Coverage You Can Rely On

Transcription

1 Coverage You Can Rely On

2 Plan Highlights Voluntary Group Short Term Disability Insurance COVERAGE Disability income protection insurance provides a benefit for short term disability resulting from a covered injury or sickness. Benefits begin at the end of the elimination period and continue while you are disabled up to the maximum benefit duration. ELIGIBILITY Each Active, Full-time employee working 30 or more hours per week, and earning an annual salary of at least $15,000, except any person working on a temporary or seasonal basis. BENEFIT AMOUNT You may elect a weekly benefit in increments of $25, from a minimum of $100 up to a maximum benefit of $1,250 per week, not to exceed 60% of your covered earnings (rounded to the next lower increment). DAY BENEFITS BEGIN Injury (accident) and Sickness (illness): benefits begin on the 15th consecutive day of disability; or the day following the number of accumulated sick days applicable to the employee. MAXIMUM BENEFIT DURATION Benefits for one period of disability, will be paid up to a maximum of 11 weeks. CONTRIBUTION REQUIREMENTS Coverage is 100% employee paid. RATES See next page. FEATURES Maternity covered as any other illness Non-occupational coverage Partial Disability benefit included Transfer of Coverage provision Zero Day Residual included Definition LIMITATIONS Pre-Existing Condition Limitation 3/12 Please note pre-ex limitations also apply to benefit increases EXCLUSIONS Benefits will not be payable for any disability caused by: an intentionally self-inflicted injury; an act of war (declared or undeclared); commission of a felony; sickness covered by workers compensation or other workers disability law; injury occurring out of or in the course of work for wage or profit. For a comprehensive list of exclusions, limitations, and any applicable benefit offsets, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for coverage and benefits. This Plan Highlights is a brief description of the key features of the RSL insurance plan. The availability of the benefits and features described may vary by state. It is not a certificate of insurance or evidence of coverage. Insurance is provided under group policy form LRS-6451, et al.

