2025 Brunswick Community College Employee Benefits Guide : simplebooklet.com

Benefit & Plan Information Eligibility: Full-time employees working 30 hours or more per week. Benefit Plan Year: The annual Brunswick Community College Benefit plan year is January 1 through December 31 General Employee Information: Spending Accounts Enrollment is required during open enrollment to either accept or decline the opportunity to participate in these benefits and declare your participation level. You will not be automatically enrolled. Pre-taxed Insurance Products You must enroll for new pre-taxed and/or change pre-taxed benefits during open enrollment. Payroll Deductions Spending Accounts and Insurance Products Deductions will begin monthly with your pay period in January 2025. New Benefits Effective January 1, 2025 •You must be actively at work for insured benefits to become effective.Spending Accounts – Use It or risk Losing It •Health Flexible Spending Account are fully funded on the first day of the plan year.•Do not set aside more funds than you can use by December 31, 2025.•Dependent Care funds will not be available until funds are deposited into your account.Insurance Products•Benefits effective January 1, 2025oEmployees must be actively at work (not on disability or FMLA).oIf you are out of work due to injury or sickness on January 1, 2025, benefits become effectiveon the first day back at work performing your regular duties on a full-time basis.Page 3

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Benefit Counselor Sessions Enrollment Information Face-to-Face enrollment Benefit counselor meetings provide an opportunity to have questions answered while enrolling for benefits selected for you and your family. The counselor will complete the submission for you assuring accurate an d timely activation of benefits. Please review the information made available to you prior to your meeting. Family Information for Enrollment When enrolling your spouse and/or children, please have their dates of birth and social security numbers available. Benefit Summary of Coverage After enrolling in one or more of the benefit plans, the Provider may issue a policy or certificate of coverage for you. Insurance certificates are 40 or more pages in length. The carrier may issue a single certificate for all insureds and have it available at the office of human resources for viewing. Certificates are also available via PDF files, and online. Having the policy or certificate online makes it easy to determine the benefits of your plan 24 hours a day. Certificate and/or Policy Information Coverage provided by the various voluntary supplemental benefits may have limitations and exclusions. Please refer to your policy or certificate for specific coverage. Even though several policies are deducted from your pay before taxes, the benefits may be subject to federal and/or state tax. IMPORTANT NOTE & DISCLAIMER This is neither an insurance contract nor a Summary Plan Description; actual policy provisions apply. Information provided in this booklet is subject to change. Policy descriptions are for information purposes only. Actual policies may be different from the policies described in this booklet. Page 4

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The NC 401(k) Plan The NC 401(k) Plan is a retirement savings plan administered by the North Carolina Department of State Treasurer, and available exclusively to North Carolina public employees who are actively contributing to one of the NC Retirement Systems. North Carolina state and local government employers offer this Plan to help you reach your retirement savings goals. The Plan offers you these benefits: • Automatic payroll deductions. Contributions to the NC 401(k) Planare made through payroll deduction.• You may change or stop your contributions at any time, andno minimum contribution is required.• 100% vesting. You are fully vested in the NC 401(k) Plan from yourfirst contribution to your last. To be “vested” means to own, whichmeans the money is always yours.• Convenient asset consolidation. To simplify your financial life, the NC401(k) Plan allows for rollovers from other retirement plans you mayhave from former employers, including 401(k), 401(a), 403(b),Governmental 457 and TSP plans, and some IRAs.• Multiple investment choices. You can invest in vehicles thatrange from potentially high growth to highly conservative, soyou can make the most appropriate choice to help you meet yoursavings goals.• Simple investing with GoalMaker. GoalMaker® is an optional,easy-to-use asset allocation program available at no additional costthat automatically guides you to an age-appropriate investmentmix based on your investor style. Past performance of investmentsor asset classes does not guarantee future results.• Quarterly statements to keep you informed. Statements areprovided after the end of each quarter to help you monitor activityin your account.• Online retirement planning tools. You may access your account24 hours a day, 7 days a week. You may also access a host ofretirement articles, interactive calculators and other resourcesat myNCPlans.com.• One-on-one help. The NC 401(k) Plan has knowledgeableRetirement Education Counselors* strategically located throughoutNorth Carolina to help you get the most from your participationin the Plan. These representatives are a resource available to Planmembers by phone, email or in person.*Retirement counselors are registered with Empower Financial Services,Inc., Member FINRA/SIPC. EFSI is an affiliate of Empower Retirement, LLC; Empower Funds, Inc.; and registered investment adviser Empower Advisory Group, LLC. This material is for informational purposes only and is notintended to provide investment, legal or tax recommendations or advice.For details about the Plan’s investment options, please visit myNCPlans.com and go to the Choose Investments tab to view the quarterly fund fact sheets. Page 5

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Traditional pre-tax contributions Pre-tax contributions are automatically deducted from your paycheck before any federal or state income taxes are taken out, therefore reducing your taxable income. As a result, your take-home pay is not impacted by the full amount of your contribution. Additionally, these contributions have the potential to grow tax-deferred until withdrawal. At that point, federal and state income taxes will be incurred. Roth after-tax contributions Roth contributions are automatically deducted from your paycheck after taxes are paid and therefore reduce your take-home pay dollar for dollar. Roth contributions and returns have the potential to grow tax-deferred and can benefit members who anticipate being in a higher tax bracket while in retirement and would rather pay taxes at today’s tax rate. Qualified distributions are federal income tax-free.* Special “One Time” Contributions If you wish to defer additional compensation that will be deducted for only one payroll cycle for reasons such as longevity payments, or final payouts of unused vacation and/or bonus leave, you may coordinate this deduction with your payroll office. You can obtain a One Time Contribution Form by visiting the Tools & Resources tab at myNCPlans.com. Submit the completed form directly to your payroll office. Total annual contributions may not exceed IRS limits. * Amounts withdrawn before age 59½ may be subject to a 10% federal income tax penalty, applicable taxes and plan restrictions. Withdrawals are taxed at ordinaryincome tax rates. See plan information regarding limitations on withdrawals from your 401(k) account. According to IRS rules, a distribution from a Roth 401(k)is qualified to be tax-free if the first Roth contribution to your account remains in the account for at least five tax years AND: a) you are age 59½ or older, or b) disability or death. If your withdrawal does not meet these conditions, then the Roth earnings—but not the Roth contributions—may be subject to state andfederal income taxes.Information and interactive calculators are made available to you as self-help tools for your independent use and are not intended to provide investment advice.We cannot and do not guarantee their applicability or accuracy in regards to your individual circumstances. All examples are hypothetical and are for illustrative purposes.We encourage you to seek personalized advice from qualified professionals regarding all personal finance issues. We do not provide investment OR tax advice; please consult a tax advisor for more information.You save per month $25 $100 $200 $300 10 years $4,327 $17,308 $34,617 $51,925 15 years $7,924 $31,696 $63,392 $95,089 20 years $13,023 $52,093 $104,185 $156,278 30 years $30,499 $121,997 $243,994 $365,991 Assumes 7% annual return. The compounding concept is hypothetical and for illustrative purposes only and is not intended to represent performance of any specific investment, which may fluctuate. This example is based on a hypothetical rate of return of 7% compounded annually. No taxes are considered in the calculations; generally withdrawals are taxable at ordinary rates. It is possible to lose money by investing in securities. The Plan accepts rollovers from other qualified retirement plans you may have from former employers, including 401(k), 401(a), 403(b), governmental 457 plans and TSP plans, as well as Traditional, Conduit, SIMPLE and SEP IRAs. Under current IRS guidelines, Roth IRAs are not eligible for rollover into the Plan. All rollover requests must receive pre-approval from the Plan before funds can be received. Initiating a rollover into your 401(k) Plan is easy, and it offers many benefits, including: Page 6

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We understand that there may be times when you need to access the funds in your retirement account sooner rather than later. The NC 401(k) Plan gives you the ability to do this through: • Loans. Active employees may be eligible to borrow money from theiraccount for any purpose. Loans are repaid through payroll deduction,with the interest paid directly to your account. The minimum loan is$1,000, and the maximum loan is 50% of your account value, up to$50,000. You have up to five years to repay a loan. You may only haveone loan outstanding at any time. Restrictions apply. There is a $60 feefor taking out a loan. Please keep in mind that loans and withdrawalscan affect your account balance.1• In-service distributions. Plan members who are age 59½ or oldercan withdraw or roll over all or part of an account balance to anotherqualified retirement savings vehicle, like an IRA. In addition, andregardless of age, members may elect to roll over all or a portion of theirbalance to the North Carolina Retirement Systems to purchase servicecredits—this type of distribution is NOT subject to ordinary income tax.• Hardship withdrawals. If you’re younger than age 59½, several typesof hardship withdrawals are available, depending on the circumstances.Qualifying hardship withdrawals include: – Expenses for medical care previously incurred by you, your spouse,your primary beneficiary or any dependents.– Costs directly related to the purchase of your principal residence,excluding mortgage payments.– Tuition, related educational fees, and room and board expensesfor the next 12 months of post-secondary education for yourself,your spouse, your primary beneficiary or dependents.– Funeral/burial expenses for a parent, spouse, child, dependent orprimary beneficiary.– Payments necessary to prevent your eviction from your principalresidence or foreclosure on the mortgage of your principal residence.– Certain expenses relating to the repair of damage to yourprincipal residence.– Expenses and losses (including loss of income) incurred on accountof a FEMA-declared disaster if you live or work in a FEMA-designateddisaster area.Hardship withdrawals are subject to income tax and, if prior to age 59½, a 10% tax penalty. When you leave employment, you can choose what to do with your money in the NC 401(k) Plan:* Withdrawal restrictions apply to participants who retire or leave a covered position at an employer that participates in the NC 401(k) Plan, and, after doing so, transition to a covered position with another employer that participates in the Plan. • Leave your funds in the Plan: Contributions to the Plan stop whenyou leave employment, but the investments in your account remaininvested and continue to work for you. Federal rules require thatyou must begin taking minimum distributions by April 1 in the yearfollowing the year that you turn age 72,2 provided you are no longerworking for the plan sponsor (employer).• Take a systematic withdrawal (periodic payments to fit your need):You can opt to receive monthly, quarterly, semiannual or annualinstallment payments.*• Take a full or partial lump-sum withdrawal: This option allows you towithdraw all or a portion of your account balance on an as-neededbasis, at your discretion.**• Roll over all or a part of your balance to an eligible employer- sponsored retirement plan or to an IRA (Individual RetirementAccount): A rollover to a qualified plan is not subject to taxes orpenalties, provided the check is made payable to the financialinstitution receiving the funds.• Generate monthly lifetime income: Transfer all or a portion of yourpre-tax account balance to North Carolina’s Teachers’ and StateEmployees’ Retirement System (TSERS) or Local GovernmentalEmployees’ Retirement System (LGERS), where it can be paid asa monthly benefit for your lifetime and/or the lifetime of yourdesignated survivor. At or after retirement with TSERS or LGERS, Planmembers can select from among a variety of income stream options inaddition to their monthly pension benefit. This one-time (irrevocable)transfer is only applicable to pre-tax contributions, including fundsrolled into the Plan and any employer contributions.1 Any outstanding loan balance not paid back at termination becomes taxable in the year of default. Under the Tax Cuts and Jobs Act of 2018 for defaults related to termination of employment after 2017, the individual has until the due date of that year's return (including extensions) to roll over this amount to an IRA or qualified employer plan. Page 7

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The NC 457 Plan The NC 457 Plan is a deferred compensation plan administered by the North Carolina Department of State Treasurer, and available exclusively to those North Carolina public employees whose employers offer the Plan. This includes full-time, part-time and temporary employees; elected and appointed officials; rehired retired employees and North Carolina state and local government employees. The Plan offers you these benefits: •Automatic payroll deductions. Contributions to the NC 457 Planare made through payroll deduction.•You may change or stop your contributions at any time, andno minimum contribution is required.•100% vesting. You are fully vested in the Plan from your firstcontribution to your last. To be “vested” means to own, whichmeans the money is always yours.•Penalty-free withdrawals. Withdrawals from your NC 457 Plan accountare never subject to a 10% federal income tax penalty, regardless ofyour age at the time of withdrawal. Remember that the NC 457 Planis a single-state plan, administered by the North Carolina Departmentof State Treasurer, available to all eligible employees whose employersoffer the Plan. Withdrawal restrictions apply to participants who retireor leave a covered position at an employer that participates in theNC 457 Plan, and, after doing so, transition to a covered position withanother employer that participates in the Plan.•Convenient asset consolidation. To simplify your financial life, theNC 457 Plan allows for rollovers from other retirement plans youmay have from former employers, including 401(k), 401(a), 403(b),governmental 457 and TSP plans, and some IRAs.•Online retirement planning tools. You may access your account 24hours a day, 7 days a week. You may also access a host of information,interactive calculators and other resources at myNCPlans.com.•Multiple investment choices. You can invest in vehicles that rangefrom potentially high growth to highly conservative, so you can makethe most appropriate choice to help you meet your savings goals.•Simple investing with GoalMaker. GoalMaker® is an optional, easy- to-use asset allocation program available at no additional cost thatautomatically offers you an age-appropriate investment mix based onyour investor style. Past performance of investments or asset classesdoes not guarantee future results.•Quarterly statements to keep you informed. Statements are providedafter the end of each quarter to help you monitor activity in your account.•One-on-one help. The NC 457 Plan has knowledgeable EmpowerRetirement Education Counselors* strategically located throughoutNorth Carolina to help you to get the most from your participationin the Plan. These representatives are a resource available to Planmembers by phone, email, in person, or through a virtual one-on-onefrom your smartphone or computer.*Retirement counselors are registered with Empower Financial Services, Inc.,Member FINRA/SIPC. EFSI is an affiliate of Empower Retirement, LLC; EmpowerFunds, Inc.; and registered investment adviser Empower Advisory Group, LLC. This material is for informational purposes only and is not intended to provide investment, legal or tax recommendations or advice.For details about the Plan’s investment options, please visit myNCPlans.com and go to the Choose Investments tab to view the quarterly fund fact sheets. Page 8

