Cape Fear Community College

January 1, 2015 - December 31, 2015 Plan Benefit Descriptions Cape Fear Community College Medical Reimbursement Dependent/Child Care Reimbursement Disability Insurance Life Insurance Cancer Insurance Critical Illness Insurance Accident Insurance Dental Insurance Vision Insurance Long Term Care

TABLE OF CONTENTS What is Section 125? Page 1 What Benefits are Available? Page 2 How Do I Enroll? Page 3 Medical Reimbursement Expense Page 5 Accounts Dependent Care Expense Accounts Page 12 Debit Card Page 14 Medical-Dependent Care Expense Page 15 Voucher Benefit Brochures Short Term Disability Page 18 Permanent Life Page 22 Term Life Page 25 Critical Illness Page 26 Cancer Page 35 Accident Page 37 Dental Page 45 Vision Page 47 Long Term Care Page 49 CAPE FEAR COMMUNITY COLLEGE FLEX GROUP #: 75034 Cape Fear Community College has adopted a Section 125 Flexible Benefit Plan for all eligible employees. The purpose of this booklet is to provide you with a brief description of the Plan and the benefits available to you under the Plan. In the event that a conflict develops between this booklet and the terms of the Plan, the latter instrument must control since it is the legal instrument which actually constitutes the Plan. Although the employer currently intends to continue all of the benefits described in this booklet, the employer reserves the right to amend, reduce or terminate any of these benefits at any time.

WHAT IS A SECTION 125 FLEXIBLE BENEFIT PLAN? A Section 125 Flexible Benefit Plan allows you, the employee, to spend benefit dollars for benefits that you choose to meet your needs. The benefits from which you may choose are listed later in this booklet. The benefits that you elect under the Plan are paid for with benefit dollars made available to you by your employer or through a salary reduction agreement with your employer. Salary reduction means that you are able to use "pre-tax" dollars to pay for certain benefits that you may have previously paid for with "after-tax" dollars. HOW CAN THIS PLAN HELP YOU? By implementing this Plan, your employer is helping you reduce your taxes and increase your spendable income. The cost saving advantage of the Plan is simple. Any benefit costs or insurance premiums you pay under the plan are paid on a pre-tax basis. The example below illustrates the advantage of the Section 125 Plan in comparison with a situation without the benefits of a Plan. The bottom line is that you may have more dollars available to you for the purchase of other benefits you may need or available to you as increased take-home pay. WITHOUT SECTION 125 WITH SECTION 125 Average Monthly Salary $2,000 Less Estimated Federal Withholding (20%) -400 $1,600 Less Insurance Premium(s) -200 Net Take-Home Pay $1,400 Less Out-of-Pocket "Flex" Expenses -50 Spendable Income $1,350 Average Monthly Salary $2,000 Less Qualified Insurance Premium(s) -200 Less Out-of-Pocket "Flex" Expenses -50 Taxable Income $1,750 Less Estimated Federal Withholding (20%) -350 Net Take-Home Pay/Spendable $1,400 Income 1

WHAT BENEFITS ARE AVAILABLE? The following benefits are available to you under the Plan: Insurance Benefits: Cancer, Accident, Vision, Dental, Disability*, Critical Illness, and Life* * coverages available outside Section 125 only Expense Reimbursement Accounts: Medical Expense Reimbursement Dependent Care Expense Reimbursement * If maternity benefits are provided: Group health plans and health insurance issuers offering group insurance coverage generally, under federal law, may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a normal vaginal delivery, or less than 96 hours following a caesarian section, or require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of the above periods. WHO CAN PARTICIPATE IN THE PLAN? All employees of Cape Fear Community College who normally work at least 30 hours per week or are regular part-time status who meet eligibility requirements will be able to participate in the Plan. If you are an existing employee, you must sign an election form for the next plan year during the annual enrollment period. New employees are eligible immediately. HOW MUCH DOES IT COST TO PARTICIPATE? There is a no charge to participate in the Cafeteria Plan! 2

HOW DO I ENROLL IN THE PLAN? During the enrollment period, there will be group meetings scheduled for all employees to attend. These meetings will allow you the opportunity to hear a presentation concerning how the Plan works and information on the benefits available. Following the meeting, you will have the opportunity to visit with a representative from Wellington Benefits on a one-on-one basis concerning your individual needs. At this meeting, you will again have the opportunity to ask questions and you will complete an election form. This election form must be completed and signed by each employee, whether or not you wish to elect to participate in the benefit portion of the Plan. MAY I CHANGE MY BENEFIT ELECTION? The benefit election made during the enrollment period will remain in effect for the plan year. The plan year will be from January 1, 2015 to December 31, 2015. If you wish to change your benefit election, you must effect the change prior to the beginning of the next plan year. You may, however, change your benefit election during the plan year if you experience a change in status which affects your need for a benefit. Any election change must be consistent with the change in status that has occurred. The following circumstances are examples of events that qualify as a change in status: Marriage, divorce, or legal separation; Birth or adoption of a child; Death of a dependent child or spouse; A change in the employment status of the employee or spouse, such as the termination or commencement of employment, or going from part-time to full-time or full-time to part-time employment, which affects the eligibility for that benefit. You may also revoke any election you made for the period during which you are absent from work for a family medical leave covered by the federal Family and Medical Leave Act (FMLA). You may reinstate your election of group medical benefits when you return from the FMLA leave. However, you may not reinstate a revoked election as to the non-health insurance benefits until the next regular enrollment period. 3

CAN I STAY IN THE PLAN IF I AM ABSENT ON A FAMILY MEDICAL LEAVE? If you are absent from work on a leave of absence covered by the Family Medical Leave Act (FMLA) for periods totaling 12 weeks during the plan year, you are entitled to maintain the coverage you have under the Plan during your absence. Of course, you must pay the premiums for the coverage during your absence using one of the following methods: Prepayment: Under the prepayment option, you may (at your option) increase your salary reduction in an amount sufficient to cover the premiums that will come due during the FMLA leave. Pay-as-you-go: With the pay-as-you-go option, you continue to pay premiums on a regular basis through the FMLA leave. If you continue to receive your salary while you are gone, the premiums will be paid with pre-tax money as if you had not taken the leave. On the other hand, if your FMLA leave is unpaid and you choose this option, you will have to reimburse the Plan at regular intervals from your after-tax funds for the premiums that come due during the leave. The language above regarding the two payment methods assumes that both the prepayment and the pay-as-you-go methods are offered under the Plan. PREMIUM CONVERSION The following insurance products may be purchased under the Section 125 Flexible Benefit Plan with the premiums paid on a pre-tax basis: Cancer, Accident, Vision, and Dental Enrolling in any of these benefits on the election form does not enroll you in the insurance product itself. In most cases, an insurance application to the company issuing the insurance product must also be completed. EXPENSE REIMBURSEMENT ACCOUNTS The following expense reimbursement accounts are available under the Section 125 Flexible Benefit Plan with your contributions to the account paid on a pre-tax basis: Dependent Care Expense Reimbursement Medical Expense Reimbursement CAPE FEAR COMMUNITY COLLEGE FLEX GROUP #: 75034 4

EXPENSE REIMBURSEMENT ACCOUNTS If available as a plan benefit option, expense reimbursement accounts allow you to establish an account to reimburse certain types of expenses on a tax exempt basis. There are two types of reimbursement accounts which may be elected. The first is the Medical Expense Reimbursement Account to reimburse uninsured out-of-pocket medical expenses, and the second is the Dependent Care Expense Reimbursement Account to reimburse dependent day care expenses. HOW DO THE REIMBURSEMENT ACCOUNTS WORK? Each month, pre-tax payments are made to an account set up in your name. As one of your Section 125 Flexible Benefit Plan elections, you can specify the payment amount to be set aside on a tax-free basis for one or both of the reimbursement accounts. As you incur qualified medical expenses or dependent day care expenses, you can submit a voucher form for reimbursement from the proper account. HOW DO I GET REIMBURSED FOR MY QUALIFIED EXPENSES? Each month in which you incur an expense, you may submit a voucher form for reimbursement. This voucher form must be accompanied by your original receipts or, in the case of a dependent day care expense, a dependent care provider acknowledgment form. These forms will be provided to you. The voucher will be processed and you will be sent a reimbursement check for your expense(s). The medical expense reimbursement check will be for the expenses claimed up to the maximum benefit amount you elected for the year less expenses previously reimbursed. The dependent care expense check will be for the expense you claimed up to the amount you have in your account. WHAT HAPPENS IF MY EXPENSES ARE LESS THAN THE AMOUNT SET ASIDE? Any expense dollars not used for expenses are forfeited. This is known as the "use it or lose it" provision of Section 125. It is very important that you be conservative and accurate when estimating your expenses for the plan year. USE IT OR LOSE IT! 5

IMPORTANT GUIDELINES FOR ENROLLMENT IN REIMBURSEMENT ACCOUNTS 1. Be sure that the amount set aside is conservative amounts not used for qualified expenses cannot be carried over or returned to you. 2. You cannot be reimbursed for these expenses from any other source. 3. All expenses to be reimbursed must be incurred in the plan year in which your contributions are made. 4. Expenses reimbursed under the Plan may not be used when calculating your medical expense deduction or the dependent care tax credit. 5. You have a 90-day grace period at the end of the plan year to request reimbursement of expenses you incurred during the plan year. 6. You should consult with your tax advisor concerning participation in the reimbursement accounts. MEDICAL EXPENSE REIMBURSEMENT ACCOUNTS The Medical Expense Reimbursement Account can benefit you if you have any predictable out-ofpocket medical, dental or vision care expenses. Only expenses incurred for you or your dependents during the plan year may be reimbursed. For the Medical Expense Reimbursement Account, you will only be allowed to change your benefit election due to termination of your employment. HOW MUCH IS AVAILABLE FOR REIMBURSEMENT? The total amount of a qualified expense is available for reimbursement upon receipt of a voucher and original bill or receipt. The amount of the reimbursement, however, will not exceed the total contribution for the plan year less any reimbursements paid to date. Total reimbursements for the plan year will not exceed the contribution amount for the plan year. IS THERE A CONTRIBUTION LIMIT? Maximum amount available under the Medical Expense Reimbursement Account is $2500 per plan year. 6

SECTION 125 FLEXIBLE BENEFITS PLAN PARTICIPANT GUIDELINES FOR SPENDING ACCOUNTS - Medical Expense Reimbursement - Dependent Care Reimbursement PREPARED BY: First Financial Administrators, Inc. For your Employer s Plan 7

Section 125 Flexible Spending Account First Financial Administrators, Inc. WE ARE COMMITTED First Financial Administrators, Inc. is dedicated to providing excellent service to our customers and are delighted to serve as your cafeteria plan service provider. Our role is to process your requests for reimbursement according to the plan designed by your employer.» There are two types of Flexible Spending Accounts (FSAs): The first is unreimbursed medical (URM) and the second is dependent day care (DDC).» Your participation in an FSA program allows a portion of your salary to be redirected to provide reimbursement for these types of expenses on a tax-exempt basis.» At the beginning of each plan year, you elect a specific dollar amount for each FSA you wish to participate.» Participation in one or both FSAs can save you money by reducing your taxable income. This is because taxes will be calculated after the elected amount is deducted from your salary.» If applicable, your taxable income will be reduced for Social Security purposes; therefore, there may be a corresponding reduction In Social Security benefits.» Once you have elected your annual amount, you cannot change your election unless you experience a change in family status. See Election Irrevocability» To ensure that you are aware of your account balance at all times, we send a new explanation of benefits with each claim that is paid. The explanation of benefits will provide you with information regarding your account balance, claims paid to date, and claims pending.» We send notifications 45 days prior to the end of the plan year. The notification reflects your current available balance. You can view account information by logging into our secure website. FILING A CLAIM Before submitting your claim, make sure you have had the service(s). TO FILE YOUR CLAIM 1. Complete a claim form, and be sure to sign and date it. 2. Attach a legible receipt(s) from the service provided or an EOB (Explanation Of Benefits) showing:» A description of the service or a list of supplies furnished.» The charge(s) for each service.» The date(s) of service.» The name of the person(s) receiving the service.» The amount you are responsible for. 3. For convenient direct deposit, complete the Automatic Deposit Agreement form. Or use your FFA Benefits Card REQUESTING SERVICES (Toll-free) For Inquires: 1-866-853-3539 For Claim Forms: www.ffga.com To Submit Claims by Fax: 1-800-298-7785 8

