofwar,whetherdeclaredorundeclared;or
thesuspension,revocationorsurrenderofYourprofessionallicensetopractice inYourOccupation;or
normalpregnancyorchildbirthduringthefirst90daysofDisability(Wewill

paybenefitsforlosscausedbycomplicationsofpregnanc.yComplicationsare

physicalconditionsthatphysiciansconsiderdistinctfrompregnancyeven thoughcausedorworsenedbypregnancy.Examplesofconditionsthatarenot complicationsincludefalselaborandmorningsickness.)

Yourcommissionorattempttocommitacrime,orYourbeingengagedinanil legal occupation;or
intentionallyselfinflictedinjuries;or
anylossWehaveexcludedbynameorspecificdescription(anysuchexclusion willappearinthePolicySchedule).

WewillnotpaybenefitsforanyperiodYouareincarcerated duringaDisability.

Wewillnotpaybenefitsformorethan12 monthswhileYouresideoutsidetheUnited StatesorCanada.YouwillbeconsideredtoresideoutsidethesecountrieswhenYou havebeenoutsidetheUnitedStatesorCanadaforatotalperiodof6 monthsormore duringany12 consecutivemonthsduringaDisability.

Pre-existing ConditionsLimitation

WewillnotpaybenefitsforaDisabilitycausedbyaPre-existingConditionthatwas notdisclosed,orthatwasmisrepresented,inanswertoaquestionintheapplication forthisPolicy. APre-existingCondition1)thatwasdisclosedandnotmisrepre sentedintheanswertoaquestionintheapplication,or2)aboutwhichaquestion

wasnotaskedontheapplication,willbecoveredfrmotheEffectiveDateshownon

thePolicySchedul.eTheInsuredisresponsibleforverifyingtheaccuracyofeach

andeverystatementintheapplication.

Page8

PARTJ- PREMIUM ANDREINSTATEMENT

PaymentofPremium

ThefirsttermofthisPolicystartsontheEffectiveDateshowninthePolicy

Schedul.eItendsontheFirstRenewalDate.LatertermsareperiodsforwhichYou

payrenewalpremiums. Alltermswillbeginandendat12:01A.H.,StandardTimeat Yourhome.YoucontinuethePolicyinforcefromtermtotermbypayingpremiumswhen due. Therenewal premiumforeachtermisdueonthedaytheprecedingtermends, subjecttothegraceperiod.

Premiumsmaybepaidannuallyorsemi-annually.IfOurrulespermitit,Youcanpay thepremiumsquarterlyormonthly.WewillallowYoutochangethisbywrittenre quest.But,WewillnotallowachangewhileYouareDisabled.

Grace Period

Afterthefirstpremiumhasbeenpaid,agraceperiodof31daysisallowedforlate paymentofpremium.YourPolicywillremaininforceduringthegraceperiod.

Ifthepremiumisnotpaidwhenitisdueorwithinthegraceperiod,thePolicywill lapse.

Reinstatement

Ifarenewalpremiumisnotpaidbeforethegraceperiodends,thePolicywilllapse. YoumayapplytoreinstatethisPolicywithinsixmonthsfromthedateofthePolicy lapseby:1)completinganapplicationforreinstatementand2)payingthefull amountofoverduepremium.Youwillbegivenaconditionalreceiptforthepremium tendered.IfYourapplicationisapproved,thePolicywillbereinstatedasofthe approvaldate.IfWefailtoactonYourapplication(byapprovingordisapproving it)within45daysfromthedateoftheconditionalr-eceipt,thePolicywillbe reinstatedonthat45thday.

IfWeoroneofOurauthorizedrepresentativesaccepttheoverduepremiumswithout requiringanapplicationforreinstatement,thePolicywillbereinstated.

Ther-einstatedPolicywillcoveronlylossthatresultsfromInjuriesthatoccurafter thedateofreinstatementorSicknessthatoccursmorethan10daysafterthatdate. Inallotherrespects,YourrightsandOurswillremainthesame,subjecttoany provisionsnotedonorattachedtothereinstatedPolicy.

Premium Refund

Wewillmakepro-ratarefundsofpremium:

1.intheeventofYourdeath(suchrefundswillbemadetoYourestateforany premiumpaidforaper-iodbeyondthedateofYourdeath.);

2.ifthePolicyterminatesbecauseYoustopwor-king(exceptbecauseofInjuryor Sickness)whenthisPolicyhasbeenc·ontinuedafterYour65thbirthday,orif later,afterithasbeeninforceforfiveyears;

3.ifYoususpendYourPolicyinaccordancewiththeSuspensionDuringMilitary Serviceprovision;or

4.inaccordancewiththeWaiverofPremiumprovision.

