Agmt 2004 Hartford Life Insurance Company

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EXCLIISIONS FROM COVERAGE However, persons holding sucdi policies are not protected by this Gverantee Association if: Theo i~urer' was not antborized to do business in this state yvhen it issued the policy or conxract; Their policy was issued by a health care service plan (HMO), Blue Cross, Blue Shield, a charitable' organization, a fraternal benefit society, a mandatary state Pooling Plan, a mutual assessmert company, an ins~uance exchange or a grants and amities society', They are eligibly for protection under the laws of another state. This may o~ when the insolvent insurer yeas incorporated in another state whom gum~sm:ty associationprotec~ insureds who live outside that state. The C3uaraatee Association also does not provide coverage foot: 1:Tnallocated annuity contracts; that is, contracts which are not issued to and awned by an individual and which guarantee rights to group contract holders, not individuals; Employer and association plans, to the extant they, are self-funaied ar unhoslaed; • Synthetic gtrararrteed interest contracts;. • Any policy or portion of a policy yvluc3i is not guaranteed by the insurer or for yvhieh flee individuml has assumed the risk, such as a variable comt[act sold by prospectus; • Any policy of reinsurance, unless an assumption certificate was issra3d; + Merest rate yields that exceed aa. average rate; + Any portion of a contract that provides dividends or experience raring credits. 'LIMI.TS ON AMOIINT OF COVERAGE The Act limits the Association to pay benefits as follows: LIFE AND ANNI7TI'I' BENEFTl'S SO'/o of what the life insurance company would owe under a life policy or aninrity contract up to:. + $100,006 in cash surrendervahres; • $100,000 in p~resa~ value of annuities; or + $250,006 is ]ife instrraace death benefr#s: + A maximum of $250,006 for any o~ insured life ~ matter how many policies and co~aots there were with the same company, even if the policies provided diffeaemt tykes of coverages. HEALTH BEN&FITS + A maxiravm of $'1.00,000 of the contractual obligations that the health insurance company would owe were it not insolvent. The maximum may increase or dea~esse amaaally based upon changes in the health care cost component of flee of+*+~er-price index. PRE14II0M SURCHARGE Member;na~.+rrs are required to n°caup assessments paid to the Association by way of a surcharge on premiums cb0rged for health insurance policies to which the Act aPpiies. A1r13683-2 (Revised 312001) Psintnd is U.S.A W196R2FRM