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Traditional pre-tax contributions Pre-tax contributions are automatically deducted from your paycheck before any current federal or state income taxes are taken out,therefore reducing your taxable income. As a result, your take- home pay is not impacted by the full amount of your contribution. Additionally, these contributions grow tax-deferred until withdrawal. At that point, federal and state income taxes will be incurred. Roth after-tax contributions Roth contributions are automatically deducted from your paycheck after current taxes are paid and therefore reduce your take-home pay dollar for dollar. Roth contributions and earnings grow tax-deferred and can benefit members who anticipate being in a higher tax bracket while in retirement and would rather pay taxes at today’s tax rate. Qualified distributions are federal income tax free.* Special “One-Time” Contributions If you wish to defer additional compensation that will be deducted for only one payroll cycle for reasons such as longevity payments, or final payouts of unused vacation and/or bonus leave, you may coordinate this deduction with your payroll office. You can obtain a One Time Contribution Form by visiting the Tools & Resources tab at myNCPlans.com. Submit the completed form directly to your payrolloffice. Total annual contributions may not exceed IRS limits.*There are two separate sets of rules for taking distributions from your NC 457 Roth account on a tax-free basis. The first NC 457 Plan rule states you can only take adistribution after you: (i) separate from service; or (ii) attain age 59½ while still in service. The second, an IRS rule, defines what is considered a “qualified” distributionfrom a Roth Account in order to be tax free.** Taken together, this means that you can withdraw money from your NC 457 Roth Account tax free once you meet thefollowing criteria: The first Roth contribution to your account must remain in your account for at least five tax years; AND: a) you have separated from service and areage 59½ or older; or b) you have separated from service due to a death or disability retirement; or c) you are still working and are at least age 59½. If your withdrawaldoes not meet these conditions, then the Roth earnings—but not the Roth contributions—may be subject to state and federal income taxes.**The criteria outlined by the IRS is for tax-free treatment for federal income tax purposes. Your withdrawal may also be eligible for state tax-free treatment.You save per month $25 $100 $200 $300 10 years $4,327 $17,308 $34,617 $51,925 15 years $7,924 $31,696 $63,392 $95,089 20 years $13,023 $52,093 $104,185 $156,278 30 years $30,499 $121,997 $243,994 $365,991 Assumes 7% annual return. The compounding concept is hypothetical and for illustrative purposes only and is not intended to represent performance of any specific investment, which may fluctuate. It is possible to lose money by investing in securities. No taxes are considered in the calculations; generally, withdrawals are taxable at ordinary rates. Page 9

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We understand that there may be times when you need to access the funds in your retirement account sooner rather than later. The NC 457 Plan gives you the flexibility to do this through: •Loans. Active employees may be eligible to borrow money from theiraccount for any purpose. Loans are repaid through payroll deduction,with the interest paid directly to your account. The minimum loan is$1,000, and the maximum loan is 50% of your account value, up to$50,000. You have up to five years to repay a loan. There’s also a15-year repayment allowed for the purchase of a primary residence.You may only have one loan outstanding at any time. There is a $60processing fee for taking out a loan. Please keep in mind that loansand withdrawals can affect your account balance.1•Voluntary small balance cash out request. You are allowedto withdraw your funds after 24 consecutive months with nocontributions and an account value of less than $5,000 withoutpenalty, but the amount may be subject to ordinary income tax.•In-service distributions.2 Plan members who are age 59½ or oldercan withdraw or roll over all or part of an account balance to anotherqualified retirement savings vehicle, like an IRA. In addition, andregardless of age, members may elect to roll over all or a portion of their balance to the North Carolina Retirement Systems to purchase service credits—this type of distribution is NOT subject to ordinary income tax. •Hardship withdrawals. There are several types of hardshipwithdrawals available, depending on the circumstances. Qualifyinghardship withdrawals include:–Medical expenses not covered by insurance for you, your spouseor dependents–Payments to prevent eviction from your principal residence,or foreclosure on the mortgage of your principal residence–Funeral/burial expenses for a parent, spouse, child orother dependent–Certain expenses relating to the repair of damage to yourprincipal residenceWhen you leave employment, you can choose what to do with your money in the NC 457 Plan The NC 457 Plan is a single-state plan, administered by the North Carolina Department of State Treasurer, available to all eligible employees whose employers offer the Plan. Withdrawal restrictions apply to participants who retire or leave a covered position at an employer that participates in the NC 457 Plan, and, after doing so, transition to a covered position with another employer that participates in the Plan. •Leave your funds in the Plan. Contributions to the Plan will stopwhen you leave employment, but the investments in your accountremain invested and continue to work for you. Federal rules requirethat you must begin taking minimum distributions by a certain age,provided you are no longer working for the plan sponsor (employer).To learn more, you can contact a tax professional.•Take a systematic withdrawal (periodic payments to fit your need).You can opt to receive monthly, quarterly, semiannual or annualinstallment payments.•Take a full or partial lump-sum withdrawal.3 This option allows youto withdraw all or a portion of your entire account balance on anas-needed basis at your discretion.*•Roll over all or a part of your balance to an eligible employer- sponsored retirement plan or to an Individual Retirement Account (IRA).3 A rollover to a qualified plan is not subject to taxes orpenalties, provided the check is made payable to the financialinstitution receiving the funds.•Generate monthly lifetime income. Transfer all or a portion of yourpre-tax account balance to the North Carolina’s Teachers’ and StateEmployees’ Retirement System (TSERS) or the Local GovernmentEmployees’ Retirement System (LGERS), where it can be paid asa monthly benefit for your lifetime and/or the lifetime of yourdesignated beneficiary. At or after retirement with TSERS or LGERS,Plan members can select from a variety of income stream options inaddition to their monthly pension benefit. This one-time, irrevocabletransfer is only applicable to pre-tax contributions, including fundsrolled into the Plan and any employer contributions.Page 10

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Flexible Spending Accounts from HealthEquity You must re-enroll each year to participate in FSA’s! Register to learn more about your options. Covered employees should register for online administration. You will be able to file and follow claims, check account balances, establish payments for dependent care, and more. Debit Card for Flexible Spending Account – The current Maximum Annual Available is $3200 Existing FSA participants may continue to use your current debit card. N ewly hired employees will receive a debit card to use for qualified purchases. Prior to receiving your card, you may file claims using the procedures provided in the back of this booklet. Benefit elections made during open enrollment cannot be changed after enrollment closes unless there is a qualifying event as defined by the Internal Revenue Code. Examples of qualifying events are marriage, divorce, death of a spouse or child, birth or adoption of a child, termination or commencement of a spouse's employment, or certain changes of a spouse's employment. You have 30 days from the date of the qualifying event to request a change in benefits. Flexible Spending Account expenses must be incurred during the Plan Year to be eligible for reimbursement. Filing claims timely can prevent loss of funds. If employment terminates during the plan year, the employee's plan year ends the day employment ends. All claims should be submitted immediately upon termination. Dependent Care Flexible Spending Account – The Current Maximum Available is $5,000 The Dependent Care Flexible Spending Account maximum reimbursement is equal to your account balance. You cannot be reimbursed more than the amount in your account. Benefit Accessibility You will have access to your annual Medical FSA election on the ﬁrst day of the plan year. You will have access to your Dependent Care FSA after deductions are made and the funds have been transmitted to your account. Use it or Lose it Make sure you plan the use of your FSA. Leftover funds will be forfeited. Be sure to submit claims immediately after the end of the plan year. #1 USE YOUR CARD WHENEVER POSSIBLE #2 USE YOUR FSA TO PAY FOR SPOUSE & DEPENDENTS NEEDS #3 PAY FOR ELIGIBLE DENTAL AND VISION EXPENSES #4 CHECK AND KNOW YOUR FSA BALANCE Page 11

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GROUP VOLUNTARY ACCIDENT INSURANCE BENEFIT HIGHLIGHTS With Accident insurance, you’ll receive payment(s) associated with a covered injury and related services. You can use the payment in any way you choose – from expenses not covered by your major medical plan to day-to-day costs of living such as the mortgage or your utility bills. Every year nearly 3 million emergency room visits are caused by youth sports.1The Hartford can ease the financial pain!Brunswick Community CollegeCOVERAGE INFORMATION You have a choice of two accident plans, which allows you the flexibility to enroll for the coverage that best meets your needs. This insurance provides benefits when injuries, medical treatment and/or services occur as the result of a covered accident. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s). PLAN INFORMATION OPTION 1 OPTION 2 Coverage Type On and off-job (24 hour) On and off-job (24 hour) BENEFITS OPTION 1 OPTION 2 EMERGENCY, HOSPITAL & TREATMENT CARE Accident Follow-Up Up to 3 visits per accident within 90 days $100 $150 Accident Prevention Benefit Once per year for each covered person $75 $75 Acupuncture/Chiropractic Care/PT Up to 10 visits each per accident within 365 days $50 $75 Ambulance – Air Once per accident within 72 hours $2,000 $2,500 Ambulance – Ground Once per accident within 90 days $750 $1,000 Blood/Plasma/Platelets Once per accident within 90 days $300 $400 Child Care Up to 30 days per accident while insured is confined $35 $50 Daily Hospital Confinement Up to 365 days per lifetime $400 $600 Daily ICU Confinement Up to 30 days per accident $600 $800 Diagnostic Exam Once per accident within 90 days $300 $400 Emergency Dental Once per accident within 90 days Up to $450 Up to $600 Emergency Room Once per accident within 72 hours $200 $250 Hospital Admission Once per accident within 90 days $1 ,500 $ 2,000 Initial Physician Office Visit Once per accident within 90 days $100 $150 Lodging Up to 30 nights per lifetime $150 $175 Medical Appliance Once per accident within 90 days $200 $300 Rehabilitation Facility Up to 15 days per lifetime within 90 days $300 $450 Transportation Up to 3 trips per accident $600 $800 Urgent Care Once per accident within 72 hours $150 $200 X-rayOnce per accident within 90 days $150 $200 SPECIFIED INJURY & SURGERY OPTION 1 OPTION 2 Abdominal/Thoracic Surgery Once per accident within 90 days $3,000 $4,000 Arthroscopic Surgery Once per accident within 90 days $500 $750 Burn Once per accident within 72 hours Up to $15,000 Up to $20,000 Burn – Skin Graft Once per accident 50% of burn 5 0% of burn Concussion Up to 3 per year within 72 hours $200 $250 Dislocation Once per joint per lifetime Up to $8,000 Up to $12,000 ACCIDENT BHS_ ACTIVE FULL-TIME EMPLOYEE 0 01651 26 Page 13

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Eye Injury Once per accident within 90 days Up to $750 Up to $1,000 Fracture Once per bone per accident within 90 days Up to $10,000 Up to $12,000 Hernia Repair Once per accident within 364 days $400 $600 Joint Replacement Once per accident within 90 days $4,000 $6,000 Knee Cartilage Once per accident within 12 months Up to $2,000 Up to $3,000 Laceration Once per accident within 72 hours Up to $1 ,000 Up to $1,500 Ruptured Disc Once per accident within 365 days $2,000 $3,000 Tendon/Ligament/Rotator Cuff Once per accident Up to $2,000 Up to $3,000 CATASTROPHIC OPTION 1 OPTION 2 Accidental Death Within 90 days; Spouse @ 50% and child @ 25% $75,000 $100,000 Common Carrier Death Within 90 days 2 times death benefit 3 times death benefit Coma Once per accident within 90 days Up to $15,000 Up to $20,000 Dismemberment Once per accident within 90 days; spouse @ 100% and child @ 100% Up to $75,000 Up to $100,000 Home Health Care Up to 30 days per accident $75 $ 100 Paralysis Once per accident Up to $75,000 Up to $100,000 Prosthesis Once per accident Up to $3,000 Up to $4,000 Organized Amateur Sports Injury Enhancement Benefit adds extra benefits 25% of non- catastrophic benefits 25% of non-catastrophic benefits PREMIUMS The amounts shown are monthly amounts (12 payments/deductions per year) :4COVERAGE TIER OPTION 1 OPTION 2 Employee Only $11.91 $16.55 Employee & Spouse/Partner $18.77 $26.07 Employee & Child(ren) $20.38 $28.16 Employee & Family $31.88 $44.09 ASKED & ANSWERED WHO IS ELIGIBLE? You are eligible for this insurance if you are an active full-time employee who works at least 20 hours per week on a regularly scheduled basis. Your spouse and child(ren) are also eligible for coverage. Any child(ren) must be under age 26 (or under age 26 if a full -time student). CAN I INSURE MY DOMESTIC OR CIVIL UNION PARTNER? Yes. Any reference to “spouse” in this document includes your domestic partner, civil union partner or equivalent, as recognized and allowed by applicable law. AM I GUARANTEED COVERAGE? This insurance is guaranteed issue coverage – it is available without having to provide information about your or your family’s health. All you have to do is elect the coverage to become insured. HOW MUCH DOES IT COST AND HOW DO I PAY FOR THIS INSURANCE? Premiums are provided above. You have a choice of plan options. You may elect insurance for you only, or for you and your dependent(s), by choosing the applicable coverage tier. Premiums will be automatically paid through payroll deduction, as authorized by you during the enrollment process. This ensures you don’t have to worry about writing a check or missing a payment. WHEN CAN I ENROLL? You may enroll during open enrollment. WHEN DOES THIS INSURANCE BEGIN? You must be actively at work with your employer on the day your coverage takes effect. Your spouse and child(ren) must be performing normal activities and not be confined (at home or in a hospital/care facility). ACCIDENT BHS_ ACTIVE FULL-TIME EMPLOYEE 0 01651 26 Page 14