SuspensionDuringH;1;taryServ;ce

IfYouenterfulltime,activedutyinthemilitary(land,sea,orair)serviceof anynationorinternationalauthority,YoumaysuspendthisPolicy.However,Youmay notsuspendthePolicyduringactivemilitarytraininglastingthreemonthsorless. ThePolicywillnotbeinforcewhileitissuspended,andYouwillnothavetopay anypremiums.WhenWereceiveYourwrittenrequesttosuspendthePolicy,Wewill refundthepro-rataportionofanypremiumpaidforaperiodbeyondthedateWereceive Yourrequest.

IfYourfulltimeactivedutyinmilitaryserviceendsbeforeYour65thbirthday,You mayplacethisPolicybackinforcewithoutevidenceofinsurability.Yourcoverage willstartagainwhen:

1.WereceiveYourwrittenrequesttoplacethePolicybackinforce;and

2.Youhavepaidthepro-ratapremiumforcoverageuntilthenextpremiumduedate.

WemustreceiveYourrequestandpremiumpaymentwithin90daysafterthedateYour activedutyserviceinthemilitaryends.Premiumswillbeatthesameratetheywould havebeenhadYourPolicyremainedinforce. ThePolicywillnotcoveranylossdue toInjuriesthatoccurorSicknessthatisfirstmanifestedwhilethePolicyissus pended.Inallotherrespects,YouandWewillhavethesamerightsunderthePolicy asbeforeitwassuspended.

Ma,ver ofPremium

After90daysofDisabilityresultingfromInjuriesorSicknessnotexcludedfrom coverage,Wewill:

1.refundanypremiumsforthisPolicythatweredueandpaidwhileYouwereDis abled;and

2.waivethepaymentofpremiumsthatthereafterbecomedueforaslongasthe Disabilitycontinues,butnotbeyondthemaximumbenefitperiod.

AftertheDisabilityends,orafterthemaximumbenefitperiodends,whichevercomes first,tokeepthisPolicyinforceYoumustresumethepaymentofpremiumsbypaying thepro-ratapremiumuntilthenextpremiumduedate. Thereafterpremiumswillbe dueand payableasprovided inthePolicy.

Forpremiumstobewaived,YoumustprovideUswithsatisfactoryproofofDisability.

PART4-RENEWAL OPTIONIFEMPLOYED

BENEFITSFORTOTALDISABILITY-LINITEDBENEFITPERIOD

Renewal Opt;on

AfterYour65thbirthdayYoumaycontinueYourPolicywhile:

1.Youremainactivelyandregularlyemployedforatleast30hoursperweek;and

2.Thepremiumispaidontime.

WecanrequireproofafterYour65thbirthdaythatYouhavecontinuedtobeactively andregularlyemployedforatleast30hoursperweek.

ThePolicymustbeinforcewhenYouelectthisoption.

TheonlybenefitsthatwillcontinueunderthisoptionareBenefitsforTotalDisa bility. AllotherbenefitsandoptionsinforceonYour65thbirthdaywillendon thatdate,unlessotherwisestatedinYourPolicy.

Maximum Benefit Period for Total Disability

IfYouelectthisoption,WewillpaytheTotalDisabilityMonthlyAmountsubjectto thesameprovisions,exceptionsandlimitationsinthePolicy.

For TotalDisability starting:

AfterYour65thbirthday,butbeforeYour75thbirthday,theHaximumBenefit PeriodforTotalDisabilitywillbe24monthsortheperiodshowninthePolicy Scheduleifless;and
AfterYour75thbirthday,theMaximumBenefitPeriodforTotalDisabilitywill be12months.

Premiumsafter Age65

ThepremiumwillbetheratethenineffectforYourratinggroup.Wecanchangethe premiumratebutonlyifMechangetherateforeveryonewhohasthispolicyformin YourratinggroupinYourstate.Awrittennoticeofanyrateincreaseshallbegiven toYouatleast30daysbeforetherateincreasebecomeseffective.

AnypremiumpaidafterYour65thbirthdayforaperiodnotcoveredbyYourPolicyunder thisoptionwillbereturnedtoYou.

