NOT FOR USE IN NEW YORK.

Policy Form No. I H0920 and Rider Form Nos. R I0921, R I0922, R I0923, R I0925, R I0927, R I0928, R I0929, R I0721, R I1601 and R I1602 underwritten by Assurity Life Insurance Company, Lincoln, NE.

Assurity is a marketing name for the mutual holding company Assurity Group, Inc. and its subsidiaries. Those subsidiaries include but are not limited to: Assurity Life Insurance Company and Assurity Life Insurance Company of New York. Insurance products and services are offered by Assurity Life Insurance Company in all states except New York. In New York, insurance products and services are offered by Assurity Life Insurance Company of New York, Albany, NY. Product availability, features and rates may vary by state.

Limitations

Foreign Travel and Residency

Assurity will pay up to a maximum of three disability monthly benefits for any disability sustained or continued outside the United States or Canada.

Mental/Nervous Disorders; Substance Abuse

Assurity will pay up to a maximum of 24 disability monthly benefits during the insured’s lifetime for disabilities due to mental/nervous disorders and substance abuse.

Pre-existing Condition

If the insured’s disability is within two years from the issue date and is due to a pre-existing condition, no benefits will be paid unless the condition was disclosed and not misrepresented on the application and is not excluded by a policy amendment rider.

A pre-existing condition is a sickness or physical condition for which, during the two years before the issue date, the insured:

• had symptoms which would cause an ordinary prudent person to seek diagnosis, care or treatment; or
• received medical consultation, advice or treatment from a physician or had taken prescribed medication.

Exclusions

Assurity will not pay benefits for conditions that are caused by or the result of the insured:

• being pregnant, experiencing childbirth or having an elective abortion (complication of pregnancy is deemed to be a sickness);
• losing an occupational or professional license or certification;
• being exposed to war or any act of war, declared or undeclared;
• engaging in an illegal occupation;
• participating in or attempting to commit a felony;
• intentionally self-inflicting a sickness or injury;
• committing or attempting to commit suicide, while sane or insane;
• being incarcerated or is caused while incarcerated in a penal institution or government detention facility;
• being intoxicated (as determined by the laws governing the operation of motor vehicles in the jurisdiction where the disability occurs) or under the influence of an illegal substance or a narcotic (except for narcotics used as prescribed to the insured by a physician); or
• actively serving in any of the armed forces, or units auxiliary thereto, including the National Guard or Reserves, except during the active duty training of less than 60 days.