The nursing home confinement must last for a period of at least 90 days before You are eligible for this benefit. Proof of confinement must be provided and must be accompanied by a Written statement from a licensed Physician that such confinement is medically necessary. This waiver provision applies to partial withdrawals requested no later than 90 days after the last day of confinement in an Eligible Nursing Home. This waiver provision does not apply if You were confined in an Eligible Nursing Home on the Date of Issue. You must be 90 or younger on the Date of Issue and must have entered an Eligible Nursing Home at least 90 days after the Date of Issue.
For the purposes of this Rider, the following definitions apply: Eligible Nursing Home. An institution or special nursing unit of a hospital which satisfies either (1) or (2) below: (1) it is Medicare approved as a provider of skilled nursing care services; or (2) it meets all of the requirements (a through f) below:
NURSING HOME CONFINEMENT WAIVER OF WITHDRAWAL CHARGE WAIVER PROVISION APPLIES AFTER THE FIRST CONTRACT YEAR WAIVER DOES NOT APPLY WITH RESPECT TO THE NURSING HOME CONFINEMENT BENEFIT IF YOU ARE CONFINED ON THE DATE OF ISSUE. IF NOT CONFINED ON THE DATE OF ISSUE, THERE IS NO WAIVER UNTIL AFTER 90 DAYS OF CONFINEMENT.
A Fraternal Benefit Society Since 1892 4254 Saw Mill Run Boulevard, Pittsburgh, PA 15227-3394 412-884-5100 1-800-765-4428 service@gbu.org
After the first contract year, We will waive the withdrawal charge on partial withdrawals upon Your confinement in an Eligible Nursing Home. This provision only applies in contract years 2 and later and is limited to a single partial withdrawal per contract year during each year of eligible confinement in an Eligible Nursing Home.
This Rider becomes a part of the contract to which it is attached. Unless otherwise stated, the provisions of the contract apply.
RIDER
Subject to the conditions described in this provision, We will waive the withdrawal charge on a partial withdrawal in an amount equal to 20% of the Fund Value on the date of withdrawal, if, based upon a Physician’s recommendation, You are confined in an Eligible Nursing Home as a part of a plan of care because it is medically necessary.
(a) it is licensed as a nursing home by the state in which it is located; (b) its main function is to provide skilled, intermediate or custodial nursing care; (c) it is engaged in providing continuous room and board accommodations to three or more persons; (d) it is under the supervision of a registered nurse (RN) or licensed practical nurse (LPN); (e) it maintains a daily medical record of each patient; (f) it maintains control and records for all medications dispensed. Institutions or places which primarily provide residential facilities are not Eligible Nursing Homes.
NHW END 2012
Physician. A person who is legally licensed by the state in which he or she practices medicine and performs surgery as a doctor of medicine (MD) or as a doctor of osteopathy (DO) and who is not the Owner or the Annuitant or the parent, child, sibling or spouse of the Owner or Annuitant. Signed at Our home office on the Date of Issue unless a later date is shown here: William W. Hunt, Chief Executive Officer Lesley B. Mann, Chief Marketing Officer
