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03/10/99 16:36 FAX PHIL BRETT <br />Q3/93/1999 98:10 4407775618 FORTIS <br />Forts Benefr~s Insurance Company <br />2490 Country Club 6Nd, Suite 33b, North Olmsted, OH 44070 <br />(4.40)777-3170 {titm)472-4678 EP,)c: (440)777-561 H <br />-* LAW DIR ~ 011 <br />PAGE 05 <br /> <br />. ~~~~~ <br />.. <br />~~~ <br />F(~RTIS~' <br />Leta Entrant Waiting Periods will also apply to those employees who were not covered under their <br />employer's prior dent8l plan given that they were hired more then ~3 monttfs prior b the Fortis Benefits dermal <br />plan becoming effectlve_ <br />PROPpSaL coNnrrrONS <br />This proposal is not a contract If there is any conflict between the proposal and the subsequenttl+ [slued group <br />policy, the latter cGnvols_ The rates quotee are based Orr the group's characteristics and beneTits requested at <br />'he t!m® the proposal was requested. Any change in these factors may result in a change of the rates_ <br />This proposes pnriides a generel description aFour oonirtot. State mandated provisions are not shown, but all <br />issued polices comply with eppUcable state law_ <br />To betomv insur+ad, all persons must be actively at work on a full-time basis at ttT61f usual place of business on <br />the proposed effet~ive dato. If they are not actively at work (due t4 disa4iGty, leave of absence. atc.~ on a full- <br />time basis on that dery, the date of coverage will be deferred un61 they return to active work_ <br />vupNam~_ MayHerdYga~ oacvrtwoa+azrnnntiM.~ow <br />