PART5-CLAIMS

TimeofLoss

AlllossesmustoccurwhileYourPolicyisinforce.

MrittenNoticeofClaim

WrittennoticeofclaimmustbegiventoUswithin30daysafterYourDisabilitybe gins. Ifthiscannotbedone,thennoticemustbegivenassoonasreasonablypos sible.

Claim Forms

AfterWereceivethewrittennoticeofclaim,WewillsendYouOurproofoflossforms within15 days. IfWedonot,Youwillmeetthewrittenproofoflossrequirements ifYousendUs,withinthetimesetforthbelow,awrittenstatementofthenature andextentofYourloss.

MrittenProofofLoss

WrittenproofoflossmustbesenttoUswithin90daysaftertheendofeachperiod forwhichYouareclaimingbenefits.Ifthatisnotreasonablypossible,Yourclaim willnotbereducedordeniedforthatreason ifsuchproofisfiledassoonasis reasonablypossible. However,unlessYouarelegallyincapacitated,writtenproof mustbegivenwithinoneyearafterthedateitwasrequired.

WecanrequireanyproofthatWeconsidernecessarytoconsideryourclaim.Thismay includemedicalinformation,personalandbusinesstaxreturnsfiledwiththeInternal RevenueService,financialstatements,accountant'sstatementsorotherproofac ceptabletoUs.Also,WeoranindependentaccountantretainedbyUsshallhavethe righttoexaminethefinancialrecordsofthebusinessandoftheInsuredasoften asWemayreasonablyrequire.

Examinations

AtOurexpense,WecanrequirethatYouundergoamedicalexamination,functional capacityexaminationand/orpsychiatricexamination,includinganyrelatedtestsas arereasonablynecessarytotheperformanceoftheexaminationbyaPhysicianor specialistappropriatefortheconditionatsuchtimeandplaceandasfrequentlyas Wemayreasonablyrequire.Wereservetherighttoselecttheexaminer.Wewillpay fortheexamination,includingthecostsassociatedwithYourtraveltotheexamina tion,iftheexaminationcannotbeconductedlocally.

YoumustmeetwithOurrepresentativeforapersonalintervieworreviewofrecords atsuchtimeandasfrequentlyasWereasonablyrequire.

ResponsibiHtytoObtainAppropriateMedicalCare

Youhavetheresponsibilitytoobtainallreasonablyappropriatemedicalcareand treatmentusingallgenerallyacceptedmedicalproceduresfortheconditionuponwhich theclaimforbenefitsunderthePolicyisbased.Thismedicalcaremustbemedically reasonableforsuchconditionstoanordinarilyprudentperson.

TimeofPaymentOfClaims

AfterWereceivesatisfactory writtenproofofloss,Wewillpaymonthlyallbenefits WeoweYouattheendofeachmonthofDisability. Forperiodslessthanonemonth, Wewill pay1/30thofthebenefitforeachdayofDisability. Thebalanceofany unpaidbenefitswillbepaidpromptlyattheendoftheclaim.

Payment of Cll1ims

AllbenefitswillbepaidtoYou.BenefitsterminateuponYourdeath.Ifanybenefit ispayablebutnotyetpaiduponYourdeath,thenWewillpayYourestate. IfYou arenotcompetenttogive validrelease,Wecanpayupto1,000dollarstooneofYour relativeswhoWebelieveisentitledtoit. IfWedothatingoodfaith,Wewillnot beliabletoanyonefortheamountWepay.

PART 6 - THECONTRACT

Entire Contract; Changes

ThisPolicy(withtheapplicationandattachedpapers)istheentirecontractbetween YouandUs.NochangeinthisPolicywillbeeffectiveuntilapprovedbyaCompany officer. ThisapprovalmustbenotedonorattachedtothisPolicy. Noagentmay changethisPolicyorwaiveanyofitsprovisions.

T;meL;mttOnCerta;nDefenses

Misstatements intheApplication

AftertwoyearsfromtheEffectiveDateofthisPolicy,nomisstatementsoromissions, exceptfraudulentmisstatementsoromissions,madebyYouintheapplicationforthis PolicywillbeusedtovoidorContestthePolicyortodenyaclaimforlossincurred orDisabilitythatstartsaftertheendofsuchtwoyear period.