General IRS Rules & Information The following rules apply to both URM and DDC FSAs ELECTION IRREVOCABILITY You may not make changes before the beginning of the next plan year unless there is a qualified change in status (as permitted by your plan) that affects Eligibility. Qualified changes in status may include:» Change in employee s legal marital status» Change in number of tax dependents» Change in employment status that affects eligibility» Dependent satisfies or ceases to satisfy eligibility requirements» Change in residence that affects eligibility» Judgment, decree, or court order dictating provision of coverage» Entitlement of Medicare or Medicaid (URM only)» Change in cost of the benefit (DDC only) Addition or elimination of benefit option Change in coverage of spouse or dependent under his/her employer s plan Significant curtailment of coverage If a change in status occurs, you may make changes consistent with the qualifying event or as otherwise defined by your plan document. See your plan Sponsor for further details about making changes. Dollar Limits Unreimbursed Medical Account: Your plan sponsor determines the maximum benefit that may be elected. Please see your employer for the maximum benefit amount allowed under your plan. Note: Due to Healthcare Reform, all URM Accounts will have an annual maximum of $2,500 starting January 1, 2013. Dependent Daycare Account: This reimbursement (when aggregated with all other dependent care reimbursements during the same calendar year) may not exceed the least of the following:» $5,000, or» $2,500, if married but filing separate tax returns Use-it-or-lose-it-Rule Money remaining in your FSA account(s) will not be returned to you at the end of the plan year. Any amount remaining after the end of the runoff or grace period, if your employer offers one, will be forfeited. Because of the use-it-or-lose-it rule, it is important for you to carefully estimate your out-of-pocket URM and DDC expenses for the upcoming plan year. TERMINATION OF EMPLOYMENT URM Account: Your salary redirections will end; however, you may still file claims for dates of service that were incurred within your employment period. You have 90 days after termination to submit a claim. DDC Account: If you have not received reimbursement for all contributions made to your DDC account upon termination, you have 90 days after the end of the plan year to submit a claim. COBRA COBRA does not apply to DDC. However, it may apply to your URM account and allow you to continue participation in your URM, thus allowing you to receive reimbursement for medical expenses incurred after your employment termination if:» The plan sponsor is subject to COBRA, and» When you terminate employment and you have contributed more for URM than you have received in URM benefits. Note: Under COBRA you must elect coverage within 60 days and continue to submit contributions to your employer to continue coverage under your URM account for the current year. 9

General IRS Rules & Information UNREIMBURSED MEDICAL FSA Almost every person has a number of necessary and predictable expenses that are not paid by their insurance plans. You can save money by putting that amount directly into your Unreimbursed Medical FSA. The FSA will help you pay for these predictable expenses with your pre-tax dollars. Please be aware of change in tax law Beginning Jan. 1, 2011, money from flexible spending accounts will no longer be available to pay for most over-the-counter drugs and medicines without a doctor s prescription. ELIGIBLE EXPENSES With the FSA, you can pay out-of-pocket health care expenses for yourself, your spouse and all of your eligibile dependents for health, dental, and vision care expenses. The services must be incurred while you are actively participating in the FSA plan. The eligible expenses may be reimbursed regardless of whether you, your spouse or dependents are covered by your employer s medical, dental, or health plan. Expenses for medical care will be limited to expenses incurred primarily for the prevention or improvement of a physical or mental defect or illness. An expense that is merely beneficial to your general health is not an eligible expense. It must be an expense to treat an existing medical condition. INELIGIBLE EXPENSES Some expenses that you incur during your plan year may not be eligible for reimbursement under current IRS regulations.» EXPENSES NOT YET INCURRED - Expenses that have been paid, but not yet incurred (i.e. Prepayment of service), cannot be reimbursed until the service is rendered. Expenses don t necessarily have to be PAID, but merely incurred.» PREMIUMS FOR INSURANCE - Premiums and payments to insurance policies are not eligible for reimbursement.» EXPENSES PAID BY ANOTHER PLAN OR THIRD PARTY - Expenses that have already been paid by an insurance company or other reimbursement through your FSA plan.» EXPENSES INCURRED AFTER TERMINATION/SEPARATION FROM YOUR EMPLOYER - If you are no longer participating in the FSA plan through your employer (termination, resignation, etc) any claims incurred after your participation ends are not eligible for reimbursement. COMMON ELIGIBLE EXPENSES» Co-Payments» Co-Insurance» Deductibles» Over-the Counter Drugs (with physician s prescription)» Dental Treatment» Orthodontia» Lab Fees» X-Rays» Vision Expenses» Lasik Surgery» Physical Therapy» Chiropractor Services» Acupuncture» Eye Contact Solution» Eye Drops COMMON INELIGIBLE EXPENSES» Cosmetic Surgery» Teeth Whitening» Veneers» Botox» Non Prescribed Vitamins and Supplements» Toiletries» Medical Insurance Premiums» Health Club Membership Fees 10

General IRS Rules & Information EXAMPLES OF ELIGIBLE MEDICAL CARE EXPENSES The following lists are examples of the types of expenses that may or may not be reimbursed. These lists are not intended to be complete, as other expenses may also be eligible or ineligible under federal tax law or under employer s plan. To be eligible under an FSA URM account, the medical expense(s) must be incurred for medical care that is not reimbursed from any other source. Medical care means the drug or service is needed to treat a medical condition. First Financial Administrators, Inc. may request additional information from you to substantiate that an expense is for health care. ELIGIBLE MEDICAL EXPENSES INELIGIBLE EXPENSES» Acupuncture» Alcohol and drug rehabilitation expenses» Ambulance» Anesthetist» Artificial limbs and teeth» Birth control pills» Blood donor (expense)» Chiropodist» Chiropractor» Christian Science Practitioners» Certain corrective surgery» Contact lens solution and cleaner» Co-payment for health insurance» Dental care and dentures» Drugs and medical supplies» Examinations» Eye exam, eyeglasses, and contacts» Gynecologist» Hearing aids and batteries» Home health care» Hospital and skilled nursing facility expenses» Laboratory fees» Lip-reading lessons» Midwife» Nursing care» Obstetrical expense» Oculist» Operations and related treatments» Optometrist» Orthodontist**» Osteopath» Outpatient clinic» Over-the-Counter Medications (with physician s prescription)» Pediatrician» Physician» Podiatrist» Practical nurse» Prescription drugs» Psychiatrist» Psychologist» Rental or purchase of medical equipment, including special equipment for use by handicapped persons» Sanitarium» Stop Smoking Programs and Drugs» Support or corrective devices» Surgery» Therapy» Transportation expenses» Weight Loss for Obesity*» X-ray» Dancing or swimming lessons» Medications purchased outside US» Expenses reimbursed under any health plan or other source» Health Club Dues» Face creams, moisturizers, etc.» Hair removal treatments/waxes» Vacation» Cosmetic Surgery» Teeth Whitening» Vitamins taken for overall health» OTC Medications not for Medical Care» Toothpaste/Toothbrushes» Mouth washes, oral anesthetics, etc. * This service requires a letter of medical necessity with a diagnosis from the referring physician. ** Requires an active orthodontia contract be on file. 11

General IRS Rules & Information The following rules apply to both URM and DDC FSAs DEPENDENT CARE FSA The Dependent Care FSA allows you to pay for day care expenses for your qualified dependent/child with pre-tax dollars while you (and your spouse) are working, seeking employment, or attending school as a full-time student for at least 5 months during the year. ELIGIBILITY REQUIREMENTS Eligible dependents must be claimed as an exemption on your tax return. These dependents can include step-children, grandchildren, adopted children, or foster children. In a divorce situation, you must have custody of the child in order for the child to be considered an eligible dependent. Under IRS regulations, eligible dependents are further defined as: under the age of 13, and/or physically or mentally unable to care for themselves, such as a disabled spouse, disabled child, or elderly parents that live with you. ELIGIBLE EXPENSES Eligible dependent care expenses are those expenses you must pay for the care of a dependent so that you and your spouse can work. The care may be provided in your home or at a licensed center outside of your home. If the care is in your home, the service cannot be provided by another child of yours under the age of 19, by your spouse, or by your dependents. INELIGIBLE EXPENSES Only those dependents care expenses that enable you and your spouse to work are eligible. Some expenses that you incur during your plan year may not be eligible for reimbursement under current IRS regulations» Educational Costs» Weekends/Evening-out babysitting» Transportation, books, clothing, food, activities, entertainment, and registration fees are ineligible if these expenses are shown separately on your bill COMMON ELIGIBLE EXPENSES» Day Camps» Before/After School Care» Babysitters/Day Care Centers» Au Pair» Nanny» Nursery School COMMON INELIGIBLE EXPENSES» Registration Fees» Care for child while not working» Kindergarten» Food/Activity expenses if separate from cost of care» Care provided by anyone under age 19» Pre-School» Books and Supplies» Field Trips 12

Claims Information THE REIMBURSEMENT PROCESS REIMBURSEMENTS- The healthcare/medical FSAs are pre-funded; therefore, you are eligible to receive reimbursement up to your elected annual contribution from the beginning of your FSA plan year. The healthcare/medical FSA funds that are reimbursed to you will be recovered as your deductions are taken from your paycheck throughout the plan year. Dependent Care FSAs are NOT pre-funded; therefore, you will only receive reimbursement up to your year-to-date contributions from payroll deductions. The remainder of the reimbursement request is paid when additional funds are received from payroll deductions. PAYMENT METHOD CHOICE- For Unreimbursed Medical expenses you may pay with your FFA Benefits Flex Card at the time you incur the expense, or pay the provider out-of-pocket and file a manual (paper) claim to receive a reimbursement. The FFA Benefits Flex Card is only available for Healthcare/Medical FSAs. MANUAL CLAIMS-To obtain reimbursement from your FSA, you must complete a manual claim form and attach all itemized receipts from the service provider. Cancelled checks, bankcard/credit card receipts, and credit card statements are NOT acceptable forms of documentation. The receipt must come from the service provider or the Explanation of Benefits from your medical health carrier and must include the following information:» Patient name» Date of service incurred» Provider / Merchant name» Amount of your out-of-pocket charge incurred» Type of service incurred» Must include prescription number REMEMBER-You must sign and date all claim forms. FFGA recommends submitting an Explanation of Benefits (EOB) from your insurance company, if available. CLAIMS PROCESSING AND PAYMENTS All claim reimbursements are handled with strict adherence to IRS adjudication and reporting regulations. Claims are processed daily, and our turn around time upon receipt is 3-5 business days and during peak periods (December-March) 5-10 business days. Your reimbursement check will be mailed to your home address on file. You may also elect to receive payment via direct deposit. You have a 2 ½ month grace period (employer permitting) to incur claims with an additional 2 weeks to file claims. Online Service to View Account Information, visit www.ffga.com 13

FFA Benefits Flex Card Medical reimbursement accounts only BENEFITS FLEX CARD The First Financial Administrators, Inc. Benefits Flex Card is available for Medical Reimbursement Flexible Spending Accounts. Cards can be issued to spouses and dependent children (ages 18 to 26) for no additional fee. The initial cards are free, but if a replacement card is issued, the cost is $10.00 per card and will be deducted from your account balance. Cards are good for three years from the issue date as long as you participate each consecutive plan year. Claims can also be submitted directly for reimbursement. If funds remain in your account after the end of the plan year, you may use the debit card during the 2½ month grace period (if your employer has elected to participate in the grace period option). The system will deduct all remaining funds from your old plan year and then deduct any balance from the new plan year, if you continue to participate. New cards (not replacement cards) are only activated with the upcoming plan year -- they are not activated to use money from the prior plan year. The IRS requires validation of most transactions you must submit receipts for verification of expenses when requested. If you fail to substantiate by providing a receipt to us within 60 days of purchase, your card will be suspended until the necessary receipt or explanation of benefits from your insurance provider is received. Claim forms can be found on our website, www.ffga.com. Copies can either be mailed to: First Financial Administrators, Inc. P.O. Box 670329 Houston, TX 77267-0329 or faxed to: (800) 298-7785 WHERE TO USE YOUR DEBIT CARD FOR ELIGIBLE UNREIMBURSED MEDICAL EXPENSES:» Pharmacies always use your debit card at the pharmacy counter only.» In-Store Pharmacies If merchant code is programmed pharmacy, the expense will be authorized. However, if the MasterCard transaction code is programmed grocery/retail, the transaction may be denied. The debit card may not work, and the expense may be declined in some grocery/discount stores. (Your FFA Benefits Flex Card cannot be used past your termination date. If you have available funds in your account, a manual claim will be required.) First Financial Administrators, Inc. can provide you with a list of eligible expenses associated with your Medical Reimbursement Flexible Spending Account. This card is a signature debit card and does not require a PIN for use. Transactions must always be submitted as credit. Participants may review Flexible Spending Account balances online at www.ffga.com. CALL (866) 853-FLEX FOR MORE INFORMATION.» Physician Offices» Specialist Physician Offices» Dental Offices» Over-the-counter drugs (must be accompanied by a Physician s Rx)» Vision Care Providers» Medical Facilities» Medical Clinics» Hospitals, including Emergency Rooms 14