3 Weekly Earnings Weekly Benefit Amount Voluntary Group Short Term Disability Insurance Employee Weekly Premiums $288 $100 $1.27 $1.27 $1.36 $1.43 $1.34 $1.45 $1.80 $2.63 $3.09 $3.42 $4.22 $5.61 $288 $125 $1.59 $1.59 $1.70 $1.79 $1.67 $1.82 $2.25 $3.29 $3.87 $4.27 $5.28 $7.01 $288 $150 $1.90 $1.90 $2.04 $2.15 $2.01 $2.18 $2.70 $3.95 $4.64 $5.12 $6.33 $8.41 $292 $175 $2.22 $2.22 $2.38 $2.50 $2.34 $2.54 $3.15 $4.60 $5.41 $5.98 $7.39 $9.81 $333 $200 $2.54 $2.54 $2.72 $2.86 $2.68 $2.91 $3.60 $5.26 $6.18 $6.83 $8.45 $11.22 $375 $225 $2.86 $2.86 $3.06 $3.22 $3.01 $3.27 $4.05 $5.92 $6.96 $7.68 $9.50 $12.62 $417 $250 $3.17 $3.17 $3.40 $3.58 $3.35 $3.63 $4.50 $6.58 $7.73 $8.54 $10.56 $14.02 $458 $275 $3.49 $3.49 $3.74 $3.93 $3.68 $4.00 $4.95 $7.23 $8.50 $9.39 $11.61 $15.42 $500 $300 $3.81 $3.81 $4.08 $4.29 $4.02 $4.36 $5.40 $7.89 $9.28 $10.25 $12.67 $16.82 $542 $325 $4.13 $4.13 $4.43 $4.65 $4.35 $4.73 $5.85 $8.55 $10.05 $11.10 $13.73 $18.23 $583 $350 $4.44 $4.44 $4.77 $5.01 $4.68 $5.09 $6.30 $9.21 $10.82 $11.95 $14.78 $19.63 $625 $375 $4.76 $4.76 $5.11 $5.37 $5.02 $5.45 $6.75 $9.87 $11.60 $12.81 $15.84 $21.03 $667 $400 $5.08 $5.08 $5.45 $5.72 $5.35 $5.82 $7.20 $10.52 $12.37 $13.66 $16.89 $22.43 $708 $425 $5.39 $5.39 $5.79 $6.08 $5.69 $6.18 $7.65 $11.18 $13.14 $14.52 $17.95 $23.83 $750 $450 $5.71 $5.71 $6.13 $6.44 $6.02 $6.54 $8.10 $11.84 $13.92 $15.37 $19.00 $25.23 $792 $475 $6.03 $6.03 $6.47 $6.80 $6.36 $6.91 $8.55 $12.50 $14.69 $16.22 $20.06 $26.64 $833 $500 $6.35 $6.35 $6.81 $7.15 $6.69 $7.27 $9.00 $13.15 $15.46 $17.08 $21.12 $28.04 $875 $525 $6.66 $6.66 $7.15 $7.51 $7.03 $7.63 $9.45 $13.81 $16.23 $17.93 $22.17 $29.44 $917 $550 $6.98 $6.98 $7.49 $7.87 $7.36 $8.00 $9.90 $14.47 $17.01 $18.78 $23.23 $30.84 $958 $575 $7.30 $7.30 $7.83 $8.23 $7.70 $8.36 $10.35 $15.13 $17.78 $19.64 $24.28 $32.24 $1,000 $600 $7.62 $7.62 $8.17 $8.58 $8.03 $8.72 $10.80 $15.78 $18.55 $20.49 $25.34 $33.65 $1,042 $625 $7.93 $7.93 $8.51 $8.94 $8.37 $9.09 $11.25 $16.44 $19.33 $21.35 $26.39 $35.05 $1,083 $650 $8.25 $8.25 $8.85 $9.30 $8.70 $9.45 $11.70 $17.10 $20.10 $22.20 $27.45 $36.45 $1,125 $675 $8.57 $8.57 $9.19 $9.66 $9.03 $9.81 $12.15 $17.76 $20.87 $23.05 $28.51 $37.85 $1,167 $700 $8.88 $8.88 $9.53 $10.02 $9.37 $10.18 $12.60 $18.42 $21.65 $23.91 $29.56 $39.25 $1,208 $725 $9.20 $9.20 $9.87 $10.37 $9.70 $10.54 $13.05 $19.07 $22.42 $24.76 $30.62 $40.66 $1,250 $750 $9.52 $9.52 $10.21 $10.73 $10.04 $10.90 $13.50 $19.73 $23.19 $25.62 $31.67 $42.06 $1,292 $775 $9.84 $9.84 $10.55 $11.09 $10.37 $11.27 $13.95 $20.39 $23.97 $26.47 $32.73 $43.46 $1,333 $800 $10.15 $10.15 $10.89 $11.45 $10.71 $11.63 $14.40 $21.05 $24.74 $27.32 $33.78 $44.86 $1,375 $825 $10.47 $10.47 $11.23 $11.80 $11.04 $11.99 $14.85 $21.70 $25.51 $28.18 $34.84 $46.26 $1,417 $850 $10.79 $10.79 $11.57 $12.16 $11.38 $12.36 $15.30 $22.36 $26.28 $29.03 $35.90 $47.67 $1,458 $875 $11.11 $11.11 $11.91 $12.52 $11.71 $12.72 $15.75 $23.02 $27.06 $29.88 $36.95 $49.07 $1,500 $900 $11.42 $11.42 $12.25 $12.88 $12.05 $13.08 $16.20 $23.68 $27.83 $30.74 $38.01 $50.47 $1,542 $925 $11.74 $11.74 $12.59 $13.23 $12.38 $13.45 $16.65 $24.33 $28.60 $31.59 $39.06 $51.87 $1,583 $950 $12.06 $12.06 $12.93 $13.59 $12.72 $13.81 $17.10 $24.99 $29.38 $32.45 $40.12 $53.27 $1,625 $975 $12.38 $12.38 $13.28 $13.95 $13.05 $14.18 $17.55 $25.65 $30.15 $33.30 $41.18 $54.68 $1,667 $1,000 $12.69 $12.69 $13.62 $14.31 $13.38 $14.54 $18.00 $26.31 $30.92 $34.15 $42.23 $56.08 $1,708 $1,025 $13.01 $13.01 $13.96 $14.67 $13.72 $14.90 $18.45 $26.97 $31.70 $35.01 $43.29 $57.48 $1,750 $1,050 $13.33 $13.33 $14.30 $15.02 $14.05 $15.27 $18.90 $27.62 $32.47 $35.86 $44.34 $58.88 $1,792 $1,075 $13.64 $13.64 $14.64 $15.38 $14.39 $15.63 $19.35 $28.28 $33.24 $36.72 $45.40 $60.28 $1,833 $1,100 $13.96 $13.96 $14.98 $15.74 $14.72 $15.99 $19.80 $28.94 $34.02 $37.57 $46.45 $61.68 $1,875 $1,125 $14.28 $14.28 $15.32 $16.10 $15.06 $16.36 $20.25 $29.60 $34.79 $38.42 $47.51 $63.09 $1,917 $1,150 $14.60 $14.60 $15.66 $16.45 $15.39 $16.72 $20.70 $30.25 $35.56 $39.28 $48.57 $64.49 $1,958 $1,175 $14.91 $14.91 $16.00 $16.81 $15.73 $17.08 $21.15 $30.91 $36.33 $40.13 $49.62 $65.89 $2,000 $1,200 $15.23 $15.23 $16.34 $17.17 $16.06 $17.45 $21.60 $31.57 $37.11 $40.98 $50.68 $67.29 $2,042 $1,225 $15.55 $15.55 $16.68 $17.53 $16.40 $17.81 $22.05 $32.23 $37.88 $41.84 $51.73 $68.69 $2,083 $1,250 $15.87 $15.87 $17.02 $17.88 $16.73 $18.17 $22.50 $32.88 $38.65 $42.69 $52.79 $

4 Plan Highlights Voluntary Group Long Term Disability Insurance COVERAGE Disability income protection insurance provides a benefit for long term disability resulting from a covered injury or sickness. Benefits begin at the end of the elimination period and continue while you are disabled up to the maximum benefit duration. ELIGIBILITY Each Active, Full-time employee working 30 or more hours per week, and earning an annual salary of at least $15,000, except any person working on a temporary or seasonal basis. BENEFIT AMOUNT You may elect a monthly benefit equal to 50% of your covered earnings, up to a maximum benefit of $3,500 per month. ELIMINATION PERIOD 90 consecutive days of total disability MAXIMUM BENEFIT DURATION Benefits will not extend beyond the longer of: Social Security Normal Retirement or Duration of Benefits below: at Disablement 65 or less Duration of Benefits 2 years /4 years /2 years /4 years 69 and older 1 year CONTRIBUTION REQUIREMENTS Coverage is 100% employee paid. RATES See next page. FEATURES Minimum Benefit Payable $50 Own Occupation Coverage 24 months Residual and Partial Disability Specific Indemnity Benefit Survivor Benefit 3 months Work Incentive & Child Care provisions VALUE ADDED SERVICES Travel Assistance Service LIMITATIONS Mental/Nervous Illness Limitation 24 month out-patient Offsets (such as, but not limited to, Social Security, Workers Compensation, State Disability Plans) Pre-Existing Condition Limitation 3/12 Substance Abuse Limitation 24 months Please note- pre-ex limitations also apply to benefit increases EXCLUSIONS Benefits will not be payable for any disability caused by: an intentionally self-inflicted injury; an act of war (declared or undeclared); commission of a felony; injury or sickness occurring while confined in any penal or correctional institution. For a comprehensive list of exclusions, limitations, and any applicable benefit offsets, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for coverage and benefits. This Plan Highlights is a brief description of the key features of the RSL insurance plan. The availability of the benefits and features described may vary by state. It is not a certificate of insurance or evidence of coverage. Insurance is provided under group policy form LRS-6564, et al.