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WHEN DOES THIS INSURANCE END? This insurance will end when you or your dependents no longer satisfy the applicable eligibility conditions, premium is unpaid, you are no longer actively working, you leave your employer, or the coverage is no longer offered. CAN I KEEP THIS INSURANCE IF I LEAVE MY EMPLOYER OR AM NO LONGER A MEMBER OF THIS GROUP? Yes, you can take this coverage with you. Coverage may be continued for you and your dependent(s) under a group portability policy. Your spouse may also continue insurance in certain circumstances. The specific terms and qualifying events for portability are described in the certificate. 1National Health Statistics Reports, November 2019. CDC/National Center for Health Statistics: https://www.cdc.gov/nchs/data/nhsr/nhsr133-508.pdf, as viewed as of 10/14/2020 4Rates and/or benefits may be changed on a class basis. The Buck’s Got Your Back ® The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including underwriting company Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. All benefits are subject to the terms and conditions of the policy. LIMITATIONS & EXCLUSIONS This insurance coverage includes certain limitations and exclusions. The certificate details all provisions, limitations, and exclusions for this insurance coverage. A copy of the certificate can be obtained from your employer. GROUP ACCIDENT INSURANCE LIMITATIONS AND EXCLUSIONS The benefits payable are based on the insurance in effect on the date of the covered accident, subject to the definitions, limitations, exclusions and other provisions of the policy. You and your dependent(s) must be citizens or legal residents of the United States, its territories and protectorates. This insurance does not provide benefits for any loss that results from or is caused by:  Suicide or attempted suicide, whether sane or insane, or intentionally self-inflicted injury War or act of war, whether declared or undeclared, or a nuclear, chemical, biological, or radiological event A covered person's participation in a felony, riot or insurrection A covered person's service in the armed forces or units auxiliary to it  A covered person's taking drugs, unless as prescribed by or administered by a physician, or being intoxicated as defined by the jurisdiction in which the cause ofloss was incurred A covered person’s sickness or bacterial infection A covered person’s participation in bungee jumping or hang gliding A covered person’s participation or competition in semi-professional or professional sports Cosmetic surgery or any other elective procedure that is not medically necessary While a covered person is on any aircraft: as a pilot, crewmember or student pilot; as a flight instructor or examiner; if it is owned, operated or leased by oron behalf of the policyholder, or any employer or organization whose eligible persons are covered under the policy; or being used for tests, experimentalpurposes, stunt flying, racing or endurance tests Operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft Riding in or driving any motor-driven vehicle in a race, stunt show or speed test All exclusions may not be applicable, or may be adjusted, as required by state regulations in the situs state of a group. NOTICES THIS IS A LIMITED ACCIDENT ONLY BENEFIT POLICY THIS POLICY IS A LIMITED ACCIDENT ONLY BENEFIT POLICY. This limited benefit plan (1) does not constitute major medical coverage, and (2) does not satisfy the individual mandate of the Affordable Care Act (ACA) because the coverage does not meet the requirements of minimum essential coverage. In New York: This Accident policy provides ACCIDENT insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services. IMPORTANT NOTICE—THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS. 5962g NS 05/21 Accident Form Series includes GBD-2000, GBD-2300, or state equivalent. © 2020 The Hartford. ACCIDENT BHS_ ACTIVE FULL-TIME EMPLOYEE 0 01651 26 Page 15

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GROUP BENEFITS ACCIDENT INSURANCE Accident Prevention Benefit The Accident Prevention Benefit is an optional benefit available with The Hartford s group accident plans. The Accident Prevention Benefit is not available in all states.* (Please consult your Hartford representative or see below for current limitations.) The Hartford s Accident Prevention Benefit is payable once each year for each covered person employee/member, spouse/partner and any dependent child(ren). Accident Prevention Benefit claims may be submitted by the employee/member over the phone, through the online claims portal, or through traditional paper claim form (fax or mail). Methods of payment include traditional check or EFT/ACH (upon completion of registration for EFT/ACH payments). When the Accident Prevention Benefit is included in an accident plan, the exams, screenings and programs covered under the benefit include: a dental exam an eye exam a hearing exam an annual physical a sports physical a well-child exam an employer-sponsored wellness or biometric screening a serum cortisol test (for stress levels) successful completion of an appropriately licensed or accredited: -emotion management or stress reduction program-driver safety and training program-motorcycle safety and training program-workplace safety and training program*As of 5/7/20, the Accident Prevention Benefit is not available to group policies sitused in the following jurisdictions: CA, CO, DC, IN, MI, ND, NM, NH,NY, OR, VT or WA$75.00 Reimbursement The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including underwriting company Hartford Li fe and Accident Insurance Company. Home Office is Hartford, CT. All benefits are subject to the terms and conditions of the policy. Policies underwritten by the underwr iting company listed above detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued inforce or discontinued. ©2020 The Hartford. Accident Form Series includes GBD-2000, GBD-2300, or state equivalent. Page 16

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Group Voluntary Cancer (North Carolina) Benefits and Amounts HOSPITAL AND RELATED BENEFITS OPTION 1 OPTION 2 Continuous Hospital Confinement (daily) $100 $300 Government or Charity Hospital (daily) $100 $300 Private Duty Nursing Services (daily) $100 $300 Extended Care Facility (daily) $100 $300 At Home Nursing (daily) $100 $300 Freestanding Hospice Care Center (daily) or $100 $300 Hospice Care Team (per visit) $100 $300 RADIATION, CHEMOTHERAPY, AND RELATED BENEFITS Radiation/Chemotherapy for Cancer (every 12 months) $5,000 $12,500 Blood, Plasma, and Platelets (every 12 months) $5,000 $12,500 Hematological Drugs (yearly) $100 $250 Medical Imaging (yearly) $250 $625 SURGERY AND RELATED BENEFITS Surgery (maximum, depending on surgery) $1,500 $3,000 Anesthesia (% of Surgery Benefit) 25% 25% Ambulatory Surgical Center (daily) $250 $500 Second Opinion $200 $400 Bone Marrow or Stem Cell Transplant - Autologous* $500 $1,000 Non-autologous* $1,250 $2,500 Non-autologous for Leukemia* $2,500 $5,000 MISCELLANEOUS BENEFITS Inpatient Drugs and Medicine (daily) $25 $25 Physician’s Attendance (daily) $50 $50 Ambulance (per confinement) $100 $100 Non-Local Transportation (per trip or mile) Coach Fare or Coach Fare or $0.40/Mile $0.40/Mile Outpatient Lodging (daily, $2,000 max/12 months) $50 $50 Family Member Lodging (daily) and $50 $50 Transportation (per trip or mile) Coach Fare or Coach Fare or $0.40/Mile $0.40/Mile Physical or Speech Therapy (daily) $50 $50 New or Experimental Treatment (every 12 months) $5,000 $5,000 Prosthesis (per amputation) $2,000 $2,000 Hair Prosthesis (every 2 years) $25 $25 Nonsurgical External Breast Prosthesis $50 $50 Anti-Nausea Benefit (yearly) $200 $200 Waiver of Premium (primary insured only) Yes Yes OPTIONAL BENEFITS Cancer Initial Diagnosis (one-time benefit) $5,000 $5,000 Wellness (yearly) $100 $100 * Yearly Page 18

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Group Voluntary Cancer (North Carolina) PLAN DESIGN EE EE + SP EE + CH F Option 1 - Monthly $17.48 $27.81 $24.20 $34.50 1 Unit Hospital Benefits, 2 Units Radiation & Chemotherapy Benefits, 1 Unit Surgery Benefits, 1 Unit Miscellaneous Benefits, 4 Units Wellness Benefit, 5 Units Cancer Initial Diagnosis. Option 2 – Monthly 3 Units Hospital Benefits, 5 Units Radiation & Chemotherapy Benefits, 2 Units Surgery Benefits, 1 Unit Miscellaneous Benefits, 4 Units Wellness Benefit, 5 Units Cancer Initial Diagnosis. $30.30 $47.10 $42.73 $59.50 In addition to cancer, benefits (unless noted specifically for cancer) are also payable for: Muscular Dystrophy, Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease), Poliomyelitis, Multiple Sclerosis, Encephalitis, Rabies, Tetanus, Tuberculosis, Osteomyelitis, Diphtheria, Scarlet Fever, Cerebrospinal Meningitis (bacterial), Brucellosis, Sickle Cell Anemia, Thalassemia, Rocky Mountain Spotted Fever, Legionnaires' Disease (confirmation by culture or sputum), Addison's Disease, Hansen's Disease, Tularemia, Hepatitis (Chronic B or Chronic C with liver failure or Hepatoma), Typhoid Fever, Myasthenia Gravis, Reye's Syndrome, Primary Sclerosing Cholangitis (Walter Payton's Liver Disease), Lyme Disease, Systemic Lupus Erythematosus, Cystic Fibrosis, Primary Biliary Cirrhosis. EE=Employee EE + SP = Employee + Spouse EE + CH = Employee + Children F = Family Page 19

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G 4PICV BVA A 63831MJBC ecnarusnI ssenllI lacitir P sisongaid ssenlli lacitirc a htiw decaf nehw noitcetorI .ylkciuq worg nac secnanif ruoy ot tcapmi eht ,krow fo tuo uoy speek ti dna ssenlli lacitirc a htiw desongaid er’uoy f C .retteb gnitteg no sucof nac uoy os dnim ruoy esae pleh nac stifeneB etatsllA morf ecnarusnI ssenllI lacitirH skroW tI woH s'ere• muimerp dna tifeneb a tceleSa sdeen ruoy teem ot tnuom• hcae detcuded eb lliw smuimerPp doirep ya• lacitirc a htiw desongaid er'uoy fIi a eviecer dna mialc a elif ,ssenlll *tifeneb hsac mus-pmuP secnaniF ruoY gnitcetor M sdeeN ruoY gniteeT SIHT TUOBA KNIHB ,5302 y 4 .S.U eht fo %1.5 p ot detcejorp si noitalupo h DVC fo mrof emos eva† †E ,sdnoces 04 yrevs .S.U eht ni enoemo h ekorts a sa† E ,sdnoces 04 yreva reffus lliw naciremA n a kcatta traeh † †H noitaicossA traeH naciremA eht morF tropeR A :etadpU 3202—scitsitatS ekortS dna esaesiD trae . ††C /ne/gro.traeh.www//:sptth .esaesiD ralucsavoidraC = DV n wohs-scitsitats-stluda-nacirema-fo-flah-ylraen-tceffa-sesaesid-ralucsavoidrac/13/10/9102/swe * .eruhcorb siht fo noitces snoitatimiL dna snoisulcxE eht ot refer esaelPY – sgnivas ruoy rof drah dekrow ev'uo d .tuo meht epiw ssenlli lacitirc a tel t'no• sgnivas dna gnikcehc ruoy tcetorP• )k(104 ro ASH ruoy otni pid t'noD• tuohtiw egarevoc eussI deetnarauGa *noitatimiL noitidnoC gnitsixE-erP • stnedneped ruoy edulcni nac egarevoC• rehto yna fo sseldrager diap stifeneBm egarevoc nalp ytilibasid ro lacide• ot refer ;deunitnoc eb yam egarevoCy sliated rof etacifitrec ruoPage 22

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G 4PICV BVA A 63831MJBT levarC rof yap pleh na e elihw sesnepx r ni tnemtaert gniviece a ytic rehtonH emoC eht yap pleh na m latner eunitnoc ,egagtro p emoh droffa ro ,stnemya r erac retfa rof sriapeE sesnepxC s’ylimaf sih yap pleh na l sa hcus ,sesnepxe gnivi b sag dna ,yticirtcele ,slliF secnaniC ,sASH tcetorp pleh na s snalp tnemeriter ,sgniva a morf s)k(104 dn b detelped gnieC ESOOHU ESC .tnemllornE nepO s'reyolpme sih gnirud ecnarusnI ssenllI lacitirC stﬁeneB etatsllA rof pu sngis solraT .yrav yam ecneirepxe laudividni ruoy ;noitautis lanoitcif a sliated evoba elpmaxe ehF .5 dna 4 ,3 segap ees ,stnuoma tifeneb dna stifeneb fo gnitsil a roC ,latrop bew tneinevnoc eht hguorht egarevoc ssenllI lacitirC stifeneB etatsllA sih htiw mialc a selif solra M .*stifeneByH :rof tifeneb hsac mus-pmul a seviecer eC MIAL• ssenlleW dexiF• yregruS ssapyB yretrA yranoroCR yrevoceD noisiceD sisongaiW maxE ssenlle S yregruH sdnemmocer rotcod si s a evomer ot yregru b sllet dna egakcol C lliw yrevocer sih solra t skeew thgie ot xis ekaC sah solra b dna yregrus ssapy i rof latipsoh eht ni s 4 syad C emoh seog solra t yrevocer sih nigeb o a raluger sah dn d stisiv rotcoA a dna stset erom retf v ,tsigoloidrac a ot tisi C desongaid si solra w yranoroc htia esaesid yretrC stceted rotcod ’solra a noitidnoc traeh d launna sih gniru w maxe ssenlleM solraC teeO dna timbus ,ngiSe .stifeneb ruoy tuoba noitamrofni tnatropmi ot ssecca 7/42 sreff c tcerid eb ot stifeneb hsac tseuqer ,)yrotsih mialc gnidulcni( smialc ruoy kceh d .erom dna ,noitamrofni lanosrep ot segnahc ekam ,detisope* latroP gniliF mialC stifeneByMA moc.etatslla.stifenebym :sseccA :yrots sih s'ereH .esaesid yretra yranoroc a sah eh snrael solraC ,retal shtnom wef H stifeneb hsac sih esu nac solraC syaw eht fo emos era erePage 23