Flexible Benefits Reimbursement Voucher PO Box 670329, Houston, TX 77267-0326 Telephone: (866) 853-3539 Fax: (800) 298-7785 PARTICIPANT INFORMATION ADDRESS CHANGE? Yes No NAME MAILING ADDRESS CITY STATE ZIP COMPLETE ONLY FOR DEPENDENT CARE PROVIDER NAME ADDRESS CITY STATE ZIP SS # TAX ID # SIGNATURE OF PROVIDER EMPLOYER SOCIAL SECURITY # E-MAIL ADDRESS TELEPHONE ( ) COMPLETE ONLY FOR ORTHODONTIA REIMBURSEMENT NAME AMOUNT DUE $ DATE SERVICE PERFORMED I certify that the dental procedure for the above patient HAS BEEN COMPLETED IS IN PROGRESS SIGNATURE OF DENTIST / ORTHODONTIST BENEFIT TYPE (please check as appropriate) MEDICAL REIMBURSEMENT DEPENDENT CARE REIMBURSEMENT PREMIUM REIMBURSEMENT DATE OF SERVICE FAMILY MEMBER DESCRIPTION OF EXPENSE AMOUNT GRAND TOTAL ALL PAGES $0.00 IMPORTANT NOTICE Effective January 1, 2011, all over-the-counter drugs eligible for reimbursement must be accompanied by a doctor s prescription and a reimbursement voucher. ADDITIONAL FORMS AVAILABLE AT: www.ffga.com and click on Participant Forms I hereby affirm that, to the best of my knowledge, all expenses listed above are eligible for reimbursement under Section 105(h) or 129 of the IRS Code and in accordance with my contract with First Financial Administrators, Inc. I further certify that these expenses have not been, nor will not be, reimbursed under any other health plan coverage. If you need verification of the eligibility of an expense, please contact First Financial Administrators, Inc. at 1-866-853-3539. Please send me additional envelopes (additional voucher given with every reimbursement) NOTE: If you have direct deposit, First Financial Administrators, Inc. will not pay bank charges for Insufficient funds. Please call your financial Institution to verify deposit before writing any checks on the amount SIGNATURE DATE Mail or Fax Completed Form To: First Financial Administrators, Inc. P.O. Box 670329, Houston, TX 77267-0329 Fax Number: 1-800-298-7785 15

Reimbursement Itemization Continued DATE OF SERVICE FAMILY MEMBER DESCRIPTION OF EXPENSE AMOUNT SUB-TOTAL THIS PAGE $0.00 MEDICAL REIMBURSEMENT SUBMISSION GUIDELINES: ACCEPTABLE DOCUMENTATION to accompany the reimbursement voucher: 1. Professional bill or receipt that includes:» Provider of service» Type of service rendered» Original date of service» Charges for the service 2. Insurance company Explanation of Benefits 3. Pharmacy statement that includes Rx number and name of the prescription DAYCARE SUBMISSION GUIDELINES: ACCEPTABLE DOCUMENTATION to accompany the reimbursement voucher: 1. Vouchers for Dependent Care signed by the Provider. Voucher must also be completed with the Provider s tax identification number or Social Security number and dates of service, Or... 2. Voucher with receipt from Provider, including Provider name, Provider signature, dates of service, amount for service, and tax identification/social security number. I.R.S Regulations prevent us from reimbursing dependent care yearly contracts. Monthly submissions are required. UNACCEPTABLE DOCUMENTATION 1. Cancelled checks / Credit card receipts 2. Bill or receipt that only shows a balance forward or previous balance 3. Cash register receipt Note: It is important to note that the date of service, not the date of payment, must fall within the dates of the plan year for which you are enrolled. 16

Debit Card Agreement Medical reimbursement accounts only I ACCEPT RESPONSIBILITY FOR THE FOLLOWING: All card transactions will be solely for qualified expenditures incurred (not billed or paid) during the plan year; To the extent that if I misrepresent any card transaction as a qualified expenditure when it is a non-qualified expenditure, I hold you harmless for whatever penalties and consequences that may occur as a result of my actions; If I misrepresent any card transaction on a non-qualified expenditure, I must immediately repay all expenses to the account upon notification; if not repaid, I understand the amount will be considered taxable income. I agree to submit expense receipts to the third party administrator for all purchases when requested; If failure to substantiate, card will be suspended. Each time I present the card for payment, I will sign a receipt evidencing that the expense has been incurred and reaffirming my representation that it is a qualified expenditure that has not been and will not be reimbursed from any other source. DEBIT CARD VALID FOR 3 YEARS OF CONTINUAL PARTICIPATION PLEASE PRINT EMPLOYER NAME SOCIAL SECURITY NUMBER MAILING ADDRESS CITY / STATE / ZIP DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS SIGNATURE DATE ADDITIONAL CARDS DEPENDENT CARDS ISSUED TO SPOUSES AND/OR DEPENDENT CHILDREN (AGES 18-26) NAME RELATIONSHIP DATE OF BIRTH PLEASE MAIL COMPLETED FORM TO: FIRST FINANCIAL ADMINISTRATORS, INC. PO BOX 670329, HOUSTON TX 77267-0329 PHONE: 1-800-523-8422 OR 281-847-8422 FAX: 1-800-298-7785 17

Disability Income Plus North Carolina School Districts Disability Income Plus provides a monthly disability income benefit as a result of a non-occupational off-the-job accident or sickness. If you re totally disabled by an accident or illness, Disability Income Plus can be there to help, helping pay the bills that won t go away just because you can t work: housing costs, food, car payments, and additional medical costs. You can focus on a full recovery and successful return to the workplace. Coverage type Benefit amount Plan design Benefit period Elimination period Definition of disability Disability Income Plus is a group disability income insurance policy that provides a monthly disability income benefit due to a non-occupational off-the-job accident or injury. Minimum benefit of $300 and maximum benefit of $5,000 per month, not to exceed 65% of base monthly income. Accident & Sickness: Provides coverage for disabilities caused by either an accidental injury or sickness. Twelve months Provides non-occupational coverage for injuries after 0, 14 or 30 days and off-the job sicknesses after 7, 14 or 30 days of total disability (depending on your selection). Total disability: for the first 24 months of a disability that the employee/member is unable to perform the substantial and material duties of his or her regular occupation, not working in any other occupation, and under the care of a physician for the disability. After 24 months of total disability, totally disabled means that the employee/member is unable to perform the duties of any occupation, and under the care of a physician for the disability. Partial disability: because of a covered sickness or injury, the employee/member is working more than 20% but not more than 80% of the normal pre-disability schedule, and under the regular care of a physician. The normal pre-disability schedule is as defined by the employee/member s employer but does not include overtime. Recurrent disability: total and/or partial disability that is due to the same or related causes as a prior period of disability, follows a prior period for which a monthly benefit was paid, and occurs within 180 days after the end of a prior period for which a monthly benefit was paid. Optional benefit COBRA rider: Provides eligible candidates with reimbursement, minimum of $200 up to $2,000 per month, of COBRA premium when an employee is totally disabled, terminated, and receiving disability income benefits from inforce coverage. Benefit pays for the duration of the disability or until COBRA benefits terminate, whichever occurs first. This benefit pays in addition to the total disability benefit of the policy. Presented by Benefit amount selected Premium amount per paycheck Insured by Kanawha Insurance Company, a Humana company. This is not a complete disclosure of plan qualifications and limitations. Your broker will provide you with specific limitations and exclusions as contained in the Regulatory and Technical Information Guide. Please review this information before applying for coverage. The amount of benefits provided depends on the plan selected. Premiums will vary according to the selection made. Policy: 8014 Underwritten by Kanawha Insurance Company 18 1-800-327-9728 HumanaVoluntaryBenefits.com

Disability Income Plus rates Disability Income Plus rates Monthly deductions, elimination period: 0/7 Age Benefit amount $100 $200 $300 $400 $500 $600 $700 $800 $900 $1,000 18-35 $5.96 $9.67 $13.38 $17.09 $20.80 $24.51 $28.22 $31.93 $35.64 $39.35 36-45 $6.25 $10.25 $14.25 $18.25 $22.25 $26.25 $30.25 $34.25 $38.25 $42.25 46-55 $6.84 $11.43 $16.02 $20.61 $25.20 $29.79 $34.38 $38.97 $43.56 $48.15 56-65 $7.53 $12.81 $18.09 $23.37 $28.65 $33.93 $39.21 $44.49 $49.77 $55.05 66+ $9.47 $16.69 $23.91 $31.13 $38.35 $45.57 $52.79 $60.01 $67.23 $74.45 $1,100 $1,200 $1,300 $1,400 $1,500 $1,600 $1,700 $1,800 $1,900 $2,000 18-35 $43.06 $46.77 $50.48 $54.19 $57.90 $61.61 $65.32 $69.03 $72.74 $76.45 36-45 $46.25 $50.25 $54.25 $58.25 $62.25 $66.25 $70.25 $74.25 $78.25 $82.25 46-55 $52.74 $57.33 $61.92 $66.51 $71.10 $75.69 $80.28 $84.87 $89.46 $94.05 56-65 $60.33 $65.61 $70.89 $76.17 $81.45 $86.73 $92.01 $97.29 $102.57 $107.85 66+ $81.67 $88.89 $96.11 $103.33 $110.55 $117.77 $124.99 $132.21 $139.43 $146.65 $2,100 $2,200 $2,300 $2,400 $2,500 $2,600 $2,700 $2,800 $2,900 $3,000 18-35 $80.16 $83.87 $87.58 $91.29 $95.00 $98.71 $102.42 $106.13 $109.84 $113.55 36-45 $86.25 $90.25 $94.25 $98.25 $102.25 $106.25 $110.25 $114.25 $118.25 $122.25 46-55 $98.64 $103.23 $107.82 $112.41 $117.00 $121.59 $126.18 $130.77 $135.36 $139.95 56-65 $113.13 $118.41 $123.69 $128.97 $134.25 $139.53 $144.81 $150.09 $155.37 $160.65 66+ $153.87 $161.09 $168.31 $175.53 $182.75 $189.97 $197.19 $204.41 $211.63 $218.85 $3,100 $3,200 $3,300 $3,400 $3,500 $3,600 $3,700 $3,800 $3,900 $4,000 18-35 $117.26 $120.97 $124.68 $128.39 $132.10 $135.81 $139.52 $143.23 $146.94 $150.65 36-45 $126.25 $130.25 $134.25 $138.25 $142.25 $146.25 $150.25 $154.25 $158.25 $162.25 46-55 $144.54 $149.13 $153.72 $158.31 $162.90 $167.49 $172.08 $176.67 $181.26 $185.85 56-65 $165.93 $171.21 $176.49 $181.77 $187.05 $192.33 $197.61 $202.89 $208.17 $213.45 66+ $226.07 $233.29 $240.51 $247.73 $254.95 $262.17 $269.39 $276.61 $283.83 $291.05 $4,100 $4,200 $4,300 $4,400 $4,500 $4,600 $4,700 $4,800 $4,900 $5,000 18-35 $154.36 $158.07 $161.78 $165.49 $169.20 $172.91 $176.62 $180.33 $184.04 $187.75 36-45 $166.25 $170.25 $174.25 $178.25 $182.25 $186.25 $190.25 $194.25 $198.25 $202.25 46-55 $190.44 $195.03 $199.62 $204.21 $208.80 $213.39 $217.98 $222.57 $227.16 $231.75 56-65 $218.73 $224.01 $229.29 $234.57 $239.85 $245.13 $250.41 $255.69 $260.97 $266.25 66+ $298.27 $305.49 $312.71 $319.93 $327.15 $334.37 $341.59 $348.81 $356.03 $363.25 Policy: 8014 Underwritten by Kanawha Insurance Company 19 1-800-327-9728 HumanaVoluntaryBenefits.com