5 Premium Worksheet Voluntary Group Long Term Disability Insurance Scheduled Benefit: Each eligible employee may elect 50% of their monthly earnings, up to $3,500 per month benefit maximum. To calculate your monthly payroll deduction, use the formula indicated below: (Round all numbers to the nearest whole number) 1. Enter your Annual Earnings. 1. $ 2. Divide your annual earnings by 12 (monthly earnings). Average monthly income cannot exceed $7, $ 3. Find your rate from the age table displayed Multiply the amount on Line 2 by the appropriate rate for your age entered on Line $ 5. Divide the amount on Line 4 by 100 and enter the amount on Line 5 to get your monthly payroll deduction. 5. $ 6. Multiply the amount on Line 5 by 12, then Divide by 52 to get your weekly payroll deduction. 6. $ Example Calculation: Jane Smith is Enter your Annual Earnings. 1. $ 50,000 Rate per $100 of covered payroll $ $ $ $ $ $ $ $ $ $ $ Divide your annual earnings by 12 (monthly earnings). Average monthly income cannot exceed $7, $ 4,167 (monthly earnings) 3. Find your rate from the age table displayed (rate for age 35-39) 4. Multiply the amount on Line 2 by the appropriate rate for your age entered on Line Divide the amount on Line 4 by 100 and enter the amount on Line 5 to get your monthly payroll deduction. 6. Multiply the amount on Line 5 by 12, then Divide by 52 to get your weekly payroll deduction. 4. $ $ 14.17(monthly payroll deduction) 6. $ 3.27(weekly payroll deduction)

6 Plan Highlights Voluntary Group Term Life and AD&D Insurance ELIGIBILITY Employees: Each Active, Full-time employee working 30 or more hours per week, except any person working on a temporary or seasonal basis. Dependents: You or your spouse must be insured in order for Dependent children to be covered. Dependents are: Your legal spouse under age 70. Spouse coverage terminates at age 75. Your unmarried financially dependent children* age 14 days to 20 years (to 26 years if full-time student). *natural and adopted children upon finalization of adoption; stepchildren and foster children living with you. limit does not apply to handicapped children. A person may not have coverage as both an Employee and Dependent. Only one insured spouse may cover Dependent children. BENEFIT AMOUNT Employee and Spouse: Choose from a minimum of $10,000 to a maximum of $500,000 (in $10,000 increments) for yourself and/or your spouse. The benefit amounts chosen need not be the same. Eligible Dependent Child(ren): 14 Days to 6 months: $1,000 6 months to 20 years of age (26, if full-time student): choice of $10,000 Choose one benefit amount for all eligible children in family. GUARANTEED ISSUE (Initial Eligibility Period Only) Employee: Under age 60: $100, but under age 70: $100, or older: none Spouse: Under age 60: $20, or older: none GUARANTEED ISSUE is subject to underwriting rules and is not available in all circumstances. FEATURES Living Benefit Rider(expressed as Accelerated Death Benefit in some states and Imminent Death Benefit in PA) Portability Waiver of Premium RATE See next page. CONTRIBUTION REQUIREMENTS Coverage is employee paid. AD&D SCHEDULE For Accidental Loss of: Amount Payable: Life 100% Both hands or both feet 100% Sight of both eyes 100% One hand and one foot 100% One hand and sight of one eye 100% One foot and sight of one eye 100% Speech and hearing 100% One hand or One foot 50% Sight of one eye 50% Speech or Hearing 50% BENEFIT REDUCTION DUE TO AGE (applicable to employee/spouse coverage) At Face Amount Reduces to: % of available or in force amount at age % of available or in force amount at age % of available or in force amount at age % of available or in force amount at age % of available or in force amount at age % of available or in force amount at age 74 EXCLUSIONS Death by suicide is not covered during the first two years an insured s insurance is in force. Insurance coverage is incontestable after it has been in force two years during the insured s lifetime, except for non-payment of premium. AD&D benefits will not be payable for a loss which results from: intentionally self-inflicted injury; any act of war, declared or undeclared; sickness or disease which contributes to a loss (except infection which results from an accidental cut or wound). Additional exclusions may apply and vary by state. For a comprehensive list of exclusions and limitations, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for coverage and benefits. This Plan Highlights is a brief description of the key features of the RSL insurance plan. It is not a certificate of insurance or evidence of coverage. Insurance is provided under group policy form LRS-8349, et al.

