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Please read this entire Certificate of Coverage carefully, including the SUMMARY OF BENEFITS which contains information specific to your Group. This document, and any attached riders, describes your rights, obligations, and those of Atlantis.

Under the Group Contract, your Employer/Group engages Atlantis to make arrangements through which medical and hospital services will be delivered in accordance with the terms and conditions of the Group Contract and in reliance upon the statements you made in your application for coverage. Atlantis agrees with the Group to provide the Covered Services set forth in the Group contract, as may be amended from time to time by Atlantis, following approval by the New York State Department of Insurance. Please note:

� The Group Contract and any schedules or attachments have been delivered in consideration of the Group�s timely payment of Premiums.

� No services are covered under the Group Contract in the absence of current payment of Premiums, subject to a 30-day Grace Period and the terms and conditions of the Contract.

� No services are covered under the Group contract unless coverage was in force at the time the service was obtained, except in the case of an extension of benefits after termination pursuant to Section XIX of this Certificate of Coverage.

� In some instances a medical procedure may not be covered or may require Pre-authorization. It is your responsibility to understand the terms and conditions in this Certificate of Coverage.

� The Group contract replaces any older Contract issued to your Employer/Group, which provided coverage under the Plan.

� The Group contract is not in lieu of and does not affect any requirements for coverage by Workers� Compensation Insurance.

� The Group contract is guaranteed renewable on the annual contract renewal date.

The laws of the State of New York govern this Certificate of Coverage.

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