Life Insurance Highlights For the employee purelife-plus Flexible Premium Life Insurance to Age 121 Policy Form PRFNG-NI-10 Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. Designed to be in force when you die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually costs more and declines in death benefit. The policy, purelife-plus, is underwritten by Texas Life Insurance Company, and it has these outstanding features: High Death Benefit. With one of the highest death benefits available at the worksite, 1 purelife-plus gives your loved ones peace of mind, knowing there will be significant life insurance in force should you die prematurely. Minimal Cash Value. Designed to provide high death benefit, purelife-plus does not compete with the cash accumulation in your employer-sponsored retirement plans. Long Guarantees. Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time (after the guaranteed period, premiums may go down, stay the same, or go up). Refund of Premium. Unique in the marketplace, purelife-plus offers you a refund of 10 years premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.) Accelerated Death Benefit Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months (24 months in Illinois), you will have the option to receive 92% (84% in Illinois) of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.) You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, minor children and grandchildren. Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative for costs and complete details. 1 Voluntary and Universal Whole Life Products, Eastbridge Consulting Group, October 2008 See the purelife-plus brochure for details. 10M055-C 1040 (Expires 0612) 22 Not for use in WA.

monthly premiums PureLife-plus Standard Risk Table Premiums Non-Tobacco Express Issue Monthly Premiums for Life Insurance Face Amounts Shown Includes Added Cost for Non-Tobacco GUARANTEED PERIOD Age to Which Issue Accidental Death Benefit (Ages 17-59) Coverage is Age Guaranteed at (ALB) $10,000 $25,000 $40,000 $50,000 $75,000 $100,000 $125,000 $150,000 $200,000 Table Premium 15D-10 7.75 75 11-16 8.00 70 17-20 10.00 15.10 18.50 27.00 35.50 44.00 52.50 69.50 66 21 10.25 15.50 19.00 27.75 36.50 45.25 54.00 71.50 66 22 10.25 15.50 19.00 27.75 36.50 45.25 54.00 71.50 65 23-25 10.50 15.90 19.50 28.50 37.50 46.50 55.50 73.50 63 26 10.75 16.30 20.00 29.25 38.50 47.75 57.00 75.50 63 27 11.00 16.70 20.50 30.00 39.50 49.00 58.50 77.50 63 28 11.00 16.70 20.50 30.00 39.50 49.00 58.50 77.50 62 29 11.25 17.10 21.00 30.75 40.50 50.25 60.00 79.50 62 30-31 11.50 17.50 21.50 31.50 41.50 51.50 61.50 81.50 60 32 12.00 18.30 22.50 33.00 43.50 54.00 64.50 85.50 61 33 12.50 19.10 23.50 34.50 45.50 56.50 67.50 89.50 62 34 13.00 19.90 24.50 36.00 47.50 59.00 70.50 93.50 62 35 13.75 21.10 26.00 38.25 50.50 62.75 75.00 99.50 64 36 14.25 21.90 27.00 39.75 52.50 65.25 78.00 103.50 64 37 14.75 22.70 28.00 41.25 54.50 67.75 81.00 107.50 64 38 15.50 23.90 29.50 43.50 57.50 71.50 85.50 113.50 65 39 16.50 25.50 31.50 46.50 61.50 76.50 91.50 121.50 66 40 17.50 27.10 33.50 49.50 65.50 81.50 97.50 129.50 67 41 18.75 29.10 36.00 53.25 70.50 87.75 105.00 139.50 68 42 20.50 31.90 39.50 58.50 77.50 96.50 115.50 153.50 70 43 22.25 34.70 43.00 63.75 84.50 105.25 126.00 167.50 72 44 24.00 37.50 46.50 69.00 91.50 114.00 136.50 181.50 73 45 26.00 40.70 50.50 75.00 99.50 124.00 148.50 197.50 74 46 28.00 43.90 54.50 81.00 107.50 134.00 160.50 213.50 75 47 29.75 46.70 58.00 86.25 114.50 142.75 171.00 227.50 76 48 31.75 49.90 62.00 92.25 122.50 152.75 183.00 243.50 77 49 34.00 53.50 66.50 99.00 131.50 164.00 196.50 261.50 78 50 15.60 36.75 57.90 72.00 107.25 142.50 79 51 16.90 40.00 63.10 78.50 117.00 155.50 80 52 18.50 44.00 69.50 86.50 129.00 171.50 82 53 20.10 48.00 75.90 94.50 141.00 187.50 83 54 21.70 52.00 82.30 102.50 153.00 203.50 85 55 23.10 55.50 87.90 109.50 163.50 217.50 86 56 24.10 58.00 91.90 114.50 171.00 227.50 85 57 24.80 59.75 94.70 118.00 176.25 234.50 84 58 25.60 61.75 97.90 122.00 182.25 242.50 84 59 26.60 64.25 101.90 127.00 189.75 252.50 84 60 27.30 66.00 104.70 130.50 195.00 259.50 84 61 29.60 71.75 113.90 142.00 212.25 282.50 85 62 32.40 78.75 125.10 156.00 233.25 310.50 87 63 35.50 86.50 137.50 171.50 256.50 341.50 89 64 39.60 96.75 153.90 192.00 287.25 382.50 93 65 42.50 104.00 165.50 206.50 309.00 411.50 94 66 45.30 95 67 47.80 96 68 50.40 96 69 53.20 96 70 56.20 95 PureLife-plus is permanent life insurance to Attained Age 121 that can never be cancelled as long as you pay the necessary premiums. After the Guaranteed Period, the premiums can be lower, the same, or higher than the Table Premium. See the brochure under Permanent Coverage. Form: 10M014-rpltic EXP-K-M-1AD R 01-15-11 23

monthly premiums PureLife-plus Standard Risk Table Premiums Tobacco Express Issue Monthly Premiums for Life Insurance Face Amounts Shown Includes Added Cost for Tobacco GUARANTEED PERIOD Age to Which Issue Accidental Death Benefit (Ages 17-59) Coverage is Age Guaranteed at (ALB) $10,000 $25,000 $40,000 $50,000 $75,000 $100,000 $125,000 $150,000 $200,000 Table Premium 15D-10 11-16 17-20 14.25 21.90 27.00 39.75 52.50 65.25 78.00 103.50 66 21 14.75 22.70 28.00 41.25 54.50 67.75 81.00 107.50 66 22 14.75 22.70 28.00 41.25 54.50 67.75 81.00 107.50 65 23-25 15.50 23.90 29.50 43.50 57.50 71.50 85.50 113.50 63 26 15.75 24.30 30.00 44.25 58.50 72.75 87.00 115.50 63 27 16.00 24.70 30.50 45.00 59.50 74.00 88.50 117.50 63 28 16.25 25.10 31.00 45.75 60.50 75.25 90.00 119.50 62 29 16.50 25.50 31.50 46.50 61.50 76.50 91.50 121.50 62 30-31 18.50 28.70 35.50 52.50 69.50 86.50 103.50 137.50 60 32 19.00 29.50 36.50 54.00 71.50 89.00 106.50 141.50 61 33 19.25 29.90 37.00 54.75 72.50 90.25 108.00 143.50 62 34 19.50 30.30 37.50 55.50 73.50 91.50 109.50 145.50 62 35 20.75 32.30 40.00 59.25 78.50 97.75 117.00 155.50 64 36 21.50 33.50 41.50 61.50 81.50 101.50 121.50 161.50 64 37 22.75 35.50 44.00 65.25 86.50 107.75 129.00 171.50 64 38 23.50 36.70 45.50 67.50 89.50 111.50 133.50 177.50 65 39 25.00 39.10 48.50 72.00 95.50 119.00 142.50 189.50 66 40 11.80 27.25 42.70 53.00 78.75 104.50 130.25 156.00 207.50 67 41 12.50 29.00 45.50 56.50 84.00 111.50 139.00 166.50 221.50 68 42 13.40 31.25 49.10 61.00 90.75 120.50 150.25 180.00 239.50 70 43 14.80 34.75 54.70 68.00 101.25 134.50 167.75 201.00 267.50 72 44 15.60 36.75 57.90 72.00 107.25 142.50 177.75 213.00 283.50 73 45 16.70 39.50 62.30 77.50 115.50 153.50 191.50 229.50 305.50 74 46 17.70 42.00 66.30 82.50 123.00 163.50 204.00 244.50 325.50 75 47 18.70 44.50 70.30 87.50 130.50 173.50 216.50 259.50 345.50 76 48 19.70 47.00 74.30 92.50 138.00 183.50 229.00 274.50 365.50 77 49 21.30 51.00 80.70 100.50 150.00 199.50 249.00 298.50 397.50 78 50 22.40 53.75 85.10 106.00 158.25 210.50 79 51 24.10 58.00 91.90 114.50 171.00 227.50 80 52 26.20 63.25 100.30 125.00 186.75 248.50 82 53 27.90 67.50 107.10 133.50 199.50 265.50 83 54 30.00 72.75 115.50 144.00 215.25 286.50 85 55 31.50 76.50 121.50 151.50 226.50 301.50 86 56 32.80 79.75 126.70 158.00 236.25 314.50 85 57 33.80 82.25 130.70 163.00 243.75 324.50 84 58 35.60 86.75 137.90 172.00 257.25 342.50 84 59 37.10 90.50 143.90 179.50 268.50 357.50 84 60 38.10 93.00 147.90 184.50 276.00 367.50 84 61 40.70 99.50 158.30 197.50 295.50 393.50 85 62 44.00 107.75 171.50 214.00 320.25 426.50 87 63 47.40 116.25 185.10 231.00 345.75 460.50 89 64 51.10 125.50 199.90 249.50 373.50 497.50 93 65 53.60 131.75 209.90 262.00 392.25 522.50 94 66 56.40 95 67 59.20 96 68 62.30 96 69 65.50 96 70 69.00 95 PureLife-plus is permanent life insurance to Attained Age 121 that can never be cancelled as long as you pay the necessary premiums. After the Guaranteed Period, the premiums can be lower, the same, or higher than the Table Premium. See the brochure under Permanent Coverage. Form: 10M014-rpltic EXP-K-M-1AD R 01-15-11 24

PLATINUM If you had a heart attack tomorrow, what would you worry about? Paying your bills? Taking care of your family? Getting better? If you re like most people, being diagnosed with a critical illness can be overwhelming, even scary. The last thing you want to worry about is money. Critical Illness Champion pays you directly to help with your bills, your mortgage, your rent, your childcare you name it so you can focus on recovery. CRITICAL ILLNESS CHAMPION 26

CRITICAL ILLNESS CHAMPION No one plans on getting sick... But just in case, we ve got you covered. Critical illnesses, such as heart attack, cancer and stroke, happen every day. They can have serious consequences, both physical and financial. To maintain your lifestyle and help you recover, you may need some financial help. Are your savings enough to pay your bills? While you re being treated for a critical illness, your income could be affected for 3 to 6 months. Most families do not have enough savings to keep up with: Rent or Mortgage Payments Car Payments Credit Card Debt Childcare Savings for College & Retirement Household Expenses More than 50% of all personal bankruptcies in America are due to critical illness. 1 Critical illnesses are expensive Simply put, critical illnesses cost money. Even with medical insurance, out-of-pocket expenses like these can pile up quickly: Medical Deductibles and Co-Pays Out-Of-Network Specialists Prescriptions Rehabilitation Nursing Care Medical Travel Would a check for $20,000 help? Critical Illness Champion pays you cash immediately. Upon diagnosis, we send a lump sum check directly to you. You can use your cash benefit however you choose to help with your everyday living expenses, pay your out-of-pocket medical costs or replace lost income. Your benefit is paid in full regardless of any other insurance you may have. How much would YOU need? $ Mortgage/Rent $ Car Payments/Repairs/Gas $ Credit Card Payment $ Groceries/Household Expenses $ Kids Childcare/Activities Expenses to Consider Basic Necessities Mortgage/Rent Groceries Utilities Childcare Tuition Payments Car Payments Medical Expenses Deductibles Coinsurance Prescriptions Experimental Treatment Medical Travel Savings Plans College Retirement Out-of-pocket medical expenses for Cancer average $35,000. 2 x3 $ Other Dollars of Protection YOU need $ per month for recovery $ x6 $ Plus Medical $ $ Out-of-Pocket $ $ YOU Need Activities for Kids Pre-school Camp Dance Lessons Band Gymnastics Soccer Loss of Income Parent Care 1 Harvard Study, Illness and Injury as Contributors to Bankruptcy, 2009 2 Duke University Medical Center and Dana-Farber Cancer Institute Study, Medical Bills Force Cancer Patients to Skimp on Care and Necessities, 2011. Wouldn t your recovery be easier if you didn t have to worry about money? Critical Illness Champion can help! 27

