Termination Policy

PARTICIPANT INSURANCE

Your insurance stops on the earliest of the following dates:

The date you are no longer eligible for insurance under the Group Policy.
The date the Group Policy stops.
The end of the period for which you paid premiums, if you do not make the next required premium contribution when due.
The date you enter active military service, except active military service for training purposes of one month or less.
For your spouse, the date the employee’s insurance terminates.
For AD&D Insurance, your 65th birthday.
For Accelerated Life Benefit, the date your Life Insurance stops. The Accelerated Life Benefit stops at the beginning of the period in which you are eligible to convert your Life Insurance.

Prudential stops providing a specific benefit to you on the date that benefit is no longer provided under the Group Policy.

DEPENDENT’S INSURANCE

Your dependent’s insurance stops on the earliest of the following dates:

The date the Dependent’s Insurance part of the Group Policy stops.
The date the Group Policy terminates.
The end of the period for which you made your last premium contribution for Dependent’s Insurance if you do not make the next required contribution when due.
The date your insurance stops.
The date your dependent’s insurance is converted under the Conversion Right.
The date your insured dependent is no longer a dependent as defined.
The date your insured dependent enters active military service, except active military service for training purposes of one month or less.

Prudential stops providing a specific benefit under your dependent’s insurance on the date that benefit is no longer provided under the Group Policy.

Disclosures
This coverage is not health insurance coverage (often referred to as “Major Medical Coverage”).

Group Insurance coverages are issued by The Prudential Insurance Company of America, a Prudential Financial company, Newark, NJ. The Booklet-Certificate contains all details, including any policy exclusions, limitations, and restrictions, which may apply. Contract Series: 83500

This policy provides ACCIDENT insurance only. It does NOT provide basic hospital, basic medical, or major medical insurance as defined by the New York State Department of Financial Services.

IMPORTANT NOTICE – THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS.

THIS IS AN EXCEPTED BENEFITS POLICY. IT PROVIDES COVERAGE ONLY FOR THE LIMITED BENEFITS OR SERVICES SPECIFIED IN THE POLICY.

1082833-00001-00