LimitationonPre-existingConditions

NoclaimforlossincurredorDisabilitythatstartsaftertwoyearsfromtheEffec tiveDateofthisPolicywillbereducedordeniedonthegroundthatasicknessor physicalconditionnotexcludedbynameorspecificdescriptionhadexistedbefore theEffectiveDateofthisPolicy.

Conform;ty WithStateStatutes

AnyprovisionsinthisPolicywhich,onitsEffectiveDate,conflictwiththelaws ofthestateinwhichYouresideonthatdateisamendedtomeetthe minimum re quirements ofsuch laws.

Legal Action

Youcannotbringlegalactionwithin60daysfromthedatewrittenproofoflossis given. Youcannotbringitafter3yearsfromthedatewrittenproofoflossisre quired.

Assignment

WewillnotbeboundbyanassignmentofYourPolicyforanyclaimunlessWereceive awrittenassignmentatOurhomeofficebeforeWepaythebenefitsclaimed.Wewill notberesponsibleforthevalidityofanyassignment. Anabsoluteassignmentisa changeofpolicyownertotheassignee.Acollateralassignmentisnotachangeof thepolicyowner;inthiscasebenefitswillbepaidjointlytothepolicyownerand theassignee.

MisstatementofAge

IfYouragehasbeenmisstated,thebenefitsunderthePolicywillbethosethatthe premiumYoupaidwouldhavepurchasedatYourcorrectage.

PART7-BENEFITS

Benefits for TotalDisability

IfYouareTotallyDisabled,Wewillpaybenefitsasfollows:

1.BenefitsstarttoaccrueonthedayofTotalDisabilityfollowingtheElimi nationPeriod.

2.TheTotalDisabilityMonthlyAmountwillbepaidforaslongasTotalDisability continues,butnotbeyondtheMaximumBenefitPeriodforTotalDisability.

BenefitsforDisabilityResultingfromaMentalDisorder

IfYourDisabilityiscontributedtoorcausedbyaMentalDisorder,Wewillpay benefitsaccordingtotheprovisionsofthisPolicy,exceptaslimitedbytheMaximum BenefitPeriodforHentalDisorders.

If,attheendoftheMaximumBenefitPeriodforHentalDisorders,Youarecontin uouslyconfined,duetoaDisabilityfromHentalDisorders,inaHospitalunderthe careofaPhysician,WewillwaivetheMaximumBenefitPeriodforMentalDisorders forthedurationofYourhospitalconfinementforthisDisability.

Benef1tsfor ResidualDisability

IfYouareResiduallyDisabled,Wewillpaybenefitsasfollows:

1.BenefitsstarttoaccrueonthedayofResidualDisabilityfollowingtheElim inationPeriodorafterYourTotalDisabilityends,iflater.

2.TheResidualDisabilityMonthlyAmountwillbedeterminedeachmonthusingthe followingformulas:

DuringtheWorkIncentivePeriod,thefollowingformulawillbeused: PriorEarnings minus(-)MonthlyEarnings = ResidualDisability

Monthly Amount*

*ResidualDisabilityMonthlyAmountcannotexceedtheTotalDisabilityMonthly Amount.

AftertheWorkIncentivePeriod,thefollowingformulawillbeused:

LossofEarnings Prior Earnings

XTotalDisabilityMonthlyAmount

=ResidualDisabilityMonthlyAmount

IftheLossofEarningsequals75¾orgreaterofPriorEarnings,Wewilldeem thelosstobe100¾ofPriorEarnings.

3.TheResidualDisabilityMonthlyAmountwill.bepaidforaslongasResidual Disabilitycontinues,butnotbeyondtheMaximumBenefitPeriodforResidual Disability.

ResidualDisabilitybenefitswillnotbepaidforanydaysforwhichTotalDisability benefitsarepaid.

RehabilitationBenefit

RehabilitationwillbevoluntaryonYourpartandonOurpart.IfYouandWeagree onaprogramofoccupationalrehabilitationinadvance,Wewillpayfortheprogram assetforthinawrittenagreement. ThegoaloftheprogrammustbetoreturnYou towork.

TheextentofOurrolewillbedeterminedbythewrittenagreement. Generally,We willpaytheexpensesoftheprogramthatarenotalreadycoveredbysomeothersocial orinsuranceprogram. Someoftheservicesthatmightbeprovidedcouldinclude,but arenotlimitedto:

coordinationofphysicalrehabilitationandmedicalservices;
financial and businessplanning;
vocationalevaluationandtransferableskillsanalysis;
careercounselingandretraining;
labormarketsurveysandjobplacementservices;and
.evaluationofnecessaryworksitemodificationsandadaptiveequipment.