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G 4PICV BVA A 63831MJBB stifene - I STIFENEB SSENLLI LACITIRC LAITIN ( )setanimret egarevoc eht ,desu neeb evah stifeneb lla nehW .nosrep derevoc rep ecno diap stifeneBH kcattA trae - t eht fo noitrop a fo htaed eh h .ylppus doolb etauqedani ot eud elcsum trae E dna noitcrafni laidracoym )dlo( dehsilbats c derevoc ton era tserra caidraS ekort - t niarb eht fo noitrop a fo htaed eh p gnidulcni ealeuqes lacigoloruen gnicudor i dna egahrromeh ,eussit niarb fo noitcrafn e .ecruos lainarc-artxe na morf noitazilobm T ,yrujni daeh ,)sAIT( skcatta cimehcsi tneisnar c elbisrever dna ycneiciffusni ralucsavorberec cinorh i derevoc ton era sticifed lacigoloruen cimehcsE eruliaF laneR egatS dn - i fo eruliaf elbisreverr b ro sisylaid laenotirep ni gnitluser ,syendik hto h citamuart yb desuac eruliaf laneR .sisylaidome e derevoc ton era ,amuart lacigrus gnidulcni ,stnevM tnalpsnarT nagrO roja - p rehtie sya C tnalpsnarT lanoitaN no decalp fi tifeneB etadidna L ,traeh fo tnalpsnart rof tifeneB yregruS ro ,tsi l syendik dna sgnuL .syendik ro saercnap ,revil ,sgnu a fo sseldrager ,nagro rojam eno deredisnoc hcae er w era syendik ro sgnul htob ro eno rehteh t etadidnaC fi diap ton tifeneB yregruS .detnalpsnar B diap ton osla ;nagro rojam emas eht rof diap tifene f snagro namuh-non ro lacinahcem roC yregruS ssapyB yretrA yranoro - 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t eviecer ot gnilevaro ssenlli lacitirc derevoc a rof tnemtaert tneitaptu m emoh morf selim 57 naht ero• gnigdoL tneitaptuO - w tneitaptuo gniviecer elih t naht erom ssenlli lacitirc derevoc a rof tnemtaer 7 emoh morf selim 5• noitatropsnarT dna gnigdoL rebmeM ylimaF - f erac dna ynapmocca ot rebmem ylimaf tluda eno ro f lacol-non gnirud nosrep derevoc detaticapacni na roh ylimaf morf selim 57 naht erom( syats latipso m .tnemtaert dezilaiceps rof )emoh s'rebme T lacoL-noN fi diap ton tifeneb noitatropsnar T diap tifeneb noitatropsnarS rediR ssenllI cinorhC deificep - m eb tsu c eht fo eno gnivah sa naicisyhp a yb deifitre f noitcnufopyH lanerdA :sessenlli cinorhc gniwollo ( ;)SLA( esaesiD s’girheG uoL ;)esaesiD s’nosiddA A ;sisorelcS elpitluM ;aerohC s’notgnitnuH ;sitirhtr M .sisoropoetsO ;sitileymoetsO ;yhportsyD ralucsu M yliad owt tsael ta mrofrep ot elbanu eb tsu a seitivitca yliaD .syad 09 tsael ta rof seitivitc i dna reddalb ,gniteliot ,gnisserd ,gnihtab :edulcn b stifeneB .gnitae dna gnirrefsnart ,ecnenitnoc lewo p stifeneb lla nehW .nosrep derevoc rep ecno dia h setanimret egarevoc eht ,desu neeb evaS rediR yrujnI ro ssenllI cinorhC deificep - m tsu b eno ro yrujni na gnivah sa naicisyhp a yb deifitrec e o noitcnufopyH lanerdA :detsil sessenlli cinorhc eht f ( ;)SLA( esaesiD s’girheG uoL ;)esaesiD s’nosiddA A ;sisorelcS elpitluM ;aerohC s’notgnitnuH ;sitirhtr M .sisoropoetsO ;sitileymoetsO ;yhportsyD ralucsu M yliad owt tsael ta mrofrep ot elbanu eb tsu a seitivitca yliaD .syad 563 tsael ta rof seitivitc i dna reddalb ,gniteliot ,gnisserd ,gnihtab :edulcn b stifeneB .gnitae dna gnirrefsnart ,ecnenitnoc lewo p stifeneb lla nehW .nosrep derevoc rep ecno dia h setanimret egarevoc eht ,desu neeb evaS rediR ssenllI lacitirC latnemelppu - • esaesiD s'remiehzlA decnavdA - m tibihxe tsui deifitrec eb dna tnemgduj dna yromem deriapm u seitivitca yliad owt tsael ta mrofrep ot elban w :edulcni seitivitca yliaD .ecnatsissa tluda tuohti b lewob dna reddalb ,gniteliot ,gnisserd ,gnihta c gnitae dna gnirrefsnart ,ecnenitno• esaesiD s'nosnikraP decnavdA - m tibihxe tsut ,ytidigir elcsum :gniwollof eht fo erom ro ow t dna lacisyhp ni ssenwols( sisenikydarb ro ,romer m ot elbanu deifitrec eb dna ;)sesnopser latne p tluda tuohtiw seitivitca yliad owt tsael ta mrofre a ,gnihtab :edulcni seitivitca yliaD .ecnatsiss d ,ecnenitnoc lewob dna reddalb ,gniteliot ,gnisser t gnitae dna gnirrefsnar• romuT niarB ngineB - a romut tnangilam-non l ro sevren lainarc ,segninem ,niarb ot detimi p yratiutip ,lluks eht fo sromuT .dnalg yratiuti a era samonimreg dna ,mm01 naht ssel samonedn derevoc to• amoC - u ot evisnopser ton dna suoicsnocne lanretni ot evisnopser ro noitalumits lanretx n gnitluser amoc ,amoc decudni-yllacideM .sdee f niarb fo sisongaid dna ,esu gurd ro lohocla mor d derevoc ton era htae• gniraeH fo ssoL etelpmoC - p fo ssol tnenamreh srae htob ni gnirae• thgiS fo ssoL etelpmoC - p fo ssol tnenamrev seye htob ni noisi• hceepS fo ssoL etelpmoC - p fo ssol tnenamres noitacinummoc labrev ro hceep• sisylaraP - p ni noitcnuf elcsum fo ssol tnenamre t seoD .yrujni ro esaesid ot eud ,sbmil erom ro ow n ot detimil noitcnuf elcsum fo ssol edulcni to f seot ro sregniF rediR ssenlleW dexi - 2 rep ecnO .smaxe 4 p dexiF ees ;raey radnelac hcae yrogetac rep ,nosre W derevoc rof tset dna secivreS fo tsiL rediR ssenlle w stset dna secivres ssenlleF STSET DNA SECIVRES FO TSIL REDIR SSENLLEW DEXIB ,sedirecylgirt rof stset doolB ;recnac niks rof yspoi C ,)recnac nairavo( 521AC ,)recnac tsaerb( 3-51A C enoB ;)recnac etatsorp( ASP ,)recnac noloc( AE M rof eussit ro doolb fo gnilpmaS ;gnitseT worra g ;yar-X tsehC ;ksir recnac rof gnitset citene C ro ditorac rof gnineercs relppoD ;ypocsonolo p ;GKE ;margoidracohcE ;esaesid ralucsav larehpire F ;sisylana loots tluccomeH ;ypocsodiomgis elbixel H dipiL ;noitaniccaV )surivamollipaP namuH( VP p ,yhpargommaM ;)tnuoc loretselohc latot( lena i gnidulcni ,raemS paP ;dnuosartlU tsaerB gnidulcn T siserohportcelE nietorP mureS ,tseT paP perPnih ( ;llimdaert ro ekib no tset ssertS ;)amoleym rof tset T rof gnineercs dnuosartlU ;yhpargomreh a smsyruena citroa lanimodbB snoitidnoc gniwollof eht fo eno fo sisongaid nopu diap stifene ( )4 dna 3 segap no detsil sa smumixam ot tcejbusPage 24

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G 4PICV BVA A 63831MJBA .noitaroproC etatsllA ehT fo yraidisbus a ,ynapmoC ecnarusnI efiL egatireH naciremA yb desu eman gnitekram eht si stifeneB etatsll© moc.stifenebetatslla ro moc.etatslla.www .ynapmoC ecnarusnI etatsllA 4202T .YCILOP EHT NI DEIFICEPS SECIVRES RO STIFENEB DETIMIL EHT ROF YLNO EGAREVOC SEDIVORP TI .YCILOP STIFENEB DETPECXE NA SI SIHT ni desutis stnemllorne ni esu rof si eruhcorb sih VA. T ,ycnegA ,tnegA stifeneB etatsllA na yb edam eb yam tcatnoc ;ecnarusni fo noitaticilos a si tnemesitrevda sih o .evitatneserpeR rT naht retal tneve on ni tub ,tnerruc sniamer noitamrofni sa gnol sa dilav si lairetam sih A .7202 ,90 tsuguG .foereht snoitairav etats ro ,4PICVG mrof ycilop rednu dedivorp era stifeneb ssenllI lacitirC puor C redir gniwollof eht rednu dedivorp era stifeneb rediR ssenllI lacitir f :foereht snoitairav etats ro ,smro C deificepS ;RES4PICG rediR gnigdoL dna noitatropsnarT ,noitaulavE dnoceS ;REC4PICG rediR tnemecnahnE yranomlupoidra C rediR ssenlleW dexiF ;2RS4PICG rediR ssenllI lacitirC latnemelppuS ;R2CS4PICG rediR yrujnI ro ssenllI cinorhC deificepS ;R1CS4PICG rediR ssenllI cinorh G .RWF4PICT .ecnarusnI ssenllI lacitirC latnemelppuS tifeneB detimiL si dedivorp egarevoc eh T weiver ,eracideM rof elbigile fI .yciloP tnemelppuS eracideM a ton si ycilop eh M .stifeneB etatsllA morf elbaliava ediuG s'reyuB tnemelppuS eracideT .)LF ,ellivnoskcaJ ,eciffO emoH( ynapmoC ecnarusnI efiL egatireH naciremA yb nettirwrednu ycilop puorg eht rednu elbaliava stifeneb eht fo weivrevo feirb a si sih D etatsllA ruoy tcatnoc yam uoy ,noitamrofni lanoitidda roF .deussi setacifitrec eht ni dedulcni era snoitatimil rehto dna snoisulcxe gnidulcni ,egarevoc eht fo sliate B .evitatneserpeR stifeneT tnemeriuqer eht yfsitas ton seod dna )”egarevoc lacidem rojam“ sa ot derrefer netfo( egarevoc ecnarusni htlaeh evisneherpmoc etutitsnoc ton seod egarevoc eh o .tcA eraC elbadroffA eht rednu egarevoc laitnesse muminim fC SNOITACIFICEPS ETACIFITRE E SNOITATIMIL DNA SNOISULCXE ytilibigil - Y rof elbigile si ohw sediced reyolpme ruo y sruoh dna ecivres fo htgnel sa hcus( puorg ruo w .revo dna 81 era sega eussI .)keew hcae dekroD noitanimreT/ytilibigilE tnednepe -F esuops ruoy era egarevoc rof elbigile srebmem ylima o rof egarevoC .nerdlihc dna rentrap citsemod r c sselnu ,62 ega sehcaer dlihc eht nehw sdne nerdlih h na fo stnemeriuqer eht teem ot seunitnoc ehs ro e e dilav nopu sdne egarevoc esuopS .tnedneped elbigil d rentrap citsemoD .htaed ruoy ro ecrovid fo eerce c sdne pihsrentrap citsemod eht nehw sdne egarevo o .htaed ruoy rW sdnE egarevoC neh - C ycilop eht rednu egarevo e si etacifitrec eht etad eht :fo tseilrae eht no sdn c pots uoy ;delecnac si ycilop eht etad eht ,delecna p evitca fo yad tsal eht ;muimerp ruoy gniya e ;elbigile regnol on era ssalc ruoy ro uoy ;tnemyolpm a neeb evah stifeneb lla nehw ro ;delif si mialc eslaf p .elbacilppa fi ,sredir dna ycilop eht rednu diaC egarevoC ruoY gniunitno - Y ot elbigile eb yam uo c ycilop eht rednu egarevoc nehw egarevoc eunitno e .sliated rof ecnarusnI fo etacifitreC ruoy ot refeR .sdnC stimiL dna snoitidno - A ton si snigeb egarevoc ruoy erofeb gnirrucco sisongaid p retfa esaesid deﬁiceps ro ssenlli lacitirc derevoc yna fo sisongaid a ,revewoh ;elbaya y .snoisulcxe dna snoitatimil lla ot tcejbus era stﬁeneB .elbayap eb lliw etad evitceffe ruo A eht ni detats sesongaid fo setad dna snoitinﬁed eht teem tsum sessenlli lacitirc ll p .tceffe ni si egarevoc elihw naicisyhp a yb desongaid eb dna yciloE snoitatimiL dna snoisulcx - B yrujni detciﬂni-fles yllanoitnetni :rof diap ton era stﬁene o elihw ,noitcurtsed-fles ro ,enas elihw edicius ;snoitapucco ro seitivitca lagelli ;noitca r i esuba ,msilohocla ,lohocla gnidulcni ,esuba ecnatsbus ;rehtie ta tpmetta yna ro ,enasn o ro ,sgurd debircserp-non fo esu lagelli ro ,noitacidem noitpircserp deniatbo yllagel f n sselnu ,scitocran ro sgurd ,lohocla fo ecneuﬂni eht rednu gnieb ro ;scitocra a .naicisyhp a yb debircserp sa nekat dna deretsinimdPage 25

