Policy Number:

RS 05 77 05 09

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CURE PERSONAL INJURY PROTECTION COVERAGE (STANDARD PERSONAL AUTO POLICY) – NEW JERSEY
With respect to coverage provided by this endorsement, the provisions of the policy apply unless modified by the endorsement. SCHEDULE I. Principal Personal Injury Protection Coverage Benefits Medical Expenses "Named Insured" and "Family Members"

Limit Of Liability

$ per person per accident However, regardless of the limit shown above, a limit of $250,000 per person per accident is available for a "named insured" or "family member" for "catastrophic injury treatment".

"Insureds" Other Than "Named Insured" and "Fam- $250,000 per person per accident ily Members" Income Continuation Essential Services Death Benefits Income Producer Essential Services Provider Funeral Expenses II. Extended Medical Expense Benefits Coverage Benefits Medical Expenses $100 per week to a maximum of $5,200 $12 per day to a maximum of $4,380 $5,200 less any Income Continuation Benefits paid $4,380 less any Essential Services Benefits paid $1,000

$

Limit Of Liability per person per accident

III.

Medical Expense Benefits Deductible Unless otherwise indicated below or in the Declarations, medical expense benefits are subject to a deductible of $250 per accident. If indicated to the left or in the Declarations, medical expense benefits applicable to: A. The "named insured" and "family members" shall be subject to a deductible of $ Per accident instead of the $250 deductible; and B. "Insureds" other than the "named insured" and "family members" shall be subject to a separate deductible of $250 per accident. Medical Expense Benefits Co-Payment Medical expense benefits are subject to a co-payment of 20% per accident for amounts payable between the applicable deductible and $5,000.

IV.

RS 05