WecanperiodicallyreviewtheprogramandYourprogressinit.Wewillcontinueto payfortheprogramaslongasWedeterminethatitishelpingYoureturntoworkin YourOccupationduringYourOccupationPeriodorAnyOccupationthereafter.

AslongasYoucontinuetoqualifyforPolicybenefits,participation intheprogram willnot,ofitself,beconsideredarecoveryfromInjuryorSickness,andbenefits willcontinueasprovidedinthePolicywhileYouareactivelyparticipatinginthe program.

PARTI-RECURRENTDISABILITYANDCONCURRENTDISABILITY

RecurrentDisability

IfaftertheendofaDisabilityYouhaveaRecurrentDisability,itwillbeconsidered tobeacontinuingDisabilityinordertodeterminetheEliminationPeriodandthe maximumbenefitperiodappliedtoit.

ConcurrentDisability

WewillpaybenefitsforaConcurrentDisabilityasifitwascausedbyonlyoneInjury

orSicknes.sWewillnotpayformorethanoneDisabilitybenefitforthesameperiod,

exceptintheeventofaCatastrophicDisability.Wewillalwayspaythe larger benefit.

VOURRIGHTSUNDERTHE

ENPLOVEERETIREMENTINCOMESECURITYACTOF197CERISA>

ProceduresforDisabilityClaimsandAppealsfor

Provident Life and Accident Insurance Company

<"Me"or"Us")

ForclaimsfiledonorafterJanuary1,2002

Ifthecoverageofyourpolicyqualifiesunderanemployeewelfarebenefitplanes tablishedandmaintainedbytheemployerandgovernedbyERISA,ProvidentLifeand AccidentInsuranceCompanywillbetheclaimsadministrator.

HOMTOFILEACLAIM

Ifyouwishtofileaclaimforbenefits,youshouldfollowtheclaimproceduresde scribedinyourindividualinsurancepolicy.Memustreceiveacompletedclaimform. Theformmustbecompletedbyyou,yourattendingphysicianandyouremployer.If youhaveanyquestionsaboutwhattodo,youshouldcontactusdirectly.

CLAIMSPROCEDURES

Mewillgiveyounoticeofthedecisionnolaterthan45daysaftertheclaimisfiled. Thistimeperiodmaybeextendedtwiceby30daysifwebothdeterminethatsuchan extensionisnecessaryduetomattersbeyondthecontrolofthePlanandnotifyyou ofthecircumstancesrequiringtheextensionoftimeandthedatebywhichweexpect torenderadecision.Ifsuchanextensionisnecessaryduetoyourfailuretosubmit theinformationnecessarytodecidetheclaim,thenoticeofextensionwillspecif icallydescribetherequiredinformation,andyouwillbeaffordedatleast45days fromreceiptofthenoticewithinwhichtoprovidethespecifiedinformation.Ifyou delivertherequestedinformationwithinthetimespecified,any30dayextension periodwillbeginafteryouhaveprovidedthatinformation.Ifyoufailtodeliver therequestedinformationwithinthetimespecified,wemaydecideyourclaimwithout thatinformation.

Ifyourclaimforbenefitsiswhollyorpartiallydenied,anynoticeofadverseben efitdeterminationunderthePlanwill

a.statethespecificreason(s)fordetermination;

b.referencespecificPlanprovision(s)onwhichthedeterminationisbased;

c.describeadditionalmaterialorinformationnecessarytocompletetheclaim andwhysuchinformationisnecessar;y

d.describePlanproceduresandtimelimitsforappealingthedetermination, andyourrighttoobtaininformationaboutthoseproceduresandtheright tosueinfederalcourt;and

e.discloseanyinternalrule,guidelines,protocolorsimilarcriterionre liedoninmakingtheadversedetermination(orstatethatsuchinformation willbeprovidedfreeofchargeuponrequest).

Noticeofthedeterminationmaybeprovidedinwrittenorelectronicform. Electronic noticeswillbeprovidedinaformthatcomplieswithanyapplicablelegalrequire ments.