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PLAN 1 PLAN 2$10,000 $20,000$10,000 $20,000$10,000 $20,000$10,000 $20,000$2,500 $5,000Yes YesPLAN 1 PLAN 2Yes YesPLAN 1 PLAN 2$2,500 $5,000Pulmonary Embolism (25%)$2,500 $5,000Pulmonary Fibrosis (25%)$2,500 $5,000$1,000 $1,000Non-Local Transportation1 Air Fare(per trip or mile ) Personal Vehicle$500$0.50/mi.$500$0.50/mi.Outpatient Lodging2 (daily)$100 $100Family Member Lodging2 (daily) Transportation1 (per trip) Air Fare Personal Vehicle (per trip or mile)$100$500$0.50/mi.$100$500$0.50/mi.5,000$ 10,000$ $5,000$10,000 $10,000$20,000 10,000$ 20,000$ Advanced Parkinson's Disease (100%) 10,000$ 20,000$ Benign Brain Tumor (100%) 10,000$ 20,000$ Coma (100%) 10,000$ 20,000$ Complete Loss of Hearing (100%) 10,000$ 20,000$ Complete Loss of Sight (100%) 10,000$ 20,000$ Complete Loss of Speech (100%) 10,000$ 20,000$ Paralysis (100%) 10,000$ 20,000$ 50$ 50$ Cardiopulmonary Enhancement Ridert Sudden Cardiac Arrest (25%)Group Critical Illness (GVCIP4)Critical Illness Insurance from Allstate BenefitsBENEFIT AMOUNTSPercentages below are based on the Basic Benefit Amount of$10,000 (Plan 1) or $20,000 (Plan 2)tCovered dependents receive 50% of your benefit amount.INITIAL CRITICAL ILLNESS BENEFITStHeart Attack (100%)Stroke (100%)End Stage Renal Failure (100%)Major Organ Transplant (100%)Coronary Artery Bypass Surgery (25%)Waiver of Premium (employee only)REOCCURRENCE OF CRITICAL ILLNESS BENEFITStInitial Critical Illness (same amount as Initial Critical Illness Benefit)RIDER BENEFITSFixed Wellness Rider (per year)1Limit of $5,000 in a calendar year. 2Limit of $1,000 in a calendar year. Maximum of 1,000 miles.Second Evaluation, Transportation and Lodging Rider Second EvaluationSpecified Chronic Illness Ridert (50%)Specified Chronic Illness or Injury Ridert Illness (50%)Injury (100%)Supplemental Critical Illness Ridert Advanced Alzheimer's Disease (100%)Page 26

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PLAN 3$30,000$30,000$30,000$30,000$7,500YesPLAN 3YesPLAN 3$7,500Pulmonary Embolism (25%) $7,500Pulmonary Fibrosis (25%) $7,500$1,000Non-Local Transportation1 Air Fare(per trip or mile ) Personal Vehicle$500$0.50/mi.Outpatient Lodging2 (daily)$100Family Member Lodging2 (daily) Transportation1 (per trip) Air Fare Personal Vehicle (per trip or mile)$100$500$0.50/mi.15,000$ $15,000$30,000 30,000$ Advanced Parkinson's Disease (100%)30,000$ Benign Brain Tumor (100%)30,000$ Coma (100%)30,000$ Complete Loss of Hearing (100%)30,000$ Complete Loss of Sight (100%)30,000$ Complete Loss of Speech (100%)30,000$ Paralysis (100%)30,000$ 50$ Initial Critical Illness (same amount as Initial Critical Illness Benefit)INITIAL CRITICAL ILLNESS BENEFITStHeart Attack (100%)Stroke (100%)End Stage Renal Failure (100%)1Limit of $5,000 in a calendar year. 2Limit of $1,000 in a calendar year. Maximum of 1,000 miles.Group Critical Illness (GVCIP4)Critical Illness Insurance from Allstate BenefitsBENEFIT AMOUNTSPercentages below are based on the Basic Benefit Amount of$30,000 (Plan 3)tCovered dependents receive 50% of your benefit amount.Specified Chronic Illness Ridert (50%)Specified Chronic Illness or Injury Ridert Illness (50%)Injury (100%)Supplemental Critical Illness Ridert Advanced Alzheimer's Disease (100%)Fixed Wellness Rider (per year)RIDER BENEFITSCardiopulmonary Enhancement Ridert Sudden Cardiac Arrest (25%)Second Evaluation, Transportation and Lodging Rider Second EvaluationMajor Organ Transplant (100%)Coronary Artery Bypass Surgery (25%)Waiver of Premium (employee only)REOCCURRENCE OF CRITICAL ILLNESS BENEFITStPage 27

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Dental InsuranceDental Option High Plan including OrthodontiaBenefits for covered Adults and ChildrenVoluntary Dental High Plan BenefitsCoverage Type In-Network Out-of-Network*PaymentNegotiated FeeScheduleR&C90th PercentileType A – Preventive 100% 100%Type B – Basic 80% 80%Type C – Major Restorative 50% 50%Orthodontia 50% 50%Calendar Year DeductibleDeductible for coverage Individual FamilyType B & C$0$0Type B & C$0$0Calendar Year Maximum(applies to A,B,C services)$2,250 $2,250Orthodontia 50% 50%Ortho Lifetime Maximum $2,000 $2,000* Out of Network benefits are payable for services rendered by a dentist who is not a participating provider. TheReasonable and Customary charge is based on the lowest of (1) the dentist’s actual charge (the ‘Actual Charge’), (2)the dentist’s usual charge for the same or similar services (the ‘Usual Charge’) or (3) the charge of most dentists inthe same geographic area for the same or similar services as determined by MetLife (the ‘Customary Charge’).Services must be necessary in terms of generally accepted dental standards.Dental Option High Plan including OrthodontiaBenefits for adults and childrenVoluntary Dental High Plan Rate Per Month Employee Only $52.15 Employee + Spouse $102.73 Employee + Child(ren) $96.78 Employee + Family $147.31Page 29

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Selected Covered Services and Frequency Limitations*High Planand Low PlanType A – Preventive How Many / How OftenOral Examinations 2 in 12 monthsFull Mouth X-rays 1 in 5 yearsBitewing X-rays (Adult/Child) 1 in 12 monthsProphylaxis - Cleanings 2 in 12 monthsTopical Fluoride Applications 2 in 12 months - Children to age 17Sealants 1 in 60 months - Children to age 15Space Maintainers No limit - Children up to age 14Type B – Basic Restorative How Many / How OftenAmalgam and Composite Fillings 1 in 24 monthsRepairs 1 in 12 monthsEndodontics Root Canal 1 per tooth per lifetimeOral Surgery (Simple Extractions)Oral Surgery (Surgical Extractions)Other Oral SurgeryEmergency Palliative TreatmentGeneral AnesthesiaType C – Major Restorative How Many / How OftenCrowns/Inlays/Onlays 1 per tooth in 10 yearsPrefabricated Crowns 1 per tooth in 10 yearsPeriodontal Surgery 1 in 36 months per quadrantPeriodontal Scaling & Root Planing 1 in 24 months per quadrantPeriodontal Maintenance 4 in 1 year, includes 2 cleaningsBridges 1 in 10 yearsDentures 1 in 10 yearsConsultations 1 in 12 monthsImplant Services 1 service / tooth in 10 years – 1 repair / 10 yearsHigh PlanOnlyType D-Orthodontia Adult and Child Coverage. Dependent children up to age 26. Age limitations may vary bystate. Please see your Plan description for complete details. In the event of a conflict with thissummary, the terms of the certificate will govern. All dental procedures performed in connection with orthodontic treatment are payable asOrthodontia. Benefits for the initial placement will not exceed 20% of the Lifetime Maximum BenefitAmount for Orthodontia. Periodic follow-up visits will be payable on a monthly basis duringthe scheduled course of the orthodontic treatment. Allowable expenses for the initialplacement, periodic follow-up visits and procedures performed in connection with theorthodontic treatment, are all subject to the Orthodontia coinsurance level and LifetimeMaximum Benefit Amount as defined in the Plan Summary. Orthodontic benefits end at cancellation of coveragePage 31

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IMPORTANT ENROLLMENT INFORMATIONYou may only enroll for Dental Expense Benefits within 31 days of your Personal Benefits Eligibility Date, or if youhave a Qualifying Event or during the Plan's Annual Open Enrollment Period.Qualifying Event: Request to be covered, or to change your coverage, upon a Qualifying EventIf there is a Qualifying Event you may request to be covered, or to change your coverage, for Personal DentalExpense Benefits only within 31 days of a Qualifying Event. Such a request will not be a late request. Except formarriage or the birth or adoption of a child, you must give us proof of prior dental coverage under your spouse'splan if you are requesting coverage under This Plan because of a loss of the prior dental coverage. If you make arequest to be covered for Personal Dental Expense Benefits or a request for change(s)in Personal Dental ExpenseBenefits within thirty-one days of a Qualifying Event, your Personal Dental Expense Benefits or the change(s) inPersonal Dental Expense Benefits will become effective on the first day of the month following the date of yourrequest, subject to the Active Work Requirement, and provided that the change in coverage is consistent with yournew family status.Cancellation/Termination of Benefits:Coverage is provided under a group insurance policy (Policy form GPN99) issued by Metropolitan Life Insurance Company. Subjectto the terms of the group policy, rates are effective for one year from your plan's effective date. Once coverage is issued, the termsof the group policy permit Metropolitan Life Insurance Company to change rates during the year in certain circumstances. Coverageterminates when your full-time employment ceases, when your dental contributions cease or upon termination of the group policyby the Policyholder. The group policy may also terminate if participation requirements are not met, or on the date of the employee’sdeath, if the Policyholder fails to perform any obligations under the policy, or at MetLife's option. The dependent's coverageterminates when a dependent ceases to be a dependent. There is a 30-day limit for the following services that are in progress:Completion of a prosthetic device, crown or root canal therapy after individual termination of coverage.Deﬁni ons & Footnotes for High and Low Plans1"In-Network Beneﬁts" means beneﬁts provided under this plan for covered dental services that are provided by a MetLife PDP den st. "Out-of-Network Beneﬁts" means beneﬁts provided under this plan for covered dental services that are not provided by a MetLife PDP den st. U lizing an out-of-network den st for care may cost you more than using an in-network den st.2Negotiated fees refer to the fees that participating dentists have agreed to accept as payment in full for coveredservices, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject tochange.3Applies to Type B and C services only.4Out-of-network benefits are payable for services rendered by a dentist who is not a participating provider. TheReasonable and Customary charge is based on the lowest of:· the dentist’s actual charge (the 'Actual Charge'),· the dentist’s usual charge for the same or similar services (the 'Usual Charge') or· the usual charge of most dentists in the same geographic area for the same or similar services as determined byMetLife (the 'Customary Charge'). For your plan, the Customary Charge is based on the 90th percentile. Servicesmust be necessary in terms of generally accepted dental standards.Understanding Your Dental Beneﬁts PlanThe Preferred Den st Program is designed to provide the dental coverage you need with the features you want. Like the freedom to visit the den st of your choice – in or out of the network. .If you receive in-network services, you will be responsible for any applicable deduc bles, cost sharing, nego ated charges a er beneﬁt maximums are met, and costs for non-covered services. If you receive out-of-network services, you will beresponsible for any applicable deduc bles, cost sharing, charges in excess of the beneﬁt maximum, charges in excess of the nego ated fee schedule amount or R&C Fee, and charges for non-covered services. Plan beneﬁts for in-network covered services are based on a percentage of the Nego ated fee – the Fee thatpar cipa ng den sts have agreed to accept as payment in full for covered services, subject to any deduc bles,copayments, cost sharing and beneﬁt maximums.Nego ated fees are subject to change. Plan beneﬁts for out-of-network services are based on apercentage of the Reasonable and Customary (R&C)charge. If you choose a den st who does not par cipate in the network, your out-of-pocket expenses may be greater.Once you’re enrolled you may take advantage of onlineself-service capabili es with MyBeneﬁts.com Check the status of your claims Locate a par cipa ng den st Access MetLife’s Oral Health Library Elect to view your Explana on of Beneﬁts online To register, just go to www.metlife.com/mybeneﬁts and follow the easy registra on instruc ons.Page 32

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Common Questions … Important AnswersWho is a participating dentist? A participating, or network, dentist is a general dentist or specialist who has agreed toaccept negotiated fees as payment in full for covered services provided to plan members, subject to any deductibles,copayments, cost sharing and benefit maximums. Negotiated fees typically range from 30-45% below the average feescharged in a dentist’s community for the same or substantially similar services.*In addition to the standard MetLife network, your employer may provide you with access to a select network of dentalproviders that may be unique to your employer’s dental program. When visiting these providers, you may receive a betterbenefit, have lower out-of-pocket costs and/or have access to care at facilities at your worksite. Please sign into MyBenefits formore details.* Based on internal analysis by MetLife. Negotiated fees refer to the fees that participating dentists have agreed to accept as payment in full for covered services, subject to any copayments,deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. Savings from enrolling in a dental benefits plan will depend on various factors, including the cost ofthe plan, how often members visit a dentist and the cost of services rendered. Negotiated fees are subject to change.How do I find a participating dentist? There are thousands of general dentists and specialists to choose from nationwide --so you are sure to find one that meets your needs. You can receive a list of these participating dentists online atwww.metlife.com/dental or call 1-800-275-4638 to have a list faxed or mailed to you.What services are covered by my plan? Please see your Certificate of Insurance for a list of covered services.May I choose a non-participating dentist? Yes. You are always free to select the dentist of your choice. However, if youchoose a non-participating (out-of-network) dentist, your out-of-pocket costs may be greater than your out-of-pocket costs whenvisiting an in-network dentist.Can my dentist apply for participation in the network? Yes. If your current dentist does not participate in thenetwork and you would like to encourage him or her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application.* The website and phone number are for use by dental professionals only.* Due to contractual requirements, MetLife is prevented from soliciting certain providers.How are claims processed? Dentists may submit your claims for you which means you have little or no paperwork. You cantrack your claims online and even receive email alerts when a claim has been processed. If you need a claim form, visitwww.metlife.com/dental or request one by calling 1-800-275-4638.Can I get an estimate of what my out-of-pocket expenses will be before receiving a service? Yes. You can ask fora pretreatment estimate. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate ofbenefits. The estimate helps you prepare for the cost of dental services. We recommend that you request a pre-treatment estimatefor services in excess of $300. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9.You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Actual payments may varydepending upon plan maximums, deductibles, frequency limits and other conditions at time of payment.Can MetLife help me find a dentist outside of the U.S. if I am traveling? Yes. Through international dental travelassistance services* you can obtain a referral to a local dentist by calling +1-312-356-5970 (collect) when outside the U.S. toreceive immediate care until you can see your dentist. Coverage will be considered under your out-of-network benefits.**Please remember to hold on to all receipts to submit a dental claim.*International Dental Travel Assistance services are administered by AXA Assistance USA, Inc. (AXA Assistance). AXA Assistance provides dental referral services only. AXA Assistance is notaffiliated with MetLife and any of its affiliates, and the services they provide are separate and apart from the benefits provided by MetLife. Referral services are not available in all locations.** Refer to your Certificate of Insurance for your out-of-network dental coverage.How does MetLife coordinate benefits with other insurance plans? Coordination of benefits provisions in dentalbenefits plans are a set of rules that are followed when a patient is covered by more than one dental benefits plan. These rulesdetermine the order in which the plans will pay benefits. If the MetLife dental benefit plan is primary, MetLife will pay the full amountof benefits that would normally be available under the plan. If the MetLife dental benefit plan is secondary, most coordination ofbenefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. The amountof benefits payable by MetLife may be reduced due to the benefits paid under the primary plan.Do I need an ID card? No, You do not need to present an ID card to confirm that you are eligible. You should notify yourdentist that you are enrolled in a MetLife Dental Plan. Your dentist can easily verify information about your coverage through atoll-free automated Computer Voice Response system.Do my dependents have to visit the same dentist that I select? No. You and your dependents each have the freedomto choose any dentist.Page 33