Innovative Flexible Affordable Competitive Critical Illness Champion gives you peace of mind so you can focus on getting well. Critical illnesses change life in an instant. If you get sick, the last thing you want to worry about is money. Let Critical Illness Champion help protect you from financial hardship while you recover. PLATINUM Here s how it works... As soon as you are diagnosed with a covered condition, submit your claim and we ll send you a check. It s that simple. You can use your money however you choose. Triple Benefit If you get sick again, you re still covered. With Triple Benefit, you can receive up to 3 times the Face Amount for each person you choose to cover. That means if you choose a $20,000 Face Amount you can receive as much as $60,000 in cash. Recurrence Benefit If we have paid a critical illness benefit for Benign Brain Tumor, Cancer, Coma, Heart Attack or Stroke, and there is a recurrence, you can receive up to 25% of your Face Amount, as long as you were back to work and treatment-free for at least 6 months. The Recurrence Benefit can be paid up to 2 times. Triple Benefit in Action Example $20,000 Face Amount x3 = $60,000 Total Maximum Benefit Heart Attack Diagnosis $20,000 Stroke Diagnosis $20,000 Stroke Recurrence $5,000 Remaining coverage: $15,000 The Critical Illness Benefit can be paid once per covered condition up to the Maximum Benefit Amount. Covered conditions must be diagnosed at least six months apart. Standard Conditions Benign Brain Tumor Cancer Carcinoma In Situ* Coma Coronary Artery Obstruction* End Stage Renal Failure Heart Attack Major Organ Failure Multiple Sclerosis Paralysis or Dismemberment Skin Cancer ($250) Stroke* * Benefit payment is 25% of face amount. Additional Innovative Benefits With Critical Illness Champion, you get even more than a substantial lump sum cash benefit. To help you avoid financial hardship and ease your recovery, you get these innovative benefits too: Mortgage and Rent Helper If you miss work due to a critical illness, you may need some extra help making mortgage or rent payments. Mortgage and Rent Helper pays you an extra $500 each month if you miss 5 or more days of work, for up to 6 months. Kids Are Free! Dealing with a childhood illness can be overwhelming. Your CI Champion covers any children you may have now or in the future, at no additional charge. It pays 25% of the Face Amount for any of the Standard Conditions. Advocacy Benefits Personal and confidential assistance from professionals Best Doctors Find Best Docs Physician Referrals Ask the Expert Hotline Diagnosis & Treatment Advice ComPsych Help understanding your insurance Financial Advice Medical Travel Assistance Wellness Benefit Health screening tests can help diagnose a condition early or prevent an illness altogether. This benefit pays you $50 after you go for an annual health screening test. Automatic Benefit Increase Your face amount will increase each year for 5 years to help you keep up with increasing needs. Each year the weekly premium will increase by $1 and your face amount will increase accordingly. You can cancel the increases at any time. 28

HOW DOES CRITICAL ILLNESS CHAMPION HELP? Chances are good that you will survive a critical illness. Will your financial wellbeing survive as well? You do everything you can to stay active and healthy, but critical illnesses happen every day, and when they do, it s good to know we ve got you covered. Features Affordable, Extensive Coverage Powerful protection at an affordable price. Family Coverage You can insure yourself and your spouse, and kids are free. Your children and dependent grandchildren under age 27 are covered automatically. No Age Penalty Your rates will never change due to your age. Full Portability You can keep your coverage at the same cost even if you change jobs or retire. Guaranteed Renewable Your coverage cannot be cancelled as long as premiums are paid as due. Benefit Summary Name: My Face Amount $ Spouse (50% of My Face Amount) Children (25% of My Face Amount) Payroll Deduction $ This document is a brief description of Group Certificate Form No. C16670. Benefits, rates, exclusions and limitations may vary by state. Refer to your certificate of insurance for specific details. This product is not major medical insurance and does not meet the requirements of the Affordable Care Act. Automatic Benefit Increases Guaranteed increases to your face amount without underwriting No Benefit Reduction Benefits never decrease due to age Convenient Payroll Deduction No bills to watch for or checks to mail. Premiums are paid automatically. No Coordination of Benefits Payments are made in addition to any other insurance you may have. HSA Compatible You can have this coverage even if you have a Health Savings Account. No Treatment Requirements You are not required to be hospitalized or get treatment to receive benefits. Facts? More than 50% of bankruptcies are due to an illness or medical bills. 1 About 1 of 2 men and 1 of 3 women will contract cancer. 2 About every 25 seconds an American will have a coronary event. 3 On average, every 40 seconds someone in the U.S. has a stroke. 3 Exclusions No benefits will be paid for losses resulting from any intentionally self-inflicted injury Limitations A Pre-existing Condition is not covered unless the date of diagnosis for such condition is at least 12 months after the certificate effective date. Initial Eligibility Active employees age 18 and up, working at least 17.5 hours per week Spouses age 18 and up, legally married. Domestic partner and civil union partner coverage available in some states. Children ages 0 through 26, no student status required Combined Insurance Company of America 1 David U. Himmelstein, MD, Deborah Thorne, PhD, Elizabeth Warren, JD, Steffie Woolhandler, MD, MPH. Medical Bankruptcy in the United States, 2007: Results of a National Study. American Journal of Medicine, 2009. 2 American Cancer Society, Cancer Facts & Figures, 2012 3 Circulation, Journal of the American Heart Association, Heart Disease & Stroke Statistics, 2010 CBS-462-EE-P (02-14) 29

CUSTOM CRITICAL ILLNESS CHAMPION PLATINUM PLAN Rate Sheet includes Riders (C1-WCS-02) Mode Monthly Face Amounts Ee 10,000 10,000 10,000 10,000 10,000 10,000 10,000 10,000 Sp 5,000 5,000 5,000 5,000 Ch 2,500 2,500 2,500 2,500 Ee Ee Ee+Sp Ee+Sp Ee+Ch Ee+Ch Ee+Fam Ee+Fam Issue Age NT TB NT TB NT TB NT TB 18-25 9.80 13.20 17.01 22.47 11.04 14.44 18.23 23.70 26-30 10.34 14.22 17.82 24.01 11.58 15.46 19.05 25.25 31-35 12.06 17.36 20.42 28.76 13.29 18.60 21.65 30.00 36-40 15.20 23.09 25.17 37.41 16.44 24.32 26.39 38.65 41-45 18.45 29.30 30.08 46.80 19.69 30.53 31.31 48.04 46-50 23.90 39.72 38.32 62.55 25.14 40.96 39.54 63.79 51-55 28.90 49.93 45.87 77.99 30.14 51.17 47.11 79.23 56-60 37.84 66.72 59.40 103.37 39.09 67.96 60.62 104.61 61-65 48.26 86.77 75.14 133.67 49.49 88.01 76.37 134.91 66-69 57.60 105.41 89.26 161.86 58.84 106.65 90.48 163.10 70+ 66.99 124.47 103.46 190.66 68.23 125.71 104.68 191.90 Mode Monthly Face Amounts Ee 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 Sp 7,500 7,500 7,500 7,500 Ch 3,750 3,750 3,750 3,750 Ee Ee Ee+Sp Ee+Sp Ee+Ch Ee+Ch Ee+Fam Ee+Fam Issue Age NT TB NT TB NT TB NT TB 18-25 12.16 16.71 20.58 27.76 13.56 18.11 21.97 29.16 26-30 12.98 18.23 21.80 30.07 14.37 19.63 23.19 31.47 31-35 15.55 22.95 25.70 37.20 16.95 24.34 27.09 38.60 36-40 20.26 31.53 32.82 50.17 21.66 32.93 34.20 51.57 41-45 25.14 40.85 40.19 64.26 26.54 42.24 41.58 65.66 46-50 33.31 56.48 52.54 87.89 34.71 57.88 53.93 89.28 51-55 40.81 71.80 63.88 111.05 42.21 73.21 65.28 112.45 56-60 54.23 96.98 84.17 149.11 55.64 98.38 85.55 150.52 61-65 69.85 127.06 107.78 194.56 71.25 128.46 109.17 195.97 66-69 83.86 155.02 128.95 236.85 85.26 156.42 130.34 238.25 70+ 97.95 183.61 150.25 280.05 99.35 185.01 151.64 281.46 30

CUSTOM CRITICAL ILLNESS CHAMPION PLATINUM PLAN Rate Sheet includes Riders (C1-WCS-02) Mode Monthly Face Amounts Ee 50,000 50,000 50,000 50,000 50,000 50,000 50,000 50,000 Sp 25,000 25,000 25,000 25,000 Ch 12,500 12,500 12,500 12,500 Ee Ee Ee+Sp Ee+Sp Ee+Ch Ee+Ch Ee+Fam Ee+Fam Issue Age NT TB NT TB NT TB NT TB 18-25 28.70 41.24 45.57 64.80 31.24 43.77 48.10 67.34 26-30 31.41 46.32 49.66 72.51 33.94 48.86 52.18 75.05 31-35 39.99 62.03 62.66 96.26 42.53 64.56 65.18 98.80 36-40 55.70 90.65 86.37 139.51 58.24 93.19 88.89 142.05 41-45 71.95 121.70 110.95 186.47 74.49 124.23 113.47 189.00 46-50 99.20 173.82 152.12 265.22 101.74 176.36 154.64 267.75 51-55 124.20 224.86 189.91 342.43 126.74 227.44 192.47 344.96 56-60 168.91 308.82 257.53 469.30 171.49 311.36 260.06 471.88 61-65 220.99 409.07 336.24 620.80 223.53 411.61 338.77 623.38 66-69 267.70 502.28 406.82 761.76 270.24 504.81 409.35 764.30 70+ 314.66 597.57 477.82 905.76 317.19 600.11 480.35 908.34 Mode Monthly Face Amounts Ee 75,000 75,000 75,000 75,000 75,000 75,000 75,000 75,000 Sp 37,500 37,500 37,500 37,500 Ch 18,750 18,750 18,750 18,750 Ee Ee Ee+Sp Ee+Sp Ee+Ch Ee+Ch Ee+Fam Ee+Fam Issue Age NT TB NT TB NT TB NT TB 18-25 40.51 58.76 63.43 91.26 43.86 62.11 66.77 94.61 26-30 44.58 66.38 69.55 102.82 47.92 69.73 72.89 106.17 31-35 57.45 89.95 89.05 138.45 60.80 93.29 92.39 141.80 36-40 81.01 132.88 124.62 203.32 84.36 136.23 127.95 206.67 41-45 105.39 179.45 161.49 273.76 108.74 182.79 164.83 277.11 46-50 146.26 257.63 223.24 391.89 149.61 260.98 226.58 395.23 51-55 183.76 334.20 279.93 507.70 187.11 337.61 283.33 511.05 56-60 250.83 460.13 381.37 698.01 254.24 463.48 384.70 701.42 61-65 328.95 610.51 499.43 925.26 332.30 613.86 502.77 928.67 66-69 399.01 750.32 605.30 1,136.70 402.36 753.67 608.64 1,140.05 70+ 469.45 893.26 711.80 1,352.70 472.80 896.61 715.14 1,356.11 33

CUSTOM CRITICAL ILLNESS CHAMPION PLATINUM PLAN Rate Sheet includes Riders (C1-WCS-02) Mode Monthly Face Amounts Ee 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 Sp 50,000 50,000 50,000 50,000 Ch 25,000 25,000 25,000 25,000 Ee Ee Ee+Sp Ee+Sp Ee+Ch Ee+Ch Ee+Fam Ee+Fam Issue Age NT TB NT TB NT TB NT TB 18-25 52.33 76.28 81.28 117.72 56.49 80.44 85.43 121.88 26-30 57.74 86.45 89.45 133.14 61.90 90.61 93.60 137.30 31-35 74.91 117.86 115.45 180.64 79.07 122.02 119.60 184.80 36-40 106.33 175.11 162.87 267.14 110.49 179.27 167.02 271.30 41-45 138.83 237.20 212.03 361.05 142.99 241.36 216.18 365.21 46-50 193.33 341.45 294.37 518.55 197.49 345.61 298.52 522.71 51-55 243.33 443.53 369.95 672.97 247.49 447.77 374.18 677.13 56-60 332.74 611.45 505.20 926.72 336.99 615.61 509.35 930.96 61-65 436.91 811.95 662.62 1,229.72 441.07 816.11 666.77 1,233.96 66-69 530.33 998.36 803.78 1,511.64 534.49 1,002.52 807.93 1,515.80 70+ 624.24 1,188.95 945.78 1,799.64 628.40 1,193.11 949.93 1,803.88 34

