Page 45 - PWH.19 Employee Benefits

Dependent Children (age at death) $1,000
0 days old but less than 14 days $5,000
14 days and older

Dependent Children (age at death) $1,000
0 days old but less than 14 days $10,000
14 days and older

*The Scheduled Benefit is subject to the Proof of Good Health requirements as described in the booklet on GH 111. If,
because of these Proof of Good Health requirements, We approve an amount of insurance that is different than the
Scheduled Benefit, the approved amount will be paid.

For the age(s) shown below, your Dependent spouse’s amount of insurance will be the percentage of the Scheduled
Benefit (or approved amount, if applicable) as shown below.

Age % of Scheduled Benefit
(or approved amount,
whichever applies)

Age 65 but less than age 70 65%
Age 70 and Over 50%

In no event will a Dependent’s Scheduled Benefit be more than 100% of your Scheduled Benefit amount. If you elect a
Dependent Life benefit in excess of 100% of your Scheduled Benefit amount, the Dependent will be given the highest
amount available, not to exceed 100%.

GH 109 (VTL)-1 4