APPEAL PROCEDURES

Youhave180daysfromthereceiptofNoticeofanadversebenefitdeterminationto fileanappeal.Requestsforappealsshouldbesenttotheaddressspecifiedinthe claimdenial.Adecisiononreviewwillbemadenotlaterthan45daysfollowing receiptofthewrittenrequestforreview.Ifwedeterminethatspecialcircumstances requireanextensionoftimeforadecisiononreview,thereviewperiodmaybeex tendedbyanadditional45days(90daysintotal>.lolewillnotifyyouinwriting ifanadditional45dayextensionisneeded.

Ifanextensionisnecessaryduetoyourfailuretosubmittheinformationnecessary todecidetheappeal,thenoticeofextensionwillspecificallydescribetherequired information,andyouwillbeaffordedatleast45daysfromreceiptofthenoticeto providethespecifiedinformation.Ifyoudelivertherequestedinformationwithin thetimespecified,the45dayextensionoftheappealperiodwillbeginafteryou haveprovidedthatinformation.Ifyoufailtodelivertherequestedinformation withinthetimespecified,wemaydecideyourappealwithoutthatinformation.

Youwillhavetheopportunitytosubmitwrittencomments,documents,orotherinfor mationinsupportofyourappeal.Youwillhaveaccesstoallrelevantdocumentsas definedbyapplicableU.S.DepartmentofLaborregulations.Thereviewoftheadverse benefitdeterminationwilltakeintoaccountallnewinformation,whetherornot presentedoravailableattheinitialdetermination.Nodeferencewillbeafforded totheinitialdetermination.

Thereviewwillbeconductedbyusandwillbemadebyapersondifferentfromthe personwhomadetheinitialdeterminationandsuchpersonwillnotbetheoriginal decisionmaker'ssubordinate. Inthecaseofaclaimdeniedonthegroundsofa medicaljudgment,wewillconsultwithahealthprofessionalwithappropriatetraining andexperience.Thehealthcareprofessionalwhoisconsultedonappealwillnotbe theindividualwhowasconsultedduringtheinitialdeterminationorasubordinate. IftheadviceofamedicalorvocationalexpertwasobtainedbythePlaninconnection withthedenialofyourclaim,wewillprovideyouwiththenamesofeachsuchexpert, regardlessofwhethertheadvicewasreliedupon.

Anoticethatyourrequestonappealisdeniedwillcontainthefollowinginformation:

thespecificreason(s)fortheappealdetermination;
areferencetothespecificPlanprovision(s)onwhichthedetermination isbased;
astatementdisclosinganyinternalrule,guidelines,protocolorsimilar criterionreliedoninmakingtheadversedetermination(orastatementthat suchinformationwillbeprovidedfreeofchargeuponrequest);
astatementdescribingyourrighttobringacivilsuitunderfederallaw;
astatementthatyouareentitledtoreceiveuponrequest,andwithout charge,reasonableaccesstoorcopiesofalldocuments,recordsorother informationrelevanttothedetermination;and
astatementthat"Youoryourplanmayhaveothervoluntaryalternative disputeresolutionoptions,suchasmediation.Onewaytofindoutwhat maybeavailableistocontactyourlocalU.S.DepartmentofLaborOffice andyourStateinsuranceregulatoryagency."

Noticeofthedeterminationmaybeprovidedinwrittenorelectronicform.Electronic noticeswillbeprovidedinaformthatcomplieswithanyapplicablelegalrequire ments.

Unlesstherearespecialcircumstances,thisadministrativeappealprocessmustbe completedbeforeyoubeginanylegalactionregardingyourclaim.

LIFETIMECONTINUATIONOPTIONRIDER

ThisriderisapartofYourPolicytowhichitisattached.Thisbenefitissubject tothetermsandconditionsofthisriderandtherestofthePolicy.Allprovisions ofYourPolicyapplytothisriderandremainthesameexceptwhereWechangethem bythisrider.

ThisrideriseffectiveontheEffectiveDateofYourPolicyortheRiderEffective Date, whichever islater.

YourPolicyisamendedbyaddingorchangingthefollowingprovisions:

DEFINITIONS

Benef;tAmountforLongTermCarePolicyisshowninthePolicySchedule.Itisthe benefitamountWewillissuetoYouundertheLongTermCarePolicy,subjecttoYour timelypaymentofpremiumsforYourPolicy.

LifetimeMaximumBenefitAmountforLongTermcarePolicyisshowninthePolicy Schedule.ItisthetotaldollaramountofbenefitsthatwillbepaidundertheLong TermCarePolicy.

