ACCIDENTAL EXPENSE POLICY

Please note that several benefits of this policy require that the treatment or services must be received within 72 hours of the covered injury or accident (e.g., x-ray and emergency medical service benefit, hospital indemnity benefit and ambulance benefit).

LIMITATIONS

THIS IS A LIMITED BENEFIT POLICY. IT DOES NOT PAY ANY BENEFITS FOR LOSS FROM SICKNESS. THIS POLICY PROVIDES RESTRICTIVE COVERAGE FOR CERTAIN LOSSES THAT OCCUR AS A RESULT OF AN ACCIDENT.

Statements Made in Your Application and Time Limit on Certain Defenses

After your policy has been in force for two years (LA, RI, VT-three years) after the issue date, Assurity cannot use your application answers against you unless they are fraudulent. No claim for loss (GA-in the absence of fraud) that starts after two years (LA, RI, VT-three years) from the issue date will be reduced or denied because a physical condition existed before the issue date unless it is limited or was excluded by name or specific description.

Misstatement of Age

If your age was misstated in the application, the policy benefits will be changed to those the premium paid would have provided for the correct age. In MD, if coverage would not have become effective or would have ceased before the acceptance of a premium for the policy, our liability is limited to the refund, on request, of the premiums paid for the period not covered by this policy.

Sprained or Lame Back

Benefits for loss resulting from sprained or lame back or any intervertebral-disk condition as a result of a covered accident will be paid up to the lesser of the maximum benefit or three months.

Work-Related Accidents

Benefits payable in connection with the accidental death, dismemberment or loss of use benefit and/or the loss of time benefit will be reduced 50% (PA-by any amount payable by Workers' Compensation; SD- not applicable) if such covered accident occurred while you were at work for your employer.

Elimination Period

The loss of time benefit (employee only) has a seven-day elimination period before we will pay benefits.

EXCLUSIONS

We will not pay any benefits for loss caused by or resulting from:

•  Sickness, illness or bodily infirmity.

•  War or act of war whether or not declared.

•  Suicide or attempted suicide or intentional self-inflicted injury, whether sane or insane (except in PA).

•  Committing or attempting to commit a felony or an assault (MD-your participation in).

•  Your engaging in an illegal occupation (ID,CT-not applicable).

•  Voluntary inhalation of gas or fumes, or taking of poison or asphyxiation from (CT, ID, IL, OK, PA, SC-not applicable; (VT-unless prescribed by a physician).

•  Travel in or descent from an aircraft, except when you are a fare-paying passenger.

•  Injury sustained while on full-time duty in the armed forces.

•  Hernia or carpal tunnel syndrome, or any complications there from; any of which are within six months after the issue date unless requiring emergency care (CT,ID, MA-not applicable; IL, OK-carpal tunnel syndrome not applicable; NJ-hernia not applicable).

•  Dental treatment due to accidental injury to natural teeth.

•  Injury caused directly or indirectly by (MT- voluntary) intoxication as defined by the laws and jurisdiction of the geographical area in which the loss or cause of the loss was incurred, except in ID, IL, OK and SD (SC-of the state in which this policy was issued).

•  Treatment of mental or nervous disorders (except in DC), defined as any disorder classified as such in the “Diagnostic and Statistical Manual of Mental Disorders” published by the American Psychiatric Association (KS- shall not include conditions not attributable to a mental disorder that are a focus of attention or treatment). In CT, DE, IA, IL, NJ, RI, VT, WV and WI, disorders are defined as including neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder (PA, UT-without demonstrable organic origin; TX-without demonstrable origin; VA-including physiological and psychological dependence on alcohol and drugs).

•  Treatment of alcohol or drug dependence or addiction (except in DC; PA-unless administered on the advice of a physician).

•  Injuries sustained outside the U.S. , except for those that require emergency care in a hospital (ID-not applicable).

•  Injury occurring prior to the date of issue (MD-not applicable).

•  Voluntary ingestion or injection of any drug, narcotic or sedative, unless administered on the advice and taken in such doses as prescribed by a physician (LA-intoxicant instead of drug; CT, ID, OK, PA-not applicable).

•  Injury to an insured person while practicing for or being a part of organized or competitive football (ID, OK, SC-not applicable).

•  Injury to an insured person while practicing for or being a part of organized or competitive rodeo, sky diving, hang gliding, parachuting or scuba diving (ID, OK, SC-not applicable).

•  Driving in any race or speed test or while testing an automobile or vehicle on any racetrack or speedway (ID, OK, SC-not applicable).

•  Except in ID, any bacterial infection (except pyogenic infections which shall occur with and through an accidental cut or wound). In MO, the exception is a bacterial infection which results from the accidental ingestion of contaminated substances or pyogenic infections that result from an accidental bodily injury.

•  In MD, we will not pay any benefits otherwise covered under this policy that are in connection with or resulting from a prohibited referral, defined as a referral by one physician to another physician or entity in which the physician directly or indirectly owns a beneficial interest, in which the physician indirectly owns a beneficial interest of 3% or more, or in which there exists a compensation arrangement. This does not apply if the other practitioner is a member of the same group practice as the referring health care provider.

•  In MN, an injury sustained while operating a motor vehicle under the influence of alcohol as evidenced by a blood alcohol level in excess of the state legal intoxication limit.

•  In CT, loss caused by the voluntary use of any controlled substance as defined in Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, unless as prescribed by the physician for the insured.

RENEWABILITY

This policy is guaranteed renewable (TX-limited guarantee or renewable; MA-guaranteed renewable for life) to age 70. This means as long as you pay premiums when due, we cannot cancel or change your policy until the policy anniversary after your 70 th birthday.

PREMIUMS

We reserve the right to change the premium rates. If we do this, we can only do it to all policies in your class. In LA and NC, we will not increase rates during the first policy year. In LA, thereafter, we will not increase rates more frequently than once in every six-month (MT-12 months) period. We will give you 31 days (MD-40 days; LA, NC- 45 days; GA, WI-60 days) notice if we change premium rates.

TERMINATION

Your coverage will terminate on the earliest of the following:

•  When any premium due is not paid before the end of the grace period

•  When you give us a written request to do so

•  When you establish residence in a foreign country (MA-not applicable)

•  Upon your death

•  When you reach age 70 (MA-not applicable).

Termination of this policy will be without prejudice to any claim arising prior to such termination. We will give you at least 180 days notice before the date coverage will be discontinued. Any extension of benefits beyond the period this policy is in force will end on the earlier of:

•  Payment of the maximum benefits

•  Three months

CANCELLATION BY INSURED (ONLY IN ID, KS, OH and VA)

The insured may cancel this policy at any time by written notice to us. The unearned portion of any premium paid will be refunded.

This policy may not be approved in all states and its provisions vary by state. This description of benefits is intended only to highlight your benefits and should not be relied upon to fully determine coverage. This policy may not cover all your health care expenses. Please refer to your policy for a complete listing of benefits, limitations, exclusions and a description of all the terms and conditions of coverage. If this description conflicts in any way with the terms of the policy, the terms of the policy prevail.

Revised 1/10/06