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Hospital Indemnity Insurance Hospital Indemnity (HI) Insurance Hospital Indemnity Benefits – The Hartford’s Hospital Indemnity plan(s) will pay a scheduled benefit for hospital1 confinement that occurs for a covered person while insurance is in effect. Additional benefits for certain services or treatments may also be available, if described below. All benefits are subject to applicable policy limitations and exclusions. State specific variations may apply to the benefits shown below. Policy Information Detail Class Description(s) All Active Full-time Employees Min. Hours for Active Work 30 hours per week Plan Options Custom Plan 1 or Custom Plan 2 Underwriting Type Guaranteed issue for all covered persons Dependent Coverage Available with Dependent benefits the same as the employee benefits Plan Information Custom Plan 1 Custom Plan 2 Coverage Type 24 Hour 24 Hour Covered Events Illness and Injury Illness and Injury Pregnancy Covered5 (SAAOI) Same as any other illness Same as any other illness Pre-Existing Condition Limits None - Day 1 Coverage None - Day 1 Coverage HSA Compatible Yes No Benefit(s) Custom Plan 1 Custom Plan 2 First Day Hospital Confined $1,000; Once/year $1,000; Once/year Daily Hospital Confinement $150; Up to 30 days/year $150; Up to 30 days/year Daily ICU Confinement $200; Up to 10 days/year $200; Up to 10 days/year Medical Travel $100; Up to 2 days/year $100; Up to 2 days/year Companion Lodging $100; Up to 10 days/year $100; Up to 10 days/year Health Screening $50; Once/year $50; Once/year Continuous Care Confined (Rehab, Skilled Nursing & Hospice) $150; Up to 10 days/year $150; Up to 10 days/year Inpatient Surgery Not Included $500; Once/year Outpatient Surgery–Physician Office/ER Not Included $150; Once/year Outpatient Surgery–Hospital/ASC Not Included $150; Once/year Newborn Routine Hospital Care $150; Once/Live Birth $150; Once/Live Birth Page 34

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Additional Features & Services Continuity of Coverage from a Prior Plan Included Continuation of Coverage Included Portability Included Ability Assist® 2 Included Health ChampionSM 2 Included The Hartford’s Claims Connections Concierge-Guided Experience⁶ – Employees receive text or email notification of potential claims opportunities based on core claim events with option for telephonic claims intake Monthly Premium Rates4 Custom Plan 1 Custom Plan 2 Employee $20.62 $25.20 Employee & Spouse/Partner $39.96 $48.44 Employee & Child(ren) $32.07 $38.02 Family $52.09 $62.97 1. Hospital does not include: convalescent homes, or convalescent, rest or nursing facilities; facilities affordingprimarily custodial, educational or rehabilitory care; or facilities primarily for care of the aged/elderly, persons withsubstance abuse issues/disorders or mental/nervous disorders. Confined means the assignment to a bed in amedical facility for a period of at least 20 hours. State variations may apply.2. HealthChampion℠ and Ability Assist® are offered through The Hartford by ComPsych®. ComPsych is not affiliatedwith The Hartford and is not a provider of insurance services. The Hartford is not responsible and assumes noliability for the goods and services provided by ComPsych.3. Assumes all eligible employees can enroll in the plan and/or increase existing benefits without providing evidenceof insurability during the scheduled initial enrollment period and subsequent scheduled enrollment periodsoccurring annually thereafter. Pre-existing condition limitations may apply.4. Rates/benefits may change on a class or plan basis. Actual per pay period premium deductions may differ slightlyfrom monthly billed amounts due to rounding. The Hartford offers a billing tolerance to help account for thisdifference.5. Complications of pregnancy (as defined in the policy) are always covered under the policy withoutlimitation.Qualifications and Assumptions 1. Assumes employees must be actively-at-work on the effective date and the deferred effective date provisionapplies.2. Coverage for Retirees is not included unless ported at retirement.3. We assume all eligible employees are U.S. citizens or U.S. residents, working in U.S. locations who have metthe full time eligibility requirements.4. This proposal is only a summary of the benefits.Page 35

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Hospital Indemnity (HI) Insurance – Limitations & Exclusions Exclusions A benefit is not payable for any illness or injury that results from or is caused by a covered person’s:  suicide or attempted suicide, whether sane or insane, or intentional self-infliction voluntary intoxication (as defined by the law of the jurisdiction in which the illness or injury occurred) or whileunder the influence of any narcotic, drug or controlled substance, unless administered by or taken accordingto the instruction of a physician or medical professional voluntary intoxication through use of poison, gas or fumes, whether by ingestion, injection, inhalation orabsorption voluntary commission of or attempt to commit a felony, voluntary participation in illegal activities (except formisdemeanor violations), voluntary participation in a riot, or voluntary engagement in an illegal occupation incarceration or imprisonment following conviction for a crime travel in or descent from any vehicle or device for aviation or aerial navigation, except as a fare-payingpassenger in a commercial aircraft (other than a charter airline) on a regularly scheduled passenger flight orwhile traveling on business of the policyholder ride in or on any motor vehicle or aircraft engaged in acrobatic tricks/stunts (for motor vehicles),acrobatic/stunt flying (for aircraft), endurance tests, off-road activities (for motor vehicles), or racing participation in any organized sport in a professional or semi-professional capacity participation in abseiling, base jumping, Bossaball, bouldering, bungee jumping, cave diving, cliff jumping,free climbing, freediving, freerunning, hang gliding, ice climbing, Jai Alai, jet powered flight, kite surfing,kiteboarding, luging, mountain biking, mountain boarding, mountain climbing, mountaineering, parachuting,paragliding, parakiting, paramotoring, parasailing, Parkour, proximity flying, rock climbing, sail gliding,sandboarding, scuba diving, sepak takraw, slacklining, ski jumping, skydiving, sky surfing, speed flying, speedriding, train surfing, tricking, wingsuit flying, or other similar extreme sports or high risk activities travel or activity outside the United States or Canada active duty service or training in the military (naval force, air force or National Guard/Reserves or equivalent)for service/training extending beyond 31 days of any state, country or international organization, unlessspecifically allowed by a provision of the policy involvement in any declared or undeclared war or act of war (not including acts of terrorism), while serving inthe military or an auxiliary unit attached to the military, or working in an area of war whether voluntarily or asrequired by an employerIn addition, benefits are not payable unless required by law for:  elective abortion or complications thereof artificial insemination, in vitro fertilization, test tube fertilization sterilization, tubal ligation or vasectomy, and reversal thereof aroma therapeutic, herbal therapeutic, or homeopathic services any mental and nervous disorder, unless specifically allowed by a provision of the policy substance abuse, unless specifically allowed by a provision of the policy medical mishap or negligence on the part of any physician, medical professional, or therapist, includingmalpractice treatment, supplies or services provided by, through or, behalf of any government agency or program; unlesspayment is required by a covered person custodial care, unless specifically allowed by a benefit provision in the policy or any rider attached to thepolicy (if applicable); elective or cosmetic surgery or procedures, except for reconstructive surgery:- incidental to or following surgery for disease, infection or trauma of the involved body part- due to congenital anomaly or disease of a dependent child which has resulted in a functional defect dental care or treatment, except for:- treatment due to an injury to sound natural teeth within 12 months of the accident- treatment necessary due to congenital disease or anomalyPage 36

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Hospital Indemnity Insurance Benefit and Feature InformationThe added financial stress of being in the hospital can make recovery from an accident or serious illness more challenging. Even with the best primary health insurance plan, out-of-pocket costs from a hospital stay can add up. This insurance pays a fixed indemnity benefit for each day a covered person is confined in a hospital for a covered event, with optional additional daily benefits for related services. These benefits can help offset expenses that primary health insurance doesn’t cover (like deductibles, co-insurance amounts or co-pays), or benefits can be used for any non-medical expenses (like housing costs, groceries, car expenses, etc.). Lump sum benefits are paid to the employee (or designated beneficiary) based on the amount stated in the schedule of benefits and subject to any plan limitations or exclusions. As medical costs continue to rise and employers continue to increase employees’ share of these costs, HI provides an additional level of financial protection. Employers can make this insurance available without affecting the company’s bottom line (voluntary/100% employee-paid), or they can fund all or some of the cost of this insurance to help minimize the impact of more significant health insurance plan changes (noncontributory/100% employer-paid or contributory/cost-sharing). Both HSA compatible and non-HSA compatible expanded plan designs are available. Voluntary Enrollment Services We are committed to making it as easy as possible to communicate information on your plan and the associated cost to your employees. Our goals are to engage employees so they fully understand the benefits offering, and make it easy for them to enroll. Enrollment Annual Open Enrollment: This standard enrollment type has scheduled enrollment periods for initial enrollment and for subsequent enrollments occurring annually thereafter. Annual Open Enrollment requires that certain employer characteristics are met and defined enrollment experience practices are agreed upon and implemented by the employer. These practices include: • Personalized enrollment experience.• Mandatory employee group meetings or, Benefit Fairs.• Employer support of enrollment events to help ensure the attendance of at least 75% of eligible employees.• On-site benefit counselors at each employer location for group meetings, Benefit Fairs and on-site enrolling.Coverage is guaranteed issue and does not require evidence of insurability, including when: • Enrolling or changing coverage during any scheduled annual enrollment period.• Enrolling new hires within 31 days of eligibility.• Enrolling or changing coverage within 31 days of Change in Family Status.Electing or changing coverage outside of scheduled annual enrollment periods (or additional enrollment events, if available) or qualified Family Status Change periods is not permitted. Enrollment or coverage changes will be deferred until the next scheduled annual enrollment period. For certain coverages, pre-existing condition limitations apply. See the policy for details. Page 37

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Ability Assist® Employee Assistance Program2 Employees receive professional counseling for financial, legal and emotional issues, 24/7/365. Includes unlimited phone access and three face-to-face sessions per year. Services are also available to spouses and dependent children. HealthChampionSM Health Care Support Service2 This service offers unlimited access to benefit specialists and nurses for administrative and clinical support to address medical care and claims concerns. Available services include: claim and billing support, explanation of benefits, cost estimates/fee negotiation, information related to conditions and available treatments and support to help prepare for medical visits. Specialists are only available during business hours. Inquiries outside of this timeframe can either request a call-back the next day or schedule an appointment. Portability The Hartford’s hospital indemnity policies allow insureds to port their coverage due to a qualifying event. With this valuable feature, participants can port their coverage with a choice of three different plan designs. All an employee has to do is enroll for portability at termination. The choice in plan design allows the employee to select the coverage that best meets their financial protection needs at the time of port. Since the coverage is offered at a group rate, this can be an affordable way for many insureds to help stay protected even when they leave their employer, subject to a pre-existing condition limitation. Portability is not available if an employee or covered dependent is entering active military service. An employee cannot port coverage if termination of coverage is due to non-payment of premium, termination of the group policy or termination of the employer as a participating employer under a group policy. Continuation of Coverage The Hartford’s policies allow insurance to continue under the group plan in certain circumstances when an employee is unable to satisfy the active work and/or minimum work hours requirements of a plan, such as when an employee is on family or medical leave. Flexible options are available to meet employee needs. Continuity from a Prior Policy The Hartford's policies allows any employee who was previously eligible for and insured under a hospital indemnity (or similar) policy sponsored by the policyholder and offered by another insurance carrier immediately prior to the effective date of The Hartford's policy, but is not actively working on the effective date of The Hartford's policy, to be eligible for coverage. If coverage is continued for an employee under this provision, coverage may also be continued for any eligible dependents who were also insured under the prior policy. Insurance under the continuity provision is subject to uninterrupted payment of premium when due.Page 38

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Standard Lens Enhancement Ultraviolet coatingUp to $12Applied to the allowance for theapplicable corrective lens Standard Polycarbonate(child up to age 18)Covered in FullApplied to the allowance for theapplicable corrective lensAdditional Lens Enhancements1 Progressive StandardUp to $55 $50 allowance Progressive PremiumUp to $110 $50 allowance Progressive UltraUp to $150 $50 allowance Progressive UltimateUp to $225 $50 allowance Standard Polycarbonate(adult)Up to $40Applied to the allowance for theapplicable corrective lens Scratch-resistant coating(variable by type)Up to $15 - $30Applied to the allowance for theapplicable corrective lens Tints (plastic lenses – Solid)Up to $15Applied to the allowance for theapplicable corrective lens Tints (plastic lenses –Gradient)Up to $18Applied to the allowance for theapplicable corrective lens Anti-reflective coating(variable by type)Up to $50 - $120Applied to the allowance for theapplicable corrective lens Photochromic (variable bytype)Up to $80Applied to the allowance for theapplicable corrective lens Blue Light FilteringUp to $15Applied to the allowance for theapplicable corrective lens Digital Single VisionUp to $30Applied to the allowance for theapplicable corrective lens PolarizedUp to $75Applied to the allowance for theapplicable corrective lens High Index (1.67/1.74)Up to $80 / $120Applied to the allowance for theapplicable corrective lensFrame Allowance(You will receive an additional 20% offany amount that you pay over yourallowance. This offer is available fromall participating locations exceptCostco, Walmart and Sam’s Club.)$130 allowance$70 allowanceContact Lenses Elective$130 allowance $105 allowance NecessaryCovered in full$210 allowance Contact Fitting andEvaluationStandard: Covered in Full after $25copaySpecialty: $50 allowance after $25copayApplied to the contact lensallowancePage 40