Humana Cancer Expense (Cancer Plus) North Carolina A key aspect of coping with cancer is knowing that funds are available to cover treatment and related costs. That way, you and your family can concentrate on what s most important: successful treatment and a positive outcome. Cancer expense coverage provides unlimited lifetime benefits and is renewable for life, paid directly to you. You can take the policy with you if you leave your current job, and premiums don t increase if you change employers. Coverage type Benefit amount Coverage for cancer Additional included benefits A cancer expense insurance policy provides funds to help offset the expenses incurred for treatment of a covered cancer. This is an annually restorable benefit policy. Benefit amounts are available at various levels. You can choose: $10,000, $15,000, $20,000, $25,000, $30,000, $35,000, $40,000, $45,000 or $50,000 100% of usual and customary charges for the following covered expenses for each family member insured: Chemotherapy and radiation Medical or surgical services and anesthesia Services of a Professional Nurse other than yourself or a member of your immediate family Braces, crutches, and wheel chairs Prosthetic devices X-rays and cobalt treatment Hospital room and miscellaneous services Laboratory services, blood transfusions and actual charges for blood and plasma Ambulance service (ground or air) Cancer travel benefit: Pays $200 per day maximum for travel to and from a cancer treatment center in connection with surgery, chemotherapy, radiation therapy, or medical evaluation by a physician. Travel must be at least 60 miles each way outside the residence area. Presented by Cancer wellness benefit: We ll pay for usual and customary expenses up to $150 per insured per calendar year for mammography, cystologic screening, and prostate cancer screening. There is 12-month waiting period for this benefit. Benefits do not accumulate toward the policy s calendar year maximum. Mammography - One screening for breast cancer by low-dose mammography for an insured female per calendar year. Cystologic Screening - One cystologic screening (PAP smear) for an insured female per calendar year. Prostate Cancer Screening - One prostate specific antigen blood test (PSA) and one digital rectal exam for an insured male per calendar year. Cancer lump sum first diagnosis: Pays a one-time lump sum payment of 50% of the face amount at first diagnosis of a covered cancer. This benefit is not included in the calendar year maximum. This rider does not include coverage for skin cancer other than malignant melanoma. Bill Mode Frequency Action Monthly Semi-Monthly Divide modal premium by 2 Monthly Bi-Weekly Multiply modal premium by 12, then divide by 26 Monthly Weekly Multiply modal premium by 12, then divide by 52 Thirteenthly (Billed every 28 days) Bi-Weekly Divide modal premium by 2 Thirteenthly (Billed every 28 days) Weekly Divide modal premium by 4 Tenthly Monthly for 10 Months Multiply modal premium by 12, then divide by 10 20 Pay Semi-monthly for 10 Months Multiply modal premium by 12, then divide by 20 9thly Monthly for 9 Months Multiply modal premium by 12, then divide by 9 This is not a complete disclosure of plan qualifications and limitations. Please access our website to obtain a completed list for the Workplace Voluntary Benefit products at Disclosure.Humana.com. Please review this information before applying for coverage. The amount of benefits provided depends on the plan selected. Premiums will vary according to the selection made. Policy: 70240 4/98 Underwritten by Kanawha Insurance Company NCHHGQ3HH 1/13 Insured by Kanawha Insurance Company, a Humana company. 35 1-800-327-9728 HumanaVoluntaryBenefits.com

Humana Cancer Expense (Cancer Plus) rates North Carolina Monthly Employee rates Displaying monthly payroll deductions based on monthly premium calculation include Cancer Lump Sum First Diagnosis Benefit, Cancer Travel Benefit, and Cancer Wellness Benefit. Age Benefit Amount Benefit $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 18-50 $21.31 $30.17 $39.03 $47.89 $56.75 $65.61 $74.47 $83.33 $92.19 51-59 $35.86 $51.81 $67.76 $83.71 $99.66 $115.61 $131.56 $147.51 $163.46 60-69 $45.09 $65.56 $86.03 $106.50 $126.97 $147.44 $167.91 $188.38 $208.85 Employee & Spouse rates Displaying monthly payroll deductions based on monthly premium calculation include Cancer Lump Sum First Diagnosis Benefit, Cancer Travel Benefit, and Cancer Wellness Benefit. Age Benefit Amount Benefit $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 18-50 $35.32 $49.76 $64.20 $78.64 $93.08 $107.52 $121.96 $136.40 $150.84 51-59 $58.98 $84.96 $110.94 $136.92 $162.90 $188.88 $214.86 $240.84 $266.82 60-69 $74.00 $107.33 $140.66 $173.99 $207.32 $240.65 $273.98 $307.31 $340.64 Employee & Children rates Displaying monthly payroll deductions based on monthly premium calculation include Cancer Lump Sum First Diagnosis Benefit, Cancer Travel Benefit, and Cancer Wellness Benefit. Age Benefit Amount Benefit $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 18-50 $26.37 $36.43 $46.49 $56.55 $66.61 $76.67 $86.73 $96.79 $106.85 51-59 $41.04 $58.26 $75.48 $92.70 $109.92 $127.14 $144.36 $161.58 $178.80 60-69 $50.25 $71.98 $93.71 $115.44 $137.17 $158.90 $180.63 $202.36 $224.09 Family rates Displaying monthly payroll deductions based on monthly premium calculation include Cancer Lump Sum First Diagnosis Benefit, Cancer Travel Benefit, and Cancer Wellness Benefit. Age Benefit Amount Benefit $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 18-50 $40.39 $56.04 $71.69 $87.34 $102.99 $118.64 $134.29 $149.94 $165.59 51-59 $64.16 $91.40 $118.64 $145.88 $173.12 $200.36 $227.60 $254.84 $282.08 60-69 $79.14 $113.72 $148.30 $182.88 $217.46 $252.04 $286.62 $321.20 $355.78 Policy: 70240 4/98 Underwritten by Kanawha Insurance Company 36 1-800-327-9728 HumanaVoluntaryBenefits.com

CAPE FEAR COMMUNITY COLLEGE Dental Highlight Sheet Dental Plan Summary Coinsurance Type 1 100% Type 2 80% Type 3 50% Deductible $25/Calendar Year Type 2 & 3 Waived Type 1 No Family Maximum Maximum (per person) $1,500 per calendar year Allowance 85th U&C Waiting Period None Annual Eye Exam None LASIK Advantage None Annual Open Enrollment None Orthodontia Summary - Adult and Child Coverage Allowance U&C Coinsurance 50% Lifetime Maximum (per person) $1,000 Waiting Period None Sample Procedure Listing (Current Dental Terminology American Dental Association.) Type 1 Type 2 Type 3 Routine Exam (2 per benefit period) Bitewing X-rays (2 per benefit period) Full Mouth/Panoramic X-rays (1 in 3 years) Periapical X-rays Cleaning (2 per benefit period) Fluoride for Children 18 and under (1 per benefit period) Space Maintainers Sealants (age 16 and under) Restorative Amalgams Restorative Composites Endodontics (nonsurgical) Endodontics (surgical) Denture Repair Simple Extractions Complex Extractions Anesthesia Monthly Rates Employee Only (EE) $44.16 EE + Spouse $84.40 EE + Children $96.48 EE + Spouse & Children $136.68 Onlays Crowns (1 in 5 years per tooth) Crown Repair Periodontics (nonsurgical) Periodontics (surgical) Prosthodontics (fixed bridge; removable complete/partial dentures) (1 in 5 years) Ameritas Information We're Here to Help This plan was designed specifically for the associates of CAPE FEAR COMMUNITY COLLEGE. At Ameritas Group, we do more than provide coverage - we make sure there's always a friendly voice to explain your benefits, listen to your concerns, and answer your questions. Our customer relations associates will be pleased to assist you 7 a.m. to midnight (Central Time) Monday through Thursday, and 7 a.m. to 6:30 p.m. on Friday. You can speak to them by calling toll-free: 800-487-5553. For plan information any time, access our automated voice response system or go online to ameritasgroup.com/member. 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 Type 1 and Type 2 procedures for the first 12 months they are covered. 45

CAPE FEAR COMMUNITY COLLEGE Dental Highlight Sheet Dental 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. 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 $750 Dental benefits received for the year cannot exceed this amount Annual Carryover Amount $250 Dental Rewards amount is added to the following year's maximum Maximum Carryover $1,000 Maximum possible accumulation for Dental Rewards PPO Information To find a provider, visit ameritasgroup.com and select FIND A PROVIDER, then DENTAL. Enter your criteria to search by location or for a specific dentist or practice. California Residents: When prompted to select your network, choose PPO Dental Network. Pretreatment While we don't require a pretreatment authorization form for any procedure, we recommend them for any dental work you consider expensive. As a smart consumer, it's best for you to know your share of the cost up front. Simply ask your dentist to submit the information for a pretreatment estimate to our customer relations department. We'll inform both you and your dentist of the exact amount your insurance will cover and the amount that you will be responsible for. That way, there won't be any surprises once the work has been completed. Section 125 This plan is provided as part of the Policyholder's Section 125 Plan. Each employee has the option under the Section 125 Plan of participating or not participating in this plan. If an employee does not elect to participate when initially eligible, he/she may elect to participate at the Policyholder's next Annual Election Period. This document is a highlight of plan benefits provided by Ameritas Life Insurance Corp. as selected by your employer. It is not a certificate of insurance and does not include exclusions and limitations. For exclusions and limitations, or a complete list of covered procedures, contact your benefits administrator. 46

CAPE FEAR COMMUNITY COLLEGE Eye Care Highlight Sheet Focus Plan Summary VSP Network Out of Network Deductibles $15 Exam $15 Exam $15 Eye Glass Lenses or Frames* $15 Eye Glass Lenses or Frames Annual Eye Exam Covered in full Up to $45 Lenses (per pair) Single Vision Covered in full Up to $35 Bifocal Covered in full Up to $50 Trifocal Covered in full Up to $70 Lenticular Covered in full Up to $90 Progressive See lens options NA Contacts Fit & Follow Up Exams 15% discount No benefit See Additional Focus Features. Elective Up to $105 Up to $105 Medically Necessary Covered in full Up to $210 Frames $120 Up to $50 Frequencies (months) Exam/Lens/Frame 12/12/24 12/12/24 Based on date of service Based on date of service *Deductible applies to a complete pair of glasses or to frames, whichever is selected. Lens Options (member cost)* VSP Network Out of Network Progressive Lenses Up to provider's contracted fee for Lined Up to Lined Trifocal allowance. Trifocal Lenses. The patient is responsible for the difference between the base lens and the Progressive Lens charge. Std. Polycarbonate Covered in full for dependent children No benefit $25 adults Solid Plastic Dye $13 No benefit (except Pink I & II) Plastic Gradient Dye $15 No benefit Photochromatic Lenses $27-$76 No benefit (Glass & Plastic) Scratch Resistant Coating $15-$29 No benefit Anti-Reflective Coating $39-$75 No benefit Ultraviolet Coating $14 No benefit *Lens Option member costs vary by prescription, option chosen and retail locations. Eye Care Plan Member Service Focus eye care from Ameritas Group features the money-saving eye care network of VSP. Customer service is available to plan members through VSP's well-trained and helpful service representatives. Call or go online to locate the nearest VSP network provider, view plan benefit information and more. VSP Call Center: 1-800-877-7195 Service representative hours: 5 a.m. to 7 p.m. PST Monday through Friday, 6 a.m. to 2:30 p.m. PST Saturday Interactive Voice Response available 24/7 Locate a VSP provider at: ameritasgroup.com/member View plan benefit information at: vsp.com Monthly Rates Employee Only (EE) $9.70 EE + Family $23.76 47