7 Voluntary Life Insurance Premium Table Scheduled Benefit: Each eligible employee and spouse may elect an amount of insurance, in increments of $10,000 from a minimum of $10,000 to a maximum of $500,000. Rates are subject to change. Voluntary Life Election Amount < Weekly Premiums Child Rates $10,000 $0.39 $0.37 $0.49 $0.76 $1.24 $1.95 $3.32 $4.06 $6.08 $11.59 $10,000 - $0.43 $20,000 $0.79 $0.74 $0.98 $1.52 $2.47 $3.91 $6.65 $8.11 $12.16 $23.17 $30,000 $1.18 $1.11 $1.47 $2.28 $3.71 $5.86 $9.97 $12.17 $18.24 $34.76 $40,000 $1.58 $1.49 $1.96 $3.04 $4.95 $7.82 $13.29 $16.23 $24.32 $46.35 $50,000 $1.97 $1.86 $2.45 $3.80 $6.18 $9.77 $16.62 $20.28 $30.40 $57.93 $60,000 $2.37 $2.23 $2.94 $4.56 $7.42 $11.73 $19.94 $24.34 $36.48 $69.52 $70,000 $2.76 $2.60 $3.42 $5.31 $8.66 $13.68 $23.26 $28.40 $42.57 $81.11 $80,000 $3.16 $2.97 $3.91 $6.07 $9.90 $15.64 $26.58 $32.46 $48.65 $92.70 $90,000 $3.55 $3.34 $4.40 $6.83 $11.13 $17.59 $29.91 $36.51 $54.73 $ $100,000 $3.95 $3.72 $4.89 $7.59 $12.37 $19.55 $33.23 $40.57 $60.81 $ $110,000 $4.34 $4.09 $5.38 $8.35 $13.61 $21.50 $36.55 $44.63 $66.89 $ $120,000 $4.74 $4.46 $5.87 $9.11 $14.84 $23.46 $39.88 $48.68 $72.97 $ $130,000 $5.13 $4.83 $6.36 $9.87 $16.08 $25.41 $43.20 $52.74 $79.05 $ $140,000 $5.52 $5.20 $6.85 $10.63 $17.32 $27.36 $46.52 $56.80 $85.13 $ $150,000 $5.92 $5.57 $7.34 $11.39 $18.55 $29.32 $49.85 $60.85 $91.21 $ $160,000 $6.31 $5.94 $7.83 $12.15 $19.79 $31.27 $53.17 $64.91 $97.29 $ $170,000 $6.71 $6.32 $8.32 $12.91 $21.03 $33.23 $56.49 $68.97 $ $ $180,000 $7.10 $6.69 $8.81 $13.67 $22.26 $35.18 $59.82 $73.02 $ $ $190,000 $7.50 $7.06 $9.30 $14.43 $23.50 $37.14 $63.14 $77.08 $ $ $200,000 $7.89 $7.43 $9.78 $15.18 $24.74 $39.09 $66.46 $81.14 $ $ $210,000 $8.29 $7.80 $10.27 $15.94 $25.98 $41.05 $69.78 $85.20 $ $ $220,000 $8.68 $8.17 $10.76 $16.70 $27.21 $43.00 $73.11 $89.25 $ $ $230,000 $9.08 $8.55 $11.25 $17.46 $28.45 $44.96 $76.43 $93.31 $ $ $240,000 $9.47 $8.92 $11.74 $18.22 $29.69 $46.91 $79.75 $97.37 $ $ $250,000 $9.87 $9.29 $12.23 $18.98 $30.92 $48.87 $83.08 $ $ $ $260,000 $10.26 $9.66 $12.72 $19.74 $32.16 $50.82 $86.40 $ $ $ $270,000 $10.65 $10.03 $13.21 $20.50 $33.40 $52.77 $89.72 $ $ $ $280,000 $11.05 $10.40 $13.70 $21.26 $34.63 $54.73 $93.05 $ $ $ $290,000 $11.44 $10.77 $14.19 $22.02 $35.87 $56.68 $96.37 $ $ $ $300,000 $11.84 $11.15 $14.68 $22.78 $37.11 $58.64 $99.69 $ $ $ $310,000 $12.23 $11.52 $15.17 $23.54 $38.34 $60.59 $ $ $ $ $320,000 $12.63 $11.89 $15.66 $24.30 $39.58 $62.55 $ $ $ $ $330,000 $13.02 $12.26 $16.14 $25.05 $40.82 $64.50 $ $ $ $ $340,000 $13.42 $12.63 $16.63 $25.81 $42.06 $66.46 $ $ $ $ $350,000 $13.81 $13.00 $17.12 $26.57 $43.29 $68.41 $ $ $ $ $360,000 $14.21 $13.38 $17.61 $27.33 $44.53 $70.37 $ $ $ $ $370,000 $14.60 $13.75 $18.10 $28.09 $45.77 $72.32 $ $ $ $ $380,000 $15.00 $14.12 $18.59 $28.85 $47.00 $74.28 $ $ $ $ $390,000 $15.39 $14.49 $19.08 $29.61 $48.24 $76.23 $ $ $ $ $400,000 $15.78 $14.86 $19.57 $30.37 $49.48 $78.18 $ $ $ $ $410,000 $16.18 $15.23 $20.06 $31.13 $50.71 $80.14 $ $ $ $ $420,000 $16.57 $15.60 $20.55 $31.89 $51.95 $82.09 $ $ $ $ $430,000 $16.97 $15.98 $21.04 $32.65 $53.19 $84.05 $ $ $ $ $440,000 $17.36 $16.35 $21.53 $33.41 $54.42 $86.00 $ $ $ $ $450,000 $17.76 $16.72 $22.02 $34.17 $55.66 $87.96 $ $ $ $ $460,000 $18.15 $17.09 $22.50 $34.92 $56.90 $89.91 $ $ $ $ $470,000 $18.55 $17.46 $22.99 $35.68 $58.14 $91.87 $ $ $ $ $480,000 $18.94 $17.83 $23.48 $36.44 $59.37 $93.82 $ $ $ $ $490,000 $19.34 $18.21 $23.97 $37.20 $60.61 $95.78 $ $ $ $ $500,000 $19.73 $18.58 $24.46 $37.96 $61.85 $97.73 $ $ $ $579.35