LongTermCarePolicymeansanindividuallongtermcarepolicythatissubjectto thefollowingterms:

l.ItwillbeanindividuallongtermcarepolicythatWe,orOuraffiliatesoffer atthetimetheexchangeismadeandwillbeissuedwiththeBenefitAmountfor LongTermCarePolicyandLifetimeMaximumBenefitAmountforLongTermCare Policy;

2.Itwillmeetorexceedallapplicablefederalandstateminimumstandardsin effectforsuchpoliciesatthetimetheexchangeismade;

3.ThepremiumfortheLongTermCarePolicywillbethepremiumWechargeforYour ageandLongTermCareBenefitAmountatthetimetheexchangeismade.

BENEFITS

YoumayexchangeYourPolicyforaLongTermCarePolicywithoutsubmittingevidence ofinsurability:

Betweenage60andage70ifYouarenotDisabled;
Betweenage65andage70ifYouareDisabled,buthavereceivedthemaximum benefitsallowableunderthisPolicy.
OnYourage70.IfYouareDisabledandreceivingbenefitsonthisdate,You

maydefertheexchangeuntilYouhavereceivedthemaximumbenefitamountfor the Disability.

PROVIDENTLIFEANDACCIDENTINSURANCECOMPANY

President and Chief Executive Officer

FIXEDCOSTOFLIVING ADJUSTMENTS

ThisrideriseffectiveontheEffectiveDateofYourPolicyortheRiderEffective Date,whicheverislater.

YourPolicyisamendedbyaddingorchangingthefollowingprovisions:

DEFINITIONS

AdjustedCatastrophicDisabilityBenefitistheCatastrophicDisabilityBenefitshown onpage3withCostofLivingAdjustments.TheAdjustedCatastrophicDisability BenefitwillincreaseeachyearontheReviewDateby3¾oftheAdjustedCatastrophic DisabilityBenefitineffectonthatdate.

AdjustedTotalD1sabilttyl'lonthlyAmountistheTotalDisabilityHonthlyAmountshown onpage3withCostofLivingAdjustments.TheAdjustedTotalDisabilityHonthly AmountwillincreaseeachyearontheReviewDateby3¾oftheAdjustedTotalDisa bilityBenefitineffectonthatdate.

ReviewDatemeanseachanniversaryofthedatethatbenefitsbegintoaccruefora DisabilityaftertheEliminationPeriodhasbeensatisfied.

ReviewPeriodmeansaoneyearperiodendingonaReviewDate.

TotalDisabilityHonthlyAmountisshowninthePolicySchedule. Itcanbeincreased bya"SocialInsuranceSubstitute(SIS)Benefit"ifitisincludedinYourPolicyand whenitisapplicable.

BENEFITS

IfYouareDisabledunderthisPolicyandhavereceivedDisabilitybenefitpayments underthisPolicyfor12months,WewillcomputeCostofLivingAdjustmentsoneach ReviewDate.MonthlybenefitswhichthereafteraccrueduringthatDisabilitywill beadjustedasfollows:

ForanyTotalDisabilityHonthlyAmountthataccruesduringaReviewPeriod, WewillpayinsteadtheAdjustedTotalDisabilityHonthlyAmount.
ForanyCatastrophicDisabilityBenefit(ifincludedinYourPolicy,)thatac cruesduringaReviewPeriod,WewillpayinsteadtheAdjustedCatastrophic DisabilityBenefit.
WewilladjustanyResidualDisabilityHonthlyAmount,GainfulOccupationBen efitorRecoveryBenefit,ifincludedinYourPolicy,whichaccruesduringa ReviewPeriod.Todothis,WewillusetheAdjustedTotalDisabilityMonthly Amountintheformulatodetermineeachbenefitthatistobepaidduringthat ReviewPeriod.ItwillbeusedintheformulainsteadoftheTotalDisability MonthlyAmount.
ComputationsofCostofLivingAdjustmentswillendontheearliestof:

a.theendoftheDisability(seedefinitionofDisability);

b.theendofabenefitperiod;or

c.Your65thbirthday.

IfthecomputationsendbecauseofCa)orCb)above,benefitamountswillrevertto thoseshowninthePolicySchedule.Benefitsdueandpayableforthefirst12months ofanewDisabilityfollowingtheendoftheEliminationPeriodwillnotincludea CostofLivingAdjustment. AnewReviewDatewillapplytoeachnewperiodofDisa bilitywherebenefitsarepayableformorethan12months.

