EXHIBIT 10(ch)
GROUP EXCESS BENEFIT PLAN
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POLICY
NUMBER:
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G -
00144
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POLICYHOLDER:
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National
Western Life Insurance Company
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POLICY
EFFECTIVE DATE:
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May 1,
1990
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POLICY
ANNIVERSARY DATES:
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May
1
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STATE OF
DELIVERY:
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TEXAS
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This policy is issued in consideration of the
application of the Policyholder and payment of premiums as provided
in the policy. The Company agrees to pay group insurance
benefits as provided herein with respect to each Insured
Person.
The initial premium is due on the Policy
Effective Date and subsequent premiums shall be due on the same day
of each month thereafter
This policy is
governed by the laws of the state of delivery.
All periods of insurance hereunder shall begin
at 12:01 A.M., Standard Time, at the Policyholder’s normal
place of business. The policy is amended and
restated effective
May 1,
2009 .
The following pages are part of the policy as
fully as if recited over the signatures below.
The Company has
caused this policy to be executed on the Policy Effective
Date.
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/S/J. Mark Flippin
SECRETARY
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/S/G. Richard
Ferdinandtsen
PRESIDENT
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GROUP EXCESS BENEFIT PLAN
CONTENTS
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Section
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Page
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Description
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1.
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3
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Schedule of
Benefits
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II.
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3
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Definitions
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III.
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4
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Premiums
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IV.
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6
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Eligibility and
Effective Date
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V.
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8
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Benefits
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VI.
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9
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Coordination of
Benefits
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VII.
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11
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Payment of
Benefits
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VIII.
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13
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Termination of
Insurance
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IX.
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14
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General
Provisions
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X
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15
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Continuation
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I. SCHEDULE OF BENEFITS
BENEFITS:
100% of all Covered Expenses
MAXIMUM BENEFIT
FOR EACH CLASS OF EMPLOYEES: The Maximum Annual
Benefit for each Benefit Year as specified in the application of
the Policyholder and as approved by the Company.
LIMITATION. This Schedule of
Benefits is subject to all of the provisions contained in this
policy.
II. DEFINITIONS
Benefit
Year : The
twelve month period which:
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Begins on the
Effective Date of this policy, and the same date each calendar year
thereafter; and
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Ends on the day
before that date each calendar year thereafter (herein called the
Anniversary Date).
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Class: A classification of its Employees by
the Policyholder, which is determined by salary, position, length
of service or other conditions of employment. The amount
of Coverage under this Policy will be identical for each covered
Unit of the same class.
Coverage: The Benefits granted by the Company
with respect to each Class. The maximum amount of such
Benefits for each Benefit Year is as specified in the application
of the Policy and as approved by the Company.
Covered
Expenses: Any
bona fide medical or dental expense which is:
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Incurred while
this Policy is in force and while the Insured Person is covered
hereunder; and
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Recognized as a
covered expense in accordance with the provision of Section 213 of
the Internal Revenue Code of 1954, as amended, and of the
Regulations and rulings promulgated thereunder; and
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Not an expense
which is payable under any other Plan, regardless of whether claim
for such payment has been made; and
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Not an expense
due to an injury or illness which is covered by Workers'
Compensation, maritime, or any occupational disease law.
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Covered
expenses include Cosmetic Surgery as any procedure that is directed
at improving the patient's appearance and does not meaningfully
promote the proper function of the body or prevent or treat
illness.
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Covered
expenses also include Well Baby Care nursing or attendant services
for a period of 90 days with a doctor’s recommendation due to
the health of the mother.
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Covered
Unit: An
Insured Employee or an Insured Employee and his
Dependents. The terms "Insured Employee", "Insured
Dependent", and "Insured Person" are used in this Policy to denote
the individuals so covered where applicable.
Plan : Refer to definition provided in
Section VI. Coordination of Benefits
III. PREMIUM
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Premium
Payment Agreement . The amount and manner of payment of
premiums due under this Policy is specified in the Premium Payment
Agreement between the Policyholder and the Company.
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Grace
Period. Unless the Policyholder has given
notice of termination, a grace period of 31 days shall apply during
which coverage under this Policy shall remain in
force. This Policy shall automatically terminate at the
end of the Grace Period if the Policyholder has failed to pay the
full amount of any premium due within the time required by the
Premium Payment Agreement. This provision does not apply
to the initial (advance) premium.
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Limitation
of Liability for Premium . The maximum liability of the
Policyholder for the payment of Reimbursement Premiums, as defined
in the Premium Payment Agreement, for each Benefit Year shall be
equal to 85% of the Aggregate Liability applicable to such year as
provided below.