8 Plan Highlights Voluntary Group Critical Illness Insurance COVERAGE Voluntary critical illness insurance provides a fixed, lumpsum benefit upon diagnosis of a critical illness, which can include heart attack, stroke, paralysis and more. These benefits are paid directly to the insured and may be used for any reason, from deductibles and prescriptions to transportation and child care. ELIGIBILITY Employees: Each Active, Full-time employee working 30 or more hours per week,except any person working on a temporary or seasonal basis. Dependents: You must be insured for Dependents to be covered. Dependents are: Your legal spouse. Spouse must be under age 70 at date of application. Coverage terminates at age 75. Your dependent children* from age 14 days to 26 years. *natural, legally adopted, children dependent on Insured during waiting period before adoption, stepchildren, and foster children in Insured s custody limit does not apply to handicapped children. A person may not have coverage as both an Employee and Dependent. BENEFIT AMOUNT Employee: Choose from a minimum of $5,000 to a maximum of $50,000 in $1,000 increments. Spouse: Choose from a minimum of $5,000 to a maximum of $50,000 in $1,000 increments, not to exceed 100% of approved employee amount. Dependent child(ren): 25% of approved employee amount up to a maximum of $12,500 GUARANTEED ISSUE Employee: $10,000 Spouse: $10,000 Child: all child amounts are guaranteed issue BENEFIT REDUCTION DUE TO AGE (applicable to employee/spouse coverage) Original Benefit Reduced To 70 50% LIMITATIONS Pre-ex Condition Limitation 12/12 Benefit Waiting Period 30 Days Please note benefit waiting periods and pre-ex limitations also apply to benefit increases CONTRIBUTION REQUIREMENTS Coverage is 100% employee paid. RATES See next page. FEATURES Basic 100% of Insurance Amount for: Life Threatening Cancer, Heart Attack, Stroke, Kidney (Renal) Failure, Major Organ Transplant Partial 25% of Insurance Amount for: Coronary Artery Bypass or Cancer in Situ Lifetime Maximum Benefit per Category 200% of Insurance Amount Subsequent Occurrence Benefit (Different Category of Critical Illness diagnosed 6 months or later) 100% if Basic; 25% if Partial Recurrence Benefit-(Same Category of Critical Illness diagnosed 18 months or later)- 50% if Basic; 12.5% if Partial FMLA / MSLA Continuation Portability to employee age 70 Wellness (Health Screening) Benefit- $50 CRITICAL ILLNESS CATEGORIES Category 1 Life Threatening Cancer 100% Cancer in Situ 25% Category 3 Kidney (Renal) Failure 100% Major Organ transplant 100% Category 2 Coronary Artery Bypass 25% Heart Attack 100% Stroke 100% EXCLUSIONS A benefit will not be paid if the Critical Illness is caused by or contributed to by one of the following: an act of war, declared or undeclared; intentionally selfinflicted Injury; commission or attempted commission of a felony; the use of alcohol or drugs unless taken as prescribed by a Physician; a Sickness or Injury that occurs while confined in a penal or correctional institution; cosmetic or elective surgery that is not medically necessary; committing or attempting to commit suicide while sane or insane; participation in a riot or insurrection; a Critical Illness Diagnosed outside of the US unless confirmed within the US; *for a Critical Illness which is Diagnosed before or during the Benefit Waiting Period; or a Heart Attack that occurs within 24 hours of a medical procedure. * A Pre-existing Condition unless the Critical Illness has been Diagnosed after a specific period after the Insured s or Insured Dependent s effective date of coverage. For a comprehensive list of exclusions and limitations, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for benefits. This Plan Highlights is a brief description of the key features of the RSL insurance plan. The availability of the benefits and features described may vary by state. It is not a certificate of insurance or evidence of coverage. Insurance is provided under group policy form LRS , et al.