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Class:All Active Full Time EmployeesFrequencies Examinations  1 per 12 Months Standard Corrective Lenses  1 per 12 Months Frames  1 per 24 Months Contact Lenses  1 per 12 MonthsEither glasses or contacts allowedper frequencyExclusions Services and/or materials not specifically included in the Summary of Benefits as covered Plan Benefits. Any portion of a charge in excess of the Maximum Benefit Allowance or reimbursement indicated in theSummary of Benefits. Plano lenses (lenses with refractive correction of less than ± .50 diopter) Two pairs of glasses instead of bifocals. Replacement of lenses, frames and/or contact lenses furnished under this Plan which are lost, stolen ordamaged, except at the normal intervals when Plan Benefits are otherwise available. Orthoptics or vision training and any associated supplemental testing. Medical or surgical treatment of the eyes. Prescription and non-prescription medications. Contact lens insurance policies or service agreements. Refitting of contact lenses after the initial (90-day) fitting period. Contact lens modification, polishing or cleaning. Local, state and/or federal taxes, except where MetLife is required by law to pay. Any eye examination or any corrective eyewear required as a condition of employment. Services and supplies received by You or Your Dependent before the Vision Insurance starts for thatperson. Missed appointments. Services or materials resulting from or in the course of a Covered Person’s regular occupation for pay orprofit for which the Covered Person is entitled to benefits under any Workers’ Compensation Law,Employer’s Liability Law or similar law. You must promptly claim and notify the Company of all suchbenefits. Services: (a) for which the employer of the person receiving such services is not required to pay; or (b)received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital. Services or materials received as a result of disease, defect, or injury due to war or an act of war (declaredor undeclared), taking part in a riot or insurrection, or committing or attempting to commit a felony. Services and materials obtained while outside the United States, except for emergency vision care. Services, procedures, or materials for which a charge would not have been made in the absence ofinsurance.Page 41

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G PLTP BVA A 83831MJBG PLTP BVA A MJB A 83831MJBH emoC ,egagtrom eht yap pleh na c ro ,stnemyap latner eunitno p sriaper emoh dedeen mrofreE sesnepx s’ylimaf ruoy yap pleh naC l ,sllib sa hcus sesnepxe gnivi e sag dna ,yticirtcelF secnaniC deen eht etanimile pleh na t ro sgnivas etelped o r snalp tnemeriteC ESOOHU EST .tnemllornE nepO s’reyolpme reh gnirud ecnarusnI efiL 001 egA ot mreT puorG stﬁeneB etatsllA rof pu sngis ynaffiT .yrav yam egarevoc rof snosaer dna sdeen laudividni ruoy ;sdeen dna sessecorp thguoht lanoitcif liated evoba selpmaxe ehT ,latrop bew tneinevnoc eht hguorht egarevoc ecnarusnI efiL 001 egA ot mreT stifeneB puorG etatsllA no mialc a selif dnabsuh s’ynaffi M .*stifeneByH :rof stifeneb hsac seviecer eC MIALN noitacﬁitoA ecnalubmC despalloT gnilevar D srotcoA saw ecnalubma n t eht ot reh gnika n nehw latipsoh tserae h deppots traeh reD sesrun dna srotco w ot ylsselerit dekro r yeht tub ,reh evive c reh evas ton dluoH dnabsuh re w fo deifiton sa h gnissap reS ,gniteem a ni saw eh e prahs a decneirepx p fo ssentrohs ,nia b despalloc dna ,htaerdelevart ynaffiT o a no nwot fo tu b ot pirt ssenisu m tneilc a htiw teeM ynaffiT teeO timbus ,ngiSe .stifeneb ruoy tuoba noitamrofni tnatropmi ot ssecca 7/42 sreff a tcerid eb ot stifeneb hsac tseuqer ,)yrotsih mialc gnidulcni( smialc ruoy kcehc dn d .erom dna ,noitamrofni lanosrep ot segnahc ekam ,detisope* latroP gniliF mialC stifeneByMA stifenebym/moc.stifenebetatslla :sseccS :yrots reh s’ereH .detatsaved era nerdlihc dna dnabsuh reH .yawa sessap dna kcatta traeh a sreffus ynaffiT ,retal shtnom lareveH desu eb nac tifeneb hsac eht syaw eht fo emos era ere• :tifeneB htaeD ecnarusnI efiL mreTA tifeneb hsac mus-pmul Page 49

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IssueAge25,000 50,000 75,000IssueAge25,000 50,000 75,00010.8321.6732.5050 29.40 58.79 88.197.50 15.00 22.5051 32.44 64.88 97.3120 7.50 15.00 22.50 52 35.50 71.00 106.5021 7.50 15.00 22.50 53 38.54 77.08 115.6322 7.50 15.00 22.50 54 41.58 83.17 124.7523 7.50 15.00 22.50 55 46.88 93.75 140.6324 7.50 15.00 22.50 56 51.10 102.21 153.3125 7.50 15.00 22.50 57 55.33 110.67 166.0026 7.63 15.25 22.88 58 59.56 119.13 178.6927 7.75 15.50 23.25 59 63.79 127.58 191.3828 7.88 15.75 23.63 60 67.98 135.96 203.9429 8.00 16.00 24.00 61 74.52 149.04 223.5630 8.13 16.25 24.38 62 81.06 162.13 243.1931 8.54 17.08 25.63 63 87.63 175.25 262.8832 8.96 17.92 26.88 64 94.17 188.33 282.5033 9.38 18.75 28.13 65 100.71 201.42 302.1334 9.79 19.58 29.38 66 110.79 221.58 332.3835 10.21 20.42 30.63 67 120.85 241.71 362.5636 10.65 21.29 31.94 68 130.94 261.88 392.8137 11.56 23.13 34.69 69 141.00 282.00 423.0038 12.44 24.88 37.31 70 151.06 302.13 453.1939 13.31 26.63 39.94 71 ^ 177.79 355.58 533.3840 14.19 28.38 42.56 72 ^ 184.52 369.04 553.5641 15.56 31.13 46.69 73 ^ 191.79 383.58 575.3842 16.92 33.83 50.75 74 ^ 202.27 404.54 606.8143 18.27 36.54 54.81 75 ^ 214.79 429.58 644.3844 19.65 39.29 58.94 76 ^ 264.88 529.75 794.6345 21.00 42.00 63.00 77^ 280.85 561.71 842.5646 22.71 45.42 68.13 78 ^ 293.77 587.54 881.3147 24.40 48.79 73.19 79 ^ 305.29 610.58 915.8848 26.06 52.13 78.19 80 ^ 317.50 635.00 952.5049 27.73 55.46 83.19° Guarantee Issue underwriting limits are subject to account specific offer.Quotes denoted † or ³ require EOI.¹ Initial Death Benefit is guaranteed level for the first five (5) years.The death benefit may decrease after five years,but never be less than the minimum guaranteed in the policy.The current, non-guaranteed death benefit is projected to be level to age 100.² Premium is level to age 100. MONTHLY means 12 times per year.^ Evidence of insurability (EOI) is required for ages 71-80 and applications in excess of U/W offer³.This rate card is for certificate form GPTLC underwritten by American Heritage Life Insurance Company.Refer to the state specific policy form for exact benefits, limitations, and exclusions.Allstate Benefits is the marketing name for American Heritage Life Insurance Company.Home Office, Jacksonville, FL, a subsidiary of The Allstate Corporation. ©2024 Allstate Insurance Company.GroupT erm to100 InitialDeathBenefit¹Guaranteed Issue Group Term to Age 100 Life InsuranceNON-TOBACCO CLASSM on thlyPrem ium s² M on thlyPrem ium s²GroupT erm to 100 InitialDeathBenefit¹1819Page 50

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IssueAge25,000 50,000 75,000IssueAge25,000 50,000 75,00050 49.10 98.21 147.318.3316.6725.0051 53.60 107.21 160.8120 8.75 17.50 26.25 52 57.98 115.96 173.9421 9.17 18.33 27.50 53 62.52 125.04 187.5622 9.58 19.17 28.75 54 66.94 133.88 200.8123 10.00 20.00 30.00 55 70.98 141.96 212.9424 10.42 20.83 31.25 56 76.69 153.38 230.0625 10.83 21.67 32.50 57 82.17 164.33 246.5026 11.25 22.50 33.75 58 87.50 175.00 262.5027 11.67 23.33 35.00 59 92.98 185.96 278.9428 12.08 24.17 36.25 60 98.40 196.79 295.1929 12.50 25.00 37.50 61 106.46 212.92 319.3830 12.92 25.83 38.75 62 114.42 228.83 343.2531 13.33 26.67 40.00 63 122.13 244.25 366.3832 13.75 27.50 41.25 64 129.67 259.33 389.0033 14.17 28.33 42.50 65 136.73 273.46 410.1934 14.58 29.17 43.75 66 150.02 300.04 450.0635 15.00 30.00 45.00 67 163.00 326.00 489.0036 16.52 33.04 49.56 68 175.67 351.33 527.0037 17.98 35.96 53.94 69 188.06 376.13 564.1938 19.50 39.00 58.50 70 200.10 400.21 600.3139 21.10 42.21 63.31 71 ^ 232.77 465.54 698.3140 22.60 45.21 67.81 72 ^ 243.44 486.88 730.3141 24.96 49.92 74.88 73 ^ 255.17 510.33 765.5042 27.35 54.71 82.06 74 ^ 268.33 536.67 805.0043 29.71 59.42 89.13 75^ 283.17 566.33 849.5044 32.10 64.21 96.31 76 ^ 300.54 601.08 901.6345 34.40 68.79 103.19 77 ^ 311.25 622.50 933.7546 37.19 74.38 111.56 78^ 322.63 645.25 967.8847 40.13 80.25 120.38 79 ^ 334.63 669.25 1,003.8848 43.15 86.29 129.44 80 ^ 347.25 694.50 1,041.7549 46.17 92.33 138.50° Guarantee Issue underwriting limits are subject to account specific offer.Quotes denoted † or ³ require EOI.¹ Initial Death Benefit is guaranteed level for the first five (5) years.The death benefit may decrease after five years,but never be less than the minimum guaranteed in the policy.The current, non-guaranteed death benefit is projected to be level to age 100.² Premium is level to age 100. MONTHLY means 12 times per year.^ Evidence of insurability (EOI) is required for ages 71-80 and applications in excess of U/W offer³.This rate card is for certificate form GPTLC underwritten by American Heritage Life Insurance Company.Refer to the state specific policy form for exact benefits, limitations, and exclusions.Allstate Benefits is the marketing name for American Heritage Life Insurance Company.Home Office, Jacksonville, FL, a subsidiary of The Allstate Corporation. ©2024 Allstate Insurance Company.Issueage18w illbeissuedN on-tobaccoGuaranteed Issue Group Term to Age 100 Life InsuranceTOBACCO CLASSMonthly Premiums² Monthly Premiums²GroupT erm to 100 InitialDeathBenefit¹ GroupT erm to 100 InitialDeathBenefit¹1819Page 51