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Maximum
Annual Aggregate Liability . The Maximum Annual Aggregate
Liability (Aggregate Liability) for each Benefit Year is the sum of
the Maximum Annual Benefits for each Covered Unit which is insured
under this Policy at any time during the Benefit Year.
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Initial
Amount . The
initial amount of the Aggregate Liability is the sum of such
Maximum Annual Benefits specified in the Policyholder's
application, as approved by the Company.
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Increases. A Policyholder may, at any time,
increase the amount of the Aggregate Liability for any Benefit Year
by applying to the Company for the addition of Covered Units or for
an increase in the amount of Coverage applicable to a Class of
Covered Units. The increase in the amount of Aggregate
Liability will take effect upon the Company's approval of a written
notice from the Policyholder which includes the name of the persons
to be added and the amount of coverage for each.
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Decreases. In no event will the amount of the
Aggregate Liability for a Benefit Year be decreased during such
year. Termination of a Covered Unit's coverage will not
operate to decrease the amount of the Aggregate Liability during
that Benefit Year.
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Renewal
Aggregate Liability . A
Policyholder may establish a new Aggregate Liability to take effect
as of the Anniversary date for the next Benefit
Year. The amount of such Aggregate Liability may be more
or less than the amount applicable to the prior year, and will take
effect for the next Benefit Year, provided the Company approves a
written notice from the Policyholder which includes the names of
all persons to be covered and the amounts of coverage for
each. All such applications must be received at the
Company prior to such Anniversary.
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Liability
Not Limited . The limitation of liability for the
payment of Reimbursement Premiums for each Benefit Year shall not
apply with respect to each and every one of the
following:
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The amount of
any Benefits which are not actually paid by the Company during a
Benefit Year, regardless of whether the expenses were incurred
during such year. Any claim for Benefits on which a
completed proof of loss, which does not require any additional
information or follow-up, has been received by the Company and
which has been date stamped at the Home Office of the Company at
least 10 days before the end of a benefit year will be considered
"paid" during such Benefit Year, if subsequently app
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roved by the
Company for payment; and
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The amount of
any medical expense incurred prior to the Effective Date of
coverage; and
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The amount of
any medical expense incurred after the date coverage terminates;
and
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The amount of
any Benefits paid with respect to an Insured Person, if such
payment is made during a Benefit Year in which the person is not
covered under this Policy; and
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The amount by
which the Coverage applicable to an Insured person during the
Benefit Year in which Benefits have been paid is less than the
amount of such person's coverage during the immediately preceding
Benefit Year; and
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The amount of
any and all costs, expenses, and damages, as provided in the
Indemnification Section of the Premium Payment
Agreement.
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IV. ELIGIBILITY
AND EFFECTIVE DATE
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Eligible
Employee. Any person who is:
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a.
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I.
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Chairman of the
Board or his
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$350,000.00
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surviving
Dependents
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II.
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Retired
Chairman of the Board
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$350,000.00
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and his Dependents or surviving
Dependents
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of same (who
has served 7 or more years since 1980)
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III.
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President
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$100,000.00
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IV.
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Retired
President
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(who has served
7 or more years since 1980 and
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was employed on
January 1, 2004)
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$100,000.00
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V.
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Retired
President
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(who has served
7 or more years since 1980 and
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was employed
prior to January 1, 2004)
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$
50,000.00
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VI.
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Executive Vice
President
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$
50,000.00
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VII.
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Senior Vice
Presidents
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$
50,000.00
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VIII.
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Vice
Presidents, hired or promoted
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$
50,000.00
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prior to May
1, 2007
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IX.
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Members of the
Board
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$
50,000.00
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X.
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General
Counsel
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$
50,000.00
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and
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b.
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Covered as an
Insured Person under the Policyholder's Group Health plan named in
the application, or such other Health Plan, which is accepted by
the Company
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A dependent of
an Insured Employee who is covered as an Insured Dependent under
the Policyholder's Group Health Plan or other accepted Health Plan,
as stated above; or
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A child of the
Insured Employee who is incapable of self-support and maintenance
because of mental disability or physical handicap and is chiefly
dependent upon the Insured Employee for support and
maintenance. The Insured Employee must furnish proof of
such incapacity and dependency that is satisfactory to the
Group. Coverage will be continued as long as the child
is incapacitated and dependent, unless otherwise terminated in
accordance with the terms of the Contract.
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Effective
Date. The
insurance of an Employee or an Employee and his Dependent will take
effect as of the date, and for the amount of Coverage, which is
specified in the Application, upon approval by the
Company. In no event may such date be prior to the
beginning date of the current fiscal year.
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Changes. The amount of Coverage may be
increased or decreased with respect to each Class of Covered Units,
and additional Covered Units may become insured at any time during
a Benefit Year, by written notice from the Policyholder, which
includes the name of the persons and the amount of Coverage for
each. Such increases an
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