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6-1000.6

G-13(A)—Change in Insurance Provider Model Form (Combined Notice)

The credit card account you have with us is insured. This is to notify you that we plan to replace your current coverage with insurance coverage from a different insurer.
If we obtain insurance for your account from a different insurer, you may cancel the insurance. [Your premium rate will increase to $ 
per 
.]
[Your coverage will be affected by the following:
  • The elimination of a type of coverage previously provided to you. [(explanation)] [See 
    of the attached policy for details.]
  • A lowering of the age at which your coverage will terminate or will become more restrictive. [(explanation)] [See 
     of the attached policy or certificate for details.]
  • A decrease in your maximum insurable loan balance, maximum periodic benefit payment, maximum number of payments,or any other decrease in the dollar amount of your coverage or benefits. [(explanation)] [See 
    of the attached policy or certificate for details.]
  • A restriction on the eligibility for benefits for you or others. [(explanation)] [See 
    of the attached policy or certificate for details.]
  • A restriction in the definition of “disability” or other key term of coverage. [(explanation)] [See 
    of the attached policy or certificate for details.]
  • The addition of exclusions or limitations that are broader or other than those under the current coverage. [(explanation)] [See 
     of the attached policy or certificate for details.]
  • An increase in the elimination (waiting) period or a change to nonretroactive coverage. [(explanation)] [See 
    of the attached policy or certificate for details).]
[The name and mailing address of the new insurer providing the coverage for your account is (name and address).]

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