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ǁǁǁ͘ƌĞůŝĂŶĐĞƐƚĂŶĚĂƌĚ͘ĐŽŵdŚŝƐWůĂŶ,ŝŐŚůŝŐŚƚŝƐŶŽƚĂĐŽŵƉůĞƚĞĚĞƐĐƌŝƉƚŝŽŶŽĨƚŚĞŝŶƐƵƌĂŶĐĞĐŽǀĞƌĂŐĞ͘/ŶƐƵƌĂŶĐĞŝƐƉƌŽǀŝĚĞĚƵŶĚĞƌŐƌŽƵƉƉŽůŝĐǇĨŽƌŵ>Z^Ͳϴϯϰϵ͕ĞƚĂů͘dŚŝƐŝƐŶŽƚĂďŝŶĚŝŶŐĐŽŶƚƌĂĐƚ͘^ŚŽƵůĚƚŚĞƌĞ ďĞ ĂĚŝĨĨĞƌĞŶĐĞ ďĞƚǁĞĞŶ ƚŚŝƐWůĂŶ ,ŝŐŚůŝŐŚƚ ĂŶĚƚŚĞ ĐŽŶƚƌĂĐƚ͕ ƚŚĞĐŽŶƚƌĂĐƚ ǁŝůů ŐŽǀĞƌŶ͘dŚĞ ĞƌƚŝĨŝĐĂƚĞ ŽĨŽǀĞƌĂŐĞ ǁŝůů ďĞŵĂĚĞ ĂǀĂŝůĂďůĞ ƚŽ ǇŽƵ ƚŚĂƚZĞůŝĂŶĐĞ^ƚĂŶĚĂƌĚ>ŝĨĞ/ŶƐƵƌĂŶĐĞŽŵƉĂŶǇŝƐůŝĐĞŶƐĞĚŝŶĂůůƐƚĂƚĞƐ;ĞǆĐĞƉƚEĞǁzŽƌŬͿ͕ƚŚĞŝƐƚƌŝĐƚŽĨŽůƵŵďŝĂ͕WƵĞƌƚŽZŝĐŽ͕ƚŚĞh͘^͘ sŝƌŐŝŶ/ƐůĂŶĚƐĂŶĚ'ƵĂŵ͘/ŶEĞǁzŽƌŬ͕ ŝŶƐƵƌĂŶĐĞ ƉƌŽĚƵĐƚƐ ĂŶĚ ƐĞƌǀŝĐĞƐ ĂƌĞ ƉƌŽǀŝĚĞĚ ƚŚƌŽƵŐŚ &ŝƌƐƚ ZĞůŝĂŶĐĞ ^ƚĂŶĚĂƌĚ >ŝĨĞ /ŶƐƵƌĂŶĐĞ ŽŵƉĂŶǇ͕ ,ŽŵĞ KĨĨŝĐĞ͗ EĞǁ zŽƌŬ͕ Ez͘ WƌŽĚƵĐƚ ĨĞĂƚƵƌĞƐ ĂŶĚĂǀĂŝůĂďŝůŝƚǇŵĂǇǀĂƌǇďǇƐƚĂƚĞ͘Plan Highlights Brunswick Community College  GUARANTEED ISSUE Initial eligibility period only EĞǁ,ŝƌĞƐ͗ΨϮϬϬ͕ϬϬϬ ZĞͲĞŶƌŽůůŵĞŶƚEmployeeƐ:hŶĚĞƌĂŐĞϲϬ͗ΨϱϬ͕ϬϬϬDĂǆŐĞϲϬďƵƚůĞƐƐƚŚĂŶĂŐĞϳϬ͗ΨϱϬ͕ϬϬϬDĂǆŐĞϳϬĂŶĚŽǀĞƌ͗ΨϱϬ͕ϬϬϬDĂǆSpouse:hŶĚĞƌĂŐĞϲϬ͗EĞǁ,ŝƌĞƐΨϱϬ͕ϬϬϬZĞͲĞŶƌŽůůŵĞŶƚΨϭϬ͕ϬϬϬDĂǆŐĞϲϬďƵƚůĞƐƐƚŚĂŶĂŐĞϳϬ͗K/KŶůǇͲEŽ'ƵĂƌĂŶƚĞĞĚ/ƐƐƵĞ ŐĞϳϬĂŶĚŽǀĞƌ͗EŽƚǀĂŝůĂďůĞChild(ren):ΨϭϬ͕ϬϬϬCONTRIBUTION REQUIREMENTS ŽǀĞƌĂŐĞŝƐϭϬϬйŵƉůŽǇĞĞWĂŝĚ͘BENEFIT REDUCTION DUE TO AGE (Applicable to employee / spouse coverage) ƚŐĞ &ĂĐĞŵŽƵŶƚZĞĚƵĐĞƐdŽ  Voluntary Group Term Life ϳϱͲϳϵ ϲϬйŽĨĂǀĂŝůĂďůĞŽƌŝŶĨŽƌĐĞĂŵŽƵŶƚĂƚĂŐĞϳϰϴϬͲϴϰ ϯϱйŽĨĂǀĂŝůĂďůĞŽƌŝŶĨŽƌĐĞĂŵŽƵŶƚĂƚĂŐĞϳϰϴϱͲϴϵ Ϯϳ͘ϱйŽĨĂǀĂŝůĂďůĞŽƌŝŶĨŽƌĐĞĂŵŽƵŶƚĂƚĂŐĞϳϰϵϬͲϵϰ ϮϬйŽĨĂǀĂŝůĂďůĞŽƌŝŶĨŽƌĐĞĂŵŽƵŶƚĂƚĂŐĞϳϰϵϱͲϵϵ ϳ͘ϱйŽĨĂǀĂŝůĂďůĞŽƌŝŶĨŽƌĐĞĂŵŽƵŶƚĂƚĂŐĞϳϰϭϬϬн ϱйŽĨĂǀĂŝůĂďůĞŽƌŝŶĨŽƌĐĞĂŵŽƵŶƚĂƚĂŐĞϳϰRATES PER $10,000ϭϴͲϯϵ͗ΨϬ͘ϴϬϰϬͲϱϵ͗Ψϭ͘ϴϬϲϬн͗ΨϮ͘ϱϬŚŝůĚ;ƌĞŶͿƉĞƌŵŽŶƚŚ͗ΨϮ͕ϱϬϬ͗ΨϬ͘ϰϮΨϱ͕ϬϬϬ͗ΨϬ͘ϴϮΨϳ͕ϱϬϬ͗Ψϭ͘ϮϮΨϭϬ͕ϬϬϬ͗Ψϭ͘ϲϮFEATURESWŽƌƚĂďŝůŝƚǇtĂŝǀĞƌŽĨWƌĞŵŝƵŵELIGIBILITYůůĐƚŝǀĞ&ƵůůͲdŝŵĞŵƉůŽǇĞĞƐǁŽƌŬŝŶŐϯϬŚŽƵƌƐŽƌŵŽƌĞƉĞƌǁĞĞŬ͕ĞǆĐĞƉƚĨŽƌĂŶǇƉĞƌƐŽŶǁŽƌŬŝŶŐŽŶĂƚĞŵƉŽƌĂƌǇŽƌƐĞĂƐŽŶĂůďĂƐŝƐ͘Dependents: zŽƵŵƵƐƚďĞŝŶƐƵƌĞĚĨŽƌǇŽƵƌĞƉĞŶĚĞŶƚƐƚŽďĞĐŽǀĞƌĞĚ͘ĞƉĞŶĚĞŶƚƐĂƌĞ͗fzŽƵƌůĞŐĂůƐƉŽƵƐĞǁŚŽŝƐŶŽƚůĞŐĂůůǇƐĞƉĂƌĂƚĞĚŽƌĚŝǀŽƌĐĞĚĨƌŽŵǇŽƵ͕ƵŶĚĞƌĂŐĞϳϬŽŶĂƉƉůŝĐĂƚŝŽŶĚĂƚĞ͘fzŽƵƌůĞŐĂůůǇͲƌĞĐŽŐŶŝǌĞĚĚŽŵĞƐƚŝĐŽƌĐŝǀŝůƵŶŝŽŶƉĂƌƚŶĞƌf zŽƵƌƵŶŵĂƌƌŝĞĚĨŝŶĂŶĐŝĂůůǇĚĞƉĞŶĚĞŶƚĐŚŝůĚƌĞŶďŝƌƚŚƚŽϮϬǇĞĂƌƐ;ƚŽϮϲǇĞĂƌƐŝĨĨƵůůͲƚŝŵĞƐƚƵĚĞŶƚͿ͘f ƉĞƌƐŽŶŵĂǇŶŽƚŚĂǀĞĐŽǀĞƌĂŐĞĂƐďŽƚŚĂŶŵƉůŽǇĞĞĂŶĚĞƉĞŶĚĞŶƚ͘f KŶůǇŽŶĞŝŶƐƵƌĞĚƐƉŽƵƐĞŵĂǇĐŽǀĞƌĚĞƉĞŶĚĞŶƚĐŚŝůĚƌĞŶ͘BENEFIT AMOUNTVoluntary Life: ŚŽŽƐĞĨƌŽŵĂŵŝŶŝŵƵŵŽĨΨϭϬ͕ϬϬϬƚŽĂŵĂǆŝŵƵŵŽĨΨϱϬϬ͕ϬϬϬ ŝŶΨϭϬ͕ϬϬϬŝŶĐƌĞŵĞŶƚƐ͖ƐƵďũĞĐƚƚŽĂƐĂůĂƌǇĐĂƉŽĨϭϬƚŝŵĞƐďĂƐĞĂŶŶƵĂůĞĂƌŶŝŶŐƐ͘Spouse:ŚŽŽƐĞĨƌŽŵĂŵŝŶŝŵƵŵŽĨΨϭϬ͕ϬϬϬƚŽĂŵĂǆŝŵƵŵŽĨ ΨϱϬϬ͕ϬϬϬŝŶΨϭϬ͕ϬϬϬŝŶĐƌĞŵĞŶƚƐ͘Child(ren):ŝƌƚŚďƵƚůĞƐƐƚŚĂŶϲŵŽŶƚŚƐ͗Ψϭ͕ϬϬϬ͖ϲŵŽŶƚŚƐƚŚƌŽƵŐŚ ĂŐĞϮϬ͗ĐŚŽŝĐĞŽĨ ΨϮ͕ϱϬϬ͕Ψϱ͕ϬϬϬ͕Ψϳ͕ϱϬϬ͕ŽƌΨϭϬ͕ϬϬϬ;ƵƉƚŽĂŐĞϮϲŝĨ ĂĨƵůůͲtime student).Page 53

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Information to identify your policyPolicy number Policyholder’s name Policyholder’s date of birth Policyholder’s addressClaim details & documentationPatient or Claimant nameAttending Physician StatementPathology report with initial diagnosis (If nosurgery or biopsy was performed, submitmedical imaging and lab work confirmingdiagnosis)Pathology and Operative Report for anysurgery following initial diagnosis Surgeon’s/physician’s bill with procedure codes andcharges (Note: Please contact thephysician’s office, not hospital billing office)Surgeon’s/physician’s bill with procedurecodes and charges (Note: Please contact thephysician’s office, not hospital billing office)Radiation- Itemized bills showing the procedurecodes/full charge description and actual chargesChemotherapy- Itemized billing statement or receiptshowing the drug name and/or procedure code andactual charges (Please note, some policies may alsorequire an Explanation of Benefits from theprimary insurance carrier)Transportation- List of specific dates traveled andround trip mileage for dates. For airline, bus, or traintravel, please provide the receipt of itinerary withtravel dates and costLodging – itemized bill/itinerary with dates oflodging and costsFile your claim quicker using MyBenefits1. Login at https://mybenefits.allstate.com. Register first, if new to MyBenefits.2. With multiple payment options, choose how you will receive your benefits.3. Click ‘File a Claim’ to begin. Our system will guide you through each step along the way.4. Securely upload supporting documents by scanning or attaching stored files.5. Submit your completed claim.Other ways to file a claimFax claim submissions: 1 (866) 424-8482Wellness Claims: 1 (800) 430-4188Mail: American Heritage Life Insurance Company1776 American Heritage Life DriveJacksonville, FL 32224Page 57

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Experiencing an illness, accident and/or a hospital stay can be challenging. Now you need to fi.le a claim, and the processmay seem overwhelming. But The Hartford is here to make this as easy as possible.REFERENCE THE ACTION STEPS AND RESOURCES BELOW TO HELP YOU WITH YOUR CLAIM.When should aclaim be filed?Critical Illness'•After a physician has diagnosed you or a covered dependent with a covered illness.•After you or a covered dependent have undergone a health screening and are eligible for a wellness orhealth screening benefit.Accident•After you or your covered dependents receive services performed as a result of an accident.•After you or a covered dependent have undergone a health screening and are eligible for a wellness orhealth screening benefit.Hospital Indemnity•After you or a covered dependent have had a hospital stay as the result of a covered illness or injury.•After you or a covered dependent receive services performed as a result of a covered illness or injury(if included in the policy).•After you or your dependent have undergone a health screening and are eligible for a wellness or healthscreening benefit.Who can file aclaim and how?Anyone insured under the policy, or an authorized representative, can file a claim at any time, from anywhere.You can file your claim in different ways depending on what's most convenient to you:1.ONLINE•Visit the Supplemental Insurance Claims Portal atTheHartford.com/benefits/myclaim.•Register for access if you have not done so already. (Please note: We must have current eligibility from yourbenefits administrator for you and any dependents to be eligible to register on the portal.)•Log in to the portal.• Click on"Complete Your Claim Form Online"under the Quick Links section.•Follow the prompts to complete and submit a claim.2. FILE A CLAIM OVER THE PHONE(Applicable to Health Screening Benefit/Accident Protection Benefit Only)•File your claim by calling866-547-4205.• Available Monday through Friday, 8:00 a.m. - 6:00 p.m. EST.3.SUBMIT A CLAIM VIA MAIL OR FAX•Download a claim form atTheHartford.com/benefits/myclaim.•Complete the form and mail or fax it to: The Hartford Supplemental Insurance Benefit DepartmentP.O. Box 99906Grapevine, TX 76099Fax Number: 469-417-1952For assistance filing your claim, call866-547-4205.HOW TO SUBMIT A CLAIM FORCRITICAL ILLNESS, ACCIDENT ANDHOSP TAL NDEMN TY NSURANCEPage 58

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What informationwill you need toprovide whensubmitting yourclaim?•The form will ask you to provide some information about you, and if you're filing the claim for adependent, their information as well.•Then, select which type of claim you're filing. Continue through the form, only filling out the relevantsections.•In the Benefit Information section, check off each box that applies to the event or services youreceived as a result of your covered illness and/or accident and/or hospital stay.•Be sure you sign the Authorization to Obtain and Disclose Information (which helps us obtaininformation for the claim from medical providers, if needed) and sign the claim form itself.In addition to filling out the form, you'll also need to provide supporting documentation to prove theclaim.Examples of documents include:ER, urgent care, physicianvisit or hospital discharge papers;exam, lab or test results/reports; physician notes; Explanation of Benefits (EOBs) from your healthinsurance provider; itemized medical or hospital bills;or medical records.Please call us for guidance with your claim submission - we're happy to help you understandhow to complete the claim successfully. By thoroughly completing the form and gathering yourdocumentation, we'll be able to better serve you and ensure your claim is processed as quickly aspossible.We may also need to work with medical providers to fully prove your claim, but we'll let you knowduring the claims process if this is necessary.What happensnext?After you submit your claim, our dedicated claims team will review the claim and contact you withany questions or to request additional information needed for your claim. Our goal is to ensure youreceive all benefits you're entitled to, as quickly as possible.We will review your total voluntary benefits coverage with The Hartford to determine if you mightbe eligible for additional benefits based on other insurance policies you've purchased. If you arefiling a Critical Illness claim and forgot to tell us about a hospital stay for a Hospital Indemnity claim,for example, we've got you covered.Once the claim has been approved, the standard turnaround time for benefits to be paid is between3-10 business days.2Standard mail times will apply (if applicable).In the meantime, if you filed your claim online, you can use the site to monitor your claim status andaccess additional claims-related information atTheHartford.com/benefits/myclaim.For all claims,you are welcome to call 866-547-4205 for claims status or questions.TO GET STARTED,visit TheHartford.com/benefits/myclaimOr contact our Customer Service Center at866-547-4205for assistance.THEHARTFORDPage 59

2025 Brunswick Community College Employee Benefits Guide

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