Ifthecomputationsendbecauseof(c)above,benefitswillbepaidattheAdjusted TotalDisabilityAmountandtheAdjustedCatastrophicDisabilityBenefit(ifappli cable)ineffectjustpriortoYour65thbirthday.

QUALIFIEDRIGHTTOINCREASETOTAL DISABILITY HONTHLV AMOUNTTOADJUSTED AMOUNT

YoumayincreasebenefitswhenYoureturntoactiveandgainfulfull-timeworkafter theendofaDisabilityduringwhichCostofLivingAdjustmentsweremade.Youmay increasetotheamountoftheAdjustedTotalDisabilityMonthlyAmount(lessanySIS Benefitifincluded)orAdjustedCatastrophicDisabilityMonthlyAmountwhateverap pliestoYourDisabilitywhichwasusedtodeterminethelastmonthlyclaimpayment, if:

YouhavenotreachedYour60thbirthdayonthedateYouelecttheincrease;and
within90daysaftertheDisabilityends,YoumakeapplicationtoUsonaform whichWewillfurnishYouuponrequest.Onthisform,YoumustconfirmthatYou areactivelyandgainfullyemployedfull-time.Otherevidenceofinsurability willnotberequired.

TheeffectivedateoftheincreasewillbethefirstofthemonthafterWeapprove Yourapplicationfortheincrease. Therequiredadditionalpremiummustbepaid within31daysofthatdate. Laterpremiumsfortheincreasemustbepaidaspart oftherenewalpremiumsforthePolicy.

ThepremiumfortheincreasewillbebasedonYourattainedageatthetimeofthe increase. Itwillalsobebasedonourtableofpremiumratesthenineffect.

TheincreaseinbenefitwillapplytonewDisabilitieswhichstartaftertheeffective dateoftheincrease.

IfYoudonotelectandobtainthisincrease,theTotalDisabilityMonthlyAmountwill reverttotheamountshowninthePolicySchedulefornewDisabilities.

PROVIDENTLIFEANDACCIDENTINSURANCECOHPANV

PresidentandChiefExecutiveOfficer

600-COAL-3TNSAMPLE06-600-9540970Page2

AZ SAMPLE, the Insured Policynumber06-600-950970

Disability IncomePolicy

TABLEOFCONTENTS

POLICY SCHEDULE

------Summary of Premium------

------a-b-l-e-o-f TotalDisabilityBenefits------

ToAge65:BeforeAge61ToAge65

------Residual Disability Benefits------

Work IncentivePeriod

LongTermCarePolicy

------TableofAdditionalBenefits------

FixedCostofLivingAdjustmentOption Rider EffectiveDate:

Exclusions

Pre-existing ConditionsLimitation

PaymentofPremium

Grace Period

Reinstatement

Ma,ver ofPremium

Renewal Opt;on

Maximum Benefit Period for Total Disability

MrittenNoticeofClaim

MrittenProofofLoss

Examinations

ResponsibiHtytoObtainAppropriateMedicalCare

AfterWereceivesatisfactory writtenproofofloss,Wewillpaymonthlyallbenefits WeoweYouattheendofeachmonthofDisability. Forperiodslessthanonemonth, Wewill pay1/30thofthebenefitforeachdayofDisability. Thebalanceofany unpaidbenefitswillbepaidpromptlyattheendoftheclaim.

Conform;ty WithStateStatutes

Legal Action

Assignment

MisstatementofAge

Benefits for TotalDisability

BenefitsforDisabilityResultingfromaMentalDisorder

RehabilitationBenefit

PARTI-RECURRENTDISABILITYANDCONCURRENTDISABILITY

RecurrentDisability

ENPLOVEERETIREMENTINCOMESECURITYACTOF197CERISA>

Provident Life and Accident Insurance Company

ForclaimsfiledonorafterJanuary1,2002

APPEAL PROCEDURES

LIFETIMECONTINUATIONOPTIONRIDER

DEFINITIONS

BENEFITS

PROVIDENTLIFEANDACCIDENTINSURANCECOMPANY

DEFINITIONS

BENEFITS

QUALIFIEDRIGHTTOINCREASETOTAL DISABILITY HONTHLV AMOUNTTOADJUSTED AMOUNT

PROVIDENTLIFEANDACCIDENTINSURANCECOHPANV