Chevron Auto Club - Billing Terms Coverage

Billing Term Coverage

FOR GOLD

Chevron Auto Club Gold Plan membership includes four categories of Accidental Loss of Life Insurance Coverage at affordable group rates! No health questions! No medical examination! See category section below. Full details of coverage limitations and exclusions will be provided with your membership kit. The availability of this offer may change; not available in all states.

Category 1.1:

$6.00 Monthly Dues. Member and covered family enjoy all Auto Club benefits, except the Accidental Loss of Life and Common Carrier Accident insurance coverage, which apply to Member only. Member’s Accidental Loss of Life benefit is $20,000, if the member is under age 75, $10,000 if age 75 through 79, or $5,000 if age 80 or older; Member’s Common Carrier Accident benefit is $50,000.

Category 2.1:

$6.25 Monthly Dues. Member and covered family enjoy all Auto Club benefits, except the Accidental Loss of Life and Common Carrier Accident insurance coverage, which apply to Member and legally married spouse only. Member’s Accidental Loss of Life benefit is $20,000, the same as Category 1.1; Spouse’s benefit is $10,000 if the spouse is under age 75, $5,000 if age 75 through 79, or $2,500 if age 80 or older. The Member’s Common Carrier Accident benefit is $50,000; Spouse’s benefit is $25,000.

Category 3.1:

$6.75 Monthly Dues. Member and covered family enjoy all Auto Club benefits, except the Accidental Loss of Life and Common Carrier Accident insurance coverage, which apply to Member and Covered Children* only. Member’s Accidental Loss of Life is $20,000, the same as Category 1.1; Children’s benefit is $5,000 each. The Member’s Common Carrier Accident benefit is $50,000; Covered Children’s benefit is $10,000 each.

Category 4.1:

$7.25 Monthly Dues. Member and covered family enjoy all Auto Club benefits. Insurance coverage applies to Member, legally married spouse and *Covered Children. Member’s Accidental Loss of Life benefit is $20,000, the same as Category 1.1; Spouse’s benefit is $10,000 the same as Category 2.1; Covered Children’s benefit is $5,000 each. The Member’s Common Carrier Accident benefit is $50,000; Spouse’s benefit is $25,000; Children’s benefit is $10,000 each. Extra Indemnity: If you and your spouse lose your lives in the same accident, this plan pays, in addition to the benefits outlined above, $100 a month to each eligible child until child reaches age 21.

*Covered Children: The Member’s unmarried child (includes stepchild, legally adopted and foster children) who lives at the same permanent address as the Member, who is dependent on the Member for support and who is under age 21 or who is under 23and is a full-time student at an accredited school or college. If, while insured, an injury of a Member or Covered Dependent results in loss of life within 365 days of the date of the accident that caused the injury, the full benefit stated in the applicable membership category will be paid.

Exclusions:

The Group Policy does not cover loss of life caused by or resulting from: A. Intentionally self-inflicted injuries, suicide, self-destruction or any attempt thereat, while sane or insane; B. Declared or undeclared war, or any act thereof; C. Travel or flight in any vehicle or device for: (1) Navigation beyond the earth’s atmosphere, or (2) Aerial navigation, including boarding or alighting therefrom: a. While being used for any test or experimental purpose, or b. While operating, learning to operate or serving as a member of the crew thereof, or c. While being operated by, or for, or under the direction of any military authority except any transport aircraft operated by or for the Air Mobility Command (AMC) of the United States of America or by the similar air transport service of any other country; D. Hernia of any kind, except as a result of an accident; E. Illness, disease, pregnancy, childbirth, miscarriage, or any bacterial infection not occurring in consequence of an accidental cut or wound; being legally intoxicated or under the influence of any narcotic, barbiturate or hallucinatory drug unless administered under the advice of a licensed physician and taken in accordance with the prescribed dosage.

Coverage for the Member will continue as long as dues are paid, until the Group Policy is terminated or the date you are no longer a Chevron Travel Club member, whichever occurs first. Coverage for Covered Dependents will end when your coverage ends or they no longer qualify. Terms and conditions of coverage are set forth in The Group Policy issued by the Life Insurance Company of North America to the Chevron Travel Club (Policy Number GA5144-B, Rev. 1/96). Additional information is contained in the Certificate of Insurance issued to persons enrolling in the plan. The availability of this offer may change. Offered and underwritten by the Life Insurance Company of North America as a service to Chevron Travel Club Gold Members.

FOR PREMIER

Two Premier Plans are available for membership in the Chevron Auto Club. Full Details of coverage limitations and exclusions will be provided with your membership kit. The availability of this offer may change; not available in all states.

Category 1C.1:

$6.75 Monthly Dues. Member and Spouse enjoy all Premier benefits, except the Accidental Loss-of-Life Insurance, which applies to member only. Member’s benefit is $20,000*.

Category 1C.2:

$8.00 Monthly Dues. Member, Spouse and Eligible Children** enjoy all Premier benefits, except the Accidental Loss-of-Life Insurance, which applies to member only. Member’s benefit is $20,000*.

*A member shall have their benefits reduced by 50% upon becoming age 75 and another 50% upon becoming age 80. A member who has attained membership at age 75 or age 80 shall immediately have their benefit reduced to the amount applicable to their attained age.

**Eligible Children:

The Member’s unmarried child (includes stepchild, legally adopted and foster children) who lives at the same permanent address as the Member, who is dependent on the Member for support and who is under age 21 or who is under 23and is a full-time student at an accredited school or college. If, while insured, an injury of a Member or Covered Dependent results in loss of life within 365 days of the date

of the accident that caused the injury, the full benefit stated in the applicable membership category will be paid.

Exclusions:

Coverage for the Member will continue as long as dues are paid, until the Group Policy is terminated or the date you are no longer a Chevron Travel Club SafeTrek Premier member, whichever occurs first. Coverage for Covered Dependents will end when your coverage ends or they no longer qualify. Terms and conditions of coverage are set forth in The Group Policy issued by the Life Insurance Company of North America to the Chevron Travel Club (Policy Number GA5144-B, Rev. 1/02). Additional information is contained in the Certificate of Insurance issued to persons enrolling in the plan. The availability of this offer may change. Offered and underwritten by the Life Insurance Company of North America as a service to Chevron Auto Club Premier Members.