CAPE FEAR COMMUNITY COLLEGE Eye Care Highlight Sheet Additional Focus Features Contact Lenses Elective Additional Glasses Frame Discount Laser VisionCare Low Vision Allowance can be applied to disposables, but the dollar amount must be used all at once (provider will order 3 or 6 month supply). Applies when contacts are chosen in lieu of glasses. For plans without a separate contact lens fit & follow up exam allowance, the cost of the fitting and evaluation is deducted from the contact allowance. 20% discount off the retail price on additional pairs of prescription glasses (complete pair). VSP offers a 20% discount off the remaining balance in excess of the frame allowance. VSP offers an average discount of 15% on LASIK and PRK. The maximum out-of-pocket per eye for members is $1,800 for LASIK and $2,300 for custom LASIK using Wavefront technology, and $1,500 for PRK. In order to receive the benefit, a VSP provider must coordinate the procedure. With prior authorization, 75% of approved amount (up to $1,000 is covered every two years). Section 125 This plan is provided as part of the Policyholder's Section 125 Plan. Each employee has the option under the Section 125 Plan of participating or not participating in this plan. If an employee does not elect to participate when initially eligible, he/she may elect to participate at the Policyholder's next Annual Election Period. This document is a highlight of plan benefits provided by Ameritas Life Insurance Corp. as selected by your employer. It is not a certificate of insurance and does not include exclusions and limitations. For exclusions and limitations, or a complete list of covered procedures, contact your benefits administrator. 48

If they need you, you need a Champion Good things in life happen every day, and unfortunately, hardship happens too. You need a champion to defend and protect everything you value your family, your goals, your dreams, your independence in essence, your life. A Special Life Insurance and Long Term Care Benefit Offering Available to North Carolina School Educators and Staff Served by LBT-LTC-EE-NC LIFETIME BENEFIT TERM CHAMPION Life Insurance with Money for Long Term Care 49

LIFETIME BENEFIT TERM CHAMPION Life Insurance with Money for Long Term Care Life Insurance Powerful protection for your loved ones You work hard to provide a good life for your family. However, what if something happens to you? If they need you, you need a champion to defend and protect your family with money to help pay for: Rent and mortgage College Education Retirement Household Expenses Long Term Care Childcare Family Debt Burial Let LifeTime Benefit Term be your Champion! Make a promise to protect the future. Let LifeTime Benefit Term (LBT) be your Champion. It lasts a lifetime guaranteed. LifeTime Benefit Term provides money to your family at death, and while you are living too, if you need home health care, assisted living or nursing care. For the same premium, Lifetime Benefit Term provides higher benefits than whole life and lasts to age 120. Innovative Benefit Design Guaranteed Premiums Life insurance premiums will never increase and are guaranteed through age 120. Guaranteed Benefits During Working Years Death Benefit is guaranteed 100% when it is needed most during your working years when your family is relying on your income. Through age 70 (or 25 years if greater) your death benefit is 100% guaranteed. Guaranteed Benefits After Age 70 Even after age 70, when income is less relied upon, the benefit is guaranteed to never be less than 50%. And based on current interest rates the full death benefit is designed to last a lifetime. Long Term Care (LTC) If you need LTC, you can access your death benefit while you are living for home health care, assisted living, adult day care and nursing home care. You get 4% of your death benefit per month while you are living for up to 25 months to help pay for LTC. Insurance premiums are waived while this benefit is being paid. Terminal Illness Benefit You can receive 50% of your death benefit immediately, up to $100,000, if you are diagnosed as terminally ill. LifeTime Benefit Term is a great way to protect your most important asset and help provide the peace of mind your family deserves. Paid-up Benefits After 10 years, paid up benefits begin to accrue. At any point thereafter, if premiums stop, a reduced paid up benefit is guaranteed. Flexibility is perfect for retirement. 50

Innovative Flexible Affordable Competitive Life insurance provides your family with money after your death. It helps replace your income and ensure that your dependents are not burdened with debt. Here s how LifeTime Benefit Term can be Your Family s Champion As Life Insurance LifeTime Benefit Term protects your family with money that can be used any way they choose. It is most often used to pay for mortgage or rent, education for children and grandchildren, retirement, family debt, and final expenses. For Long Term Care If you become chronically ill, LifeTime Benefit Term will pay you 4% of your death benefit each month you receive Long Term Care. You can use this money any way you choose, and your life insurance premiums will be waived. Your death benefit will reduce proportionately each month as your receive benefit payments for Long Term Care. Your life insurance will continue to help you protect your assets for 25 months. After 25 months of receiving Long Term Care Benefits, your death benefit will reduce to zero. Flexible Benefit Choices Once you make the promise to protect your family with Lifetime Benefit term, there are several ways it can work for you. You don t have to make any decisions on how you use your benefits until you actually need them. Here is an example how LifeTime Benefit Term can be your Champion. $100,000 LifeTime Benefit Term Coverage Maximize Death Benefit You lead a full life and don t need any long term care. $100,000 Death Benefit For Terminal Illness You can receive 50% of your death benefit immediately, up to $100,000, if you are diagnosed as terminally ill. Features Affordable Financial Security Lifelong protection with premiums beginning as low as $3 per week. Strong Guarantees Guaranteed life insurance Premium* and Death Benefits last a lifetime. Highly Competitive Rates For the same premium, Lifetime Benefit Term provides higher benefits than whole life and lasts to age 120. Fully Portable and Guaranteed Renewable for Life Your coverage cannot be cancelled as long as premiums are paid as due. Family Coverage Coverage is available for your spouse, children and dependent grandchildren. Split Your Benefits You lead a full life and needs some home health care. Maximize Your LTC You lead a full life and need an assisted living lifestyle and/or nursing home care. $48,000 LTC Benefit $52,000 Death Benefit $100,000 LTC Benefit 51 * Long Term Care Rider premiums can increase. Premium increases can only occur if all contracts in a state where this benefit is issued are increased. Premiums cannot be increased solely because of an independent claim.

LIFETIME BENEFIT TERM CHAMPION Life Insurance with Money for Long Term Care You need a champion to defend and protect everything you value your family, your goals, your dreams, your independence in essence, your life. Choose a Champion. Choose LifeTime Benefit Term. Flexible and Customizable Every plan starts with guaranteed death benefits and accelerated benefits for Long Term Care. Benefit Summary Applicant: Spouse: Children/Grandchildren: Death Benefit Child Term Benefit Waiver of Premium Payor Waiver of Premium LTC Benefits $ $ $ $ $ $ $ $ Total Payroll Deduction $ Premium/ This is not an application for coverage. Refer to your enrollment form in order to apply for coverage. Enrollments are subject to underwriting approval. LifeTime Benefit Term Exclusions If the insured commits suicide, while sane or insane, within two years (one year in some states) from the Date of Issue, and while this Coverage is in force, We will pay in one sum to the Beneficiary, the amount of premiums paid for this Coverage. Additional Benefit Options Child Term Benefit Death Benefits available up to $25,000. Guaranteed conversion to individual coverage at age 26 up to 5 times the benefit amount. Waiver of Premium Waives premium if you become totally disabled. Payor Waiver of Premium Waives premium of your spouse, if you become totally disabled. This document is a brief description of Certificate Form No. C34544NC. Benefits, rates, exclusions and limitation may vary by state. Refer to your certificate of insurance for specific details For costs and further details of the coverage, including exclusions, any reductions or limitations and terms under which the policy may be continued in force, see your agent or write to the company. Combined Insurance Company of America 52 LBT-LTC25-EE-NC-NCS (9-14)

Combined Insurance Company of America Lifetime Benefit Term Quotes, Page 1 of 1 Generated from Quote System (...035_140602.xls) Prepared For: Sample rates Defined Benefit (OPTIONAL AMOUNTS) Monthly (12 times) RIDERS INCLUDED(*): TI, LTC25 Class: M30_NS_NC Riders TI, LTC25 TI, LTC25 TI, LTC25 TI, LTC25 TI, LTC25 TI, LTC25 TI, LTC25 TI, LTC25 Iss Age $ 10,000 $ 25,000 $ 50,000 $ 75,000 $ 100,000 $ 125,000 $ 150,000 $ 175,000 19 N/A N/A 19.12 28.69 38.25 47.81 57.37 66.93 20 N/A N/A 19.12 28.69 38.25 47.81 57.37 66.93 21 N/A N/A 19.54 29.31 39.08 48.85 58.62 68.39 22 N/A N/A 19.96 29.94 39.92 49.89 59.87 69.85 23 N/A N/A 20.33 30.50 40.67 50.83 61.00 71.16 24 N/A N/A 20.83 31.25 41.67 52.08 62.50 72.91 25 N/A N/A 21.25 31.87 42.50 53.12 63.75 74.37 26 N/A N/A 21.98 32.97 43.96 54.96 65.95 76.94 27 N/A N/A 22.76 34.14 45.51 56.89 68.27 79.65 28 N/A N/A 23.53 35.30 47.06 58.83 70.60 82.36 29 N/A N/A 24.39 36.59 48.78 60.98 73.17 85.37 30 N/A N/A 25.25 37.87 50.50 63.12 75.75 88.37 31 N/A 13.17 26.35 39.52 52.70 65.87 79.05 92.22 32 N/A 13.75 27.49 41.24 54.98 68.73 82.47 96.22 33 N/A 14.34 28.67 43.01 57.35 71.68 86.02 100.36 34 N/A 14.93 29.86 44.79 59.71 74.64 89.57 104.50 35 N/A 15.58 31.17 46.75 62.33 77.91 93.50 109.08 36 N/A 16.39 32.77 49.16 65.55 81.93 98.32 114.71 37 N/A 17.25 34.51 51.76 69.01 86.27 103.52 120.77 38 N/A 18.14 36.28 54.42 72.56 90.70 108.85 126.99 39 N/A 19.11 38.22 57.34 76.45 95.56 114.67 133.78 40 N/A 20.10 40.21 60.31 80.41 100.52 120.62 140.72 41 N/A 21.14 42.29 63.43 84.58 105.72 126.87 148.01 42 N/A 22.25 44.50 66.75 89.00 111.25 133.49 155.74 43 N/A 23.39 46.79 70.18 93.58 116.97 140.37 163.76 44 N/A 24.60 49.21 73.81 98.41 123.02 147.62 172.22 45 N/A 25.85 51.71 77.56 103.41 129.27 155.12 180.97 46 N/A 27.56 55.12 82.68 110.25 137.81 165.37 192.93 47 N/A 29.37 58.75 88.12 117.50 146.87 176.24 205.62 48 N/A 31.31 62.62 93.93 125.24 156.56 187.87 219.18 49 13.37 33.42 66.83 100.25 133.66 167.08 200.49 233.91 50 14.27 35.67 71.33 107.00 142.66 178.33 213.99 249.66 51 15.07 37.68 75.36 113.05 150.73 188.41 226.09 263.77 52 15.91 39.78 79.56 119.35 159.13 198.91 238.69 278.47 53 16.80 42.01 84.01 126.02 168.03 210.03 252.04 294.05 54 17.75 44.38 88.75 133.13 177.51 221.89 266.26 310.64 55 18.74 46.85 93.70 140.56 187.41 234.26 281.11 327.97 56 20.15 50.38 100.76 151.14 201.53 251.91 302.29 352.67 57 21.67 54.18 108.36 162.54 216.72 270.91 325.09 379.27 58 23.29 58.23 116.46 174.69 232.92 291.16 349.39 407.62 59 25.02 62.55 125.10 187.65 250.21 312.76 375.31 437.86 60 26.87 67.18 134.37 201.55 268.74 335.92 403.11 470.29 61 29.15 72.88 145.76 218.64 291.52 364.40 437.28 510.16 62 31.57 78.93 157.86 236.79 315.72 394.65 473.58 552.51 63 34.15 85.38 170.75 256.13 341.50 426.88 512.25 597.63 64 36.90 92.26 184.52 276.78 369.04 461.29 553.55 645.81 65 39.82 99.56 199.12 298.68 398.23 497.79 597.35 696.91 66 44.33 110.82 221.65 332.47 443.30 554.12 664.95 775.77 67 49.12 122.80 245.60 368.40 491.20 614.00 736.80 859.59 68 54.23 135.59 271.17 406.76 542.34 677.93 813.52 949.10 69 59.72 149.29 298.58 447.87 597.16 746.45 895.74 1,045.03 70 65.59 163.97 327.95 491.92 655.89 819.86 983.84 1,147.81 Actual premiums may vary slightly due to administrative system rounding. (*) Rider Keys: TI=Terminal Illness Accelerated Benefit: All ages, LTC25=LTC Accelerated Benefit (excluding term riders) up to 25 months: Ages 18-80 Initial death benefit is guaranteed to later of 25 years or age 70. After this period, death benefit is projected level to age 121. Guarantees are based upon 2.00% interest and guaranteed insurance charges. Non-guaranteed benefits include credits based upon 3.5% interest and current insurance charges. The Age Paid Up is the attained age where the initial base death benefit (excluding death benefit provided by term rider) is projected to be fully paid-up under current assumptions. The plan has no cash surrender or loan values. Prepared: This quote 8/14/2014 These are quotations 53and not a contract