9 Critical Illness Insurance Premium Table Scheduled Benefit: Each eligible employee may elect for himself and/or his eligible spouse an amount of insurance shown in the table below. Employee/Spouse Premiums: To find you and your spouse s premium Determine your age band: Your age = your age at your last birthday. Spouse age = spouse age. For employees age 70 or older, benefit amounts are reduced according to the age-based reduction chart shown in the Plan Highlights. When selecting an amount of insurance, you must select at pre-age 70 benefit amount. Select an employee and spouse benefit from the table below. Employee and spouse rates change as insured moves from one age bracket to the next, based on the age determination rules. Please note: these rates are approximate and subject to change. Benefit Amount WEEKLY RATES $5,000 $0.52 $0.84 $1.08 $1.75 $3.02 $4.75 $6.55 $9.37 $13.43 $17.25 $23.33 $29.05 $40.27 $6,000 $0.62 $1.01 $1.30 $2.10 $3.63 $5.70 $7.86 $11.24 $16.12 $20.70 $28.00 $34.86 $48.32 $7,000 $0.73 $1.18 $1.52 $2.46 $4.23 $6.66 $9.18 $13.12 $18.80 $24.15 $32.66 $40.68 $56.38 $8,000 $0.83 $1.35 $1.74 $2.81 $4.84 $7.61 $10.49 $14.99 $21.49 $27.60 $37.33 $46.49 $64.43 $9,000 $0.93 $1.52 $1.95 $3.16 $5.44 $8.56 $11.80 $16.86 $24.18 $31.05 $42.00 $52.30 $72.48 $10,000 $1.04 $1.68 $2.17 $3.51 $6.05 $9.51 $13.11 $18.74 $26.86 $34.50 $46.66 $58.11 $80.54 $11,000 $1.14 $1.85 $2.39 $3.86 $6.65 $10.46 $14.42 $20.61 $29.55 $37.95 $51.33 $63.92 $88.59 $12,000 $1.25 $2.02 $2.60 $4.21 $7.26 $11.41 $15.73 $22.49 $32.23 $41.40 $55.99 $69.73 $96.65 $13,000 $1.35 $2.19 $2.82 $4.56 $7.86 $12.36 $17.04 $24.36 $34.92 $44.85 $60.66 $75.54 $ $14,000 $1.45 $2.36 $3.04 $4.91 $8.46 $13.31 $18.35 $26.23 $37.61 $48.30 $65.33 $81.35 $ $15,000 $1.56 $2.53 $3.25 $5.26 $9.07 $14.26 $19.66 $28.11 $40.29 $51.75 $69.99 $87.16 $ $16,000 $1.66 $2.70 $3.47 $5.61 $9.67 $15.21 $20.97 $29.98 $42.98 $55.20 $74.66 $92.97 $ $17,000 $1.77 $2.86 $3.69 $5.96 $10.28 $16.16 $22.28 $31.86 $45.66 $58.65 $79.32 $98.78 $ $18,000 $1.87 $3.03 $3.90 $6.31 $10.88 $17.11 $23.59 $33.73 $48.35 $62.10 $83.99 $ $ $19,000 $1.97 $3.20 $4.12 $6.66 $11.49 $18.06 $24.90 $35.60 $51.04 $65.55 $88.66 $ $ $20,000 $2.08 $3.37 $4.34 $7.02 $12.09 $19.02 $26.22 $37.48 $53.72 $69.00 $93.32 $ $ $21,000 $2.18 $3.54 $4.56 $7.37 $12.70 $19.97 $27.53 $39.35 $56.41 $72.45 $97.99 $ $ $22,000 $2.28 $3.71 $4.77 $7.72 $13.30 $20.92 $28.84 $41.22 $59.10 $75.90 $ $ $ $23,000 $2.39 $3.87 $4.99 $8.07 $13.91 $21.87 $30.15 $43.10 $61.78 $79.35 $ $ $ $24,000 $2.49 $4.04 $5.21 $8.42 $14.51 $22.82 $31.46 $44.97 $64.47 $82.80 $ $ $ $25,000 $2.60 $4.21 $5.42 $8.77 $15.12 $23.77 $32.77 $46.85 $67.15 $86.25 $ $ $ $26,000 $2.70 $4.38 $5.64 $9.12 $15.72 $24.72 $34.08 $48.72 $69.84 $89.70 $ $ $ $27,000 $2.80 $4.55 $5.86 $9.47 $16.32 $25.67 $35.39 $50.59 $72.53 $93.15 $ $ $ $28,000 $2.91 $4.72 $6.07 $9.82 $16.93 $26.62 $36.70 $52.47 $75.21 $96.60 $ $ $ $29,000 $3.01 $4.89 $6.29 $10.17 $17.53 $27.57 $38.01 $54.34 $77.90 $ $ $ $ $30,000 $3.12 $5.05 $6.51 $10.52 $18.14 $28.52 $39.32 $56.22 $80.58 $ $ $ $ $31,000 $3.22 $5.22 $6.72 $10.87 $18.74 $29.47 $40.63 $58.09 $83.27 $ $ $ $ $32,000 $3.32 $5.39 $6.94 $11.22 $19.35 $30.42 $41.94 $59.96 $85.96 $ $ $ $ $33,000 $3.43 $5.56 $7.16 $11.58 $19.95 $31.38 $43.26 $61.84 $88.64 $ $ $ $ $34,000 $3.53 $5.73 $7.38 $11.93 $20.56 $32.33 $44.57 $63.71 $91.33 $ $ $ $ $35,000 $3.63 $5.90 $7.59 $12.28 $21.16 $33.28 $45.88 $65.58 $94.02 $ $ $ $ $36,000 $3.74 $6.06 $7.81 $12.63 $21.77 $34.23 $47.19 $67.46 $96.70 $ $ $ $ $37,000 $3.84 $6.23 $8.03 $12.98 $22.37 $35.18 $48.50 $69.33 $99.39 $ $ $ $ $38,000 $3.95 $6.40 $8.24 $13.33 $22.98 $36.13 $49.81 $71.21 $ $ $ $ $ $39,000 $4.05 $6.57 $8.46 $13.68 $23.58 $37.08 $51.12 $73.08 $ $ $ $ $ $40,000 $4.15 $6.74 $8.68 $14.03 $24.18 $38.03 $52.43 $74.95 $ $ $ $ $ $41,000 $4.26 $6.91 $8.89 $14.38 $24.79 $38.98 $53.74 $76.83 $ $ $ $ $ $42,000 $4.36 $7.08 $9.11 $14.73 $25.39 $39.93 $55.05 $78.70 $ $ $ $ $ $43,000 $4.47 $7.24 $9.33 $15.08 $26.00 $40.88 $56.36 $80.58 $ $ $ $ $ $44,000 $4.57 $7.41 $9.54 $15.43 $26.60 $41.83 $57.67 $82.45 $ $ $ $ $ $45,000 $4.67 $7.58 $9.76 $15.78 $27.21 $42.78 $58.98 $84.32 $ $ $ $ $ $46,000 $4.78 $7.75 $9.98 $16.14 $27.81 $43.74 $60.30 $86.20 $ $ $ $ $ $47,000 $4.88 $7.92 $10.20 $16.49 $28.42 $44.69 $61.61 $88.07 $ $ $ $ $ $48,000 $4.98 $8.09 $10.41 $16.84 $29.02 $45.64 $62.92 $89.94 $ $ $ $ $ $49,000 $5.09 $8.25 $10.63 $17.19 $29.63 $46.59 $64.23 $91.82 $ $ $ $ $ $50,000 $5.19 $8.42 $10.85 $17.54 $30.23 $47.54 $65.54 $93.69 $ $ $ $ $ Dependent Child(ren): Your dependent child(ren) is eligible for a benefit amount of 25% of your Critical Illness benefit election, limited to a maximum of $12,500. To calculate Dependent Child(ren) Benefit: Employee Benefit Amount x 25% = Dependent Child(ren) Benefit. No rounding needed. To calculate Dependent Child(ren) Premium: Dependent Child(ren) Benefit/1000 x Please Note: One rate and benefit amount for all eligible children in family, regardless of number. 85+