Combined Insurance Company of America Lifetime Benefit Term Quotes, Page 1 of 1 Generated from Quote System (...035_140602.xls) Prepared For: Sample rates Defined Benefit (OPTIONAL AMOUNTS) Monthly (12 times) RIDERS INCLUDED(*): TI, LTC25 (vary) Class: M30_NS_NC Riders TI, LTC25 TI, LTC25 TI, LTC25 Iss Age $ 200,000 $ 225,000 $ 250,000 19 76.50 86.06 95.62 20 76.50 86.06 95.62 21 78.16 87.93 97.70 22 79.83 89.81 99.79 23 81.33 91.50 101.66 24 83.33 93.75 104.16 25 85.00 95.62 106.25 26 87.93 98.92 109.91 27 91.03 102.41 113.79 28 94.13 105.90 117.66 29 97.56 109.76 121.95 30 101.00 113.62 126.24 31 105.40 118.57 131.74 32 109.96 123.71 137.45 33 114.70 129.03 143.37 34 119.43 134.36 149.29 35 124.66 140.24 155.83 36 131.09 147.48 163.87 37 138.03 155.28 172.53 38 145.13 163.27 181.41 39 152.89 172.01 191.12 40 160.83 180.93 201.03 41 169.16 190.30 211.45 42 177.99 200.24 222.49 43 187.16 210.55 233.95 44 196.83 221.43 246.03 45 206.83 232.68 258.53 46 220.49 248.05 275.61 47 234.99 264.36 293.74 48 250.49 281.80 313.11 49 267.32 300.74 334.15 50 285.32 320.99 356.65 51 301.45 339.14 376.82 52 318.25 358.04 397.82 53 336.05 378.06 420.07 54 355.02 399.40 443.77 55 374.82 421.67 468.52 56 403.05 453.43 503.81 57 433.45 487.63 541.81 58 465.85 524.08 582.31 59 500.41 562.96 625.52 60 537.48 604.66 671.85 61 583.04 655.92 728.80 62 631.44 710.37 789.30 63 683.01 768.38 853.76 64 738.07 830.33 922.59 65 796.47 896.03 995.59 66 886.60 997.42 1,108.25 67 982.39 1,105.19 1,227.99 68 1,084.69 1,220.28 1,355.86 69 1,194.32 1,343.61 1,492.90 70 1,311.78 1,475.75 1,639.73 Actual premiums may vary slightly due to administrative system rounding. (*) Rider Keys: TI=Terminal Illness Accelerated Benefit: All ages, LTC25=LTC Accelerated Benefit (excluding term riders) up to 25 months: Ages 18-80 Initial death benefit is guaranteed to later of 25 years or age 70. After this period, death benefit is projected level to age 121. Guarantees are based upon 2.00% interest and guaranteed insurance charges. Non-guaranteed benefits include credits based upon 3.5% interest and current insurance charges. The Age Paid Up is the attained age where the initial base death benefit (excluding death benefit provided by term rider) is projected to be fully paid-up under current assumptions. The plan has no cash surrender or loan values. Prepared: This quote 8/14/2014 These are quotations 54and not a contract

Combined Insurance Company of America Lifetime Benefit Term Quotes, Page 1 of 1 Generated from Quote System (...035_140602.xls) Prepared For: Sample rates Defined Benefit (OPTIONAL AMOUNTS) Monthly (12 times) RIDERS INCLUDED(*): TI, LTC25 Class: M30_SM_NC Riders TI, LTC25 TI, LTC25 TI, LTC25 TI, LTC25 TI, LTC25 TI, LTC25 TI, LTC25 TI, LTC25 Iss Age $ 10,000 $ 25,000 $ 50,000 $ 75,000 $ 100,000 $ 125,000 $ 150,000 $ 175,000 19 N/A N/A 25.08 37.62 50.16 62.71 75.25 87.79 20 N/A N/A 25.08 37.62 50.16 62.71 75.25 87.79 21 N/A N/A 25.79 38.69 51.58 64.48 77.37 90.27 22 N/A 13.25 26.50 39.75 53.00 66.25 79.50 92.75 23 N/A 13.62 27.25 40.87 54.50 68.12 81.75 95.37 24 N/A 14.02 28.04 42.06 56.08 70.10 84.12 98.14 25 N/A 14.40 28.79 43.19 57.58 71.98 86.37 100.77 26 N/A 14.89 29.78 44.67 59.56 74.46 89.35 104.24 27 N/A 15.43 30.86 46.29 61.71 77.14 92.57 108.00 28 N/A 15.95 31.89 47.84 63.78 79.73 95.67 111.62 29 N/A 16.50 33.01 49.51 66.01 82.52 99.02 115.52 30 N/A 17.08 34.17 51.25 68.33 85.41 102.50 119.58 31 N/A 17.80 35.59 53.39 71.18 88.98 106.77 124.57 32 N/A 18.55 37.10 55.65 74.20 92.75 111.30 129.84 33 N/A 19.32 38.65 57.97 77.30 96.62 115.95 135.27 34 N/A 20.14 40.28 60.42 80.56 100.70 120.85 140.99 35 N/A 20.98 41.96 62.93 83.91 104.89 125.87 146.85 36 N/A 22.05 44.10 66.15 88.20 110.25 132.29 154.34 37 N/A 23.20 46.41 69.61 92.81 116.02 139.22 162.42 38 N/A 24.40 48.80 73.20 97.60 122.00 146.39 170.79 39 N/A 25.70 51.40 77.10 102.80 128.49 154.19 179.89 40 N/A 27.02 54.04 81.06 108.08 135.10 162.12 189.14 41 N/A 28.66 57.31 85.97 114.63 143.29 171.94 200.60 42 N/A 30.42 60.84 91.26 121.68 152.10 182.52 212.94 43 N/A 32.24 64.49 96.73 128.98 161.22 193.47 225.71 44 13.68 34.19 68.39 102.58 136.78 170.97 205.17 239.36 45 14.49 36.23 72.46 108.68 144.91 181.14 217.37 253.59 46 15.44 38.59 77.18 115.77 154.36 192.95 231.54 270.13 47 16.44 41.10 82.20 123.30 164.39 205.49 246.59 287.69 48 17.50 43.75 87.50 131.26 175.01 218.76 262.51 306.27 49 18.65 46.61 93.23 139.84 186.46 233.07 279.69 326.30 50 19.86 49.64 99.29 148.93 198.58 248.22 297.86 347.51 51 21.13 52.83 105.66 158.49 211.32 264.16 316.99 369.82 52 22.48 56.21 112.41 168.62 224.82 281.03 337.24 393.44 53 23.91 59.77 119.54 179.31 239.07 298.84 358.61 418.38 54 25.39 63.48 126.95 190.43 253.91 317.38 380.86 444.34 55 26.97 67.43 134.87 202.30 269.74 337.17 404.61 472.04 56 28.97 72.42 144.84 217.25 289.67 362.09 434.51 506.93 57 31.09 77.71 155.43 233.14 310.85 388.57 466.28 543.99 58 33.32 83.30 166.60 249.90 333.20 416.50 499.81 583.11 59 35.71 89.28 178.57 267.85 357.14 446.42 535.70 624.99 60 38.22 95.56 191.12 286.68 382.23 477.79 573.35 668.91 61 41.38 103.45 206.90 310.35 413.80 517.25 620.70 724.15 62 44.71 111.78 223.56 335.34 447.12 558.89 670.67 782.45 63 48.23 120.57 241.13 361.70 482.26 602.83 723.40 843.96 64 51.94 129.85 259.71 389.56 519.41 649.27 779.12 908.97 65 55.86 139.66 279.32 418.98 558.64 698.31 837.97 977.63 66 62.02 155.06 310.11 465.17 620.23 775.28 930.34 1,085.39 67 68.56 171.39 342.78 514.17 685.56 856.94 1,028.33 1,199.72 68 75.51 188.78 377.57 566.35 755.14 943.92 1,132.70 1,321.49 69 82.92 207.30 414.61 621.91 829.22 1,036.52 1,243.83 1,451.13 70 90.84 227.10 454.19 681.29 908.38 1,135.48 1,362.57 1,589.67 Actual premiums may vary slightly due to administrative system rounding. (*) Rider Keys: TI=Terminal Illness Accelerated Benefit: All ages, LTC25=LTC Accelerated Benefit (excluding term riders) up to 25 months: Ages 18-80 Initial death benefit is guaranteed to later of 25 years or age 70. After this period, death benefit is projected level to age 121. Guarantees are based upon 2.00% interest and guaranteed insurance charges. Non-guaranteed benefits include credits based upon 3.5% interest and current insurance charges. The Age Paid Up is the attained age where the initial base death benefit (excluding death benefit provided by term rider) is projected to be fully paid-up under current assumptions. The plan has no cash surrender or loan values. Prepared: This quote 8/14/2014 These are quotations 55and not a contract

Combined Insurance Company of America Lifetime Benefit Term Quotes, Page 1 of 1 Generated from Quote System (...035_140602.xls) Prepared For: Sample rates Defined Benefit (OPTIONAL AMOUNTS) Monthly (12 times) RIDERS INCLUDED(*): TI, LTC25 (vary) Class: M30_SM_NC Riders TI, LTC25 TI, LTC25 TI, LTC25 Iss Age $ 200,000 $ 225,000 $ 250,000 19 100.33 112.87 125.41 20 100.33 112.87 125.41 21 103.16 116.06 128.95 22 106.00 119.25 132.49 23 109.00 122.62 136.24 24 112.16 126.18 140.20 25 115.16 129.56 143.95 26 119.13 134.02 148.91 27 123.43 138.86 154.29 28 127.56 143.51 159.45 29 132.03 148.53 165.04 30 136.66 153.74 170.83 31 142.36 160.16 177.95 32 148.39 166.94 185.49 33 154.59 173.92 193.24 34 161.13 181.27 201.41 35 167.83 188.80 209.78 36 176.39 198.44 220.49 37 185.63 208.83 232.03 38 195.19 219.59 243.99 39 205.59 231.29 256.99 40 216.16 243.18 270.20 41 229.26 257.91 286.57 42 243.36 273.78 304.20 43 257.96 290.20 322.45 44 273.56 307.75 341.94 45 289.82 326.05 362.28 46 308.72 347.31 385.90 47 328.79 369.89 410.98 48 350.02 393.77 437.52 49 372.92 419.53 466.15 50 397.15 446.79 496.44 51 422.65 475.48 528.31 52 449.65 505.85 562.06 53 478.15 537.92 597.68 54 507.81 571.29 634.77 55 539.48 606.91 674.35 56 579.34 651.76 724.18 57 621.71 699.42 777.14 58 666.41 749.71 833.01 59 714.27 803.56 892.84 60 764.47 860.03 955.59 61 827.60 931.05 1,034.50 62 894.23 1,006.01 1,117.79 63 964.53 1,085.09 1,205.66 64 1,038.83 1,168.68 1,298.53 65 1,117.29 1,256.95 1,396.61 66 1,240.45 1,395.51 1,550.56 67 1,371.11 1,542.50 1,713.89 68 1,510.27 1,699.06 1,887.84 69 1,658.43 1,865.74 2,073.04 70 1,816.76 2,043.86 2,270.95 Actual premiums may vary slightly due to administrative system rounding. (*) Rider Keys: TI=Terminal Illness Accelerated Benefit: All ages, LTC25=LTC Accelerated Benefit (excluding term riders) up to 25 months: Ages 18-80 Initial death benefit is guaranteed to later of 25 years or age 70. After this period, death benefit is projected level to age 121. Guarantees are based upon 2.00% interest and guaranteed insurance charges. Non-guaranteed benefits include credits based upon 3.5% interest and current insurance charges. The Age Paid Up is the attained age where the initial base death benefit (excluding death benefit provided by term rider) is projected to be fully paid-up under current assumptions. The plan has no cash surrender or loan values. Prepared: This quote 8/14/2014 These are quotations 56and not a contract

Section 125 Services Provided By: Wellington Benefits a Member of the First Financial Group of America 3904 Oleander Drive, Suite 200 Wilmington, NC 28403 (800) 924-3539 Section 125 Third Party Administrator: First Financial Administrators, Inc. P.O. Box 670329 Houston, TX 77267-0329 (800) 523-8422 www.ffga.com