10 Plan Highlights Voluntary Group Accident Insurance COVERAGE Voluntary accident insurance provides a range of fixed, lump-sum benefits for injuries resulting from a covered accident, or for accidental death and dismemberment (if included). These benefits are paid directly to the insured and may be used for any reason, from deductibles and prescriptions to transportation and child care. ELIGIBILITY Employees: Each Active Full-Time Employee working 30 or more hours per week, except any person working on a temporary or seasonal basis. Employee must be under age 70 at date of application. Dependents: You must be insured in order for Dependents to be covered. Dependents are: Your legal spouse. Spouse must be under age 70 at date of application. Your dependent children* from live birth to 26 years. * natural, legally adopted, children dependent on Insured during waiting period before adoption, stepchildren, and foster children in your custody BENEFIT AMOUNT See Full Schedule of Benefits on next page. CONTRIBUTION REQUIREMENTS Coverage is 100% employee paid. RATES See below. FEATURES Portability to employee age 70 FMLA/MSLA Continuation EXCLUSIONS Benefits will not be paid for any loss caused by: sickness; suicide; war; air travel (except as a passenger on commercial flights); assault/felony; acute or chronic intoxication; voluntary consumption of illegal or controlled substance or prescribed narcotic or drug; or injuries arising out of or in the course of employment for wage or profit For a comprehensive list of exclusions and limitations, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for benefits. This Plan Highlights is a brief description of the key features of the RSL insurance plan. The availability of the benefits and features described may vary by state. It is not a certificate of insurance or evidence of coverage. Insurance is provided under group policy form LRS ,et al. accident Insurance Premium Table Scheduled Benefit: Each eligible employee may elect a Plan Type and Coverage Option from the table below. Plan Type: Choose from the options below, refer to your plan highlight sheet for plan details Coverage Options: Employee Only, Employee and Spouse, Employee and Child(ren), or Employee & Family (which includes both spouse and child(ren) Plan Type Employee Weekly Premiums Employee & Spouse Employee & Child(ren) Employee & Family Plan A $2.71 $4.42 $6.66 $8.39 Plan B $3.74 $6.16 $9.37 $11.82

11 Voluntary Group accident Insurance SCHEDULE OF BENEFITS Plan A Emergency Care Benefits Plan B Ambulance Transportation $100 Ground, $500 Air $150 Ground, $750 Air Emergency Treatment $150 $200 Diagnostic Examination (once per covered accident) Initial Physician Office Visit (once per covered accident) Initial Hospital Admission (once per covered accident) $100 $200 $50 $75 General Treatment Benefits $500 $1,000 InitialI CU Hospital Admission $1,000 $1,500 Hospital Confinement per day $200, 365 days max $250, 365 days max ICU Confinement per day $400, 30 days max $500, 30 days max Rehabilitation Facility Confinement $50/day, 30 days max $100/day, 30 days max Follow-up Physician Office Visit (once per covered accident) Transportation (more than 100 miles, 3 roundtrips max) Lodging (for 1 person, more than 100 miles from residence) Paralysis Benefits SurgeryBenefits $50 $75 $300 $450 $100/30 days max $150/30 days max Paralysis Benefits $10,000 quadriplegia; $5,000 paraplegia/hemiplegia Surgery Benefits $100 for Exploratory no repair; $300 for Knee Cartilage $1,000 for Abdominal or Thoracic;$500 for Ruptured Disc; Up to $600 Tendon, Ligament, or Rotator Cuff Transitional Benefits $15,000 quadriplegia; $7,500 paraplegia/hemiplegia $150 for Exploratory no repair; $450 for Knee Cartilage; $1,500 for Abdominal or Thoracic; $750 for Ruptured Disc; Up to $900 Tendon, Ligament, or Rotator Cuff Medical Appliance $100 $150 Prothesis $1,000 for two or more, $500 for one $1,500 for two or more, $750 for one Physical Therapy $25 per session, up to 6 sessions $35 per session, up to 6 sessions Fractures Dislocations Specific Covered Injury & Treatment Benefits Up to $5,000 for certain surgical repair; Up to $2,500 for non-surgical; Chip:25% of nonsurgical full fracture benefit; Multiple:100% of highest sustained fracture Up to $3,200 for surgical; Up to $1,600 for non-surgical; Partial- 25% of non -surgical full dislocation; Multiple -100% of highest dislocation benefit Up to $7,500 for certain surgical repair; Up to $3,750 for non-surgical; Chip:25% of nonsurgical full fracture benefit; Multiple:100% of highest sustained fracture Up to $4,800 for surgical; Up to $2,400 for non-surgical; Partial- 25% of non-surgical full dislocation; Multiple-100% of highest dislocation benefit Blood/Plasma/Platelets $200 $300 Burns Up to $800 for 2nd degree burns; Up to $6400 for 3rd degree burns; Skin Graft- 25% of benefit payable for Burns Up to $1,600 for 2nd degree burns; Up to $12,800 for 3rd degree burns; Skin Graft- 25% of benefit payable for Burns Coma $5,000 $7,500 Concussion $100 $150 Dental Injury $150 for Crown; $50 for Extraction $300 for Crown; $75 for Extraction Eye Injury $100 for removal of foreign object; $200 for surgical repair $150 for removal of foreign object; $300 for surgical repair Lacerations Up to $400 Up to $600

12 Plan Highlights Voluntary Dental Plan Plan 1: Dental Plan Summary Coinsurance Type 1 100% Type 2 80% Type 3 50% Deductible $50/Calendar Year Type 2 & 3 Waived Type 1 3 Family Maximum Maximum (per person) $1,000 per calendar year Allowance 90th U&C Waiting Period None Sample Procedure Listing (Current Dental Terminology American Dental Association) Type 1 Routine Exam (1 in 6 months) Bitewing X-rays (1 in 12 months) Full Mouth/Panoramic X-rays (1 in 5 years) Periapical X-rays Cleaning (1 in 6 months) Fluoride for Children 13 and under (1 in 12 months) Sealants (age 13 and under) Space Maintainers Type 2 Restorative Amalgams Restorative Composites Denture Repair Simple Extractions Type 3 Onlays Crowns (1 in 10 years per tooth) Crown Repair Endodontics (nonsurgical) Endodontics (surgical) Periodontics (nonsurgical) Periodontics (surgical) Prosthodontics (fixed bridge; removable complete/ partial dentures) (1 in 10 years) Complex Extractions Anesthesia Weekly Rates Employee Only (EE) $6.92 EE + Spouse $14.02 EE + Children $17.95 EE + Spouse & Children $25.11 Maximum Rewards This dental plan includes a valuable feature that allows qualifying plan members to carryover part of their unused annual maximum. A member earns dental rewards by submitting at least one claim for dental expenses incurred during the benefit year, while staying at or under the threshold amount for benefits received for that year. In addition, a person earning dental rewards who submits a claim for services received through the dental PPO network earns an extra reward, called the PPO Bonus. Employees and their covered dependents may accumulate rewards up to the stated maximum carryover amount, and then use those rewards for any covered dental procedures subject to applicable coinsurance and plan provisions. If a plan member doesn t submit a dental claim during a benefit year, all accumulated rewards are lost. But he or she can begin earning rewards again the very next year. Benefit Threshold Annual Carryover Amount Annual PPO Bonus Maximum Carryover $500 Dental benefits received for the year cannot exceed this amount $250 Maximum Rewards amount is added to the following year s maximum $100 Additional bonus is earned if the member sees a PPO provider $1,000 Maximum possible accumulation for Maximum Rewards and PPO Bonus combined Late Entrant Provision We strongly encourage you to sign up for coverage when you are initially eligible. If you choose not to sign up during this initial enrollment period, you will become a late entrant. Late entrants will be eligible for only exams, cleanings, and fluoride applications for the first 12 months they are covered. Dental Network Information To do a network search/find a provider please just follow the following directions: 1. Go to 2. Click on the Find dental and vision providers near you tab in the bottom right of the screen 3. Then click on the find a dentist link 4. Next enter a Zip Code and click Search You can search by the provider s name too but it is strongly recommended to search by zip code as if the provider name is not entered exactly as it is listed in the system then it will not pull that provider. This form is a benefit highlight, not a certificate of insurance. The coverage outlined here highlights the benefits available through Reliance Standard Life, and does not include exclusions and limitations. For details on exclusions and limitations, or a complete list of covered procedures, contact your benefits coordinator.

13 Plan Highlights Voluntary Vision Plan Plan 1: TrueView Plan H Summary EyeMed Select Network Out of Network Deductibles $10 Exam No deductible $25 Eye Glass Lenses Annual Eye Exam Covered in full Up to $30 Lenses (per pair) Single Vision Covered in full Up to $25 Bifocal Covered in full Up to $40 Trifocal Covered in full Up to $55 Lenticular 20% discount No benefit Progressive See lens options NA Contacts Fit & Follow Up Exams Standard Standard: Member No benefit cost up to $40 Premium Premium: No benefit (Allowance) 10% off of retail Elective Up to $115 Up to $100 Medically Necessary Covered in full Up to $200 Frames $100 Up to $45 Frequencies (months) Exam/Lens/Frame 12/12/24 Based on date of service 12/12/24 Based on date of service Lens Options (member cost) EyeMed Select Network Out of Network Progressive Lenses No benefit Standard Standard: $65 + lens deductible Premium Premium: lens cost - 20% discount - $120 allowance + Standard Progressive cost Std. Polycarbonate $40 No benefit Tint (solid and $15 No benefit gradient) Scratch Resistant $15 No benefit Coating Anti-Reflective $45 No benefit Coating Ultraviolet Coating $15 No benefit Lasik or PRK Average discount of 15% off retail price or 5% off promotional price at US Laser Network participating providers. No benefit WEEKLY Rates Employee Only (EE) $1.75 EE + Spouse $3.50 EE + Children $2.86 EE + Spouse & Children $4.60 Additional TrueView H Features EyeMed In-Network Discounts 15% discount off the remaining balance in excess of the conventional contact lens allowance. 20% discount off the remaining balance in excess of the frame allowance. 20% discount on items not covered by the plan at network providers, which may not be combined with any other discounts or promotional offers. This discount does not apply to EyeMed Provider s professional services, or contact lenses. EyeMed In-Network Secondary Purchase Plan Members receive a 40% discount on a complete pair of glasses once the funded benefit has been exhausted. Members receive a 15% discount off the retail price on conventional contact lenses once the funded benefit has been exhausted. Discount applies to materials only. Contact Lens Replacement by Mail Program After exhausting the contact lens benefit, replacement lenses may be obtained at significant discounts on-line. Visit EyeMedvisioncare.com for details. EyeMed Select Network Information To do a network search/find a provider please just follow the following directions: 1. Go to 2. Click on the Find dental and vision providers near you tab in the bottom right of the screen 3. Then, click on EyeMed link under the Find a PPO Vision Provider toward the bottom of the page 4. Next, click on the Find a Provider link toward the top right of the screen 5. Last, enter a zip code, choose the Select network from the drop down menu, and click get Results This form is a benefit highlight, not a certificate of insurance. The coverage outlined here highlights the benefits available through Reliance Standard Life, and does not include exclusions and limitations. For details on exclusions and limitations, or a complete list of covered procedures, contact your benefits coordinator.

14 About Us Reliance Standard Life Insurance Company (Reliance Standard) is a leading insurance carrier specializing in innovative and flexible employee benefits solutions including disability income and group term life insurance, a suite of voluntary (employee paid) coverage options and fully integrated absence management. Reliance Standard markets these solutions through independent brokers and agents to employers of all sizes. Rated A+ (Superior) by A.M. Best, Reliance Standard celebrated its centennial year in Together with sister companies Matrix Absence Management, Inc., and Safety National Casualty Corporation, Reliance Standard Life Insurance Company is a leader in managing all aspects of employee absence to enhance the productivity of its clients. Our asset accumulation business emphasizes individual annuity products. Reliance Standard Life Insurance Company is a member of the Tokio Marine Group. Tokio Marine Holdings, Inc., the ultimate holding company of the Tokio Marine Group, is incorporated in Japan and is listed on both the Tokyo and Osaka Stock Exchanges. The Tokio Marine Group operates in the property and casualty insurance, reinsurance and life insurance sectors globally. The Group s main operating subsidiary, Tokio Marine & Nichido Fire (TMNF), was founded in 1879 and is the oldest and leading property and casualty insurer in Japan. TMNF conducts business in the United States mainly through its U.S. branch and enjoys an A.M. Best rating of A++, which ranks among the highest in the industry. Reliance Standard Life Insurance Company is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. In New York, insurance products and services are provided through First Reliance Standard Life Insurance Company, Home Office: New York, NY.